Many medical school programs require clinical hours in a hospital to help bridge a student’s studies to daily duties they can expect once they begin a career in health care.
“The key thing is to know that you have support, and there are people to turn to and to know when you don’t know something,” says Dr. Rebecca Berman, a professor of medicine and program director for internal medicine residency at the University of California San Francisco.
While each day likely brings different experiences, there are some similarities regardless of the intern’s location.
What to Expect on a Typical Day: A Tale of Two Interns
A Hospital Intern
For the last year, Garrett Kettle has been an intern at Clarion Hospital in Pennsylvania, where he’s learning efficient patient diagnosis and care. Kettle, who attended Lake Erie College of Osteopathic Medicine, says he’s practicing working in an orderly manner so that he doesn’t miss gathering essential information like medical and family history, X-rays, and past surgeries and examinations.
“As a medical student, this allows me to see patients and formulate plans and workups based on my own knowledge while being watched by medical professionals with more experience,” says Kettle, who received a master’s in medical physiology from Case Western Reserve University in Ohio.
Kettle gets to the hospital before 7 a.m. and meets with the night team members, who transfer responsibility for care and provide information about patients. He then heads to the morning lecture for information updates on medical workups, where he gets data for diagnosing and treating specific patients. Workups are typically a thorough medical examination with the goal of making a diagnosis.
From 8 a.m. to 9:30 a.m., Kettle does pre-rounding, a routine that consists of checking patients’ lab work and vital signs and performing physical exams. This typically takes about 15 minutes per patient, although that can vary.
From 9:30 a.m. to noon, Kettle reviews each inpatient’s status and care plan. He records and shares observations, like things that could affect treatment.
From noon to 1 p.m., he attends a lunch lecture for continued education, learning about new and developing areas in the field through media and publications, for example. From 1 p.m. to the end of the day, which usually is between 4 p.m. and 5 p.m., Kettle finishes charting medical data for new patients with the guidance of professionals.
“This acts as a safety net so nothing is missed or they can educate me on things I missed,” he says.
A Dermatology Office Intern
James Kacsur is working toward becoming a physician assistant and is a medical assistant and scribe at a dermatology office in Yardley, Pennsylvania. He has a bachelor’s degree in biology, health and society from the University of Michigan and worked in dermatology for more than eight months with both surgical and general patients.
Kacsur normally starts his day at 8 a.m. He escorts usually four to six patients from the waiting area to an examination room over about an hour.
For patients recovering from surgery, he checks for signs of infection and whether surgical incisions are healing well. If the time is appropriate, he removes the stitches.
“For patients doing full-body exams, I ask for any updates on their medical history and give them a gown to undress before the doctor sees them,” he says. “If they are elderly or incapable of undressing themselves, I sometimes give assistance, or a family member or caregiver assists them.”
For surgeries, Kacsur cleans the room, prepares a sterile surface to place instruments and sutures, and brings the patient back. “I then assist in the surgery by stopping bleeding, cutting sutures and other technical processes to ensure minimal risk for infection and ease for the doctor or physician assistant I work under,” he says.
Most of his studies did not prepare him for the technical aspects of the experience or patient bedside manner, he says.
“Besides knowing the chemical compounds involved in the medications we prescribe, most of my undergraduate education has not helped me during any of my positions,” he says. “While my education was important and will come up when I am a full-fledged medical provider, the bulk of what I currently do, and eventually will do, will not be heavily influenced by my undergraduate studies.”
He says his intern experiences have taught him good bedside manner, how to talk with patients, technical skills and how to be confident and smart in providing health care.
Advice for Medical Interns
“My key advice would be to view your colleagues as a team and to never worry alone,” Berman wrote in an email. “Your residents and attendings are there to help you. No one expects you to know everything and everyone wants to help you succeed. Speak up if you are worried about a patient or about yourself.”
Dr. Susan Sander, founding physician of Tohickon Internal Medicine in Pennsylvania, says interns nowadays will find that, compared to years ago, doctors more often diagnose and treat patients in telehealth appointments via a computer or phone.
Interns should rely on the group of professionals they work with and be receptive to advice and constructive criticism, says Sander, who earned an M.D. at Stanford University School of Medicine in California and has decades of experience working with medical interns.
Kacsur says questions “are imperative and you should ask as many as you can to learn as much as you can.” He recalls the words of a doctor he once shadowed: “It’s called medical practice for a reason, and you need to use every opportunity as a learning experience because medicine is always evolving and we can always get better.”
Medicine has higher stakes than some jobs because it involves health outcomes, Kacsur says, and mistakes will be made – not just by interns, but by doctors at the highest level.
“You can make mistakes, and you definitely will, even more so at the intern level and starting new positions. You just have to learn from them,” he says.
Sometimes interns fall into the trap of “worrying that they’re not learning enough,” Berman says. “But the system works, and you learn more during your intern year than you will learn at any other time in your life. I would encourage them to think … ‘what are the three things that I learned today’ just to help consolidate that knowledge.”
Some medical facilities have long training periods, from three months to up to a year. This is based on the difficulty of a specific position and can be a benefit to take advantage of if an intern needs additional training, Kacsur says.
“Use the training period to learn, ask questions and avoid mistakes with help from your supervising trainers,” he says. “There will be stressful days, busy days, days with angry patients, days with patients who are noncompliant with their treatment, but each day will teach you something new.”