5 Tips for Surviving Internal Medicine Intern Year

Congrats on embarking on the most mentally rigorous, physically exhausting and emotionally intense three years of your medical career! If you browse through Knowmedge’s various outlets on Facebook, Twitter, Google+, Pinterest, in addition to our subscription QVault containing 900+ ABIM-prep questions, you will come across a wealth of medical content. The purpose of this blog post is not to delve into medical tidbits related to diagnosis and treatment of common illnesses as has been done in previous posts.

Here, I present to you the 5 lessons I learned during residency, in no particular order.

1. Pack wisely for call/night float

Flashback to end of June 2009: My first day of residency. When I arrived at the intensive care unit at 5:00 that morning I was told that I was “on call, by the way.” And at that time, “on call” meant a 30-hour shift with little supervision throughout the night. Needless to say, I was unprepared. I hadn’t brought any clothes aside from the ones I was wearing. No toiletries. No grub. Nothing at all. As jolting as the experience was, it was the last time I came unprepared for a call night. Even when Allegheny General Hospital pivoted to a night float system, I still brought ample supplies to last me from 7PM-7AM. Below is a checklist of items I’d regularly bring:

Small duffle bag to carry your stuff
Extra pair of scrubs (most hospitals have spare ones but you should bring your own)
Snacks not requiring refrigeration (in case your hospital doesn’t have a fridge)
Deodorant, additional undershirt, socks, etc. (so that you’re presentable/hygienic post-call)
Toothbrush/toothpaste (trust me you don’t want to use the ones supplied to patients)
Comb
Reading material (fortunately, there are even light call nights)
Facewash/shaving cream/razor
Towel
Additional items you take with you? (please share below)

2. When in Rome…

If you’re like many of your fellow interns, you left your locality, state, or even country to attend residency. It’s easy to fall into the trap of playing the role of an outsider for the entire three years. While no attending, nurse, or patient expected me to be an expert on the history of the Pittsburgh steel industry, I wanted to make sure that I fit in.

I read the local papers (Pittsburgh Post-Gazette and Pittsburgh Tribune-Review) for a couple of minutes daily and found myself able to relate to my patients in the clinic so much more than if I had kept my blinders on. Even a glance of the front pages or website home pages will make you informed. Keep in mind that your clinic patients are likely to be long-time residents if not natives. When they see that you know a bit about the town’s history, the local sports teams, the arts scene, popular tourist destinations, etc they’ll think of you not only as an outstanding doctor, but also an inquisitive person always ready to learn. All in all, it’ll make for a more enjoyable clinic experience.

3. Speaking of Reading…

You’re going to be inundated with medical journals in print and on-line. There was a time when I was so overwhelmed by the number of titles that I just stopped reading them all together. Then I decided that rather than expecting to imbibe every medical study, case study, and meta-analysis published every week or month, I’d pick a couple of journals whose content was relevant to the diagnoses I was likely to encounter on the wards and in continuity clinic.

New England Journal of Medicine (NEJM) is so well-written and edited that it’s wortha glance, more so than the other frequently cited Journal of the American Medical Association (JAMA). Images every week, audio summaries, interactive medical cases and beautifully created tables covering all the major specialties are but a few of the many unique NEJM features.

While not at the caliber of NEJM in general, Annals of Internal Medicine (the journal of the American College of Physicians) has superior disease reviews contained in their “In the Clinic” series. During my orientation, our program director and chief residents compiled for us a collection of those reviews, making for a far more satisfying ambulatory experience.

As I progressed through residency and realized I wanted to focus on primary care, I found that American Family Physician, a semi-monthly journal published by the American Academy of Family Physicians, also provided excellent answers to the common clinical queries seen in outpatient medicine.

The point is that you’ll have a lot to choose from. Find what works for you and don’t get overwhelmed by the other stuff. By also keeping abreast with major studies in the lay press and the latest guideline announcements from the respective specialty societies, you’ll have a wealth of medical knowledge to become a contributor to your team on rounds and a trusted physician to your patients in the clinic.

4. It could always be worse…

My first few call nights in the ICU of my intern year were disastrous. It felt like I was playing catch up the entire 30 hours. My pulmonary/critical care fellow had seen all the night’s 5 or so admissions while I was desperately trying to draft my first H&P between pages from the floor to address cross-cover issues that all seemed to arise once the sun set.

I reminded myself that 5 years prior, there weren’t any work-hour regulations. During those days, at some programs, residents had to draw blood from their patients for morning labs every day. No electronic medical record to enter orders, meaning every order had to be manually placed in the written record. Consultation reports weren’t dictated and easily accessible or legible. By the time I raced out of the hospital parking lot at noon of my post-call day, I was still leaving about 4-6 hours earlier than I would have had my residency happened in the early ‘90s.

In the hours when you aren’t in the hospital (in addition to reading and sleeping of course), make sure you take care of your own health. I recall counseling so many of my clinic patients on the importance of exercising, specifically cardiovascular workouts lasting at least 30 minutes a day for at least 4-5 days a week. It certainly made it easier for me to tell these folks to follow such a recommendation when I too was doing it in my free time.

Residents a decade or so may have struggled to find time for caring for themselves due to the brutal hours but in the year 2014, don’t let lack of time be a reason you can’t maintain your physical health.

5. Stay Positive

Obtaining a medical license–a process that began from your undergraduate years through medical school and finally to the completion of residency training–remains one of the most challenging education tracts of all professions. For starters, it’s financially and socially sacrificing. Inevitably some of you will encounter your former college buddies changing their relationship status on Facebook to engaged or married or others posting photos of the five-bedroom home they just closed on. You may come across these announcements while eating Cup Noodles on a makeshift coffee table in a studio apartment wondering how you’ll ever have time to meet someone and move into more comfortable accommodations. At those times, quickly remind yourself that life as an attending when you complete your training will be leaps and bounds better.

You may not believe it every single day and night of your Internal Medicine residency but rest assured, coming from someone who recently completed the journey that it will surely be worth the effort. Patients will trust you and look to you as a guide and support. They will share details of their lives they would never disclose to others, even family members. Some will have children who will be inspired to be doctors just because of the compassionate care you provided their parents. If you decide to remain in a teaching position, you’ll be blessed with residents of your own. And then you’ll be able to reassure this next generation of doctors that everything will be just fine.

Now go enjoy the next 3 amazing years of your life!