Typical Work Day Of An Internal Medicine Intern / PGY1

Typical Life of Medical Interns:
One of the residency applicants asked me to give an idea of what a typical day of a first year resident or an intern looks like. I tried to put together some things that happen typically on a day to day work at the hospital. This is slightly different for different hospitals.

530 a.m.: Wake up time. Dress up quick. Be in the hospital by 7am for Morning report. Keep your dress ready the previous night so that it gets easy in the morning. Use two alarms if necessary to make sure you wake up. Go to the hospital little earlier than 7am and talk to the night interns who admitted patients from ER overnight and get “sign out” about your new patients from them. You will know your newly admitted patients this way. Print out your patient list for that day [most from the previous day and some new added].

Never forget to take your pager, cell phone, ID badge and wallet to your work. Obviously, your white coat is a must but most of the times, you may leave your white coat at the hospital.

It purely depends on the institution but if your hospital does not have good ancillary services in the form of IV [Intravenous] team, you may have to draw blood on your patients for blood work. This situation is not very good. Half of your valuable time will be wasted for this kind of scut work. There are many hospitals like this especially in big cities like New York.

You have to come to the hospital early and check your patients’ vitals, “am labs” results, see if any body is very sick [crashing] and needs immediate help etc.

7:00 am: Be in the “morning report“. One intern from the night shift will present an interesting case that he or she admitted overnight. Either senior resident or program director or a medical attending will attend the morning report and teach little bit more about the case. You can ask questions.

After morning report, you will have your break-fast. The timings and order of the things you do, may vary based on your program.

8 a.m.: Grand Rounds. These happen periodically [not daily] and may last up to 1-2 hours. You will have breakfast first and then go to grand rounds.

9 a.m.: Bed side patient Rounds. You must have seen all or most of your patients, reviewed their morning lab results, must have read History & Physicals of your overnight admissions and be ready to present your patient cases to the attending. The rounds consist of 2 teams in each floor. A team includes two second year residents, 4 interns [2 for each second year], medical students, nurses, and attending.

Whenever you get a chance, take care of the electrolyte abnormalities like ordering Potassium chloride for hypokalemia, Magnesium oxide for hypomagnesemia etc.

Make sure you follow your attending’s recommendations regarding future plan for your patients that were made during rounds. This may include ordering more tests, calling consults, etc.

If any patient is very sick, you page your second year resident immediately for help. You may have to call “Rapid Response Team [RRT]” if patient needs urgent help or activate ” Code Blue“if patient has no pulse [if dead].

On every 4th day, your second year attending may be “on call” and will admit patients from ER during the day time. So, you may be left alone in the floor the rest of the day to take care of your patients, talk to their families [family meeting], follow lab results, talk to the consultants, etc. Some “second years [PGY2]” are nice and will help you a lot but some don’t help at all. It is your luck.

11 a.m: Probably around this time, there will be an Interdisciplinary rounds where attending, PGY2, Interns, social worker, case manager and medical students all meet and discuss social aspects of each patient. You need to be able to tell approximate date of discharge for each patient, whether patient needs to be placed in rehab, nursing home, LTACH [Long Term Acute Care Hospital] or if patient can go home, if patient needs home IV antibiotics or home oxygen or home nursing/physical therapy etc.

The social worker takes care of issues related to anything other than patient going home like rehab, nursing home issues, etc. If patient is going home, then, case manager takes care of those issues related this patient.

12 p.m.: Noon conference: Everyday, an attending or a fellow teaches the rest of the residents a topic.

After the noon conference, it is Lunch time. You have to eat quickly and come back to the floor and start writing your patient notes. It can be in the paper form or in the computer depending on the institution.

Through the course of the day, you may get new admissions and might have to discharge some of your patients. If you have too many of either admissions or discharges, that day would be very hectic for you.

4:00 – 5:00 PM: Sign-out. A third year resident takes sign out for all the patients that each intern is carrying. All the medical patients are reviewed by the PGY3, whom we call SMR [Senior Medical Resident]. So finish seing all the patients and writing notes by that time if possible. You need to concentrate on “what brought the patient in to the hospital” and “whether the patient is stable or needs SMR evaluation” to see if the patient needs ICU care.

6:00 p.m.: May be the time to go home if done with all your work. Never leave the hospital if your work is not done. You must own the patient and take care of them completely on a daily basis. If a patient needs continuous help but it is getting too late for you to go home, you have to sign out that patient to the night interns.

8:15-9:15 p.m.: Eat, Watch TV, relax for a few minutes, talk to your family etc..

10:00 p.m.: Go to Bed early so that you can wake up at 5 a.m. the next day and do it all over again.

You work 6 days a week. Some public holidays, interns are free. You can use around 12 or so sick days per year. There are approximately 30 days a year interns have to work nights. You probably won’t have too much of social life but definitely you can make some time for relaxation and attending very important social events here and there.

All the “bold” words in the article above are some terms you will use daily.

Never forget: You need to work hard, be humble, take care of your patients and take responsibility for your actions. You might have been an excellent candidate all your life but still you will need to be nice to every one and learn from everyone for the first several months of your residency.