Dr Caitlyn Flint’s proudest moment of 2020 wasn’t finally starting work as a doctor after nine years of study. It was the joyful look on her son’s face on his third birthday.
“My son wanted a dinosaur cake and I spent four days making it. I was really worried it wouldn’t turn out, that the structure wouldn’t be right. He loved it so much he asked me to make a second one in pink,” she says.
She doesn’t usually have much time to make cake. This year, interns who are parents have juggled long hours and, due to COVID-19 lockdowns, a changing family routine. Interns work 51 hours a week on average, above the 47 hours a week average of all Doctors-in-Training, according to the AHPRA 2019 Medical Training Survey. It’s not uncommon for some of them to already be parents. The average age of doctors in their internship year is around 29, according to AHPRA. This is just below the peak ages for Australians to have children, 30-34.
After graduating from the University of Newcastle with an MBBS, Dr Flint commenced work at Calvary Hospital ACT. She moved to Canberra from Newcastle with her husband and their two sons, aged 1 and 3. She is one of around 3,500 interns across Australia for whom the pandemic has affected their first year of clinical practice.
Like many other health professionals with kids, many interns who are parents initially feared the impact of the pandemic on their family.
“I had conversations with my family about whether I would need to live independently from them,” says Dr Flint. She is glad her husband, parents, and parents-in-law haven’t had to try to fill the gap that would have been left by her not being able to be physically there for her children. “Being a parent is one of the most joyous things I could do. Knowing that my family has supported me so much so far and may have had to continue supporting me in such a way would have been difficult,” she says.
She has found it harder than she expected to balance clinical responsibilities with teaching sessions on zoom. The usual teaching auditorium at Calvary can only accommodate 15 interns with social distancing, but there are 90 interns. “The problem is with social distancing there is nowhere for us to go to be socially distanced. We are doing it on our phones rather than going to a physical location. It makes it harder for that time to be physically protected, because you are on the wards and doing other tasks,” she says.
The situation has been especially tough for interns who have been through long lockdown periods or been assigned to COVID-19 wards. Dr Simon Watson graduated with an MD from the University of Notre Dame last year and is completing his internship at Melbourne’s Northern hospital. Having battled a rare multisystem disorder and undergone an autologous stem cell transplant whilst in medical school, he is no stranger to the need to be resilient.
His training has been totally different to what he expected. “My first two rotations were surgery based. The second one was very quiet because they shut down all the elective surgery. A lot of the things that traditionally would have been an opportunity for the intern to get in and get their hands dirty just weren’t available. That was probably one of the really disappointing things.”
He continues: “After I did my surgical rotation, I did a general medicine rotation. My team got converted to the COVID-19 team. We were basically looking after COVID-19 patients. That changed things around.”
One of the things he missed was having medical students to help with ward-based tasks. “As an intern you really quickly realise the value of having good medical students when they are not there,” he says.
“The other thing was having to wear the PPE (personal protective equipment). It became really uncomfortable after a while having to wear the PPE for 10 or 12 hours a day. It made life a bit challenging, particularly with communication,” he says, referring to the difficulty of talking to patients through a mask.
He was not overly concerned about catching COVID-19 and passing it on to his children, however. “One thing I was really confident about was that I knew that the patients I was dealing with all had COVID-19, so it wasn’t like there was any uncertainty about it. It was all or nothing when it came to PPE. If you wore the PPE and you did things in a really methodical, measured way, then you were going to be pretty safe. That’s the way I rationalised it,” he says.
Dr Hashim Abdeen, Chair of the Australian Medical Association Council for Doctors in Training says early planning federally with the Medical Board of Australia helped protect interns’ pathway to general registration.
“Just before COVID-19 took off, we spoke to the Medical Board and advocated that there be flexibility for interns, as it was a very stressful situation where a lot of interns felt they couldn’t progress,” says Dr Abdeen, speaking about the requirement for interns to complete mandatory rotations such as surgery and emergency care.
“The Medical Board has said that they weren’t going to hold the interns responsible for not being able to fulfil those requirements,” he says. Other concessions included reducing the required weeks of internship service from 47 to 40 to allow for isolation and sick leave.
Dr Abdeen thinks that overall, interns have not faced the same level of disruptions with placements and exams as many other Doctors-in-Training. “They are protected a lot more because of accreditation by the AMC and the PMC, so they have to make sure they are in a space that provides good education, supervision, training and orientation.”
Dr Flint says her internship experience has had some surprises but has been positive thanks to the workplace support she has had.
“I expected that I would need to make more big decisions,” she says, comparing the bigger picture clinical planning she had practised in medical school with her now more task-based role as an intern. “It has been really nice to be out and working and doing an ok job. Nothing can really prepare you for what internship will be like, but that doesn’t mean that you will be unprepared. It’s a new job, you just need to know what you are and aren’t comfortable doing and people will help you,” she says.
Dr Watson says resilience, for him, is about having trusted mentors and being realistic about what is expected at internship level.
“I think resilience comes from your ability to go and talk to people and have a conversation with a mentor or a friend. To talk to someone who is trusted, someone who is going to listen and take it on board and hear what you have to say and doesn’t try and fix your problems for you,” he says. “Even though you are a doctor, you are still very much a training doctor. Don’t walk away at the end of the day thinking ‘why didn’t I know the answer to that or why didn’t I pick up on that’ or feel that you should have. It’s probably something that people wouldn’t have expected of you anyway. Don’t put too much pressure on yourself. Be kind to yourself,” he says.
For interns who are parents, their kids can bring a sense of lightness away from the pressures of the hospital and the new role.
“Being a parent, you come home, and you are forced to switch off,” says Dr Watson. “You don’t really have the luxury to keep thinking about work, or thinking about studying, or thinking about something that happened that day that you need to read up on. It’s really about coming home and shutting off and thinking that’s work done for the day, I’ve got a few other things to do.”