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On Your First Day of Internship

June 21, 2020
by Mark David Siegel

To our magnificent new interns:

Welcome to your first day of internship! You are now officially Yale Residents, and permanently wed to an adoring medical family. Consider yourself embraced.

The year ahead will be demanding and rewarding. Sometimes, you'll doubt yourself, just like every intern who came before you. Sometimes, you'll wonder why you agreed to this- like when it's 3-in-the-morning and everyone else is sleeping. But that's exactly when you'll know you made the right choice. You'll be surrounded by spectacular colleagues. You'll do essential work. You'll heal with your presence.

We'll travel far this year. Your attendings, your chiefs, your senior residents, and, most importantly, your co-interns will be your traveling companions. We'll teach you, we'll look out for you, and we'll help you reach your goals. For now, we have few expectations - just be the bright, idealistic, committed physicians we know you to be. Before you realize it, you'll become the skilled, wise, compassionate internists you were meant to be.

Just work hard, take care of yourselves, look out for one another, and do your best.

We're going to have a phenomenal year.

Have a wonderful first day (if you want to say hello, come see me in the MICU),


PS Our residents and faculty are fonts of wisdom. In honor of your first day, many have shared precious advice to get you started. Enjoy!



Don’t be afraid to ask questions, whether it’s logistical, medical knowledge or where the bathrooms are.

Don’t be afraid to put yourself out there and be wrong. This is your time to challenge yourself and learn in a safe environment, and Yale is the perfect place for that. No one expects you to be perfect and becoming a clinician takes lifelong learning. Your residents are still asking questions and getting things wrong every day!

-Sam Magier, PGY2


Ask for help! Don’t spend 30 minutes trying to figure out how to put in a complicated order. We’ve all been there before and want to share our knowledge.

-Matt Ringer, PGY3


Be kind to patients, patient families, nurses, PCAs, co-residents, consultants, yourselves! Almost any situation, no matter how difficult, can be made a little better with some kindness! ☺️

-Mona Lalehzari, New Graduate


Find the nearest restroom and the place to refill your water bottle (and now where to find PPE) on day 1, make sure to write down the codes somewhere

Have a checklist and go through it multiple times a day

Just because you put an order on Epic does not mean it happened. Speak with nurses/RT/consultants to follow through

Ask, ask, ask! You can figure anything out but what might take you an hour to find (how to order a very specific transfusion protocol or what's the number for the radiology reading room), might take your resident 2 minutes to explain.

Anything that will take less than 5 minutes, do it right away. This will keep your to do list shorter than you'd think.

-Sofia Cruz, PGY2


The CCU attendings and nurses will like you more if you bring chocolate. (Editorial Comment from the Program Director- we all love chocolate)

Do not worry too much about if you do not have the answer to every single medicine-related question. Focus on learning the system, the work-flow, the electronic medical record, the esoteric institution-specific things first. It will make your life much easier.

Attendings, fellows, and residents all have different styles and different things they like to focus on. Do not let that get you down on the first few days of a new rotation. Just go with the flow.

-Manan Pareek, PGY2


The biggest piece of advice I have is to not be afraid to ask for help and admit you don’t know something. It’s much more dangerous to pretend you know something you don’t or to take on more than you can safely handle - this hurts patients. Medicine is a team sport and your residents are here to help you!

-Katy Zuchowski, New Neurology Resident _____________________________________________________________________________________

Ask questions. You are here to learn and you are not expected to know everything. There are lessons to be learned in even the smallest of tasks, so go ahead and ask about electrolyte repletions, fluids, and antibiotic choices... Now is your time!

-Jadry Gruen, Chief Resident for Quality and Safety _____________________________________________________________________________________

Imposter syndrome is real. The people you look up to likely still have it. Don’t let it paralyze you! Your enthusiasm, curiosity, and patience will serve you better this year than anything you think you should “know” already.

And even if you have truly terrible day, this phrase always got me to work the next morning: “80% of success in life is just showing up”.

-Jess Dolman, New Graduate


As mentioned on the ZOOM the other day- you have been carefully selected through a rigorous process, so in moments of real doubt, always remember that you deserve to be here.

Residency training is a process. Sometimes you need to know the right answer now, as in better intubate this patient, but for the large part and big-ticket items, it is ok to get it wrong and learn from what did not work, adjust and re-evaluate. We put way too much pressure on getting the answer right, and too little emphasis on inherent virtue of the process. So long as there is progress, you are succeeding.

For crying out loud, get a hobby. At parties, docs talk about medicine. Don't be that person. The other side of you needs nurturing too. Take lessons. Start something that compels you to buy equipment. Look into something you have never done before and take a risk.

From Dr. Vivek Murthy's video message to the graduates: be present. No matter how little time you have with a patient, staff, friend or family, be there fully while you are there physically.

-Paul Bernstein, APD


As you master the art and science of Medicine in the next few years, recognize that the heart of medicine lies in human connectivity. Listen to your patients and colleagues, hear their stories, absorb and understand the variegated spectrum of human experience that you enter each day you arrive at work. There’s nothing that compares to this. Regardless of what lies years ahead, what you will choose to practice and where, this experience will inform how you will practice. Welcome to the program of the open-hearted and the vast-minded! :-)

-Shaili Gupta, Infectious Diseases Attending _____________________________________________________________________________________

Your job during this year is to learn how to care for patients, embrace it. You will make mistakes, but mistakes can be the best teachers if you let them be.

-Michael Mankbadi, PGY2


Be kind - to yourself, your patients and those around you - everyday.

Meditate - daily

Do aerobic exercise - frequently

Do something non-medical at least once a week.

Doubt is real - however use it to stimulate you to learn what you do not know.

Surround yourself with others who know more than you do - and let their knowledge stimulate you to learn more.

Ask, ask, ask - especially when you think you know the answer.

Realize what you do not know and admit it. Ask, ask, ask.

There are many people who want you to succeed - let them help you to be successful.

Watch Amy Cuddy’s TED talk at least once this year -

-Deborah Proctor, GI Attending


YOU DESERVE TO BE HERE! Don't be afraid to ask questions or ask for help. That's expected. Nobody will ever fault you for asking for help or admitting you don't know something. It's when you don't ask for help or assume you know everything that you can get into trouble.

Take it one day at a time. Sometimes, you'll need to take it one hour or one minute at a time and that's okay.

For your first month, just focus on the following: show up on time, admit if you've made a mistake (we've all been there many times), have a good attitude, ask for help when you need it and follow-up on tasks. If you're a team player you'll be successful.

Your co-residents can get you through anything. Lean on them and let them lean on you. You can't take care of your patients unless you take care of yourself. Reach out when you need it and I promise we will be there for you.

-Laura Glick, PGY2


Congratulations and welcome to the Yale Internal Medicine family! You are entering medicine during an unprecedented time in history and this has and will continue to be a learning process for all of us. But we will be here together, by your side, working together through it all. Nerves and fear are natural, but you can be reassured that there are so many layers of support and guidance nearby (and perhaps the best ice cream in the country at Arethusa). Looking forward to an intellectually, physically, and emotionally vigorous but also rewarding year ahead!

-Cynthia Tsay, PGY3


Trust the process. If you’re ever doubting yourself and looking at your senior resident and attending, amazed by how much they know, realize that they once felt the same way you do. You will get there with time!

-Nadeen Hussain, PGY2


#Being patient with ourselves

It takes time for all of us to grow our clinical muscles. A bad presentation, a missed exam finding, or not being efficient does not mean that you are a bad doctor. If you did not make it to the sign out time to finish up your task that is OK. You have tomorrow to challenge yourself. It takes time to become efficient. It takes time to excel in presentation. Medicine is a marathon, not a sprint.

#Words matter

Communication is the most important part of our job. We have to read our progress notes and sign outs everyday to ensure that we are not confusing anyone with our words. Additionally, we should be careful to pick appropriate words to judge one another including ourselves. There is no such thing as "weakness", but only "opportunities to improve". If you identify an opportunity for one of your colleagues to grow, be honest and generous. Let them know that you care about them and you want to shape the best work-environment. Feedback is love. We need a lot of it. When you are giving feedback make sure you are focusing on people's behavior and not their personality.

-Hassan Mirbolouk, PGY2


Prioritize an always-accessible form of endurance exercise (ie run East Rock). Maximize your limited number of Goldens with mini getaways.

-Erin Gombos, PGY3


Never stop listening to your patients or hearing what they say.

-Lynda Rosenfeld, Chief of Goodyer Firm _____________________________________________________________________________________

Write down the things you are not certain about your patients so that you can look them up in the evening. You won’t always have the luxury of time to dig out primary resource to learn about a new knowledge or a decision-making process during busy admitting days. When you finish your day and go home, try to find out why you give certain amount of potassium, magnesium for repletion or why you are checking anti-Xa instead of PTT or how to choose the intensity of an insulin sliding scale based on your patient’s home regimen or the dose/duration of steroids that would warrant PJP prophylaxis and so forth. If you do it consistently, you will learn nuggets of knowledge every day which will go long way for rest of your career.

-Denizhan Ozdemir, New Graduate


As a fortune cookie I opened prior to Step 1 said, “Trust yourself — you know more than you think.”

-Harry Sutherland, New Neurology Resident _____________________________________________________________________________________

Embrace the small things that spark joy throughout the day.

The skill that really matters at the start of intern year is knowing when to ask for help.

Spend time outdoors with tasty food and people you like.

-Max Eder, PGY3


One of the things that can make a day feel really meaningful for me is taking some time in the afternoon to sit with a patient that seems like they could use a little extra support. Don't hesitate to ask your resident for help with some other tasks so that you have time to do this (and still get home at a reasonable hour).

-Christina Dimopoulos, PGY2


Keep an open mind and be prepared to grow. Embrace the challenges with grace

Make your day of your own. Do something that brings you joy.

You will witness healing and recovery and you will witness patients succumb to their illness. While you will be working hard, all your actions are only one piece of much larger pie impacting outcomes. You will play an intimate role in their lives of patients as you care of them, and your character is what means the most to them.

Your patients are your best teachers. Study their conditions and you will have a face/story to accompany what you are learning.

-Mellisa Pensa, Fair Haven Community Health Center _____________________________________________________________________________________

Always ask for help if you need it - there are a hundred people eager to help you out at all times

Get to know your co-residents outside of work. They will bring you such joy and working alongside friends makes it not feel like work!

Explore all the delicious food in New Haven - I love Koon Thai, Sherkaan, Nolo, and High George among many others

-Marla Jalbut, PGY2


Beginnings are hard. Try to be easy on yourself. You have an incredible amount of people around to help you: senior residents, attendings, nurses, pharmacists, case managers, social workers, BAs, and more.

-Ann Soliman, PGY2


Listen to the nurses!!! If they are worried about something, chances are you should be too. Especially our ICU nurses who have been doing this since before many of us were born.

Intern year you will always inexplicably be trying to reach IR or on the phone with IR. Just make peace with this fact.

Never be afraid to ask for help or worry about what you “should know.” Everyone will appreciate that you recognize that you need help! At the end of the day this is about patient care and it’s a team sport. Don’t worry! We’ve got your back.

When in doubt, just get an ABG.

A sense of humor will get you everywhere.

-Jemma Benson, PGY3


Nothing you do in the name of patient care is ever beneath your dignity.

-Ethan Bernstein, Recent Chief Resident, New PCCSM fellow _____________________________________________________________________________________

The imposter syndrome is true phenomenon. Some days you will certainly feel inadequate and out of your comfort zone, but the reality is that you have MANY more skills than you give yourself credit for. Try to get into a routine where you pre-round and present with intention and ask others when you are concerned, confused or overwhelmed. Knowledge is power!

-Andrew Cox, PGY2


See attached!

-Chris Sankey, APD


Welcome to Yale - we are so happy that you are joining our team! You are joining a wonderfully rich learning environment with an outstanding faculty who are committed to your personal and professional development. Use us, we are here for you. You will also be supported by a brilliant team of junior and senior residents who have "been there and done that." They too are committed to your success. Perhaps most importantly, you have each other to rely on. Support for your success is everywhere you look. Enjoy your new adventure as a member of the Yale family!

-Patrick O’Connor, Chief of GIM and Co-Chief of Generalist Firm _____________________________________________________________________________________

Starting internship is incredibly overwhelming, and I remember that feeling well, but please know that everyone is/was in the same boat and that it gets a lot easier with time. Don't be afraid to ask your seniors for help and to rely on your co-interns for support. We are so excited to have you join the Yale family!

-Nona Jiang, PGY3


Be committed. Be kind. Be yourself.

-Vincent Quagliarello, Vice Chair for Education _____________________________________________________________________________________

If you have even just 5 minutes free, visit the healing garden on NP7, day or night. You'll feel more refreshed afterwards!

-Natalie Mackow, PGY3


Everybody has a story, an interesting and great story. The key to being a great doctor is to hear each patient's story. Don't forget to ask each patient, "What do you like to do when you're not in the hospital?". By following this basic tenet, you will be a much more satisfied physician as well as being a better doctor.

-Daniel Federman, Associate Chief of Medicine, VA Connecticut Healthcare System _____________________________________________________________________________________

Keep reading, keep learning, and keep caring. And always remember, you can do ANYTHING for 2 weeks.

-Anisha Garg, New Neurology Resident


We all make mistakes. Keep faith that you are well trained, well supported at Yale, and here to get the necessary training to make it to the next level. We all have faith in you!

-Manisha Juthani-Mehta, APD


If a nurse calls you about a patient- go and see them. Always.

Do not criticize the night team. They are so tired and they tried their best.

NEVER be afraid to say "I don't know."

Always remember that most things in life are funny, but there are some things that are not

-Becky Osborn, PGY3


Go over your to-do list right after rounds and prioritize the things that need to be done first (e.g. calling consults, ordering studies) versus items that can wait until later.

Read the nurses' notes to find out what's really been going on with the patient. This is especially helpful when you accept a patient from the ED.

Get to know the names of the staff on your unit from custodians on up and greet them by name.

-Elizabeth Holt, Co-Chief of Fitkin Firm _____________________________________________________________________________________

Take care of yourself and remember to always make time to get some food and stay hydrated. Try to learn something from every patient, no matter how trivial it may seem. And remember that you are never alone, there is always support, so do not be afraid to ask questions or ask for help.

-Evangelos Oikonomou, PGY2


Take a breath periodically as intern, pause and look around. Recognize how far you have come since you started, how many more things you know how to do, how much more medicine you know. When you are in the midst of rotations, it is hard to recognize your progress, especially as you can always feel like there is so much more to know and to learn. But, taking some time to be proud of all you have accomplished is good for your soul. This is an exponential growth year for you, which is stressful, but that growth is amazing and should be enjoyed!

-Seonaid Hay, APD


You are never alone.

Nobody is perfect.

Imposter syndrome is real, and we have all been there. Not only as interns, but also as residents, fellows, attendings!

Mental Health = Physical Health. We all need help sometimes, and there are resources and support for all.

You are more than your M.D.

We are part of a history of healers, as old as human kind. It is truly an honor and a privilege to do this work.

Whenever I had a particularly challenging day, I would remember "And whoever saves a life, it is considered as if he saved an entire world." At first, this meant saving a life. Since, it has evolved to mean supporting life, for however long and in whatever sense life is most meaningful for the patient and family. Never forget that you are doing important work, and learning the essential skill of healing.



About half way through my intern year, one of my seniors introduced me to her "brain outside her body." It was a One Note document where she had sections for every organ system and subsections for individual topics (Ex: Cardiovascular --> ACS). She had compiled various studies, helpful clinical pearls, pathophysiology etc. that she had been taught about on rounds/conferences and essentially created her own personal UpToDate. I started keeping a document like this too after she had shown me, but I wish I had started from day 1. It ends up being a great reference guide!

Residency is a team sport. I remember in med school I felt embarrassed if I said my patient's potassium was 4.3 when it was really 3.9 (which is so silly in hindsight). Your team will never judge you and is here to help you. Your resident will jump in with all the up-dated labs and studies. Pre-rounding on 8 patients by 7:30 is not easy. Please don't sweat the more minuscule details! We will put the picture together as a team and come up with a plan together.

Asking for help is never a sign of weakness. This is something I am telling myself too as I move on to PGY2 year. It's always better to admit you don't know something rather than "fake it till you make it".

Take Step 3 sooner rather than later. I wouldn't trust Prometric to stay open.

I know it's scary to start something new, and I remember feeling lonely when I first moved to New Haven from the Midwest. That feeling went away VERY quickly. When we call ourselves "Yale Family" we mean it. We really take care of each other are and we are all ready to welcome you with open arms ❤️

A good attitude is everything!

-Raksha Madhavan, PGY2


So these are some precepts you must consider: Give each patient enough of your time. Sit down; listen; ask thoughtful questions; examine carefully…be appropriately critical of what you read or hear…Follow the example set by William Osler: Do the kind thing and do it first."

As your acquaintance with clinical teachers grows, you will observe that although each of them has special knowledge and experience in some area of clinical medicine, they make no pretense of knowing it all.

To work well, a hospital must be a tightly-knit community of people who respect one another and enjoy working together

-Paul Beeson, Chair of Medicine, 1952-1965

Submitted by Mark David Siegel on June 21, 2020