Intern year is the steepest learning curve of your career. This free physician-written guide covers what to do before July, practical survival tips for the wards, work-hour rules, USMLE Step 3 timing and extra advice for international medical graduates (IMGs).
A presentation designed to discuss essentials for Intern year.
Live Presentation and Q&A with Dr. Irfan S. Sheikh, MD
Every program is different, but most interns go through the same four phases. Knowing what is coming makes each one easier.
Check overnight events, vitals, labs and new results the same way for every patient. A consistent template saves time and prevents missed findings.
Use a structured hand-off such as I-PASS. Say clearly what to watch for overnight and what to do if it happens.
Keep one running list per patient and tick tasks off as you go. When you are paged, write it down before you forget.
Nobody expects an intern to know everything. Calling your senior early is a sign of safe practice, not weakness.
Nurses, pharmacists and case managers will teach you more than any textbook. Treat them as partners and they will have your back.
Focus on the assessment and plan. Avoid copy-forward errors and update every note each day.
Look up one question from each patient. Ten minutes a day adds up and prepares you for Step 3 and boards.
Ask your senior or attending mid-rotation what you should do differently. Small changes early make a big difference.
Keep healthy snacks and water with you, use your days off to recover, and never drive home if you are dangerously tired.
Keep in touch with family, friends and co-interns. Talk to someone when things feel heavy. You do not have to do this alone.
ACGME-accredited programs must follow common clinical and educational work-hour limits. Your program may have stricter rules.
| Rule | Limit |
|---|---|
| Weekly hours | No more than 80 hours per week, averaged over four weeks (including in-house call and moonlighting) |
| Days off | At least one day in seven free of clinical work and education, averaged over four weeks |
| Longest shift | 24 hours of continuous work, plus up to 4 hours for hand-off and education |
| Rest after 24-hour call | At least 14 hours free after 24 hours of in-house call |
| Time between shifts | Should have 8 hours off between scheduled work periods |
| Moonlighting | PGY-1 residents are not allowed to moonlight |
Based on ACGME Common Program Requirements (Section VI). Always check your program's own policy.
Insurance, discharge planning, consults and documentation work differently in the US. Ask your senior to walk you through a full admission and discharge in your first week.
Speak slowly, confirm orders by repeating them back, and use plain language with patients. Teach-back helps patients and protects you.
Keep copies of your documents and note every renewal date. Ask your GME office early about anything you are unsure of.
Many programs expect residents to pass Step 3 during PGY-1 or by a set point in PGY-2. Book it on an elective or lighter rotation and give yourself time for a possible retake.
Programs that sponsor H-1B visas usually require Step 3 to be passed before they file the petition. If you need an H-1B for PGY-2 or a future fellowship, plan Step 3 early. Our USMLE guide has more detail.
Talk to a Resiyay physician advisor about your intern year, Step 3 timing or planning ahead for fellowship. Real advice from doctors who have trained in the US.
Intern year is the first year of residency, also called PGY-1 (postgraduate year 1). It is when you start working as a doctor in a US hospital under supervision.
In ACGME-accredited programs, residents can work up to 80 hours a week, averaged over four weeks, with at least one day off in seven. Actual hours depend on the specialty and rotation.
No. ACGME rules do not allow PGY-1 residents to moonlight.
Most residents take Step 3 during PGY-1 or PGY-2, often on a lighter rotation. If you need an H-1B visa, you will usually need to pass Step 3 before the visa petition is filed.
That is very common. Talk to your senior, chief residents or program director, and use your program's wellness or employee assistance services. In the US you can call or text 988 at any time if you are in crisis.
Physician-led residency and fellowship advising for international and US medical graduates. Our advisors have been through the US Match and help you build a stronger application, prepare for interviews and match with confidence.
Founded by Dr. Tabassum Fayyaz, MD
