Approaching July: Prepping Advisees for Internship

Congratulations – your advisees matched!  After the well-deserved celebration and sighs of relief, both of you realize that there is still another mentorship question to answer: now what? This question has never been harder to answer than in the spring of 2020. 

Matching into EM residency is a huge accomplishment, but that’s not where the adventure stops!  As relentlessly forward-thinking planners, many medical students will start thinking about residency and how to use their time before it starts, especially as their first day gets closer.

In our new COVID era, the picture is more complex, the choices muddier, the logistical challenges greater and the stakes higher.

While every situation is different in this uncertain time, your advisees will need you now more than ever as they navigate this year’s transition into residency. The time before residency is an important one and can still be a healthy balance of wellness, gentle preparation, and figuring out the logistics of your mentee’s next chapter in life.  

What follows are a few suggestions for communication with your advisee—like everything else at this time, the “right” answers on how to proceed are subject to factors that are unpredictable and rapidly changing. It will be critically important to remind your advisee (and yourself) that difficulty figuring out how to manage this transition are a natural reflection of the times rather than a personal failure. The most important action you can take right now is simply to stay in touch.

  1. Wellness
  • Take time to appreciate how far you’ve come – Make sure to look back and appreciate the long journey and your exciting future.  If nothing else, this pandemic has highlighted the critical role emergency physicians play in individual and public health. 
  • “Vacation” and relax– Although travel is certainly not recommended, this is still a rare time without clinical / educational obligations.  While it might feel odd after working so hard for the past year and as the medical world you’ll be entering is spinning in a crisis, this pause is deserved and should be enjoyed. This opportunity won’t likely come again for a while – consider making sure a good portion of each day is spent doing something simply for enjoyment. 
  • Reconnect with hobbies, friends, family, and enjoyment of non-medical things – Students often have deferred spending time with hobbies and loved ones in medical school.  Although perhaps unable to physically reconnect with them now, find ways to reconnect with loved ones emotionally – via phone, videochat, email, or even netflix-partiesdiscord chats, joint online winetastings and sure, online yoga Now is the time to figure out and solidify new pathways that can be used during residency. 
  • Recognize this is an extraordinary time for us all—your faculty and leadership may not anticipate new needs, and you may not recognize the symptoms of a serious decline in mental wellness.  Reach out early and often, to friends, family, advisors, program directors. 
  • Reflect – Take some time to think about what you’re looking for in medicine (career-wise and on a day-to-day basis) and what you’re expecting in residency.  This is a great time to reflect on the big picture, set broad goals for yourself, and consider how you’re going to grow in residency.

2. Residency Mentality

  • You’re not alone – Even in the best of times, starting residency can be exciting and intimidating, but trust us–everyone knows you will need help in intern year and throughout residency.  While the experience can be difficult at times and this year brings a host of new challenges, remember to ask for help when you need it—your co-interns, seniors, faculty, and social network are there for you.
  • Don’t be afraid of new experiences– As you already discovered by now, this is how you grow and re-prioritize your career and life.  This is also how you can become more comfortable and an expert in your field.  This year will be different than all others for starting interns, with likely more joint learning along with your seniors and faculty as well as the traditional top-down learning.  It’s the perfect time to let go of your fear of “not knowing enough” and just gather gather gather data and experience. 

3. EM Knowledge (finally)

  • Brush up if you feel like it – While you will get some time during intern orientation (and year) to remember and start to grasp EM knowledge firmly, many rising interns may feel obligated to brush up before residency starts. Consider reviewing what you learned in clerkships and subIs, then start reviewing topics you’re uncomfortable with (maybe it’s OB-GYN, peds, ophtho, ortho, or tox). 
  • And of course, spend some time on COVID-19, a topic whose ever-changing landscape ensures that you—if you read just a bit now—will be as expert as anyone else. You’ll feel a lot better if you understand what people are talking about when you arrive.  A few suggestions for Twitter follows (not endorsed by ASC-EM or CORD but noted to be joining in the clinical COVID conversation): @NEJM, @CDCgov, @BrighamWomen’s, @PeroneFrancesco, @airwaycam, @VivekJainMD.  Remember, though, to focus on other topics: Yes, you should read about COVID, but there is so much more to emergency medicine! Consider the AliEM bridge to EM for a structured approach. 
  • Think about approaches to chief complaints – Just as you were doing during your subI, try to find a way to focus on the pertinent parts of the history and physical, then your immediate plan to rule out the emergent differentials for common chief complaints (headache, chest pain, shortness of breath, abdominal pain, vision loss, etc). With this pre-planned arsenal, you can feel comfortable dealing with many of the problems thrown your way by intern year.  Consider reviewing your approach to ECGs, x-rays, and common procedures. But remember, this is what residency is for – don’t feel like you have to master any of this yet.
  • Think about how you best learn – There isn’t a right way to learn in residency and you might start playing around with your own. Some examples include: textbooks (Tintinalli’s Rosen’s, Harwood-Nuss), FOAMed, EM:RAP, Rosh review, and Emergency Medicine Foundations. Keep in mind that your residency might provide some of these resources and you should try them all to find what works best for you.

4. Life Logistics

  • Moving – Depending on your situation, the residency might have a housing stipend or subsidized housing that you might benefit from.  Alternatively, there might be a moving reimbursement for certain distances.  Look into these and the timing of your moving well in advance.  These offerings may be changing rapidly—stay in close touch with your receiving institutions and enlist the help of your advisors at your graduating institution to discuss any COVID-related challenges.
  • Benefits – Figure out what your residency will provide you with, and fill in the gaps if you find it necessary for your circumstances.  Benefits to consider include: salary, educational / meal stipend, insurance (health, dental, vision, disability, life), vacation, leave (parental), and retirement plan.  One particular thing to consider is self-purchased disability insurance and when to buy it. 
  • Budget – Now that you’re making actual money, you should consider carefully how you will spend (or save) it.  Consider your estimated take-home salary and your monthly expenses (rent/mortgage, utilities, groceries, loans, discretionary fund) and try to make a realistic monthly budget accordingly. Consider saving for an emergency fund.  These measures can hopefully protect your financial well-being during and after residency (a couple non-endorsed resources: White Coat Investor book and whitecoatinvestor.comInvestopedia.com)

Congratulations again to both advisor and advisee on the 2020 EM match!

by Daniel Ichwan, MD R3 at UCLA-Olive View

with editing by Shannon Moffett, MD (@BrickCityEM), at Rutgers New Jersey Medical School, on behalf of CORD ASC-EM

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