What to expect during your first year of residency

The transition from the fourth year of medical school to the first year of residency can be daunting. From keeping up with a steep learning curve to being fully responsible for patients, it is natural for new DOs to feel challenged during their intern year.

“I wish I had known that I was not the only one who felt overwhelmed,” said Chase Stauffer, DO, a general surgery resident at Henry Ford Allegiance Health in Jackson, Michigan. “As resident physicians, some of us have a tendency to make it seem like we’re floating along peacefully. But in reality, early on we’re all like ducks; we may look fine on the surface, but we’re paddling like crazy below the water.”

To help outgoing medical students feel more prepared for the transition, The DO spoke with five current DO residents, who shared insights on the challenges they faced during their first year, how they’ve been able to manage their time and find mentors. They provided general advice for the newest class of residents.

What are some things you wish you’d known about residency before you started?

“The level of responsibility is something that that is hard to get used to. You hit the ground running, and you have all these patients you’re responsible for. The more you learn in residency, the more you realize how much you don’t know.” — Zach Ryan, DO, transitional PGY1 resident at Largo Medical Center in Largo, Florida

“Everybody starts out more or less on the same page, and it’s OK to not know everything. It’s OK to just say you don’t know. You’re not really expected to know everything and be perfect right from the get-go. It’s a huge learning process. There’s a steep learning curve, and you eventually get there.”— Pooja Patel, DO, internal medicine resident at Geisinger Health System in Danville, Pennsylvania

What is the most difficult challenge you’ve faced?

“I had a patient who coded pretty early on in my intern year. I had been taking care of him for a week, and it was difficult because I had grown close to him. I didn’t handle it very well because I blamed myself.

“I kept it to myself for a while. It ate away at me because I questioned my decisions. But I talked to my senior resident about it and we agreed it was not any one person’s fault, which was an important reframing of my perspective.” — Annie Liu, DO, MPH, internal medicine resident at Maine Medical Center in Portland, Maine

Dr. Ryan: “Adjusting to the longer hours is something that takes getting used to. Waking up really early in the morning takes a special kind of courage for me, and a lot of coffee. Just try to set up a morning routine as well as you can.”

How have you maintained your mental health during residency?

Dr. Patel: “Some weeks can be tough and long, and sometimes you have some really difficult patients, and it’s really important to take your day that you have off to wind down and do something you enjoy. Doing this helps you come back to work for the following week refreshed, and you don’t have the lingering exhaustion and unresolved feelings from the prior week.”

Dr. Liu: “Sleep is one of the best medicines. Make it a priority to actually get seven hours a night. I’ve also been journaling. At the end of the day, I write two lines about how it went, which really helps me to reflect on anything that bothered me.”

Dr. Stauffer: “Find a few minutes for yourself or your family to step away from medicine, allow your mind to recharge, and then come back into it. Also, try and treat each and every day as a new opportunity with a clean slate, despite what’s happened the day before.”

Dr. Ryan: “I like to work out a lot, which I think is important for physicians. You don’t have to lift weights or be the best runner or anything, but getting your heart rate up and releasing endorphins and having a healthy body helps you have a healthy mind.”

How did you find mentors and make connections?

Dr. Stauffer: “My program has a mentor system set up where we select a third, fourth, or fifth-year resident that we feel we are compatible with, and then have them as a mentor. On top of that, we also select an attending physician to ask for information, advice and help along the way.

“These relationships can change, though. You may start off connecting with someone and then later on, you may find someone who aligns better with you. It’s OK to switch, and I don’t think any attending physician would ever hold that against you.”

How did you make a new location feel like home?

Dr. Patel: “Find a place to live that feels like a home, and make it homey. Put up pictures and things like that around the house. Go out and explore the area that you live in or towns and cities that are close by.”

Dr. Stauffer: “When my family and I got here, we found the fun things that happen in town every year, and we made sure that we attended them. When I have time off now, we go find trails or parks to walk in, or we look for cute ice cream shops. Those little things help make a place feel like home.”

Any additional tips?

Dr. Stauffer: “I categorize all of my upcoming tasks into green, yellow and red boxes. Red boxes mean “this has to be done today, period,” yellow boxes mean it can wait, and green boxes mean I’ve got all the time in the world to finish something. Organizing all of my responsibilities that way has been really helpful.”

“Go into residency knowing that you can do everything in your power to become the best physician that you can be, and when you finish your program, it will be a better place for the next resident that fills your shoes.” — Pete Nesbitt, DO, MSMEd, interventional radiology intern at Henry Ford Health System in Detroit, Michigan

Dr. Liu: “My personal motto is to be present. Be present with your patients, and be present during your didactics because those pieces of information can be very helpful along the way throughout your medical journey.”

Dr. Patel: “Enjoy the latter half of your fourth year of medical school, because once you start residency, you’re constantly going to be learning and working. It’s important to take the time to enjoy the last part of your medical school career.”

Related reading:

5 habits for residents to develop during residency

How to plan a wedding during med school or residency