Organizational Tips for Internal Medicine Intern Year

Written by Annie Kopera, DO

Acknowledge your beginner status and come to peace with it

In the weeks leading up to the start of intern year, a lot of people worry about not being good enough or prepared enough to start. It’s useful to anchor yourself on the reminder that the entire purpose of residency is to train to become an attending. If you already knew everything, residency would not exist! Take advantage of this experience, and especially intern year, to own your beginner status as an opportunity to ask questions and learn about topics you feel like you know nothing about (which, in the beginning, may feel like everything). Each person has their style for staying organized throughout the day on the wards. Below I share my method in hopes it gives you some groundwork for creating your own!

Keep chart review and morning routine systematic

With time and repetition, everything that you do will become more efficient. Having patterns and habits early in the year will help you to become more efficient within these systems later on. Morning chart review should be done using the same method for each patient. For example, I start by reading any new notes written by other specialties or services, then proceed to review vitals, labs, imaging, cultures, and the med rec. I will open my new note for the day and make any updates that I already have, followed by placing any immediate orders that should be done before rounds (repleting electrolytes, ordering any diagnostics based on overnight changes). I do this in the same order for each patient each morning. By keeping chart review systematic, it allows you to be thorough, and will become second nature in no time!

Capitalize on the list

While in medical school, I kept a notebook in which I hand-wrote all information about the patients I saw. Each morning I would write vitals, all labs, and all imaging, and for new patients, I would write the majority of the H&P. Although this helped me recall information, it was time-consuming. I attempted to use this method when starting my intern year. I quickly realized my chart review was taking forever -- everyone else using the folded-list system was so much faster than me. Pending which EMR your hospital uses, there will be a way to print a sign-out list for your patients. This typically includes their one-liner, 24-hr vitals, basic labs with trends from the day before, medications, and action items on the sign-out. As long as this information is updated, it saves you from having to write each value. Then, I will circle abnormalities in red and hand-write in any special labs that resulted from that day (lipid panel, iron panel, imaging, etc.).

With the list, fold each sheet (hot-dog style) just short of halfway so that you can see the patient’s name. This will give you more white space associated with each patient, and this is where you can put your checkboxes. Having all of the information you need on your list, rather than a notebook and a separate sheet of paper, keeps your data organized and consolidated.

Checkbox system

The checkbox system is how I manage my to-do list. Using the folded-over blank space discussed above, I will write my tasks in red with a check-box next to it. For example, by the end of rounds my list may look like this:

           [ ] Start antibiotics

           [ ] Order chest XR

           [ ] F/u chest XR

           [ ] Consult Pulm

I also include a check box for a follow-up task. If I place an order for a chest XR, I also create a separate task to follow up on the result later. Using a separate color, I create another checklist for each patient which includes:

           [ ] See

           [ ] Staff

           [ ] Note

           [ ] Labs

           [ ] Hand-off

           [ ] Family

I like to keep checkboxes to see and staff each patient especially when I’m working in hospitals where the patients are in different units and have different attendings. As soon as my note is written, labs are ordered, hand-off for the night team is updated, and families are called. As soon as items are done, these get checked off. This way, at the end of the day I can quickly skim my list to be sure all my tasks are done, and I’m not panicking on my walk to the car second-guessing if I signed over my note!

There will likely be some trial and error until you develop your flow and a system that works for you. If you find yourself struggling and feeling inefficient, reach out to your senior resident or chiefs for ideas on how to adjust. You will be an efficient intern machine in no time!