In general surgery, I am privileged each year to witness the development of interns into competent, confident medical practitioners.  Interns are in their first year of work after medical school.  The year acts as a provisional training year – the final test before being awarded general registration.

The task of an intern is basically to be there and take time.  They are often the first doctor to assess a patient and they try to assemble some facts in a logical manner.  If the problem is straightforward, they might manage it – like writing up medications, changing painkillers, organising a follow up appointment etc.  They are also responsible for a lot of the brainless administrative work that requires a qualified doctor – documentation, organisation of scans and tests, chasing up results, and making referrals to other services.  In lots of ways, they are the personal assistant of the unit, because their job involves a lot or organisation, list keeping, tracking and chasing.

When interns start their job, they have some natural ability, but most of the tasks they do, they learn by experience.  Organising a CT quickly is a skill specific to the hospital, as well as the radiologists on that day, and the intern’s own organisational style.  Over twelve months, interns turn from unsure, nervous young doctors, into confident, capable residents (well, mostly).  It is probably the greatest learning year in any doctor’s career and often transforms them completely.  They are not magic at the end of their year, but they are infinitely better than an unformed medical student.

So last week our new interns started.  Our confident 12 month old interns, were replaced by newbies, who have a lot to learn.  In honour of all the wonderful interns I have worked with, I would like to share the differences between the new and the old.

• Old interns can listen to a room full of consultants talking and walk out with ten tasks written in priority order.  New interns can’t tell which ones are consultants.

• New interns call me Ms Cuthbertson.  Old interns have no memory of respecting me in that way.

• New interns are scared to come to theatre with me because they worry about contaminating the sterile field.  Old interns are scared to come to theatre with me because they know I will ask them anatomy questions.

• New interns triage tasks by time.  Old interns actually triage tasks.

• New interns colour-code tasks to keep from missing important things.  Old interns can pick a deteriorating patient out of a scrawled task list at two am.

• New interns ask their registrars to help them resite an IV cannula.  Old interns know which resident in the hospital has the current unbroken record for successful IV resites (and which is the butcher of B ward).  They never bother asking their registrars.

• New interns need to be asked  to look up a result/bed number/previous operation note.  Old interns stop at three generations of family history and five years of old results, but only if they run out of time during the ward round.

• New interns ask at the end of the round which ultrasounds they should organise first.  Old interns organised it before the round started, based on probabilities.

• New interns give their mobile numbers to consultants who ask.  Old interns have learnt that all consultants are not created equal, and are reminded each time they are woken by a 2am control-freak SMS.

• New interns call anaesthetists/radiologists/other registrars without all the answers.  Old interns laugh at their folly.

• New interns have to run three laps of the hospital to get a serum rhubarb and a request signed in blood.  Old interns can get a CT approved in 30 words or less, while avoiding all known rage-trigger-phrases.

• New interns think people will remember their name.  Old interns tell you their name each time they meet you.  And give you a feedback form with a photo and a brief description of all the impressive feats they performed in front of you.

• New interns approach most staff members with an open mind.  Old interns have an internal list of people they plan to slap one day.

• New interns think similar basic management rules apply to all patients, regardless of admitting service.  Old interns can navigate the minefield of IV fluid orders, suitability of non-steroidal administration, when to give medications and fast everyone for everything.

• New interns think registrars and consultants are important to impress.  Old interns know senior ward nurses, radiologists and booking clerks are much more important.

• New interns think they know where they are going and what their career will be like.  Old interns can tell you the one job, or one registrar, one consultant or one experience that completely affected their view of medicine, and changed their plans forever.