Day in the Life of an Intern
Amy Wang, MD
Welcome to Michigan Medicine! My name is Amy Wang and I am a Med-Peds second year and will graduate in 2021. Let me tell you about intern year! As an intern, you will spend a lot of time on inpatient services. Your day will look different whether you are on medicine or peds, but both programs do a fantastic job of building in dedicated time for didactics and providing opportunities for bread and butter medicine as well as exposure to more tertiary level complex care.
This is the side I started on as intern, but it makes no difference whatsoever where you start. At Mott, we have general teams paired up with subspecialty services (for example, the Plaid team is general patients and cardiology patients). This means you have two attendings - a pediatric hospitalist and a cardiologist that you round with. It gives you an interesting mix and keeps things interesting! I was on the Silver team, which is general and gastroenterology patients. Each day, if a subspecialty patient needs to be admitted they go to your team. General peds patients go to the service that’s on call. Some teams are pure subspecialty patients, like pulmonology and heme/onc.
My day usually starts at 5:30 am when I get ready for the day and make sure I have coffee at all times during the AM. I get to the hospital between 6-6:30 am depending on my patient list and get sign out from the night team and start to pre-round on my patients. Often, I am working with medical students who are also following along, so before rounds we see the patients together and go over their plan for the day. The majority of the time I am done by 8 am, which is when morning report is. Morning report is a mix of traditional lectures and case based learning, lead by our attendings, fellows, or chief medical residents.
After morning report, we round! The team structure is usually 1 senior resident, 2-3 interns, 2-3 medical students, and our beloved, cherished resident assistants that makes your life as an intern so much better. Orders are usually placed on rounds so that patient care is not delayed. After rounds, we call consults and get to more time sensitive work. Noon conference always has yummy food and interesting lectures, journal club discussions, or wellness sessions. Every other week I leave at noon for my continuity conference in the afternoon. All other days, in the afternoon we follow up on our patients, finish notes, or if on call we are seeing new patients. There is a lot of support and supervision on peds, and most days I finish on time (signout at 6 pm to night team). After work, the world is your oyster! I often will make dinner or meet up with friends and go to happy hour, and once a week play league kickball (well, not during the winter). On inpatient services you get one day off a week.
Inpatient services on internal medicine is not that different in terms of work flow, but there are some distinct differences. The inpatient rotations you complete as an intern include Gen Med, GI/Liver, Cardiology, Heme/Onc, and CCMU (what we call our MICU). The general layout of the day is similar - wake up, coffee, get sign out, pre-round, round, and then do your work (consults/orders/notes/new admissions). On medicine, I find that there is more autonomy in terms of the initial workup and management of a new patient, but I’ve always had support in my senior residents or fellows when I have a question or am unsure of what to do.
My favorite didactic on the medicine side is senior report at 11 am, which is not required of interns. However, if you can make it you should definitely go! It’s lead by the chiefs and is pure case based learning with a faculty discussant. Always interesting, always applicable to clinical practice. There is a dedicated curriculum for interns, which takes place in the form of intern report twice weekly at lunch. Initially, it is fundamental skills like managing ACS, review of antimicrobials, or cross cover emergencies. There are also workshops on how to lead a goals of care discussion, wellness sessions like narrative medicine, and also case based learning.
Intern year is difficult and can be stressful and overwhelming (PSA: this is going to be true no matter where you go). But what I love and appreciate about Michigan is the tremendous outpouring of support, from faculty advisors to program leadership to your attending on service to senior residents to your co-interns. You don’t fully appreciate the scope of what you’ve learned until you’re a second year. My best advice for intern year is to embrace, as quickly as you can, that you often won’t know the answer and that’s perfectly okay. To decompress, love taking advantage of social events in both categorical programs as well as our monthly med-peds social events (ask us about our yearly curling event!). Good luck - you’re going to be great.