Dear Intern

12 Jul 2020

By Ross Willis, PhD

I was asked to write a #DearIntern blog post discussing how this year’s start of residency would be different from past years due to the COVID-19 situation we are facing. From a residency program leadership perspective, we are not quite sure what new resident orientation will look like. We know the onboarding process will be conducted via virtual meetings. These sessions have always been unidirectional blasts of information about policies and medical records systems. These sessions should be fine in a virtual meeting platform. However, all of our team-building meetings and activities will also need to move to a virtual platform. We have been conducting these sessions in-person for over 15 years. In these sessions, new residents get to know each other, other residents in the program, faculty, and the layout of the hospital. These sessions are usually highly interactive, complete with an “Amazing Race” scavenger hunt through the hospital, an informal breakfast with residents and faculty, and other “ice breaker” games. All of these things are designed to make you, the new resident, feel more comfortable in your new world. To be frank, we are quite nervous that our online versions of these sessions will not be as helpful as past live events. We worry that these events may fall flat and we will fail in our quest to make you feel comfortable and welcome and put you in a position to be successful. Just as you are nervous about entering a new world, we are too. We are in uncharted territory and we are not comfortable with that. Please be patient with us. We will be patient with you. This brings me to a phrase that can help you navigate your first year of residency… or life, for that matter…

“Assume altruistic intent”

You have undoubtedly heard your medical school classmates say things like: “Why surgery?”, “It’s so hard”, “Surgeons are so malignant”, “So many residents get fired from that program”, “They hold back residents for failing the ABSITE”, and so on. Yes, learning surgery is hard. Yes, some surgeons aren’t good at phrasing feedback. Yes, some residents leave programs. Stop. Assume altruistic intent. Faculty care deeply about your training and want you to succeed. A psychologist named Elizabeth Dunn has studied prosocial behavior for decades, and her research shows that humans like to help other humans. Individuals who choose to become surgeons have done so because they wanted to enter a profession that is almost entirely based on helping others. Furthermore, surgeons who chose to go into academic surgery have taken that desire to help others one step further.

Faculty often make assumptions about residents. Faculty should assume that residents are talented, hard-working, and want to do the right thing for patients. Residents make assumptions about faculty. Residents should assume that faculty care about residents, will demand that residents be the best they can be, will support all residents throughout their training, and believe that faculty will be there to help them personally and professionally. If everyone in the system assumes the best of one another and is open to feedback when they make mistakes, the system benefits everyone.

Your faculty will give you feedback – lots of feedback. Sometimes that feedback may sound harsh. You need to look past the packaging to get to the core of the message. I recommend reading a book titled “Thanks for the Feedback: The Science and Art of Receiving Feedback” by Douglas Stone and Sheila Heen. We work with our faculty frequently to improve their feedback methods. If faculty work to improve the feedback package and residents work to receive the package, everyone wins.

The feedback you will receive is formative. This is a vast departure from what you have received most of your academic career. Up to this point, you have been assigned content to read to prepare for periodic tests. Each of those tests was important because each could determine whether you passed or failed a course or matched into a good residency program. The days of frequent high stakes tests are over. In residency, you will be tested every day. That test may be Mr. Smith with the hernia or Ms. Jones who was struck by a car. You will struggle on some of these tests. But you should know that no single test will determine whether you pass or fail surgery residency. A single ABSITE score will not determine whether you pass or fail residency. None of these tests is meant to be summative or decisive. The next high stakes test you will take will be your written board exam (American Board of Surgery Qualifying Exam), some 5 to 7 years from now.

This doesn’t mean you are off the hook in terms of studying. On the contrary. You should be reading and engaging in repeated quizzing on a daily basis. It takes at least 5 years to “learn enough surgery” to be allowed to go into the world and be a safe, competent surgeon. There will be days when you are exhausted from working a long shift and you won’t feel like reading or answering some questions from a Q-bank. Learn how to study smarter, not harder. I recommend reading a book called “Make it Stick: The Science of Successful Learning” by Peter Brown and colleagues. You owe it to your patients.

To summarize my thoughts about navigating residency, I’d recommend that you learn to recognize your assumptions and consider assuming altruistic intent. You will struggle. Your faculty expect that you will struggle. Some faculty may not be great at giving feedback but that doesn’t mean they want you fired. Learn how to take poorly constructed feedback and make it usable. Realize that the feedback you get in residency has a different purpose from the feedback you have received in your academic career. Study efficiently. Welcome aboard, doctor. We’re glad you’re here.

Join the Association of Women Surgeons in our #DearIntern tweetchat co-hosted with @RASACS and @AcademicSurgery to discuss tips for navigating intern year. This #AWSchat will be hosted on Monday July 20th, 8pm Eastern Time. To participate, follow @womensurgeons, @RASACS, and @AcademicSurgery along with our moderators Dr. Alan Harzman (@AlanHarzmanMD), Dr. Ross Willis (@RossWillisPhD) and Dr. Lauren Agoubi (@laurenagoubi). The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more.

We will be discussing the following questions in the tweetchat:

  1. What are the tips and tricks to survive intern year?
  2. What can be the challenges of finding mentorship and sponsorship during the pandemic?
  3. What kind of virtual learning is your program doing for residents?
  4. Being an intern is hard, especially during the pandemic.  What kind of support system does your residency program offer?


Dr. Willis holds a master’s degree in human factors psychology and a doctoral degree in cognitive psychology from Texas Tech University. Dr. Willis has been the Director of Surgical Education at the UT Health San Antonio since 2007. His primary roles include conducting research on applying principles of learning theory to the world of surgical education, curriculum development, and evaluation. You can find him on twitter @RossWillisPhD.





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.

One Reply to “Dear Intern”

  1. magnificent publish, very informative. I
    ponder why the other specialists of this sector don’t realize this.
    You must continue your writing. I am sure, you’ve a great readers’ base already!

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