It is July, which means that newly minted physicians graduated from medical school and are now embarking on their residency training. Residency generally starts with Intern Year, a year that is full of new experiences. Many physicians credit Intern Year to be the hardest year of their medical training. You have to learn quickly, complete tasks, and take care of your patients to the best of your ability. It’s a true year of transformation from a medical student to a physician.

Depending on your schedule, intern year can start with rotation that eases you in, or you can jump in with two feet. A few rotations that fall into the “jump in with two feet” category include Night Float, Intensive Care Unit (ICU), and really any surgical service. There are a few reasons:

1. Learning curves are steep

2. You’re covering A LOT of patients (they are all your responsibility to monitor while in the hospital)

3. The patients can be really sick (cough, cough the ICU!)

I had the fortune of starting my residency on night float, and I wanted to write down a few tips to anyone who may find themselves cross

Here are my top five tips:

1) Humility

Always, always stay humble. This includes admitting when you do not know something.

PS. You’re expected not to know A LOT, you’re a first year intern.

At the same time, do not use your lack of knowledge or “how to” interfere with getting things done. If you don’t know, simply ask for the answer or where to the find the answer and look it up. This is how you learn.

Much of the things you’ll be faced with a new intern include procedural and institutional knowledge of what is typically done in these situations - not likely your textbook knowledge, or how well you can think through the differential of hyponatremia.

Stay humble. Be a team player.

2) Checkboxes

Make your to-do list. Prioritize it.

My workflow would go as this: Admission or discharge orders. Consults. Orders (especially antibiotics). Notes.

Orders and consults are what take care of your patients and get the work done. Timely ordering or medications and labs are what brings your patient one step closer to health and home.

Once all of your action items are finished, you can write your concise notes. Notes communicate with your team and providers. If your note isn’t done, its much more efficient to pick up the phone and communicate directly with your consultants, nursing staff, etc. Write your note starting with the plan, so teams can see what you’re thinking while it’s not yet finalized.

3) Listen to your senior residents

They are going to be a wealth of information. They are also SUPER busy doing admissions and supervising you to make sure you’re providing safe and timely care to your patients.

When they teach you something, consider taking notes so you can refer to it the next time. Example: the lengthy and awkward process of admission orders. Show them your process and checklist and ask for their blessing. “Does this look right?” If so, then you’re off flying and try your best to work independently.

Try your best to ask for instructions once, be efficient with their generosity of time and teaching. Yes, they are there to help you, but it’s always appreciated if they can provide instruction once and not have to repeat the same instructions over and over. Take notes. Refer to your “intern survival guide” or institutional handbook or Pocket Medicine - annotate and become efficient with your work.

4) Nurture your sleep and your mind

If you’re starting on night float, please recognize this takes a toll on your body and you need to prioritize and plan for sleep. Try to adjust your schedule the day before. Consider melatonin after your shift. Get black out shades. Sleep as much as you can during the daytime.

I started night float with children. They don’t necessarily respect sleeping boundaries. So, I asked for help. My family came to stay with me in addition to our full time au pair. Unfortunately, I didn’t see my family much during night float, but it was temporary.

Lastly, when it comes to sleep and safety. If you are tired. LEAVE your car at the hospital. Get an Uber, do not risk driving impaired.

5) Go see the patient

When a nurse calls you to see the patient. GO SEE THE PATIENT. Seriously. I’m not sure what else to say, but your nursing and bedside team has a lot more bedside experience than a rookie intern. If they are concerned - you must be concerned.

Perhaps there’s a perfectly good explanation and you can provide reassurance, but don’t do that until you’ve evaluated the patient and talked through your reasoning with your bedside team and seniors.

Always remember… what would I want if I were the patient.

What if the patient were my mom, dad, grandma, or child sitting in that bed.

If you stay patient focused and humble, you can surely learn the rest.

Trust the process.

What advice do you have for new interns starting on night float?

Drop some of your pearls in the comments below!

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