The Art of Staying Organized During Intern Year

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Although my intern year was over a decade ago, some of the experiences I had during that formative time have stuck with me through the years. Here’s one simple rule that will help you stay afloat during your own intern year.

There we were, running the list like we did every morning after rounds. Each of our 20 patients had 3-5 tasks associated with them. We called them “checkboxes.”

It was all simple stuff: “Touch base with social work,” “13:00 recheck K,” “Consult nutrition for TPN.”

In an attempt to stay organized, most of us were furiously scribbling notes next to patient names on our folded list.

But one co-intern took the occasional note, and stored the rest in his memory bank.

I can still hear my chief resident smugly chiding the odd man out:

“There are two types of interns—the ones I trust, and the ones that don’t write everything down.”

It was a witty axiom, but I wondered if it was true. Was it really necessary to write every single thing down? We were doctors now—we’d graduated medical school and were now full-fledged MDs, taking care of dozens of patients. We had spent years developing systems to make sure nothing fell through the cracks.

Did we really have to approach the workload exactly as the chief wanted us to?

The short answer: yes.

The Reality of Being a New MD

To understand why, it’s useful to invoke another axiom I remember from those days:

“Nothing can prepare you for the shock and awe that is the first few months of intern year.”

The truth was, despite now being MDs, on some level we still didn’t know what to expect. It was fun and novel managing 1-3 patients in medical school, and maybe back then, when there were 10 hours to perform those 3-10 tasks, relying on memory was good enough.

But now that the responsibility had grown to a patient list many times that size, dogged note-taking was a necessity. And forget about daytime work. When cross-covering on night float, we had four pagers dragging down the waistline of our scrubs, and 60 patients to account for. If you weren’t taking notes, it was bound to be a problem at some point.

Two Key Benefits of Taking Notes During Intern Year

1. It makes you reliable.

Writing down every single task you get handed is not a crutch. It’s a systematic way to make sure nothing is forgotten.

The fact is, interns have so much to do. They’re the foundation of getting patients admitted, taken care of, and discharged. They’re responsible for the throughput of an academic medical center! A lofty task indeed, though perhaps not a glamorous one.

Reframe your job this way: intern year is a year of execution, not a year of brilliance. No one expects you to crack a medical mystery or find the bleeder in a CABG takeback. Those moments will come. For now, the move is to be known for your reliability. If you’re someone that your senior residents can rely on, you will ascend the ranks, no questions asked.

2. Taking notes means you can learn more.

Writing everything down also lightens your mental burden, and allows your mind to work more freely. Less brain power and working memory will be devoted to your tasks, so you will be able to use that awareness for other aspects of your job.

This means rather than trying to remember all the key details of your patients, you’ll be able to notice and internalize things like how your senior residents conduct themselves, the qualities they possess that you would like to emulate, how they to go about delegating a heavy workload to a team, and how a resident can serve as the liaison between a busy attending and a team of green doctors learning the ropes. In short, the more you write down, the more you will learn.

Things to Keep in Mind When Taking Notes

Some practical advice when it comes to note-taking includes:

1) Make a note of important times.

Much of what you will have to do or follow up on is time dependent. Absolutely write down when data is expected to come in. When it’s 2 p.m. and you scan your list to see a 13:00 task staring at you, you know that task is now a priority. Set an alarm (with a name) on your phone if you’re expecting something to happen at a certain time.

2) Ask questions/write down answers during meetings.

If you aren’t sure exactly what’s being asked, the time to get clarity and write down the key information is when you are sitting down together and running your list. You don’t want to have to pop into the OR and interrupt the senior who’s trying to learn how to operate when you could have asked them a question earlier.

3) Don’t expect to be perfect.

Even if you do take good notes, you may forget something or be unable to complete a task before the end of your shift. If this happens, be honest. Everyone makes mistakes, but if you get caught withholding information or lying, it’s an incredibly difficult reputation to shake.

Final Thoughts

Writing everything down keeps patients safe and keeps your team afloat. The health of your community, your reputation, and your future all depend on your accountability. And that begins with the click of your pen!

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By Brian Radvansky, MD