Surviving Intern Year: 5 Key Tips Every Medical Resident Should Know

I survived my intern year of residency, and so can you.

I’d describe intern year as pleasantly challenging. It starts off chaotic, but you quickly get the hang of it and find your rhythm. Along the way, you’re learning something new every day but also growing as a physician (and person). Honestly, it’s quite cool to look back and see how far you’ve come from day one.

Throughout my first year of residency, I’ve noted what worked well for me and where I could improve. I wanted to share these notes with you (assuming you’re heading into the start of residency or you’re already a resident and just want to see what this newbie—me—has to say).

So, enjoy my top 5 survival tips for the first year of residency.

1. Nail down your workflow.

The start of residency is chaotic, and you should solely focus on finding your footing. Said another way, your job at the start of residency isn’t to show off your clinical knowledge; it’s to figure out how to be efficient and effective with tasks while operating in a complex healthcare system.

As a medical student, you didn’t have to interact too much with the system. You didn’t place orders. Perhaps you called a couple of consults during your clinical rotations.

As an intern, though, you’ll be doing everything. And you’ll quickly find out that the system is unforgiving.

So, you need to find your flow and figure out the process that puts you in control and keeps you organized.

Here are the steps I took to organize myself before starting each rotation:

• EHR Organization: Organize your EHR so that you can visualize key data (vitals, labs, notes) without having to open a patient’s chart. This will help with pre-rounding and make you way more efficient than if you were opening all of your patients' charts. If you use Epic, single-click a patient and then look at the bottom for the tab that pops up. You can manipulate which data are shown down there.

• Patient List Organization: When you print out your patient list, organize it by patient location. This will streamline your pre-rounding process since you’ll see all the patients at each location instead of running around seeing patients in alphabetical order. I accidentally did the latter on day one—not good.

• Write down the 3 most active problems for each patient: Each patient will have several problems but likely only has 1-3 active problems. You should write down these active problems and know the plan for each. For example, on my patient list, I have patient one-liners, and underneath those one-liners, I list the active problems:

Now, here’s what my typical workflow looked like:

• Arrive at 6:30 AM for sign-out

• Pre-round (20 mins): review 24-hour events, consults, labs, imaging, and plan (remember, you only need to know what you’re doing for the most active issues!)

• See patients (20 mins): only ask high-yield questions and perform a high-yield physical exam.

• Run the list with senior resident (15 mins)

• Round with team (depends on attending… you hope 1 hour, but it could be 2-3 hours)

  • Update and sign progress notes during rounds if you have a computer.

  • Start paging consults as you finalize the patient plan (e.g., if you need to consult renal, just page them then and there to get the ball rolling. Never page a consult in the afternoon unless it’s an emergency).

• Complete patient tasks (1 hr)

• Noon conference/lunch (1hr)

• Review new consult notes, labs, and imaging and address any abnormal findings

• Update the signout tab with day events

• Sign out to the night team

• Go home

• Repeat

2. The Iteration Mindset.

My goal throughout my intern year was to be better than I was yesterday. I constantly looked for ways to improve (iterate!) my clinical knowledge and workflow.

Improving your clinical knowledge and workflow efficiency compound overtime, which is why I strive to do this every day. As an intern, there is ample time to seek feedback. Ask your senior resident where or how you can improve. Ask your attending, too. You can ask for feedback more frequently with your senior resident, but I wouldn’t ask the attending for feedback more than twice during a rotation. Just ensure the attending doesn’t give you feedback for the first time on the last day of the rotation!

3. Read.

I made it a goal to stay up to date on my healthcare knowledge and clinical knowledge.

Healthcare knowledge is just as important as clinical knowledge, in my opinion. I’m biased, though, since I write about healthcare every single week. But knowing what’s happening to the system will make you a better physician since what impacts the system will impact your patients.

For my clinical knowledge, I set aside 1 hour per week just to breeze through JAMA and NEJM. I subscribe to their newsletters, so throughout the week, I get emails about the latest articles and save them for when I alott time for catching up. NEJM also has a residency briefing newsletter, which is high-yield.

Additionally, I jot down research questions based on my patient experiences throughout the day. I just throw the questions in my reminders app. There’s a new AI platform called OpenEvidence (you can sign up with your NPI number) that’s trained on journal publications. You can ask it any research question, and it will answer it and provide citations for the answers. This is a great way to impress your attending!

4. Take care of yourself.

The first year of residency is brutally time-consuming. It’s a slap in the face compared to all the free time you had as a fourth-year medical student. It’s very, very easy to let yourself go and not take care of yourself.

Be cognizant of this.

I realized a bit late that it would be even harder to take care of patients if you didn't take care of yourself. So, try to take care of yourself: eat healthy, work out, and spend time with friends and family. You don’t need to break records. But even just working out 20 minutes a day or every other day can make a huge difference. Hanging out with your friends or family once a week can make an even bigger difference.

5. Don’t be scared.

You can be nervous, stressed, and anxious for intern year, but please—don’t be scared.

You’re not alone. People are going through this process with you. There’s always someone to help you.

Approach each situation with the mindset that you’ll learn from it. Your goal is to get as much experience as you can as an intern so that you will be prepared as a senior resident to teach your own intern. This means getting comfortable with procedures, talking with patients, thinking through patient presentations, dealing with families, navigating a complex system, and more.

Good luck!

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