Code New: How to Survive Intern Year Happy

Jennifer Kanapicki, MD

Disclosures

November 20, 2008

Introduction

After spending more than twenty years of your life in school, it has come to this; you are a doctor. Fourth year of medical school was probably one of the greatest academic years of your life with a mixture of fun, travel, celebration and apprehension. Graduation may have left you feeling like you have forgotten much of what you learned in medical school. So, you're a doctor. Now what?

Reflecting on this past year, I remember the swirling mixture of emotions about beginning residency. I had been a student all of my life. The drastic change of entering "the real world" in foreign territory was unsettling. Leaving my safe, familiar environment and heading into the unknown with new people and an anticipated paycheck seemed surreal. Such high expectations as to "save lives" felt intimidating. However, apprehension and insecurity slowly evolved to experience and confidence. Intern year has proven to be empowering and one of the most amazing years of my life thus far. I have learned not to be afraid of my pager every time it goes off. I survived shifts in the Medical Intensive Care Unit (MICU) alone. I experienced new emotions, and I found the value of a true friend who would listen after an especially horrible day. The most important learning came with the discovery of how to be comfortable in my own skin in my new role as a physician. I learned that I could handle almost anything, even if it meant just asking for help.

I can assure you that you will survive intern year and just maybe have some fun in the process. I want to inspire hope. As others have done before you, you will succeed. Here are five tips to keep you happy along the way:

1. Don't Believe the Hype:

It is hard to ignore the stigma of intern year: grueling overnight calls, absence of family and/or friends, lack of sleep, and basically being the "scut monkey." It sounds scary and intimidating, but I live by the phrase "a good attitude is half the battle." This year I went into each rotation with an open mind. I tried not to focus on others' comments about a certain rotation. I found that the overall "hype" seemed too generalized, and I needed to seek my own truths. I often found the rumors to be false compared to my own experiences. Keeping a positive attitude boosted my team's morale as well as mine.

Feeling like the "new kid" is hard. Every month, as the ED intern, you are starting a new rotation with other interns who may have been doing that specialty for a number of months more than you. It's tough, but by going into each rotation with a good attitude, you will be able to learn from your colleagues. In my experience, by being an active member of the team, I was treated as an equal member and not just the "ED intern." Not only did this increase what I got out of every rotation, but allowed me to thoroughly enjoy my time on off-service rotations. Remember, we are the lucky residents that get the chance to spend a month in the shoes of so many different specialties and take from them what is pertinent to our practice in the ED. Savor this opportunity, and enjoy the wide variety of medicine we get to practice!

2. Social Life - Have One:

Residency is like nothing you've experienced before. You are suddenly spending up to eighty hours per week in a hospital; at times I felt like I should have been paying the hospital rent, instead of my landlord. A key to happiness is to try to maintain some kind of normal social life that the non-medical people of the world adhere to. This may mean going to your residency social events or creating some of your own. This not only allows you to interact with your colleagues in order to decompress, but also will afford you the opportunity to talk about something non-medical (although somehow the conversation always tends to get back to the hospital). Normal life can also mean traveling, concerts, sporting events and anything the general public takes part in. You will learn that sometimes the best option is just vegging out in front of your television after an extremely hard shift, but your mental state also sometimes requires you to venture out of your apartment into the real world. Our class decided to make the night before conference our "hang out" night; this would include a variety of activities such as bowling, dinner parties, bars, etc. Whatever your activity may be, make a conscious effort to attend, even bring your significant other if you're missing out on time with him/her too. Remember, being an ED intern is sometimes difficult since we are spread out all over the hospital: take time to hang out with your class, because they will be a vital asset to you in surviving residency.

3. Practice Good Medicine:

I think I know how you are feeling: you've lost a great proportion of your medical knowledge in the depths of fourth year. I will tell you, your current co-interns probably feel the same. We have all been there, and although I hate to break this to you so early on, you will make mistakes. Making mistakes is part of the learning process, and a lot of the time we learn the most from our mistakes. Residents and attendings are essential tools; make sure to use them as a resource and learn from their experience.

Another essential: Reading. Although at times reading seems to be impossible to fit into your schedule, it is vital to the practice of good medicine. My personal system was to place the patient stickers on an index card and then write the treatment plan, tips from attendings, etc., on the card. After my shift, I would spend an hour going through the cards and reading in my EM book of choice about my patients. This way you are not only pairing an illness with an actual patient, but adding in personal "tips of the trade" from your attendings. This is an excellent way to stay on top of reading and keep a reference of your patients. Another suggestion: on off-service rotations - make sure to read the relevant section of your preferred emergency medicine text. For example, when I was on orthopedics I read the musculoskeletal section of Tintinalli. Not only did this help during the rotation, but also assisted me in getting out of the rotation what was pertinent to my practice of emergency medicine.

4. Maintain a Healthy Mindset and Healthy Living:

There will be times during your intern year that you will be frustrated because you're working incredibly long hours and under an extreme amount of stress. As I mentioned before, mindset is everything. If a certain issue is bothering you, the best approach is to be active about it; instead of taking a back seat, do something! This means getting involved with your residency program and its advancement. Taking an active role will be a healthy way to manage your frustrations and benefit you, your peers and your residency program in the end. I did this by becoming an active member in applicant recruitment for my residency program. I also became a board member of AAEM/RSA, which has been such an amazing experience and fulfilled my desire to get involved on a national level. It makes me feel like I'm doing something for my specialty as well as my own well being. So if there is something about the system that interests you, get involved and make a difference.

Healthy living is also a huge aspect of intern year. I have to confess I probably did spend a month or two living on cookie dough that I swore I deserved for all my hard work. In retrospect, although immediately rewarding, it was probably not the best way to manage stress (well, maybe if it is done in moderation). I find, for most residents, being able to work out and eat healthy, helps to relieve stress. Healthy eating can be tough, and even the best hospital café doesn't always have the most nutritious options. I would try to bring fruit and my favorite water bottle to work to stay hydrated. Most residents forget to take care of the most important patient: him/herself. Always do things to make yourself happy and relieve stress, whether it is a pedicure or going to watch your favorite sporting event.

5. Remember That You Are Not Alone:

I know that on several occasions during your intern year, you will feel alone. From my personal experience, going from medical school where I basically lived in a dorm with a roommate, to living by myself in suburbia was quite a drastic transition. I felt lonely, but gradually I met others who felt the same way I did. Throughout intern year, you will have many experiences - some good and others not so good. My best advice is to share your stories; not only does this help you vent, but it also helps you realize you are not the only person that these things happen to. The best response you can get after your toughest day of work is from a co-worker saying, "I know how you feel." Sometimes we think the stresses and strains of residency are just happening to us, but take comfort in knowing that you are not alone.

So there are my five tips for how I succeeded in being happy during my intern year. It does take work, but I am proof that it's possible. I do want to end with some advice for non-interns: the best thing you can do for new interns is to welcome them with a positive attitude, reassurance and guidance. Remember, you were once in their shoes and can be their best resource when times get tough. Interns, you will have an amazing year of learning, not only clinically, but also about yourself and the doctor you strive to become. Just remember to stop and smell the roses along the way.

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