After graduating from med school, I was worried that I wasn't ready to start intern year. You might feel the same way right now. Trust that you are prepared.
In July, l started in the cardiac ICU, on the highest coding floor in the state. I learned more that month than in my final year of med school. And over the next year, I learned how to take care of very sick and complex patients. And so will you. Trust the process. Trust that you will learn what you need to learn at work, by taking care of patients. You are prepared. You are ready. You are qualified for what comes next.
I've included some tips here in this survival guide that I hope will help carry you through your first year of residency.
And please remember that although I'm a doctor, I'm not your doctor. Please consult your medical team before making any health-related decisions.
Patient Care
1. The most important advice I can give you is to continue to care about your patients. The knowledge will come, but empathy often declines with training. Remember that each patient is a person, with a story, with hopes and fears. Being in the clinic or hospital is often anxiety-provoking for them. They need you to care, to listen, to show compassion. I use the doorframe of the clinic room/ER room/hospital room as a reminder as I walk through it, reminding myself: This is a human being who is counting on me to pay attention.
2. Five ways to communicate well: Sit down on a stool, chair, or ledge. Give the first 30-45 seconds of the encounter to your patient (trying not to interrupt). Use simple terms. Be respectful and mindful of what you say outside of the room. Offer a statement of support (such as, “This is really difficult, and it’s normal to feel scared. We’re here to support you, and we’ll be with you every step of the way.”)
3. Develop a clear system to keep track of orders for each patient, and write down every order during rounds (trust me, it’s easy to forget by the time you’ve seen 10 patients). I use the printed patient’s sheet, and make a box on the righthand side. As I place orders and complete tasks, I check off the items. When I sign a note for the day, I make a circle and put a check mark inside it. Even as a fellow I use this system to not miss any orders or forget to sign notes.
4. Be intentional about sign out and try not to rush it. If a patient is really sick, or a diagnosis is unclear, or you’re worried about someone, say it. The covering team will be better prepared to care for that person.
5. When you’re the doctor on night coverage, have a low threshold to go see the patient. If you get paged multiple times, or if the nurse is worried, or if something seems off, go see the patient. This can (and does) save lives to pick up on nuances of patient care early.
6. Try to read about something each day about your patients. If your patient has asthma, take this opportunity to read about asthma. Or fever of unknown origin. Or diabetes. Or gallstones. Learn in the moment and do it every day while at work. The knowledge will add up and help your patients at the same time.
7. Be kind to the nurses. Remember it isn’t their fault they are paging you overnight. They are either advocating for a patient or following a protocol. Anger directed towards nurses is unproductive and can set you up for failure.
On Call Tips
Working overnight is hard. If you get any rest at all, it is often fragmented. We also know that sleep deprivation isn't good for our mental or physical health, or for the safety of patients. We must protect the sleep of doctors as much as possible.
That being said, here are my best tips for surviving call. And remember that you are human too, that you are deserving of the health you strive so hard to bring to your patients. Please keep advocating for yourself and others.
1. Rest when you can. Even if that means simply putting your feet up and closing your eyes.
2. It’s normal to feel anxious and unable to fall asleep despite being tired. It’s hard to suddenly detach from the busyness of the day and fall asleep. The only thing that works for me is acceptance. I tell myself, If I fall asleep, wonderful. If another patient needs me, that’s okay. I accept what is to come of this night. This allows me to relax and actually fall into sleep.
3. Use caffeine judiciously. It can decrease non-REM sleep, i.e., deep sleep. When this happens, you wake up feeling tired even if you’ve had 7 or more hours asleep of time. The half-life of caffeine is 6 hours, so try to drink your last cup of caffeine at least 12 hours before trying to fall asleep.
4. Your compassion will likely fade throughout your long calls. Try to be as caring as possible with your admissions coming in the early morning. Take a moment to reset before you enter each patient’s room. And give yourself grace.
5. When the night is done, don’t drive home if you’re overly exhausted. Instead, take a nap in the call room, take an Uber, or call a loved one. Too many trainees have died or have had lifelong injuries from driving while tired. Please protect yourself and others.
6. To help sleep during the day, keep your bedroom cool (<68 F). Use a sleep mask and blackout shades. Wear earplugs if you need to.
7. If you have young children, it helps to call/text your partner when you arrive home so you can sneak to a bedroom to sleep. In our house, my husband tells my daughter he’s taking out the trash. Then I come inside when he does, without her noticing, and sleep. If you’re a parent, let go of any guilt about sleeping. Your children need you to rest.
Relationship Tips
In residency, you work long hours and experience high levels of stress. No matter how much you care about someone, the stress of residency can drain your energy, your vitality, and your relationships. Here are some tips that help:
1. Remember that exhaustion is not a competition, and life is not a suffering contest. It’s not about who worked more, who has more stress, who is more exhausted. Our hard days are hard for our partners, too. Their feelings are valid and important. Minimizing how they feel only fractures the relationship.
2. Find ways to thank the people in your life regularly, and tell them how much they mean to you. (Thank you for doing the dishes/laundry/cleaning. Thank you for supporting me. Thank you for encouraging me to rest…)
3. If your partner is not in the medical field, they won’t be able to understand what you’re going through. They’ll try to compare it to what they’ve been through—not to lessen your experience, but to try to understand. Try not to diminish their experiences or who they are, especially when they’re just trying to understand.
4. Use your vacation time intentionally. This doesn’t mean you have to travel, but being intentional about quality time during staycations helps too.
5. Your partner, your family, and your friends want to support you, and you don’t have to pretend that things are easy when they’re not. In the medical field, we default to saying we’re okay (even when we’re not). Be open with your people, be vulnerable. Ask for what you need.
6. Living in a hurried state can impair our ability to connect with others. It’s important to practice slowing down, through listening to music, meditating, walking in nature, or taking time to do nothing.
Tips for Interns with Children
My daughter was 11 months old when I started intern year. These are some things that helped us survive:
1. Be present when you’re home. Try to finish work at work, and study at work when possible. When you’re home, try to mentally be home.
2. When you come home, your child needs your immediate attention. Give them 15 minutes of undivided attention and then address whatever needs you have. This helps with tantrums/frustrations and allows them to know they matter to you.
3. When you miss a holiday or birthday, find a day off (the week before if possible) to celebrate in advance with your people.
4. When on jeopardy (AKA back up call), be cautious to tell your kids you’re off. I’ve made this mistake before and it can lead to a lot of disappointment and tears. Better to have a bonus day off than have to cancel plans.
5. If your program is not supporting you with what you need (e.g., time and space to breastfeed), make sure to talk to your chief or a mentor you trust.
Mental and Physical Health Tips
The gifts we have to offer—our energy, our empathy, our intellect—are not endless. We are human too. We have limits. We need sleep, we need space, we need healing. We are better at caring for patients when we care for ourselves.
1. When hard things happen—patient deaths, medical mistakes, disappointment—know where you can go to breathe, to grieve. This may be a rooftop garden, a meditation room, a conference room, a call room, a stairwell, your car, or a bathroom even. Identify people who can understand and help, like other residents, fellows, a therapist, your friends or family. Try to create a safe space for others, to talk about death, loss, and stress.
2. After a code or difficult experience, talk about it with your team. Debrief. If you are leading the team, take a moment to check in with everyone and provide support.
3. Sleep when you can. Aim for 7 hours or more, and know this isn’t always possible. Advocate for better duty hours and call schedules at your program if sleep deprivation is an ongoing issue.
4. Bring your own food to work, things like simple lunches and snacks. I like to keep a lunchbox with utensils, a mug and herbal tea, a jar of nut butter, an assortment of whole fruits and veggies, and mixed nuts. Having healthy snacks to reach for reduces the amount of junk food you’ll eat from the hospital breakrooms.
5. Try to stay active in the hospital on call or when working long hours. Things that worked for me: setting a timer for 30 minutes on my phone, then walking the halls and up and down the stairs. If you get paged after five minutes, stop and address the page. When you’re able, restart the timer and start again. Sometimes this pause would be a few minutes, or hours later. Celebrate any activity you get, even if you don’t hit 30 minutes.
6. Music in the team room can reduce stress, if only for 30 minutes. Jazz, guitar, and piano are some of my favorites. Appropriate times to play music are when your level of work is manageable and your co-workers are okay with it.
7. Finally, your mental health matters most. If you ever experience thoughts of self-harm, please reach out for support. You can also call the free physician support hotline: 1-888-409-0141 or physiciansupportline.com.
And remember, if you knew how to practice medicine already, you wouldn’t have to go through residency. Ask questions. Learn something every day. Be kind to each other. And be good to your body and mind. Intern year will teach so much about medicine, and yourself. Trust that you are prepared for what comes next.
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