The Next Generation: Advice for Interns

The Next Generation is a CRN column penned by residents, fellows and post-docs. In this Next Generation column from our archives, originally published in June 2015, Elizabeth Richey, MD, who is now starting her third year in BWH’s Internal Medicine Residency Program, reflects on her intern year and offers advice to incoming interns who recently began their training at BWH .

Elizabeth Richey 1

Elizabeth Richey

I clearly remember Match Day one year ago when I found out that I had matched at BWH. I felt so many emotions: shock, joy, relief and above all, a huge sense of accomplishment. But that sense of capability and achievement washed away as I approached my first day of internship and realized how little I knew – even the simple things. I found myself asking the most basic questions to get through those first few days: “Where do I find the patients?” and “How do I log into the computer?”

I soon found out that intern year is both incremental and rapid. I went from not knowing which patients I’d be caring for that day to confidently managing acute situations. Formal teaching sessions helped to solidify my basic knowledge base and encouraged my curiosity; however most of my learning came from repeatedly managing cases of sepsis, hypoxia, delirium and more, and from the thoughtful supervision and teachings from senior residents.

My intern year was a flurry of contradictions that make the experience difficult to describe. And now, as I think about advice for interns who are on the precipice of this experience, I find myself thinking back to the advice I received when I began my first year at BWH.

There are many pieces of advice that are offered to incoming interns: Know your patients. Be organized. Listen to and respect nurses. Be honest. Don’t worry alone. Take care of yourself. Each of these pearls of wisdom may be self-evident, but they are important and have served generations of interns, including me, well.

As I approach the end of my Internal Medicine intern year at BWH, I hardly feel that I’ve reached a position where I should be doling out advice. I will though share my reflections on what I wish I had known last June when I eagerly approached 75 Francis St. as an intern.

  • Ask why: As you juggle the numerous and ever-appearing tasks of an intern, it can be easy to focus more on getting an answer than the reasoning behind it. Take time to ask follow-up questions in a patient interview. If you don’t understand a consultant’s reasoning, ask them to explain. Asking questions allows you to be an advocate for your patient and your own learning.
  • Ask for help: Being responsible for patients is empowering, but also terrifying. You are part of a large team and it’s your job to ask for help when you need it.
  • It always bears repeating: Listen to the nurses. Without the BWH nurses, I would not have made it through intern year. Their practical knowledge of delivering care at the bedside; a well-tuned sense of when a patient may be getting sicker; and advocacy for a patient and family’s needs are some of the many reasons nurses will be your invaluable partners this year.
  • When you can, see your patients at the end of your shift: It will solidify your therapeutic relationship with them, and it’s also for you. Allow yourself this time to find meaning and connection with your patients that brought us to this profession.
  • Take time to reflect on what you are learning: Often, it feels like intern year is filled with daily tasks of patient care and that learning is pushed to the side. Take stock of the transformation that happens as you learn to apply knowledge to real-world patient care each day. For the truly dedicated, this can take the form of daily reflection on patients. If you are more like me, stop and think of what you now know or can now do once every few weeks. Moments of success, as well as the more difficult moments of errors or near misses, are the most important experiences to reflect on and learn from.
  • Ask for feedback on communication: Handoffs and transitions of care are two of the most important things we do, and we do a lot of them. Practice giving and receiving feedback and learning how to improve these skills.
  • Enjoy your companions and be kind to one another: This is one of the true joys of intern year. In the midst of work that can be grueling and heartbreaking, we share the company of colleagues who bring deep kindness and humor to each day and understand all the ups and downs of this shared experience.
  • Relish the opportunity to be your patients’ doctor: I won’t miss tracking down the paper vitals sheets for my patients each morning – a task that incoming interns can now perform in Epic – but it’s with some sadness that I relinquish the role of being the first person to see patients each morning and the first to hear their concerns. While medicine continues to transform as we begin our careers, the stories your patients share with you, their doctor, remains a rightfully hallowed core of our profession.

As you begin your internship, you will receive a lot of advice. I encourage you to filter it through your own lens. You bring thoughtfulness, depth and diverse knowledge to your work. Borrow knowledge and technique freely from those you most respect and trust yourselves to develop your own style.

Soon enough, you will learn how to log in and where to find your patients. The rest of what you gain and the care that you provide over the course of your internship are up to you.

Elizabeth Richey is a graduate of Geisel School of Medicine at Dartmouth College. She will be continuing her post-graduate year two (PGY2) as part of the BWH Residency Program in Primary Care and Population Medicine at BWH, Harvard Vanguard Medical Associates and its Department of Population Medicine.

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