What to Expect on Your First Year as a Medical Resident

Olivia Kelly, MD
Updated May 06, 2021
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What to Expect on Your First Year as a Medical Resident

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After four years as an undergraduate and passing the Medical College Admission Test (MCAT) examination, finishing medical school, and smashing the United States Medical Licensing Examination (USMLE), finding a Match is one of the most challenging phases of this journey. During this period, you may have considered the specialty you’d like to pursue. Happening only once a year every March, newly minted doctors then proceed to graduate school residency for at least three years (or more) depending on their chosen specialty. If you’re wondering what it’s like in your first year, here’s an idea of what your routine might look like.

What happens after the Match?

Completing medical school is just the tip of the iceberg. Your training will come after you’ve been matched for a residency program. Residency programs are usually available as early as the fourth year of medical school where interviews follow suit. Expect the Match Day for DOs to happen in February and MDs in March.

If you don’t have a match, you will be notified for a ‘scramble’, a post-match process that allows participants to still get into a residency program even if it’s not the specialty they’re going for.

How do I best prepare for my first year as a medical resident?

This significant change in environment (and pacing) could leave you overwhelmed. Once you’ve had a match, your next step is preparation to suit your clinical and personal lifestyle.

Preparation for relocation

This is the most intensive part of your training where you will apply all that you’ve learned in medical school.

First, relocation plans should be in place after Match Day. Find a suitable living arrangement to fit your financial and lifestyle goals. Talk with your spouse about this move and set everything in order so you can transition more easily to your new workplace. You can opt for renting, buying, or co-sharing with other renters. Ideally, your allocation under living space should be around 35 percent maximum of your total monthly income.

Maximize your remaining days in medical school

The Match ends the tedious academic phase of your medical school and a start of your real-life clinical application. While some students have completed their coursework by this time, some may have a few more months left to finish the remaining requirements in medical school. Take advantage of looking for like-minded individuals by attending training and seminars. Look for potential advisors or mentors that can help you with your training. You can plan out long-term goals to help you plot out your next steps before the start of your residency.

Plan your budget

Aside from honing your skills as a doctor, you should also allocate some time to sit down and budget your income and expenses. On average, interns earn around $64,400 per annum according to the Medscape’s Residents Salary and Debt Report in 2020. Working around this budget for housing, food, and bills expenses could help you prepare for what’s ahead.

Most medical students have a loan debt of around $170,000 or more. Most likely, student debt is a part of your medical training that follows you even after becoming a full-fledged physician. Juggling a busy schedule shouldn’t be a reason to overlook this aspect. Understanding your debt loan including loan forgiveness, credit score improvement, consolidation, and financing could effectively reduce the time (and money) consumed on late payments and loan interest. If you’re planning to work in a non-profit hospital, looking into these options should help you create a more realistic budget to pay off student loans.

What do program directors expect from first-year interns?

Your first year as an intern should be an exciting experience. It’s where you put all that knowledge into practice. Program directors will be the ones to help you achieve your best in this field. But it’s always better to prepare.

Here are some things to keep in mind before entering the hospital premises for the real deal.

They’re not like medical school

Time flies faster during your first year as a resident. There’s a study showing residents divulge most of their time engaged in using the electronic health record (EHR) compared to direct patient contact when doing rounds. On average, doctors only engage with patients a fraction of a time throughout their shift. Residents roughly spend 10.3 hours looking into the patient’s medical records or charting activities done, 5.9 hours interacting with the medical team involved in patient’s care, and 3.3 hours for those not involved in patient’s care.

When it’s not mastering paperwork, you will still find yourself looking into stacks of reading materials, meetings, and journal club. You may feel that there’s never a period where you can get a breather and pursue hobbies or things that you love—aside from work.

Residents may face the following challenges: overwork and sleep deprivation, emotional stress, lack of personal time outside work, and other events that may disrupt the clinical routine. The rigorous discipline needed for training might also coincide with personal challenges such as marriage and childbirth affecting their performance. Other factors may include student loan debt, family obligations, and financial demands.

Despite the busyness, residents are given vacation days. However, some may be hesitant to use it. It is advisable to take breaks whenever possible to maintain a balanced lifestyle.

It can get lonely

Dealing with loneliness could be another factor residents need to face once they enter the internship. Most of the time, your match may be on the other side of the city or state. For the next three or more years, you will be moving to a new town with a different environment than you’re used to.

Being a part of a community can help counter this. You can check for a local organization where you share the same interests or hobbies. It’s okay to let your fellow interns know what you’re going through. It’s also beneficial to become a part of a hospital support network where you can talk to someone after work. Find mentors or advisors whom you trust to talk about this ordeal and seek ways to overcome it.

You don’t always know the answer

You might be tempted to think that you need to ALWAYS know the answer to every query thrown at you. During residency, expect to be wrong and don’t know what to do at times.

As an intern, you shouldn’t feel burdened with this. You have years of training ahead of you and that’s what the program should be about. Understand that you are a work in progress and needed time (and patience) to learn the routines.

There will be days where you will be frustrated with yourself. Residents shouldn’t feel discouraged with themselves since the learning curve is steep. Expect to be corrected by your advisors and choose to keep improving as you go along.

As part of a team, you and your fellow interns can help reassure each other when in doubt. Journaling could also help you find balance when these events happen and see the good in each situation.

Living a balanced life can be challenging but not impossible

Juggling between work and personal life throughout residency is a never-ending process. Maintaining good physical and mental health can be tricky in your first year since you’ll be adjusting to the busy schedules.

Detaching from work can sometimes feel like an impossible feat. However, many seasoned residents would agree that finding activities outside clinical work will help you cope with the stresses that come with the training.

Anxiety and depression might rear their ugly head during the intern year, so best prepare for it by scheduling day-offs around activities that you love. Spend quality time with family and friends who are there to support you. Find hobbies to pursue in your free time and make the most of these days. Remember you’re pursuing a dream so keeping focused on the goal will get you through tough times.

Handling emotions when a patient dies

Your ideals may be challenged when a patient dies under your care. You will tend to feel frustrated with yourself and overthink the situation.

Anticipate that there is no way you can prepare for this. However, when it does arise, having a support system helps. Talking with colleagues whom you can trust will help you get through the experience and move forward.

Your advisors might be expecting these from you

There are certain tasks that program directors expect from you. These are some of the common tasks that require no supervision from faculty members of the program.

They expect that you will be able to do history taking and physical examination. Develop good communication skills so you can convey questions and ideas. Leave no room for miscommunication and be articulate in describing activities done.

Most program directors expect interns to write patient care tasks in handwritten or electronic form. While it may not look much, taking up a short writing course before transitioning to residency could help you document your clinical encounters more clearly.

Become part of the team. Interns are expected to collaborate with fellow residents and other members of the healthcare team. On a positive note, being part of a team allows you to voice out your ideas and adding value to the team’s cause. Socializing with other doctors outside training would also help you gain confidence in communicating and developing professional relationships that could benefit you in the future.

Program directors expect interns to be able to recognize urgent care for their patients. Interns should be able to assess illnesses or injuries that require immediate medical attention though it is not life-threatening. They expect you to be able to initiate management and provide appropriate care specific to that need.

Additional ‘survival’ tips for incoming interns fresh off Match Day

Residency is everything they say it would be—and more. It shouldn’t come as a surprise to you if you feel overwhelmed at certain times. But that’s the reality of your training: you’re here to learn and make sure you’re giving the best care for your patients. Intelligence alone won’t be enough to get you through residency. But here are some things you can do to make the transition a little easier.

  1. Your biggest hurdles will come during your first few months in the training. Interns who think they know everything usually struggle the most. Not only will you struggle, but you may also leave a reputation of being unapproachable and distant.
    1. Be willing to ask when you’re unsure about some of your clinical duties. You need to collaborate with multiple members of the hospital such as fellow residents, patients, and even non-medical individuals who are essential to the management. Do your best to be congenial with everyone.
  2. Keeping organized will help you get through your training years with ease. Though interns have their own set of challenges, your organizational ability will help you keep your time, tasks, and personal life in order. Learning this skill will make you more productive and achieve a clearer schedule of what your day to day activities will be like. Having this trait will keep you on top of things and most likely prepared for any cases that will come your way. Aim to be efficient in all the tasks you handle.
  3. Don’t lose touch with your humanity. In the long run, clinical duties can become a routine. Patients can become just a statistic and you become less compassionate of their pain and worries. It is recommended to learn one or two things about the patient and let them feel they are cared for.

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