Life in residency

First year of residency: 5 things to expect as an intern

Residency can feel overwhelming. Understanding the typical challenges of intern year can make it more manageable.

As a new DO, you’ll be referred to as a doctor and have your own patients for the first time during residency.

Residency is the culmination of years and years of hard work finally manifesting itself. Interns learn communication skills, coordinate care, consult with patients’ families, write orders and work with EHRs.

“You’ll never forget the first patient you’ll see as a resident,” says Janna Quiling, DO, family medicine intern at Grandview Medical Center in Dayton, Ohio. “You’ll think, ‘This is why I worked so hard, this is the dream.’”

With new challenges and responsibilities, intern year can feel overwhelming.

“You can’t mentally prepare yourself for what residency is going to throw at you,” says Adam Hunt, DO, Central Michigan University emergency medicine core faculty at Covenant Emergency Care Center in Saginaw, Michigan.

Here are 5 things to expect during intern year.

1. Time feels scarce

Residency can feel even busier than medical school. When they’re not seeing patients, interns will have paperwork, journal club, reading, department meetings and more to occupy their time.

“Residents feel like they have no free time at all, they always have something to do on their list,” says Angela Carrick, DO, emergency medicine associate program director at Norman Regional Hospital in Oklahoma. “Expect to feel like you’re at the hospital all the time.”

Residents do receive vacation days, but Dr. Quiling noticed her fellow residents were hesitant to use them.

“Some of my co-workers didn’t sign up for any vacation days,” says Dr. Quiling, who has taken vacation days during intern year. “I recommend encouraging each other to take time off.”

When interns have time off, whether it’s regularly scheduled or a vacation day, they should make plans with friends and family or indulge in a hobby to ensure they’re getting a proper break from training, Dr. Carrick says.

2. You’ll be wrong or not know the answer—often

Residents are often too hard on themselves. Expect to be wrong in residency. Residents should be comfortable with not always knowing what to do, Dr. Carrick says.

“You’re not good at residency starting off, but that’s why you have years of training,” she says. “Forgive yourself. This is supposed to be a work in progress.”

Interns will sometimes get frustrated about how much they don’t know yet and feel as if they’re not measuring up to expectations. Be willing to accept feedback and be teachable, Dr. Carrick says.

“You’ll feel stressed and pressured because the learning curve is very steep. It will get better,” Dr. Hunt says.

Gaining self-confidence takes time in medicine, he notes, and interns’ efforts to improve will drive them to become better physicians.

“If you’re insecure about certain things, you’ll read more, research more and ask more questions,” Dr. Hunt says.

When Dr. Quiling and her co-residents feel doubt, they reassure each other that they were wanted in their program, matched there and that their patients need them.

When she has a good day, she writes it down so she can look back on it and remember.

3. Coping with patient death

For Dr. Quiling, it was challenging to see patients die and witness other negative outcomes.

“You’ll blame yourself, worry and think, what if I missed something,” Dr. Carrick says. “You can’t prepare for the first time a patient dies.”

Talking through the experience with other residents helped, Dr. Quiling says.

4. Sustaining physical, mental and emotional wellness can be difficult

With busy schedules, some DOs have difficulty maintaining wellness in residency. Physical activity levels decrease during this time, which can impact personal health, mental health and patient care, according to one study.

Detaching from medicine at the end of the day is essential to wellness, Dr. Hunt says. Outside of medicine he enjoys working in his yard, spending time with his family and hunting.

“Depression, underlying anxiety issues and other psychological issues might come out intern year,” Dr. Hunt says. “Find someone you trust to vent to, and reach out for help if you need it.”

5. You’ll need support inside and outside of residency

Residency often requires DOs to move to a new town or state away from friends and family.

“You will deal with loneliness,” Dr. Quiling says. “Let your fellow interns know. Have a plan to surround yourself with community and people.”

Dr. Quiling moved with her husband from Virginia to Ohio for her program. They joined the YMCA to be more involved with their community.

A support network inside your program or hospital is also important.

“You need someone to talk to who’s done it before so they can help you realize whether what you’re going through is normal,” Dr. Hunt says.

Find a head resident or faculty member whom you trust. Talk through your worries with this person, and ask them questions.

Further reading:

Where first-year residents train affects their risk of becoming depressed, study suggests

You’ve matched—congrats! Here’s how to prepare for your residency or internship

Advice for incoming residents: 8 tips on professionalism, work-life balance, and more

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