Clinicals
Intern Prep Guide
Apr 11, 202610 min read
By Mike
By MikeDisclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content below is not medical or clinical advice and is intended for educational purposes and general guidance only. Clinical protocols and workflows vary by institution. Always defer to your program's policies and your supervising physicians.
The weeks before intern year are for rest, not cramming. That said, a few small things done ahead of time will make your first days significantly smoother.
Get your logistics in order. Make sure your hospital badge, EMR access, paging system, and parking are set up before day one. These things sound trivial until you are locked out of the building at 5:30 AM on July 1.
Buy the essentials. A good stethoscope, comfortable shoes (you will be on your feet 10+ hours), a clipboard or folding reference card holder, pens (bring extras, they disappear), and a small notebook or pocket reference. Some interns like carrying a pocket pharmacopoeia or clinical reference app on their phone.
Download key apps. UpToDate, Epocrates or Medscape (drug references), MDCalc (clinical calculators), and your hospital's paging or secure messaging app. Many of these are free through your institution.
Review high-yield clinical topics. You do not need to study like you are preparing for boards. Focus on bread-and-butter inpatient management: CHF exacerbation, COPD exacerbation, sepsis, DKA, AKI, GI bleed, chest pain workup, and common electrolyte corrections (potassium, magnesium, calcium, sodium). Knowing the initial workup and first-line management for these will cover a large portion of your first month.
Set up your EMR environment. If you have early access, build your dot phrases, customize your patient list, and favorite common orders. See the Epic Workflow Tips article for a detailed walkthrough.
Knowing who does what and who to call for what will save you time and stress.
Attending: The supervising physician ultimately responsible for patient care. You will "staff" patients with the attending, meaning you present your assessment and plan and they provide feedback and final decisions.
Senior resident: Your direct supervisor on the team. They oversee clinical decision-making, help you troubleshoot, and are your first call when you are unsure about something. Use them. That is what they are there for.
Intern (you): You are the primary provider managing the day-to-day care of your patients. You write notes, place orders, coordinate with nursing and consultants, and present on rounds.
Medical students: If students are on your team, they will follow a subset of your patients. You are responsible for reviewing their notes, guiding their assessments, and teaching when possible.
Cross-cover / night float: The resident covering your patients overnight. A thorough signout is critical for patient safety (see Handoffs section below).
Consultants: Specialty teams you call for help with specific clinical questions. When calling a consult, have a clear question in mind and relevant data ready.
Your day will follow a predictable rhythm. Getting efficient at this cycle is the single most impactful thing you can do as an intern.
Arrive early enough to see all your patients before rounds. For each patient:
Write down key data points for your presentation. Many interns use a printed patient list or a rounding sheet with space for vitals, labs, and a plan.
You will present your patients to the attending and senior resident. The standard format for a progress note presentation:
One-liner: "[Patient name] is a [age] [sex] with [relevant PMH] admitted for [reason] on [hospital day #]."
Subjective: How the patient is doing. Overnight events, symptoms, complaints, PRN use.
Objective: Vitals (include trends if relevant), pertinent exam findings, labs, imaging, micro results.
Assessment and Plan: Organize by problem. For each active problem, state the diagnosis or working diagnosis, what you think is going on, and what you want to do about it. Include disposition planning (when applicable).
Keep presentations concise. Your attending does not need every lab value recited. Focus on what changed, what is abnormal, and what your plan is. You will get a feel for what each attending wants over time.
This is when the bulk of your work happens:
Prioritize tasks by urgency. Stat orders and unstable patients come first. Notes can wait. A useful framework: do everything that affects patient care now, and everything that is documentation later.
Before leaving, make sure:
Chief Complaint: One sentence. Why the patient is here, in their words or the referring provider's words.
HPI: Tell the story. Start with the acute presentation, include relevant positives and negatives, then provide relevant PMH context. Write it so someone unfamiliar with the patient can understand what happened and why they are in the hospital.
ROS: Document pertinent positives and negatives. You do not need to list every system if it is not relevant, but a complete ROS is expected for billing purposes on an admission.
PMH / PSH / Medications / Allergies / Social Hx / Family Hx: Be thorough on admission. This is the foundation other providers will reference.
Physical Exam: Document what you actually examined. Be specific (e.g., "2+ pitting edema to the mid-shin bilaterally" rather than "edema noted").
Assessment and Plan: Problem-based. List each active problem, your differential or working diagnosis, and your plan including workup and treatment. Include disposition thinking early (expected length of stay, barriers to discharge).
Follow the SOAP format. Keep it focused on what changed in the last 24 hours and what the plan is going forward. Do not copy-forward large blocks of unchanged text without reviewing and updating them.
Write for the next reader. Your note should allow any provider picking up the chart to understand the patient's current status, active problems, and plan without needing to read the entire chart.
Be specific in your plan. "Continue current management" is not a plan. "Continue vancomycin/piperacillin-tazobactam for HAP, day 3/7, follow cultures, trend WBC and procalcitonin" is a plan.
Document clinical reasoning. If you are choosing one approach over another, briefly explain why. This is good for patient care, education, and medicolegal protection.
A poor handoff is a patient safety issue. Use a standardized format. Many programs use I-PASS:
I — Illness severity (stable, watcher, unstable) P — Patient summary (one-liner with active problems) A — Action list (what needs to be done overnight: pending labs, titrations, specific monitoring) S — Situation awareness (what could go wrong and what to do if it does) S — Synthesis (the receiver reads back key action items)
Be explicit about anticipatory guidance. "If BP drops below 90 systolic, give 500 mL NS bolus and call me if no improvement" is far more useful than "call if any issues."
A poorly organized consult call wastes everyone's time. Before you call:
Structure the call:
"Hi, I'm [name], the intern on [team]. I'm calling to request a [specialty] consult for [patient name] in [room number]. They are a [one-liner]. My specific question is [question]."
Then provide relevant details as needed. Consultants appreciate brevity and a clear question over a full H&P recitation over the phone.
New admissions will feel overwhelming at first. Develop a systematic approach.
1. Get the story. Review the ED note or transfer documentation. Talk to the patient and examine them.
2. Place initial orders. Use admission order sets when available. At minimum, ensure:
3. Write your H&P.
4. Staff with your senior and/or attending.
5. Communicate with nursing. Introduce yourself, discuss the plan, and set expectations for overnight monitoring.
Not asking for help. There is no award for suffering in silence. Call your senior resident early when you are unsure. It is better to ask a question that feels basic than to make a decision that puts a patient at risk.
Falling behind on notes. Notes pile up fast. Try to write your progress notes during or immediately after rounds while the plan is fresh. Batching notes at the end of the day leads to late nights.
Forgetting follow-up tasks. Keep a running task list. Write down every task as it comes up and cross items off as you complete them. Many interns use a paper list or a column on their printed patient list.
Not reading the nursing notes. Nurses document important observations that often do not make it into physician notes. Check them regularly.
Not reconciling medications at discharge. Medication errors at discharge are a leading cause of readmissions. Review every medication with the patient before they leave.
Skipping meals and hydration. You cannot take care of patients if you are running on empty. Eat when you can. Bring snacks. Stay hydrated.
Intern year is a marathon. Your wellbeing matters.
Sleep. Protect your sleep on post-call and days off. Sleep deprivation compounds over weeks and months.
Eat. Bring food to the hospital. Do not rely on the cafeteria being open when you have time to eat.
Exercise. Even 20 to 30 minutes a few times a week makes a meaningful difference in energy and mood.
Stay connected. Maintain relationships outside of medicine. Call your family. See your friends. Do things that have nothing to do with the hospital.
Ask for help when you need it. If you are struggling, reach out to your program, a trusted co-resident, or your institution's wellness resources. Struggling during intern year is normal. Suffering alone is not required.
Best of Luck!
— Mike