The Intern to Junior Resident Transition (Internal Medicine)
Written by Lindsey Ulin, MD
The transition from PGY1 to PGY2 is an exciting but nerve-wracking time as your role and responsibilities are completely different. While the initial transition is daunting, being a junior resident is incredibly rewarding as you help interns grow into their roles, have more time to think about the big picture, and realize how far you’ve come in a year. Here are things I wish I knew when starting as a junior resident and some tips to help make the transition smoother.
As the team leader, it can feel like you suddenly are supposed to have all of the answers. I’ve found a helpful reframing is it’s less about knowing the answers to every question posed on rounds and more about knowing where to look for them and how to make care happen. Acknowledging when you don’t know something and how you’ll figure it out together creates a positive learning environment. This is a training program, you are not expected to know everything, and there is so much uncertainty in medicine. Lean on your co-residents in whatever group text modality you have. My program has a WhatsApp for PGY2s and 3s that is used daily.
It can be overwhelming to think about many more patients at a time as a resident leading a team than as an intern. If you use Epic having the vitals tab in your default settings view allows you to quickly check vitals without opening individual charts. Adding the physical therapy discharge recommendation auto populates PT’s dispo recommendation which is key for care coordination. Find a system (ie the handoff tool vs a separate spreadsheet) for keeping track of the important elements for discharge and transitions of care including new or changed meds, where patients are being discharged, barriers to discharge, and any follow-up appointments needed. Trust but verify that orders were placed using the vitals tab in Epic.
People cannot meet your expectations if they don’t know what they are so consider sending an introductory email to the team before the rotation starts. Mine has my contact info, things I want to hear about (rapid response, code, intern or RN is worried, having trouble getting a task done or not knowing where to start) in addition to whatever else they want to tell me and how to approach tasks so we don’t delay care—ie first orders, consults, following up labs/imaging we ordered, and notes come last. Figure out how frequently you want to run the list with your team. It’s okay to check in about things you can’t track for example asking if they’ve heard back from a consultant. You’ll find your balance of promoting intern autonomy while making sure things don’t get missed and avoiding micromanaging.
You are the work environment you create. Ask interns what they want to learn, and their goals which allows you to give specific feedback instead of a general "good job". Provide space for debriefing as we bear witness to a lot of suffering and challenging interactions. Take tasks off interns’ plates, as they already have too much to do. The little things do turn out to be the big things- get to know your team and who they are beyond the hospital. Try not to let the team miss lunch and make time for snacks and coffee breaks. Be patient with yourself as you figure out your leadership, managerial, and teaching style. Know that it will continue evolving throughout the year and that you are ready.
