One Saturday morning, after a 24-hour shift at the Salt Lake City Veterans Affairs Medical Center, I got out of a call room bed and realized I had done it. The year everyone dreads, the one everyone says "you just need to get through," was finally over.
I had completed my write-ups on all the patients I had admitted overnight. My emergency room consultation requests had been seen. I checked my pager for missed pages: nothing. I was done. I walked out to the parking lot, took a last look at the massive Wasatch Mountain Range behind me and went home. I was no longer a medical intern. I was officially a resident physician.
Waking up in scrubs that last day in a call room bed that had become as familiar as my bed at home contrasted starkly with my first day walking in my ill-fitting tie and oxford onto the inpatient psychiatric unit at the University Hospital.
The number of "I don't knows" that first day was daunting. I had never even used a computerized medical record so I could not review my patients' histories before rounds. I had just been hired on the basis of a credential that took eight years after high school to earn and yet I didn't know how to read a patient's chart.
The path to independent medical practice starts in the initial awkwardness of internship. When I was first called "Dr. Rama" I thought people were talking to someone else. And yet I was now a salaried physician, albeit in a training capacity, with obligations to patients and even in charge of my own medical students. By the end of the year not only was I responding with my actual title, I was also making clinical decisions with authority.
The concept that graduated medical school students are not prepared to take full responsibility for patient care may be difficult to grasp and even a bit frightening. Internship is where "medical education" (textbooks and lectures) meets "medical training" (on-the-job experience). Residency training (the years following internship) is the formative period when one delves deeply into a specialty and over time makes decisions with progressively less supervision.
The "M.D." on every new graduate's blindingly white (yet to be used) new coat speaks to two polar-opposite qualities: This will forever be the apex of one's grasp of the theoretical basis of medicine and the absolute nadir of one's experience with respect to applying these concepts in an actual hospital. Although medical students spend considerable time in the hospital, the gravity of these experiences is tempered by the fact that the word "student" is attached both in the minds of staff as well as the student. The word "student" takes on a convenient amorphousness. Some days I found it irritatingly pejorative, on others I clung to it with the desperation of a security blanket.
This month, roughly 20,000 newly minted M.D.s will begin internships in American hospitals. In other words, on Monday, July 1, 20,000 people had their blankets taken away. If you listened carefully you could almost hear the collective rush of wind and inevitable whimper.
Arjune Rama completed his psychiatry internship at the University of Utah Hospital. He is currently a resident physician in psychiatry at Yale University School of Medicine and a staff writer for Hum Magazine. He lives with his family in New Haven, Conn. A longer version of this column appeared in Hum Magazine and KevinMD.