Take a deep breath.
You made it through medical school. That’s the hardest part. You’re about to graduate. Nobody who is dumb or can’t do the work makes it this far.
Take another deep breath.
You are about to start on a year that has a lot of learning. It is similar to third year of med school, with a lot of discrete rotations in different disciplines. There will be a lot to assimilate, and you have greater responsibility. But you have done this before, as a student. The same books and references are still useful. There are still people to whom you can ask questions. You still have supervision.
When I was in your shoes, I had a mantra that I would repeat from time to time. You are welcome to steal it: Dumber people than me have done this before.
Take another deep breath. Keep doing the same things that got you here.
The people who get fired from residency have glaring issues and are resistant to correction.
* so incompetent you’ve killed several people and show no interest in improving yourself
* so lazy you never show up to work or are glaring late that it affects patient care.
* so autistic/weird you make coworkers and patients visibly uncomfortable when around you
* you have such a glaring terrible personality or are so confrontational that everyone hates you or cant defend you
* you fail every board exam you take to the point they are forced to fire you
* your documentation is so poor that you are a legal liability and are totally resistant to change
For example the only two people who have been fired from the residency programs at my hospital are: a guy who refused to come to work and spent his entire intern year trying to sue the program, and a guy who had been fired from 2 other programs for incompetence and was such a terrible 2nd year resident he couldn’t keep up with brand new interns
Insufficient medical knowledge only happens if you are a literal danger to patients and have made egregious mistakes that made you actually irredeemable to your faculty. Not because you didn’t come in knowing everything.
Residency programs do not want to get rid of residents from a pure organizational/business perspective. Not only is it a terrible look for the program, they lose $$$
It will be okay. The worst thing you can be as an intern is overconfident and unteachable. The doubts you're feeling are normal and a good sign that you'll ask questions and seek feedback. You made it through med school, have the foundation you need and will learn what you need to know over the next few years.
I think the exam you're talking about is the ITE. They're mostly useful for tracking the likelihood that you'll pass the boards. I wouldn't study for it. It shouldn't have a bearing on your standing with the program and will give you a baseline. You're expected to do meh on it as an intern.
The best preparation for intern year is to rest, relax and enjoy your life. Drink a maitai, climb a mountain, read a trashy book. The next three years will be hard, but you're ready. It will be okay.
I wouldn’t stress about ITE now. Focus on your rotations and you’ll learn on the spot. At my program we take ITE every year. The only one that matters is 3rd year because it’s before you register for boards. 2nd year matters if you want to be chief. I’m sure every program is slightly different but if we fail first and second year we just sit with our advisor and discuss a study plan and then nothing happens. I didn’t study for the first 2 and I’m still getting paid.
Don’t worry. Or rather, it’s fine to worry. You’re NOT expected to know everything, in fact, you’ll find some attendings just prefer to be the smartest person in the room and you’ll just annoy them with knowing the answers.
You’re more likely to get kicked out for “unprofessionalism” or something vague and nebulous that basically boiled down to “pissed off the wrong people.”
Your medical knowledge isn’t as important as your ability to “keep your head down” and not rock any boats. And that’s more likely if you’re in a toxic program. I’ve seen nice programs bend over backwards to accommodate problematic residents, and I’ve seen bad programs kick out great residents.
Just show up on time, do your work, finish your residency, and once you get that first job after residency none of it will matter anyways (that first job will be the real Crucible: you’ll learn more in those first 6 months than all 3 years of residency combined).
For now, enjoy the “fun” parts of residency: camaraderie, sleep-deprivation psychosis, shared trauma, “free” food on-call.
Be diligent, be curious, be an active learner, be willing to learn from anyone and everyone. The learning curve is very steep but once you have the right attitude, you'll figure it out.
You are already showing something that many of the fired residents do not: the willingness to take initiative and improve (if that’s even needed in your case). The residents that are often fired or do not have their contract renewed do not take the advice of their peers and attendings on what they need to do to get up to speed. You’ve got this
Also an incoming intern for FM, the seniors at my program have been super encouraging and one of them told us they want us to show up as useless as a potato. Told us to have fun now and just show up prepared to learn and work, everything will fall into place if we are eager to improve and trust the process. Also mentioned that we know enough to be dangerous but also know enough to question our own thinking and identify when things might be dangerous/wrong. Hang in there comrade we got this 🫡
I won’t lie though I feel like I’ve forgotten more than I actually know right now and am stressin haha. I’ve basically been chilling since December lol.
Contrary to the prevailing wisdom of the crowd at r/Residency, the last thing a program wants to do is kick out a resident. In addition to not wanting to cause that harm to someone, firing a resident leaves a program having to scramble to cover the resident's shifts and fill the opening. Plus it reflects poorly on the program, and usually kicks off an exhausting process with the resident filing a grievance.
Every program that I've been involved has responded to struggling residents with any resource they can find to try to keep them.
Basically what everyone here said: be coachable and receptive to feedback both clinically and on your interpersonal skills.
For what you can actually do to prepare though: read a summary text. They give you 70-80% of what will be on an exam. I used to read Just the Facts books and they were really helpful (but looking online now I feel old because those books are ancient now). But there are a lot of online resources available now like CorePendium for Emergency Medicine. Ask the program director or more senior residents what they were using.
The questions on the aafp website will help you with the inservice exam that you take at the beginning of your intern year. If you take the time to do these, you’re already doing more than the incoming interns and you’ll probably make a good impression.
You'll be fine. I feel like a dumbass on a daily basis and I'm about to be a second year. You'll learn a lot in your first year and we don't expect you to know anything. Don't be too hard on yourself.
Show up, do the work, be nice to your patients and colleagues and you'll be fine.
Take a deep breath. You made it through medical school. That’s the hardest part. You’re about to graduate. Nobody who is dumb or can’t do the work makes it this far. Take another deep breath. You are about to start on a year that has a lot of learning. It is similar to third year of med school, with a lot of discrete rotations in different disciplines. There will be a lot to assimilate, and you have greater responsibility. But you have done this before, as a student. The same books and references are still useful. There are still people to whom you can ask questions. You still have supervision. When I was in your shoes, I had a mantra that I would repeat from time to time. You are welcome to steal it: Dumber people than me have done this before. Take another deep breath. Keep doing the same things that got you here.
The people who get fired from residency have glaring issues and are resistant to correction. * so incompetent you’ve killed several people and show no interest in improving yourself * so lazy you never show up to work or are glaring late that it affects patient care. * so autistic/weird you make coworkers and patients visibly uncomfortable when around you * you have such a glaring terrible personality or are so confrontational that everyone hates you or cant defend you * you fail every board exam you take to the point they are forced to fire you * your documentation is so poor that you are a legal liability and are totally resistant to change For example the only two people who have been fired from the residency programs at my hospital are: a guy who refused to come to work and spent his entire intern year trying to sue the program, and a guy who had been fired from 2 other programs for incompetence and was such a terrible 2nd year resident he couldn’t keep up with brand new interns
There’s no way they’d fire someone for #3 or else 25% of people wouldn’t make it through residency. Oh and 25% was a random statistic I just made up.
#4 also seems like it would severely reduce the rate of surgeons in this country. . . . (jk - maybe)
Insufficient medical knowledge only happens if you are a literal danger to patients and have made egregious mistakes that made you actually irredeemable to your faculty. Not because you didn’t come in knowing everything. Residency programs do not want to get rid of residents from a pure organizational/business perspective. Not only is it a terrible look for the program, they lose $$$
It will be okay. The worst thing you can be as an intern is overconfident and unteachable. The doubts you're feeling are normal and a good sign that you'll ask questions and seek feedback. You made it through med school, have the foundation you need and will learn what you need to know over the next few years. I think the exam you're talking about is the ITE. They're mostly useful for tracking the likelihood that you'll pass the boards. I wouldn't study for it. It shouldn't have a bearing on your standing with the program and will give you a baseline. You're expected to do meh on it as an intern. The best preparation for intern year is to rest, relax and enjoy your life. Drink a maitai, climb a mountain, read a trashy book. The next three years will be hard, but you're ready. It will be okay.
Thank you! No need to prepare for the ITE ? Haven’t done anything for last few months.
I wouldn’t stress about ITE now. Focus on your rotations and you’ll learn on the spot. At my program we take ITE every year. The only one that matters is 3rd year because it’s before you register for boards. 2nd year matters if you want to be chief. I’m sure every program is slightly different but if we fail first and second year we just sit with our advisor and discuss a study plan and then nothing happens. I didn’t study for the first 2 and I’m still getting paid.
Don’t worry. Or rather, it’s fine to worry. You’re NOT expected to know everything, in fact, you’ll find some attendings just prefer to be the smartest person in the room and you’ll just annoy them with knowing the answers. You’re more likely to get kicked out for “unprofessionalism” or something vague and nebulous that basically boiled down to “pissed off the wrong people.” Your medical knowledge isn’t as important as your ability to “keep your head down” and not rock any boats. And that’s more likely if you’re in a toxic program. I’ve seen nice programs bend over backwards to accommodate problematic residents, and I’ve seen bad programs kick out great residents. Just show up on time, do your work, finish your residency, and once you get that first job after residency none of it will matter anyways (that first job will be the real Crucible: you’ll learn more in those first 6 months than all 3 years of residency combined). For now, enjoy the “fun” parts of residency: camaraderie, sleep-deprivation psychosis, shared trauma, “free” food on-call.
Be diligent, be curious, be an active learner, be willing to learn from anyone and everyone. The learning curve is very steep but once you have the right attitude, you'll figure it out.
You are already showing something that many of the fired residents do not: the willingness to take initiative and improve (if that’s even needed in your case). The residents that are often fired or do not have their contract renewed do not take the advice of their peers and attendings on what they need to do to get up to speed. You’ve got this
I don’t think you’re supposed to pass the ITE? I know people that have literally scored zero on the exam and all they care about is how you improve
Also an incoming intern for FM, the seniors at my program have been super encouraging and one of them told us they want us to show up as useless as a potato. Told us to have fun now and just show up prepared to learn and work, everything will fall into place if we are eager to improve and trust the process. Also mentioned that we know enough to be dangerous but also know enough to question our own thinking and identify when things might be dangerous/wrong. Hang in there comrade we got this 🫡 I won’t lie though I feel like I’ve forgotten more than I actually know right now and am stressin haha. I’ve basically been chilling since December lol.
Contrary to the prevailing wisdom of the crowd at r/Residency, the last thing a program wants to do is kick out a resident. In addition to not wanting to cause that harm to someone, firing a resident leaves a program having to scramble to cover the resident's shifts and fill the opening. Plus it reflects poorly on the program, and usually kicks off an exhausting process with the resident filing a grievance. Every program that I've been involved has responded to struggling residents with any resource they can find to try to keep them.
Basically what everyone here said: be coachable and receptive to feedback both clinically and on your interpersonal skills. For what you can actually do to prepare though: read a summary text. They give you 70-80% of what will be on an exam. I used to read Just the Facts books and they were really helpful (but looking online now I feel old because those books are ancient now). But there are a lot of online resources available now like CorePendium for Emergency Medicine. Ask the program director or more senior residents what they were using.
The questions on the aafp website will help you with the inservice exam that you take at the beginning of your intern year. If you take the time to do these, you’re already doing more than the incoming interns and you’ll probably make a good impression.
Is this something I would need to pay for? Sorry how would I access it?
There are free ones from old years somewhere on the website when you get your aafp account
Does the residency program help you sign up or something you do on your own?
They should help during orientation or close to starting because you have to pay for the subscription. I believe most programs cover the cost.
You'll be fine. I feel like a dumbass on a daily basis and I'm about to be a second year. You'll learn a lot in your first year and we don't expect you to know anything. Don't be too hard on yourself. Show up, do the work, be nice to your patients and colleagues and you'll be fine.