Life as an Intern in Residency

I thought this would be an helpful post considering I have seen this question posted in many forums by interns who are simply struggling in residency. I am currently a 3rd year resident in Internal medicine and, never thought I would say this but, enjoying residency. Two years ago when I was an intern I remembered being completely lost. What is my role as an intern? Why do I feel like I do all of the work and the senior does nothing? When will I have time to learn all this stuff? What is the purpose of pre-rounding?

In hindsight, I believe I did have the wrong attitude and mindset starting residency. I sort of stepped into residency focused more on “training” and less on “working”. Little did I realize, when you’re a resident, you are actually an employee as well, with expectations and duties. The secret that was taught to me while I traveled around the country auditioning for residency was this: “residency is all about attitude”. It took me a very long time to fully understand this, but is very true and if you believe in this, you will make it through residency. I feel the way to “learn” to practice medicine is one thing to be taught how to do everything (how to take a history, do physical exam, and come up with differentials) but also doing it yourself. Which is why intern year is a confusing period because it starts off with the intern being guided/taught on how to do things, to eventually placing greater responsibilities on the intern to grow. Therefore there is no specific guideline created for an intern - there are general expectations but the “role” of an intern varies depending on the skillsets brought by an intern and the timeline during the year.

Fast forward 2 years later, I can genuinely say that while intern year is certainly a confusing time, things do begin to make more sense, and there is light at the end of the tunnel. To address the question above (“Why do I feel like I do all of the work and the senior does nothing?”), my perspective on this is two-fold. The first one is, consider the extreme other end, where senior takes all of the patients from you and you end up watching him/her do everything. This comes very close to shadowing, and if you think about it, this is what we did in high school when we’d volunteer at the doctors office. The second point is, then, is that the senior likely went through the same experience when he/she was an intern as well: The hope is that the intern is trained enough to a point where intern is complete independent and prepared to be a senior and can teach it to their future intern. And by the same token, hopefully when the intern becomes a senior, their future intern is trained enough where he/she can do everything on their own without much teaching.

Having said all of this, yes, the burden does fall a lot on the intern, and the reality is that intern year is difficult. Some may even feel like they’re declining from medical school, i.e. underperforming a 4th year medical student. And actually this is quite common to see, especially in the beginning of the year. Unlike in medical school, interns are placed under the more pressure as they must place orders, answer pages, all while familiarizing themselves with the hospital system.

And the last question - When will I have time to learn all this stuff? I think the best way to learn is for every patient/case that is handed to you, spend a little time reading up about the condition either in the hospital or, if too busy, at home after work for 30 min - 1 hour. This is the best way I have found to learn as you have both the actual patient and case to remember how to properly assess and treat the patient. Do this enough times and soon enough you’ll know how to manage the bread and butter cases very quickly without looking things up too much and help you become more efficient as a resident and future attending.

To summarize, there is so much going on during intern year, including getting acclimated to their dynamic roles, getting comfortable with the EMR, understanding the hospital culture. honestly, it is then not surprising that residents do not even learn much of medicine until start of second year.

Overall, to all those struggling interns, I would like to say a word of encouragement by saying I have been there myself personally and it does get better. I would discourage you from comparing yourself to your peers and trust the system. Ask questions and seek help because faculty is there to support you.