What to expect when you're 'interning'

 by Dr Sally Wark | Physician RAH

"I know none of the advice which follows is particularly original, and most of it would have been heard before but it has guided me through and helped me survive the roller coaster that is internship"

Dr Sally Wark graduated from Adelaide Medical School in 2017 and completed her internship at the Royal Adelaide Hospital in 2018, where she will commence her Basic Physician Training this year. As an intern working in South Australia she learned a number of invaluable lessons during the year.

Here are her top 10 tips for navigating your first years in medicine:

1. Ask questions

There is never a moment during your internship when it is not okay to ask questions. Take advantage of that. Be hungry for knowledge; it’s a privilege and a tool.

2. Be an educator

  • To your students – remember how it feels to be in their place

  • To your peers, who are with you for the ride 

  • To your seniors – don’t presume they know everything (from someone who will be your senior in a few months, I can promise you, we don’t)

  • To your patients – not only is it their right to understand and be involved in decisions regarding their medical issues and management plans; but being in hospital can be a frightening and isolating experience, and you have the opportunity to provide them with answers and comfort. 

3. Make people laugh

It’s almost always acceptable.

4. Recognise when you’re getting stressed

Stay courteous, talk to a friend or loved one at home, a colleague or a mental health professional and look out for yourself. 

5. Don’t be afraid of your mistakes 

"Experience is simply the name we give our mistakes” - Oscar Wilde

Everyone makes mistakes. As an intern, you rarely have enough responsibility to make big mistakes; but it can happen. I have made loads of mistakes this year. The first time it tangibly adversely affected a patient, it rocked me to my core. The patient was fine in the end; but I have since felt more keenly the weight of the responsibility we carry and appreciated more fully our capacity to do harm if we’re careless. Over the course of the year I’ve watched my peers second-guess their decisions, similarly struck by fear that they’d exacted harm upon somebody. I’ve seen registrars and consultants grappling with it, too. So, my advice regarding mistakes is in four parts:

  • Be vigilant; none of us is immune to error, and complacency gets you nowhere. 
  • When you do make a mistake: acknowledge it, examine it, learn from it. Choose to say sorry rather than getting defensive or trying to ascribe responsibility to someone else. Take it as an opportunity and be a better doctor tomorrow. 
  • Don’t beat yourself up about it. The career ahead of you is too long and promising to sustain that.
  • Don't be afraid to consult with your colleagues and superiors; it often avoids a mistake and you continue to learn.

6. Remember why you’re there

There will be patients that are heaps of work, or not very nice, or terrifying because they’re so unwell. There will be patients and families who demand to speak with the doctor in the middle of a busy day. Sometimes, it can feel like the patients are getting in the way of you doing your job. When you have those moments, check yourself; they’re the reason you turn up to work, not an obstacle to overcome.

7. Debrief with your peers

There will be plenty of stressful and overwhelming experiences next year, and I cannot overstate the importance of talking through them with your friends or colleagues. But I think that, as with every other job, it’s great to talk through all the non-stressful stuff too; about every part of our job that is weird and specific and not relatable. Only last week there was a robust discussion about the technique for manual disimpaction and while we got some strange looks from the other diners in the restaurant, I think it was important for our group to share this information.

8. Say no to things

Time off becomes relatively scarce, and therefore precious. Be greedy with it; spend it cautiously.

9. Treat yourself

I don’t advocate for spending all your newfound income at once; but I would bring your attention to a paper called Buying time promotes happiness1, which demonstrated that – in our time-scarce world – spending money on time-saving services is associated with greater life satisfaction, irrespective of wealth. I should admit that I only read the abstract, because, you know… that was all I had time for.

10. Treat yourself WELL

Sleep, exercise, laugh, stretch, have sex, have vegetables, call your parents, remember to vote.

Perhaps, at some point next year, you’ll reflect on this advice and find it rings true. Most likely, you’ll rise to the challenges of internship. In truth, if you’ve made it this far, there are only three essential things you need to know before you begin:

  1. The number to call switch (dial ‘9’ at the Royal Adelaide Hospital)
  2. The dose of paracetamol (1g QID)
  3. When in doubt, take a deep breath and ABCDE

Good luck!

Reference
1 Whillans, AV, Dunn, EW, Smeets, P, Bekkers, R & Norton, MI 2017, ‘Buying time promotes happiness’, Proceedings of the National Academy of Sciences, vol. 114, no. 32, pp. 8523-8527.

Disclaimer The materials provided are for educational purposes only. Whilst all reasonable care has been taken in preparing these materials, including the accuracy of the information supplied, MIPS does not accept any liability whatsoever arising out of the use or reliance of the information provided. 

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The materials provided are for educational purposes only. Whilst all reasonable care has been taken in preparing these materials, including the accuracy of the information supplied, MIPS does not accept any liability whatsoever arising out of the use or reliance of the information provided. Contact MIPS 24/7 Clinico-Legal Support 1800 061 113 or education@mips.com.au for specific advice.