Residency Tips #34-43 – Anxiety & Stress in Internship

Questions & Answers About Internship & Residency Stress

Residency tips and pearls should be a little more accessible than having to ask all of the time. Especially because there are some questions people are reluctant to ask… like about stress. Here are some coping tips for internship and residency…

No baby yet, so I had time to address some questions… One question was posed (on a forum) about extreme levels of stress and anxiety in internship and residency. Here was my response. Some of these tips and pearls come from the free report you can signup for at the right (just put your name & email in there & follow the directions… easy-peasy). Some of the other tips & strategies come from RookieDoc members-only videos. And some of the others were specific to the questioner. Anyway, check out my response and let me know if it helps you.

Also, if you have a question for me, Just Ask.


What you have expressed is ultra-common. It is, by far, the biggest thing I deal with every year from May to about October. I give talks to and provide services for new interns… I’m not going to plug my stuff here, but I am going to give you some background and a little proof that it is common.

When I started internship, I came in pretty average or slightly below average. I felt like any minute I was going to be declared a fraud & that somehow this whole medical school thing was actually a mistake. I was also immensely fearful of hurting someone.

Because of those two things – harming someone & being declared a fraud – I was always the first one in… always the last one to leave… At night I was dreaming about my patients. During the day I had palpitations, fatigue, reflux, etc. And throughout the day I was dreading any situation in which I could be called on or humiliated. Now, I wasn’t paralyzed with fear and I did my best not to show it, but I was definitely burning out.

So much so, in fact, that there was an intervention. Two attendings pulled me aside and took me under their wings.

One & a half years later I was Resident of the Year, then Chief Resident, and now I hold a prestigious position at my institution. Now the unfortunate thing is that not everyone gets attendings to guide them through it all (despite the whole idea behind our training). The fact is, you’re right, many people do talk about specific interns behind their backs. Some even pigeon-hole them into categories and give them labels that stick with them throughout their training – passed from attending to attending.

So I started giving talks to new interns and started some web sites and services. In the process, I have interviewed or surveyed well over 1100 interns anonymously and as a coach/counselor.

And guess what? Most of them list those same two top fears that I said I had. (My surveys always ask for the 3 top fears… and these 2 are the most common) Fear of harming someone is always number one… and fear of being the weakest link or worst of your peers or exposed as a fraud – almost always number two.

So what you are feeling is more common than you think. Actually, it’s probably normal.

Now, is it as intense as you describe? Not usually.

Now, on to some things to help cope…

1 – You are not alone. You know when you’re sitting around with the whole team – the students, the interns, the residents, maybe fellows, and the attending? And you know when the attending starts throwing questions out to the group? At that moment, everyone is secretly hoping they’re not called on. Everyone is eager to blurt out an answer when they know it… because they want to be absolved from answering the ones they don’t know. (Incidentally, because of this fear, I always start with the students, then the interns, then the residents when I’m asking questions to my team)

2 – The 10-Year Litmus Test. Ask yourself, “10 years from now, will any of this matter?” And the answer is no. It will not.

3 – Strengthen Your Strengths. This might sound like an odd suggestion & maybe even unrelated, but it is not. Most people are worried sick about their weaknesses. But think about this… How are you going to stand out? How are you going to provide the most value to your program? How are you going to forge the career you want, that’s in line with your passions and goals? Do you think you will do these things by working on your weaknesses? No.

If you want to stand out… If you want the people around you to say good things when you’re not there… If you want to like the company you keep… and if you want to make an impact in your patients lives or even on the world at large…

Then you should strengthen your strengths. Provide value to your program and your patients and your fellow interns with the areas you are strong in. (Related to medicine or not)

4 – Compare Yourself To Yourself. Too many of us worry where we stand relative to someone else. Like you said, “i will compare myself to my class mates and convince myself that they are all so much better than i am”. You are comparing what you know of yourself to what you do not know of others. You have no idea what they are thinking… what their fears are… or even what attendings think of them… or the vibe that patients get from them… or whatever. The best comparison to make is “This is where I am now – am I better than a few months ago? And how much better do I want to become?”

5 – You Are Not At The End Of The Road. Just because you are a doctor doesn’t mean that you are done. You are not at the “end of your training journey”… you’re right in the middle of it. You’re in the middle of the process. Trust the process a little bit.

Thousands of interns have come before you and thousands will come after you. All have their strengths and their weaknesses. This process helps make those weaknesses into competencies (maybe even strengths depending on you and your program). But the ultra-successful ones will be the ones who leverage their strengths.

So trust the process and add value along the way.

6 – It’s All About Communication. It’s not about knowing the right answers or even ordering the right tests the first time around. Those things come with time.

The best doctors are the best communicators. (By the way, so are the best wives, husbands, parents, etc) More on this another time.

7 – Avoid Complainers – Steer clear of complainers. Complaining is infectious. And whining will get you nowhere.

8 – Avoid the backbiters.

9 – Laugh a little bit. Check out sites like GiggleMed.com’s Medical Humor Blog, Placebo Journal and Q-Fever. But find humor only in appropriate things related to work – not in individuals or demeaning things.

Anyway, I hope this helps.