It was my third day of residency and I found myself on the orthopedic floor. I was putting some scripts in a chart when a nurse came to me stating that one of our patients had been hypotensive. My first response was, “ He probably should get a bolus of fluid”. She responded, “ He already has but he is still slowly dropping his pressures”. I politely carried on putting my scripts in the charts. She came a bit closer and just stood there staring at me. My first thought was, “ What’s wrong with this lady? Why is she still here in front of me?. It was at this moment that I realized I was not a medical student anymore.The casual shrug of the shoulder will not cut it any longer. This nurse wanted a plan and she wanted me to give it to her. Long story short…. of course I saved the day. But this was the biggest revelation of the year for me. You’re a doctor now. We are going to drop a few gems to help get you through intern year. 

Get Used to Your New Role Doc

MS5 vs MD1

Just like we said above, throughout the year you will realize you are the acting MS5 (5th year medical student) or you are the MD/DO1 (The doctor). In med school most of the times there is a curriculum lined out for you and you are told what to study and you have regular tests to ensure that you are studying. Now, it is up to you to study the material and know how to manage different condition. You are now the one putting in the orders that will be carried out on actual living people throughout the day. Also, even though we are the “bone docs”, we can’t forget the basics. If one of your patients has chest pain, you should still know how to work that up and the basic labs (CXR, EKG, troponins, CKMB, etc). Instead of expecting to be taught, learn to seek out knowledge. You get out what you put in this year. 

Work Hard

For lack of better terms, remember you are at the bottom of the totem pole again. You have to do all of the stuff that the upper levels don’t feel like doing anymore. You are there to work, don’t complain, just put your head down and get it done. If you have to be the one that stays late to follow up on a patient, stay. One day you will have interns who will do the work that you don’t want to do. You will also learn how to work smarter instead of harder. First hand experience is the best way to learn for most people anyway so soak it up.

Study Hard

The sheer amount of new knowledge you have to take in can be overwhelming. Lucky for us, residency is a 5 year process. You will continue to learn more as time goes by. Try not to feel overwhelmed or like you are behind. Truth is, you probably are, but you will catch up. 

You will learn something new everyday. Experience is a great teacher in itself, but you still must spend some time studying from one of the core textbooks. You will surely be using some quick review resources such as orthobullets, handbook of fractures, Netters, etc. Though quick review is helpful throughout the day and studying up for cases, the core textbooks gives a more comprehensive understanding of the subject. I personally use Rockwood and Green’s Fractures in Adults. Fitting study time into residency may be the most difficult part when you also consider all of the time required from your daily duties and keeping up with the basic necessities of life. We recommend going home and reading 5-10 pages of your core textbook DAILY. It seems small, but it will pay off dividends over time. Try your best to stick to this and just make it part of your routine. 

Good

This is a mentality I got from listening to a former navy seal called Jocko Willink. Here is the link to the video/speech. To sum it up, reply to everything and situation with the word GOOD. This helps your mentality on handling situations that you may at first get frustrated with or not know what to do. Examples of how to apply this:

• Got 10 consults to see? – Good, I need the experience.
• Attending didn’t let you ream? – Good, maybe I need to perfect closing and read up on reaming some more.
• Never dealt with this type of fracture before and you are there by yourself? – Good, look it up, figure it out. Time to learn something new.
• Got to redo a splint after you thought you had it down and spent all that time getting a reduction? – Good, I need more practice. This will make me better.
• Been up for 36 hours straight? Tired? – Good, 24 hour shifts will be easy for me now.
• Your upper level is pushing all the work on you and wants you to see all of the patients and discharge them?- Good, this will make me more efficient.

It’s all about how you look at things and respond to situations.

Be Respectful

Playing nice with all of the hospital staff can make or break your intern year. Nurses can make sure you look like an all star to your seniors/attending. Social workers can make sure you quickly get your patients out. The ED team can make conscious sedation a priority and keep your work flow moving. I could go on and on with these examples. You do not want to be known at the hospital as the resident with a bad attitude or a person who’s always upset. You have to always be courteous and professional with all individuals you’re in contact with. If you do this right during your intern year, you will continue to reap the benefits throughout your residency.

Play Hard

Intern year has its ups and downs. The long hours and new responsibilities wears on you over time. One of the most important things you can do is make some time for yourself. That could be working out, going out to dinner with friends, catching a movie, or even just spending time with your loved ones. Even when those “80 hour” weeks become a bit more than 80 hours, you have to have that stress relief. It will help keep you sane over this year and keep you smiling. Of course you have to “play” in moderation to make sure you handle all of your other responsibilities. But keep in mind, we can’t help others if we can’t help ourselves. 

Written by, Jay Fitts, MD and Wendell Cole, MD

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