You made it through the Leaving Cert, the years spent in the lecture theatres of the Health Sciences Building on college campus, and then it is time to don the white coat as the clinical years begin. But what happens next? The life of a medical intern can be hard to understand past the headlines dominating the media - long hours, fatigue, a fluctuating pay- scale – so what is the reality? 

According to Dr. Ken Fitzpatrick, “It’s not so bad. You’ll enjoy it – really”. A current surgical intern at St. Vincent’s University Hospital, the experience is not how Ken initially expected. “During your clinical years you don’t really have the chance to see the interns at work, so when you start it can seem like you’re in at the deep- end at first. But I can honestly say I learned more in my first month working, than the entire previous four years of graduate medical school”.

After applying competitively for schemes following graduation, interns in Ireland find themselves across the country, becoming the newest team member, and the one responsible for managing the patient list. A list of all those in the care of your team, it is “the most important thing for an intern. It can change drastically, whether your team was on-call the night before or not”. This list keeps the team focused on their patients, and is the source of all information – from what tests and imaging have been taken, to those that are still outstanding - and what is next in the treatment plan. With 7am morning rounds led by the Specialist Registrar, it is the intern who makes a list of jobs that needs to be carried out for each patient before evening rounds. And with 20-40 patients to be seen within 30-60 minutes, focus and attention are imperative. On how to manage these jobs, while balancing other duties, such as admitting new patients, Ken stresses the need for organisation and teamwork skills. “There are usually at least two interns on any team, so it’s useful to meet up after rounds and split the workload to avoid double jobbing”.

In times of a greater workload, epitomised by the sounds of a never-ending bleeper, it is the supportive network of the team that allows interns to work without feeling too overwhelmed. “There can be a feeling of guilt when you call someone, but it’s specified that no-one minds. The Senior House Officers (SHOs) are really approachable, and while there is a chain-of-command, in that Registrars prefer to be called by SHOs who are called by you (the intern), patient safety is what ultimately matters – that’s the rule”.
 

"Patient safety is what ultimately matters - that's the rule"

With the recent ‘24 No More’ campaign, and regular media coverage of doctors' working hours, it might not be a surprise to learn that it is the on-call shift which most worries new interns. “The first couple of shifts were pretty terrifying – I was definitely nervous. You have this idea in your head that you’re not going to be able to deal with, what could be, a vast number of problems. But the assessments are all the same at the end of the day, so as long as you get the wheels in motion you’re keeping up with the team’s expectations”.

For surgical interns on-call, it is the medical Registrar on-call who becomes their saviour. Unlike surgical Registrars, who can go home if not needed in theatre, the medical Registrar stays in the hospital and is often at the other end of the phone, willing to give advice. “You definitely feel like a student at first. Being on-call teaches you that you need to get things done. When you no longer have an SHO to turn to, you realize that you have to keep trying. This makes you learn fast and, while it might seem a lot of pressure at first, it stands to you in the long run. By the second or third on-call shift the worry fades – physical exams and taking a history followed by collecting bloods and taking cultures become part of the motion”.

During a night shift interns are ruled by ‘sweeps and bleeps’. Sweeps - a list of non-urgent jobs put up by the nurses on each ward – can range from rewriting drug card indexes to placing cannulas; while bleeps are usually a call to assess a patient. Interns prioritize these duties, and while a 24-hour shift can be hard to adjust to “it can be fun – there’s usually a great camaraderie between the two interns on-call. There’s a chance for some down-time and to order-in food - generally the work load is divided to allow each intern to take 2-3 hours of sleep at a time”.

"while a 24-hour shift can be hard to adjust to "it can be fun - there's usually a great camaraderie between the two interns on-call"

With interns starting at 6:45am, mornings need to quickly be adjusted to – there are, however, a few silver linings. “There’s very little traffic at 6am, and always plenty of parking”. Another matter is breakfast - which really does become the most important meal of the day - as being busy, while good for time passing by, can often lead to missed meals. “You never know when you’re going to be bleeped, so be prepared to take any opportunity you have to grab something”.

Formal teaching continues throughout the year, with two lunchtime meetings per week, via the Dublin Academic Medical Centre (DAMC) Intern Training Program. As well as teaching, this also offers interns the opportunity to present interesting cases, and network with other interns across different schemes. Within the surgical team, there are further opportunities to learn more after morning ward rounds during the week – from a radiology meeting on Tuesday, to a Journal Club across general surgery on a Wednesday, or a research meeting on Thursday.

Though much of current media has focused on the rising emigration of Irish doctors, Ken is more hopeful on the subject. “Irish doctors have always emigrated. I think a lot of graduates want the experience of working in a different country, but most intend to return with new skills”. He also feels that the issue of the European Working Time Directive is being tackled within hospitals, but wider changes have to be implemented before progress becomes apparent.

When asked what medical students should be doing now to help pave the way for the intern year, Ken’s advice is clear: “Put yourself forward. Talk to as many patients as possible, practice taking histories, and performing physical exams when you get the chance. Don’t hold back - everything that’s good for you as a student is nerve-wracking!”