As medical trainees, many of us made the very deliberate choice to pursue careers in medicine, to live and work by deeply held values (e.g., advocacy, integrity, relationships). Yet the daily grind of training can leave us feeling profoundly disconnected from these very values. Considering this paradox, here are my reflections on how we might all navigate intern year and emerge relatively unscathed, wiser, and with our empathy intact.
Accept the Unpredictability
Transitioning from an MS4 to intern is jarring; time is no longer our own. I’d often deny this and make plans during the week in hopes I’d have a “Quetiapine” day; simply uttering the word “quiet” is taboo on the floors. (Who knew medical residents could be so superstitious?) Inevitably, though, I end up having to cancel said plans in the name of patient care. Then I irrationally misdirect my anger at patients, instead of my own poor planning. When I eventually came, instead, to appreciate the thrill of unpredictability and plan accordingly, I was able to slow down and cherish being a front-line clinician, and took the times I found a few free hours as a pleasant surprise.
Listen to Your Body
In the early days of intern year, I was running on near constant adrenaline. I felt like my life was on the line, not just my patients’. Operating in fight-or-flight mode narrowed my attention and led me to neglect my basic need for food and water and even using the bathroom. After realizing this, I committed to tending to my body’s signals — eating when I was hungry, breathing deeply when my mind raced, and taking an extra few minutes to organize myself before entering a patient’s room. I learned that we often have more time than we think. Use that time to tend to your body; you may be surprised at how much easier it is to learn and connect with others once we’ve tended to ourselves.
Whether or not I had a “good day” during intern year was largely dependent on the quality of connections I had with my immediate team members, interdisciplinary staff, and patients and their family members. Emotions are contagious, and cultivating gratitude, enthusiasm, interest, and curiosity — even when greeted at first with apprehension or a cold stare — transformed low-quality interactions into high-quality interactions. It was often worth making a phone call or meeting face-to-face, rather than texting or instant messaging (“Epic Chat”). Stress brings out the worst in everyone, and a little genuine kindness goes a very long way.
As I cultivated compassion for colleagues, I also learned to turn that grace inward. The constant need to adapt to each block brought with it a series of tyrannical “shoulds,” e.g., “I should know how to do this by now!” I combatted this negative internal chatter with self-kindness: “I am doing the best I can”; mindfulness: “Imagine how much easier this will be in a few months!”; and humanity: “Change is hard for everyone.” Ask yourself: “What would I say to a dear friend experiencing these struggles?” That is precisely how we should treat ourselves.
Set Healthy Boundaries
Time is the single most precious resource we have. Learning to say "no" more often and setting restrictions on low-value, disruptive tasks like emails and Epic Chat opened up time and mental space for me to manage note-writing, rounding, and patient interactions. Optimize efficiency by chunking these tasks into discrete periods every hour or so, rather than taking them on as they stream in throughout the day.
Embrace Your Beginner’s Mind
We might consider our lack of experience as interns a burden to our teams and feel like impostors when we introduce ourselves as “doctor,” or we could view this inexperience as an opportunity and embrace our humility and how much we get to learn. When you are questioning your abilities and feel like that MD/DO title after your name is there by some accident, imagine what your mentors might have been like when they started out.
Lead With Your Strengths
As we are constantly stretched outside of our comfort zones, recognizing our shortcomings is inevitable. None of us starts out proficient in ultrasound-guided IVs or crafting a perfect differential diagnosis. However, we all have unique character strengths (e.g., curiosity, love of learning, bravery, creativity, humor) that will help us do our jobs in ways that only we can. Every time a weakness comes to your attention, think about how you might address it using a strength you already possess.
Savor the Good
We all experience moments — even micro-moments — of mastery, nail an intake, or get great feedback from an attending. Yet we often let these moments pass us by as we rush to put out the next fire. Even if we can’t fully appreciate these moments in real time, we must celebrate them, and allow them to fully crystalize and energize us. How can we all prolong, deepen, and multiply these moments?
Get a Therapist
Possibly the biggest boon for me in intern year was starting therapy. I needed space to process my experiences. I scheduled my appointments week by week to accommodate the dynamic schedule, and on the few occasions work demanded, I took telesessions from a private work room on the floors. I never faced pushback from senior residents or attendings and didn’t cancel a single session all year. I am grateful and fortunate to have a residency program that supports this, and insurance that covers 100% of the costs.
Transcend the False ‘System vs. Individual’ Dichotomy
Heeding this advice does not absolve our institutions from taking responsibility for trainee well-being. The most powerful drivers of our malcontent are rooted in systems, cultures, and outdated beliefs of illness and wellness that reduce humans to individual organ systems, often bereft of a psychosocial context. However, we cannot wait for others to step in and meet our needs. Perhaps a part of changing the system starts with us recognizing, committing to, and living by our own values. From there, our field just might grow alongside us.
Have any of these approaches helped you early on in your medical training? Share what's worked for you in the comment section.
Jordyn H. Feingold, MD, MAPP, MSCR is a resident physician in psychiatry at the Icahn School of Medicine at Mount Sinai in NYC. She’s developed and teaches an elective course called Positive Medicine at Mount Sinai and is co-founder of the trainee well-being curriculum called PEERS: Practice Enhancement, Engagement, Resilience, and Support. She is co-founder of Positive Psychology for Physicians and an online well-being course for clinicians, Thrive-Rx, where clinicians can learn more about the science of positive psychology and leadership and how to infuse these into life and practice. She is co-author of the book "Choose Growth: A Workbook for Transcending Trauma, Fear, and Self-Doubt."
Illustration by April Brust