So you’re about to embark on your intern year. While you’re likely keen to get going, you may also feel a tad trepidatious about what to expect, and how best to navigate your first hospital year.
To help you out, two Senior Medical Education Officers – Samantha (Sam) Ward from Toowoomba Hospital and Christina Kapitsalas from Redcliffe Hospital – share their insights and key tips for intern success.
You’ll have more support than you may realise
When it comes to hospital resources and those you can ask for help, Sam says your options abound.
“Your support team consists of many people. Nurse unit managers, senior nurses, pharmacists and allied health professionals are all excellent resources to draw from, as well as the obvious members of your medical team,” she says.
“The Medical Education Unit is also available to give advice around career planning and term choices, support you through difficult terms, and listen to any concerns you have.”
Sam also recommends looking to your peers.
“Your fellow interns are a great support as you’re often facing the same challenges. Cultivate friendships amongst your intern cohort and seek mentors from the PGY2 and 3 group.”
What to expect in your first week and month
Sam says you should expect to ‘feel overwhelmed’ during your first week and month, especially as you encounter a host of brand new processes, people and places.
“It’s a huge step from medical student to doctor, and many interns experience feelings of inadequacy. Remember that it’s a steep learning curve, but you’ve been studying for many years to get to this point. At the end of the first month, look back and see how far you’ve come in four short weeks,” she suggests.
To help you settle in, Christina says your hospital will provide a comprehensive orientation week. You’ll be given a thorough briefing on what you’re required to do, along with introductions to your support network.
“All interns are also provided with a chance to shadow a Resident Medical Officer in the unit they’ve been allocated in their first term,” Christina says.
“They also have an awesome opportunity to meet the GPTQ team and connect for support through their career as a GP, should they choose this pathway.”
Common intern errors and how to deal with them
Christina feels the biggest mistake many interns make is failing to reach out for support early on.
“Asking for help should not be the last point of call. It should be quite soon if you feel out of your depth. Lots of interns just struggle on and it may be something someone can help with really quickly, and they don’t have to put themselves through that much stress,” she says.
Sam adds, “If you’re unsure, refer. If a senior nurse suggests that you refer, do it. If your gut tells you that you’re out of your depth, refer. You should never be penalised for seeking help.”
“Remember that you are not wholly responsible for your patients’ care. Interns often take on too much responsibility, stay long hours and blame themselves for their inefficiencies. This leads to burn out. Take breaks, claim your overtime and pass jobs off if possible.”
Tips for dealing with ward rounds, night shifts and more
Ward rounds are both exciting and challenging, and Sam says good time management and organisation skills are essential.
“Come to work early and be prepared. Nerd boxes (clipboards with storage) are very useful for extra paperwork. If you can do something in a minute or less, do it rather than adding it to your job list.”
Christina adds, “Often asking the consultant their preferences during your orientation or first ward round could help break the ice.”
When it comes to dealing with patients, Christina says it’s all about good communication.
“The majority of complaints and incidents that occur in hospital have communication failure as their root cause.”
Sam suggests trying to see things from the patient perspective.
“Often the annoyed patient in ED will be mollified by your apology for keeping them waiting. Fear and frustration are often manifested as hostility. Be kind, but do not tolerate unacceptable behaviour,” she says.
For night shifts and long hours, both Christina and Sam encourage you to take your breaks, especially when fatigue starts to set in.
“Make the time to stop, sit and eat something during your shift. Most of the time, 10 minutes doesn’t make a difference. Exercise and eating well will help with fatigue,’’ Sam suggests.
Navigating the hospital hierarchy might seem like a mammoth task, so Christina says you should ‘try and learn who is who in the zoo’ as soon as possible. Her advice is to tap into all the resources provided including photo boards, orientation and shadowing sessions, and your near peer mentors.
Sam says to be mindful that you’re part of the hierarchy too.
“Listen and say thank you for any advice. When nursing staff offer a suggestion, accept it graciously. A lot of the time, they will be right and will save your bacon! If they aren’t, you should explain why in a respectful manner. If you’re cranky with them, they may not approach you next time and this puts patients at risk,” she explains.
As for transitioning to a new term, it’s all about handover.
Sam says, “Seek out the intern who is leaving and spend some time with them before you start. Ask who you can seek guidance from.”
Christina adds, “Comprehensive Unit Orientation manuals are available and these can be a real lifesaver. A checklist for the end of term handover can also be very useful.”
Advice for managing each rotation
Christina suggests being prepared for an ‘exciting rotation with longer shifts’, while Sam says you’ll have plenty of autonomy with great support, adding you should take the chance to sleep when you can.
“You will often feel like a ‘real doctor’ when in the ED. Make the most of opportunities as they arise. But if you hate shift work, then the ED is not the career for you,” Sam says.
Christina feels this term is a great chance to learn from very interesting patient cases and treatment options, while Sam describes the rotation as ‘long days with a revolving door of patients.’
She says, “The term provides excellent learning opportunities you can build on throughout your career. Chronic disease can be disheartening, especially when patients don’t seem to prioritise their health. This might be the rotation where you see expected deaths. Learn what dying well looks like, so that you can translate this into other rotations.”
Sam’s advice for your surgery rotation is to ‘move fast’, while trying to work as a team when possible.
“Don’t consent patients to procedures you haven’t seen and aren’t familiar with. If you love surgery, then make the most of it. Get to theatre as often as you can, and ensure your registrars know you’re keen,” she advises.
“If surgery is not for you, try to learn things that will make your referrals to surgeons better in the future – and remember it’s only 10 weeks.”
What to do if you’re struggling to adjust or cope
With so much to learn and many competing demands, it’s natural for you to feel stressed and tired during your internship. But there are some warning signs that indicate you may need extra support.
“Signs of burnout include emotional exhaustion, depersonalisation, a sense of low self-esteem and negative evaluation of your performance,” Christina says.
Sam adds, “If you are feeling very negative and cynical about your job, wake up dreading going to work or are avoiding certain people or situations, then you might need to get some help.”
If that’s the case, there is plenty of support available and you shouldn’t feel reluctant to speak up.
“Your Medical Education Unit (MEU) is used to talking to interns going through what you are. Doctor’s Health have a 24/7 phone helpline staffed by doctors to provide colleague-to-colleague support. Make sure you also have a GP; most MEUs will have a list of GPs that take doctors as clients,” Sam advises.
Hopefully Christina and Sam’s insider tips will go some way towards ensuring your intern year is successful. Our next blog article draws on the intern perspective, with advice from two previous interns who have now finished their first hospital year.