Tips for Thriving During Your Intern Year

Congratulations! You are about to embark on one of the most memorable years of your life. The next 12 months will undoubtedly be challenging, exhausting, and stressful. Taking ownership of patients will be difficult at first. However, with organization, focus, consistent documentation, and a willingness to ask for help, the intern year can be extremely rewarding. 

Survival Tips 

Be courteous. Take the initiative to introduce yourself to members of the staff. For example: “Hi, I’m Jane and I’m a new intern, it’s so nice to meet you” goes such a long way with staff and nurses. Treat all members of the health care team, including the support staff, with respect. Do not underestimate the power of kindness. 

Stay organized. Keeping an active "To Do" list will help you stay organized and maximize efficiency. Write everything down when it is suggested or ordered. Write down test results so that you can quickly recall the specifics when your senior resident or attending asks for them. When there are multiple items for follow up during your shift, consider writing out a chronological timeline of time-sensitive action items.  

Communicate. Sit down with your senior resident and attending at the beginning of each block to establish expectations and get off to a good start. Continue to touch base throughout the month, requesting interval assessments of your performance. Ask for specific examples of your strengths and the areas in which you need improvement. Be sure to incorporate any suggestions as soon as possible. 

Utilize your resources. Consult with the senior resident, nurses, respiratory therapists, and other qualified staff if you are not comfortable making a decision or assessing a patient. The biggest mistake you can make as an intern is to misjudge a situation and subsequently face an avoidable unfavorable outcome. 

Embrace your role as a teacher. One of your most important duties as an intern is to help teach medical students and fellow residents. Lead by example. Incorporate clinical pearls of wisdom on rounds, bring evidence-based articles to rounds to help guide patient care, pull students aside after rounds to review their documentation, or give a quick talk on some fundamental pediatric topics you're comfortable with. Think of the best residents you worked with as a student and emulate what made them so great to work with. Teachers are always learning too. Never be afraid to say you don’t know! You can always have the medical students look something up and teach YOU, so you can learn together. 

Reconcile your charts daily. Make sure you are aware of all standing lab orders, cultures, and medications. Scrutinize each one to ensure that only necessary and clinically relevant therapies are employed.  

Trust but verify. Take nothing at face value; investigate everything yourself. When called because a patient's status changes, go to assess the patient – even if it is the middle of the night. If a family is not sure of a medication dose for a newly admitted child, call the pharmacy or prescribing physician. Whenever possible, do not rely on hearsay or supposition. Be your own eyes and ears. 

Read about patients’ conditions and consider their perspective. Take every possible opportunity to learn as you go. Even the most straightforward patient can be a learning opportunity. Challenge yourself to learn from each patient experience and think about the family that is being impacted by their care. Consider reviewing the AAP Family Partnership Network's Tips For Successful Family Partnerships During the Healthcare Experience to help you understand how best to interface with families.  

SOPT News & Views Blog Article – Intern year: Tips for That First Night on Call (member login required to access)

Find a Good Mentor  

Many residency programs have a structured mentorship program built into their curriculum, but don't let that limit you. Like patients, mentors come in many different shapes and sizes, and you can learn from all of them. 

In general, the goal is to be paired with a mentor who shares your professional interests and has a wealth of knowledge in your desired field. An experienced mentor in any specialty can be an invaluable resource, providing not only information but less tangible support through the challenges of residency. From academic to personal to career-oriented issues, a mentor can provide impartial and confidential advice.

If your program does not offer an official mentoring program, be your own advocate and seek one yourself! Don't be afraid to approach an attending you enjoy working with and ask him or her for advice and support. Also, senior residents, chief residents, and program directors are excellent sources of informal mentoring.   

Patient Ownership & Responsibility  

Remember to relate. Patients are anxious, feel crummy, and want to know what is wrong with them and what their medical team is going to do about it. They want to know the plan before it is executed. They also want to be listened to and treated with compassion and dignity. 

Communicate with the patient and family. You should see your hospitalized patients' multiple times each day. Keep in contact with the family, update them often, assess their needs, answer their questions, reassure them when appropriate, and provide them with education. Families will appreciate the extra time you spend to help guide them through what is probably a frightening experience. Try to place yourself in their position and let the insight from that perspective guide your interactions. 

Know all there is to know about your patients. It can be difficult for interns to balance patient ownership with work demands and duty hour restrictions, but it is important to have the facts readily on hand (if not memorized). Spend the time going through the chart to get a picture of where the patient has been in terms of their past medical history and care. Sometimes this helps put their current issues in perspective and allows you to answer questions that may come up on rounds. When the clinical picture is not making sense, these details may be the clues that reveal the diagnosis.  

Be accountable and responsible for patient care. You are supervised and will have to report most of the things you do to senior residents and attendings. Discuss your diagnosis, differential, and plan for evaluating and treating the patient. It is okay to be unsure and ask for help but start by disclosing what you are thinking. Make sure to talk to your senior resident or attending about how you should handle difficult patient encounters or disclose medical errors if they were to happen. 

Lead the way. Actively interact with your consultants and ancillary providers such as respiratory, speech, physical, and occupational therapists. Use all available resources to ensure that your patients are receiving the best possible care. Your job is to be the captain of your patient's team, the person who assimilates and integrates information from all relevant sources. Keep everyone informed of the patient's condition and promptly employ suggested recommendations. When caring for hospitalized patients, communicate with their primary care pediatricians.  

Give (and request) thorough sign-out. Know each patient's status and tie up any loose ends before transitioning care to the next team. If you are concerned about a patient's condition, emphasize that to both your fellow intern and the senior resident. Tell the oncoming team about any worrisome developments that you have been tracking and offer a contingency plan for managing possible acute changes. Similarly, when receiving sign-out, ask questions to ensure that you understand the patient's status, active issues, and preferred course of action. Document all interventions or changes in management right away. Good notes contribute to a better sign-out and facilitate better patient care. If your institution uses an EMR patient handoff tool/system, be sure to familiarize yourself with it early on. 

Anticipate and have a plan. At every phase of care, from your initial assessment to discharge planning, always try to think a few steps ahead. This is one of the biggest differences between being a medical student and being a successful intern. When an issue arises, identify, and gather data that is relevant to the problem, research potential answers, and present a proposed course of action to your supervising resident. Don't get tunnel vision and forget about follow-up plans, home health services and therapies, pharmacy issues, and family education. This applies to both inpatient and outpatient settings. 
 
Expedite patient care. Decreasing hospital length of stay is a worthy goal. Be the advocate for your patients and their families. Advocating can help to mobilize resources, expedite their care, and provide efficient discharge planning.