The current interns finish work this week, handing over to the newly graduated class of 2017. If you’re about to start your internship, you’ve no doubt heard from friends a wild mix of horror stories, stockholm syndrome induced ravings and hopefully at least one actual positive account of friendship and camaraderie.
I was brave (foolish?) enough to assist with organizing 2018’s intern orientation at my health service and had some brief thoughts about my previous experience with the student ⇒ doctor transition. Going to sleep Sunday as a ‘doctor’ and waking up Monday as a doctor doesn’t change you; you’ll need to grow into your role and you’ll learn a lot along the way. You’ll also learn reasonably quickly that medical school is well removed from what you actually do on a daily basis. Things tend to have a new meaning in the hospital system…
ABCD: Arrive, Blame, Criticise, Depart
The professional (and personal) development process doesn’t really require much of you as an intern, other than the right attitude. Although oversight can unfortunately be lacking at times, your colleagues expect you to ask and learn, albeit without being acopic. The best interns I’ve worked with prefaced questions with their own opinions and thoughts about management.
Your initial role as a junior doctor is very much about organisation, akin to that of a personal assistant, whereby you frantically chase and call more important people™ so that they can tell you what to write down and show another more important person™ on the next ward round. It’s a departure from what new interns typically expect (Faxes? In 2018??!) but once you adjust to this and find your feet, you’ll be able to begin writing discharge summaries practising medicine.
Some more concrete advice, beyond my big picture ramblings;
If you don’t write something down, it won’t happen/never happened
This is both advice for your daily work and a warning about documentation. It’s absolutely impossible to remember every job you need to do, every result you chased and every speciality opinion you received. Write them on an A4 piece of paper (perhaps your patient list…), your hand, an app on your phone and you’ll have a record forever.
This also applies to documenting your actions. If you talk about patient care with a registrar/family member/pharmacist and don’t write it down, it didn’t happen. They’ll forget what they said and you’ll forget you asked them. This goes double for the discharge summary – when your patient arrives in ED, the only document to receive even a cursory glance is the summary you wrote six months ago. If it’s not in there, it doesn’t exist!
The learning curve is completely unreasonable
The learning process in internship isn’t so much a ‘two steps forward, one step back’ affair as it is a ‘twenty steps forward, zero steps back because you have to be able to do all these things at once’. You’ll replace a doctor at the end of their internship, with a year of clinical experience, and the system won’t account for this. Your seniors will cut you slack where they can, but they can’t change the fact that the hospital isn’t particularly flexible; it won’t lower its requirements and grind to a halt, even though nobody ever actually told you radiology need this one special form to process your request.
There isn’t much you can do about this one (sorry!), other than to be forewarned. It does get better eventually and most interns have a moment during the year where they realise how much more efficient they’ve become. When you’re new, focus on what you can do and avoid the negativity that comes from fixating on your own inadequacies, perceived or real. Seriously, it’ll get better eventually. I promise.
You need two pens
There are so many bits and pieces of doctoring equipment, but the best advice I ever received was that all you need to bring to work is a pen. The second pen is for when your first pen gets stolen. The only other thing you may need is a stethoscope, but it’s far easier to borrow one of those than a pen!
It’s a small world and you need a favour from everybody, so be nice
Firstly, you should obviously treat everybody positively irrespective of what they can offer you. Extrinsic rewards shouldn’t be necessary for that – this is more of a warning about how it’s easy to be less than pleasant when you’re stressed, grumpy and hungry. It’s also easy to remember to always be nice to the people that have direct influence over you ie. your boss, the NUM, the theatre in-charge.
I can guarantee you, however, that your hospital is a small world. Getting a surgical whoever offside when you’re on medicine tends to cause you trouble in six months when you’re asked to get your patient onto the list or clinic that person administrates and they’re suddenly obstructive. Upsetting your IT helpdesk will backfire when you get locked out at 1630 and need to order bloods before you can leave. Please do be nice!
Internship is a wild ride
You’ll learn a lot and you’ll go from the highs to the lows (and back up!) very fast. Try to approach every rotation with an open mind, regardless of what you hear or are told. Try to get a reference from people that seem to vaguely like you, but don’t stress – everybody that went before you made it through!