What Makes a Good Intern
On my penultimate day of internship, I have been reflecting a lot this week as I've been training up our successors on what makes a good intern and what makes for a good intern year. Here are some nascent thoughts.
(This was originally published as a twitter thread)
Awareness of the limitations of your knowledge and experience. Acknowledging that there are many people across many other professions in the hospital — nursing, allied health, pharmacy, ward clerks, porters — who are a wealth of information and intuition.
The ability to speak up when you are worried about something, someone, or can see a potential chain reaction unfolding with capacity to cause harm, whether to a patient, a colleague or yourself. Never easy, but so essential to good clinical (and self) care.
It is a normal part of our job. We spend weeks, sometimes months, with patients we grow to know and care for deeply. Sometimes we have to let them go. It can be traumatic. During these pandemic days we can be the only ones there during those final moments. A proxy for love.
So difficult to have, particularly starting out. You are so worried about every single decision you make, it can be very tall trees and no forest. Take a moment to get out of the hospital and out of your head - sitting in the sun, taking off the mask. It helps.
So important. The best interns are part of cohesive units where a premium is placed on a flat hierarchy where everyone feels valued and willing to voice opinions and concerns. Understanding that everyone has something to offer and eminence≠precedence.
Expect internship to throw you curveballs and surprises. You will encounter challenges you hadn't foreseen — patients that push you to the limit, experiences that mark you in a thousand small ways, leaving an indelible mark. The more you can soften, the easier it is.
Be someone who is willing to listen and evolve. Model yourself as that person who is always approachable. Thank colleagues for their time and generosity. Learn people's names and use them. Take a genuine interest and keep a proverbial open door. It makes a difference.
I've been blown away more times than I can say during the course of this first year of doctoring by the incredible privileges of the job. The capacity to make a difference, in a hundred small ways, every day. We are so lucky. Keeping sight of that is everything.
For our patients, our colleagues and ourselves. Don't document or comment on someone being a poor historian, or acopic. Understand the scale of challenges many people face in their lives. By design, we are the privileged few. Don't be blinkered by prejudice.
Compassion #2 FORGIVE YOURSELF
Things go wrong. People will die. Some you will take home with you and stew over. Could you have done something different? Was it preventable? Did you prolong life but extend suffering? Have a place/person to process with. Find ways to let go.
If you make a mistake, own up to it quickly and work to ensure it doesn't happen again. You are only ever a cog in the machine, and if there's a squeaky wheel it needs to be addressed. We are only human and we have bad days. The system should be a safety net.
Check everything you do twice, trust your instincts when something doesn't feel right. ALWAYS run your thinking past a senior — it's a safeguard and an opportunity to learn and grow. Ask for help. Internship is the moment in your career when it's ok to be lost and scared.
Don't ever feel there is something wrong with you if the weight of the job feels - at times- as though you can't continue to bear it. But don't work through those moments. There is always space to step back. Have an outlet for your sadness, different for everyone, but is key.
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