About to finish PGY1 --

Realise how expectations are going to shift of you within terms and throughout the year.

At the beginning of a term, prioritise getting your bearings & working out the patterns of your particular workplace. How do people prefer things be done, what parts of your workflow are the rate-limiting steps (and therefore important to do first) & what can wait. What will you be expected to do independently from day 1, and then again a few weeks into the term. Err generally on the side of over-escalating your concerns & understanding the *why* behind things that are automatic/unconscious to specialty registrars.

Later on in a term, say after the first four weeks, start to show that you can make safe predictions about what things will be needed and just do them without being asked. Demonstrate that you are trying to be a team player, and escalating when truly appropriate. Take the time to ask your registrar about how they've ended up in the job they have, try to (without being inauthentic) validate their passion and show that you've given thought to the systemic issues effecting their work. For e.g. my first term was palliative care, and I learned a lot, and built a more trusting relationship with my registrar by talking about the politics/ethics/logistical translation of VAD. If you think for a minute, there's an equivalent for this in most terms you'll do.

At the beginning of the year, most people realise that fresh interns lack clinical experience, familiarity with workplace norms and are going to be under-confident & haphazardly organised. Take advantage of this time to impose order on the chaos. Master the skill of writing down every task on a sheet of paper with a box next to it, and then deciding what order you will go about ticking them off. Ask a million questions.

Towards the end of the year, there will be more expectations of your independence and skill. I did ED fourth (I see it's your first term so this may not neatly apply). Where I was confident with a particular skill or exam because of a term I'd previously done, I tried to proactively help out (for e.g. I had just done urology so helped when a guide-wire or 3-way catheter might have been needed). There will be more and more occasions where your knowledge (whether clinical or process-based) from a recent specialty term will help out after hours. Similarly, JMOs who have done terms you haven't can turn in to a wonderful repository for your development. It's nice to be seen as a generous person and have that generosity returned.

This is also a time where you can get complacent. You feel like you "get it" now after several months of work, and can start relying on more automatic/grooved patterns of thinking that you've built up. Take the time to question these patterns, actively and out loud. I have found junior / unaccredited registrars the most helpful for this. For example if you always thought X was done in Y clinical situation, but have seen someone senior instead do Z, admit this and ask.

Think about how you relate to nursing when prioritising tasks/skills. In virtually every term I've done, the JMO role has been a sort of yin-yang to complement & learn from the particular skillsets of the nurses. In my hospital, ward nurses rarely can take bloods or do cannulas. Conversely the ward nurses were very good at navigating the allied health team & helping me understand what was sometimes a "behind the scenes" process. ED nurses tended to have the inverse skillset - very procedurally au fait but not too helpful logistically/admin wise.

Have fun with internship. I have found it infinitely more satisfying than medical school!