From medical school to intern

The huge transition from medical student to doctor is exciting

It is normal to experience anticipatory anxiety with this new stage in your medical career.

Despite all the advice and preparation, there will be days as an intern where you don’t have time to exercise, when you have to eat takeaway for three days straight, don’t get to reply to that important message or go to that family dinner. There may be times when you feel out of your depth at work and you have to call your registrar three times with the same question. It happens to most interns and it passes.

You can do a few practical things to prepare for your amazing first year.

It is very likely that your medical training has equipped you with most of the skills you need, but there are a few things you may do to make it easier for yourself.

For example, try to proactively look after your mental and physical health and practise healthy habits, which are realistic to maintain throughout your intern year.

Before your first week

Try to plan ahead for your first week. First, establish a trusting relationship with a GP close to where you live.

Talk to them about starting your new role. Seek treatment for any common low-grade or chronic medical conditions. For example, anaemia, migraines, irritable bowel, dysmenorrhoea, anxiety often resolves with simple treatments.

Discover relaxing ways to fall asleep and to manage fatigue. Try to establish healthy patterns of sleep by conditioning your brain with mindfulness, meditation, relaxation techniques and/or breathing exercises. Do whatever works for you.

An online brief course in cognitive behavioural therapy techniques has been shown to reduce depressive symptoms in first year doctors. You can try it at: moodgym.com.au

Establish a regular exercise routine that may be continued while you are working. For example, attend a regular gym or dance session, use the stairs instead of the lift, join a sporting team that does not mind if you miss a few games, walk to work if possible, get up earlier for a run or a bike ride with friends.

Arrange to live in a stable household with or near people you love when you start your new position.

During your first term as an intern

Reassure yourself you are still learning and it is normal to feel out of your comfort zone with new rotations.

Ask for assistance, support and teaching. If you find any aspect of being a doctor difficult, ask for help from a trusted colleague. You will often find that other new doctors are concerned about the same things but don’t talk about them.

Also ask for help from allied health staff, especially nursing staff. They have often been on the ward or in a department for a lot longer than the doctors and know exactly what is going on. They may seem really busy but if you are honest and say you need their help because you are unsure of what exactly to do, they are more than willing to help.

For instance ask the administrative staff about paperwork, the pharmacists about doses and drug interactions, the nurses to help with procedures, the speech pathologists to help assess swallowing.

Debrief with your clinical team and your own trusted GP after any traumatic experiences.

Manage fatigue and night shifts. Sometimes night shifts can wreak havoc with your body clock.

It’s often surprising how adrenalin keeps you going while you are working and then makes it difficult for you to sleep.

Treat fatigue as you would treat jet lag. Get through it knowing it is temporary. Don’t overthink it.

Try to get enough sleep on your time off by implementing the sleep techniques you practised as a medical student.

Remember the simple things like drinking enough water, having a bath, eating healthy food, getting out in the fresh air during the day.

On your precious time off work

Manage your time off effectively. You may work about 40 to 50 hours a week and require about 56 hours a week for sleep, leaving you about 60 hours a week of flexible time.

Obviously you need time to do housework, commute and attend to administrative tasks. However, some of these tasks may be delegated, minimised or avoided.

You can now afford to pay for home help, shop online, engage a competent accountant, and live reasonably close to where you work if possible.

Try to connect with your family and people who energise you, eat nutritious food, get enough sleep, exercise, relax and take time for solitude and things you enjoy.

Try to keep connected with people you love  – your family and your non-medical and medical friends.

Plan things that help you relax on your time off. Sometimes scheduling all your administrative tasks and social gatherings into your few days off can be stressful in itself.

Getting away if you have a few days off in a row may help you switch off. If this is not possible, simply get out into the fresh air as often as you can.

Try to separate your work life from your home and social life, this will help you rejuvenate and you will be a more effective, empathetic doctor when you return to work.

Avoid ruminating about work on your precious time off. To try to change your mindset and ask:

  • Can I influence it?
  • Why am I reacting this way?
  • Is there another explanation?
  • Why is this triggering me?
  • What is the worst that could happen?
  • What is the best that could happen?
  • What is the most realistic outcome?
  • What would you advise a colleague?

Reading this short article may seem a little overwhelming, but the suggestions are not prescriptive. Experiment with what works for you.

Trust yourself. Be kind to yourself. Keep connected. We are all still learning – please spread this article around and add your own ideas.

Clinical Professor Leanne Rowe AM is a GP and past Chair of the RACGP. Her book ‘Every Doctor: Healthier Doctors=Healthier Patients’ www.everydoctor.org, co-authored with Professor Michael Kidd AM, is about thriving in medicine as well as addressing the tough issues in medicine.

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