transition to residency

First Shifts: Intern Mini-Series Pt. 2

by

In Part 2 of the Intern Mini-Series, Drs. Edleda James (PGY-3) and Nick Cummins (PGY-3) continue their deep dive into intern year, focusing on the remaining core rotations and how to truly thrive during them. They reflect on experiences in EMS, anesthesiology, ultrasound, and pediatric emergency medicine, highlighting what each rotation offers, key skills to prioritize, and resources that make the learning curve more manageable. The conversation expands beyond rotations to include practical advice on studying for Step 3 and the ITE, managing time and energy, and maintaining wellness during demanding months. Throughout the episode, they emphasize perspective, relationship-building, and self-compassion as essential tools for navigating residency and growing into a confident emergency physician.

EMS

Where you learn how emergency care begins and gain deep respect for prehospital medicine.

Pearls:

  • EMS clinicians are your coworkers and learning their workflow improves ED handoffs.
  • Ride-alongs highlight the physical, logistical, and cognitive challenges of prehospital care.
  • Dispatch centers teach you how calls are triaged, mapped, and prioritized.
  • Critical care transport offers insight into mobile ICUs and interfacility transfers.
  • Relationship-building pays dividends later when you see the same crews in the trauma bay.
  • This rotation can spark interest in EMS fellowship or prehospital leadership.

Anesthesiology (with Ultrasound)

A controlled environment to refine airway skills and a time to learn foundational ultrasound skills.

Pearls:

  • You get out what you put in- be proactive about getting your reps.
  • Don’t just intubate: learn preparation, medication setup, and backup planning.
  • Bag-valve-mask technique is a life-saving skill. Practice seal and positioning.
  • Use the OR’s controlled setting to build muscle memory and troubleshoot difficulty.
  • Show up early to walk through meds and equipment before the patient arrives.
  • Ultrasound training is robust and longitudinal. Image review and feedback matter.

Pediatric Emergency Medicine

A high-volume, high-acuity pediatrics experience that builds confidence with sick and well children.

Pearls:

  • You’ll see everything from critically ill, medically complex children to low-acuity complaints.
  • You’ll often be the primary resident communicating with consultants so document clearly.
  • Child Life Specialists are invaluable for patient comfort and family support.
  • Suture techs teach more than technique. You can observe how they calm and engage children.
  • Pediatric clinical pathways (asthma, abdominal pain, ortho injuries) are excellent learning tools.
  • Skills learned here translate directly to community ED practice.

Studying & Exams (Step 3 and ITE)

A short but eye-opening rotation that changes how you think about poisoning and drug exposures.

Top Resources:

Pearls:

  • Plan early for Step 3. Intern year is often the best window.
  • EMS, OB, Tox, and Ortho may be better study months than anesthesia/ultrasound.
  • Consistency beats cramming for the ITE.
  • Pair studying with enjoyable activities (walking, climbing, downtime).
  • Didactics count and active participation is real studying.
  • EM physicians often have a natural advantage on Step 3 due to focus on acute care.
  • Be honest about your learning style and build routines around it.

Wellness & Thriving as an Intern

Your chance to get hands-on with labor and delivery.

Top Resources:

  • Employee Assistance Program
  • GME Counseling
  • GROW (Gearing Residence for Overall Wellbeing)
  • Program leadership, chiefs, and senior residents
  • RAFFT mentorship and community
  • Peer support and co-resident friendships

Pearls:

  • Perspective matters. Every rotation is short and intentional.
  • Be open to correction; you are not expected to know everything.
  • Ask for expectations and recommended resources early.
  • Build relationships with nurses, techs, CRNAs, and staff. It improves care and joy.
  • Maintain hobbies, therapy, movement, and sunlight when possible.
  • Plan trips and social events when schedules allow.
  • Lean on your people. Residency is hard, but you don’t do it alone.

Final Takeaways

  • It is okay to not be okay. Asking for help is part of becoming a good physician.
  • Intern year is challenging, humbling, and finite. It is shaping you into the emergency physician you are becoming.

Podcast: Play in new window | Download

First Shifts: Intern Mini-Series Pt. 1

by

In the first episode of the Intern Mini-Series, Drs. Edleda James (PGY-3) and Nick Cummins (PGY-3) share what it was like to begin residency and how they learned to balance the steep learning curve of intern year with personal growth and self-compassion. They share their paths to emergency medicine and experience transitioning from MS4 to intern. Finally, they walk through the major rotations of the first year, highlighting what each block teaches, helpful resources, and practical strategies for success.

Emergency Medicine Rotations

Where you start building your identity as an EM physician- learning to juggle patients, manage uncertainty, and lean on your team.

Top Resources:

Pearls:

  • Focus on forming solid habits: think through your differentials and double-check doses.
  • Learn from physicians and other team members including nurses, RTs, and pharmacists.
  • Keep a few go-to resources on your phone and actually get comfortable using them.
  • Check your university library before buying textbooks- you probably already have access.

Orthopedics

A hands-on month to get comfortable with procedures and take the perspective of ortho consultants.

Top Resources:

Pearls:

  • Practice reductions and splinting as much as possible- these are core EM skills.
  • Watch what ortho looks for: imaging, markers, mechanism, and documentation.
  • Ask questions about how they manage injuries after you hand off the patient.
  • Use this block to refine your comfort with musculoskeletal exams and joint taps.

Surgical ICU / MICU

Where you really start learning how to manage critical illness.

Top Resources:

  • EMCRIT
  • ICU nurses and respiratory therapists (invaluable teachers)
  • Fellows, pharmacists, and attendings during rounds

Pearls:

  • Focus on vent settings, pressors, sedation, and team communication.
  • ICU nurses and other team members can teach you workflow, priorities, and troubleshooting.
  • Trust your instincts- you know more than you realize.
  • Build relationships with surgery, anesthesia, and ICU teams; off-service months are great for networking and understanding hospital systems.

Toxicology

A short but eye-opening rotation that changes how you think about poisoning and drug exposures.

Top Resources:

Pearls:

  • Watch how poison-center staff and toxicologists reason through cases.
  • Don’t hesitate to call the poison center- they are a tremendous resource.
  • Follow cases beyond the ED; seeing outcomes helps connect the dots.

OB/GYN

Your chance to get hands-on with labor and delivery.

Top Resources:

  • Rosen’s and Tintinalli’s Emergency Medicine textbooks, OSU library digital access
  • Refreshers on labor terminology and fetal-heart-tracing basics

Pearls:

  • Work closely with midwives- they can help you with meeting your required number of deliveries and solidify your understanding of normal labor.
  • Learn the language of OB- it builds confidence when calling consults later.
  • Pay attention to positioning, hand placement, and what to do when deliveries don’t go smoothly (shoulder dystocia, breech presentations, etc.).
  • OB attendings are very approachable and eager to teach.

Cardiology

A great month for sharpening EKG skills and understanding what happens after you consult cardiology in the ED.

Top Resources:

Pearls:

  • Review EKGs and telemetry- repetition builds pattern recognition.
  • Understand how cardiology stratifies risk and decides on further workups (echo, coronary CT, cath).
  • Tie what you see in the ED to later care.

Final Takeaways

  • You don’t have to “drink from a firehose.” Learn it one manageable piece at a time.
  • Intern year is busy, humbling, and transformative — but completely doable.
  • Each rotation adds something valuable to your EM skill set.
  • Build relationships, ask for help often, and give yourself grace.

Podcast: Play in new window | Download