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Overview

This section is intended to give you a rough idea about the three main types of jobs interns can be allocated to and broadly what to expect

Hopefully you will have absorbed much of this as a student – though it may have been in a different hospital – but you will learn rapidly on the job regardless.

This section is intended just to ease the transition, ever so slightly.

Term Descriptions and Rover Forms

There are three major types of intern terms: Wards, ED and Relief. But before explaining these, it is worth noting that every term has an official term description. This requirement is an accreditation standard, and explains why they all follow the same template and all have the HETI logo – as HETI is the accrediting body for intern training. Some terms also provide additional orientation material at the beginning of the term.

A Rover Form (short for Rolling Handover) is a wiki document, maintained by JMOs, which contains all of their most useful tips for how to survive in the term. JMOs are expected to review and update their Rover forms at the end of each term, and use these as the basis of a handover with the incoming JMO.

So… in terms of what to expect - these two documents are always a good starting point and should be read prior to starting each new term.You can find all the Term descriptions and Rover forms elsewhere on this website, under JMO Resources

Ward Based Terms

In a ward based term you will be the junior medical staff member of a clinical team which will usually consist of several consultants, at least one registrar - sometimes more - and at least one junior (intern or RMO). Some of the larger teams may also include an SRMO or a fellow.

In some teams the nature of the work is considered sufficiently complex or demanding as to require an RMO as the junior rather than an intern. Every intern and resident term has to be accredited, and every term will be nominated on the term description as either an “intern/RMO” term, or “RMO” only. Needless to say, interns should never be allocated to an “RMO only” term, nor are they allowed to swap into one.

Ward based terms most commonly involve a fixed length shift running Mon-Fri, for the whole term. The standard hours at Westmead are 08:30-17:00 (ie an 8 hr day, with an unpaid half hour lunch break).There are many variations from this standard shift:
  • Most surgical terms at Westmead are rostered from 07:00-17:00
  • Cardiology is rostered from 07:30-17:00
  • Some Ward based terms have irregular rotating shifts. You will come across this in Upper GI surgery and Neurosurgery.
  • Trauma has a 7 on / 7 off roster
  • Some terms have stagerred - early and late -starts. It is anticipated that this will be the case in Vascular and Orthopaedics in 2019

Regardless of the roster, your day will generally fall into a similar sort of pattern:
  • Preparing for the early morning round
  • Participating in the early morning round
  • Carrying out the tasks arising from the round (ensuring any consults are organised early in the day)
  • Doing things to facilitate patient discharge (finalising discharge summaries, discharge medication scripts, organising out-patient bookings)
  • Towards the end of the day – prepping your discharge summaries for tomorrow's discharges
  • Handing over any problems to the evening ward after hours staff

Starting out in a ward based term, it is easy to fall into the trap of thinking that you are not much more than an over-qualified secretary – that your registrar/consultant will make most of the clinical decisions and your job is to take care of the documentation and organisation.

While there is much truth in this, you must never think of this as a bad thing. Excellent organisational skills and communication skills - without exception  - define the best interns and you can’t be a fierce patient advocate, without getting both of these things right. If discharge summaries are not done on time, if test are delayed, if handover is poor or if there are gaps in communication and documentation – your patients will suffer.

In every ward based term there will be opportunities to learn specialty specific skills, but just as importantly, there will be opportunities to learn generic skills about looking after sick patients in a hospital setting. This is particularly the case in surgical terms, like orthopaedics or vascular, where you will be one of the key players in managing the medical co-morbidities of surgical patients.

Interns doing ward based terms with regular shifts, will also participate in the general wards after hours roster. This will come around with a frequency of about 3-4 weekend days per term, 2-4 evenings per term, and about 3-4 on call (sick relief) periods per term – though this can be highly variable from term to term and for different positions.

More information about after hours is found below.

Emergency Department

ED terms often give interns their first taste of what they imagine it is like to be a “real” doctor. You can be assigned undifferentiated patients to be worked up relatively autonomously, but at the same time having excellent supervision and support at all times of the day.

Rosters in Westmead ED are based around 10-10.5 hour shifts, starting at 8:00, 13:00 or 22:00. You will be rostered to 8 shifts per fortnight rotating through days evenings and nights. Because we have excellent night time supervision, you are likely to be rostered to nights early in the term – but this is not something to be feared.

At Westmead, interns can be assigned to one of four locations: Acute (Category 1,2 & 3 pts), Urgent Care (for Category 4 & 5 patients), SAFE-T (Triage) and ESSU (Emergency Short Stay Unit). No matter where you are, there will always be pressure to move your patients through the department rapidly. Time management is a highly valued skill in ED. For this reason, many JMOs find that although the absolute number of hours worked in ED will always be less than the wards, the nature of the work is more constant and intense than the wards.

Relief

Relief is the term that many new interns fear, because it seems much less structured and more random then ED or the Wards. However, by the end of the term most interns value the experience, having gained confidence in skills of assessing sick and deteriorating patients. You will be given your relief roster for the whole term, usually 2-4 week before the term commences. Usually you will be asked beforehand if you have any special preferences with regard to your roster. Because RSU has to juggle requests from about 50 interns when constructing this roster, if you want particular days rostered off, these should be for exceptional events. If you want to attend your sister’s wedding, the RSU will always try to accommodate. If you feel that it would be nice just to have every weekend off, then less so.

You can be rostered to 3 things
  1. Annual Leave. Greater than 95% of interns will take their annual leave during their relief term. It is possible to request leave at alternate times – but this can impact on whether you get enough weeks exposure to your core terms and therefore, whether or not you’ll be eligible to be issued a certificate of completion of internship after 12 months

  2. The Westmead general ward after hours roster  - where you’ll be rostered to 5 evenings/weekend shifts per week, or 7 night shifts per fortnight. The latter is usually organised in a week on week off pattern. While seven long nights straight sounds daunting, most interns rapidly learn that, in reality, these are little different to the evenings, but come with the added benefit of a week off. The same small group of interns, RMOs and medical registrars are rostered for the whole week and usually form a cohesive and supportive unit. You will also learn that the Westmead relief pool is used to staff the Auburn evening after hours, so some relievers may find themselves at Auburn for a few weeks.

  3. Relief interns rostered to evening shifts are required to attend simulation training which commences at 2:30 in the Sim Lab each Wednesday.

  4. Ward teams or ED, where you will either be replacing someone who is not available (for whatever reason), or on occasions, assigned as a supernumerary (inevitably to one of the busier teams). Whether you are replacing someone, or you are a supernumerary, it is always wise NOT to assume that the team is expecting you, and to take steps to introduce yourself and explain your presence.
    You will find that we tend to have an over-supply of intern relievers in Term 1 of each year, and you may spend more time than usual working as a supernumerary in Term 1.

After Hours Rosters

Between the hours of 17:00-08:30 the ward medical staffing drops from hundreds back to a few dozen. As interns you can be rostered to evenings and weekends either during your relief term - as your regular shifts - or as overtime, performed after your day shift on a ward based term.

If you are in a ward term, how often can you expect this? The answer is that it varies from position to position and from term to term BUT…roughly speaking about 3-4 weekend days per term, 2-4 evenings per term, and about 3-4 on call (sick relief) periods per term. In 2018, the Health Department introduced a mminimum of 10 hour breaks between shifts which means that surgical interns, who commence at 7:00 am cannot be rostered to overtime which finishes at 10pm. Therefore surgical interns can only work their rostered overtime on Saturdays.

When relievers are rostered to evenings, the shift starts at 2pm and finished at 10pm. The first few hours, tend to be fairly slow, so we expect the relievers to get up onto the wards and help out the busier JMOs on the wards they are covering - to give them a chance at getting away earlier. If an evening shift is rostered as overtime, it starts when your usual day shift finishes, at 17:00.
Weekends at present are 14 hour shifts and are the same for relievers and non relievers. Currently, if you can find someone to share the shift with you, it is acceptable to split the shift. With the current focus on excessive working hours this may become more common in the future.

Each after-hours shift has a nominated page which should either be picked up from the switch or (in some instances) from the outgoing JMO on the preceding shift. Each shift is responsible for a specific grouping of wards. The details of the relationship between specific shifts and their specific wards can be found in the documents below.

Most of the work consists of responding to emergent issues which will either be recorded in Cerner EMR, in the electronic task book, or which will be communicated directly by paging you.

Handovers
  • There is no formal day to evening handover meeting. Communication between day and evening staff about sick patient should happen one-on-one, by phone or face to face communication.
  • There is an evening handover between evening and night staff every night at 9pm in the RMOs lounge.
  • There is a morning handover meeting for all general ward night staff Mon to Fri in the executive suite (E Block Level 2) at 7:30.
  • On weekends, there is a handover between night and day staff, which occurs at 08:00 in the RMOs lounge.

For more detailed information on After hours shifts download the following documents:

What to Wear

We don’t have a fixed dress code, but we expect you to use your common sense and wear clothing which is safe and appropriate. By “appropriate” you should be guided by what would inspire confidence among your patients. 

Doctors assigned to emergency and after hours shifts during relief tend to prefer to wear scrubs, and these are also entirely appropriate - though not required -in surgical terms.The Westmead ED scrubs tend to be considered the most fashionable and can be ordered through "Infectious - Medical Scrubs Australia" on www.infectious.com.au/Westmead-ED.  Reasonably priced uniforms can be also be purchased through the government supplier, TAMS, or Total Apparel Management System. You can search for TAMS on the intranet and you will be directed to a login page where you can lodge an order, or go through the following link: https://www.adaorders.com.au/DefaultHSS.aspx 

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