Harrison Hayward, MD
Pediatrician, Children’s National, Washington, DC.
Editor, The Differential: Primary Care
Congratulations, you matched! It’s a monumental day in your life and you should be proud of this accomplishment. Reflecting on my own Match Day, I remember the overwhelming rush as all my hard work culminated in finally knowing where I would train. As you look forward to the year ahead, here are some pieces of advice on how to excel as an intern.
- Don’t be afraid to say, “I don’t know.” During medical school, we are bred to believe that the best student is the one who knows everything, but this doesn’t necessarily translate into clinical practice intern year. Confidently answering questions on rounds is important when you’re right. However, after rounds are done and you’re making decisions without your attending in front of you, being comfortable with your gaps in knowledge is incredibly important. Not only will it prevent you from making medical mistakes, but it will build trust in you. Your senior or attending will know where to direct your teaching and where to let you function independently. Also, your nurses will more readily trust what you’re thinking, which leads me to the next item.
- Be kind to nurses. I wish that this went without saying, but I have seen far too many interns make critical errors here. Think about this on a couple of levels. As an intern/resident, you’re in training to become the big, bad team leader someday. An effective leader has a good rapport with their team and you should get into this mindset sooner rather than later. Furthermore, nurses on specialized units very often have insight that you don’t know and that is okay. Consider the general surgery intern on trauma or the medicine resident on heme/onc. Listen to those nurses and absorb their insight. It will expand your pool of knowledge and make you a better doctor. Finally – and everyone who has finished residency will attest – it is an uphill battle to get off a unit’s naughty list once you’re on it. Do yourself the favor of avoiding it entirely.
- Take care of yourself. An under-slept, poorly-fed intern does not offer peak performance. It’s hard to take care of yourself when intern hours are what they are, but you should really try your best. At a minimum, give yourself a few hours on that day off to refrain from studying. Whether it’s going to the gym, visiting your friends, or kicking back with your favorite sweatpants on your couch, regularly take the time to mentally and physically recharge.
- Correctness is more important than quickness. Efficiency is a quality that can take all of intern year – or even residency – to learn. In the early stages, you should consider the correctness of your work to be more important than the quickness with which you finish it. Your team members will appreciate reliable, quality work over hastily-done work that needs double and triple-checking.
- Know the most common conditions in your field. You’re fresh out of medical school. You aren’t board-certified in anything. No one expects you to know everything about every condition. You will get a leg up in the eyes of your superiors, however, by at least having a good grasp on the common offenders. Brush up on a little bit of diagnosis and management before starting. Pediatrics? Be ready for bronchiolitis and asthma. Orthopedics? Read how to interpret plain films of radial fractures and how to splint them.
- Remember what it was like to be a student. Remember that time your intern made you do all their scut work? Or how about those days that you stayed for hours after your last meaningful contribution to the team? Reflect on how the residents impacted your experience on different rotations. Try to embody the good qualities and make a conscious effort to avoid some of those negative ones. If nothing else, it will lead to excellent feedback in your reviews, which will then make its way into your letters of recommendation for fellowship or a job.
- Teamwork makes the dream work. Your day-to-day will be better if you foster a cooperative work environment. Make your senior look good. Raise each other up and challenge one another. Effective teamwork can make exhausting days (and rotations) so much more bearable.
- Ask for help when you need it. There is a difference between the educational value of being outside your comfort zone and being unsafe with tasks that make you feel that overwhelmed. You should strive to be as independent as possible, but never hesitate to ask for help when it’s needed. If you do that, folks will know that you and your patients are doing okay when you aren’t asking. It isn’t weak, it’s yet another way to build trust.
Taken together, these tips should show you that a propensity for teamwork and humility make great interns and arguably, more importantly, a fruitful residency experience for you.