Abstract
BackgroundThe transition from medical student to hospital-based first year junior doctor (termed “intern” in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition.MethodsFinal-year University of Queensland medical students recruited junior doctors working in diverse hospital settings, and videorecorded individual semi-structured interviews about their transition from medical student to working as a junior doctor. Two clinical academics (NS and JT) and an intern (ZT) independently conducted a descriptive analysis of interview transcripts, and identified preliminary emerging concepts and themes, before reaching agreement by consensus on the major overarching themes.ResultsThree key themes emerged from the analysis of 15 interviews: internship as a “steep learning curve”; relationships and team; and seeking help. Participants described the intern transition as physically, mentally and emotionally exhausting. They learned to manage long days, administrative and clinical tasks, frequent interruptions and time pressures; identify priorities; deal with criticism without compromising key relationships; communicate succinctly; understand team roles (including their own status within hospital hierarchies); and negotiate conflict. Participants reported a drop in self-confidence, and difficulty maintaining self-care and social relationships. Although participants emphasised the importance of escalating concerns and seeking help to manage patients, they appeared more reluctant to seek help for personal issues and reported a number of barriers to doing so.ConclusionFindings may assist educators in refining their intern preparation and intern training curricula, and ensuring that medical school and intern preparation priorities are not seen as competing. Insights from non-medical disciplines into the organisational and relational challenges facing junior doctors and their health-care teams may enhance inter-professional learning opportunities. Workplace support and teaching, especially from junior colleagues, is highly valued during the demanding intern transition.
Highlights
The transition from medical student to hospital-based first year junior doctor is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace
The transition from medical student to first year junior doctor is known to be stressful; it has been described as a test of “fortitude and resolve” [1] and “a wilderness experience” [2]
The intern transition is a key opportunity for senior medical students and junior doctors to “learn to play the role of physician, acquire the language of medicine, understand the hierarchy of the profession and its power structures, and learn how to live with ambiguity” [15]
Summary
The transition from medical student to hospital-based first year junior doctor (termed “intern” in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. It is possible that medical students are currently graduating less well prepared for their junior doctor roles in terms of both knowledge and skills, and their developing professional identities. This may increase the abruptness and stressfulness of the intern transition
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