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Facing Incompetence: Intern Year (Part 1 of 3)

To the freshly green intern:

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. People will take you seriously when you don your long white coat. Nurses will call you “Doctor” and patients will hang up on phone calls when you walk into the room. You will get paged from staff when your patient becomes unresponsive, and you will make the decision to call the code if the patient decompensates. You will pronounce patients as deceased, you will hold the hands of families as you have to break the news.

But be honest. With mere months into residency, you probably don’t feel qualified enough to be called “doctor” in public. You will spend more hours at work than at home. Each night you will get leave the hospital more tired than the day before, and every morning, you wake up to do it again. You will plow through each day, confident only in the knowledge that there is much, much more that you do not yet know.

Incompetency is a legitimate fear for newly fledged residents. There is a significant change in your role in patient care as you transition from a medical student to a resident physician. You are now fully accountable for the patients on your team. Not only has your knowledge base likely remained stagnant since the end of medical school, but you are also expected to perform at a higher level than ever before. It’s hard to ask for a patient’s consent for a procedure that you may have never seen. It’s hard to deliver the bad news about cancer when you don’t fully understand the disease course, prognosis, or treatment. How can you expect your patients to trust you when you can barely trust yourself?

Subsequently, a vital aspect of being an intern involves facing your own incompetence. In medicine, professional competence is the ability to acquire, apply, and communicate knowledge through our actions for the benefit of the community. A good physician is expected to integrate these abilities successfully in a way to provide patient care and maintain a good team dynamic.

The beginning of a new year of residency is fraught with a steep learning curve. The “Aha!” moments in medicine are far outnumbered by the fears of crippling doubt as you constantly rethink your clinical decisions.

How can you prepare yourself for intern year? To put it simply, you need to learn how to adapt. As an intern, you will be wrong, and you will make mistakes that your senior resident or attending will gently correct. Accept that you won’t always know what you’re doing and sometimes, you will need help. That is okay. You are not a fraud. You are merely an infant in medicine.

Take every opportunity you can to expand your knowledge base. Learn from the subspecialty fellows with each consult that you place for your patients. Deepen your knowledge base. Now is not the time to stop learning. Don’t be discouraged. Practice makes perfect. Keep going. Try to be a better physician tomorrow than you were today.

You have a lot of learning and improving to do in the next year, and you will come out of intern year a more resilient individual. Good luck.

Please continue on to Part 2.

Image credit: Antonio Lucas Lerga via Getty Images and iStockphoto.

Jarna Shah, MD Jarna Shah, MD (3 Posts)

Editor-in-Chief Emeritus (2016-2019)

University of Illinois at Chicago Hospital

Jarna Shah is a third year anesthesiology resident at University of Illinois at Chicago. She has been an editor with in-Training since 2012. In her free time, she bakes ridiculous desserts, practices martial arts, and writes novels every November.