Anyone nervous about starting residency?

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If there's a single intern starting that isn't nervous and excited, I don't ever want to meet them. It's weird getting used to people calling you "Doctor" and expecting a response the first few months, and it feels wrong to suddenly have the ability to write orders and prescriptions without someone having to co-sign things.

The great thing is that it's July... everyone understands. Most programs try to put strong attendings and upper levels on in July, and the nurses are on high alert to check orders and are usually willing to offer advice if you look like a deer in headlights in a situation (side note, be nice to nurses... they can ruin your life or make you look stellar). Just don't be afraid to seek help when you're in over your head in situation; recognizing that is a sign of maturity, not weakness. I was an upper level on wards in July of my second year. I fully expected to be asked about every Tylenol order and such that my interns were putting in because we all remember how we felt in July. And the only intern that made me and the nurses nervous was the one who tried to avoid asking for help.

Good luck!
 
girlofgrace7 said:
Most programs try to put strong attendings and upper levels on in July,
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As opposed to putting them on vacation? Where else would they be?

That said, I agree with just about everything else. All the 2nd, 3rd, etc... years will all be around and making sure you don't kill anyone while you get your bearings. You'll be fine. Just make sure you ask (or look it up) when you don't know as opposed to blindly stumbling forwards.
 
BoardingDoc said:
As opposed to putting them on vacation? Where else would they be?

That said, I agree with just about everything else. All the 2nd, 3rd, etc... years will all be around and making sure you don't kill anyone while you get your bearings. You'll be fine. Just make sure you ask (or look it up) when you don't know as opposed to blindly stumbling forwards.
Click to expand...

I meant on wards or other inpatient services rather than in clinic or on elective rotations. At my program, the attendings do a week on at a time, and they try to make sure that the really strong attendings are on inpatient services (and not on off-service/office work/clinic/vacation weeks) in July and that the upper levels in charge of ward teams and other more stressful rotations are knowledgeable, helpful, and good teachers.
 
I think I'm still in denial. Once I start orientation and get closer to my actual clinical start date I think I will be nervous!

But I also kinda feel like there have been so many other people who have been interns before me so it will be survivable.
 
Quoted from aPD:

Also, it's important that your anxiety doesn't become so severe that it actually affects your performance -- that can lead to a feedback cycle of anxiety --> poor performance --> meeting with PD --> closer scrutiny of your work --> more anxiety --> repeat.

Chill out.

Focus your anxiety on getting things squared away to have a strong start.
Another thread suggested getting a place ASAP and being as moved in and settled as possible before orientation - I think this is huge
Get to know the city
Think about transferring driver's license and registration (this can involve more steps than you can imagine sometimes)
Locating the closest grocery store, gas station, their hours
Other businesses important to you (I always need a Petsmart)
Car maintenance (definitely replace those tires if they need it)
A good cheap drycleaner
Get any health related stuff out of the way and think about establishing care in your new locale (now's the time for all your dental, get your Pap if due, etc)
Get to know your hospital's layout
Get to know the EHR if you can
Get some good pocket resources for your field
Study whatever is weakest for you that you know is important (EKGs, abx, whatever)
Start getting rid of stuff and thinking about packing
Have fun with your friends and family as much as you can during orientation - whip out skype!

All things myself had wished they had known/thought about before or did and was glad. All pretty basic easy adult stuff too.

I'm the biggest doom and gloom on this board, and I'm here to tell you it'll be all right.

My next post will be more specific to life inside the hospital.
 
BoardingDoc said:
As opposed to putting them on vacation? Where else would they be?

That said, I agree with just about everything else. All the 2nd, 3rd, etc... years will all be around and making sure you don't kill anyone while you get your bearings. You'll be fine. Just make sure you ask (or look it up) when you don't know as opposed to blindly stumbling forwards.
Click to expand...
weaker pgy2 and 3 may be given electives or ambulatory rotation as opposed to being on the ward or the ICU...at least it was that way at my program...
 
Crayola227 said:
Quoted from aPD:

Also, it's important that your anxiety doesn't become so severe that it actually affects your performance -- that can lead to a feedback cycle of anxiety --> poor performance --> meeting with PD --> closer scrutiny of your work --> more anxiety --> repeat.

Chill out.

Focus your anxiety on getting things squared away to have a strong start.
Another thread suggested getting a place ASAP and being as moved in and settled as possible before orientation - I think this is huge
Get to know the city
Think about transferring driver's license and registration (this can involve more steps than you can imagine sometimes)
Locating the closest grocery store, gas station, their hours
Other businesses important to you (I always need a Petsmart)
Car maintenance (definitely replace those tires if they need it)
A good cheap drycleaner
Get any health related stuff out of the way and think about establishing care in your new locale (now's the time for all your dental, get your Pap if due, etc)
Get to know your hospital's layout
Get to know the EHR if you can
Get some good pocket resources for your field
Study whatever is weakest for you that you know is important (EKGs, abx, whatever)
Start getting rid of stuff and thinking about packing
Have fun with your friends and family as much as you can during orientation - whip out skype!

All things myself had wished they had known/thought about before or did and was glad. All pretty basic easy adult stuff too.

I'm the biggest doom and gloom on this board, and I'm here to tell you it'll be all right.

My next post will be more specific to life inside the hospital.
Click to expand...

This is very helpful. Thank you!

I feel a lot better now that I am settled in. I haven't studied since last X-mas, studying now again to prepare for my first rotation of intern year feels a little strange. However, the anxiety does help me stay focus and pushes me to study.
 
rokshana said:
weaker pgy2 and 3 may be given electives or ambulatory rotation as opposed to being on the ward or the ICU...at least it was that way at my program...
Click to expand...

I'm curious if this is true for surgical specialties as well (I imagine it would be). Do the stronger residents get placed on the more difficult rotations starting out?
 
Wordead said:
I'm curious if this is true for surgical specialties as well (I imagine it would be). Do the stronger residents get placed on the more difficult rotations starting out?
Click to expand...

That means if I am on out-patient or some other easy rotation for the month of July next year, then I should take the hint that my program considers me as a weaker resident of the pack.
 
0ncogene said:
That means if I am on out-patient or some other easy rotation for the month of July next year, then I should take the hint that my program considers me as a weaker resident of the pack.
Click to expand...

I think it depends too on how much weight the Chief puts on individual scheduling requests if that is even taken into account at your institution
someone else might request a more difficult track starting out PGY2 for various personal reasons, allowing some other lucky bloke to have the easier schedule

don't start stressing about at now! you just started intern year!

believe me, if they thing you are the weaker resident staring PGY2 there will be other clues, more obvious ones I'm betting

and keep in mind, having your "strongest" residents get a different schedule doesn't have to mean you are "weak," it's not a zero sum game
you can be exactly where you are expected to be and someone else in the program is just better
 
0ncogene said:
That means if I am on out-patient or some other easy rotation for the month of July next year, then I should take the hint that my program considers me as a weaker resident of the pack.
Click to expand...
depends, but if you didn't ask for an elective month for july (say if you needed vacation), then maybe...
 
I second Crayola 227's advice above. It gets really difficult during residency to get errands done, especially on difficult rotations. Make sure you definitely have recent doctor's, dentist's, and hair (provided you don't buzz it yourself) appointments not long before the start of residency. Stock your fridge and pantry (and maybe buy some toiletries in bulk so you don't have to think about them for a while). Get completely unpacked. Get your oil changed in your car and get any work done on it that you anticipate needing soon. Your time off will likely fall during hours that stores, banks, etc aren't open the bulk of the time, and when you do have a day off, you just want to sleep, relax, and have some fun.

And I wouldn't say they put all the strong residents on in July or even the strongest (a lot of people request vacation or easy rotations in July), but they usually try to make sure whoever is on ward/ICU months are residents who are patient, knowledgeable, and able to carry some extra weight.
 
0ncogene said:
That means if I am on out-patient or some other easy rotation for the month of July next year, then I should take the hint that my program considers me as a weaker resident of the pack.
Click to expand...

Depends on your program. I am a strong resident (evidenced by the fact that I have been promoted to senior early in order to cover for graduating residents), and I had an elective in July last year because I had a rough second half of intern year (no vacation from January til the end), but was senior in August. Someone has to take the elective months early, and the chiefs making the schedule may not feel that any one person is stronger than another and so assigns people more randomly.
 
Wordead said:
I'm curious if this is true for surgical specialties as well (I imagine it would be). Do the stronger residents get placed on the more difficult rotations starting out?
Click to expand...

I think there is a LOT of variability depending on who needs vacation when, etc. But in my experience, there is a tendency for the stronger residents to be put on the busier services in the summer. Personally I always asked for the harder rotations early on because I loved teaching, enjoyed the lowered faculty expectations, and was always completely burned out by the time spring rolled around.

That being said, my chief year the weakest resident got put on those services early on because he/she was on probation and the faculty wanted to proceed with trial by fire.
 
MediCane2006 said:
I think there is a LOT of variability depending on who needs vacation when, etc. But in my experience, there is a tendency for the stronger residents to be put on the busier services in the summer. Personally I always asked for the harder rotations early on because I loved teaching, enjoyed the lowered faculty expectations, and was always completely burned out by the time spring rolled around.

That being said, my chief year the weakest resident got put on those services early on because he/she was on probation and the faculty wanted to proceed with trial by fire.
Click to expand...

termination by fire? like giving them enough rope to hang themselves with?
 
Wordead said:
I'm curious if this is true for surgical specialties as well (I imagine it would be). Do the stronger residents get placed on the more difficult rotations starting out?
Click to expand...
Yes, this happens at my program. Stronger residents start night float (which is only resident for my specialty in the hospital at night) earlier.
 
markrivers said:
the patients should be more nervous.. LOL!
there's a joke in our school which goes like, if you're going to be sick
and you have to have surgery or be admitted,
AVOID july to september .
Click to expand...
Not really a joke. There are outcome studies around that support this.

Sent from my SM-G900V using SDN mobile
 
So for my incoming intern class half of us start on wards and half start on an elective month, which at my program generally means light hours. They have me starting on wards. Could that mean anything or is it probably random?
 
ordersol7 said:
So for my incoming intern class half of us start on wards and half start on an elective month, which at my program generally means light hours. They have me starting on wards. Could that mean anything or is it probably random?
Click to expand...

Almost certainly random.
 
ordersol7 said:
Ah ok. All the talk above about scheduling residents according to how strong they are got me wondering.
Click to expand...

It's different for residents who are already in the program, and will soon become seniors. One of the things that your attendings will look for as you progress is leadership skills. Can you teach others? Can you lead a team? Can people reliably turn to you if there is a patient emergency or the clinic is falling apart or the ER is slammed? It's not just enough to be clinically good as a physician; people (nurses, mid-levels, techs, students, interns) will turn to you as a team leader when the s**t hits the fan, and can you rise to the challenge?

And, as Winged Scapula pointed out, they don't know anything about you or your abilities.
 
MLT2MT2DO said:
Not really a joke. There are outcome studies around that support this.

Sent from my SM-G900V using SDN mobile
Click to expand...
There's other outcome studies that show the July Effect is BS. Supervision is intensified in July relative to later in the year, likely counteracts the effects of newbies for all the major outcomes (death, disability, not misdosing of Tylenol)
 
Raryn said:
There's other outcome studies that show the July Effect is BS. Supervision is intensified in July relative to later in the year, likely counteracts the effects of newbies for all the major outcomes (death, disability, not misdosing of Tylenol)
Click to expand...
Thank god the supervisors weren't just interns the day before. Everything changes over in July. While attendings are aware of this, that doesn't mean they all change their habits.

Sent from my SM-G900V using SDN mobile
 
MLT2MT2DO said:
Thank god the supervisors weren't just interns the day before. Everything changes over in July. While attendings are aware of this, that doesn't mean they all change their habits.

Sent from my SM-G900V using SDN mobile
Click to expand...

Regardless it is true that the literature regarding the "July effect" is mixed.

Also, a June intern is very different from a July intern.
 
0ncogene said:
That means if I am on out-patient or some other easy rotation for the month of July next year, then I should take the hint that my program considers me as a weaker resident of the pack.
Click to expand...

Nope. no correlation at all.
ordersol7 said:
Ah ok. All the talk above about scheduling residents according to how strong they are got me wondering.
Click to expand...

with our program, scheduling is based on the vacation days that "we" requested.
so before the interns began, they submitted a vacation request and the coordinator tried his best to accommodate their request.
that's how it works folks.
 
markrivers said:
Nope. no correlation at all.


with our program, scheduling is based on the vacation days that "we" requested.
so before the interns began, they submitted a vacation request and the coordinator tried his best to accommodate their request.
that's how it works folks.
Click to expand...
at your program...please don't speak for other ones.
 
let's just say there are way better indicators of what your performance is then trying to read the tea leaves of scheduling
 
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