6 Lessons I Learned During Intern Year of Residency

October 20, 2023
A few months ago, I wrote a blog post sharing that I didn’t match into residency the first time. After a year of difficult soul searching, research, and self-improvement, I finally reached my goal of starting a general surgery residency program.
Today, I’m in my fourth month of surgical residency and I want to share some of what I’ve learned, my failures, and my successes, with the hope that some of you who will be transitioning to residency in July 2024 and beyond may have a better understanding of what to expect.

What My First Day of Residency Was Like 

On day one, I was handed a pager while on the acute care surgery service and immediately the pages started coming in. 

“This patient has nausea.” 

“This one is in pain.”

“That one needs immediate surgery for a perforated gallbladder.” 

And there I was feeling lost, scared, and confused, worried that I would make a mistake and one of these real human beings, not a standardized patient, would have a bad outcome. 

It wasn’t until the end of week two that I realized this fear is completely normal, regardless of whether you’re in surgery, internal medicine, pediatrics, or pathology. For four years you were taught medicine, you spent hours on the wards, but what surprises everyone on day one is how little they know. 

As my story illustrates, day one can be tough. As is much of that initial phase of residency. There will be difficult moments, but there are things you can do that will reduce your stress and make things go as smoothly as possible. Here are six tips that can help you get through it all.

Six Tips for Your Intern Year of Residency

1. Learn to go with the flow. 

First, go into residency with an open mind and be willing to go with the flow. Things will come fast and furious and your willingness to move with it rather than resist it will make all the difference in the world. Half of the battle is the attitude you are bringing to the table. If you have a good attitude with an open mind, you will learn more and get through those challenging call days more smoothly.

If you are one of my “unmatched-to-matched” colleagues who did not match the first time around, this will be even more important. Many of you will feel as if you have a chip on your shoulder, but you don’t. You may be more susceptible to the feeling of inadequacy that comes early in residency, but starting off with a good attitude and willingness to just go with it will allow you to grow into a confident doctor. 

2. Don’t be afraid to ask questions.

Second, it’s never wrong to ask questions. If you could ask my senior what questions I had during those first weeks, they’d tell you I asked questions about everything. Remember, you’re not a medical student anymore, trying to make people believe that you know everything, you’re a doctor and not asking questions when you have them could harm someone. It’s better to say, “I don’t know” and learn something, than it is to say you know the answer when you don’t.

Your senior is your shield and support. They will protect you when things go awry and guide you every step of the way. They have been at that hospital for possibly years and know the ins and outs of how things operate. As you learn more medicine from different people, you’ll start being able to develop your own personal medicinal flare. You’ll learn what you like, what you’re comfortable with, and what makes sense to you. Just be certain your opinions are always based on evidence. 

3. Create a system for staying organized. 

Design your own organizational system that ensures every task gets completed in order of importance. Every person does this differently. Many people use multicolor pens to organize things or to mark them as complete, needing following up, or incomplete if you had to attend to something else before completing a task. Most of the time this will be somewhere on your list of patients that you print every day. This list is your brain and without it, your job will be impossible.

Try different systems, take advice from seniors, and eventually you will develop something that works every time. Organization in residency is vital and possibly the single skill that separates good residents from great ones. Good organization helps with efficiency and ensures each patient gets the care they need. My personal system didn’t start to solidify until my third month and even now, I’m still adjusting. This ties in with the idea of going with the flow and being willing to adjust.

4. Read, read, read!

Read, read some more, and then keep reading. The more information you absorb the more comfortable you’ll be making decisions. However, just like I tell my Step 1 and Step 2 students, you must avoid resource overload. Pick some books you like to reference, which make sense to you, you can get through quickly, and have a question bank that’ll help identify your weak points and prepare you for your in-training exam.

Your program, hopefully, will provide resources of some sort. You’ll learn a lot just by going about your work, but you’ll need those extra resources to fill in gaps and help you see the bigger picture. The earlier you start reviewing them, the better off you will be.

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5. Admit your mistakes. 

Next, be ready to admit your mistakes and embrace the fact that you will fail and make bad decisions. This is why we have residency. Every mistake you make will be one that you never make again, and you can do it with the protection of your program. You’ll feel guilt and shame but whenever you do, recognize that every single resident and physician that you’re working with has experienced the same feelings at some point.

Every attending has stories of bad outcomes, mistakes, and learning opportunities. Some day, you will too. Making mistakes is human and expected of interns, as long as you learn from them and actively make adjustments, you’ll come out ahead. Repeat, “Making mistakes is human and everyone around me has made mistakes,” whenever things go wrong during residency. 

6. Take care of yourself. 

Finally—and this may be the most important thing—take care of yourself. It’s easy to let the stresses of residency get to you, but it’s important to understand this will put you and your patients at risk. There is a lot of talk about residency burnout going around and your goal is to avoid it at all costs.

This is something you can get ahead of even before starting residency. Find a comfortable place to live where you can come home and let the hospital stress melt away. Maintain a hobby, whether it be music, sports, board games, video games, anything. Be sure to spend at least one or two hours a week on it to keep you centered.

Additionally, the need for sleep cannot be overstated. If you are able, you want to have a scheduled bedtime where you hit the hay and shut your brain off. There is a point where your learning will no longer be efficient, and what you need to be your best is sleep.

Finally, call upon your friends and family. Don’t hide your stresses and sorrows from them. Your co-residents can commiserate with you, and your family can support you. Getting through this time is tough but it becomes much more tolerable with the help of others.

Further Reading 

Residency is a challenge, and the transition to residency may seem insurmountable. But you’ve made it this far—whether it was in one application cycle or multiple—so be proud of yourself! Learn to go with the flow, ask questions, get organized, read all you can, admit mistakes, and most importantly, take care of yourself! Do those six things and you’ll be an excellent, caring physician for many patients and their families.

For more (free!) content to help you navigate residency and beyond, check out these other posts on the Rosh Review blog:

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By Landon Cluts

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