As the sun’s about to set on what’s been an eventful and enriching intern year, I wistfully look out the window on a once alien edifice that has since become home. Literally. I work here, eat here, sleep here, run with my social circle here, and of course, drink my coffee here. The first day I pulled into the parking deck, I distilled the description of the hospital’s unfriendly 1930’s facade into the phrase “a brick fortress.” In the beginning, it was sometimes terrifying, often difficult, and I was left with moments where I felt like I was set up for failure. Once, I was trying to get to a rapid response but instead ended up trapped in the stairwell and forced to exit the building onto a dark alley in West Philly before entering back through the main entrance. I assuaged my fears by asking myself, “What help would a first-week intern provide anyway?” I remember not having my scrub access yet and having to work around the spurting blood and exploding ostomy bags in my dress clothes, only to try and sleep in them overnight. Night float pages for things like bradycardia, hypertension, vomiting, shortness of breath... things I knew how to handle on paper, and could understand as an attending or resident managed the situation, but that would leave me second guessing in real time when the responsibility was mine. I thought long and hard about what I wish I knew at that point. Here are some thoughts to keep you afloat in the leaky boat of intern year: Never hesitate to ask for help. The algorithm for the treatment of all serious situations starts the same, no matter what level you are at: call for help. At the very least, even the most brilliant and experienced medical mind will need an extra set of hands. And the burgeoning mind of a new intern will need a set of hands and some extra brain power from those who possess not only the algorithmic thinking, but also the logistical knowledge, to handle situations. Sure, you know your desatting COPD-er would appreciate some nebulizers and a BiPap, but how do you get respiratory to the bedside? How long can BiPap be offered on a floor bed? How do you transfer a patient to the ICU? It is paramount to understand that there is no shame in asking a senior for help, even if they are sleeping, and even when the problem seems trivial. You should use your judgement for decisions that are within your comfort zone (i.e. tylenol, benedryl, a one-time of dilaudid), but if you have even a small degree of uncertainty, it is best to run it by someone who knows the answer for sure. It is difficult to figure out how far outside your comfort zone to step; we are, after all, supposed to learn by doing. You will build this judgement as time goes on. But in the early part of the year, definitely err on the side of asking for help and confirmation. Your team will appreciate you putting patient care before your pride. Do what it takes to find enjoyment in the outside. It is far too easy to fall into the trap of working all day, ordering-in, watching 15 minutes of mindless TV, and going to bed at 8:30 because you need to be up at 4:30. This spiral, when superimposed on a new city that you don’t know far away from your previous social network, can make for a really hard adjustment. That’s why it is a necessity to claim part of your life for yourself, even if it’s small. This can be something as simple as a 10 minute jog after work, reading a few pages of a pleasure book, dinner with a friend or lover, or holding your child until bedtime. Like the zen masters remind us: “When drinking tea, only drink tea.” Pick something to do and do only that. DO NOT try to multitask too much when you are home; you will be doing enough of this during the day. Make a good first impression. In this exciting new time, you are going to establish a reputation for yourself among co-interns, residents and attendings. These are the people who you are going to be spending up to 80 hours per week with, for about 50 weeks per year. My best advice is to be wonderful to them all. Just short of that, you have to do what it takes to establish a reputation as a hard-worker and team player. If you get labeled as anything else, it will be very hard to break free from the shackles of this label. Little things get noticed, like work you could have completed but ended up dumping on the night float intern. The flipside is also true: work that you didn’t have to do, but chose to do anyway to lighten your night float’s load will certainly get noticed. Every little bit counts! If you get known as a slacker or as selfish, you will be fighting a constant war with this reputation throughout residency. Make confident decisions. This is probably the hardest thing you will have to do. Although your confidence will grow with time and experience, as an intern, you will do loads of second guessing. Does the patient with the mildly distended abdomen need a KUB, or is this a waste of resources? Is this EKG worth consulting cardiology for, or am I overreading? Does this GI bleeder warrant MICU care, or is he just suffering from a pestersome hemorrhoid? Is it too soon to call radiology to have this fresh 1200-slice MRI read? WIthout any real experience as an intern, it is difficult to know what is appropriate. It is also difficult to make a management decision and have total confidence that you did the right thing. Think through all that you do, and have a reason for making these decisions. If you can put a solid case together, then you are probably in the right. And remember, there will be countless times when there is no 100% correct decision, and it will be up to your (better-than-you-think-it-is) clinical acumen. When in doubt, and the stakes are high, remember Step 1: get some help. One last thing to remember: Sleep when you can. It is the best. Fourth years! What concerns are you having about your upcoming intern year? Interns and residents, what advice will you give to those who follow? Let us know in the comments. Source
I think Intern year is interesting, at first you’re guided by fear and easily influenced by recommendations from your upper-levels, but as you develop your own style and confidence becomes more accessible, your ego can get in the way. No one should evertake you for a pompous, self-centered, and misguided rookie.
