Beyond July: How Leadership Can Sustain PGY-1 Success Through Fall

When July ends, many breather a sigh of relief. Orientation is over, the interns are (mostly) acclimated, and the year has officially begun.

But by August or September, a different reality often emerges. The so-called “August wall” hits: fatigue sets in, imposter syndrome reappears, and the initial buzz can feel distant. For many first-year residents, the early momentum slows and without intentional support, that shift can shape their entire training experience.

Why the “August Wall” Isn’t Just a Phase

• Burnout starts quietly: It’s not always dramatic. It’s the intern who starts working longer hours than necessary, or the resident who stops asking questions.

• Social isolation sets in: The newness wears off, and the camaraderie built during orientation doesn’t always carry over when shifts get full again.

• Learning plateaus: Without feedback, learning stalls or worse, dips.

What Real Support Looks Like in Months 2-3

1. Weekly low-stakes check-ins

   1. Not an evaluation. Not “How are your metrics? Just:

      How did last week feel? What did you wish you had more support with?

   2. These moments build trust, normalize vulnerability, and catch small issues before they grow.

2. Peer buddy systems

   1. Pair interns: peer support is powerful

   2. Encourage monthly “coffee Chat” check-ins to build relationships and reduce isolation.

3. Psychological safety for all

   1. Leadership must message and model openness.

   2. Admit when things didn’t go as planned, as ask for ideas instead of assigning blame.

4. Refresher learning opportunities

   1. A half-day simulation, a journal club devoted to a challenging topic: these can reignite momentum and normalize lifelong learning.

Leaders on the floor

1. Regular walk-rounds. Not just for compliance, but for curiosity.

   “What surprised you this week?” ‘What felt harder than it should?”

Resilience in medicine begins with spaces that allow residents to be fully human

Have you created those spaces yet?

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Try This Checklist

Build one low-barrier support into your PGY-1 structure in the next 4 weeks:

• Schedule weekly informal check-ins with interns

• Pair up a peer-buddy for each intern

• Plan a mid-summer learning event (simulation, journal club, skill refresher)

• Block 1-2 hours for leader rounding- not for metrics, but for conversation

• Share with your team: “Here’s what we’re checking in on-mental health, question fatigue, and support needs”

You don’t have to redesign residency to move the needle. Just show up with intention and watch what unfolds.

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Also, today happens to be my birthday 🎉. If my reflections have been valuable, a small coffee or note of support or sharing my Substack with someone who’d love it would make my day! Small acts of support mean so much. https://coff.ee/withsophiag