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    7 Essential Steps Every PGY1 Needs to Take Before Their Residency

    You just matched into a residency program, and a new chapter of your career is about to begin. 

    Is it exciting? Sure! (Finally, some patient care! Cases that are actually complex! A chance to wear that long white coat! You’re one step closer to your dream!) But it can also be a bit daunting—there are so many things to think about and plan for. 

    Let’s walk through what you need to know—and do—to prepare for residency.

    How does residency work?

    During residency, you'll be a doctor-in-training either in a hospital or office. Residents diagnose, manage, and treat health conditions under the supervision of physicians. Gradually, residents receive more complex cases and gain extensive clinical experience. 

    Residency is known for being intense, with long working hours and extensive studying for future board exams. 

    There are protections in place, however. The Accreditation Council for Graduate Medical Education (ACGME) has these guidelines in place:

    1. Residents’ work weeks are capped at 80 hours
    2. Overnight call frequency is limited to no more than one in three
    3. Straight shifts are limited to 30-hour maximums
    4. Residents are to be given at least 10 hours off between shifts

    These restrictions are in place to optimize patient safety, resident education, and resident well-being.

    What do you do in residency?

    Your residency will last 3-7 years, and during that time you’ll:

    • Give examinations
    • Record medical histories
    • Order and interpret diagnostic tests
    • Perform medical procedures

    This means that you will no longer be just observing like you were during clinical rotations. 

    If your residency is in a hospital, you’ll likely rotate through different units. Whether in the NICU or emergency department, residents spend a large part of the mornings in a group of healthcare professionals on rounds, going from person to person assessing their health, and discussing treatments. Many hospital residency programs have midday conferences where a lecturer discusses a topic relating to the care of your patients. Afternoons are likely spent calling consults, ordering tests, reviewing results, and updating patient information. 

    Residents in clinics or offices participate in examinations and treatments. They also coordinate other health services as needed, so you’ll spend time calling consults, ordering tests, and reviewing results. 

    What do first year medical residents do?

    First year residents—referred to as interns—usually focus on learning to coordinate patient care. This requires an exceptional amount of growth, and interns learn to:

    • Consult with patients and their families
    • Work with a team of residents, physicians, nurses, and technicians
    • Write orders
    • Work with electronic health records

    As you move through this first year, you’ll be supported by senior residents, attending physicians, your program director, chief resident, and more. Attending physicians and senior residents will supervise the medical care you provide.

    How long is residency?

    Your residency will focus on a particular medical specialty and last from three to seven years depending on that specialty and if you pursue a fellowship or not.

    • Internal medicine residencies typically last three years
    • Pediatrics residencies typically last three years
    • Med-peds residencies typically last four years

    After completing your residency, you may want to pursue a fellowship in subspecialty training. Depending on the pathway you choose, this will add one to four more years to your training.

    7 steps to prepare for residency

    You’ve got the medical knowledge to proceed to residency, you’ve got the long white coat, and you know where you’re headed on the map. 

    Let’s go a little deeper into the mechanics of prepping to be a PGY1 and answer some daunting questions: Should you study before starting residency? How should you prepare your family for this next step? What can be done to set yourself up for financial success?

    1. Equip your loved ones

    Even though you have a fairly clear picture of what the next few years of residency will be like, your loved ones may need to be briefed on what it will be like for you. 

    Before you start 80-hour work weeks, connect with friends and family to discuss how the time commitment and stressors of residency will impact your relationships. Gently set the expectation that residents have little free time, are physically and emotionally exhausted, and may even be adjusting to a new home in a new place. 

    But don’t forget to share your excitement, too! Afterall, your parents and best friend have been rooting for you throughout your med ed journey and will want to share in your joy. 

    And when you do make the transition to residency, be intentional about your interactions with loved ones. Carve out time in your calendar—even if it's just for a phone call. Connecting with friends and family can provide a greater sense of well-being, restore your sense of purpose, and help you overcome challenging situations.

    2. Research your (new) city

    Many PGY1s will be moving to a new city to start their training. If you’re one of them, use the time leading up to your residency to:

    1. Ask your program if they have any housing resources
    2. Commit to a date to find your new home
    3. Consider your budget and plan accordingly. Keep in mind relocation costs, possible brokerage fees associated with a new home, and public transportation costs or parking fees that you’ll incur due to your new commute
    4. Have fun researching the various neighborhoods and what they have to offer

    3. Think about how you'll study

    Time will be one of your most precious commodities during your intern year. Do not waste it using study methods that don’t actually work! Make sure that what you're learning right now will last all the way through your residency to the day you retire. 

    The best way for residents to lock the must-know medical information into long-term memory is by using the MedStudy Method. Before starting residency, explore the StudyWise guide to understand how this method combines the most effective evidence-based learning techniques in an easy-to-apply, three-phase approach to study.

    Other study hacks for PGY1 residents include:

    1. Keep a running list of interesting topics encountered
    2. Study multiple subjects at a time by using interleaving
    3. Start studying with the MedStudy Method when residency begins

    Remember: Residents take the In-Training Exam every year. And while you’re not encouraged to study for it, interns are tested on what is learned throughout the experience. Go in with a study game plan and confidently take on the ITEs!

    4. Refresh your knowledge of specific topics

    You studied hard in med school and just finished up months of clinical rotations. So you may not need to put in intense hours of review in the weeks leading up to your intern year. 

    But if studying will relieve anxiety, get in a few hours each week before you start residency. What you study will depend on your specialty and any academic weaknesses. 

    For example, internists could practice recall of acid-base disorders or work through diagnosis scenarios with flashcards. Pediatricians could review developmental milestones or the steps of neonatal resuscitation.

    Whether you choose to study or not, keep in mind that it will be years before you have this much time off again. Plus, your intern year will be an intense learning process where you’ll slowly be given more responsibility—residents aren’t expected to know everything on the first day. 

    5. Get your finances in order

    The good news: You'll finally be earning a paycheck! But don't forget the added financial responsibilities of being out of med school, like student loan payments and taxes. 

    To get started on the road to making smart financial decisions, consider contacting one of your medical societies like the AMA and AAMC. They have financial literacy and planning resources available for members that are entering residency.

    Start a Roth IRA
    There is an earning cap on those contributing to a Roth, so take advantage of your chance to sock away some money now—you’ll be ineligible for the tax benefits of a Roth once you start making more later on.

    6. Consider work-life balance

    Take the next few months to recharge and reassess. Are there any unhealthy habits you need to leave behind? What healthy habits can you establish now to make for a better intern year? 

    If you don’t already do these things, use this time off to learn to meal prep, develop a sustainable exercise regimen, establish good sleep habits—anything to help you stay healthy and give you time for yourself during your 80-hour work weeks. 

    Ways to maintain work-life balance include:

    1. Make time for reflection to cultivate self-awareness
    2. Develop and accept your own professional boundaries
    3. Appreciate and focus on the positive things
    4. Cultivate strong, healthy habits

    7. Take time to relax

    We’re just going to say it one more time: You won’t get this much down-time again for years. Now is the time to relax, go on a trip, spend time with loved ones, and take long walks on the beach.

    You’ve been studying hard for years. Allow yourself to rest and recharge so that you can move into the next phase of your training with renewed energy and focus. You’ve earned it!

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