How To Be An Intern

The best thing about intern year is that it can’t last forever. This is a year that will test you in ways you’ve never been tested before, and stretch the limits of your definitions of things like “sleep,” “food,” and “weekend.” It’s hard work, and a tremendous amount of it. It’s also the time where you establish your hospital reputation, and all of the habits that will define the rest of your experience in residency, so no pressure!. 

Take intern year seriously in terms of the work itself, but try to also remember that being an intern is a temporary state, and you have plenty of time left to get everything you need out of your training, so don’t panic if you feel, by the end of the year, that you’re treading water. I promise, new challenges will come. 

‍

• Be on time and prepared for rounds. This seems basic but problems with this are surprisingly common, so here we go:
  
  • You should be ready for rounds at least a few minutes before the appointed rounding time, having checked your patients’ charts and made note of any anomalies to discuss on rounds, and prepared and printed your teams’ list. 
  • This means you have to get up early enough to complete all your tasks while also allowing for at least one mishap of some sort (printer malfunction, late phone call, etc). Lateness is understandable once in a while, but chronic lateness is disrespectful to the team. If that’s happening to you, it’s time to start getting up earlier!
• Make checklists and then do all the things. Again, this seems basic but it is perhaps the only organizational skill that you need to be an intern, and too few people are consistent about it. 
  
  • Turn the team’s discussion on rounds into a list of tasks that you are going to do. If it’s not clear how what’s being said becomes a task or what exactly the task is, then you should ask for clarification. You can’t execute a plan that you don’t understand!
  • Don’t trust your brain, trust your checklist. To quote a very smart neurosurgery resident, “you need to idiot proof your life. And the idiot you most need protection from is yourself.” 
  • Intern shifts are long, chaotic, and arduous. Don’t say to yourself, “I’ll remember,” because I promise there will be days when you just won’t. Chronic stress with a healthy pour of sleep deprivation is a powerful cocktail.
  • At the end of the day, all of your checky boxes should be checked, or you should start a new list for the next day with the remaining things you need to do. 
  • Your senior, early on, will be following up to make sure you actually do all of your tasks. If you show them you can do your tasks consistently and reliably, they’ll leave you alone and let you take on more independence/opportunity.
• When in doubt, go see the patient. ESPECIALLY if you are considering calling somebody up the chain, you absolutely need to have laid your physical eyes upon the patient first. 
  
  • Assume the nurses are lying to you. They don’t mean to be, but the reality is that they have a totally different context than you do, and you cannot make your clinical decision based on their observation. You have to go see for yourself. 
    
    • Plus, if you call your chief and you haven’t seen the patient personally yet, they will be mad and that’s the first thing they’ll tell you to do. 
• Look everything up. All the time. This is the best way to “study” intern year, just try to understand the medicine that you’re actually practicing day-to-day: why you’re ordering what you’re ordering, why the “pathway” is the way it is; and whether there’s actually any evidence to support all of that electrolyte repletion everybody’s always talking about. There’s so much in medicine that’s rote, or just things we do because of tradition or inertia, and that’s fine! But you should know what the real medicine is, because you as a doctor want to be acting from an informed, evidence-based perspective, not just doing things because that’s what somebody else is doing. 
  
  • Plus if you ask questions about things like this it will impress people because you’re obviously studying/thinking/paying attention. 
• Eat, sleep, and shower. When you’re having a really bad day, or a bad week, or even a bad month, focus on these three things. They are effective tools for altering your mood and changing your perspective, and you need to do them anyway. When the chips are down, think: do I need to eat? To sleep? To shower? And do those 3 things first before making any major life decisions.