All medical students look forward to Match Day—and all medical students look forward to the time off between Match and Orientation. After this tiny respite, you’re going to be tossed into 80-hour work weeks with 40 hours of studying on top for basically the next 5 years or more . . . so make that post-Match Netflix queue count! Something that you can watch in between stops on the European vacation you have planned.
Entertainment and travel bingeing, however, won’t set you up for success in intern year. In fact, if you’re like most students, that down time—as welcome and life-saving as it may feel in the moment—will end up costing you in lost skills and an increased study burden as you struggle to keep your head above water once you reach your Match program. Remember how awesome it felt when you matched? The world was your oyster. Now, in residency, you find yourself in the belly of the whale, and getting out in one piece is going to be tiring, dirty business.
Expectations vs Reality
Two unfounded expectations need to be cleared up. First, interns anticipate that once they show up for orientation July 1, their program will help them get up to speed, give them time to warm up, and show them all the things they need to know. And second, the programs expect that the new crop of interns will arrive ready to hit the ground running, and will need no remedial instruction or special help to excel.
However, interns—almost universally—do arrive ill-prepared, having suffered massive knowledge and skills decline from having not used and practiced their medical training for up to a whole year. Sure, they’ve studied themselves half to death the first two years, and added clinical practice to their studies in year three. But from the time their subinternship and interviews end halfway through year four, most students just coast along and do nothing.
From the moment they match they relax, recharge, and as a side effect, suffer a massive decline in their skills. They reach orientation utterly behind the eight ball, and quickly discover the second reality: their programs don’t help them catch back up. It’s up to them to put in the endless hours necessary to claw their way back to what they had in year three. Wouldn’t it be great if something could both allow the absolutely essential recharge before residency and also mitigate that skills decline?
What are our options here?
- Grin and bear it—take that vacation, settle in for the movie marathon, and deal with the fallout when you hit residency.
- Never stop studying—shun leisure, loved ones, sleep . . . you’ll enter residency grim, tired, and lonely, but darned if you won’t be top of the class!
- Find a middle path—take a well-deserved break, but keep up your chops through a few hours a week of directed study.
I think the only sane path is one that emphasizes relaxation and recharge, but also prevents that skills decline. I can’t overemphasize how important recharging is. But recharge doesn’t mean simply sitting around doing nothing. Not surprisingly, I advocate option C, the middle path. This is ultimately the easiest and the most realistic course for both maintaining skills and avoiding burnout. One way to tackle this approach is through the Clinical Cases offered by OnlineMedEd. (A companion product, Intern Bootcamp, addresses all the skills you didn’t know you would need for intern year.)
Life Isn’t Multiple Choice
At the center of patient care is clinical reasoning. And aside from face time with actual patients, Case X is the best tool to develop that skill. Through medical school you learned that there was a right answer. You were given vignettes with only the pertinent information, and a series of next steps to choose from. But you also learned that, “for the test, you should know one thing . . . but real life is different.”
“Real life” is what you encounter in residency. Residency changes the game. You aren’t out to get the answer right, the vignette isn’t curated for you, and there are no multiple-choice options. In fact, there are no answers, but you have to answer anyway.
You have a real person with whatever complaint they have, with whatever diagnosis they have. You can put in whatever order you want. As a student, you interviewed the patient, analyzed the labs, then presented to your senior, and they told you what to do. As a second-year resident, it’s you who will be telling people what to do. Through intern year you transition from a student who reports and interprets data, to a resident who makes decisions independently.
In residency, you’ll move beyond interpreting labs and imaging, and beyond taking a history; it requires the skills of synthesizing a diagnosis from that information, developing a treatment plan, knowing what to type into the computer to get the right thing to happen. When patients come to you, you’ll own the situation, not ask for help from an attending.
This is hard . . . how will you train for it? How will you get in the necessary “reps” to develop these muscles? By seeing virtual patients and being forced to answer complex questions that challenge clinical reasoning. Case X from OnlineMedEd gives you a stress-free arena to practice.
Plan Ahead, Start Ahead
You’re going to have to do all of this on Day One of your internship. Do you want to start cold turkey, or build up momentum and confidence ahead of time? Studying with Cases will help solidify the reporting and interpretation skills you acquired in medical school (mitigating skills decline), as well as force you to think in a way beyond what any test will demand—to think about what you would actually do in the moment, with a real person.
So enjoy yourself for a couple of weeks! Celebrate your successful match. Then carve out just a few hours a week to pave a path to intern year success. Clinical Cases is virtually tailor-made for completion between Match Day and First Day, because it was made by people who have been there and know that there’s a better way.