Each year, thousands of newly minted MDs are elevated from mere medical students to — drumroll, please — interns. If that’s you, congratulations and welcome to the world of residency.

Welcome to the world of motivation, inspiration and altruism — where you wake up every day knowing this was what you were meant to do.

And welcome to the world of the hungry, the tired, the poor. And I’m not talking about the patients. 

As medical students, our duties were limited. We were there to learn, to observe, to absorb. As an intern, this all changes. Now, you’re responsible for another human life. At times, you may be responsible for another 80 human lives. Point is, your duties have vastly increased, but the number of hours in the day have not. It’s going to be tough.

Your sense of altruism will be tested now more than ever. But this is when your patients need you the most. Even at your hungriest, your most fatigued and your poorest, you can still offer your patients what they cannot give themselves: hope, empathy and a chance to feel better.

I’ve compiled a list of tips, tricks and advice that helped me survive my first day as an intern and the rest of residency. I promise: They’ll help you too.

1. Get excited. This is what you wanted, right? Take a moment to appreciate how far you’ve already come. This is what those four years in medical school were building up to.  Throughout residency, you will be tested day in and day out, but it’s important to remember why you’re here in the first place.

2. Smile. The last thing a sick patient wants to see is your irritated face — even if you had to get up at 5 a.m., or you’re drowning in extra work — when all they really want is to feel better. Plus, the nurses will be less likely to throw out your coffee.

3. Be prepared. When you were a medical student, knowing your patient’s symptoms, what their creatinine was or how they sounded on exam was usually enough to impress your residents and attending. Now, it really matters, because knowing whether or not your patient has acute kidney injury (AKI) could easily become a life-or-death situation.

4. Budget yourself. Internship and residency is a time where you learn a lot about yourself and how you operate. Your intern year is going to be demanding, so why not make it easier on yourself? If you know you’re a little slower in the mornings, set your alarm a half hour earlier. If you know you might have a few spare moments, bring a copy of the Washington Manual with you and brush up.

5. Orders first, notes second. This is pretty self-explanatory. You can write a beautiful note but if you haven’t given the orders to make that note a reality, none of it matters.

6. Listen. As doctors, we love to talk. Well, maybe not if you’re a surgeon … or a pathologist. But for those of who do like the spoken word, talking is great. Listening is better. Your patients will provide you with valuable information if you just listen. Plus, many of them have unique stories to tell—as do your colleagues and your support staff. We all come from different walks of life, and sharing your experiences will not only help you work better together, it will make those long hours in the hospital a little more enjoyable.

7. Lean on each other. It’s OK to struggle. You’re not the only one. And when it gets too much to handle, there is help available. Chief residents and program directors always have an open door policy. If you don’t feel comfortable talking with someone you know, every hospital has a counseling office for employees, which you should feel free to use. No one is meant to do this alone.

8. You want action? Go to the frontline. The best way to learn is getting your hands dirty. Need I say more?

9. Ask questions. Remember, this is about your education too. How else are you going to expand your knowledge base? Yes, dumb questions do exist. But there is no such thing as a useless question. And trust me, that “dumb” question you just asked? All 20 of your co-interns were wondering the exact same thing. Some of the residents, too.

10. Read something every day. This is probably going to be the hardest part of your job. After working for 12 hours, who wants to open a book, much less lift their own pinky finger? The only thing you think about is whether to eat or sleep or do both. I get it. I’m not asking you to open up Harrison’s and read a chapter every night. An attending once told me “Read for 15 minutes a day and you’ll do fine.” It’s true. Spend fifteen minutes on UpToDate or Washington Manual reading up on the conditions you dealt with during the day. You’ll become a better clinician.

11. Don’t forget about yourself. Yeah, yeah, I know I gave you guys a long spiel on putting your patients’ needs before your own. It’s a fact of life that you’re going to experience those things as an intern. There have been multiple instances when I didn’t eat for more than 12 hours because I was so busy. But that doesn’t mean you shouldn’t take care of yourself. You are important as well. Take that day off to recharge. Stay active. And even if you only have time to eat a small bite, make that small bite count.

12. Have fun. Residency marks the beginning of the rest of your life. Walk into Podunk Hospital with your Littman stethoscope and while you may not be the best intern there ever was, this is your opportunity to gain a ton of self-reflection, grow personally and intellectually, and become the best physician the world ever saw.

Priyanka Jain is a pulmonary and critical care physician.

Image credit: Priyanka Jain