Your First 90 Days as an Intern: Month-by-Month Workload Adjustment Plan

The first 90 days of internship will break you down and rebuild you.
If they don’t feel hard, you’re probably missing something.

This is not a mindset problem. It’s a load problem. The job is too big for one brain until you grow into it. So you don’t “tough it out.” You phase in your capacity.

Here’s a month-by-month, week-by-week, and zoomed-in daily plan for how to adjust to the workload without burning out or becoming unsafe.

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Big Picture: Your 90-Day Curve

At this point you should understand the shape of the year: it’s front-loaded misery with a slow ramp to competence.

Perceived Workload vs Competence in First 3 Months

Category	Perceived Workload	Self-Rated Competence
Week 1	9	2
Week 2	9.5	2.5
Week 3	9	3
Week 4	8.5	3.5
Week 5-6	8	4.5
Week 7-8	7.5	5.5
Week 9-10	7	6.5
Week 11-12	6.5	7.5

Roughly:

• Days 1–7: Survival and orientation
• Days 8–30: Controlled drowning, learning patterns
• Days 31–60: Systems mastery, speed upgrade
• Days 61–90: Owning your list, anticipating problems

Your goal isn’t to feel good.
Your goal is a safe, sustainable upward curve in how much you can handle.

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Month 1 (Days 1–30): Controlled Survival Mode

You’re not here to be impressive in Month 1. You’re here to not harm anyone, not implode, and to build reliable habits.

First 30 Days Milestones

Period	Event
Week 1 - Day 1-2	System and workflow orientation
Week 1 - Day 3-4	Take partial patient load
Week 1 - Day 5-7	Own full but light list with close oversight
Week 2 - Day 8-10	Learn night float/page workflow
Week 2 - Day 11-14	Standardize prerounding and notes
Week 3 - Day 15-18	Handle admissions with supervision
Week 3 - Day 19-21	Learn cross-cover style for your service
Week 4 - Day 22-26	Increase patient load gradually
Week 4 - Day 27-30	Identify and fix recurring bottlenecks

Week 1: Systems, Not Speed

At this point you should:

• Stop obsessing about being fast.
• Ruthlessly focus on not missing dangerous stuff.

Daily structure (template)

• 04:45–05:15 – Wake, shower, caffeine
• 05:30–06:30 – Preround: vitals, I/Os, labs, quick exam on sickest 3 first
• 06:30–07:30 – Finish preround + draft plans, one-line summaries
• 07:30–09:30 – Team rounds
• 09:30–12:00 – Orders, pages, discharges, calls
• 12:00–13:00 – Eat. Sit. If you can’t sit to eat, something upstream is broken.
• 13:00–17:00 – New admits, follow-ups, notes
• 17:00–19:00 – Sign out prep, last checks, sign out

First 3–5 days, your only real goals:

• Learn:
  • How to place every common order in the EMR (labs, imaging, diet, nursing orders, DVT ppx, insulin).
  • Where people actually are: phlebotomy, radiology reading room, case manager, blood bank.
• Build:
  • A templated note for your main service (IM, surgery, OB, whatever).
  • A pre-round checklist you follow blindly until it’s automatic.

Example AM pre-round checklist (internal medicine style):

• Open patient list
• For each patient:
  • Skim overnight events + nursing notes
  • Check vitals, pain scores, I/O
  • Labs/imaging results and pending
  • Med rec: new meds started, any high-risk drugs
  • Brief exam focused on: mental status, lungs, heart, edema, abdomen
  • One-line summary + 3-bullet plan in your notebook

Do not try to “remember it all.” You won’t. Write it all.

Week 2: Standardizing Your Day

Now that you can basically find things, you shift to making every day look the same.

At this point you should:

• Have a consistent rounding order (by location, then by acuity).
• Be using the same structure in every H&P and progress note.
• Be asking your senior, every single day:
  “What did I do today that slowed us down?” and “What can I batch better?”

Common Week 2 upgrades:

• Batch your EMR time
  • Don’t click labs 40 times. Open all patients, then check labs for the whole list at once.
  • Same for reviewing imaging, placing routine orders, updating problem lists.
• Script your most common calls/pages
  Examples:
  • For “pain uncontrolled”: exact questions + standard order patterns.
  • For “patient hypotensive”: focused checklist in your head—confirm vitals, symptoms, recent meds, fluids, lines, bleeding, sepsis flags.

Week 3: Taking Real Ownership

You’re still new, but you’re no longer fragile-new.

At this point you should:

• Be able to present your patients clearly without your senior rescuing you.
• Write most progress notes in 5–7 minutes each, not 20.
• Carry a “normal” intern list for your service (often 6–10 patients dayshift on a busy IM service, more/less depending on specialty).

This is the week to:

• Start anticipating:
  • “This person will need SNF → loop case manager early.”
  • “This creatinine is creeping up → adjust meds today, not tomorrow.”
• Learn discharge workflows:
  • Med reconciliation fast and safe.
  • Follow-up appointments.
  • Standard instructions for your common diagnoses (CHF, COPD, post-op wounds, etc.)

Week 4: Fixing Your Bottlenecks

By week 4, your weak spots are painfully obvious.

At this point you should:

• Be able to name three specific workflow problems you keep hitting:
  • Example: notes always lag until 4 p.m.
  • Example: constantly behind on discharges.
  • Example: you get crushed by pages between 10–12.
• Have a clear plan with your senior/attending to address them.

Tactical changes you can make now:

• Move discharge planning as early as possible:
  • Pre-write discharge summaries the night before when appropriate.
  • Put “possible discharge today?” in your morning script.
• Use micro-handoffs:
  • Loop in nurses early: “I’m hoping to discharge 12A before noon; anything we can set up now?”
• Protect 30 minutes post-rounds:
  • Do not let anyone pull you into something else until:
    • All critical orders are in
    • All stat labs/imaging are ordered
    • Sickest patients rechecked

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Month 2 (Days 31–60): From Surviving to Efficient

Now your brain isn’t screaming all day. Time to increase capacity and reduce cognitive load.

Weeks 5–6: Deliberate Speed Upgrade

At this point you should:

• Stop adding “more effort” and start adding structure and automation.
• Know your most common 5–10 diagnoses cold for your service.

This is where you introduce standard operating procedures (SOPs) for yourself.

Scenario	Your Personal SOP Focus
New CHF admission	Fixed admission checklist & order set
New fever overnight	Workup steps & when to call senior
Pre-op clearance	Standard history, labs, consults
Hyperkalemia	Stepwise treatment and recheck timing
Safe discharge	Med rec, follow-up, red-flag teaching

You don’t reinvent them every time. You reuse the same pattern, adjust for the person.

Concrete weekly goals here:

• Cut your average progress note time by 25–30%.
• Reduce the number of times your senior has to:
  • Correct your plans
  • Tell you you missed labs or imaging
  • Reorient your presentation

How to do it:

• Time yourself. Literally:
  • One day: “How long did morning prerounds take? Notes? Discharge paperwork?”
  • Next day: aim to trim 10–15 minutes from the worst chunk by batching and restricting EMR wandering.
• Build 3–5 smartphrases/templates in your EMR:
  • For H&P, daily note, discharge summary, post-op check, cross-cover event.

Weeks 7–8: Managing Higher Complexity

This is where you stop thinking in isolated tasks and start thinking in the list.

Patient Load and Task Complexity Over First 8 Weeks

Category	Low-complexity tasks	Moderate-complexity tasks	High-complexity tasks
Week 1-2	8	2	0
Week 3-4	7	4	1
Week 5-6	5	6	2
Week 7-8	3	7	4

At this point you should:

• Routinely handle:
  • Multiple sick patients at once (e.g., one in step-down, one borderline in the ED).
  • Admissions during the day while managing a full list.
• Start to triage your own attention:
  • Sickest first
  • Time-sensitive discharges early
  • Stable but complicated tasks later

This is where you refine your list management system:

• One master list (paper or digital), updated:
  • Immediately after rounds
  • After each significant event (new imaging, code, transfer)
• For each patient:
  • 1-liner
  • Today’s 3 must-do tasks
  • Pending studies + who’s responsible for following them

You should also:

• Start recognizing which things can safely wait:
  • Non-urgent med changes
  • Chronic issue discussions
  • Optimization that won’t change same-day care
• And which never wait:
  • New chest pain, new neuro deficit, true hypotension, mental status changes, rapid O2 needs.

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Month 3 (Days 61–90): Owning Your List

By Month 3, you’re no longer “the new intern.” The grace period is fading. Expectations go up.

Weeks 9–10: Anticipation and Prevention

At this point you should:

• Be comfortable running the list with minimal prompting.
• Begin predicting which patients might decompensate or need ICU transfer.
• Start calling consults with a clear, concise story.

This is the “see around corners” phase.

Your daily mental checklist for each patient:

• What can go wrong in the next 24 hours?
• What can I do now to make that less likely?
• If things go bad at 2 a.m., what information or orders should already be in place?

Examples:

• Borderline O2 needs?
  • Early RT consult, standing nebs, wean plan, clear notify parameters.
• Delirium risk?
  • Sleep protocol, minimize lines, reduce restraints, family involvement.

You’re also starting to:

• Teach the medical students or observers (briefly, concisely).
• Handle low-level social friction yourself: difficult families, annoyed nurses, confused consultants.

Weeks 11–12: Running Like a Junior, Not a Student

By the end of 90 days:

At this point you should:

• Present clearly, propose plans, and accept feedback without falling apart.
• Handle a typical call pattern for your service without panicking.
• Know when to call for help, and do it early—not when the BP is 60/40 and the patient is gray.

This is when your seniors start to “trust-but-verify” rather than “hover-and-rescue.”

You’re expected to:

• Pre-round faster but more focused (sickest, newest, most complex first).
• Anchor discharges:
  • Identify them early
  • Push the process
  • Clear obstacles (PT/OT, social work, insurance)
• Maintain personal sustainability:
  • You’ve found some rhythm for sleep on your rotations.
  • You have a pre/post shift micro-routine that keeps you sane.

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Micro-Level: Daily and Weekly Checklists

You don’t grow by vague reflection. You grow by tight feedback loops.

Daily: 10-Minute Post-Shift Reset

At this point, every day, you should take 10 quiet minutes before you leave the hospital (or before bed if you must) and run through:

1. Three questions

   • What did I do today that made the team faster or safer?
   • What did I drop or almost drop?
   • Where did I feel that “I’m lost” feeling?

2. Two decisions

   • One workflow tweak for tomorrow (e.g., “Check all vitals before leaving the workroom in the morning”).
   • One thing to ask your senior about (“Can you watch me call this consult?”).

Weekly: 20–30 Minute Self-Debrief

Once a week—ideally on your lighter day—you do a quick structured review.

At this point each week you should:

• List:
  • 2–3 clinical situations you handled well
  • 2–3 that felt messy or out of control
• Ask:
  • What pattern do these share? Time of day? Type of patient? Specific task (discharges, codes, consults)?
• Plan:
  • One learning target for the coming week (e.g., “diabetic ketoacidosis ICU management basics”).
  • One workflow target (e.g., “finish all notes by 4 p.m. at least 3 days this week”).

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When Things Start to Break (Because They Will)

You will hit a wall. Usually around weeks 3–5, and again around weeks 8–10.

Common signs:

• You’re constantly staying 1–2 hours late just catching up on notes.
• You dread going in, not because of work, but because you feel out of control.
• You’re snapping at nurses or co-interns.

At this point you should not just “try harder.” You should:

1. Grab your senior and be explicit:
   • “I’m drowning in discharges and notes. Can we walk through my day and see what I should change?”
2. Ask for targeted help:
   • “Can you show me how you prep for rounds?”
   • “Can I shadow you for one admission and then you shadow me for the next?”
3. Use your program’s resources:
   • Chief residents, mentor faculty, wellness/program director if things are really going sideways.

This is not weakness. It’s the difference between interns who plateau early and interns who keep climbing.

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Quick 90-Day Progress Snapshot

Here’s how your responsibilities shift over the first three months.

Timeframe	Primary Focus	What You Should Be Doing
Days 1–7	Orientation & Safety	Learn systems, follow checklists, over-communicate with senior
Days 8–30	Building Habits	Standardize notes, solidify prerounds, handle full but supervised list
Days 31–60	Efficiency & Volume	Faster notes, more admissions, anticipate problems, call smarter consults
Days 61–90	Ownership & Anticipation	Run your list, predict issues, teach students, manage complex days

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Final Thoughts

Three points and you’re done:

1. The first 90 days are not about proving you’re brilliant; they’re about proving you’re reliable and safe.
2. At every stage—week 1, week 4, week 9—you should be tightening your systems, not just trying to “work harder.”
3. When you feel overwhelmed, that’s a signal to change the workflow, not your worth. Adjust the system, ask for targeted help, and keep your curve pointed up.