Indian Journal of Medical Ethics


Internship: A time to prioritise

FNU Anamika

Published online first on September 20, 2022. DOI:10.20529/IJME.2022.071


Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.

Keywords: internship, dilemma, medical student, mentor, residency education

Why is this resident doctor calling me now, even after my 24-hour shift, when all I’ve been able to get is two hours of sleep? I wondered despondently. Will he ask me to return to the Emergency Department (ED) for some more scutwork, or is he merely inquiring about a critical patient’s reports? As I was brooding over this, the ringing gradually became louder and louder. I picked up the phone despite my reluctance to return to the hospital. Was it my commitment to medical ethics or just the fear of getting rebuked for not answering the phone? Much to my relief, it turned out he was just informing me that I had forgotten my iPad in the doctor’s duty room, and he was taking care of it. Though relieved, I was still concerned, and I couldn’t help but think why it had taken me so long to pick up the phone. Is it possible that our allegiance and dedication to our patients isn’t enough to prevent us from having second thoughts in situations like these?

Clinical skills vs studies

I’ve always been fascinated by both diagnosis and treatment of patients. When I first started working in medicine, I volunteered for a variety of procedures, in which I had never dreamt of getting hands-on experience at such an early stage of my medical journey, such as lumbar puncture, intubation, thoracocentesis, central venous line insertion, bone marrow biopsy, and so on.

After my shifts, I used to stay up late studying the subject; on the other hand, practising skills in person takes up a lot of time — time that could have been spent studying for my postgraduate exam. An intern’s primary task is presumed to be taking blood samples, collecting reports, inserting nasogastric tubes and self-inflating catheters for every admitted patient, and considering that an average medical ward has more than 50 patients with an estimated 15-20 patients per intern, it gets nearly impossible to get any experience in diagnosing and treating patients in an 8-hour shift.

Now, the question arose: Do I need to gain clinical skills by working more than an 8-hour shift each day, with 12 and 24 hours of duty sprinkled in between at least twice a week? Or should I just take time out of my chaotic week and study for my residency?

Many of my seniors told me that internship is a time when you should devote as much time as possible to your studies or fun, rather than wasting it on the menial jobs assigned to us by our resident doctors, and I realised that they were right. Most of our residents couldn’t care less about our acquiring clinical skills, hands-on experience, or studies. They simply want us to be present and make their lives and responsibilities easier by entrusting us with the majority of their mundane tasks. However, I believe that this is due to the fact that the patient load in most tertiary health centres in Delhi is so high that residents are forced to appear helpless and assign their duties to interns. As we progress through our system’s hierarchy, consultants and professors dump their work on senior residents, who continue to boss around junior residents, who subsequently try to dump as much work as possible on interns. The biggest issue with interns dealing with such a load is that they lose track of their study schedule, and are caught in the dilemma of whether to be attentive, work hard, and try to gain clinical abilities, or try to find time for their residency preparations.

What does an internship teach us?

I remember an incident where I had an extremely hectic 24-hour shift after which I was supposed to have a day off. I even had 4-5 short naps sitting on my chair in the end. After the shift, I had a commitment to meet my family, who were coming for a few hours. I was quite happy when my duty ended, but just when I was leaving the ED, I got a call from a resident about a newly admitted sick patient, and I was required to send his investigations and monitor his vitals. Why does it have to be today? Will I not be able to see my parents? Should I just say I am not feeling well? Should I say I want to see my family and I am not coming back? This temptation is heightened since I know that someone else will fill in for me and complete the work; in essence, I will be delegating my work, rather than leaving a patient high and dry.

But I returned, because it is my obligation as a doctor, and dumping work is the root cause of many of us getting overburdened. Internship has made me realise that there cannot be a perfect balance between work and personal life in medical practice, but there are plenty of ways to even the scales. Consistency and dedication, as well as time management, are essential for getting things done more efficiently and successfully. Internship has instilled in me a sense of accountability toward my patients, society, and, more importantly, my career. I finally realise how to live up to the Hippocratic Oath. I understood that being a doctor is difficult because one must be available 24 hours a day, seven days a week, but it is more about being there for a person in need, for someone who sees a glimmer of hope in the voice and authority of a doctor. There are so many additional things that this year of grinding toil has taught me, that I can’t even begin to list them all. This has been a fantastic professional and personal learning experience for me.

Social life

Being productive at work and in one’s personal life always comes at a cost. I’ve gone days without seeing any of my batch mates, including those who live next door. The varied duty hours have made it even more difficult for many of us to find time for each other. Usually, when I have free time, my buddies are on duty or napping after their shift. Without a doubt, our social lives shrank to a trickle once we reached this stage; instead of going out, I started preferring dine-ins; instead of staying up late, I started going to bed early; and instead of inviting everyone in the group to a social gathering, we just had to find whoever was available. The difficulty with all of this is that it comes at a time in our lives when we may not be prepared for it. Our college years have just ended, we have all become financially independent, and being an Intern has practically turned into a full-time job.

Future branch and internship

Has it ever happened that the branch you’d always wanted to work in turned into a nightmare within the first month of your internship? Well, that’s nothing new in the medical field; I remember one of my colleagues who had always wanted to be a surgeon since the first day of college. After only a month in the surgery department, he switched to a less stressful branch where he didn’t have to deal with patients or round-the-clock emergencies. This situation can be viewed from two perspectives. First, that he fortunately had an early experience that helped him gain a better understanding of what the future holds for him. Second, that he just missed out on his dream branch due to the growing patient load and scarcity of doctors. Internships are critical in identifying what type of doctor or specialty one wishes to pursue in the future. Round-the-clock shifts, rotations between emergencies, out-patient departments (OPD), operation theatres, and wards offer you a taste of how different departments operate. I’d ask myself at the end of each posting if I could envision myself working here for the rest of my life. This clarified my residency decision for me.

Do you have conscientious seniors to mentor you?

It’s not hard to see how valuable you are as a member of a medical team. For a year, I’ve been a part of a few different teams. A few residents are ready to explain different situations and patients during rounds or OPDs, but the majority consider that educating an intern is a hassle or a waste of time. Similarly, some of the consultants or professors may ask us questions and try to be informative during ward rounds, while others may not even be aware of our presence. I can’t blame them entirely, because most interns aren’t interested in learning or even staying on the hospital grounds. However, it is important to separate the wheat from the chaff and focus on students who are inclined towards clinical learning.

I’ve considered spending my off-duty hours in the ward reading patient paperwork, procedures they’ve had, diagnoses, and so on. But, despite my best efforts, I still feel the need for a mentor to help me through the process, and at the end of the day, all I have is regret for not studying for my postgraduate exam. You can’t learn everything from books because each patient is different in their own way. That’s where experience, mentorship, and someone to teach you come in handy.


What internship teaches us is to experience what it’s like to see things through the eyes of a naive doctor, and to either do something by prioritising some tasks over others, or to do nothing while prioritising everything. We who are at the bottom of the doctor’s career ladder still have a lot to go through. Managing my responsibilities, studies, and social life hasn’t been simple, butdiscovering myself and learning about my profession has been, as has realising how grateful I am to be here, helping others and giving them hope to live and fight another day.

Acknowledgement: I would like to acknowledge the help of Ramansh Bandhu Gupta, also of University College of Medical Sciences.