Sole Purpose 115
What I Wish Someone Had Told Me Before Intern Year

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If you are reading this somewhere between Match Day and July 1st, first of all — congratulations. Truly. You did it. And second — I see you. The excitement, the anxiety, the quiet moments where you wonder if you are actually ready for this. You are not alone in any of it.

I have written a lot about intern year. The first month, the imposter syndrome, the call nights, the cringe-worthy moments that somehow become the stories you tell forever. But looking back now, there are things I wish had been handed to me before I ever walked through those hospital doors — not the logistics, not the packing list, but the emotional and relational reality of what this year actually asks of you.

This is that article. Consider it Your Pre-Intern guide, written by someone who survived the spiral and came out the other side with a lot of feelings and a yellow notebook full of case grades.

If you want the full picture, these are the pieces I would read alongside this one:

Together, they cover more ground than I can fit here. But this one covers the stuff I did not know to go looking for.

Feedback Is Going to Sting — That Is Not the Same as Failure

Nobody really prepares you for the specific feeling of being corrected in the OR for the first time. It is not just embarrassment. It is this sharp, full-body experience of having your competence questioned in front of other people while simultaneously trying to stay sterile, focused, and composed. And then you have to just keep going.

Here is what I want you to know: feedback hurts more at the beginning because you do not yet have enough evidence of your own growth to contextualize it. When someone corrects your suturing technique in month one, there is no track record to lean on yet — no history of cases you handled well, no proof of progress. So, the correction fills the whole room. Over time, that changes. But in the beginning, you have to trust that the discomfort of feedback is not a verdict on who you are. It is information about where you are — and those are very different things.

A few things that helped me: write it down the same day and separate what was said from how it made you feel. The technical note — your knot tension was inconsistent — is useful. The emotional residue — I felt humiliated — is valid, but it is not the lesson. Give yourself space to feel both without letting the emotional residue bury the actual feedback. And then show up the next day and apply it. That is the whole job.

The attendings who correct you most are often the ones paying the closest attention. That is not a consolation prize — it is genuinely true. The ones who stop noticing you are the ones who have quietly given up on teaching you.

Asking for Help Is Not a Weakness — Staying Silent When You Need It Is

There is an unspoken culture in medicine that rewards people who figure things out independently. And I understand why — autonomy and sound judgment matter enormously in this field. But there is a version of that culture that quietly shames residents for not knowing things they were never taught, and it produces interns who wait too long to ask questions because they are afraid of looking incompetent.

I want to be direct with you: asking for help at the right time is a clinical skill. It is not a confession of inadequacy. It is a sign that your judgment is working correctly.

You will not always know what you do not know — and that is genuinely okay in intern year. What is not okay is recognizing uncertainty and choosing silence over safety because of ego or fear. If something feels off, if a patient is not responding the way you expected, if you are unsure whether a finding is significant — call. Ask. Page. The worst outcome of asking a question you did not need to ask is a brief awkward moment. The worst outcome of not asking is something you do not want to think about.

Build your threshold early and be honest about it. Know your attendings. Know who wants to be called for everything versus who trusts you to manage small things independently. That calibration takes time, but it starts with asking questions and paying attention to how people respond — not with avoiding the conversation altogether. At some point you will be the one making decisions and it is good to ask for help if you need it, but please recognize you can’t need help with everything for forever. If someone has needed to tell you how to order a culture 3 different times, then you need to get a pen and paper and keep notes.

My article on being on call goes deeper on the mechanics of this, but the emotional piece — the shame that sometimes comes with not knowing — is worth naming here too. You are allowed to not know things yet. That is literally why you are here.

Read the Room — Every Attending Is a Different Environment

Nobody hands you a manual on this, but one of the most useful things you can develop in intern year is the ability to adapt quickly to different people's working styles.

Some attendings want you to anticipate the next step before they ask. Others want you to wait and be directed. Some teach by asking questions and genuinely want you to try to answer even when you are uncertain. Others ask questions as a performance test and get visibly frustrated when you are wrong. Some want quiet and efficiency in the OR. Others want engagement and conversation. Most of them will not tell you which category they fall into — you have to observe and adjust. One attending will love your sutures and another will think they’re sloppy. That’s life.

This is not about being inauthentic. It is about professional fluency. The same way you would not speak to a patient the same way you speak to your co-residents, you learn to read the context of each attending relationship and respond accordingly. Watch how other residents interact with each person before you do. Ask your upper-levels — privately — what someone's preferences are. Most of them will tell you exactly what you need to know.

The politics of hierarchy are real, and pretending otherwise does not help you navigate them. You are the most junior person in the room for this entire year. That does not mean your voice does not matter, but it does mean you need to earn the space to use it — by showing up prepared, being reliable, and demonstrating over time that your instincts can be trusted. Opinions land differently once people know your work.

Some Patient Interactions Are Going to Stay With You

You are going to have patients who scare you, patients who break your heart, and patients who say something so unexpectedly profound that you think about it for years. You are also going to have patients who are angry, dismissive, or unkind — and some of them are going to aim that energy directly at you.

The emotional labor of patient care is real, and it is largely invisible in how we train. We talk about clinical outcomes. We do not always talk about what it costs to sit with someone who just received devastating news, or to walk back into a room for the third time to explain something that still is not landing, or to advocate for a patient and feel like no one is listening.

Intern year will introduce you to all of it. There is no way to fully prepare for the first patient interaction that genuinely moves you, or the first one that genuinely rattles you. What I would offer instead is this: do not pretend those moments are not happening. The residents who compartmentalize everything without processing anything do not come out the other side intact. You are allowed to be affected by your patients. You are also allowed to close the chart at the end of the day and not carry every story home with you. Finding that line — and being honest when you have crossed it — matters as much as any clinical skill you will build this year.

You Will Make a Mistake That Matters — Here Is What to Do

You are going to mess up, big time. Not a pager number mix-up. Not calling someone the wrong name. I mean a mistake that has real clinical weight — a decision you made, something you missed, a communication that fell through the cracks. It is going to happen. Here is the good news: the checks and balances in the hospital make it pretty hard to kill someone. Your mistakes are often not because you are careless or unfit for this, but because you are a new physician navigating a complex system in real time with real patients, and medicine does not grade on a curve.

When it happens, the instinct is to minimize, to hide, or to spiral so deeply into self-blame that the lesson gets buried under shame. None of those responses serve you or your patients.

What does help: acknowledge it clearly and without deflection, loop in your attending as soon as possible, and then separate the action from your identity. You made an error. You are not an error. That distinction matters, and it is harder to hold onto than it sounds in the middle of the feeling.

The residents who grow the most from their mistakes are not the ones who feel the least — they are the ones who feel it fully, process it honestly, and come back the next day with that specific failure encoded as knowledge rather than shame. Your mistakes will teach you things that no lecture ever could. They will also make you a more careful, more empathetic physician if you let them. But only if you stay in the room with them long enough to actually learn.

Build a System for Learning Before You Are Too Tired to Think About It

Residency will teach you an enormous amount. It will also make you too exhausted on many days to be proactive about what you are learning and what you are missing. If you wait until you have the energy and bandwidth to build a learning system, you will wait for a very long time.

Start something simple before July. A case log. A running note on your phone where you write down one thing per case you want to look up or understand better. A way to track what surprised you and why. It does not need to be sophisticated — mine started as a yellow notebook with patient stickers in it — but it needs to exist before the pace of the year swallows the space to build it.

The goal is not to add more to your plate. The goal is to create a small, consistent container for your own growth that runs parallel to the clinical demands of the year. Without it, you can move through hundreds of cases and come out the other end having learned reactively rather than intentionally. With it, you start to see patterns in your own development — where you are improving, where you keep hitting the same gap, and what you should prioritize when you have the rare luxury of choosing what to study.

I wrote an entire piece on self-grading after surgery that gets into the specifics of this if you want a framework — but the version for intern year is simpler. Just write it down. Whatever stood out today — write it down. That is enough to start.

Your Co-Residents Are Going to Be the Most Important Relationship of This Year

Your attendings will teach you. Your program will train you. But your co-residents will get you through.

These are the people who understand your schedule without explanation, who will cover for you without keeping score, who will laugh with you at things that are genuinely not funny and cry with you over the things that are genuinely too hard. They are also people you will compare yourself to, feel competitive with, and occasionally frustrate beyond reason. Both things are true simultaneously and that is okay.

Protect those relationships deliberately. Do not let ranking anxiety turn into resentment. Do not let one hard shift become a pattern of keeping score. Show up for your co-residents the way you want them to show up for you, especially on the days when you have nothing left and it feels like a sacrifice. Those investments come back to you in ways that are hard to predict and almost impossible to overstate.

You are also going to spend more waking hours with these people this year than with almost anyone else in your life. That kind of proximity either builds something real or slowly erodes it. Choose to build it.

The Last Thing

Intern year is hard in a way that is difficult to explain to people who have not done it. It is also formative in a way that is difficult to fully appreciate while you are inside it. There will be days that feel impossible and weeks that feel like they are going to break you, and there will also be moments — small and ordinary and unexpected — that remind you exactly why you chose this.

You do not have to have it together. You just have to keep going. Please remember, you are brand new at this, and it is a learning experience.

I am rooting for you. The whole way through.