Changing roles: Graduating and employment as an intern [split thread]

[chinaski]

Despite spending a bit of time with interns I don't think I'm at all capable of predicting what sort of efficiency and work ethic I might be able to muster come internship. My problem though, is when consultants and senior registrars expect high levels of specialized knowledge and skills from juniors or when they make a big song and dance when someone makes a mistake.

I expect an intern to learn specialised knowledge as they progress through the term. For instance, a Haem intern won't be expected to understand inpatient chemo protocols and what prophylactic meds to chart in their first week, but by the first month in, I'd have far higher expectations of their working knowledge and efficiency in dealing with such patients. Mistakes are understandable, but probably less tolerated when it's from an intern who's failed to evolve.

Absolutely true, though, that some senior doctors and regs alike set unreasonably high standards - but by an large, most don't. Some of those who do ask too much, do so as a way of hoping to "inspire" interns to learn.... surprisingly, some actually thrive in these environments! On the flipside, I also think some interns set their own standards too low, and subsequently under-achieve during their rotations. If an intern's motto is "near enough is good enough", they are likely to be roasted on the wards.

 

[Liquid8]

Despite spending a bit of time with interns I don't think I'm at all capable of predicting what sort of efficiency and work ethic I might be able to muster come internship. My problem though, is when consultants and senior registrars expect high levels of specialized knowledge and skills from juniors or when they make a big song and dance when someone makes a mistake.

Organization is paramount, and it certainly helps with regards to efficiency. In terms of knowledge, I don’t expect interns to know a lot initially (anything is a bonus!), but I do expect them to have some idea how to get the things I want done. The other big issue is safety: I'd rather an intern who is more cautious and contacts me more often than less. Obviously as the term progresses, I'd expect more familiarity with the unit and gradual accumulation of confidence. In terms of consultants/registrars expecting huge amounts of knowledge - I noticed when I was an intern they tended to go after the medical students!

 

[Matt]

Oh yes, interns tend to get ignored by consultants and registrars if medical students are around to pimp. Unfortunately they also tend to get ignored when it comes to teaching as well. The expectations I'm talking about are more when a registrar comes to review a patient and is nonplussed that certain tests haven't already been ordered or medications started. Or if tests/investigations have been ordered and they're not appropriate.

There's a spectrum with all of this of course though and some expectations are very fair, some are in-between and some are asking a bit much.

 

[chinaski]

Oh yes, interns tend to get ignored by consultants and registrars if medical students are around to pimp. Unfortunately they also tend to get ignored when it comes to teaching as well. The expectations I'm talking about are more when a registrar comes to review a patient and is nonplussed that certain tests haven't already been ordered or medications started. Or if tests/investigations have been ordered and they're not appropriate.

There's a spectrum with all of this of course though and some expectations are very fair, some are in-between and some are asking a bit much.

I think you have to accept early on that as an intern, you are awarded somewhat of a social hierarchical demotion. As a student, you follow after the consultant, you get to sit at their feet, learn stuff in clinics, and only get taken to see the interesting, educational cases. You have the attention and energy of the senior staff, and to a great extent, they nurture you. It can come as a rude shock, therefore, when you are the intern, the consultant barely notices you, the reg is leaning on you to do scut, and 99% of your day is for working, not learning. That shift in priorities is definitely something they don't warn you about. The students get more attention than you do. That can get really, really annoying.

The upside is that unlike a student, you are an indispensable part of the team, and your presence rapidly becomes highly appreciated if you do your job properly. That can be really, really rewarding.

 

[Havox]

I think you have to accept early on that as an intern, you are awarded somewhat of a social hierarchical demotion. As a student, you follow after the consultant, you get to sit at their feet, learn stuff in clinics, and only get taken to see the interesting, educational cases. You have the attention and energy of the senior staff, and to a great extent, they nurture you.

I've never thought of it this way and come to think of it, I think we firsties all thrive on this attention they give us

 

[theangelofdarkness]

I think you have to accept early on that as an intern, you are awarded somewhat of a social hierarchical demotion. As a student, you follow after the consultant, you get to sit at their feet, learn stuff in clinics, and only get taken to see the interesting, educational cases. You have the attention and energy of the senior staff, and to a great extent, they nurture you. It can come as a rude shock, therefore, when you are the intern, the consultant barely notices you, the reg is leaning on you to do scut, and 99% of your day is for working, not learning. That shift in priorities is definitely something they don't warn you about. The students get more attention than you do. That can get really, really annoying.

The upside is that unlike a student, you are an indispensable part of the team, and your presence rapidly becomes highly appreciated if you do your job properly. That can be really, really rewarding.

You've managed to describe exactly what I'm concerned and simultaneously excited about for next year
One thing I hope to finally move on from is feeling like I'm getting in the way and slowing the team down, because I constantly feel like an outsider. I'm still concerned that I'll slow the team down next year but instead I'll be the team's weakest link (which is an improvement )

 

[chinaski]

I'm still concerned that I'll slow the team down next year but instead I'll be the team's weakest link (which is an improvement )

The good news is that such a concern will probably make you strive to become better. The bad news is that the first few weeks will be hard, and you will slow things down. Upside: this is expected, and generally well tolerated, and anyone who tries to become better as a result is appreciated in the end.

 

[+po1ntdext3r+]

The good news is that such a concern will probably make you strive to become better. The bad news is that the first few weeks will be hard, and you will slow things down. Upside: this is expected, and generally well tolerated, and anyone who tries to become better as a result is appreciated in the end.

I almost cried after my first shift... it was very traumatic... i use to be confident and know stuff... now i just go through and hope no one dies.. its kinda getting better.

The change from final year to intern was WORSE than the yr 12 to med school and WORSE than Pre-clin to Clin... ..

 

[chinaski]

The change from final year to intern was WORSE than the yr 12 to med school and WORSE than Pre-clin to Clin... ..

Hello stranger. Surely you weren't expecting it to be easy...?

 

[Season]

Hello stranger. Surely you weren't expecting it to be easy...?

One forgets how awful the feeling of inadequacy is until it occurs again.

 

[chinaski]

One forgets how awful the feeling of inadequacy is until it occurs again.

Unless you're a pessimist, in which case you're pleasantly surprised most days.

 

[Dave L]

I almost cried after my first shift... it was very traumatic... i use to be confident and know stuff... now i just go through and hope no one dies.. its kinda getting better.

The change from final year to intern was WORSE than the yr 12 to med school and WORSE than Pre-clin to Clin... ..

The good news is as an intern you have next to no responsibility – this ultimately falls to your supervising registrar/consultant. Decisions often need to be made that are above your level of experience – seeking help and careful documentation will hopefully ensure patient safety and contain anxiety. As you advance, you can expect more responsibility and less formal training opportunities. You’ll be the one taking calls from anxious interns - probably sooner then you expect.

 

[chinaski]

The good news is as an intern you have next to no responsibility – this ultimately falls to your supervising registrar/consultant.

The full extent of that realisation doesn't hit you until long after you're an intern, though - hindsight is a beautiful thing. Most PGY1s and 2s feel as though they've got the weight of the world on their shoulders. I know I did a lot of the time.

 

[Dave L]

The full extent of that realisation doesn't hit you until long after you're an intern, though - hindsight is a beautiful thing. Most PGY1s and 2s feel as though they've got the weight of the world on their shoulders. I know I did a lot of the time.

Indeed. In my clinical years I was fortunate enough to have spent time with an intern who was very cool under pressure and passed down similar insights about the nature of responsibility: most importantly, that internship should be a great year with heaps of paid overtime for no responsibility. While the paid overtime may or may not apply nowadays, but the relative lack of responsibility holds true.

 

[+po1ntdext3r+]

Hello stranger. Surely you weren't expecting it to be easy...?

Not at all I realise the benefits but there is alot paper work..

i think we all kinda hope we are a lil ready...
it took getting a puppy to make me feel better

 

[LemonTea]

Unless you're a pessimist, in which case you're pleasantly surprised most days.

There is no pessimism, only realism.

 

[theangelofdarkness]

You guys are totally inspiring me to have LOTS of confidence

 

[chinaski]

You guys are totally inspiring me to have LOTS of confidence

It really is 99% good organisational skills, efficiency, work ethic and plain common sense.