May 25, 2021

Surviving Internship 101

You spent years in medical school slaving away behind a mountain of textbooks, had an anxiety attack before every single OSCE and the assessment lineup was ruthless. Just as you overcome one obstacle, the next was soon to follow. One minute you're cramming the ins and outs of the spinothalamic tract, the next you are gracelessly fumbling around trying to examine your mates in clinical coaching. Some days you are nailing it and on top of the world, and others you struggle to find the JVP (uh, let's be real..... that's most days). And then you finally reach the day of graduation; you stroll across that magnificent stage, shake a few hands, a grin from ear to ear, and just like that you're making Facebook posts #nowadoctor #graduation. You thought that those grueling years of medical school would prepare you for the road ahead but in my experience... IT. JUST. DOESN'T.

I commenced my intern year as an emergency doctor, which looking back, was one of the hardest ways to begin my journey in medicine. You're still operating under a clinical team, but this team is so different from the ones that you experience on the wards. An emergency department can be so fast-paced and you do have a lot more autonomy in your role, with intermittent discussions with seniors. I guess the scariest thing about the emergency is that it's like the old box of chocolates (Forrest Gump anyone?); you never know what you're going to get. Someone could walk in and reading the triage note you think you know what to expect, but those cases can take turns in ways you never imagined. You have to familiarise yourself with resus and trauma teams, the inner workings of acute versus short stay, the protocols around ordering imaging -- and NOBODY tells you how to do this before you start. You go into this job having all this medical knowledge from years of exhausting education, only to feel utterly helpless a lot of the time. Those first few months of internship are unmerciful; this is no over-reaction, at least not in my experience.

I remember being so nervous ordering insulin for one of my patients, which now seems so laughable, but then it was terrifying. Prescribing ANYTHING, was terrifying. And don't get me started on the look some patients give you when you walk in and say "Hi, my name is Kim and I'm the junior doctor looking after you today". You receive this scrumpled-up facial expression that reads, "You're too young to be a doctor". Then when you think it cannot get much worse, they say it to your face too. Great. You have to compose yourself and find a way to respond aptly. Sometimes I would laugh it off, but as time went on I found myself becoming discouraged because I had worked so hard to get my degree, so why should my age matter? 

Things get better with time. You might transition to a ward-based job under a clinical unit. You slowly find the groove that all past interns talk about. You become a little more assured of yourself and your clinical acumen, you start to nail competence and find more expeditious ways to achieve the best outcomes. Most importantly, you learn to multi-task like an absolute god (because your registrar expects it). Don't think it's possible to wheel a computer, type progress notes, and phone radiology all at the same time? Where there is a will, there is a way. I found that as the internship progressed my good days far outweighed the bad ones. It was nice to be competent at my job, finally plunging into the role I had envisaged for so many years. Even though each rotation brought a unique assortment of challenges and unknowns, you feel more self-sufficient with each transition. It's this phase of the internship where you feel your most vivacious, comfortable, and rational. There are so many things that I wish I had been told before I became a doctor; and whether you are browsing this as a med student, current intern, or twice my senior, please know that everyone struggles with their internship in unique ways. Remember that YOU. WILL. GET. THROUGH. THIS. #competent

To ensure your are happy hash tagging as much as possible, see my top tips below for surviving internship 101:

1. Have a low threshold for asking for help. This is the most critical lesson I learned as an intern. I don't buy into the whole 'fake it till you make it' type attitude in medicine, though you could adapt this in other areas of life and be just fine. Sadly I feel that many junior doctors (including myself) feel so much pressure to know it all and execute flawlessly. I find that this pressure means asking for help can feel be so daunting. But in the end, we have to ask ourselves who is this benefiting? The answer is nobody. Best case you just stumble along and gently navigate the uncharted waters by yourself until you work it out; the worst case is you stuff up, majorly. And so here's the cake... it's not about asking your registrar for help every 8.5 seconds. They will likely get fed up with you because they're busy people with tremendous expectations weighing down on them from overarching consultants and patients alike.

It's important to acknowledge what you simply don't know, and outsource to someone else for assistance (like a patient's nurse, social work, or the NUM). For example, I had a patient who was being transferred to a rehabilitation facility and had no idea how to complete any of this paperwork. After speaking to the NUM and then switch, I eventually found the portal online and went from there. Easy. Another great example; a patient of mine required hurried commencement of Gentamicin, however, I was like four days into the job and had no idea how to order it or how to calculate the dose. Recruiting pharmacy for assistance was the best thing I ever did, and I felt confident prescribing from thereon. If you're still unsure and you definitely cannot outsource, then it's time to engage those higher up. You may need to do this with urgency depending on the circumstances. If you're a registrar or consultant reading this, I think it's important to reminisce about your internship days and keep this in mind when communicating with junior doctors. Seldom the stressed-out snapping results in unintended fear, which in my personal experience means your juniors are less likely to come to you for guidance and will be more predisposed to making avoidable errors. The take-home message here is understanding your limitations and realizing when you are out of your depth, could save a life. #noegonoproblem

2. Expect to do overtime. Before starting work, I did not apprehend how much overtime junior doctors actually do (or are expected to do). Depending on your clinical unit and treating team, the raw hours in overtime will fluctuate considerably. In my experience, you'll be rostered to start at 8 am but really it's more like 7 am if you plan to be ahead for the day. Rosters do not consider the patient list printing, preparing progress notes, checking labs, knowing exactly what happened to your patients overnight to allow for seeing the sickest first, preparing discharge notes for expected discharges... and THE. LIST. COULD. GO. ON. AND. ON. Heck, I could start two hours early some days and still not feel prepared enough for the ward round. Obviously, over time you develop a system for yourself and you streamline your internal work methods, but in the beginning it can feel so slow. Overtime in the afternoon differs wildly depending on how many inpatients require review, the number of discharged patients, and if your team was on take. Essentially your leaving time revolves around how messy your day was. My point is, expect overtime and make sure you claim it. I've overlooked claiming many hours in overtime due to feelings of unworthiness when really, I had every right to. Don't make the same mistakes that I did, declare your overtime if it's longer than one hour and is legitimate. 

3. You've got a friend in the nursing staff. I have found that amongst the medical officer population, this point is extremely overlooked and sometimes even frowned upon. Why? Nurses are a great ally to have at your back, particularly when you need extra aid. If you are friendly and keep them in the loop regarding their patients, they will develop a connection with you over time and be more likely to go the extra mile for you (ie: inserting a cannula for you if they are trained). In addition, nurses are brilliant repertoires of knowledge about your patients which can assist you in making clinical decisions. It's invariably a great idea to keep nursing staff on-side and treat them with the respect they deserve. After all, we are all on the same team, right? #teamlife

4. Self-care is a priority. The combination of long hours, developing your identity in a new role, and going above and beyond to impress your seniors is flat out exhausting - there are no two ways about it. Self-care is crucial. Find ways to wind down that are unique to you and leave you feeling invigorated and ready to fight another day. It may come in the form of a good book, working out, baking, visiting family and friends, long luxurious bubble baths, aromatherapy, or binge-watching Outlander on Netflix (which is my personal favorite) - just find something that gives you a break from living and breathing medicine.

So there you have it, my top tips for surviving a medical internship. If you'd like to chat more about your experiences or you're seeking advice, hit me up on socials. 

Until next time, (and to play on my dutch heritage for a microsecond)... 

Tot Ziens!

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