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Success in Intern Year: Momentum over Minutiae

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?”

It’s a good question. One that I’ve already discussed with many a haggard fellow intern. Most of us feel like we are just trying to survive until the next day without making any catastrophic mistakes. We’re doctors now, and even though we are only in our first year of training we hold ourselves to the standard of a seasoned practicing physician.

Personally, it’s also pertinent to the focus of my writing. If we are focusing on the wrong measures of success, unreasonable measures, then we will quickly burn out. As Dr. Shah, the UT Southwestern geriatrician who inspired me to start my own medical blog, said, “You must actively work to protect yourself against burnout.” And a big part of that work comes from knowing how to gauge whether each day was a success or a failure.

While I still don’t think I know exactly what success in intern year is, I’m pretty sure I know what it isn’t:

List One:

  1. Making clutch diagnostic and management decisions that save a patient’s life.
  2. Being able to recite all of the latest evidence and guidelines behind a certain treatment.
  3. Knowing exactly what to do at all times (or even most of the time).

That’s not to say that these things don’t make a good day. One of my best days in the cardiac ICU was the day I presented all of the issues on our most complicated patient and didn’t get interrupted once. That felt amazing because I knew I had said everything right. But if that was my only measure of success then pretty much the whole rest of that month was a failure. My plans were always met with interjections from residents, fellows and attendings. While the points in List One are things that we definitely should aim for, I have come to believe that if we make them our ultimate goals for every day than we will have many more disappointing days than satisfying ones.

That being said, I believe these measures are a little closer to what success in residency should look like:

List Two:

  1. Showing up on time every day. Simple and expected, I know, but this includes knowing when to show up earlier than the day before.
  2. Learning the workflow of each new hospital and how to become more efficient each morning.
  3. Gaining “situational awareness” of your patients. Learning to quickly determine whether someone is sick or not sick.
  4. Being inquisitive. Sometimes I have so much work I just want to get the necessary order in, write my notes, and get home. But I have found that the more satisfying days are the ones where I take the chance to learn something.

List Two is a lot less sexy. It’s a lot less Dr. House-ish. But I think it’s more realistic. And I think it’s what most upper level residents expect. A second year resident recently told me “one thing you have to know about intern year is that we (upper level residents) don’t expect you to be excellent clinicians yet. We don’t expect you to know all the evidence or make the hard diagnoses. Your job is to show up, learn the system, and get the work done, including the admissions, orders and discharges.”

While I’m still looking for a perfect definition, I think that success in intern year is more about momentum (List Two) than minutiae (List One). The minutiae will come. We will get there, but we have to develop the momentum first.

Editor’s Note: A version of this piece first appeared on Resident Hacker on September 7, 2015.

Justin Jones, MD Justin Jones, MD (5 Posts)

Attending Physician Guest Author and Contributing Writer Emeritus

Intermountain Healthcare

Justin Jones is an outpatient primary care physician in Utah. He completed his residency in 2018 in Colorado and wrote for in-House during residency. He blogs at Residency Hacker.