It’s that time of year again…

Well, it’s that time of year again in academic medicine: July 1st.

For those who don’t know, this is the time when all of the learners in academic medicine move up: the chiefs graduate, new interns come in, the old interns become the new PGY-2s, etc. What does this mean? Well, it means that on June 30th, I am doing a job that I have been doing for a year. July 1st, everyone goes from doing a job that they know well, to doing something completely new. 

I have a pretty decent grasp on how to be an intern. Sure, I still make mistakes. Everyone does. But I can manage a fair bit of stuff on my own. The 4th of July is my first shift as a PGY-2, doing a completely different job than I have been doing all year, supervised by an upper-level resident who was a mid-level resident a few days ago. We are all going to be trying to figure out how to do a new job while trying to teach the person doing our old job.

I’ve been trying to think about what I  would have wanted to know when I started my intern year, and here it goes:

Internship will be the hardest thing you have ever done. If it isn’t the hardest thing you have ever done, you probably aren’t doing it right.

You will feel like a failure at the end of the day many days. That’s normal. If you are a week into internship and you feel like you are totally on top of it, you might be overestimating your performance.

Getting the nurses on your side isn’t just about being nice. You have the actively win over the OB nurses. after a week or two, bring a bag of candy or a couple of boxes of donuts. Sit at the nurses’ station when you have a few minutes of downtime, no matter how badly you want to hide in the call room.

The nurses will save your butt at least once during your intern year. Labor and delivery nurses are not med surg nurses. Depending on your facility, they may be practically nurse practitioners or nurse-midwives. At my hospital, we have some private physicians who also deliver in our L&D. The L&D nurses do almost all of the intrapartum management for the private doctors’ patients. They do the mag checks, the cervical exams, the intrauterine resuscitation. They know half of what you will learn about routine labor management, and they can stop you from doing dumb things like checking a cervix with gel before you do your speculum exam for a patient with possible rupture of membranes. Which leads me to the next thing…

No matter what you think, at some point you will be so tired or so overwhelmed that you will start to do something dumb, because it won’t be automatic yet. If you are lucky, no harm will come of it. If you are really luck, someone will stop you before you do it.

You will be wrong. A lot. If you were right all the time on day one, you wouldn’t need a four-year residency. I know it seems obvious, but we are all highly-motivated, competitive people. We like being right, and we know a lot. And it sucks being wrong over and over and over again. But you will be, because that’s just how internship goes.

You will learn more than you ever realized you could, and you will forget more about the rest of medicine than you realized that you knew. Seriously, guys and gals, take your Step 3 early, because even by October I was amazed at how much I had forgotten. I didn’t really do much internal medicine during my fourth year of med school, and Step 3 is basically an internal medicine exam. Seriously, take it early before you forget everything.

Even at the end of your intern year, you will still make mistakes. Residency is four years long for a reason. It’s still going to be hard and there is still a lot to learn.

Here’s to the journey! And good luck to all the new interns starting in the next few days!

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