10 things I wish I knew before starting residency (internship)

1. You are ready for this.

Just a few weeks ago you were a medical student. Now, you are a qualified junior doctor. The start of residency may feel like you were thrown off the deep end and are just trying to stay afloat. Realize that you got through medical school and this is the culmination of all your hard work. You are the doctor now.

2. Grades and achievements are not important anymore.

You’ve spent your life trying to get the best grades you can. You are finally a qualified doctor. Now, grades are not important anymore. The nurse asking you to cannulate a patient doesn’t care that what prestigious medical school you went to or what grades you got. That asthmatic patient doesn’t care if you were top of your class in medical school; just as long as you treat them.

Don’t get too hung up on accolades and achievements. At the end of the day, it doesn’t matter. What matters is how you treat and manage patients with your improving clinical knowledge and skills.

3. Be prepared to dedicate the next two years in the hospital.

In my final year of medical school, I already had an idea that residency was a lot of hard work, just from shadowing the residents. Once I started residency, I realized it was even harder than I thought. There was much more responsibility and the dreaded scutwork. I would come in at 7:30am and leave the hospital by 7pm almost every day, 7 days a week. I probably spent more time in the hospital then I did in my own house.

You have to say goodbye to having the weekends and public holidays off. Be prepared to show up early and leave late, making sure that all the important work is done. Let your family and friends know that for the next two years, you will most likely miss out on some get-togethers and other social events. The time will pass quickly and you’ll be able to have more time with family and friends once you get finish residency. This segues nicely into the following point;

4. Don’t complain or whine!

With the long hours at work and away from home, residency is a big time investment. But others before you have passed through and so will others after you. At times, residency really sucks, I know. Venting with your colleagues is fine (and sometimes necessary) for releasing stress. But complaining to your seniors or to the nurses about your work will do more harm than good.

Don’t complain to your registrars or consultants; it’s not professional and a waste of time. Venting after work with colleagues over drinks is completely fine.

5. Be on good terms with your colleagues.

You will probably spent more time with your co-residents than your family over the next 2 years. They are your comrades. They are going through the same thing as you. When you are venting to your non-medical colleagues, they don’t get it. Your co-residents “get it” when you vent about your on-call, a difficult patient or about that long ward round.

Confide in your co-residents. If you see a fellow resident bombarded with ward work when you are done with yours, help lighten their burden or buy them a snack; it’ll do you both some good knowing you have each other’s back. This will be reciprocated in time. This will make it easier if you need to swap calls to attend your friend’s wedding if you’re more easy-going and helpful to your colleagues.

6. Make time for yourself and have something to look forward to after work.

I’ll admit, I had trouble with this specific point. I’ve been labelled as a workaholic by countless people throughout residency. I would skip lunch, deliberately not go to the bathroom just so that all the work would be done due to fear of getting in trouble by the consultant and also so that I could leave at a mostly-reasonable hour. I remember during my medical rotation, I was on-call with acute gastroenteritis and would visit the loo every 30 minutes. My consultant sent me home early the next day when he saw how sunken my eyes were from dehydration. In O&G, I had really bad pharyngitis throughout the day and was on-call as well. I had fevers, odynophagia and was shivering but still took the call and did admissions for 8 hours. The next day I was sent home to rest by my consultant because I was obviously wrecked. In hindsight, I did not look after myself well and should have realized that I was literally working myself sick.

Get the important work first and if there is something that can wait until the next day, defer it. There will always be more work to be done. You need to draw the line somewhere. You need to make time for yourself to still do the things you love to avoid burnout. Although you’ll have less free time during residency, try to make 15 minutes everyday doing a hobby you enjoy. Also, have something to look forward to after work. It’s easy to get caught up in the rut of residency when it just feels like all you do is wake up, eat, work, sleep and then repeat.

7. Learn at least one new thing everyday.

Try to force yourself to learn something everyday from each of your patients. It doesn’t necessarily have to be something medical, just as long you learn something everyday so that you are improving.

8. Actively think of “why” something is done.

When you are doing ward rounds with your consultant and registrar, actively think “why is X being done”. Why is the patient being started on this particular medication? Why is this chest x-ray being ordered? The answer should not be “because the consultant/registrar told me to do it”. Actively seek the answers so that you will learn and can apply it to your patients in the future.

Another useful thing I read somewhere and started implementing towards the end of my residency is to ask yourself, “if I was the only doctor seeing this patient (such as during oncall), how would I manage them?”. This gets you actively thinking and makes you a better doctor.

9. Spend a few minutes at the end of your day reading.

I initially didn’t do this because I was so exhausted by the time I got home. The last thing I wanted to do was read. But I tried it and it has helped.

Try to spend 5-15 minutes everyday reading about something you saw that day. It will help consolidate your knowledge.

10. Don’t annoy the nurses and listen to them.

Firstly, huge respect to all nurses out there, they do not get enough credit for what they do.

It is tempting to think that because you are a freshly-minted doctor now, you know more than the nurses. Well, no. you don’t. While you have more book knowledge, you are lacking in clinical knowledge, which the nurses naturally have more of at this stage. My point is, listen to the nurses. If you order a drug for a patient and the nurse asks you why, or suggests an alternative, consider it; hear them out. Your response should not be: “because I’m the doctor”. Many of the nurses are very experienced and know common treatment regimes and can even run a code if necessary. So hear them out. Also, treat nurses with respect. The last thing you want to do is to annoy them. When you are on-call and you are about to take a nap, they may call you for minor things just because they don’t like you. If you respect them, they will not call you for minor things. Basically, your attitude towards the nurses can be the difference between have a good or an annoying on-call where you couldn’t get a break from the nurses.

Bottom line: Don’t be a jerk to the nurses or you are going to have a bad time. One thing I used to do when I started residency was to ask the nurses what is usually done or given in certain situations, and I learnt from that.

Final thoughts

Be happy that you are a doctor now. All the blood, sweat and tears was to get you to this point. This has been your goal from the beginning. Although residency is demanding, you will quickly pick up a new skills and information. Try to enjoy this journey you are embarking on in furthering your medical career. You will face times of hardship but don’t be discouraged. During those tough times, remind yourself of why you chose to do take this field. Look at your med school acceptance letter, have a simple mantra that you can easily recite and have access to to help you get through. I developed my personal mantra from my favourite movie Gully Boy which is “wakati wangu utakuja” which means “my time will come” in Swahili. I have it on my phone’s home screen so it is the first and last thing I see everyday and reminds me to continue to preserve and work hard.

Kuwa salama na kukuona karibuni hivi! (be safe and see you soon!)