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THIS week marks the changing of the guard: the end of internship for some and the beginning for others. A year-long journey of the highest highs and some particularly challenging lows. Twelve months of introspective learning about who you are as a doctor and as a person, at least two or three times over.
But throughout the numerous existential crises and a potentially excessive number of coffee breaks, you’ll live, and you’ll learn, and it will all become a little bit easier with time.
So, as I prepare to take off my metaphorical bearskin hat, I share with you my top 10 tips for internship. Collected from colleagues, supervisors and personal experience with thanks, now they’re yours to share too.
It’s surprisingly difficult to kill somebody
This was the first thing I heard at intern orientation, although it wasn’t the first thing that was said. I don’t think I believed it then, but now it rings true. Being a safe intern doesn’t necessarily require you to know much of anything, except what it is that you don’t know.
If you go to work thinking that you won’t make a mistake today, you’ve already made your first mistake
Shared with me by a supervisor, I think about this most days. It’s impossible to know everything, and it would be unreasonable to expect that of anyone. Mistakes will happen, and they only reflect on you poorly if you don’t learn from them.
Fifteen minutes early saves an hour during the day
It’s as simple as it sounds, and effective too. At first you might curse yourself for getting up early, but you’ll definitely thank yourself later.
Triage your pages or perish
As we all learn, pagers don’t break no matter how many stairs you throw them down. Instead, you need to triage requests so that you can focus on one job at a time.
Be nice to everyone
Whether they are your peers, nursing staff, allied health staff, administrative staff or cleaning staff, everyone has an important role to play in the hospital. Act with kindness towards your colleagues, because teamwork makes the dream work.
And if your colleagues aren’t kind to you, there are formal pathways to deal with that. Talk to someone you trust.
Join your JMO Society
And I’m not just saying this because I was the vice-president of mine. It’s good to be part of something bigger than yourself, especially when you need help with difficult rostering discussions and pay disputes.
It’s okay to cry sometimes
You will attend MET calls, code blues and deaths. You will tell patients that they have cancer. You will witness fear, sadness and grief and be the source of some of those emotions as well. And sometimes it’s just pure exhaustion. As my registrar once said to me, when these things happen you’re not always going to feel okay and that, in itself, is okay.
Salary packaging is your friend, use it
It probably won’t make sense at first, but you’ll thank me for this one later.
Don’t listen to the residents telling you internship “isn’t that bad”, otherwise you’ll spend the whole year wondering why you find it so hard
At the end of internship, it’s easy to espouse advice, because nothing ever feels quite as difficult once you’ve already finished it.
And, finally …
You are not alone
We all struggle with imposter syndrome from time to time, some more than others. And if you find yourself on the more frequent end of that spectrum, please believe me when I say that you are not alone.
Dr Skye Kinder was Victoria’s Junior Doctor of the Year in 2017. She has just completed her internship at Bendigo Health, and was recently appointed to the Board of Directors for the Postgraduate Medical Council of Victoria. Follow @skyekinder on Twitter.
To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.
40 years after graduation and I cannot fault Skye’s advice (except we didn’t have salary packaging back then!). Learn from everyone who has something relevant to say (including patients and family); the cleaners and domestic staff often have insights into patient problems that we don’t (esp in my field of palliative care); actively seek out a trusted senior clinician as advisor/counsellor/mentor; prioritise, as Skye says – you cannot do everything at once and you cannot please all the people all the time!; seek help and support to call out unacceptable behaviour whether from your registrar, consultant or senior nurse (to name a few of the common culprits!).
Above all look after yourself and your mates; stick together – you are in this together. It is not an actual war zone so you probably won’t die and you will survive if you listen to those who have gone before.
You are well trained, you will do your best and society will value your efforts.
I still remember my Junior & Senior internships vividly and that was 54 years ago. Yes, the hours were long. It was tough sometimes when a stabbing, shooting or train crash came in. There were no after hours ancillary facilities (and this was a major teaching hospital) meaning we had to take our own X-rays then develop the films, crossmatch our own blood or do other blood tests. I recall crossmatching 18 bottles of blood for a stabbing case in the middle of the night. We didn’t watch the clock and didn’t hand over a case of hæmatemesis at 6PM because it was our knock-off time. We followed cases through. That continuity was good not only for the patient but also for our own learning processes.
But what Dr Kinder’s article reminded me of, was that at the start of both my junior & senior internships certain habitually malingering patients of ours who had turned this into an art form, knowing this was the changeover and all the doctors were just out and green would turn up in ER describing symptoms or creating signs that would fool we ingenues into prescribing or initiating procedures that they wanted.
Three or four months down the track in my junior year I attended the buck’s party of one of our colleagues. We were all interns at several teaching and other hospitals. We swapped notes on some of those patients and lo and behold they were regulars at other hospitals too! There was the taxi driver who could dislocate his mandible at will, come in feigning great pain seeking morphine. There was the man with a PDA he didn’t want fixed so that when he wanted a hospital bed for the night he would valsalva on the street so he would collapse. There were so many more.