5 things you can do to prepare for residency before the first day

As we move forward from Match Day, if you’re a fourth-year medical student, you’re probably already anxiously thinking about preparing for residency and putting your best foot forward. Contrary to popular belief, memorizing every word of Harrison’s before orientation week is not the way to do that.

Below are five things you can start thinking about now that will help you in the first months of residency.

1. Find out the secrets of your electronic medical records (EMR) system

As you definitely already expect, the learning curve in intern year is steeper than that hill your most senior attendings swear they had to walk up barefoot in the snow every day to get to morning rounds when they were interns.

What you probably don’t anticipate, however, is that the vast majority of that difficulty actually is going to come from whichever EMR system you are cursed to use.

Up until this point in your life, your experience with technology has likely been influenced by companies like Apple and Google that prioritize user experience and functionality. You are about to be thrust into a parallel universe where software seems almost intentionally designed to be impenetrable and nonsensical.

To make matters worse, you will likely get no more than a two-to-three-hour course taught by nonphysicians one random Wednesday during your onboarding to learn the most vital tool of your job.

This is a crucial area where you can start improving early. As soon as you figure out where you match, use your last easy months of med school to do some online training, watch tutorials and dig into super user tips.

Likewise, if you have attendings or preceptors that are willing to let you use their Dragon mics (maybe in exchange for scribing their notes for them), it’s never too early to practice using dictation software. Because licenses are expensive, it can be really hard (if not impossible) to get experience on the program as a student. Be warned, dictation has a bit of a steep learning curve and you will have to develop comfort with organizing your thoughts out loud, but no single skill will make you faster, more efficient or better prepared for residency.

If you can master (or at least be familiar with) dot phrases, mobile rounding apps, smart blocks, order-sets and other features offered by your particular EMR, you will circumvent months of learning the hard way, hit the ground running and stand out with your efficiency. You’ll also be able to use the extra time to actually learn medicine.

2. Start thinking in terms of A/Ps and order-sets

If you are determined to study before residency, one thing that I recommend is making some flashcards that contain a condition (like pulmonary embolism [PE]), a short paragraph assessment & plan (A/P), commonly employed scoring systems (like Wells Score for PE), a differential diagnosis and what you’ll need to order to work it up.

Most residency programs begin with you serving on an inpatient admitting service of some kind, which will require you to generate H&Ps (history and physical examination). You will look like a superstar if you already have an evidence-based plan with a reasonable differential ready to go for any given presentation. There are a ton of resources to draw from for this—see the list below.

Resources for studying conditions:

• Pocket Medicine
• Up To Date
• Epocrates
• Dynamed
• Online Med Ed-Intern Content

3. Learn some personal finance habits.

As exciting as it is to finally have money after four years of scrimping and borrowing, you will also have more responsibilities, like managing your student loans and taxes. The added challenge is that the money you do have is likely going to be very tight until you make your first attending contract and finally see the fruits of your many years of labor.

Because of this, residency is really the best time to start making smart financial decisions that you can continue as an attending and build the foundation for your future.

If you’re anything like me, however, you probably feel intimidated and like you have no idea where to start. I highly recommend getting a financial resource such as The White Coat Investor and joining some financial literacy forums or Facebook groups online.

You can see the AOA’s financial planning resources and learn about discounts available to AOA members on student loan consultations and refinancing on Osteopathic.org. Your specialty society also likely has financial literacy resources available to you as well. Because as with documentation and using EMRs, this is another crucial skill for which there was minimal instruction on in medical school. But you know every enzyme in the Krebs Cycle, right? Yeah, me neither. 

4. Get a conference schedule and some vignette templates for research.

Sorry to break it to you, but you will have to do research in residency. It’s a requirement at many programs to present or publish before you graduate. The easiest way to do this is to grab a great case as you see it.

You can prep and submit a case or clinical vignette really easily, but it helps to have a schedule of conferences coming up in your specialty or journals you can submit to. So when you get an interesting case, you’ll know exactly where to send it.

5. Figure yourself out: Take time to relax and do some things that you love.

I saved what I actually feel is the most important topic for last: before residency starts, try to figure out what your coping mechanisms are and prepare how to deploy them when you are under fire.

I can tell you honestly that all of the clichés you have heard about residency are true: it is a grueling, exhausting, soul-straining process that will test you in ways you have never been tested before. And there are moments that will break you.

Unfortunately, there’s no real way to prepare yourself for this.

My best advice is to specifically think of something you can do to recharge yourself, even if the only free time you have in an 80-hour workweek is 15 minutes before bed. If you can fit a day’s worth of self-care into 15 minutes, you can find ways to expand that mindset into the rest of the day.

The efficiency, medical knowledge and work/life balance will eventually come. The key is surviving until you get to that point, and starting on the right foot is your best chance to make the journey smooth sailing.

Related reading:

Cracking the Match: Everything a current (or future) residency applicant needs to know about the Match algorithm

Why you should consider living in a tiny home during residency