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  • Surviving the intern year

    The first two years out of medical school have traditionally been seen as a rite of passage when young postgraduates are encouraged to work as hard as possible to prove their worth as doctors. It is a commonly held (but unspoken) view that the hard work over this period proves the necessary level of emotional and physical resilience needed to establishes one’s credentials for a career in medicine. [1]

    Despite these difficulties, steps can be taken to enhance your capacity to manage this particularly intense year. Appreciating that stress is ever present is an important starting point and knowing that the stress you face requires a personal management plan to ensure a degree of work-life balance will lead to success.

     

     

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    Managing fatigue

    The heavy load of doctors in training

    The intern year – a risky time

    Coming at a time when the risk of mental illness is particularly high, the intern year adds to that risk because of the expectations of long and unpredictable working hours, little recovery time and the constant challenge of balancing work and educational requirements. An additional stressor is the limited opportunity to foster work-life balance by developing outside social support or activity.

    Adapting to shift work

    Working night shifts not only leads to exhaustion – it can increase interns’ sleepiness, lead to mistakes and put them at danger if they decide to drive after their shift[2]. The Australian Medical Association’s (AMA) risk assessment tool for fatigue suggests that doctors who work more than 70 hours over a seven-day period are at higher risk of fatigue. Being awake for 18 hours is equivalent to having a blood alcohol level of more than 0.05%.

    Greater responsibilities

    Many interns also experience anxiety around making the transition from student to intern, feeling that they are out of their depth. A study of interns at Sydney University found that 70% of respondents suffered from a psychological disturbance on at least one occasion in the first 18 months of their medical careers. [3]

    “Mental illness is the norm among interns, it’s not the exception,” says Dr Craig Hassed, senior lecturer in Monash University’s Department of General Practice.

    “This points to a major deficiency in how we train health professionals to do a demanding job – we think if they have the technical skills they are job ready, but they aren’t being trained to manage the emotional demands and pressures of medicine,” he says

    Getting focused

    A key strategy for coping is for interns to pace themselves and to learn to focus on one thing at a time, Dr Hassed recommends.

    “You can be doing one thing while you are worrying about a thousand others you have to do, and that expends a lot of excess energy.

    When you finish your work leave it behind, don’t take it with you mentally. Be present and enjoy the down time you have,” he says.

    Like all doctors, interns are encouraged to look after themselves in other ways, such as by exercising, eating a healthy diet, having their own GP and maintaining contact with friends and family. Creating the balance needed requires planning and attention.

    rising to the challenge

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    Reminder from avant-learning-centre

    Video - What to expect as an intern. This series of short videos covers five important topics to consider during your transition into an intern.

    Rising to the challenge

    Former chair of the AMA’s Council of Doctors-in-Training, Dr Will Milford, says today’s interns are better than their predecessors at taking time off and striving for a better work-life balance. However, there is still pressure for young doctors to push the limits in terms of their own health.

    “There is pressure not to be seen by their consultant or professor, on whom they will rely for good references, as not being able to cope with their job or being weak for taking a day off,” he says.

    The crucial thing is that interns seek support if they feel they are physically or mentally suffering.

    “A lot of interns don’t realise there is always someone they can call on for help, be it clinical, administrative or for their personal or mental health,” says Dr Amanda Brownlow, a young doctor who completed her internship in Newcastle.

    “There’s a difference between working hard to impress and being so neurotic about your work that it takes a toll on your health.”

    Cautionary Tale

    Tips

     

    How to survive your first year

    To help you prepare, two former members of Avant’s Doctors in Training Advisory Committee, Dr Jodi Glading and Dr Marion Davies, offer their tips on how best to navigate your first year practising medicine.

    Be very organised
    Know your patients and their investigation results. Have a current patient list on you at all times and a spare for your boss. Keep blank investigation request forms on you ready to complete during the ward round. Write lists and check items off. Prioritise your ‘to-do’ list. Don't leave discharge planning and paperwork until the last minute. Good handovers are essential for both patient care and for prioritising.

    Keep an open mind
    Be enthusiastic about all allocated terms and campus locations. It may not be your first preference but you may be surprised. Consider rural posts as there will often be greater opportunity for teaching and skills development with one-on-one supervision. You learn more than you realise when doing all the "grunt work".

    Be nice
    Always be polite and respectful to everyone - patients and work colleagues. Avoid negativity and don't get involved with office gossip or romances. Give your patients the level of care and treatment that you would want for a member of your family. Avoid complaining and arguing. If you need to disagree with a colleague, step away from the patient first. Always keep in mind that other people - including the patient or a patient’s family member - may view your notes. Remember this when certifying a death.

    Be cautious with social media
    Never check social media on your phone during work time. You will be seen and it doesn’t convey a professional image

    Practice within your limits
    You are the most junior member of the team. You are not expected to work independently. Never be afraid to ask questions. Verify and document the plan for each patient with your senior doctor. Know why you are requesting each investigation - be able to justify your request. If you're not sure about something, don't do it.

    Seek and take opportunities for personal development
    Never pass up an opportunity to learn. Participate. Help perform tasks you didn't learn or see in medical school. Document logbooks and get these signed off. Talk to your seniors, build professional relationships and find a mentor. Set goals for each term and review mid-term to stay on track or to focus on particular areas. You can learn from everyone - bosses, patients, nurses, and allied health professionals.

    Take your breaks
    Book your holidays. Manage wellbeing. Avoid burnout. Develop emotional intelligence. Eat. Allocate time to maintaining relationships with family and friends. Have a GP. Accurately record your working hours on your time sheets and turn them in on time.

    Take good notes and get your own indemnity insurance
    Chances are that something will go wrong with the management of one of your patients one day. Whether an incident is your fault or not, your hospital may not necessarily cover your defense fully. Document, document, document. Good notes will help save you. A third person should be able to read your notes and understand the reasons for the clinical decisions made. Also, beware of using jargon and acronyms that can be misconstrued - For example, GBS could be Group B Streptococcus or could be Guillain-Barre syndrome.

     

    References

    1. Wilhelm K. The student and junior doctor in distress. Medical Journal of Australia 2002; 177: S5-8.
    2. Gander PI. Work patterns and fatigue-related risk among junior doctors. Occupational and Environmental Medicine 2007; 64(11): 733–738.
    3. Willcock SM et al. Burnout and psychiatric morbidity in new medical graduates. Medical Journal of Australia 2004; 181 (7): 357-360.
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