Clinicals
Getting Ready for Intern Year
by Mike
Apr 11, 2026 · 8 min read
Clinicals
by Mike
Apr 11, 2026 · 8 min read
The weeks before intern year are for resting, not cramming. A few small things done now will still make the first days a lot smoother.
Sort out the logistics. Get your badge, EMR access, pager or messaging app, and parking set up before day one. It all sounds trivial until you're locked out of the building at 5:30 AM on July 1.
Buy the basics: a good stethoscope, comfortable shoes (you'll be standing 10+ hours), a clipboard or a folding card holder, pens (bring extras, they disappear), and a small notebook or pocket reference.
Download the apps. UpToDate, Epocrates or Medscape for drugs, MDCalc, and whatever your hospital uses for paging and secure messaging. A lot of these are free through your hospital.
Brush up on the bread and butter. You don't need to study like it's boards. Know the first workup and first-line management for CHF exacerbation, COPD exacerbation, sepsis, DKA, AKI, GI bleed, chest pain, and the common electrolyte replacements (potassium, magnesium, calcium, sodium). That covers a big chunk of your first month.
Set up your EMR. If you get early access, build your dot phrases, set up your patient list, and favorite your common orders. The Epic setup and shortcuts article walks through it.
Knowing who handles what, and who to call for what, saves a lot of stress.
The attending is the supervising physician and has final responsibility. You "staff" patients with them: you present your assessment and plan, and they give feedback and make the final call.
The senior resident is your direct supervisor on the team. They oversee decisions, help you troubleshoot, and are your first call when you're unsure. Use them. That's their job.
You, the intern, run the day-to-day care of your patients. You write the notes, place the orders, coordinate with nursing and consultants, and present on rounds.
Medical students, if you have them, follow some of your patients. You review their notes, help with their assessments, and teach when you can.
Cross-cover or night float covers your patients overnight. A good signout is a patient safety issue (more on that below).
Consultants are specialty teams you call with a specific question. Have the question and the data ready before you call.
Days follow a pretty set rhythm. Getting fast at it is the most useful thing you can do as an intern.
Get in early enough to see everyone before rounds. For each patient:
Write down the numbers you'll present. A lot of interns use a printed list or a rounding sheet with room for vitals, labs, and the plan.
You present each patient to the attending and senior: a one-liner with the hospital day, then subjective, objective, and an assessment and plan by problem. Keep it tight. Focus on what changed, what's abnormal, and what you want to do, and you'll learn what each attending likes. The guide to presenting on medicine rounds has the full format with examples.
This is where most of the work happens:
Go by urgency. Stat orders and unstable patients come first, and notes can wait. A simple rule is that anything touching patient care happens now and documentation happens later.
The admission H&P and the daily SOAP note are covered in detail in writing a SOAP note. As an intern, three habits matter most.
Write for whoever reads the chart next. They should be able to tell how the patient is doing, what's active, and what the plan is without digging through the whole chart. Be thorough with the history on admission, since everyone else will pull from it for the rest of the stay.
Make the plan specific. "Continue current management" isn't a plan. "Continue vancomycin/piperacillin-tazobactam for HAP, day 3 of 7, follow cultures, trend WBC and procalcitonin" is.
Don't copy forward without reading. Update every section of yesterday's note, and write down your reasoning when you pick one approach over another. It helps the next doctor, and it protects you.
A bad handoff is a safety problem. Use a standard format. Many programs use I-PASS:
Spell out what to do if things change. "If systolic drops below 90, give a 500 mL NS bolus and call me if it doesn't come up" is far more useful than "call with any issues."
A disorganized consult call wastes everyone's time. Before you dial, know the patient's story, have the labs, imaging, and vitals in front of you, and know exactly what you're asking.
Open like this: "Hi, I'm [name], the intern on [team]. I'm calling to request a [specialty] consult for [patient name] in [room]. They're a [one-liner]. My question is [question]."
Then give details as they ask. Consultants want a short call and a clear question, not the whole H&P over the phone.
Admissions feel overwhelming at first. Do them the same way every time.
First, get the story. Read the ED note or transfer paperwork, then talk to and examine the patient.
Second, put in the orders. Use the admission order set if there is one. At the least, make sure you have:
Third, write the H&P. Fourth, staff it with your senior or attending. Fifth, talk to the nurse. Introduce yourself, go over the plan, and say what you want watched overnight.
Not asking for help. Nobody gives out awards for struggling quietly. Call your senior early when you're unsure. A question that feels basic is better than a decision that hurts someone.
Falling behind on notes. They pile up fast. Write progress notes during or right after rounds while the plan is fresh. Saving them all for the end of the day means late nights.
Losing track of tasks. Keep a running list, write every task down when it comes up, and cross it off when it's done. Paper or a column on your patient list both work.
Skipping the nursing notes. Nurses write down things that never make it into the physician notes. Read them.
Rushing discharge med rec. Discharge is where a lot of medication errors happen. Go through every med with the patient before they leave.
Not eating or drinking. You can't take care of anyone running on empty. Eat when you can, bring snacks, and drink water.
Intern year is long, and you matter too.
Protect your sleep on post-call days and days off. Missed sleep adds up over weeks and months.
Bring food. Don't count on the cafeteria being open when you finally get a minute.
Move. Twenty or thirty minutes a few times a week makes a real difference in energy and mood.
Keep a life outside medicine. Call your family, see your friends, do things that have nothing to do with the hospital.
If you're struggling, tell someone: your program, a co-resident you trust, or your hospital's wellness resources. Struggling in intern year is normal. You don't have to do it alone.
Best of luck!
Mike
Disclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content above 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.