In childhood, summer is a season that we look forward to, but for new residents out there, summer brings with it internship and the prospect of starting this stage of training can be daunting.

New beginnings, new faces, new locations, where to start? Gone are the blissful days of medical school, where you were expected to tag along on clinical rounds, answer questions at a few pimping sessions and go home at a reasonable hour. Residency has started, and with it comes a whole new set of rules and obligations.

Don’t get me wrong—this is an exciting and intense year of learning the ropes, and it can be truly memorable. Honestly, most residents probably will not even realize how much they have learned until next year when the new interns arrive, and it will be their turn to show them the ropes. Until then, buckle down and be ready for the ride of your life!

To help guide all those residents out there, I have prepared a list: “The Surgical Intern’s Rules To Live By.” Read them carefully, repeat them to yourself until you have them memorized, and you will be well on your way to being a rock-star intern.

1. Be nice to the support staff.

Wow, that sounds so simple. Be nice to the nurses, physician assistants, technicians, office managers, cleaning staff, etc. Nothing could be easier, right? Wrong. I have seen many a resident ruin his or her reputation early on by being rude, demanding and unappreciative of the support staff. These people are the backbone of a hospital—they are what make everything work. Treat them well and they will not only help you get your job done in a timely and efficient manner, but they will also praise you to your attending. Get on their bad side and they can make your life miserable. Simple words like “please” and “thank you,” a smile and a nod hello, are what will get you where you need to go. Follow the Golden Rule: Do unto others as you would have others do unto you.

2. Do not be afraid to say, “I don’t know.”

An attending once told me, “There is no such thing as stupid questions, just stupid mistakes.” If you do not understand something, ask. If you do not know something, ask. Afterward, follow up by reading about it so that next time you do know the answer.

Intern year is all about learning. You just came out of medical school, and the attending and others you encounter are not expecting you to know everything. They will, however, expect you to read and learn the answers. Saying you “don’t know” twice for the same question never looks good. If the question deals with something uncommon, once you have read up on what you did not know, offer to spread the information. Copy the pages from the textbook pertaining to the condition, procedure or whatever else and pass them along to your fellow interns. Remember, the competition you all faced in medical school is done. You and your fellow interns are all in this together from now on.

If you are asked a question about a patient’s exam or condition, and you either do not know or are not sure of the answer, do not be afraid to apologize and say so. Offer to go back and complete the exam, look up the result, and get back to your attending or upper-year resident as soon as possible. Never bluff or say a lab result was “fine” if you are not 100% sure. The minute you are found out to be lying, your reputation is gone and likely never to return. Guard your reputation with your life, as it will follow you for the rest of your residency.

3. Read up on what you experience.

Reading for the sake of reading can be boring, and you are not likely to retain much if you have no practical way to immediately apply it. Instead, read about what you see. If your patient has an interesting condition or you scrub in on an interesting case, go home and study it. The direct and tangible application of the knowledge you gain from reading will cement it in your understanding, and leave you more likely to retain the knowledge in the future.

When choosing a textbook, first ask the senior residents (preferably the ones who are known to have better in-service scores) and get some suggestions. Then, get your hands on the different options and see which one you like best. Everyone has their own preference as to what appeals to them. Look at all of the choices to determine which one suits you best. Text-to-picture ratios, level of detail and size of the text itself—these things can all vary greatly. A textbook is a personal choice, so take your time and make the right decision for you.

4. Plan your free time.

When you are off for the day, take some time for rest and relaxation. Enjoying your downtime will keep you sane during the tougher months of internship. Go out, explore the city you are now living in, get together with your classmates and meet people outside of the hospital. Get away and reset, and you will be ready to start another day.

Do not let vacation creep up on you unexpectedly. Interns are at the bottom of the pecking order, and often have little or no choice of when they get their vacation time. Find out early if it is assigned to you, and make plans to get away. Go visit family and friends, maybe hit a beach or a slope (depending on the season), and make the most of your time off. Again, a little planning will make your downtime much more enjoyable and the rest of the year that much more tolerable.

5. Eat when you can, sleep when you can, pee when you can.

I think that about sums it up. You never know when some emergency or trauma will come up. So when downtime arrives, make the most of it because it may be the last you get for a while.

6. Practice throwing ties.

Ask the operating room staff for old suture material. Tie it to anything you can in your house, the drawstrings of your scrubs, your steering wheel (please only throw ties in your car while at a stop light and not while actually driving—you will see enough traumas without becoming one). Practice when you can, and get the skill down to muscle memory so that you can do it perfectly without thinking. Almost nothing else will impress your upper-year residents and attending more while in the operating room. Let’s face it: As an intern in the operating room, you are going to be mostly responsible for tying things off and closing incisions, so be ready.

7. Be respectful of your colleagues.

Do I really have to even say this one? They should be like family during this time period. They know what you are going through, they understand what you are feeling and they can be an enormous source of support. Make them your friends, as you are stuck with them for at least the next half-decade.

8. Get to know your hospital.

Last but not least, get to know your hospital. Take the time to navigate the ins and outs of the operating room, emergency department, patient floors and units. Find out where radiology is (both where patients get studies and where readings are done). Find the interventional radiology suite, if your hospital has one. Know the location of call rooms, the cafeteria and the clinics. You will be more efficient the sooner you memorize these locations, and your job will get infinitely easier. Oh, and make a concerted effort to find the “best bathroom” in the hospital—that can be a vital piece of knowledge in many a situation.

Well, that’s about it. Memorize this list and live by it, and I can almost guarantee that you will come out of intern year alive. Just kidding—really, it’s not that bad!

Give 110%, do not be a hog on good cases and patients, and do not slack off when you think nobody is looking. You have made it this far already, and you are on your way to the career you have always dreamed of. Treat internship for what it is: on-the-job training designed to prepare you for your future life as a surgeon.

Good luck, and join me next time for more of the Resident’s Review.


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