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The DO | In Training | Training Ground

You’ve matched—now what? How to get ahead in your internship, residency

In the ritual that plays out every winter, thousands of anxious fourth-year osteopathic medical students heave sighs of relief after learning they’ve matched into an internship or residency. Later this year, these DOs-to-be will assume colossal responsibilities and face the pressures of living up to the two new capital letters appended to their names—all while serving an 80-hour workweek.

Dr. Sees

“During your internship year, you need to have faith in your judgment and realize that you are called on to be a leader.”
Dr. Sees

So with one hard part of the educational continuum almost over and an even harder part looming, fourth-year students might want to relax during the relative lull. “Enjoy the time between graduation and residency,” suggests Gregory Harris, DO, a second-year internal medicine resident at Genesys Regional Medical Center in Grand Blanc, Mich. “Congratulate yourself on making it this far. Take a vacation. Don’t study during the break because it’s not going to help.”

Based on her experience, Jessica L. Ziebarth, DO, suggests the opposite tack for students winding down their medical studies. “When I was a fourth-year student, people said to take it easy and have a good time after match day because the next four years would be stressful,” says Dr. Ziebarth, an intern and first-year resident in physical medicine and rehabilitation at UPMC McKeesport in Pennsylvania. “I wish I had done more to prepare.

“As a new intern, you are going to feel overwhelmed on a regular basis and feel dumb every day. Every intern I know says, ‘There hasn’t been a day when I didn’t miss something or learn something new.’ So I would advise those who have just matched to continue educating themselves.”

Less disputed than how to spend their time now, however, is how new interns and residents can best spend their time when they begin their graduate training this summer. To make a good name for themselves from the get-go, rookies should hunt out mentors, demonstrate leadership, show flexibility, be sensitive to hospital politics and carve out personal time, say experienced trainees.

Make most of initial weeks

The first weeks of an internship or residency are overwhelming in both positive and negative respects, and there is no way for graduates to forestall the pressures and intense emotions, Dr. Harris says. “All of a sudden, you go from being a medical student who is constantly monitored to being a physician with a lot of responsibilities,” he notes. “You are taking care of sick people from Day 1 and are treated with much more respect because you are now a physician.”

At first, many new interns and residents experience fear, self-doubt and feelings of inadequacy. However, trainees can take comfort in their previously conquered challenges in the classroom and during clerkships, Dr. Harris says. “And remember that you are expected to make some mistakes and to not know a lot at the beginning,” he adds.

Dr. Maughan

“Don’t complain during your internship year. That does not make a good impression,” says Cory B. Maughan, DO, shown here in 2009. (Photo by Patrick Sinco)

New interns and residents are expected to read a lot and find answers on their own, but they should not be afraid to ask questions, Dr. Harris says.

“Surround yourself with mentors,” recommends Maryanne R. Samuel, DO, a second-year internal medicine resident at Palmetto General Hospital in Hialeah, Fla. “These can be attending physicians or upper-level residents.”

“Be respectful and friendly with the nurses,” Dr. Ziebarth says. “Nurses helped me out a lot at the beginning with simple procedures I was not familiar with.”

In addition to clinical procedures, new interns and residents need to learn as much as they can about hospital policies and processes, and not just formal ones. “Be aware of hospital politics,” says Dr. Harris. “Develop a good understanding of the personalities and expectations of the different attending physicians,” he says.

Take Level 3 of the Comprehensive Osteopathic Medical Licensing Examination—USA early in the first year of OGME, osteopathic trainees suggest. “If you wait too long out of medical school, when you’re entrenched in your own specialty, it will be harder,” Dr. Samuel says. “Level 3 covers everything from obstetrics and gynecology to osteopathic manipulative medicine. Take it when the subjects are still fresh in your mind.”

Cory B. Maughan, DO, advises fledgling interns to be flexible, given that OGME programs, especially new ones at virgin hospitals, are often still testing their policies and procedures. “If you’re in a new program, in which things are being fine-tuned, you are going to have to deal with changes. Try to make things work. Don’t complain during your internship year. That does not make a good impression,” says Dr. Maughan, who completed his internship year and will soon begin a dermatology residency through Samaritan Health Services in Corvalis, Ore.

Despite feeling frazzled, interns and residents should show initiative in the early weeks of their graduate medical training, some DOs urge. “During your internship year, you need to have faith in your judgment and realize that you are called on to be a leader, be it of your peers or your patients,” says chief resident Julieanne P. Sees, DO, who is in the fifth year of the orthopedic surgery residency program at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford.

Dr. Sees notes that in her program, the residents run their own continuing education sessions. Newer residents can show leadership by sharing their cases and teaching others.

Dr. Samuel points out that residents spend more time with hospitalized patients than anyone else does. “Remember that we need to be the strongest advocates for our patients,” she says. “We are able to go the extra mile. When I have questions, I sometimes call patients’ family members to talk to them. I get all the information I can to make the best decisions for my patients. You need to learn how to be a leader.”

Don’t neglect yourself

The beginning of an internship or residency does not mean the end of free time, though it will be scarcer. “You have to be extremely organized and make time for a life,” says Dr. Harris, who considers himself lucky to be married to an emergency medicine resident whom he met on the first day of medical school. “There are days when I just want to come home, eat something and go right to bed. My wife understands what I’m going through because she feels the same way.”

“The 80-hour work week for interns and residents has made it possible to enhance yourself both professionally and personally,” says Dr. Sees, who makes time to work out and be active in her church. Hobbies, such as playing a musical instrument, and spending time with family and friends provide critical balance to a hectic schedule, she notes.

Dr. Sees shares a simple formula for thriving during the internship and residency years: “Stay true to who you are. Do your best. Take your job seriously. But have fun.”

cschierhorn@osteopathic.org

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