Preparedness for internship: a survey of new interns in a large Victorian Health Service

Abstract

Objective. To gain better understanding of the work-preparedness of new interns and identify areas where further training and education should be provided. Design. Surveys of new interns assessing self-reported confidence and preparedness for tasks commonly undertaken without direct supervision. The first survey was undertaken before the cohort had started work, the second once they had completed their second intern rotation. Setting. A large metropolitan Victorian health service. Participants. All interns starting in 2009 at Southern Health. Of the total 66 interns, 52 (84%) completed the first survey and 37 (56%) completed the second. Main outcome measure(s). Self-reported confidence and preparedness for common intern tasks. Results. The surveys identified tasks that interns undertake frequently, their preparedness for these and their confidence in completing them. Although most felt reasonably well prepared by their university training for many tasks they commonly undertake as interns, this was not the case for all tasks. In particular, they did not feel well prepared for the following: preoperative patient review, handover, fluid and medication management, patient admissions, assessment of unstable patients, communication with patients and families, and pain management. Conclusions. There are particular domains of work-readiness for interns that could be improved. For best results, the training of interns in these common tasks should be undertaken jointly by hospitals and universities to ensure smooth transition from medical student to intern. What is known about the topic?Transition from student to intern requires a range of skills and attributes. Previous publications have demonstrated a link between the number of times a procedural task has been completed by junior medical staff and confidence in completion. What does this paper add?This paper documents interns' own views about the tasks commonly undertaken during internship, and their views on how well they were prepared for these tasks by university training and organisational orientation. It considers non-procedural tasks (such as communication and escalation) as well as common intern procedures. It also documents the intern hopes and concerns regarding internship immediately pre-employment and after 20 weeks of employment. What are the implications for practitioners?Later-year university training experiences and organisational orientation planning should at least in part be geared by the requirements for work-readiness at intern level.

A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors

“…However, the transition from medical student to junior doctor is a significant one and there is evidence from multiple countries that many commencing interns feel ill-prepared to deal with their new responsibilities [4-11]. Areas of particular concern in relation to intern preparedness appear to vary somewhat between jurisdictions, but include: clinical decision making [4,6,8], the management of emergencies [4,6,7,9,11], communication of difficult news [6,7,10], and the performance of practical procedures [4,7,9]. …”

“…Hilmer’s group reported that Australian graduates from multiple medical schools appear, both subjectively and objectively, to be poorly equipped for this task, giving rise to real concern about patient safety [12]. These findings were echoed in several of the recent broader studies of intern preparedness from other settings [4,9,10,13], as well as earlier specific prescribing studies by Pearson and colleagues [14,15]. …”

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