Better preparing Australian medical graduates: Learning from the New Zealand model of trainee interns

Malcolm Forbes & Dani Bersin

Tuesday, March 29th, 2011

Dr. Malcolm Forbes
MBBS, James Cook University (2010)
Intern, Princess Alexandra Hospital, Brisbane

Dr. Dani Bersin
MBBS, James Cook University (2010)
Intern, Royal Brisbane Hospital, Brisbane

Dani served a number of years in various positions for the James Cook University Medical Students’ Association, including President in 2008. He completed his fifth and sixth year clinical training at the Northern Territory clinical school, with his ‘rural internship’ in Alice Springs. He plans to specialise in the area of critical care.

The New Zealand experience of preparation

In New Zealand, the trainee intern (TI) year is a clinical apprenticeship year undertaken in a hospital under the aegis of a medical school. It is undertaken in the final year of medical school and comprises eight clinical attachments (Table 1). The year aims to provide learning in the work environment with limited clinical responsibility. Trainee interns are paid an annual stipend (60% of a house officer’s salary) from the New Zealand government via the education budget; however, the year remains under the jurisdiction of the medical school and thus retains an education focus. Although required to be supervised, TIs contribute to service (taking on approximately one-third of the patient load) and often stay on after graduation in their respective hospitals for postgraduate year one (PGY1). [1,2] Formal education and rotation assessment occur continuously throughout the year.

In Australia, there is no equivalent transition from medical school to internship and this transition may be overlooked. Medical graduates switch from enjoying little or no clinical responsibility to suddenly being accountable for the safety and management of a large number of inpatients. This precipitous change of role affords minimal time for satisfactory adaptation and preparation for the stress associated with internship. Some medical schools have attempted to soften this transition by introducing pre-internship terms into the curricula. [3]

Transitional stress from medical student to intern

The transition from university to workplace, with accompanying increase in professional responsibilities, is inherently challenging for most graduates. The reality of being personally responsible for patients can induce stress, psychiatric morbidity (including depression and anxiety) and burnout. [4] In a prospective longitudinal study of 110 interns who had graduated from the University of Sydney, 70% of interns met criteria for a psychiatric disturbance on at least one occasion during PGY1. This level of stress leads to decreased effectiveness at work and a reduced level of patient care. [4,5]

Some identified stressors include newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported. The stress of transition can be reduced with early clinical exposure, including opportunities to act in the role of a junior doctor. [6]

Lack of preparedness for internship

Despite extensive research and frequent appraisal of medical curricula, junior doctors still perceive gaps in their preparation for internship. In one survey of interns, medico-legal aspects and resuscitation skills were identified as areas where…