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Days in the life of an intern/resident/registrar

LMG!

Moderator
Staff Member of the Year 2019
Hi guys, can someone explain to me the medical career after completing your degree? I'm aware that as of 2018 in NSW, you become an intern for 2 years, undergo an interview to become a resident, but I'm not sure the process that comes after, can someone explain?
Also, what are the differences in responsibility between being an intern and a resident?
Many thanks :)
Start here. And FYI, internship is just one year, not two. Even in NSW. I believe the contract is for two years, but you’re PGY2 for the second year, not an intern.

ETA: also look here, Working conditions as a doctor

ETA2: The Realities of Studying and Practicing Medicine
 
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Benjamin

ICU Reg (JCU)
Emeritus Staff
Residency & 2019

It's been a while since I updated this, and I guess it's probably about time! Apologies for it falling off my list of priorities ... it was a little hard to keep up with in the latter part of my intern year & I kind of forgot it existed for the entirety of my resident year.

A brief overview of what has happened since I last posted, what I'm upto now & what's on the cards for this year:
- Moved from my regional hospital to a tertiary centre
- Rotated through a mixture of vascular surgery/general surgery/surgical ward call nights, cardiology, emergency, rural relieving & intensive care.
- Went on holidays to South Africa & Namibia
- Currently on holidays in Japan but got injured immediately before coming so can't snowboard.
- Start work as an ICU registrar on Monday night next week.

Moving hospitals was a pretty big decision but a pretty easy one. I knew fairly early on that I wanted to get a rotation in ICU to figure out if I liked it enough to pursue it as a training pathway & also knew that there was absolutely no chance of getting that rotation staying where I was. Deciding where to go was pretty simple too - I figured since my chances of getting "good" rotations would probably be pretty similar everywhere I might as well move somewhere I would be happy to live for the next couple of years. In the end I got pretty lucky and happened to move somewhere I love living, where they gave me all the rotations I wanted in exchange for covering a heap of nights & eventually where I got offered an ICU registrar job.

It felt pretty weird coming into a hospital that I had never been in before, where I knew almost no-one and even though I lived in a great sharehouse the start of the year was pretty isolating. My housemates (all residents) managed to get almost exactly opposite rotations & at least two of us were always away on rural or nights terms at one of the smaller hospitals. It was the same with other residents I met at work, most of us had a mish-mash of rosters (days, lates, nights) with rarely similar time off and frequent secondments to the smaller hospitals. This was all a pretty huge shock for me after internship where we all pretty much worked 8 - 5, Mon - Fri.

In contrast to my time there as an intern I found Emergency to be the rotation where I got my life the most under control. Surgical relieving was a constantly changing beast of lates, nights and weekends where I didn't even know any of my bosses names, cardiology felt like an unrelenting rotation of discharging patients with non-cardiac chest pain ... and ED was only 8 days a fortnight, which I quickly realised was amazing. I managed to finally make time to see my friends, get to music gigs, learnt to surf in the middle of winter without a wetsuit, started rock climbing ... and then quickly threw it all away again when I got seconded to a rural hospital.

My rural job was pretty much exactly as sold to me in the JCU interview I did before starting medical school - "you are the junior doctor in charge of a rural hospital overnight" kind of situation. My bosses were theoretically 30 minutes away at all times to help with "anything and everything" but more realistically were too far away to be any help when needed urgently, so instead I found myself either sorting it out myself, calling retrievals / sitting in the back of an ambulance tearing down a mountain range with lights-and-siren, and a peripheral adrenaline infusion just hoping for the best. The roster was an absolute nightmare and seemed to completely ignore any kind of workplace agreements about maximum hours/fortnight: I worked 4 late shifts (1-11pm) where I was on-call overnight until 8am followed by 3 day shifts (8am - 4pm). The result was that I could work 10 hours, get called in at 1am and get back to sleep by 4 or 5.. only to be expected to be back at work at 8am with no option of not coming in. I think it might have worked a lot better if I was able to run things over the phone overnight rather than getting out of bed .... but in PGY2 I wasn't exactly comfortable with that as an option & much preferred to see the patients myself.

After 10 long weeks living in the middle of nowhere I got sent back home and to ICU where it seems things are a lot better in many ways. The roster is 7 on - 7 off, my bosses and registrars are super available and supportive & my partner has moved to the same city as me. I start work as a registrar immediately going onto nights for two cycles followed by two cycles of paeds ICU nights which is a little daunting, but I guess that's my job now.

Will try keep this updated as best I can! BVXXhE3.jpg


ETA:
Hi guys, can someone explain to me the medical career after completing your degree? I'm aware that as of 2018 in NSW, you become an intern for 2 years, undergo an interview to become a resident, but I'm not sure the process that comes after, can someone explain?
Also, what are the differences in responsibility between being an intern and a resident?
Many thanks :)
There's a lot of "it depends" in this answer but I'll try give a general overview and if there are more specific questions then I'll answer them as best I can.

After graduating you start internship (Post-Grad-Year-1) where you have three mandatory 10-12 week terms (ED, Medicine, Surgery), 2 elective terms totalling 15 weeks and 5 weeks of paid leave. During this time you are considered to be provisionally registered, this means all your decisions are supposed to be supervised & that you aren't able to work outside of the hospital that you are interning at (i.e. no locum / additional work). Each term will have a mandatory mid-term & end-of-term assessment that you need to pass in order to have your terms counted off in internship, these are more of a safety-net for making sure interns get the support they need than they are an actual exam/assessment.

Each year while working as an intern/resident you will need to apply for your job the next year. This usually happens around June-July with offers being released a few months later (September onwards). Typically, if you have not burnt bridges you can easily reapply to stay on at the same hospital with minimal effort - hospitals like to keep their staff. If you decide to pursue a resident job in a specific field (e.g. surgical rotations only / critical care resident / paeds resident) then you will likely find yourself applying across the state/country to places where those jobs are available. Finding out where those jobs are available is a challenge in itself - they are rarely formally advertised, are typically offered in-house and often don't have a formal interview process as much as they have a "meet and greet" with the director of the unit. As such, in resident years it often is a matter of who-you-know or who you have as references that makes a significant difference to job applications.

Resident year itself is much the same as intern year but with more responsibility and less supervision. It's difficult exactly to quantify the change in responsibility as a lot of it depends on the team & the job at hand. It is likely that you will have an intern working with you that you are expected to partly supervise and who will come to you first with issues that you are expected to solve instead of escalating immediately to your registrar/consultant. You will find yourself being given a lot more night shifts now that you don't need to be supervised at all times & likely will be sent out to smaller hospitals in your catchment area for a term or two. As mentioned in my post above these smaller hospitals can (at least in QLD) be a case of you being the only doctor on call overnight manning a 24hr ED.

Resident years then progress while you get the necessary minimum number of rotations / minimum experience / meet the referees you need / sit exams / do courses etc before applying to your chosen pathway. It is possible to start some pathways/work as a junior registrar in PGY3 but more typically this is delayed a bit more. Often people will spend a year or two (or three or four) working as a resident specifically in their chosen field with progressively more and more responsibility - e.g. orthopaedic senior house officer who is also in charge of ordering necessary equipment / assisting co-ordinate the trauma list, medical senior house officer rotating through medical specialties, ED resident working in small regional hospitals with minimal supervision etc. The idea (in those cases) is that you progress incrementally until you eventually are doing the job of a registrar as a resident at which point you can step up without any issues .... unfortunately that is rarely how it works in practice!
 
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Benjamin

ICU Reg (JCU)
Emeritus Staff
The First Registrar Year

So, I suck at keeping promises and absolutely have not even thought about this until blog until today. Yesterday I finished my last shift in adult ICU for the year and am now on a few weeks leave before starting 6 months in paediatric intensive care followed by 3 months respiratory medicine & 3 months general medicine.

It is tough to try and break the year down into paragraphs, a lot has happened and a lot has changed. I walked into the ICU at the start of the year as a PGY3 who knew a tiny bit about ventilators, absolutely nothing about drugs and even less about actual medicine. Internship had shown me what is was like to talk to patients and residency had taught me how to be efficient & talk to other teams but neither of them had taught me how to make decisions when I had to. I thought they had, I genuinely thought I had an understanding of what it's like to need to make a decision on the spot with everyone staring at you and a patient's well-being depending on you making the right choice - I didn't. Recently I faced that exact situation when a patient in status epilepticus suddenly stopped seizing and also stopped breathing (this is not uncommon when they have lots of midazolam on board) -- when this happens everyone stops and looks at the ICU registrar (the one who gave all the midazolam) with a look on their face that is "now what?". I am often met with that same look at other METs or consults but thankfully the immediate answer is either "get me adrenaline and a hand pump for fluids / we're going to need to tube them here" or much more frequently & simply (and my favourite) "has anyone asked the patient/family what they want?".

When I first started in ICU I was most scared of night shifts. On nights the boss is a phone call away rather than down the hall and it's upto you to decide when you need to actually make the call - there are things you are supposed to be able to deal with on your own and things you definitely know you can't deal with on your own ... but what about the inbetween things? Those are the hard ones. As the year has gone on the gap between the two options has narrowed a bit such that there are more things I am comfortable doing on my own and less things I need to immediately call the boss about. I have also learned that the only true sin in ICU is not calling. Overall, I actually quite like night shifts now - there are less superfluous people around, the nurses and doctors all bring snacks for eachother and no-one questions why I am wearing the theatre gown/cape (it's cold and it's comfortable).

I think the thing I like the most about ICU is the teamwork of it all. There are a LOT of nursing staff in ICU, some are brilliant and some are questionable ... but even the most questionable are still the best nurses I have worked with. It has been very nice to spend a prolonged period of time in one place with the same people -- I didn't realise just how disjointing it is to change teams / wards and even hospitals every 10 weeks. I am moving to the paediatric ICU next week but thankfully it is literally in the pod next door to the adult ICU so I think I should be able to visit my friends in adults reasonably often.

While trying to write this blog I tried to think about the most important things I have learnt over the year:
  • The only real mistake is not calling the boss to discuss your plan before you do it... after you've done it is too late.
  • Pharmacology knowledge is power in ICU. If you don't know the pharmacokinetics of the drug you are prescribing / can't understand them when you look it up then you are going to need to ask someone and that person is going to make the decision instead of you.
  • Bedside ECHO & USS is the way of the future. I spent far too much time this year buried in ECHO textbooks and scanning everything that moved in the ICU and on the wards at METs - the sooner you start the easier it is to get an idea of what is normal/abnormal.

Anyway, I think I will leave it there for the moment - I am currently gearing up for sitting the ICU primary exam in March, which is quite frankly the most terrifying & overwhelming thing I have ever tried to do. So far I am upto about 800hrs of dedicated studying over the last 8 months with a planned 300 hours in the next month before sitting on the 3rd of March. It is quite odd to think that only 50% of candidates that sit for the exam pass the written section -- these are people who made it into medicine, got through medical school and internship then decided to do intensive care, studied for an exam everyone told them was ridiculous, paid $3800 for the privilege and still failed... for most of them it's probably the first big thing they have failed in their life, though I guess this is the case with most specialties.

Attached is a photo of me achieving something I set out to do at the start of the year but never thought I would actually manage - hopefully the next photo will be of me holding my primary exam certificate. So long until next time (probably next year!).

71521634_10220554246310677_8262926901752889344_o.jpg
 

Benjamin

ICU Reg (JCU)
Emeritus Staff
An Update

I sat the written component of my primary exam on the 3rd of March after studying close to 12-14hrs a day on my weeks off in the 6 months prior with 2 weeks of leave immediately before the exam that let me ramp it up to almost 16hrs a day. I did nothing other than wake up, study, eat and sleep. I did vivas & flash cards from the second I woke up, while I was in the shower, while I cooked, while I went to the gym, in my head while trying to maintain conversation with my housemates, while driving back and forth to Dominos/GYG/Nandos/my local ramen shop to get food. I practiced writing as fast as I could for hours at a time & bought a stupidly expensive fountain pen that upped my word count per minute by almost 30%.

My ANKI deck had me revising 40 past questions per day (the equivalent of sitting the entire written exam twice per day), the intricate details of 10 drugs per day & about 200 physiology facts per day for a month. When I sat down for the written and opened the first paper I held back a laugh -- I had done 9 out of the 10 questions from the first paper at least 5 times in the last week. The second paper was similar, I had effectively rote-learned model answers to 7 out of the 10 questions.

In short, the written went about as well as it could have & I walked out feeling surprisingly confident. To be clear, I still do not know whether I have passed that section yet -- the marking is due to be released next week but is very likely to be delayed & despite the fact that I felt good about it there is still a chance that the esoteric marking criteria fall the wrong way for me as they have for many others before.

For the week after the exam I relished in a sort of freedom but struggled a bit with breaking away from the ultra-productive grind. I had planned to take two weeks off between sitting the written and studying for the oral / vivas -- long enough to get some rest but not too long to lose the knowledge I had crammed into my head for the last 6 months.

This entire scheme was meticulously planned out & relied on me having an incredible amount of support from my housemates, colleagues at work that I studied with and a stupid amount of money to spend on takeaway food.

Unfortunately, things have clearly not gone to plan -- with the impending workload of the pandemic looming over intensive care units in Australia the second half of the exam has been pushed back to an as of yet unspecified but at least 7 months away date. It would be borderline impossible for me to maintain exam level knowledge for 7 months even in the best of circumstances, and these are unlikely to be the best of circumstances.

I am not going to comment on the handling of the situation at large in Australia, there are plenty of people far more educated than myself with far more important things to say. In saying that, while this blog focuses entirely on my personal experiences I have to acknowledge the millions of Australians who have lost their jobs and financial security over the last week -- for all the difficulties that healthcare workers are facing at the moment at least we are guaranteed pay & not worried about being evicted from our house or being unable to buy food. I have been in that situation before intermittently throughout medical school - it is horrible and there is nothing that makes it better other than the return of financial security.

Mostly I want to take a moment to reflect on how this entire situation is affecting me in the hopes that it will normalize the feelings that I think many other people are having right now & give me a bit of an outlet. I am anxious, scared, lacking in coping strategies & it is crippling. I am constantly being inundated with information about the impending pandemic & the ever changing information at work, at home, in the media is overwhelming & for me entirely counter-productive. This feeling is echoed by almost everyone that I have talked to at work and in my limited social interactions over the last weeks. Our hospital policies are changing so quickly that no one has any idea what the actual plan is - the other day I ended up trying to run a potential COVID-19 paediatric resus in what was effectively a negative pressure cupboard with no equipment and instead of actually solving any problems (which is my actual job & why I was called to help) I probably just made the situation worse and definitely made people feel like they were doing a bad job in what was a horrible situation. In a normal, non-pandemic world that resus would have been a simple process but in this situation it was an absolute logistical & communication nightmare - I learned a lot from reflecting on it but unfortunately that learning came at the cost of relationships with other staff which are at present difficult to repair.

In short, everyone at work is terrified both of getting sick and of being the cause of a colleague / family member / friend getting sick. A few of my colleagues from intensive care have already been exposed & are currently in quarantine, though none are sick at present. The changes to rostering at work reflect that our seniors know it is not a matter of if but rather when we get exposed / sick / quarantined. Junior and senior doctors, nurses, allied health with any critical care experience are all being pulled to ICU for refresher / further training. The entirety of my 'downtime' at work is currently spent running intubation / resus simulations, training staff how to do central lines on mannikans, giving tutorials on ventilators, haemodynamic support & other supportive care in ICU. All of this is in addition to our usual workload which has remained largely unchanged from baseline.

On top of the sense of impending doom is that my -- and many other people's-- usual coping strategies have almost uniformly been outlawed - national parks have closed to hiking and camping, rock climbing is off limits (for a number of reasons), my local gyms have closed, my local restaurants and cafes have closed, the beaches are almost certainly soon to be closed, my partner lives almost 150km away, I can't play board games with my friends or even have them over for dinner, my annual leave that I was looking forward to has been withdrawn (and what would I do, anyway?)... the list goes on. One semi-decent coping strategy I have found is playing online board games with your friends over skype / video conferencing app of your choice. I'm not sure what else I will come up with in the next months but certainly I'm willing to give almost anything a shot.

At the moment I am working on trying to find new ways to switch off from work and from information about the pandemic. I have blocked the news sites from my phone and computer, turned off my facebook account and left the dreadful "COVID-19 Australian Doctors Groups", I have stopped reading every single journal article about it and am trying to hold down some semblance of a normal life that isn't dominated by a feeling of helplessness -- I figure if anything truly important happens or changes that someone will tell me to my face.

I don't have much else to say at this point other than that I will try to keep this blog updated so as to provide some kind of a window into this situation for everyone on the 'outside'. My last advice is to remember that even though you are physically isolated at the moment there is nothing stopping you from picking up the phone and calling your friends to ask how they are doing. Look out for eachother.

- Ben
 

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As a registrar in any field, do you have to take "primary" exams every year? I'm not really sure what a primary exam is. All I know about registrars are that once you become a registrar, you sit a final exam in the end which determines whether you can practice your chosen field independently or not; that's not your primary is it? Also, what happens if you fail any of these exams (including the final one where you get your certificates), I'm guessing you get to repeat them?
 

chinaski

Regular Member
The examination requirements of training vary from specialty to specialty. There isn't a blanket rule and approach for everyone. Similarly, the rules regarding failure to pass exams is college-dependent.
 
C

CoolBeans

Guest
Reading your post and also hearing experiences from other junior doctors/interns, there is the common issue of "not knowing enough" and being placed in a situation where a patient asks you questions which you simply don't know the answer to due to lack of experience. How do you deal with those situations? Surely you cannot tell the patient "you don't know as you're not experienced enough", because wouldn't that reduce public confidence within doctors?

To add on to this; how do you deal with the situations where you're left alone in a shift and don't know how to deal with situations (e.g. your anecdote on independent shifts and your bosses staying 30 mins away)? Thinking of these situations intimidate me quite a bit, but keen to hear your insight on this.

Another question that is unrelated to the previous one, you mentioned having a few "holidays" during your time as an intern (notably the 5 week one). How often do you get holidays during your time as an intern and also a registrar? Do they coincide with the public holidays (i.e. Christmas, Easter, etc.) or do you work during those times?
 
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chinaski

Regular Member
1. If a patient asks you a question you can't answer, it is perfectly acceptable to say you don't know, but you will do your best to find out, or to refer to somebody who does. Nobody knows everything. What is unforgivable is lying.

2. If you find yourself in a situation wherein you are not knowledgeable, experienced or confident enough to safely handle it yourself, you call for help from colleagues. No junior doctor is an independent practitioner; they are by definition under supervision and therefore the buck stops with their supervisor.

3. Paid annual leave is a contractual right - usually four to five weeks per calendar year, depending on the state in which you work. Some hospitals roster leave, others will ask for preferences to be submitted and leave is allocated (but there is no guarantee you will be allocated your first choice). Obviously hospitals don't close over holidays so people must work over that time. You may wish to apply for leave over holiday periods, but again, so too will many others so you may not be granted leave.
 

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Cathay

🚂Train Driver🚆
Emeritus Staff
Surely you cannot tell the patient "you don't know as you're not experienced enough", because wouldn't that reduce public confidence within doctors?
Since I am now basically a member of the public, I can comfortably tell you that I would much rather you told me "that's a good question, I don't actually know the answer, but I can find out for you" than if you told me an answer that later turned out to be false - as chinaski said, lying is unforgivable and lying is what reduces public confidence.

The most important thing is that you are open and honest. No one is expected to be the repository of all knowledge, and if you're "pretty sure but not certain", you should say that - "I'm pretty sure it's [blah] but let me check on that for you." In time you'll get used to communicating your level of uncertainty properly; either with qualifiers like "as far as I know" or "if I recall correctly", or with something like "let me just check the dosage on that" or "let me just run it past the boss".

I can't emphasise enough how important openness and honesty will be. Medicine attracts those of us who are used to knowing things, and it can be hard to accept/admit that you don't know, but you'll need to be honest with yourself and you'll need to be honest with your patients.

When you don't know something, you should offer help in finding out - you'll notice that my examples above have said "but I can find out for you" and "let me check on that for you". Generally when a patient asks you a question (particularly if you are a med student or intern), they're not necessarily expecting you to personally know the answer, as much as they're reaching out to you to help them find the answer. So even if you don't know, as long as you can either find out or find someone that can answer their question, they won't be disappointed.

how do you deal with the situations where you're left alone in a shift and don't know how to deal with situations (e.g. your anecdote on independent shifts and your bosses staying 30 mins away)? Thinking of these situations intimidate me quite a bit,
I would say don't psych yourself out this early in the piece - during clinical years of med school you will gradually see and experience a range of situations, and get teaching that will prepare you for the more routine situations you may encounter (as well as emergency situations like CPR and resus situations), but hopefully you will also start to develop a feel for what you are comfortable with. You'll also get to know the structure of the medical team, where you are along the pecking order, and more importantly, who you can contact if you need help (whether it be guidance by phone or for someone more senior to turn up).

Also keep in mind, that not every situation requires immediate action; you will come to learn the timescale of things as you go along. There are a range of options in calling for help - from the most urgent "patient just collapsed and is unresponsive" emergency button, to "quickly step outside to phone the boss", to "discuss with the boss when you see them next", to "just note it for team review in the morning".

How often do you get holidays during your time as an intern and also a registrar? Do they coincide with the public holidays (i.e. Christmas, Easter, etc.) or do you work during those times?
Chinaski covered it pretty well, and my only comment to you would be that paid leave is an area where medicine works like any other full-time job - annual leave, sick leave, lieu days (if that's a thing in Aus) etc.

Be aware that some employers don't roster/allocate leave, and it is then up to you to figure out when you want time off and apply for leave, keeping in mind that "apply" means just that, and a leave application isn't guaranteed to be approved (refer to chinaski's public holidays example). Just don't end up working for 2-3 years straight before you realize you could've been applying for leave and having time off to travel etc.
 
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Benjamin

ICU Reg (JCU)
Emeritus Staff
Chinaski & Cathay have pretty much covered all the key points here, but I'll try add my perspective too.

As a registrar in any field, do you have to take "primary" exams every year? I'm not really sure what a primary exam is. All I know about registrars are that once you become a registrar, you sit a final exam in the end which determines whether you can practice your chosen field independently or not; that's not your primary is it? Also, what happens if you fail any of these exams (including the final one where you get your certificates), I'm guessing you get to repeat them?
For me the primary exam is a hurdle exam within intensive care training. It consists of physiology & pharmacology (no pathophysiology or clinical medicine) with a specific focus on topics relevant to intensive care - i.e. respiratory, cardiology, renal, haematology and the syllabus of ~160 drugs are done in excruciating detail but the majority of the 'rest' of physiology is also fairly decently covered. The syllabus incase you are curious is available here: https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Trainees/Assessments and Examinations/First Part Exam/CICM-First-Part-Syllabus-2017-–-FINAL-10-07-2017.pdf

The exam report (which lists questions & the examiners comments) for the 2019 August sitting is here: https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Trainees/Assessments and Examinations/First Part Exam/Reports/2019-2-FP-Exam-Report-Final.pdf

For ICU your registrar training is essentially broken into two parts - pre and post primary exam. Until you have passed the primary examination you cannot proceed into a senior registrar role - i.e. you could work as an ICU registrar for 10 years without passing the primary & you would never get any more senior & would still have to do the remaining 4-5 years of training once you have finished your primary.

At the end / in the final year of ICU training you then sit a fellowship examination. There is no 'prescribed syllabus' for this - they can ask whatever they want because you are expected to be able to answer at a boss / consultant level for all questions.

Overall ICU has a pass rate of ~40-50% each year for both the primary and the fellowship exam. They are brutal exams. Most other colleges have similar examinations that are similarly brutal - all have in common that they expect a huge amount of knowledge & test only a small fraction of it.

If you fail the ICU primary you have 3 attempts before you have to go before the college board & convince them why they should let you sit a 4th time. Most registrars fail at least once (40-50% pass rate).

Reading your post and also hearing experiences from other junior doctors/interns, there is the common issue of "not knowing enough" and being placed in a situation where a patient asks you questions which you simply don't know the answer to due to lack of experience. How do you deal with those situations? Surely you cannot tell the patient "you don't know as you're not experienced enough", because wouldn't that reduce public confidence within doctors?
As a junior doctor you are in this situation so often that it honestly doesn't even register as an issue after the first week. You are expected to run things past your seniors and most patients find comfort when you tell them "my plan is ___, I'm just going to chat with my boss & make sure I'm not missing anything". I do this in ICU almost every day - it helps me learn (because sometimes the boss says "no you're crazy"), it makes what I do safe & it makes me more comfortable making decisions when I know I have a boss to back me up because I've gone through this exact scenario when them multiple times before.

To add on to this; how do you deal with the situations where you're left alone in a shift and don't know how to deal with situations (e.g. your anecdote on independent shifts and your bosses staying 30 mins away)? Thinking of these situations intimidate me quite a bit, but keen to hear your insight on this.
These are daunting situations & it depends a lot on the exact scenario. There is almost always someone else in the hospital you can call for help - my paediatric ICU is directly next to the adult ICU where there are other registrars 24/7 and usually bosses around as well. It's very rare as a junior that you are truly alone and without further support even if it feels that way in the moment.

Often I seem to be the person who people call on now (this is the job of ICU at its heart) and doing this job has made me a lot more comfortable as it has made it clear there are few times you are truly alone and there are also few times where simple resuscitation can't buy you 30 minutes. Most of the time you can get by for 30 minutes by doing relatively simple stuff (controlling the airway, breathing, circulation) that we do in ICU every day.

The times when it is really tough are when you don't have a supportive boss to talk to or runs things by. In that case it doesn't matter how far away they are physically because if they refuse to be involved mentally then you're out of luck. There isn't really a good solution to this.

Another question that is unrelated to the previous one, you mentioned having a few "holidays" during your time as an intern (notably the 5 week one). How often do you get holidays during your time as an intern and also a registrar? Do they coincide with the public holidays (i.e. Christmas, Easter, etc.) or do you work during those times?
Depends on the job. For me I work week on - week off with either 3 days and 4 nights or 4 days and 3 nights in a run. Weekends / public holidays / the actual day of the week mean nothing to me anymore. Jobs that aren't shift work (i.e. mon - fri 8-5) get 5 weeks off while I get 6 weeks off a year that I am supposed to take but have struggled to actually take mostly due to me not organizing it rather than the hospital not giving it to me.
 
During your intern and resident years, were there examinations you had to study for? You mentioned there were some assessments, but not sure if that meant general "supervise if the junior doc is doing his things properly" or a more pen and paper exam paper. If it was the former, what sort of studying did you do if it weren't for an exam (if any additional study is required)? Was it just brushing up on prior knowledge or was there more self research on the weak areas you endeavoured at hospital?
 

Benjamin

ICU Reg (JCU)
Emeritus Staff
During your intern and resident years, were there examinations you had to study for? You mentioned there were some assessments, but not sure if that meant general "supervise if the junior doc is doing his things properly" or a more pen and paper exam paper. If it was the former, what sort of studying did you do if it weren't for an exam (if any additional study is required)? Was it just brushing up on prior knowledge or was there more self research on the weak areas you endeavoured at hospital?
Nope, no exams during intern & resident years -- these are years where you are simply learning how the job works and becoming more efficient. The assessments are a tick and flick sheet that basically says "you aren't a horrible doctor".

Most of the learning in intern / residency is on the job - you copy what your registrar does who either has actually learnt something about it, is copying their boss or is making things up blindly (hopefully one of the first two). This leads to a very practical understanding of terms you rotate through but doesn't necessarily lend itself entirely to knowing how to deal with things that exist outside of guidelines.

I personally think that you should try to limit study outside of work during your intern year. While you are adjusting to the workload and figuring everything out it's important to also figure out what kind of a lifestyle you want to achieve - as a registrar it will be tough to find time to experiment & it's a lot easier if you've already figured out what you want, and will help you decide which registrar / training pathway to head down.
 

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chinaski

Regular Member
Agree, though would point out there are some exceptions WRT college exam prep, wherein people may start preparing for/sitting as pre-vocational doctors.
 

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