The “Good” Intern

The October issue of the South African Medical Journal (SAMJ) published an article, ‘Going the extra mile: Supervisors’ perspective on what makes a ‘good’ intern (De Villiers, Van Heerden, Van Schalkwyk). The paper assesses the opinions of supervisors on interns’ practice readiness, which differs from most research on the subject, which has predominantly researched the interns’ own perception of their preparation.

The study reported on the results of interviewing 27 intern supervisors – a small, but diverse group of consultants, registrars, and medical officers.

What stood out for me was that the interviewees displayed a keen awareness of the challenges faced by interns. They recognise three areas of particular difficulty: transition from student to doctor, adjusting to a new environment, and long/hard working hours.

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Despite this awareness, it appears that the impetus is placed on the intern to “overcome” these challenges, rather than acknowledging that some of these challenges may need to be addressed by the higher-ups. Mention is made of “resilience”,  a word that particularly grates me, because it places the buck squarely on the shoulders of interns, allowing superiors to wash their hands of responsibility.

 

While I agree that interns should take some responsibility, they have shown time and time again that they are willing to put the effort in: take, for example, the Safe Working Hours Campaign – which only had some success when those in higher offices recognised the problem. Even so, because the main driver of this campaign was junior doctors, it fades into obscurity until the next tragedy occurs.

The gap between being a medical student and becoming a doctor will always be a challenge, but it is a challenge that can be ameliorated with good senior support. (As a first year intern, I especially found that the second year interns were very good at taking us under their wings.) Of greater concern is environmental factors and long hours, as these are both areas that are in serious need of review by senior clinicians, management, and the Department of Health. The are not simply things that interns must overcome – they are areas that must be addressed, and changed.

 

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This graphic is from CanMEDS, but it is the framework that has been adopted by the HPCSA.

Characteristics mentioned that certainly have value for a “good intern” include good organisational skills, good competence, social intelligence, and certain personal characteristics, such as dedication and discipline. It is worth noting, as stated by interviewees, that some of these abilities are not addressed by the HPCSA’s key competency framework. This is an area medical schools may want to give some consideration.

 

In my opinion, this research is quite good at identifying areas that are challenging, and characteristics that may be useful for an intern to have. What it does not do, is recognise that many of these characteristics are extremely difficult to maintain in an overworked and demoralised milieu – and that it is high time it be addressed.

* * *

References

Core competencies for undergraduate students in clinical associate, dentistry and medical teaching and learning programmes in South Africa.

de Villiers, M., van Heerden, B. and van Schalkwyk, S. (2018). ‘Going the extra mile’: Supervisors’ perspectives on what makes a ‘good’ intern. [online] Samj.org.za. Available at: http://www.samj.org.za/index.php/samj/article/view/12429/8634 [Accessed 13 Nov. 2018].

Kotze, K. (2018). A life-saving shift: New reductions in doctors’ hours are still far off the mark. [online] Bhekisisa. Available at: https://bhekisisa.org/article/2016-09-12-00-a-life-saving-shift-new-reductions-in-doctors-hours-are-still-far-off-the-mark [Accessed 13 Nov. 2018].

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