Since the beginning of it all, since that exact moment where I shot up from my friend's dormroom cot with a revelation to pursue my ancestral calling in medicine (see here for more on this), I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it, with terms like sub-intern, intern, senior resident and attending, it must be confusing to many where recently branded M.D.'s. and D.O.'s stand in their professional training.

Out of all the titles I've sported since picking up my first basic-science hardback from the college bookstore, the role of a medical intern appears to produce the most wrinkled noses and raised eyebrows from friends and patients alike. Are you a doctor? Good question to ask, always. When do you start residency? A very popular inquiry, indeed.

I understand the confusion. Prior to entering medical school, the only associations I had with the term "intern" were of Monica Lewinsky and a summer stint with Morgan Stanley.

Now that my medical internship has come to a close, I find it fitting to clarify the role of a medical intern and where the job title fits in the spectrum of medical training.

The Hard Facts
Yes, medical internship is in fact part of residency (with this newfound knowledge I expect a substantial number of readers to stop here). The title of medical intern is often interchangeable with first-year resident, as the role of an intern typically implies the most junior position of the residency program.

Like myself, most interns will continue to train in the same residency program for the next several years until their training in that field is complete. However, a substantial amount of interns across the nation are currently completing their internship in one program/specialty only to start their next role in a different medical program.

The reason for this program swap is that certain niche medical specialties expect a basic level of training in general medicine or surgery prior to entering their field. Think about it: no one wants his or her X-rays read by a radiologist who hasn't had at least some patient exposure to diseases that they expected to find on these films.

So yes, internships occur after medical school and are part and parcel with medical residencies.

But what does it mean to be an intern?

The Hard Truth
In earlier musings, I attempted to explain the innermost anxieties one may feel during his or her first day of a medical internship. Now that I am coming out of intern year alive (I had my doubts), it is no exaggeration to say that this year has been one of the most transformative times in my life.

During the internship interviews/clawing-for-a-job stage of my last year in medical school, the phrase "steep learning curve" often came up at least 5,000 times during each interview day. Every time the residency program director uttered these words, usually sandwiched between other such lines as "an amazing experience" and "a fun ride," I always imagined myself frolicking up a large grassy knoll, slightly out of breath while wiping some light condensation from my brow once reaching the soft peak.

Now I fully understand the meaning of a steep learning curve.

No medical textbook can prepare an intern to care for an acutely ill patient with an uncertain diagnosis. No live simulation can train an intern how to inform an entire extended family that their loved one will not survive the hospitalization let alone make it to the next holiday gathering. No humanities course can coach an intern to respect and appropriately navigate through a diverse array of cultural beliefs on disease and dying in order to deliver the best medical care possible.

Experiencing and then re-experiencing these incredibly difficult and life-changing events is the only way to leave a medical internship with enough mental conditioning to embark on the next steep curve in medical training.

Take Home Point
Although a vague and often confusing title to those outside of the medical field, the position of medical intern is a vital bridge from those just completing medical school to becoming well on one's way to independently practicing medicine.

So what does it mean to be a second-year medical resident? I'll let you know once I reach the top.

* Originally written for The American Resident Project.

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Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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