How To Prepare for Intern Year of Residency

One of the most frequently asked questions that I receive from medical students is about how to prepare for their first year of resident. It parallels one of the most common fears among medical students in that they will not be adequately prepared for day one of residency. It’s a valid concern because you will never truly be ready for intern year but if you’ve made it this far in your training then you are likely ready enough. Almost everything you learn intern year isn’t taught in medical school because you have to do actively do it to learn it. At least that’s what I thought until I came across OnlineMedEd.. It’s the only resource I’ve found that actually prepares medical students reasonably well for intern year. Again, nothing is going to make you fully prepared but this is as close as you’re gonna get.

 

I started using OnlineMedEd during third year of medical school

OnlineMedEd is an amazing resource with videos that help explain complicated topics that overlap real world experience with the textbook. They do an amazing job of translating all of that USMLE step 1 material into actual practical knowledge so you can look sharp on all of your third year rotations. I would watch a few before each rotation started and it showed. Dustin and the OnlineMedEd team also drill home all of the important facts that are frequently tested on step 2 CK. Sure, nothing will ever replace UWorld but OnlineMedEd gives it a run for it’s money. Start using OME early and often.

 

A curriculum for fourth year medical students

Your fourth year of medical school is a magical time especially after interview season is over and your rank list is finalized. You’re basically just waiting to graduate and planning your vacation to South East Asia. It is all to easy to fall into a trap of laziness and forget that you are going to be a full fledged doctor in 6 short months (well technically you’ll be an intern but a doctor nonetheless). If you dedicate yourself to the structure of OnlineMedEd during your fourth year you will have a dedicated curriculum that keeps you fresh and sharp on the wards. Sure, you’re still gonna forget a lot before intern year starts but at least OnlineMedEd will get you into some good habits.

 

It prepares you for intern year

My advise to all of my fourth year medical student is always the same- go home because life is too short to be spent in the hospital watching me type notes and at least one of us should see the sun today. I also tell them that the best way to be a good intern is to develop good habits while you are still in medical school. The dirty truth about residency is that you don’t need to be all that intelligent to be a good intern. You simply need to be efficient, thorough, and work hard. The sooner you develop habits that enable you to work smarter, and not harder, the better off you will be. OnlineMedEd has developed a fantastic Intern Boot Camp that helps you do exactly that. If I could do my fourth year all over again I would use the Intern Boot Camp and test out what does and does not work for me while I was still on the wards in the hospital. That way when I show up day one of residency I at least had a system that I knew worked for me. It’s like when I had to learn how to actually study in medical school- I wish I didn’t have to go through the process of figuring out what works best for me. I wish I knew how to study more efficiently back in undergrad. Likewise, take the time to learn the ropes of what it takes to be an intern while you are still a medical student.

 

Start studying for step 3

Ugh I know. Sorry for bringing up the USMLE’s again but you have to get it over with eventually. I’ve written extensively about when you should take USMLE Step 3 as well as how to study for USMLE step 3. If you use OnlineMedEd during your fourth year of medical school you will get a head start on it. You don’t need to use OnlineMedEd as your primary study aid but it will certainly help cement concepts in your head and make it easier for you once you start your dedicated step 3 study period as you transition from medical student to resident.

 

They also have great study products

Last thing I’ll mention are their study aides. The Intern Guide Book and the Quick Tables Book are great study tools for medical students. They succinctly provide you with a ton of well organized material. You have to fill in the blanks and annotate it just like any guide book. But if you are going to use OnlineMedEd then these books are essential as they go hand in hand with some of the videos. Just like any resource, the more you use it the more results you get from it!

 

So if you are interested in using OnlineMedEd check them out here: OnlineMedEd.

 

*Full disclosure: sponsored content. That being said, I only support brands that I believe in.*

The Difference Between An Intern and a Senior Resident

At my hospital, we call first year residents ‘interns’ and all of the second and third year residents are the ‘senior residents’. It makes it easier for everyone in the hospital when you introduce yourself as ‘the intern’ or ‘the resident’. It set’s different expectations right from the get go. The biggest difference I’ve noticed between an intern and a resident is the following:

Now take a step back all the way to medical school where you don’t even know what you don’t know. It’s absolutely terrifying. You finish two years of classroom lectures and two years of clinical rotations and are eventually given a degree that essentially says ‘I know enough medical stuff to not kill someone’. And then on day one of residency you’re given 10 patients and realize they didn’t teach you any of this stuff in medical school. And that’s normal and okay. I still barely know what I’m doing everyday (I know, not really what you want to hear from your doctor).

My point that I’m trying to make to any medical student or intern reading this is that residency is terrifying at times and you won’t be okay. For some reason people don’t acknowledge this fact. That you are going to freak out at some point along the way either from anger, anxiety, fear, or all of the above. Just know that it’s going to get better.

I remember my first rapid response. A patient was in new onset atrial fibrillation with rapid ventricular response with a heart rate in the 180’s.  He was hemodynamically unstable with oxygen saturation dropping into the low 80’s in front of my eyes. I arrived to the patient’s room and there’s one nurse getting a new EKG, another two nurses placing a new IV and drawing labs and an arterial blood gas, another nurse helping the respiratory therapist adjust the ventilator settings, as well as the rest of the floor nurses gathered outside the patient’s room to witness what was going on. “Oh good, the resident is here!” one nurse exclaimed. And then all of a sudden everyone turned and looked at me for guidance. Oh, and did I mention that this was the first time I had ever met this patient before? I was just covering overnight.

Thankfully this situation happened later on in the year so I was comfortable handling it. Not to mention I love being the center of attention and hearing the sound of my own voice so I live for these kind of moments. Ultimately the patient did fine and we resolved the underlying issue (mucous plugging caused hypoxia which induced a.fib which caused hypotension and altered mental status so regular deep suctioning would prevent this in the future).

Looking back at that rapid response, I would never have felt ready to handle that type of situation if you asked me during my first few months of residency. Even halfway through intern year I still would not have been nearly as confident in my medical knowledge or even in my ability to handle the stress of the situation. It is normal to be overwhelmed. You are only one month into residency. We don’t expect you to be full fledged attending physicians yet (again, I’m still figuring stuff out on the fly half the time). Just promise yourself to be better tomorrow than you were today. At the end of the day that’s all we can ask for. Micro improvements each and every day.

How To Write Your Residency Personal Statement (And a copy of mine!)

Initially inspired by a blog post from LifeOfAMedStudent.com about how to write your residency personal statement I wanted to share a few tips and tricks on how to write a great personal statement. By no means is the following all inclusive as the complete scope of writing your personal statement is beyond just one blog post. But hopefully any of my followers from medical schools in the Caribbean, United States, or around the world wondering how to write a residency personal statement will have a little bit more guidance. Oh, and also a copy of mine. So here are a few pearls of wisdom about how to write your residency personal statement.

 

Read ‘The Successful Match 2017: Rules for Success in the Residency Match’

I’ve pushed this book before and I’ll do it again now because I truly feel that it was the best book to read when applying for residency with regard to understanding the process. It explicitly spells out objective data about the match based on surveys filled out by program directors. No hearsay. Just facts. It’s a big book but you don’t have to read it from cover to cover in one sitting. Snag a copy and peruse through it when you need it because it helps you during each step of the residency application process, including the personal statement.

 

 

Just stay par

Don’t let your personal statement harm your application. In my opinion, personal statements aren’t going to get you an interview that you wouldn’t have gotten otherwise. However, a really bad personal statement might kill your application like a shot of potassium to the heart. You want your personal statement to keep you par. So don’t use overly eloquent wording or try and reinvent the wheel. Be conservative and try to just hit onto the green. Don’t go for a whole-in-one.

 

 

You are applying for residency- not medical school or a fellowship

When you applied to medical school you were expected to draw on past experiences that made you want to be a doctor. This is not that time. We already know you want to be a doctor. They want to hear why you want to become a specific type of doctor. Write about why you want to go into your specific field. Additionally, don’t get ahead of yourself by writing about fellowship opportunities. Sure, you might only be going into internal medicine so you can become an interventional cardiologist. But you need to sell yourself on why you want this specific specialty right now. Just remember what job you are applying for.

 

 

Know your audience

Are you applying for orthopedics or pediatrics? Because I’m willing to bet that those personal statements are going to be quite different. Not because of the style of the essay but because of what attributes those essays will convey. Surgical residencies generally value ‘compulsive, high energy, confident, hardworking, committed’ applicants while pediatrics value ‘team players, well-organized, well-rounded, flexible, positive attitudes, and flexible’ applicants1. Organize your personal statement to convey attributes attractive to your respective specialty.

 

 

How to design your personal statement

Further detail of how to construct your personal statement is outside the scope of this blog post but let me give you the basic foundation. First you need a backbone. It’s that story you think of when people ask you why you went into medicine and it should be something that happened during your clinical rotations. You know, something you probably made a Facebook status or Instagram post about. Next, you need to think a about which attributes you want to put on display (i.e. what attributes do you have that your future specialty finds attractive). Then tie those attributes back into the backbone of your story to build the rest of your skeleton. Then close it off with a strong summary and don’t be shy to tell them what you want! Here’s an example of a rough outline:

  1. Paragraph 1: I have 3 attributes that make me an ideal candidate for this specialty. For instance, this one time…
  2. Paragraph 2: I demonstrated attribute number 1 when I did this
  3. Paragraph 3: Then I used attribute number 2 when I did that
  4. Paragraph 4: And then I displayed attribute number 3
  5. Paragraph 5: I want this specialty and attributes 1, 2, & 3 make me an ideal candidate for it.

Optional: in your closing paragraph tailor your personal statement to a specific program. I personally didn’t do this…but I also applied to way too many programs. My advise is to do this for one or two programs if you know with 100% certainty where you want to match. It can be exhausting and not worth the effort to do it for every single program.

 

 

Size matters

Make your personal statement one page. It will be visually appealing to the eye and will be short enough to keep the reader’s attention. Don’t forget that the program directors are reading hundreds of personal statements. You don’t want to bore them to death.

 

 

Make them want to meet you

Personal statements are the epitome of the humble-brag. You’re being asked to humbly tell a compelling story that paints you in a positive light. That doesn’t mean your personal statement has to be a bore. You want to make the reader want to meet you. You strike that balance with two main elements- (1) having a unique story and (2) the manner in which you tell it.

For instance, a goal I set in my personal statement was to paint a picture of a patient without sharing the underlying diagnosis. And just like clockwork every program director who brought up my personal statement during my interview asked me the same question, “what was the diagnosis?”.  So write vividly about an impactful experience and make them want to meet you (even if they just want to know if they got the diagnosis correct).

 

 

Lastly, check out a copy of my personal statement from when I applied to internal medicine in 2015:

While screaming incoherently and sprinting off of her boarding flight my patient suddenly collapsed. She was immediately brought to the hospital where I was given the responsibility of her care. I remember her well because her case inspired me to pursue internal medicine as a career. I was intrigued by her unique presentation, motivated to understand the pathophysiology of her illness, and humbled by her family’s fears. My leadership experience and enthusiastic persona helped me overcome challenging scenarios while I provided quality care to my patient. Overall this experience cemented my decision to apply for an internal medicine residency, especially after my first day on her case.

My patient had been suffering from strange psychiatric manifestations, labile blood pressures, and recent-onset echolalia and athetosis. Walking into her room I immediately noticed her multiple family members at her bedside. My previous leadership experience had prepared me for this scenario. I had to communicate complex concepts that I intrinsically understood to individuals who saw it as alien. Although healing my patient’s illness was my paramount priority, I also had to effectively communicate my plan with her and her family in order to make sure that they felt that I heard their concerns and that they were safe in my care. I discussed my assessment and plan with my patient and her family while they peppered me with questions about her case. Their initially palpable anxiety began to abate as I answered each of their questions. It was heartwarming to have a positive impact on this family and showed me the value of possessing effective communication skills in building the patient-doctor relationship.

I left the room and a calm, focused tenacity propelled me to find an underlying cause. It was exciting to explore such a seemingly unrelated constellation of symptoms and it is one of the reasons why I enjoy the prospect of internal medicine. General internists have the opportunity to diagnose and treat patients with illnesses affecting them from head to toe. For my patient, every organ system was a potential culprit and I excitedly dissected each clue to find a potential suspect. Eventually though I found myself scratching the back of my head, staring blankly at the puzzling results of my patient’s lab work and sought help from more experienced minds.

Working with my resident and attending physician we were able to find the epicenter of my patient’s autoimmune battle. I took it upon myself to research the biochemical mechanism of her disease process and was happy to see that even my experienced attending physician was interested in learning about the disease pathophysiology. It showed me that every day in medicine is a school day because there is always something new to be learned no matter how much experience you have. After two months of medical management my patient was stable enough to fly and continue treatment at home. It was awesome to see the impact that treating patients medically can have on their quality of life and I look forward to learning the intricacies of the medical management of chronic illnesses during residency.

Ultimately, this case stroked my interest in internal medicine and illustrates why I will be a unique candidate for an internal medicine residency. My amazement at the body’s innate ability to harm and heal itself fuels my passion for understanding the underlying mechanism of disease and conversely of wellness. I am able to communicate in a clear and concise fashion with laypersons and medical professionals alike. Being a safe physician is a top priority of mine as well. Although I am confident in myself, part of being a safe physician is knowing your limits and asking for help when you need it, both of which are qualities that I possess. In the end, I’ve become cognizant of the fact that that the best way to practice medicine is to care for your patient, both physically and mentally. My unique perspective and skill set leave me with a strong foundation for future growth as a medical professional and I am excited to continue my medical education through an internal medicine residency.

 

 

1- Katta, Rajani, Samir P Desai, and Samir P Desai. The Successful Match. 1st ed. Houston, Tex.: MD2B, 2009. Print.