Internship: Ready, Set, Go!

21 Jun 2013

by Callie Thompson, M.D.

Congratulations to all of you newly minted Doctors of Medicine! It is almost time to start your internships! You are probably trying to imagine what it will be like, and you are probably excited, nervous, scared, and maybe even a little nauseous.

This transition from medical student to doctor will be a big adjustment. But don’t worry, you really can (and will) do this. I will start with a few general tips for how to succeed in your internship and then finish with some more specific tips that you will hopefully find helpful.

1. The patient comes first. Always. They are your North Star. When you lose your way, ask yourself “What is best for my patient?” and do that.

2. Be the doctor. I know, this one seems obvious, but you just graduated 3 weeks ago and now someone is calling you “Dr. So-and-so” and you feel both scared and like a total fraud almost all of the time. However, your patients and your team still depend on you. You are their “Dr. So-and-so” and you need to act like it. Have assessments, have plans and be willing and able to explain your reasoning for them.

And don’t forget to introduce yourself as “Dr. (YOUR LAST NAME HERE)”–you earned it.

3. Always worry, but never worry alone. If you load that proverbial boat early, at least you won’t sink alone. If someone on the floor is going south, assess them and then let your senior resident know. Immediately. No one expects you to be perfect; you will be learning and improving for the rest of your life, but we do expect that you will not keep secrets from us.

4. Never lie. Not to your seniors, not to your attending, and not to the patient.  I know that these people will be looking at you and wanting to hear “good news” but your only job is to be honest, to tell them the truth. Trust is what your relationships with these people is built on; lying, even once, can permanently damage that relationship and worst of all, put the patient at risk.

5. Utilize the nurses, but don’t let them use you. The nurses can and will be your best friends. They have experience, and they can teach you infinite amounts. If they call and tell you someone is sick, listen to them. Don’t let your ego get in the way. Everyone is on the patient’s team. The flip side of this is that some people will take advantage of your “newness” and they will ask you to do things that seem wrong to you. If that is the case, don’t do it. Politely tell them that you need to check with your senior, and check with your senior.  No one should get offended by that, as long as you remain polite and respectful.

6. Ask your senior residents and attendings for their expectations of you. There is nothing worse than finding out that you are falling short of expectations that you didn’t know existed. Asking for expectations up front will lessen their potential frustrations, and yours.

7. Ask for feedback from your seniors and attendings. Don’t wait for the end of a rotation to get an evaluation. That leaves you no opportunity to fix things and get better. Ask for feedback in the middle of your rotation (a great time for this is when you are finishing up a case) and then they will know that you were interested in improvement, and they will be able to recognize when you have improved.

And for the interns who are parents:

8. Set goals for yourself and your family. Make promises to yourself and your family about when you will study and prepare for your patients and when you will just be present for them. This is going to be an especially big period of adjustment for you, your partner, and your child(ren), but you’ll get through it. Have patience with yourself and with them.

Now for a few specifics…

Must-use Websites & Apps:

1. NCCN Guidelines. The absolute best resource for guidelines for treatment of cancers. This site will help you immensely in clinic–and they have an app.

2. Up-to-date. Obviously.

3. Epocrates. Again, obviously.

4. ACGME case log mobile app. Immediately enter all of your cases after you complete them. Seriously, don’t let them stack up. I had to enter an entire year’s worth at one point, and it was obnoxious. Open the ACGME case log site on your iPhone (if you know how to do this on a non-Apple product please weigh-in in the comments below), click the rectangle with an arrow icon on the bottom of the page, and then click “add to home screen.”

5. Twitter. Join twitter, follow people and organizations that you are interested in, and just watch. I have read more journal articles in the two months since joining twitter than I have in the prior two years. I recommend the Association of Women Surgeons, American College of Surgeons, Journal of Trauma, Annals of Surgery, NEJM, JAMA, and Journal of Burn Care and Research, but there are many more.

6. DrawMD apps. A perfect way to explain an operation to a patient.

7. Other useful (but potentially costly) resources include the SCORE curriculum (this will be an institutional license, so your program may not have it), the Gray’s anatomy app, and SESAP 14.

8. Useful books (I like e-books because they are easier to carry around): Greenfield’s Surgery, Zollinger’s Atlas of Surgical Operations, and Operative Dictations in General and Vascular Surgery.

Organizing Your Day:

Pre-rounding, rounding, clinic, OR, afternoon rounding, sign-out. The schedule probably hasn’t changed too much from medical school, except that you will be the one in charge of getting things done while still being in clinic and in the OR. Multi-tasking and triaging will be vitally important, but they can’t really be taught. They are best observed and then applied in a trial and error manner until you find a method that works for you. I will give you this tip: discharge your patients before doing anything else (unless the something else is urgent). With computerized order entry, a lot of the discharge orders can be done the night before. This is also true for the discharge summary.
The big question is, what should you do when you get home from work? You should NOT start working again immediately. You should NOT study or read for the next day’s cases. You SHOULD sit down and relax. Take a few moments for yourself. Eat some dinner. Maybe have a glass of wine. If you have a significant other or kids, spend time with them–see above. If you don’t, make some plans with friends (co-residents make great friends) or give your family a call. Then, set a time (maybe 1-2 hours after you get home) to study, prepare for the next day, and/or check in on your patients.

What You Should Know for Every Case/Procedure You Do:

Prior to scrubbing in to a case or performing a procedure you need to know…

1. Your patient’s history (including being familiar with their imaging)

2. The indications for the operation

3. The steps of the operation (including the anatomy)

4. The pitfalls for those steps

5. The general perioperative management

You may not be asked anything during the case but you should know these things all the same.
If you have a question or can’t see during the case, ask politely if it would be a good time to ask a question or for you to take a closer look. Be okay if the answer is no because the patient comes first.
At the end of every case, talk with the senior resident and attending about the perioperative plan for the patient. You should know the plan for every drain/line, diet, pain management, and wound care. You should also know the criteria for discharge. (Hint: if you do this, you will almost always have an acceptable plan for the patient on morning rounds.)

Best of luck to all of you and congratulations, again!

For those of you who have already completed internship or at the tail-end of your intern year, do you have any additional tips or advice? What helped you out most during your first year as a new surgeon-in-training? Let us know in the comments below!


Callie is a resident in general surgery at the University of Washington. She will be entering her fourth clinical year at the end of June 2013 after completing a two year research fellowship. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.

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