Work & Life
After many long nights huddled over textbooks, agonizing over the brachial plexus, committing childhood exanthems to memory, and making surgical knots of any loose fiber within arm’s reach, you have finally received the news of a lifetime: You’re accepted to a residency program! Now you know what kind of doctor you will be and where you will be spending the next few years of your training.
At this point in your medical education, you should feel proud and excited. You may also feel a bit nervous: What should you expect when you start your intern year? Should you be doing something now to prepare? Here are some things to think about before the big day.
You will soon start to receive emails filled with information from your residency program, including paperwork regarding credentialing and obtaining a trainee medical license. Make sure to read these time-sensitive documents and do not allow yourself to procrastinate. It’s easy to get lost in a sea of paperwork.
Start off on the right foot: Be professional by communicating all necessary information in a timely fashion. The earlier you return completed paperwork, the more time you will have to address any errors or concerns.
Note important dates: Especially the first day of orientation (it may be earlier than you think). Look for communication from your Chief Residents, which may include questions about your preferred rotations and days off.
Be proactive about credentialing: Check in with the appropriate institution regarding the status of your medical license and credentialing. Obtaining a medical license can be a time-consuming process but you can’t start your intern year without one.
Keep copies of all paperwork: You may need to send the documents again.
If you are moving to a new city, start researching the housing market. In some locations, you can look at housing several months in advance while in others you must be prepared to decide on the spot. Some cities have hefty broker’s fees that can catch new residents off guard.
Reach out to your program and ask them to put you in touch with a current resident for advice.
Consider price, proximity to work, availability of public transportation, parking, neighborhood safety, and proximity to recreational activities. Some programs compile a list of apartments that might be vacated by graduating residents and available to the incoming intern class.
Commit to a date to go find your new home.
You likely have a clinical rotation left before you officially receive those two hard-earned letters at the end of your name. This is a great time to develop practical skills that you will need for a successful intern year. Take on as much responsibility as you can to practice basic day-to-day skills before you graduate. The processes at each hospital differ, but you can start with some effective and efficient techniques to try when faced with the bigger workload.
If you haven’t presented a patient recently, be sure to seek out complex patients and ask for directed feedback on your written and oral presentations. You might consider these skills as an important part of earning a good grade in your medicine clerkship, but they take on new significance when you realize they are needed to accurately communicate with other physicians and patients.
Ask your residents about techniques they have developed for pre-rounding, keeping track of tasks, signing out, and other general workflow tasks.
Arrive at work early, giving yourself time to get organized before you can be paged away.
Look at yesterday’s patient list and start today’s to-do list based on what was discussed the day before.
Jot down patient concerns and abnormal physical exam findings as you leave each patient’s room. (Once you have 10 patients, it won’t be easy to remember which 4 had murmurs or lower extremity edema.)
Correlate every patient’s problem list with their medication list as you write your note. This quick check ensures that unnecessary medications are not being prescribed and that you understand the reason for each medication. This process will also help you catch medications that have fallen off the list prematurely and need to be renewed.
Write down every task that needs to be done, whether it is following up on a mid-day lab result, updating a patient’s family member, calling a consultant, or passing along a message to your co-intern. Resist the urge to scribble notes on every inch of paper in sight. Keep this running to-do list organized in a way that makes sense to you. Consider prioritizing tasks visually by color coding or writing in different columns.
In addition to individual tasks, every patient requires a note, updated sign-out, and review of morning labs. Remove redundancy in your day by adding check boxes next to each patient’s name and update throughout the day (rather than returning to the chart several times to see what is left to be done).
Use a structured sign-out format (e.g., I-PASS mnemonic for verbal handoff). Think of this as both a sign-out to the next resident and as a sign-out to yourself for the next day by writing down reminders or pending items.
You are about to embark on the next step in the journey to becoming a physician, and while it is an amazing experience, it will also mean that your free time will be limited and precious. Take the extra time you have after the match to enjoy the pleasures in life that you will not be able to indulge in as easily during the next few years. Travel, sleep, read a novel, spend time with family, or run that 5k you’ve been meaning to train for. Focusing on your wellness now is an investment in yourself as a resident.
The big question from fourth year medical students is always, “Do I need to be studying?” A bit of self-reflection on this topic is important. If you had an academic weak spot, then it could be a good idea to review this subject to help get ahead of medical knowledge gaps and feel more comfortable before starting your first rotation. However, not everyone needs dedicated study time prior to intern year to succeed. The following are some resources to consider:
NEJM Resident 360 Rotation Prep provides useful overviews of more than 30 internal medicine and pediatric rotations, with links to high-yield reviews and research articles, procedure videos, and related podcasts that take a deep dive into key topics.
MGH Pocket Medicine is a great resource for internal medicine that guides you through diagnostic and therapeutic considerations for common problems on the wards.
Medical reference apps that you will find useful in the coming years include DynaMed, UpToDate, Epocrates, Lexicomp, Sanford Guide, Hopkins Antibiotic Guide, MDCalc, and Journal Club. Ask your residents about apps they found most useful.
Evernote is useful for building your own personal reference guide and organizing random pearls that you encounter, whether it’s a beautiful flow chart or the code to your conference room.
You’ve found a place to live, armed yourself with knowledge, perfected your color-coding system, and run that 5k. Now you’re ready for the next big step! Besides honing up on your clinical skills, you will also want to explore other career-related interests including research, service, and teaching. Whatever you look forward to accomplishing, set goals to help you keep the bigger picture in mind.
Set career-related goals: Perhaps you can attend subspecialty Grand Rounds once per month or present a case report at a local conference.
Set personal goals: Find something to focus on outside of the hospital (e.g., cook a new recipe once per week or go on a hike). To keep yourself accountable, involve a loved one who can cheer you on when it comes to your well-being.
Now that you’re a physician, your job carries a great amount of responsibility. Your health and new career should take priority. Take advantage of each day and view it as an opportunity to learn from your patients and grow as a physician. When being a new doctor becomes difficult and you feel overwhelmed, remember that you have the privilege of being your patients’ biggest advocate. Stay humble and focus on their well-being and you will remember why you started this long journey in the first place.