Intern Year

Did I start this on June 2024 and end up finishing it a year later? Absolutely. What can I say? Intern year!

Orientation

Leading up to my first day was all jitters. We started orientation in late June. The first day we joined the other FM residents from our sister hospitals. Of course, I got lost getting to orientation (just like med school. I even left early!). I was the last of my class to arrive. I shuffled into a small room with my co-interns to get our professional pictures done. All my hard work on my makeup and hair went to waste. The photographer forbade me from angling my face and body. Straight on and tilted down. We’re keeping that ego in check right away.

After pictures, we were herded into a large conference room where upper management had lectures introducing us to the system. Breakfast was provided! I ate a lot of Panera this week as we sat through long lectures.

Then we traveled to our home site where we spent the rest of the week. The presentations continued. Risk managment, patient mediation, rules, blah blah. I have graduated into peak adult-ness because I was so excited to hear about benefits!

My class was on the shier side. Bonding came with time and as a slow burn person myself, I didn’t mind it. We took personality tests for everyone to get to know each other. I surprised myself as an extrovert. 54% to be exact. I took the same personality test in medical school and I was 54% introvert. It was weird. I’m now saying I’m an ambivert 50/50 +- 10%.

We ended this long orientation Panera-filled week with a day retreat with all of the classes, including the graduating one. It was intimidating. I still felt like a medical student hanging out with residents. There was a shift of settling in. I couldn’t believe that I finally got to stop moving around.

Rotations as a Resident

Let the impostor syndrome go on and on! I still feel it as a rising PGY-2. The first time I said “Hi, I’m Dr. Khabagnote”, it was weird. It took maybe half the year to start to feel like I had any right to the title. I was also scared that staff would size me up and feel like I need to be put in my place. I’ve been on tiktok too much. It was nothing like that. Staff, nurses, admin, everyone was kind and mostly understanding about where I’m coming from.

When I was catching up with a friend, I told her about my rotations. She said FM residency sounds like an extended MS4 year. In a way, yeah. FM has to know a little bit about everything, so we rotate in many specialties. We’re usually the homebase for patients. Figuring out what they need, who they need to go to, and what can actually be offered. For intern year, we did 3 months inpatient medicine, 2 months inpatient peds medicine, surgery, OB, GYN, ortho, ENT, podiatry, nights, endocrine and a couple more. Our program has workshops, clinic days, specialty clinic days like derm and peds interspersed.

Rotations felt different. I felt more ownerships over my time. I wanted to be in the rotation. Not to impress an attending or get a letter of recommendation, but my understanding would actually help my patients. Sure I still got pimped in the OR, but it felt less like my whole career mattered. Why don’t I know what the intraabdominal pressure is? Well, I’m not a surgeon. Rotating was more helpful so I know what to tell my patients. When a referral is the right thing to do. What should they expect. What options they might be offered. What labs and imaging would be helpful to send them with. How to try and cut down on possible delays of care.

I’ve learned so much! How to deliver babies, how to admit any patient, how to walk into any clinic room and be okay with not knowing what I’m walking into. On ENT, I got to help with some ear cleaning and see fungal infections. I didn’t know that was a thing. Dermatology clinic, I got to learn how to biopsy and of course froze some warts. Ortho, I got to learn how to do injections. Neuro, I got to learn more about my own migraines and learn everyone hates dizziness. Inpatient pediatrics, I got inspired about how resilient kids are. Also got lots of new fears for the future. It’s a miracle any of us are healthy.

My favorite rotation was actually inpatient medicine. I’m convinced I want to do a hybrid inpatient/outpatient gig. I like inpatient medicine, in bursts. I enjoy the teamwork working with residents, med students, and attendings. I like that problems are immediate and we can try to solve within days rather than hear from a referral months later when the patient can get in. I like the boundaries where inpatient you’re solving the immediate problems that keep them in the hospital and shortly after of what might cause them to come back. There’s also continuinty in it. That being said, it’s exhausting. 4 weeks straight is exhausting.

Some honorable mentions: in endocrine, I’ve become very strong opinioned on diabetes. Also, I got to try a continuous glucose monitor and found I often run low!

The most surprising challenge was in-basket. It’s both a blessing and a curse. I’m glad patients have less barriers to contact their physicians. However, I only have maybe 100 patients on my panel and the volume can be challenging. If there was more time (and this is the most time I’ll probably ever have), I would love to answer questions and discuss results more conveniently for my patients. I feel more torn on it now that my time is becoming less and less available and there are questions about trying to diagnose and treat over messages which has a lot more backend documenting than you would expect.

One of the highlights of this program was the limited nights. We do 2 weeks of nights intern year and then we’re done. I’d rather do that than a couple days here and there throughout the year. It was nice to just knock it out. For my night float rotation, I was working with the IM docs on purely admissions. It was actually helpful to help speed up my admissions. I would show up at 7pm. Most nights there was a call room available to claim. It came with a bed, bathroom, and desk. I watched a lot of gilmore girls because I couldn’t sleep.

If I could give Day 1 me advice, it would be:

1. To own my learning experience as a family medicine resident. In the beginning, I was very anxious and used to putting so much value on how others evaluated me. But this is my experience! This is my chance to ask questions, learn, and I’m expected to be at the start of my learning journey. One day I have to make these decisions on my own, so I should make what I want of this experience.

2. Be intentional in having things to refill my cup. There’s never a good time to live your life. After taking care of so many people, I’ve faced the reality of how fragile our bodies can be. I don’t want to wait until attendinghood, or partnership, or when my career is more stable to live.

3. Use your intern card. You get this grace for one year only. Don’t be afraid to be a beginner, by the end, it was my badge.

A note about Step 3

I had the chance to study for Step 3 before residency, but I’m glad I didn’t. First, it’s an expensive exam, and residencies usually cover the cost. Second, the period between the match and residency is such a unique pocket of time. There’s finally no exams, no pressure, nothing but space to live. We’ll all have to work hard later, so it’s worth putting in a little extra effort now — it’s easier to say that now that I’ve finished.

Unlike Step 1 and Step 2, most of us can’t afford a dedicated study period for Step 3. It’s expected to study after rotations. My program required us to take the exam before January. That deadline was helpful because it freed me up earlier, but it also made balancing residency responsibilities with studying stressful.

I only used UWorld and their study plan. Although Step 3 is a challenging two-day test, it felt more straightforward than the earlier exams. I think UWorld is adequate to pass, and honestly, the limit of what I could handle on top of working. I actually “enjoyed” the patient simulation portion the most. I received my results a few weeks later — I passed! Now I have one year off before we start thinking about boards again.

Life Goes On

I started my big girl job. It felt enormous to finally reach this point. As a non-traditional student and IMG, I was so used to just putting my head down and working. I’m so grateful for the culture of my program because otherwise, I think it’d be easy to let the job consume me. There’s just so much to learn. Similar to every new year of medical school, the more I learned, the more I saw how much I didn’t know.

As I got to know the other residents, they took pride in their lives outside of medicine. How refreshing, how strange even. But it made it easy to follow their example. I still did things I loved. I worked out. I even got to run a couple of 5Ks. We went on weekend hiking trips! I feel like we went more often than before residency, especially after Step 3 was over. What a concept to just go home, and…do whatever I want?

Even though I worked the holidays this year, it wasn’t awful. I baked cookie boxes for the first time! Of course, I underestimated the work it would take, so I’m glad fewer people were working than usual.

My program gets a one-week vacation and a two-week vacation. For my two-weeker, we went to Japan! It was on my bucket list. It was an amazing trip. We ate so much, walked so much, and I highly recommend it. Life didn’t stop even though I’ve worked 2000 hours this year. I’ve been clocking in my time just for my curiosity, and so far, 2300 hours put in! Sounds like a lot, but it flew by.

End of Year Reflections

I had no idea what this year was going to bring. I hoped for good things. I was nervous. I felt like I didn’t belong as a physician or even as a person. No matter how hard this year was, I loved it. I feel like I was forced to grow as a person, a physician, a wife, and a friend. I’m very thankful that I put my bet on this program.

My advice for IMGs with multiple interview offers is to choose the program where you truly feel you belong. Select the place where you can envision yourself growing and connecting with the people. While most programs provide excellent training, these few years are a unique and special experience. I wouldn’t want to share this time with anyone else. It makes such a difference to love the people you work with. I find myself already dreading the day we start our real jobs.

I’ve been told the 2nd year is tougher because of the jump in responsibility and more hours. I’m nervous. I miss my intern card already. Wish me luck!

Warmly, Rainee

Surprise! Stay tuned for residency pt. 2 ft baby <3