After officially completing the first block of my surgical internship, I have learned SO MUCH. From ordering labs and replacing electrolytes to pre-oping patients and managing common post-op complications, interns learn constantly every day. I expected to feel overwhelmed, and often, I am. But I’m also having so much fun. Below are the 5 things that surprised me most about my first month of intern year.
1| Varying Medical Preferences
There isn’t always a perfect way to practice medicine. In fact, the phrase “medicine is an art” is incredibly true. Some things are standard practice with evidence to back it up, but a decent percentage of decisions are based on provider preference. There is a lot of research out there, but in general, there are more questions than answers available. Physicians have to make educated decisions based on current evidence, and if that isn’t clear, they can base their decisions on their previous outcomes. For example, suppose there are 3 options for a medication that are all proven efficacious. If a provider has a bad outcome with one of them, she will likely not use that ever again, but her partner in the off next door might use it often. One challenge of residency is learning your attendings’ preferences, and eventually, being able to make your own opinions for your future career.
2| The More Mistakes You Make, the More You Learn
Residency is a lot of fun when you aren’t doing something wrong. But trust me, you will do multiple things wrong daily. This is okay! When corrected, try to learn where you went wrong and how to change in order to not make the same mistake again. Don’t shy away from criticism, and certainly don’t take it as a reflection of you or your capabilities. Everyone makes mistakes when learning, just be open to feedback. Without being corrected, how can we get better? Another key to maintaining a healthy intern mindset is remembering to celebrate your successes. It’s easy to leave the hospital only thinking about the negative parts of your day. It often takes a conscious effort to try to reflect on both what you did great and what you did less-than-stellar at the end of the day. Keep your confidence up – even the best physicians were interns at one point. As long as you learn from your mistakes, forgive yourself and get ready for the next day.
3| Interns Have So Many Superiors
And they will sometimes tell you to do opposing things. You will try to follow orders from one person and get in trouble from someone else for doing exactly what you were told to do. It happens. My best advice for this is also to not take it personally. Follow the orders of the most senior team member, or ask why they prefer to do it this way. Understanding why each provider wants it done their way will help you have a deeper understanding of the issue at hand. Open communication is key to working on a medical team.
4| Closed-Loop Communication
Speaking of communication, closed-loop communication is necessary for “July Interns.” We round each morning and discuss the action plan for each patient. Interns are often responsible for a huge variety of tasks such as putting in the new orders for the day, checking back in on a patient later in the day, and finalizing disposition. If told to do something, let the team know once it is completed. Some seniors may be more hands-off and want fewer updates, but in the early months of intern year, it helps them know what you are doing and what still needs to be done. Additionally, in a team of 3-5 people, a task can easily be overlooked if everyone assumes someone else will do it. Try to volunteer or delegate tasks as they come up to avoid things falling through the cracks. Getting in this habit of organization and management will help you as you rise through the ranks and become responsible for leading others.
5| Patient Connections
Despite the busy schedule and overwhelming novelty of residency, interns have time to go back and make meaningful connections with patients. I didn’t feel any different the day I walked through the door as a fresh MD vs a few months ago when I was still a student. But to the patients, I am now a completely different person. Once the word “doctor” preludes your last name, respect is given instantly. Patients often become more vulnerable and honest about sensitive topics. They will look to you for reassurance and answers. We, as interns, can answer questions and reexplain diagnoses that our seniors don’t have time for. We are also newer to medical jargon, so we can still remember how to explain topics to our patients in a way they can understand. This is, of course, if we finish our notes and orders in a timely fashion (which also comes with time).
Bonus| The 80-hour Workweek Demystified
Duty hours are a hot topic these days. The ACGME publishes these regulations to protect resident wellbeing.
- Maximum 80 hours per week when averaged over 4 weeks.
- One day off out of seven averaged over 4 weeks.
- Cannot have call more frequently than every 3 days averaged over 4 weeks.
- Call shifts cannot be greater than 24 hours with an additional 4 hours for charting/education.
- You must have 8 hours off between shifts (14 if it is a 24-hour call).
For example, you can work 90 hours one week if you work 70 hours during the weeks before and after so that your total average is still 80 hours or less per week. My secret to surviving the 80-hour workweek is to nap whenever you can and schedule in time for what you love. For me, this means baking sweets and playing board games. I wish I had more time to study, but I am figuring out how to fit it into my downtime at work.
In the end, intern year is about learning how to really be a doctor. It is stressful, exciting, and a time of great growth. Although I am in a surgical internship, I am sure that these themes are applicable to new doctors in every specialty. I’d love to hear about what surprised you most when you began your internship! Comment below.
