Articles and Case Studies

The Brilliant Intern Who Didn’t Make the Grade

11 Apr 2014

by Dr James Anderson


Dr H graduated from a respected university with honours and secured an internship at a large tertiary hospital in the city. She went through the year, ticking off time in medicine, surgery, emergency medicine and some sub-specialty terms. However, Dr H failed internship and was unable go on to her new RMO job which required general registration. This fictitious case study explores some reasons why one may not complete the requirements for general registration.

Dr H subscribed to the “tough love” approach with her patients and when they weren’t listening, she would find that yelling often helped. Dr H also found nurses responded best to loud snide remarks to keep them in line, reminding them who’s the boss. Every now and then she found a quick “clip round the ears” ensured medications were given on time.

Unfortunately for Dr H, the Medical Board’s Code of Conduct doesn’t recognise the tough love approach. In fact it requires a “courteous, respectful and compassionate”1 approach to patients. In addition, it states that doctors should “acknowledge and respect the contribution of all health professionals”.1

While Dr H’s technical knowledge and clinical skills were impressive, she scored poorly in professionalism in most of the end of term assessments conducted by her supervisors. In addition, a few complaints from other health staff had to be mentioned in the end of year report from the hospital to the Board. A doctor who may be technically brilliant, but discourteous to colleagues, may not meet the requirements for registration.

Around 13% of junior doctors are given an unsatisfactory mark in one of their reports throughout the year.2 A much smaller group have consistent deficiencies and actually need additional time as an intern. It’s highly recommended that junior doctors seek mid-term feedback using the term assessment forms so that any issues can be worked on, potentially avoiding a negative end of term report.

Dr H wasn’t a fan of the intern tutorials on Monday mornings – too early! Sunday sessions at the local pub were more her scene, so a sleep-in on Mondays was just what she needed. Unfortunately, apart from Dr H missing out on some great learning opportunities, the Australian Health Practitioner Regulation Agency (AHPRA) requires all doctors to complete continuing professional development. For junior doctors this is defined as “participating in the supervised training and education programs associated with their position”. The Director of Clinical Training had to report that Dr H was not participating in the educational opportunities, thus another reason AHPRA could withhold general registration. Make sure your attendance at tutorials is recorded in some way so that if you are audited, you can demonstrate your participation.

Dr H was a keen amateur BASE jumper and took four weeks annual leave during the end of her ED term to go the USA and jump off the Grand Canyon. Unfortunately, she broke both tibias and fibulas leading to a prolonged stay in a US hospital and then took several weeks off work back in Australia. This sick leave cut into her only surgical term for the year. The net result was only six weeks of emergency term and seven weeks of surgical term, both inadequate for completing internship. In this situation AHPRA may require repetition of certain terms of internship. Each doctor is responsible for planning their leave so it doesn’t compromise their internship requirements.

The community, AHPRA and the Medical Board have high expectations for medical practitioners. It is worth reviewing the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia as well as being well versed in the specific registration requirements for your level of practice.

Most practitioners are unlikely to have interactions with the Medical Board beyond reading their newsletters. But if you do, MDA National is able to offer advice.

Dr James Anderson, Anaesthetics Registrar
WA PMLC Member, MDA National

MDA National’s state-based President’s Medical Liaison Councils (PMLCs) are primary sources of Member feedback. Reporting to the Mutual Board, each state PMLC comprises local and highly experienced medical practitioners. They meet quarterly and provide integral feedback on local issues and emerging risks across various specialties. For more information, visit’s-medical-liaison-council.aspx.


1. Medical Board of Australia. Good Medical Practice: A Code of Conduct for Doctors in Australia. Available at:
2. Aram N, Brazil V et al. Intern Underperformance is Detected More Frequently in Emergency Medicine Rotations. Emergency Medicine Australasia. 2013;25:68-74.

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