Congratulations…you made it! You’re a “real doctor” now. Everything for which you have worked so hard has finally paid off and your career in Emergency Medicine is officially launching. Internship is an exciting (and challenging) starting point in that launch sequence. A smooth and successful internship can set a positive tone for your residency experience and help establish the foundation for a successful and satisfying career.
Now that you are settled into to your new home, figured out where to park at the hospital and know how to get to the restroom (ah, the mundane but crucial details!), here are a few things to keep in mind during your first 30 days of intern year.
OUTSIDE THE ED
Get to know your residency leadership and administrative staff. This starts with your residency coordinator. He or she will be your best friend and closest ally for the next few years. The crucible of residency is compounded by administrative duties, paperwork, regulatory requirements and institutional tasks. Compared to patient care and medical education, this stuff is tedious and boring. It will quickly slide to the backburner of your brain because it’s not particularly interesting and its relevance to you may not be immediately obvious. Don’t let it. It will come back to bite you. Think of it as a caged lion. If you feed it regularly with timely email replies and task completion, the lion is happy. Ignore it for too long, and you will have to go into that cage to face a ‘hangry’ lion whose bite can be painful (loss of hospital privileges, disciplinary action by your program, loss of credentials, etc). Keep the lion happy!
Connect with your residency coordinator to determine where you stand with requirements. And for your own sake, read and answer your emails promptly. Establish a habit of solid communication and compliance with paperwork. Your residency coordinator will help you with this – notice that I write “help you with this” and not “do it for you”. They cannot help you if you are constantly MIA or a chronic late-responder. Don’t be the procrastinator in your class. Get to know your coordinator, and treat her/him well…they have rescued many residents from the administrative abyss and they can help you feed the lion.
It goes without saying, but communicate regularly with your program director and other members of the residency leadership (assistant and associate program directors). They will keep you on track and they can help when you fumble, stumble or struggle. They should be checking in with you on a regular basis – but they like it when you initiate dialogue, too.
You have probably realized by now that all that “stuff” you learned in medical school is important, but not always practical for what you will be doing on a day-to-day basis. You have a mountain of emergency medicine knowledge to tackle and this can be overwhelming. So, start with the basics. Stick with basic EM texts to read about “bread and butter” emergency medicine. You will hear your senior colleagues talking about cutting-edge topics they discovered on social media outlets, podcasts, and journal articles. Don’t get swept up in that just yet. You’ll get there. For now, read the basics. Build a solid foundation of EM knowledge now. Supplement with the advanced stuff later. And, of course, attend EM conference, even while on off-service rotations (if possible).
INSIDE THE ED
Your role in the ED
Try to understand your role in the ED as a brand new intern. Pay attention to the team structure and investigate what is expected of you. What type of patients should you be picking up? Should you participate in resuscitations from day #1 or should you focus your attention on lower acuity patients? How many patients should you carry? Are you responsible for checking any equipment? Should you work on charts during or after your shift? The answers to these questions will vary from shop to shop, and they may even vary from attending to attending. Keep your ears and eyes open, and ask your seniors for guidance.
You’re an EM doc now so you want to perform surgical airways and lateral canthotomies. Of course you do. And you will….but probably not yet. As with medical knowledge, slow and steady wins the race. If you are fortunate enough to participate in an advanced procedure – terrific! But if you get elbowed out of the way, don’t take it personally. Remember, there may be a 3rd year resident who is lot closer to graduation and practicing on their own than you. They may be a little desperate to get that procedure. Or, the attending may want someone with more experience to perform that difficult procedure. And that’s okay. If that happens, ask to observe or assist – there are many ways to learn. Your turn will come. In the meantime, practice your basic procedures. Become very efficient and skilled at wound repairs, I&D’s, peripheral IV’s, ultrasound, central lines…it will come in handy later!
Lastly, a few words about professional attitude. We see interns struggle in 2 ways:
The first is the intern who is ‘professionally restless’. Eager to excel and do it all, this intern neglects their limitations and neglects to master the basics. They see seniors and attendings doing advanced stuff and it looks really fun. So, they focus all their time and effort on those “fun” parts of EM. But that intern forgets that those advanced skills are built upon a solid foundation of medical knowledge, hours of practice, and a mountain of experience. You just can’t accelerate experience. It takes time, patience and perseverance.
The second is the intern who has ‘summer camp syndrome’. Most interns arrive at internship directly from college, summer workshops and medical school. Sometimes the mentality that we develop while in these environments lingers into residency. Up to this point, we have paid handsomely for a product – higher education, career preparation, an advanced degree. Included in the price are often benefits like a meal plan, housing, and campus amenities. Coming from that environment it is easy to develop certain expectations. In college, we show up and we think “ok, now teach me something” or “where’s lunch?” At $40K tuition, these are reasonable expectations to have. But if you carry these expectations into residency, you might be disappointed.
Things are different now. This is not just a summertime gig. And while it’s called residency training, we are salaried employees with a benefits package. In some cases, we may get free parking, free scrubs, free lab coats, email account, free call rooms, and access to all the resources a medical facility has to offer. We get everything we need to do the job and learn our specialty. Some places even provide conference lunches, recruiting dinners, and paid trips to educational conferences. On top of all this, an amazing education is provided for you. Dedicated faculty members spend time and effort providing world class medical education – lectures, labs, simulations, journal clubs. Not to mention, countless hours of bedside teaching.
In short, this a job…a special, important and amazing job. We get paid to do this job. Treating patients is an incredible privilege and each patient encounter is a learning opportunity. The intern who recognizes this, and approaches residency as the golden opportunity that it is, will quickly achieve a healthy understanding of the service-education balance in residency. They recognize that the ‘work’ in residency is highly educational. This intern will have a great attitude about their job and will excel. Residency training is hard work –but it can be fun and highly rewarding if you make it so.
Stay tuned for the next installment of the Intern Road Map…