So the first year of residency is in one word, tough, but how do you get through it? How do you get past surviving instead thrive during intern year of residency? That's exactly what we'll talk about in this video. Let's get into it. All right guys, what is going on? Welcome to another episode in the MD journey and the TMJ show where here we help people just like you succeed on their medical journey with blood stress. My name is Laksha. I'm currently an internal medicine resident. We've been doing videos, blog posts, podcasts, just like this for the last almost three plus years. So if you guys enjoyed this content, if you're new, definitely consider subscribing to the YouTube channel or the podcast or wherever you're listening, if you're listening on YouTube, then go ahead and hit that notification bell and consider hitting that like button if you enjoy this video. But today I wanted to make one of my first videos on how to basically succeed and thrive during your intern year of residency. So if you're unfamiliar with the terminology, your intern year is basically your first year of residency, which can be anywhere from three to upwards to seven years. Depending on the specialty you're going into, the first year of residency can be different. Obviously, if you're going to be in surgery, you're going to have a year of surgery internship, we'll be doing different rotations on surgery, specialties, things like general surgery as well as the classical surgery and things of that sort. And if you're going into a field like internal medicine, you may do rotations such as ICU as well as general medicine services. Quickly, I just want to lay out what makes first year of residency so hard, your intern year so tough as one. This is the first time you're doing it.  And so unfortunately, you're kind of putting positions of being uncomfortable and an unknown for quite some time. You are going to be taking care of lots of patients. You'll be writing a lot of notes and you'll be working long hours. And so that over the span of years where you're feeling uncomfortable, not exactly sure what you're doing all the time, as well as the hours and the demand that the job has can be stressful. It feels like you're always trying to survive and gas for air. So in this video, I actually want to talk about the things that you should do to not only survive, but thrive during your intern year of residency. Let's get into it. So my first tip is to really learn the practice pattern recognition. And this is the concept that's becoming more and more important to me in residency. And the idea is if you go into a patient's room the first time, and that scenario, that situation is uncomfortable, you may get help or you may figure it out through the help of an attending, a fellow resident, somebody else. But now you understand in the future, you know, under this uncomfortable situation, these are the things that you consider and these are things I should do. Have that in the back of your mind that way in the next time that experience arises, you should say, okay, is this similar to that previous experience where I had no idea what to do? You know, a quick example, I remember my first ICU rotation, I got a patient that a patient was having a fever after getting a transfusion. Now, now it seems logical to just say stop the transfusion, let's see if they are having a reaction, let's get some medications to control the fever, make sure they're not having any symptoms. But at that moment, I just froze, I had no idea what to do, who do I call, what do I make sure of, what kind of symptoms to look for, and all that led me to ask help from my upper levels, who are able to quickly help me navigate how to approach the situation. The next time I had a patient with even anything that's remotely similar, they had a fever, they had a recent transfusion, I was already having kind of my wheels churning of what type of things to consider, what type of things to do, and what type of things not to do. Now, in this ability to do pattern recognition comes naturally with time, but if you want to accelerate the process, every patient experience you have, whether it's something you feel comfortable with or something you don't, there's always going to be a little element likely where you're not sure what to do. What's the dose of this medication? Which medication is better? This one, that one, how should we treat this? And anytime you have any questions, ask yourself, okay, these scenarios, just reflect for a second and saying these are typically the approaches we should take. Well, you have a little bit more on your tool belt to be able to use in future scenarios. The quicker you can say in these situations, I should consider and do A, B, and C, the next time you're faced with that situation or that page, you kind of know what to do without having to rely on your upper level supervision. But going into tip number two on that note is also very important and be okay to ask for help. Regardless of what specialty you're in, you have to remember that the person above you, whether that's just one year or several years was once in your shoes. And so it's important to be okay asking for help, even if it makes you feel a little foolish, and most importantly, making sure the patient is safe and well taken care of. And if you don't want to feel like a bother, one simple phrase that I use is saying, Hey, I don't want to really bother you at a quick question about A, B, and C. That is require you to have a little bit of a thought process of what you want to do or what type of things you're considering or if you're unsure to blatantly say it saying I'm not sure based off of A, B, and C exactly how to approach this, would you mind helping me out and what type of things would you do phrasing your request to help that way makes it seem less frantic. And also makes it seem like a more of an educational true effort on your part to use the knowledge and experience you have, which may not be a lot to eventually realize that you need help. And if so, any upper level who's been in your shoes, which all of them have should be able to say, you know, here's how I would navigate it. Let me go see the patient with you. And I found that the ease and I found that the quicker I've been comfortable asking for help when I'm uncomfortable, the more safe the patient is, as well as the easier it is for me to identify those pattern recommendations that we talked about the first tip number three, and this is really made my intern years so much more successful and I just find opportunities to be more efficient. This is definitely something I prioritize in all elements of my life. So it's just natural that it came as well as in my intern year, but have some kind of system have a system that you do every single day. And you come at the start of how you evaluate every old patient have a system when a new patient is getting admitted what everything's you look for and how you jot things down. I mean, you can obviously play with your system the first few months to get something that's honed in. But the best way to realize if you're being inefficient and ask yourself, where is a lot of your time being spent if you're somebody who is taking a lot of time writing notes, or somebody who just takes a lot of time to read about a patient before you go see them in the emergency room, or evaluate them for a surgery, then maybe you need to have a more start to finish kind of approach that then you can use in the future as you progress through residency. And these opportunities for efficiency is really going to be dependent on what you're not good at, you know, if you're slow at writing notes, then there's going to require a process that you come up with that can expedite that. Now writing notes was actually something that I struggled with initially where I was spending an excessive amount of time doing it, and I didn't feel like I knew the patients any better after finishing my note. But one thing that I now do is as soon as I start seeing the patient have a template that I create, and the first thing I do is I make a list of every single problem I could think that they have. I first start with their vitals, then I start with their labs, then I start with their medical conditions based on the medications that they're taking. And finally, I added any abnormalities that they have from this hospitalization. So if they're complaining of not being able to breathe, having shortness of breath, but that may be new, that's a new problem. Because then what it forced me to do is that I can look at each problem and ask myself how am I going to approach each and every single one. I feel like I know what I'm doing for that patient based off of the problems I've attended. But that's just an example of something that I do to just quickly get into medical and patient care and doctor mode you could say, but identify what parts in your day you're going slow on, you're kind of dragged on, and ask yourself how can I improve this process for the future. Tip number four, this is a huge one. Fake confidence and confidence of any kind is key. I feel like the biggest reason for kind of that delay and gratification and feeling like things are just clicking your intern here is because we just don't feel confident. We don't feel comfortable and that's absolutely natural. You know, that happens to me even today when I went to work, there are experiences and situations where I'm just not sure what to do. But having confidence overall allows you to one, say I'm not sure what to do, let's quickly figure out the solution by asking A, B, or C. But two, it all just makes you feel more confident to the patient, they feel more comfortable, the nursing staff feels more comfortable, you're attending your upper level and having that confidence makes you feel like, okay, even if I don't know what to do, I can somehow figure out the answers versus if you're freaking out and you don't know what to do, is usually everyone feels uncomfortable. And if you want your days and rotations to feel like they are progressing, you're heading in the right direction, then make sure you have that element of confidence. Obviously, you are capable of becoming a physician and there's just a steep learning curve and you're just on that part where it requires a lot of effort to climb that hill. So be okay with being uncomfortable, but have that confidence, if not have that fake confidence. So the next tip is one I've been using more recently, it's been really helping me on my progression and that's just to find small opportunities to learn. One of the things I've been doing since med school, for example, is making a list on the back of like a blank piece of paper that I carry with me of everything that I kind of want to look at. It also includes whenever I have some downtime, I may use an app on my phone that may quiz me on a clinical case and I can quickly do it on a trip up and down the elevator. I also make a video on all the resources that I use in residency in the future. You just find small instances where you can quickly look something up and do a little bit of reading, catch yourself. Cases are a great example of kind of testing your medical acumen. I for one am a huge fan of the New England Journal lesson. I always have a journal sent to me through my mail. I always have one on my desk and usually I will go through one every like two or three days. Not reading all the articles, but mainly just looking at the cases they have, images that they show, their review articles, to get a little bit smarter without spending a lot of time. And as a pro tip, if you do have med students or physician assistant students, nursing students under you that you could possibly teach, see if the day before you can look up something really quickly and then try to teach it to them.  And the last thing obviously is the most important is to help yourself do well as an intern, is to really focus on patient care from start to finish. Sometimes we can segment our time of being kind of freaked out and anxious, taking care of the patient, freaked out and anxious, taking care of the patient. Make sure we're focusing most of your time, taking care of the patient, and then being okay is saying okay. Here's an element that I don't feel comfortable with, let's quickly figure out the solution, move forward, take care of the patient. And that includes things like building rapport with the patients, which I absolutely love to do. Internal medicine is definitely easier than how the specialties may allow, but the easier it is for you to get along with your patients, the easier it is to just essentially take care of as well as want to look for information in better ways that you can provide better care. But those guys are my six different tips that I've kind of come with through reflections over my last year, my first year as a physician. Hopefully you guys have enjoyed it and hopefully it helps you succeed on your first year residency as well. If you want more tips on how to succeed in residency, I want to point you to two different things. One, you know, we're starting a collection of residency tips as I'm kind of going through the experience on the MD journey, as well as the YouTube channel, so the links will be down below in the playlist as well as blog posts that we may have. And the second thing is, if you want something more in depth from start to finish, in the future, if we ever do create a resource for residents who are intern here, there'll be a link down below as well where you guys can check out. But in the meantime, you may just see a waitlist and just go ahead and add your information. I can send you more info as well as tips just like this in future videos. But if you made it so far in this video, I'm assuming you kind of enjoy the content, so go ahead and hit that like button. Drop a comment down below what other elements of residency can I help you on and what questions do you have? What things may stress you out about starting residency or are stressing you out about residency right now? Just let me know in the comments down below. And again, if you haven't joined the community by subscribing, go ahead and hit that button and go ahead and hit that notification bell. We're trying to put out two videos a week just for people who just like you. So show your love by hitting the like and subscribe button. That's it for this episode guys. Thank you so much for watching and listening on the YouTube channel, the podcast. And I will see you guys in the next video. Thanks for being a part of my journey. Hopefully, I've been a little help to you guys and yours. I'll see you guys in the next one.


What's up everybody? If you watched our last video you know what tools you should always have on you, so now it's time to test you. Watch closely for a series of pictures of different bike tools and if you can name all of those tools in order you can win a prize pack from Purefix Cycles. Ready? If you can name all those parts in order, email your answer to tools at PurefixTV.com and we'll choose three lucky winners to receive a Purefix prize pack.  Check out the rest of our episodes on our YouTube channel and tune in next week at PurefixTV.com for the latest episode. Until then, I'll see you in the streets.


If your spouse has checked out or they're even filing for divorce or want to leave One of the helpful pieces of information that I've given over the years to come to individuals who've contacted me is that Is the concept of the 180 this was created by Michelle Wiener-Davis divorce busting fame and I Have a disclaimer for it.  Oh, you're dependent. You're not dependent on me.  You don't need me and then they actually want to come back to you there's something about being needy and Dependent on them actually can push them away So we want to read a few of the different things that are in time and that this entails this 180 entails And then we can talk a little bit more about it So here's some things that are recommended during the 180. Don't pursue a reason chase beg pleader employer No frequent phone calls. Don't talk about the good points in the marriage. Don't follow Don't follow them around the house. Don't follow them to the bathroom Don't encourage discussions about the future Don't ask for family members to help out like your partner's family members to get involved Don't ask for reassurances that things will be okay. Don't try to buy your way back by giving them gifts Don't schedule dates. Don't say I love you Actually start moving on with your life. Don't just act as if but actually do it Be cheerful strong outgoing and independent Don't sit around waiting for your spouse Just you know, get busy do things go with your friends. Enjoy your old hobbies and make sure you're busy When they are still home with you, don't talk too much. Don't push any issue Even if you want to If you ask your spouse, you know, where they're going just don't ask anything be disinterested so One of the things to say is that your partner who your wayward partner They need to really feel that you've kind of gotten picture the clear this picture and wake into the fact that they're done They're serious concern. They're seriously considered leaving the relationship. So you're showing that okay fine I'm gonna just move on them without you The same time we don't want to be cold nasty or angry just pull away Don't be so available as you might Another thing is and no matter how you're feeling Try to be happy towards your spouse and content Be somebody that they want to be around if you're moody or needy or pathetic.  Don't name call. Don't be too excited either Don't argue when they share with your feelings Listen carefully to what they're saying to you Keep your mouth shut. Take care of yourself exercise sleep laugh be confident and There's a few more things here, but just keep moving forward. So I Found this is this has been quite helpful to a lot of people They found that when they've done this when they showed that they can be just kind of laid off their spouse And they can show that they can be independent Then their spouse starts feeling that oh, well You know, it's like hard to get you're they're more attracted if they if they can't just easily have you but again, you want to think about this because it is extremely hard to do and There is the risk that you know, I guess the thought is basically this if you're being threatened if your spouse wants to leave So you could either just say okay fine do what you need to do and it might look like you're kind of agreeing with them and consenting to what they want to do and Then they actually go ahead and do it So you don't want that to happen You don't want them to think that you're actually giving in or that you that you actually want them to continue to continue doing it So that is one risk that you have There's also I guess the thought that you think that maybe there is something that I can do Maybe if I work hard enough, maybe if I convince them to get help, maybe they will turn around so just to kind of check out and Not do anything and not show any interests Could show yours could couldn't you could miss out on that opportunity to save the relationship? So it's kind of a difficult call I mean, I would say that if you're in a situation where they've already filed for divorce papers and you're begging and pleading And they're not doing anything and they refuse to get help and they refuse to reconsider And you have no other course of action then in this case This might be your best course of action because there's really nothing else you can do if you're in the early stage where they're not sure what they want to do You might want to just think along hard and see is this really going to work? Or is this going to backfire? It's my spouse going to actually get it. Are they going to realize that? I'm not trying to tell them that I want them to leave But I just want to let them know that I don't you know if if they want to leave You know, I can be a big boy or big girl and I can deal with it and I can be happy and you know I don't need them. So it is something that you know, use your discretion and think about whether you're comfortable doing it and Whether there might be a possibility to get your spouse on board towards working on their relationship And if that's not the case and you have no other course of action This might be the only thing to do because you really don't have anything to lose at that point once the worst papers are filed Once they're completely done or if there's an affair a Lot of times if there's an affair it's extremely hard to get them to come back Especially when you're having that emotional attachment to somebody else. So you really have nothing else to lose So sometimes doing the 180 is really the answer We love to hear from you any of you who try this to see your experience But we have found some very positive results and we did feel it's really important to share it with you Because it is a different way of going about winning your spouse back