By Marissa A. Boeck
In April 2015, Dr. Amalia Cochran had an idea. The United States Match Day had come and gone, and while most fourth year medical students were enjoying their last moments of unbridled freedom before the oft feared start of intern year, Dr. Cochran was thinking ahead. As a burn surgeon and Vice Chair of Education & Professionalism at the University of Utah, she was well-versed in the significance and misperceptions surrounding July 1st, and knew it would come sooner than most would imagine. To ease this seemingly overnight transition from student to doctor, she reached out to gather intel on how to prepare for the big day from one of the best (and arguably still untapped) resources in medicine: Twitter. The initial message asked:
Dr. Cochran’s followers and interconnected community took it from there, and #DearIntern was born.
Since the first post and subsequent blog, the hashtag has re-appeared annually as the new year approaches. Although typically surgery participants predominate, the advice applies broadly. Related messages have used #DearNewIntern and #WelcomeToMS3, among others. This also includes #TipsForNewDocs, started back in August 2011 in the United Kingdom as an advice hashtag for rising junior doctors across specialties, which has successfully maintained a nearly year-round presence since.
Upon reviewing expert posts from the past couple of years, broad themes emerge that can be organized into a Top 12 #DearIntern List of Advice:
- Medicine is a team sport: Be open to and respectful about input from others; this applies to nurses, physician assistants, colleagues (both in your specialty and others), superiors, and students. Sometimes you know more, sometimes others do, but diversity of input is always valuable. Show appreciation when and where it is due. Also, if someone calls for help, help them, don’t ridicule.
- Golden rule: treat others as you would like to be treated…or as you would want your grandma/important person in your life to be treated. It is almost always better to be working in the hospital than to be admitted to it; try to keep this perspective in mind during hard times. After all, we do this for the love of patients.
- Load the boat: Find help from senior staff members early and don’t be afraid to ask, this is not a sign of weakness. It is better to call for help when not required, than to not call when required or when a rescue opportunity is lost. Also always have a plan…and a back up plan.
- When in doubt, look at the patient: Electronic medical records have replaced a significant proportion of physician interactions with patients. An assessment for potentially acute changes in status requires actual facetime with your patient. Know them well and listen to them, they can teach you invaluable lessons. Keep a running list of interesting cases and patients you learned something new from; it’ll come in handy later.
- First impressions can be lasting: Guard your reputation with your life, but also know there will be chances for clarification and/or redemption.
- Immerse yourself in your craft: Scrub when the opportunity arises and be prepared (diagnosis, indication, anatomy, procedure, skills). Remember that you can learn a lot by observing an operation; never underestimate your opportunities.
- Show up (early) and do your best everyday: Work hard, as there is no substitute for due diligence. Be affable and available.
- The truth shall set you free…or at least keep you out of trouble. Be humble and admit when you don’t know something. We all make mistakes; and then learn from them to avoid making them again. You’re going to be yelled at. Don’t try not to be yelled at, just try to do the right thing for your patients. Trust but verify, never assume.
- Write down everything: Trust us.
- Ask questions and be curious: Read everyday, even if just for 10 mins, and learn a new fact. Be flexible, as medicine is always changing.
- Take care of yourself so you can take care of others: Keep a hobby and do it. Your wellness is important; eat sensibly, exercise, and find support in your family and friends.
- Have fun: Surgery is an awesome privilege. You’ll have good days and bad days, but the best moments in your professional life are ahead of you. Always try to keep your head up. Remember you are a valuable asset to the team.
Through posts associated with the hashtag, additional valuable resources and commentary have come to light, which include:
How to be the Best Intern in the Hospital by Dr. Mary L. Brandt (June 5th, 2010)
Hints For New Residents by Skeptic Scalpel (June 20th, 2011)
Internship: Ready, Set, Go! By Dr. Callie Thompson (2013)
What Every Resident Should Know on Day 1 (July 7th, 2014)
Stuff Surgery Interns Should Know, Behind The Knife podcast (June 23rd, 2015)
The “July Effect” and Tips for New Doctors by P.F. Anderson (July 1st, 2016)
#JulyOpportunity by Drs. Kevin Sexton & Julie Duke (July 28th, 2016)
You’ll mess up but save the day: advice to new doctors as they start work as interns by Dr. Ilana Yurkiewicz (June 29th, 2017)
Overall, this crowd-sourcing exercise highlights one of the many strengths of Twitter and social media: to generate global conversations connecting experts to those just starting out, and everyone in between. You’re able to shed the limits of location, time constraints, and hierarchies, and have the opportunity to connect with anyone, anywhere. Unlike published works, which retain their value for certain uses, these platforms uniquely enable a free flow of information that is constantly being revised and expanded, maintaining relevance to the here and now. On the flipside, the seemingly no-holds-barred rules to participation reinforces the need for discernment by the receiver, which is a useful skill to cultivate throughout one’s career both on and offline.
So what’s stopping you? Join the conversation, add your voice and knowledge, and impact the #NextGen of surgical leaders across the globe!
Acknowledgements: Thank you to Dr. Amalia Cochran for her original idea and blog post input, and to the dozens of #SurgTweeting community members who contributed to the #DearIntern hashtag over the past few years. This post would not have been possible without your contributions and wisdom!
Marissa A. Boeck MD, MPH is a chief general surgery resident at New York Presbyterian Hospital – Columbia, after which she will pursue a fellowship in trauma/critical care. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.