Every doctor has been through the exhaustion of intern year. Now it’s our turn.
The thing is, when you’re in your final year of medical school, it’s hard to imagine what the first year of residency will even feel like. “Hardest year of your life,” older resident friends and doctors may tell you. “Too difficult to describe.”
Like most things in life, you’ve got to know to understand.
I am currently a resident in California, having finished my medical school studies earlier this year. As with most final year students around the world in 2020, Covid-19 shaped my final year of undergraduate medical training significantly.
Like many of my colleagues, the first five weeks of residency have been as eye-opening as they have been humbling. Intern orientation will arrive with its combination of first year rites, like getting your white coat, personal pager, and meeting your talented co-interns.
Apprehension of the unknown stalks in the background. Swift lessons are about to be dealt out. The following are the big ones I learnt.
Lesson #1: Face the facts – you’re the rookie
My medical mentors often told me that by the end of medical school, I’d feel like I knew everything and that on the first day of intern year, my thinking would be proven wrong.
Whether you were the summa cum laude, Olympic-medal-winning triathlon runner of your med school or nearly failed anatomy in your first year, nobody will ask you to staple your CV to the wall and present your accomplishments.
It’s likely that you will be working alongside incredibly accomplished, intelligent, hardworking co-interns. They will all be as equally hesitant to put in their first order as ‘full-fledged doctors’.
When you start as an intern, nobody expects you to know how to put in orders perfectly, call consults without forgetting to mention your patient’s MRN, or know the plan for each assessment.
You will feel new and inexperienced, because you are new and inexperienced. While that truth is uncomfortable to learn, you will also get better quickly by showing up for your patients each day and asking your seniors for help.
It might feel awkward asking your senior ten questions by their first coffee break but when it comes to the lives of your patients, their safety should be your first priority — even at the expense of your pride.
Lesson #2: Your co-interns are your people
Depending on where you went to med school and the competitive pressure that surrounded you during your four years there, it may feel natural to fall into an aggressive rhythm in the pursuit of success during intern year.
If you can, take a breath and examine your viewpoint. You’ve made it to residency and are at the place you’re meant to be. It’s no longer necessary to prove that you are ‘the best’. In fact, by adopting this stance, you’re probably alienating yourself from one of your largest support networks; your fellow co-interns.
If anybody understands the 2021 experience of being the first person to arrive at a code, seeing a Covid-infected patient awaiting your assistance, or why your oral presentations become disorganized after running on five hours of sleep for weeks at a time, it’s the intern working alongside you.
Try to help out the intern coming on service after you. Whether it means writing extra discharge summaries or doing a long sign out so their first day on service isn’t horrible, take that extra time to make the lives of your coworkers a little easier.
Lesson #3: Don’t forget body and mind
As a student, you likely received countless lectures on the importance of ‘wellness in the medical field.’ If you’re like me, you still struggle incorporating all the mindfulness-based meditation and journaling practices you were taught.
While this is completely normal, the work hours of residency are more taxing on your physical and mental health than med school. When you have to own the role of a doctor and cannot excuse yourself—as the med student—for any mistakes, the pressure of the field builds up fast.
Take the time before residency to note your emotional triggers and coping skills. If you’re someone who turns to unhealthy coping mechanisms like drinking, smoking, or binge eating when stress accumulates, work with a counselor or friend to identify healthier coping behaviors.
Picking three tangible skills like exercising, journaling, and establishing with a trusted therapist prior to residency can be valuable when unexpected emotional difficulties arise.
If you find yourself not sleeping, hydrating, eating, or exercising, set a reminder on your phone at the end of each week to reflect how well you are attending to your basic needs. If you identify that a certain area is clearly lacking, write down two ways you can improve in that area and re-evaluate your performance the following week.
Lesson #4: Manage your hospital and ‘civilian’ lives
I’ve always been fascinated by how our mindset shifts when we transition from taking care of patients in the hospital to running everyday errands; our ‘civilian life’.
In the hospital—as it should be—the sole focus is efficient patient care. There is consistent pressure to rapidly make the right decisions and to communicate flawlessly with patients, families, and other members of the medical team all while witnessing pain and suffering on a daily basis.
This often means attempting to balance multiple responsibilities, shifting the priority of our tasks, and suppressing our own internal drives of thirst, hunger, and exhaustion. It also requires compartmentalization of our own emotions no matter what problems may be occurring in our personal lives.
When we step out of the hospital, these personal responsibilities come flooding back like an avalanche. We respond to the excess of unintentionally ignored texts. We apologize for being late to dinner because of a patient emergency. The list goes on.
It’s difficult to communicate this transition to our loved ones outside of medicine, but genuine attempts to do so should be made. Our families also deserve our undivided attention, even if this means setting deliberate times to turn off our work phones and listen to the people helping take care of us.
Lesson #5: Keep it humble
Residency is difficult, but it’s nothing compared to the isolation of being alone in the hospital, unable to eat regular food, hang out with friends, or get up on your own to use the bathroom.
Whenever I feel drained from waking up at 4 am, I like to remind myself of the privilege we have as medical providers of not only caring for patients, but being able to leave the hospital at the end of our shift.
We can hit the beach or take a road trip on our days off. Many of the people we take care of are too chronically ill to be able to enjoy any of these fantastic things we take for granted. No matter how long our days are, remember that it sucks more to be a sick patient than a tired doctor.
Note from the author: The views represented are my own and do not represent the opinions of my employer and/or training program.
