Train your trainees

I’ve been spending a lot of time in labour ward anaesthesia this past month. It’s great, because I get all the gratification of the caesarian sections (I remember it well from internship), without having to wade through blood and amniotic fluid and human excreta myself.

This tweet in part inspired this post.

Another thing I remember well, is the tension in theatre when the intern is cutting. I had such difficulty getting my ten caesarian sections for our logbook signed off, because so few seniors were willing to let an intern cut. It’s not only the obstetrician – often, it’s the theatre nursing staff. To be fair, nobody likes to be scrubbed in for a routine caesarean that lasts ninety minutes. Other times, it’s the anaesthetists. Because nobody likes to worry that their spinal anaesthetic might wear off before the surgery is over.

I have had a taste of the same with my new position, too. Not having done anaesthesia in four years, there is a lot I have had to relearn. My “teachers” have been great, and I seem finally to be finding my feet, but there have often been grumblings from surgical teams when I was slow. As an intern, I might have minimised myself and declined to perform the procedure. But now, I need to learn, and quickly. So I have been pushing back harder (when not to the patient’s detriment) – and to my new colleagues’ credit, they have supported me.

Check the replies on this tweet – they made me feel so much better.

Having experienced this, I will always be the annoying medical officer who encourages the intern/student/newbie to perform procedures. Not because I think I’m so wonderful, but because I want trainees to feel as nurtured as I have felt these past few months, and not as burdensome as I sometimes did as a student and an intern.

Sometimes, I think clinicians forget that they were inexperienced and under-qualified juniors once, too. There is nothing admirable about learning to place an intercostal drain on YouTube, without senior supervision, as many of us like to brag. That is a sign of a failing system. We should be taught and guided by others with experience. We deserve that. Our patients deserve that.

I also know that it is a system that fails not only interns. I know that demoralised doctors have little interest in training juniors. (But that is a discussion for another day.)

Interns who are not competent become dangerous medical officers, wherever they may go for ComServe. They have both the right and the responsibility to be trained. We have the responsibility to ensure that they attain their very best, even if they are afraid while doing so. We do it to pay forward the teaching we have received. Or if we were not so fortunate, we do it to improve where others failed us.

Train your trainees. It kind of goes without saying.

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. Continue reading “The “Good” Intern”

Questions on Blogging for Readers Past/Present/Future

I started this blog exactly eight years ago, today.

Who I was then, and who I am now, has changed drastically, and often. I wrote as I stumbled my way through new clinical and life experiences. I wrote as my mental health peaked and plummeted. I wrote as my love for medicine died, and was reborn. The first community I found was that of book bloggers, but gradually, I found the medical bloggers, too.

Continue reading “Questions on Blogging for Readers Past/Present/Future”

Tips for New Interns: First Week at Work

Last night I worked my last shift for Community Service. 1 January 2018 will mark three years since I walked into my first day of work. And on that day, more than 1,000 new interns will enter our workforce.

I remember the nerves the night before: being unable to sleep. Feeling like a fraud, like I had been allowed to graduate by accident. Worried that I would be labelled Worst Intern Ever; worried that I’d have awful colleagues. But I survived the first week, and eventually the first year, too.

And so will our new interns. I have some tips for those who need ’em.

64062aa6fd8336df8d9536c250fadde7 Continue reading “Tips for New Interns: First Week at Work”

Are We Secretly Our Own Worst Enemies?

If you’ve been reading South African news, you’ll know that at least 300 interns and community service doctors stand to be unemployed next year, due to a lack of funded posts at accredited institutions.

Perhaps you read about our inhumane working hours last year.

Perhaps you have read about the overflowing hospitals where patients pile up in the corridors.

These are not new problems, we just hear about them more because doctors and patients have phones with cameras, and social media accounts.

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Continue reading “Are We Secretly Our Own Worst Enemies?”

The Threat of Fun-employment

In final year, we thought that getting an internship post at our desired hospital was the hardest – and most coveted – thing.

Two years later, we all tried to find a community service posting that would give us a foot into the door to our future specialties.

But we didn’t know that those were the easy parts. Then, we still pretty much had guaranteed employment (most of us, at least).

Then came the end of Community Service, and reality hit us in the face: we were on our own.

* * *

That’s where I am now. The government no longer “owes” me a job, and unless I find one, I’ll be unemployed come January 2018. People used to say, “There’s no such thing as an unemployed doctor.” These days, there are plenty of them, because freezing posts is a done thing. Continue reading “The Threat of Fun-employment”

The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why

If you’ve been paying attention, working hours of doctors (especially junior doctors) have been getting some good airtime over the past few months. The Province of the Western Cape has committed to actively reducing maximum continuous working hours for doctors to twenty-four, the HPCSA has promised to “look into it” (not that we have too much confidence there), and our biggest representative, SAMA (South African Medical Association) has come out in our support.

One of the things to come from all this is the launching of an armband campaign. This has its origins, I believe, from a similar campaign in the UK – although I have not been able to find any source to this link.

608772084 Continue reading “The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why”

Abortion Care: Did I Provide My Best?

It’s funny how sometimes, long after the fact, you start questioning your levels of care and competence.

During my first rotation of internship (last year), which was Obstetrics and Gynaecology, I was one of the few interns willing to do pregnancy terminations. (For the purposes of this blog, the matter is not up for debate – I have been pro-choice for nearly half my life, and have thoroughly evaluated my own beliefs.)

Just recently I’ve found myself thinking back on those four months and wondering if I did everything I could, and if I was empathic enough. Continue reading “Abortion Care: Did I Provide My Best?”