What really happens during your internship year (stage) - a doctor tells all

Congratulations, you've finished medical school - but you're not a doctor yet. "Who am I? What am I???" And now it's time to start that not-so-clear period: the internship year (in Israel, the "stage"). So today we'll talk about what happens during this year, what your role is, how to choose electives, the emotional side that people talk about less, and a few survival tips.

Let's go.

## An intern's day-to-day

What does an intern actually do? In every department your role will be a little different - but usually there are a few basic tasks that are "the intern's domain": joining morning rounds, writing admission and discharge letters, ordering consults, drawing blood, placing IV lines, and escorting patients between departments or to various tests in the hospital.

In internal medicine - that's usually where an intern gets the most independence; once they get to know you and trust you, they'll likely let you do a full admission from start to finish. In surgery - there's a lot of ward work too, but part of the role is sometimes going down to the OR to help and be what's called a "human retractor," meaning helping the surgeon hold some instrument for a few hours. Great fun. Both surgery and pediatrics can also place you in the ER (i.e. the pediatric ER or surgical ER) and ask you to help there instead of on the ward. In an emergency-medicine month - they usually let interns do the initial intake of a patient and then present to the ER physician.

As for on-call shifts - during internship you do 4 shifts a month, and the requirement is at least 44 shifts over the internship year. You usually do shifts in the department you're assigned to that month, or ER shifts. An intern is not allowed to be on call alone in charge of a ward, and you'll almost always be there in addition to a resident. In internal medicine and surgery - you're alongside one resident, helping with admissions and whatever you can on the ward; in pediatrics you can also be placed in the pediatric ER. In the ER you're usually even two or three interns on a shift and can sometimes split the night among yourselves, and there too, of course, in addition to a resident.

And despite that, there are cases where they'll leave you in charge of a ward alone in certain situations: sometimes these are extra shifts done on quiet wards - for example, when I was an intern at Wolfson, interns would do shifts on the hematology ward, where we'd basically sleep all night and in the most extreme case write an order for IV acetaminophen - and there's also a resident from an adjacent ward known to serve as backup. There can also be two internal medicine wards that are physically right next to each other, where one has an intern and the other has a resident who is their backup. The workload on shifts depends on where you do the shift, whether there's more than one intern to split the night with, and the overall load in the hospital. As a rule of thumb I can say that the shifts are indeed less busy than shifts as a resident.

## Electives - when and how?

Let's move to strategic thinking. First, electives. Electives are months you choose to do in departments you're considering specializing in. The goal of an elective: - To test out the specialty and understand whether it suits you - To check this specific department and see whether it appeals to you - To prove to the whole department how amazing you are - And to understand how you get accepted - what the waiting time for a position is, whether there's an admissions committee, and whether it's customary to do external rotations before applying to the admissions committee

Often, in all the pressure and the attempt to make a good impression, we forget that this is also time for ourselves to check whether we're even interested in specializing there. So remember to take the time to investigate the specialty and the place in order to understand whether it suits you.

At the end of the elective month, assuming of course that you're interested in specializing there - make sure to set a meeting with the head of department, and to clearly state that you loved the department. And don't be shy to say in the conversation that you're checking out other places - remember that they too have an interest in retaining successful interns and want you to come to them.

And also - find a way to stay in touch with the department after you finish there, so they don't forget you! That could be joining to help with some research or project, keeping up a friendly connection with residents, or going to a relevant conference to meet people from the department. And one of the important relationships you can build is good rapport with the department management's secretary - do that, you're welcome.

Regarding the timing of electives: there are always a lot of questions about the ideal timing. One school of thought says do them at the beginning so you don't waste time if you need to wait for a position; another school says do them at the end, so that if you continue to external rotations they'll still remember you. The question also comes up whether to split your electives or do them back-to-back. Of course it's not always up to you, because you have to coordinate with the department that's taking you and you might have to be flexible. But I'll give my opinion here - it's best to spread them across the second half of the year if possible. That way you arrive having built up a bit of confidence as an intern, but there's still time to think and wait for a position, or to start the process of beginning external rotations right when the internship ends if you want. If there's a department where you don't need to do external rotations but it's a place where you just wait for a position - then you can schedule it a bit earlier.

In any case, I wouldn't recommend doing electives back-to-back if you can avoid it - because an elective month is a pretty exhausting month where you really pour your soul into it, and it's better to have a month's break in between to rest a little. Also don't do electives in August, because half the department might not be present at all, and many hospitals also scale down activity in the second half of August. And it's also not recommended in a month with lots of holidays, so you don't miss potential days to impress the people around you.

## Where should you do your internship?

And another strategic question - where should you do your internship? Obviously it's a lottery, so you don't have a direct choice - but you do have the option to choose how to rank the hospitals you want. Beyond geographic proximity, of course, several considerations come in here, and it's important to ask yourself a few questions:

Are you considering a residency in one of the mandatory specialties of the internship? If you want a residency in internal medicine, surgery, or pediatrics (whether you do a regular or direct internship), then here it's genuinely important to choose based on where you'd consider doing a residency - so if you want internal medicine, a hospital with good internal medicine departments that you'd consider specializing in.

And if there's no chance you'd want to specialize in one of the mandatory specialties - then it's a bit less important to do your internship in a place with an excellent internal medicine or surgery department, and it's better to choose based on features that make the experience as pleasant as possible for you. For example, although there are many advantages to doing a residency at a big hospital, for internship there are many advantages to a small hospital: often a more pleasant atmosphere, and you get more independence and actually acquire more skills. And there are also hospitals known to provide a good experience for interns, so that's an important consideration.

## The emotional side of internship

In my view, the internship period is a time of pretty significant emotional turbulence that people tend to underestimate a little.

First of all, the transition from the status of a student to that of an intern is itself a shock - for years you were in the status of a student who is coddled and whom everyone practically begs to come teach in every department. Suddenly you've come to work - and not to work in your dream specialty, but to do the grunt work of a ward.

It's also a tricky in-between status - you're not students, but you're not treated as doctors either. Our place isn't always clear: there are departments where you'll feel a bit like a student again, and other departments where you'll feel almost like a doctor, and that can be frustrating.

Another point that can be hard is this constant moving between departments. You arrive at a department, you connect, you get to know the team, and then you have to leave and move to another department - each time a goodbye and getting to know people anew. And we don't feel 100% part of the department, and that can create a feeling of loneliness.

And of course, a period of a lot of uncertainty: pressure to impress everyone during your electives, but you don't yet know where you'll be accepted and when, and it's not easy to be in that position. There's no magic solution to these issues, but the first step is to admit and acknowledge that this is a somewhat turbulent period. And now I'll give a few recommendations to get through this year in the best way.

## Survival tips!

So, 5 important survival tips:

Tip 1 - I highly recommend connecting with other interns from the hospital, especially ones doing a plan similar to yours, so you can move between departments together. I can say that a few friends and I who connected on one of the first rotations asked to make some changes to our internship plan so we'd be together in more departments, and it helped a lot.

Tip 2 - Set yourself a goal: what the internship is supposed to be. The goal isn't to learn new material, you've finished your studies; the goal is to acquire basic skills - some technical skills like placing IV lines, but no less important, learning how things work in a public hospital, the side of the hospital you don't see as a student. So set that as your goal, because this is the opportunity.

Tip 3 - Even though you're not students, you're in your professional training period, and you shouldn't be shy to ask to be taught, to have things explained, and to be allowed to do procedures you want to try. The most that happens is they say no, no harm done. And you can also ask to sit in on student lectures held in the department if you're interested.

Tip 4 - In every department you arrive at, the first thing is to ask them to tell you who the head nurse is, where the defibrillator is, and where the crash cart is.

Tip 5 - Never agree to go escort a patient before they give you the time to read the entire medical chart and understand who the patient is. There's nothing that annoys the second doctor who receives the patient more than getting them with an escort who knows nothing about them, and rightly so, because it's not medically sound. So before going out to escort - you read the whole chart, and if it's a complex, unstable patient, you ask the doctor who sent you: 1. what unusual events might happen on the way, and 2. how to handle them? Do you have all the equipment and knowledge needed to handle such a situation?

And one last thing that's important for me to say - see the internship as an opportunity. Internship is a great period to discover what you love. And here I'm not talking about the obvious case of electives, I'm talking about the day-to-day in the mandatory months too. Even if you're a million percent sure you don't want to specialize in internal medicine - it's still a great opportunity to identify the kind of work that suits you. Is the happiest moment of your day when you sit down to talk with a patient? Or when they send you to help in the ER or to escort a complex patient? I talk about this in more depth in my video on 5 mistakes in choosing a specialty, so I recommend watching it after this too - but the idea is: try to identify the kind of work and the kind of interactions with patients and colleagues that fill you with energy and feel good to you.

And remember, the internship is only 11 months - see this period as an opportunity to experiment with a safety net and to learn to know yourself professionally. Good luck!

I hope this video helped you. A reminder to subscribe to the channel, write me your questions below and I'll answer, and see you in the next video.