workCongratulations on matching into emergency medicine! We are glad to have you. The journey you are about to embark on will be equal parts grueling and rewarding. You will be pushed to your limits but you’ll see and do some amazing things along the way. Excelling at internship and residency and fulfilling your potential goes beyond taking good care of patients. You will be expected to thrive in work and life. In this 2-part blog series we will cover some basics for internship survival, including professional development, life logistics, and wellness. To begin, we will focus on work–from finding a mentor to managing your emails.

Measuring success

The biggest challenge of intern year is realizing you are no longer the big fish in a small pond. You join a class of individuals that are all uniquely gifted, hard working, and committed. It’s okay to be confident, and also okay to be scared. Going forward, there will be bad outcomes even though you did everything by the book. There will be feelings of insecurity, guilt, and frustration. You will feel misunderstood and labeled simply because you are ‘the intern’. The worst thing you can do when faced with these challenges is internalize and compare. The race starts out staggered but we all finish together.

  • Do an honest assessment of your skill set.
  • Work directly on areas that you feel are lacking.
  • Pay special attention to the intangibles such as overall workflow, and communication with patients and nurses. Improving in these areas early pays huge dividends later on.
  • Watch your seniors closely because they all have figured out their own way to get over these obstacles and emulate those that you mesh with.

Shift work

Shift work sleep disorder is a noted phenomenon and a medical diagnosis in ICD10. Establishing proper sleep hygiene early is paramount and one of the best ways to combat the disorder. This is something we could spend hours talking about but we will cover the basics for now:

  • A drop in core body temperature is a key signal for the body to get into sleep mode, so have a quiet, slightly cooler, and dark environment to sleep in.
  • Avoid blue light devices near bed time and do not work in your sleep area.
  • Avoid caffeine and alcohol prior to sleep.
  • Consider meditation or guided imagery to allow your mind to relax if you have a problem with racing thoughts and restlessness.

Email burden

workEmail is the primary form of communication when it comes to all things academic. Many programs have integrated office workspaces like Slack into their communications but the emails will never go away fully. Here are some tips for managing the email burden so you don’t miss something important:

  • Minimize your active accounts. Most of you have one or two personal accounts, a medical school account, and now yet another email domain.
    • Cut out accounts you don’t really need.
    • Centralize your existing accounts into one account through forwarding. This will allow you to stay up to date on email without having to log in to three different accounts at all times.
  • Differentiate your email by types, as per David Allen’s Getting Things Done. This is key to inbox zero:
    • If an email is just a clarification or a scheduling type of email, answer it immediately and be done.
    • Add all your commitments to your calendar right away so you are not hunting for emails from months ago to tell you where and when your orientation/lab/in service is.
    • If the email requires a significant response and you do not currently have time for it, be sure to flag it and set a reminder for yourself to get to it at your earliest convenience.
    • Creating subfolders for emails you need to keep around for lecture items, logs, receipts, references, or outstanding action items.
  • When responding to emails, be concise and efficient with your wording. Keep it short and sweet so the information is not lost by the reader.
  • Do not to go overboard with checking your email as it can be a major distraction and a downright addiction.
    • Disable pop up notifications on your phone when you need to be focused.
    • Check your email twice a day
    • Set a cap on how long you will spend working on emails so it does not detract from your main duties.

Choosing Projects

In residency there are endless opportunities available to you. While it’s good to try a variety of projects, be careful not to overcommit. Residency is harder than medical school; make sure you build a good foundation before developing your niche. Once you have a handle on residency, then you can explore.

  • Start by joining the major national EM organizations (EMRA, AAEM, ACOEP, SAEM).
    • Each of these organizations has interest groups and committees that residents can serve on. This is a great way to find out about projects that may interest you as well as network with other EM physicians with similar interests.
  • Consider getting involved locally
    • Work with local EMS crews on educational days
    • Offer to help out the EM interest group at the local medical school
    • Ask your chiefs if there are any open projects
    • Join a specialty track
      • Many residency programs have tracks in place for residents with interests in education, administration, ultrasound, EMS, Wilderness, etc.
    • Join a hospital committee
      • All residents are required by ACGME to serve on a hospital committee. Why not pick something that interests you instead of just checking a box?

As you begin adding projects to your plate, be conscious of your time. Only say yes to things you are truly excited and passionate about. While it is important to keep doors open, your primary job is to be a resident. If you are too bogged down you likely won’t be able to give a project your best effort anyways. Also, be honest with yourself; if you don’t have the bandwidth for something new at that specific time you can always offer to do it in the future. You will thank yourself later!

Finding a Mentor

Mentors are crucial for growth. Studies have shown higher levels of career satisfaction and promotion associated with mentorship during the early stages of a career. A mentor can be your voice of reason, cheerleader, confidante, and a positive example to emulate. Finding a mentor is a proactive process and one that you should start once you are settled in and ready to start exploring your field.

  • Important factors to consider are:
    • What you are looking for from your mentor?
    • What subspeciality or area of interest appeals to you?
    • How does your personality mesh with theirs?
  • It’s ok to have multiple mentors.
  • Consider a mentor outside of your institution. Many of the national organizations (SAEM, EMRA) have strong mentorship programs.
  • Contact potential mentors directly and set up a meeting
  • Come to the meetings prepared with an agenda to make efficient use of both your time.

Don’t forget to mentor someone yourself once you’re in a position to do so. Being able to positively impact a student or intern’s training and helping them reach their goals directly increases your happiness and can help avoid burnout. It also provides a wonderful perspective and allows you to see your own growth.

Stay tuned for the second post in this 2-part series, and welcome to the specialty!

Vishnu Mudrakola, DO

Vishnu Mudrakola, DO

Attending physician, Licking Memorial Hospital
Vishnu Mudrakola, DO


Emergency Medicine resident. Interests in FOAM, POCUS, and teaching. Motorcycle enthuasiast.
Vishnu Mudrakola, DO

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