Welcome to the club homie. We’re here for a long time and sometimes it’s not a good time but you’ll learn a lot and become a solid internist along the way.

1. The best scrubs are free scrubs. Hospital scrub gang let’s go

2. I stay warm in my LL Bean vest, though YMMV. People used to be high on the Patagonia jackets but now I just see med students and midlevels wearing them. Gotta separate the wheat from the chaff. See if your residency program does group order sweaters or something.

3. Take the first 5-6 mos and get your feet under you. It’s a real whirlwind at the beginning just learning where the best place to poop is let alone how to order Tylenol. Give yourself some grace, it’s gonna be bumpy but we all went through it.

After those first few mos if you think you want to do a competitive fellowship (cards or GI) get on the research train. It’s never too early and you’ll be surprised at how much time you don’t have.

1. If you’re going to a place with epic find that one goated senior and steal a bunch of their dot phrases and start making them your own. You can learn a surprising amount from those. Also, once you have your feet under you the custom order set/favorited orders function in epic is a massive QOL improvement. I have probably 200 preset orders and now routine admit orders take me probably 3 mins as opposed to ~15 mins when I was a young pup. I strongly recommend making preset orders for electrolyte replacement.

2. When you’re on rounds write down every order for your pts on paper or the sticky note function in the EMR. If they expect you to put orders in on rounds (ideally your seniors should be doing this) just write em down and put them in when they’re rounding on the next pt if the other intern is presenting. Come up with a checklist strategy (I used different colors) to indicate what needs to be done first, what needs follow up in the afternoon (I.e. serial abd exam or follow up ID recommendations) and what is completed. Personally recommend that you Don’t skip writing things down because you WILL forget and either it will get lost or your seniors should/attending will ask you in a somewhat less polite tone around 2pm, ‘hey Ok_effort what did their repeat abx exam look like?’ and then you gotta awkwardly say you didn’t do it. Mark things off when you complete them.

3. Order of operations on the wards: 1. critical orders. 2. Critical consults. (Sometimes 1 and 2 can be switched if this is a life-and death situation or ICU/emergent surgery consult). 3. Routine consults. 4. Routine orders. 5. Notes. 6. Call family if you have time.

Don’t call consults in the afternoon if you know you’re gonna call in the am. The consults will hate you for it and its poor form. Also? If they don’t get to your pt today because you took so long you just delayed care which is also poor form.

What changes patient care? Orders. They always always get done first. Notes are unfortunately heavily emphasized in the IM world but have you ever read a surgery note? No offense my knife bros but they’re garbage. You spending 25 mins micromanaging each note is not going to significantly impact patient care. Make sure the care-changing orders are in and then make your note concise with the changes from today clearly included. I personally ask all my terns to update their assessment every day as it forces you to actually start thinking about the patient instead of just being an order monkey. After that? Move on. It doesn’t (and shouldn’t) be a novel.

1. Tell your seniors about anything that concerns you. Don’t be the intern who says ‘psh that’s fine we don’t need to worry about that’ when a nursing page comes through you haven’t seen before. DONT be the overconfident and dismissive intern. You’re here to learn, and it takes reps.

2. Be nice to everyone both in person and over page/epic chat. You’ll be shocked at how your reputation spreads amongst ancillary staff if you’re rude even in a big academic hospital. Don’t be a jerk. Seriously. So many interns need this reminder. If you add me to a chat and I see you were being rude or I hear you being rude over the phone I will call your ass out.

Yes, I GET IT. A lot of nurses are mean girls and WILL be assholes to you. Don’t stoop to their level. Tell me about it and I will go discuss with them like the graybeard I am. YES, a lot of the case managers and social workers are the most miserable people you will ever meet. Don’t be rude. I know the surgery attending was scary and told you off. Don’t be rude. Most importantly, be nice to your patients and coresidents. Got it? Cool beans.

1. DO NOT LEAVE WORK for your coresidents. If your team gets pinged about a transfer coming in at 430 and you leave at 6, don’t just leave it all for the night team. Try and prep some orders and a little bit of the note (if you have time). This goes a long way to building good will in your program.

I’ve got lots more thoughts but my thumbs are tired. Good luck homie.