From a resident physician who did rotating internship

I read with interest this CMAJ article which advocates rotating internship for Canadian medical graduates.<1> I did rotating internship in the United Kingdom (called “Foundation Programme”), where I spent two years rotating to various specialties. That is meant to improve trainees’ generalist experience before entering specialty training. Each graduate is required to rotate to both medicine and surgery. Some are even required to have a mandatory rotation in general practice in hope to improve recruitment to this specialty. However, I know some colleagues, once aspiring to become GPs, changing their career goals after some horror experience of being a generalist. It obviously does not help when they encounter staff GPs who are also disgruntled about their work.

Moreover, being an intern does not guarantee you obtaining the skills you want.<2> In my 4-month surgery rotation in the UK, I was allowed to go to the operating room only once, as this is not an intern’s required learning objective. In my psychiatry rotation, I was told I was too junior to prescribe any psychotropics. In my medicine rotation, I was told I need a senior to co-sign all my CT scan requests. An intern is often being treated as someone at the bottom of totem pole, whose main duty is to provide service.<3> If the Canadian residency programs have plenty of interns to provide service, they may have less need for residents, and thereby reducing the openings for residency positions. I wonder whether this would create even more unhappy Canadian medical graduates than ever.

What happen when these graduates are still unmatched to their desired residency programs after completion of internship? In the UK, unmatched candidates could enter non-training posts where they further enrich their experience and be paid for their service provision. However, some trainees are in these non-training posts for a prolonged period due to the difficulty of moving up the training ladder. Would we have the same structure in Canada, or would Canadian trainees eventually become unmatched and jobless?

Although I see my internship as a valuable experience prior to residency training, I also want to raise awareness of how this could impact on the mental well-being of medical graduates.