At this stage in our training as residents, we are at high risk for making mistakes. These mistakes can vary in range and type. It is impossible to go through residency without making an error, no matter how big or small.
In medical school, competence was defined by studying the course pack, that stack of crucial lecture notes, and memorizing the details therein. Especially in the first two years, my classmates and I spent virtually all of our waking hours reading text books, attending lectures, highlighting and underlining every word of the course material because we were told that all of it, every word, was important. This understanding of competence reflected the clear but unspoken end game: to have the best score on the exam possible, or at least a better score than the other half of the class.
Some time ago, you walked across the stage and received your first white coat. More recently, you walked across another stage and became hooded into your profession as a physician. Congratulations. You are now the owner of a piece of thick paper that allows you to medically manage acutely ill patients and alter the course of a patient’s treatment.
Realizing that we have both inpatient and outpatient months, which require different skill sets, I feel that it would be better to split these lists into both outpatient and inpatient suggestions. After a few month of being on outpatient rotations, here is my list of eight things to master in order to break the successful intern barrier in the outpatient world.
I got an email recently from one of the faculty at my program who prompted us to each evaluate the question “what does success in intern year look like?”
“Hey hey! How are you?” someone calls out as I walk into the fluorescently lit emergency department I call home. “Living the dream,” is my habitual answer, and it’s only half facetious.
Despite EBM’s role as an incredible advancement in the history of medical care and patient management, there remains many challenges that young clinicians must face when attempting to implement EBM into their respective practices.
Everyone warns you that intern year is hard. It’s a year of little sleep, a rollercoaster of emotions both good and bad. Frustration and guilt in wanting to know everything now because everything you don’t know might be what matters for this patient, this time. And tremendous successes. Some of the things I did this year, I really can’t believe I was able to do. And survive.
I feel like there are so many things to work on in medicine. I need to be more efficient at taking a history; I need to gather morning data more quickly; I should be better at chart review when I get a new admission; I need to be more thorough at following up on labs; I could write the H&P more quickly, and so on. I also feel, from time to time, I do poorly on one thing — maybe I stay at work way too long writing my H&P — and then I obsess over how I can get faster at it.
As I reflect on the year that was, I am excited and yet terrified of what lies ahead. Intern year is unlike any other during which the training wheels—otherwise known as the short white coat—are abruptly stripped. The mannequins are traded for breathing patients, the co-signatures are traded for signatures, and the infamous “I am just the medical student” transitions to the equally unassuming “I am just the intern.” Here are my takeaways from the year that was.