D. Joanna Kim, MD
May 22, 2026
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What I Wish I Knew Starting PGY-1
I still remember being nervous to put in my first Tylenol order on day one of intern year – everything was new, from Epic to the hospital layout. You might feel lost, confused, overwhelmed, or all of the above. Everyone tells you residency is like “drinking from a firehose,” and at times, it really does feel that way. There are certain things I wish I had known starting PGY-1 year, and below are a few that might help along the way.
1How to Be Efficient
Certain tasks will take longer at first, but learning from those experiences and becoming more efficient each time will go a long way. Having a system to tackle tasks in an organized and structured manner helps tremendously.
For instance, I have my Epic set up so I can go through vitals, recent medications, active orders, and I/Os in four simple clicks. This streamlines pre-rounding and chart review. Set up your dot phrases for common handoffs or frequently used notes. Learn how to create order sets so your pre-op and post-op orders are simplified. Small tasks pile up quickly, and saving even one or two minutes on each task really adds up over the course of the day.
2How to Prioritize
Sometimes it feels like you are being pulled in a million directions. You may be in the middle of one task when an Epic message pops up with another request, or you may be writing a note while getting texts from your senior asking for updates.
One mistake I made early on was stopping the task at hand to immediately address something else. More often than not, this disrupted my workflow and caused tasks to get forgotten until later in the day. I found it more efficient and less disruptive to finish the current task first whenever possible. Unless something is urgent or emergent, try to complete what you are doing and then move on to the next priority.
3How to Communicate
Speaking of prioritizing, communication goes a long way. If something is delayed, a simple “Thank you – I’ll get to it in the next five minutes” or “I’ll get to it as soon as I can” can ease anxieties and set expectations.
When performing a procedure, communicate with the nursing team regarding timing and any pre-medications needed. This helps involve the entire care team and ensures everyone is aware of the plan and any updates. Be clear in your notes regarding assessments, plans, and pending workups that need follow-up. If there are active workups or ongoing plans, starting a group chat with the primary team or nursing team early in the day can help keep everyone on the same page. Always update families as needed and involve your senior if you do not know the answer to a question.
If you make a mistake – such as placing the wrong order, missing a lab, or forgetting a task – the important thing is knowing how to respond. Own mistakes early, tell someone if you are unsure, fix problems when able or escalate them to your senior, and learn from the experience. Building trust and rapport with patients and team members starts with communication. It shows that you are safe, reliable, and able to follow through.
4How to Study and Prep for Cases
Everyone has different study methods. I wish I had figured out earlier how to study for the OITE and prepare for cases – it is a skill that takes trial and error.
Take advice from your seniors regarding study materials and try different resources to figure out what works best for you. Whether it is Orthobullets questions, the ROCK curriculum, ResStudy, Miller’s textbook, or other resources, learning how to study efficiently and consistently will help with both knowledge retention and in-training exams.
During OR days, take notes regarding setup, positioning, equipment, exposure, surgical steps, notable anatomy, closing sutures, and attending preferences. Start building a living document for each attending’s preferences and surgical workflow and continue adding to it throughout residency. This becomes incredibly helpful when you return to a service and already know how to prep and set up for cases.
PGY-1 year is everything at once: hard, busy, humbling, exhausting, stressful, immersive, exciting, adaptive, and full of learning. It is the beginning of one of the best learning experiences of your life – alongside your residency family, the people you will spend countless hours learning and growing with together.
DISCLOSURES: Dr. Kim This individual reported nothing to disclose.
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