Your intern year is exciting, daunting and challenging all rolled into one. If you’re about to embark on yours, two recent Queensland interns – Bernie Little (left) and Edd Pepperell – have a host of lessons learnt and tips to share to help you.
What are some of the biggest lessons you learnt as an intern?
The first is you’re not alone! Every intern is taking the same big step from medical school. Try and make friends with your peers, as it makes the year much easier when you have them to rely on and share the experience with.
The second is to never be afraid to admit you don’t know how to do something. Patient safety is much more important than your pride!
My third lesson learnt is to always be open to learning new skills. One great way is to ask your seniors questions – they have a lot of knowledge to impart.
The first lesson is time management. As an intern, you quickly learn you’re expected to do many jobs simultaneously. These include finishing ward round notes and plans, writing discharge scripts, charting medications, calling consults, ordering investigations – not to mention resiting a cannula that you’ve just found out tissued four hours ago, causing the patient to miss crucial IV antibiotics doses!
To keep your day as peaceful as possible, prioritise discharges above all else (except emergencies), and try to call consults before lunch time. You’ll work out a system for everything else in time.
Another big lesson is to ask for help early. As a ‘baby’ doctor, you generally don’t make any huge treatment decisions. However, you DO have a responsibility to escalate things that could be concerning. If you notice something isn’t quite right with one of your patients, tell your registrar ASAP. Your day will be far less stressful than if you sit on the problem yourself, constantly checking in and hoping things don’t get worse.
What was your first week and month like?
The first week was a bit daunting! Everything was new and unfamiliar but thankfully, the senior staff were also interns once upon a time. For the most part, they remember how overwhelming it can feel. From my experience, if you ask for advice early, people are happy to help you find your feet.
Looking back, the first month was probably the hardest. There’s a lot to learn – ward round expectations, charting medications, hospital protocols/guidelines, finding your way around the hospital, and remembering all those new faces! But after a month, I think you start to find your feet. Strangers in the corridors become familiar smiling faces, and making referrals becomes easier as you get to know the people you’re speaking with.
I was lucky my first week was pretty easy. I started on anaesthetics and it was a very well-supported rotation with keen supervisors who were approachable and loved teaching.
After my first month, I was thrown onto one of the surgical wards and this was far more stressful, as you can sometimes be the only doctor on the ward. With so little experience at that point, it was slightly terrifying at times.
When did you feel like you had things under control?
Every new rotation brings new and unique challenges. There was inevitably a new skill or term requirement I hadn’t learnt or mastered yet, so in that sense, I never felt fully under control.
However, as the months progress, you begin to develop some structure around how to address and/or problem solve issues or areas you aren’t as familiar with. You learn who you can speak to for assistance, and what resources to draw on.
After around three to four months, I felt a lot more comfortable. By that time, I was on my general medicine rotation, I had a bit of ward experience and some super supportive registrars and consultants, and was really enjoying a great collegial environment with fellow residents.
What areas did you struggle with the most and what tips can you offer to overcome them?
Initially, learning what tasks needed prioritising and which ones might take more time to complete was something I struggled with. Sometimes the simplest of jobs took the longest due to various factors like staff availabilities.
One tip is to use the ‘divide and conquer’ approach with fellow interns/residents. On ward rounds for example, allocate one to write notes and one to do other jobs along the way, like requesting investigations or making referrals. After the round, meet up to split any further difficult and time–consuming tasks evenly. I found dividing the workload within the team really made my day run smoother.
I also struggled with being able to feel useful in MET calls/code blues. As a medical student standing in the corner of such calls mere months before, I suddenly found myself at the end of the bed reviewing a deteriorating patient.
It was quite daunting but it’s important to know help is never far away. You have skilled nursing staff with years of experience, other doctors on the wards who are happy to review a patient with you, and the medical emergency team are always close by.
I definitely struggled with juggling multiple jobs and expectations at the same time. While time management is key, it’s also worth reminding yourself that you do have worth as an intern (despite being at the bottom of the totem pole!).
You can say ‘no’. So for example, if it’s 10am and you’re prioritising discharges, and a nurse asks you to chart medications for 6pm or to do a discharge summary for tomorrow, you can politely say that you’re too busy right now.
In the beginning, most of us try too hard to please, and say yes to everything, dropping what we’re doing (and losing our trains of thought) in the process. This not only impacts on our efficiency, it can also lead to patient errors. One practical way of dealing with this is to use a notebook, jotting down a list of non-urgent jobs to do before you go home.
The other big struggle is feeling alone on the ward – “Oh my God, what if a patient starts dying?”. You’re not alone, and there are always things you can do. If a patient is imminently unwell, the nurses will know, and you are well within your rights to make a MET call. For everything else, there’s always something small you can do before panicking, for instance:
- Tachypnoeic on the surgery ward? Check pain relief
- O2 stats a bit crummy? Sit them upright, encourage deep breathing, try 2 L/min of O2
- Unexpected fever? Check lines/devices, listen to chest, CXR, blood cultures, urine M/C/S
Were there any unwritten rules and expectations you wish you’d known about upfront?
It is expected you follow through on tasks and advocate for your patients in a busy hospital where things can slip through the cracks. A follow-up phone call for important investigations is critical to help fellow staff understand why your patient needs to take priority. For example, the urgent MRI form you filled out and sent off – was it actually received? Will the patient get it today like your consultant wants?
Another part of advocating for them is to ensure your patients have a well-documented management plan before you leave for the day. At the very least, hand over concerning patients directly to your colleagues, who will then be responsible for them overnight.
Ordering investigations is very hospital-dependent. Some just need ordering in iEMR, some need iEMR order + consultant co-sign, some need approval via phone call from radiology or nuclear medicine. The best course of action is to ask your senior residents for advice.
Be mindful of your mental health
At times, juggling competing demands and a large workload can lead you to doubt your abilities during your intern year. But as Edd quite rightly points out, passing medical school proves you are good enough.
He also says that if you are struggling and your peers seem not to, try not to compare how you feel to how others appear. His advice is to chat to your friends and family early, debrief with peers or colleagues, and try to soldier on. If you’re really finding things difficult, chat to the medical education team and get some help, as there always is a way forward.
Check out part two in our intern tips series. Edd and Bernie share more advice on how to handle night shifts, ward rounds, deal with senior staff and more.