On my penultimate day of internship, have been reflecting a lot this week as I've been training up our successors on what makes a good intern and what makes for a good intern year. Some nascent thoughts below
Humility. Awareness of the limitations of your knowledge and experience. Acknowledging that there are many people across many other professions in the hospital - nursing, allied health, pharmacy, ward clerks, porters - who are a wealth of information and intuition
Respect. So important. The best interns are part of cohesive units where a premium is placed on a flat hierarchy where everyone feels valued and willing to voice opinions and concerns. Understanding that everyone has something to offer and eminence≠precedence
Courage. The ability to speak up when you are worried about something, someone, or can see a potential chain reaction unfolding with capacity to cause harm, whether to a patient, a colleague or yourself. Never easy, but so essential to good clinical (and self) care
Honesty. If you make a mistake, own up to it quickly and work to ensure it doesn't happen again. You are only ever a cog in the machine, and if there's a squeaky wheel it needs to be addressed. We are only human and we have bad days. The system should be a safety net
Compassion. For our patients, our colleagues and ourselves. Don't document or comment on someone being a poor historian, or acopic. Understand the scale of challenges many people face in their lives. By design, we are the privileged few. Don't be blinkered by prejudice
Compassion #2 - FORGIVE YOURSELF. Things go wrong. People will die. Some you will take home with you and stew over. Could you have done something different? Was it preventable? Did you prolong life but extend suffering? Have a place/person to process with. Find ways to let go
Perspective. So difficult to have, particularly starting out. You are so worried about every single decision you make, it can be very tall trees and no forest. Take a moment to get out of the hospital and out of your head - sitting in the sun, taking off the mask. It helps
Diligence. Check everything you do twice, trust your instincts when something doesn't feel right. ALWAYS run your thinking past a senior - it's a safeguard and an opportunity to learn and grow. Ask for help. Internship is the moment in your career it's ok to be lost and scared
Openness. Be someone who is willing to listen and evolve. Model yourself as that person who is always approachable. Thank colleagues for their time and generosity. Learn people's names and use them. Take a genuine interest and keep a proverbial open door. It makes a difference
Flexibility. Expect internship to throw you curveballs and surprises. You will encounter challenges you hadn't foreseen - patients that push you to the limit, experiences that mark you in a thousand small ways, leaving an indelible mark. The more you can soften, the easier it is
Grief. It is a normal part of our job. We spend weeks, sometimes months, with patients we grow to know and care for deeply. Sometimes we have to let them go. It can be traumatic. During these pandemic days we can be the only ones there during those final moments. A proxy for love
Don't ever feel there is something wrong with you if the weight of the job feels - at times - as though you can't continue to bear it. But don't work through those moments. There is always space to step back. Have an outlet for your sadness, different for everyone, but is key
Gratitude. I've been blown away more times than I can say during the course of this first year of doctoring by the incredible privileges of the job. The capacity to make a difference, in a hundred small ways, every day. We are so lucky. Keeping sight of that is everything
<thread ends, with thanks for indulgence>

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More from @coopesdetat

27 Dec 21
"If the public was more educated and could see what was going on and feel some of those emotions that I hope my photos show, I felt like it would make a bigger difference" npr.org/sections/healt…
Emphatically agree with this. Have thought more times than I care to count over the past few years that it's simple to hold dogmatic positions and harbour extremist views when there are several degrees of separation between the general public and the very sick people we care for
I think most people have a generic understanding of what COVID ICU is like, but it's just the tip of the iceberg. Post-COVID can be incredibly debilitating, probably some of the sickest people I have seen, many months after their original infection. Some awaiting organ transplant
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