Internship (medicine)

Medical intern is a term used in some countries to describe a physician in training who has completed medical school and has a medical degree, but does not yet have a full license to practice medicine unsupervised. Medical education generally ends with a period of practical training similar to internship, but the way the overall program of academic and practical medical training is structured differs depending upon the country, as does the terminology used (see medical education and medical school for further details).

Australia

In Australia, medical graduates must complete one year in an accredited hospital post prior to receiving full registration; this year of conditional registration is known as the intern year. An internship is not necessarily completed in a hospital at the same state as the graduate's medical school.

Brazil

In Brazil, medical school consists of six years or twelve semesters; the final two years (or one and a half year, depending on the University in question) are said to be the internship. During this time, students will undergo extensive hospital hours and do basic hospital work while supervised by both residents and staff. Usually, this period is divided among Internal Medicine, Surgery, Gynecology and Obstetrics, Pediatrics, Emergency Medicine, Family Medicine and a final elective period in which the student may choose an area to in which to gain further experience. Upon conclusion of internship, the student graduates to a doctor, and may then work unsupervised or enter a residency program in order to gain a specialty.

Chile

After High School, medical course in Chile consists in 7 years, having 5 years as a medical student and 2 years as an intern to obtain the degree of Médico Cirujano (the equivalent of General Practitioner in the USA). Internships should at least include the 4 basic specialties (Internal Medicine, General Surgery, Gynecology and Obstetrics and Pediatrics) throughout this period. After completing the internship, the new physician may work in primary care, hospitals or apply to residencies for a specialty.

DR Congo

DR Congo has a 2 years internship program for public health schools. Many hospitals employ Doctors prior to their full registration with the medical council (CNOM).

Ecuador

After finishing high school, students have the possibility to apply to medical school. Medical school generally consist of 6 years of medical school, of which the final year represents the Internship, through which the students rotate through different surgical and clinical specialties. After this, the student gets the title of Médico Cirujano (the equivalent of General Practitioner in the USA).

Additionally, there is one compulsory year of community medicine in order to obtain the medical register and licence from the Public Health Ministry (MSP). After this, the MD has the possibility to do residency or apply to a specialty.

Egypt

One year of Internship or Clerkship Training in a University or Teaching Hospital is done after graduating from medicine school. During this year, the graduate must complete two month rotations in each General Surgery, Internal Medicine, Paediatrics and Obstetrics/Gynaecology. They also must complete one month rotations of their choice in each a sub-specialty of Surgery, sub-specialty of Internal Medicine, Anesthesiology and ER medicine. Once the graduate has completed their Internship they are awarded licence to practise.

Germany

The regulation in Germany from 1988 to 2004 provided for medical doctors who wanted legal qualification or license to serve as “Arzt im Praktikum” (physician in internship) for 18 months. In 2004 this regulation was abolished. Since then doctors of medicine, who have successfully finished their medical studies, have received legal qualification immediately and the status of assistant doctor when taking up a medical occupation. However, they cannot enter private practice or work unsupervised until receiving their „Facharzt“ (full board certification) in their chosen specialty.

Ghana

The housemanship (internship period) is a two - year period after graduating from medical school during which newly qualified doctors, practice under supervision in designated hospitals in the country. This involves six (6) month rotations each in Medicine, Surgery, Obstetrics and Gynaecology and Paediatrics in no particular order. Alternatively, a houseman may opt for a rotation in Anaesthesia or Psychiatry in place of one of the traditional four rotation areas. During this period the houseman (intern) is given provisional registration status with the Ghana Medical and Dental Council and would only be granted full registration status after successfully completing the housemanship. They then assume the rank of Medical Officer (M.O.).

India

Main article: Compulsory Rotatory Residential Internship

After four and half years of medical school (degree of MBBS) every doctor in India has to go through a one-year compulsory rotatory internship in various specialities to get permanent registration in Medical Council of India as a physician. Only after getting permanently registered with MCI, one is licensed to practice medicine as a primary care doctor throughout the India.

Indonesia

Every medical graduate, from an Indonesian public or private university, or from an overseas-approved university/college after adaptation process, will have to apply for internship registration to Indonesian Medical Council (Konsil Kedokteran Indonesia, KKI). After the council has approved their application, intern have to apply the internship position to Ministry of Health. After the application accepted with placement process from Ministry of Health (MoH), intern will serve in rotation of 8 months at hospital and 4 months at primary healthcare under supervision. After the completion of internship, the MoH will issue Internship Completion Certificate (Surat Tanda Selesai Internsip, STSI) which is the requirement for full registration in the KKI. A full registered doctor can practice as general practitioner or pursue postgraduate education included specialty and sub-specialty.

Iran

In Iran, internship is an 18-month period at the end of the 7 year medical education which should be done in the university hospitals. Then, medical students can graduate and work independently as a Medical Doctor (MD) or participate in National Comprehensive Residency Exam and continue to study in desired specialty. If they decide to work as a General Practitioner, they should first do their compulsory service for a period, regarding their national service or their individual status, in underserved areas recognized by Iranian Ministry of Health, as part of the commitments to the ministry. Medical Internship offers a schedule that rotates through all the major and minor specialties, including emergency medicine, internal medicine, obstetrics & gynecology, pediatrics, surgery, dermatology, ophthalmology, otorhinolaryngology, infectious diseases, and psychiatry.

Iraq

In Iraq, after graduation from a 6 years medical program, graduates start their internship in hospitals. The medical internship take 2 years in which the first year the medical Intern must finish a period of 3 months in each of the specialties of internal medicine, obstetrics and gynecology, surgery, and pediatrics, And in the second year must finish a course of sub-specialties as [ENT, Radiology, Ophthalmology, Psychiatry ... etc.] for specific period for each branch. After 2 years of completion of the internship, the doctors are eligible to practice independently. After the completion of the two years, the doctor will work in the peripheral areas for at least one year, and then begin to submit to complete the study of the specialty desired by the doctor. According to the above definition of internship, interns have a degree but they are not fully licensed to practice medicine unsupervised. (This information is in accordance with the Graduation Law for Medical Professionals of the Iraqi Ministry of Health for 2019)

Ireland

In order to register fully with the Irish Medical Council, graduates are required to complete twelve months of training in an approved public hospital. Internship comprises at least one surgical rotation and at least one medical rotation. A minimum of two months and a maximum of three months may be spent in another speciality, including emergency medicine, general practice, obstetrics & gynaecology, paediatrics, psychiatry, anaesthesia and radiology.

After completion of the internship, doctors obtain a certificate of satisfactory service. Upon receipt of the certificate, the Medical Council will entitle the provisionally registered doctor to apply for full registration in the General Register of Medical Practitioners, subject to payment of a fee.

Israel

In Israel, medical graduates must complete one year in an accredited hospital prior to receiving full registration; this year of conditional registration is known as the intern year. After completing this mandatory year, the graduate can go into a specialty program, or practice general medicine. There are two kinds of internships:

• "Direct internship" is done in either internal medicine, pediatrics or surgery. Interns spend 6 consecutive months (the second half of the year) in their chosen specialty, and 2 months surgery, 2 months in pediatrics, and 1 month in emergency medicine.
• "Rotating internship" offers a schedule that rotates through all the major specialties, including 3 months of internal medicine, 2 months of pediatrics, 2 months of surgery, 1 month of emergency medicine, 1 month of anesthesiology and intensive care, and 2 elective months.

Regardless of the chosen program, every intern gets a month off.

Some applicants prefer the rotating program because it generally is not as strenuous as a straight internship. However, a straight year can provide better preparation for the second year of residency.

Jordan

In Jordan, after finishing medical school (6 years), medical students receive the M.D. degree but may only practice medicine after working in a hospital for 12 months. After completion of this year of hospital work, the student will be licensed to work as a GP.

Lebanon

In Lebanon, universities like the American University of Beirut (AUB), the University of Balamand (UOB), or the Lebanese American University (LAU), follow the curriculum similar to that of universities in the US. Beirut Arab University (BAU) on the other hand, following a 6 year program just like in Europe, have their internship as their 7th year. However, it still counts as post graduate as their students graduate in the 6th.

Other universities, that follow the French (European) system like Universite Saint Joseph (USJ) follow the French curriculum, this excludes for example Pre-medical studies (BS in science), instead the student is directly enrolled in a 7-year program during which he studies science and medicine.

Malaysia

Every medical graduate, from a Malaysian public or private university, or from an overseas-approved university/college, will have to apply for temporary registration with the Malaysian Medical Council. Once the council has approved their application, they are listed as 'Approved for Consideration'. This Approval is required for them to apply for the position of Medical Graduate Officer (Pegawai Perubatan Siswazah) from the government, to be accepted into the government service.

Once the application has been accepted by the government ( through the process of an interview, and government servant compulsory course), the Council will register them as a Medical Graduate Officer with a Temporary Registration Number, which allows them to serve as house officers (called H.O. for short), working in major government hospitals only (ones with adequate consultants of each specialties/departments).

Upon the completion of rotations in:

• Internal medicine
• Surgery
• Paediatrics
• Orthopaedics,
• Obstetrics and Gynecology
• A choice of Emergency Medicine, Anaesthesiology, Psychiatry, Family Medicine;

for 4 months in each rotation (making a total of 24 months of housemanship), they will then be registered by the Malaysian Medical Council as “Fully Registered”.

The government service is compulsory for every medical graduate in order to obtain full registration with the Malaysian Medical Council, in order for them to practice independently.

There are cases where the period of 24 months of housemanship is extended due to incompetency and health reasons, which is under the jurisdiction of the Council. A fully registered doctor (called medical officer, MO) are then free to choose to work in the government sector or the private sector.

Consultants in this country, largely, refers to a doctor with completed specialty and subspecialty training and a Master or PhD degree, approved by the Council.

Mexico

In order to become a physician in Mexico, one must study 12 years of elementary and high school before entering medical school.

Medical education includes:

• 5 years of medical school (10 semesters) that include basic sciences and clinical rotations.
• one year of rotating internship, in which the main objective is to become gradually responsible to manage clinical attention without supervision. Clinical areas included are: pediatrics, surgery, internal medicine, obstetrics and gynecology, emergency department, communitary medicine.
• one year of social service, whether the medical school one attends is private or public.

After completing medical school, the medical student is able to obtain a license to work as a general physician. If it is of interest of this general physician to train in a specific field such as pediatrics, internal medicine, orthopedic surgery, etc., he/she must complete a residency program of 3 to 7 years (depending on the chosen field) to obtain a license to work as a specialist in such field.

Nepal

Main article: Compulsory Rotatory Residential Internship

After four and half years of medical school (degree of MBBS) every doctor in Nepal has to go through a one-year compulsory rotatory internship in various specialities and pass the medical licensing examination conducted by the Nepal Medical Council (NMC) to get Temporary registration in Nepal Medical Council as a physician. Internship should be completed from their own Medical college as recommended by the NMC. Only after getting registered with NMC, one is licensed to practice medicine as a primary care doctor throughout the Nepal.

The Netherlands

Netherlands historically had a 4-year preclinical phase completed by a master-equivalent pre-doctoral degree (doctorandus) followed by a two-year internship phase, with similar responsibilities to that of a US intern. The two-year training would lead to an M.D. degree with license for independent practice upon successful completion. With the introduction of the Bachelor/Master system as prescribed by the Bologna Process, the medical education curriculum has been modified in all of the 8 medical schools in the country to consist of a three-year bachelor and a three-year master program. The bachelor phase is usually almost exclusively preclinical while the master will include internships, skills trainings and refresher courses, as well as a research internship. The "master" is awarded with an M.D. degree.

New Zealand

All graduates of New Zealand and Australian accredited medical schools undertake prevocational medical training, also known as the intern training programme. It is also undertaken by doctors who have obtained registration based on a pass in the New Zealand Registration Examination (NZREX Clinical). During postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2), interns complete a series of 13-week clinical attachments as part of their prevocational medical training. From 2020, one of these attachments needs to be community-based.

Nigeria

The internship program (Housemanship) is one-year period in most of the Hospitals in Nigeria. After internship program which is done under the supervision of qualified licensed doctors; each house officer is now required to do a compulsory one - year program in NYSC (National Youth Service Corp) where posted. During this period a provisional license must have been issued to house-officer by Nigeria Medical & Dental Council in order for them to practice, temporarily with little or no supervision. Residency program is available for any medical doctor who wishes to continue in their medical career. This involves writing a postgraduate examination termed "primaries" in any faculty of choice.

Pakistan

After completing five years of medical school each graduate is required to complete a year of training at a teaching hospital by rotating through various departments. After the completion of this mandatory training period can a candidate begin residency (specialty) training.

Peru

In Peru, the medical intern is the seventh year medical student who must to complete the specialities of internal medicine, obstetrics and gynaecology, surgery and pediatrics. In some universities, mental health is also included in the 7th year curriculum. In some hospitals this period is paid. Universidad Peruana Cayetano Heredia has internship and externship. Where the latter acts as an apprentice of the former, thus the medical student has two years of medical practice.

Slovenia

In Slovenia, medical graduates (after 6-year med school) must complete a six-month paid internship at a chosen medical institution. During the internship they must rotate through departments of internal medicine, surgery, pediatrics, OB/GYN, ENT, ophthalmology, emergency medicine and anesthesiology, with emphasys being given to emergencies in each department. Completing the internship is a condition for taking the professional medical exam, passing which gives doctor a license to practice medicine in Slovenia and apply for a specialization.

South Africa

An Internship is a compulsory (statutory) requirement that recently qualified doctors who are registered with the HPCSA work in designated hospitals under medical supervision for two years. They may work independently within this context in specified medical disciplines and for periods of time designated by the HPCSA. They are employed by the institution and this option is generally only available to South Africans. Foreign qualified doctors that have recently qualified and do not have the required medical experience to register with the HPCSA may be requested by the HPCSA to do their internship in order to qualify for full registration. They either do this back in their country or in South Africa.

In South Africa, an elective for medical students is where a student arranges to visit a hospital for a short period (3 – 6 months) of time to gain experience in a different medical context, where they will work under supervision and be mentored by experienced doctors. It is primarily a learning experience, they cannot work independently and are required to register with HPCSA if they are foreign student.

Sweden

The Swedish equivalent to an internship is the allmäntjänstgöring ("general practice"), which is a requirement for obtaining a medical license. Its duration is stated as at least 18 months, but usually lasts a bit longer, 21 months in most cases. The students have to fulfill at least 9 months practice in medicine and surgery (at least 3 months of each, but mostly 6+6 months), 3 months psychiatry and 6 months as a GP. After the allmäntjänstgöring, the students have to complete a test from the National Board of Health and Welfare ("Socialstyrelsen"), to receive their medical license. Then follows specialisation practice ("specialisttjänstgöring"), the equivalent of residency.

United Kingdom

The British equivalent of an intern is the Foundation Year 1 (F1, FY1) doctor, who is on the first year of their two-year Foundation Programme, and has provisional registration with the General Medical Council. Before the introduction of the Foundation Programme in 2005, the equivalent post was called a "House officer" (also known as 'Junior House Officer' and latterly Pre-Registration House Officer or PRHO). Despite its technical obsolescence, the term "House Officer" is still used by many clinicians. (The term "Senior House Officer" or SHO is still used to refer to a tier of doctors which may include both those who are in the second year of Foundation Programme, and those who have begun a specialty training programme). The Foundation Programme is a 2 year long training period in which competencies are developed and documented.

United States

A medical internship typically lasts one year (a loose term) and usually begins on July 1. Internships come in two variations: transitional and specialty track. After a physician has completed an internship and Step 3 of the USMLE or Level 3 of the COMLEX-USA, they can practice as a general practitioner. However, the majority of physicians complete a specialty track medical residency over two to seven years, depending on the specialty. The Accreditation Council for Graduate Medical Education (ACGME) officially dropped the term "intern" in 1975, instead referring to individuals in their first year of graduate medical education as "residents."

Venezuela

In Venezuela there are two different types of medical internship. One is a two-year postgraduate internship and the other is a one-year compulsory pre graduation internship.

• Postgraduate internship: Is an elective two year postgraduate internship done in type III or IV hospitals. It is required for obtaining a medical license (the other option is a one-year rural setting work). The intern must complete for four month each of the specialities of internal medicine, obstetrics, a surgery block (general surgery and orthopedics surgery) and pediatrics. Also there is a six months externship in a city setting outpatient clinic.
• Pre graduation internship: In Venezuela there are 2 different types medical studies conducting to a medical degree. The program conducting to the degree of "Médico cirujano" during the final year or one and a half year, depending on the university program, has a compulsory internship program under the supervision of qualified licensed doctors at a type III or IV hospital. During this time, students will undergo basic hospital work. The intern must complete for eight weeks each of the specialities of internal medicine, obstetrics and gynaecology, general surgery, orthopedics surgery and pediatrics. Also there is an eight-week externship done in a rural outpatient clinic.

In popular culture

• The character of Dr. Kildare, who was originally created by author Max Brand in the 1930s and appeared over the next five decades in numerous novels and movies, a radio series, a comic strip, and two television series, is initially presented as a new intern starting his medical career at a big city hospital. In later installments of the franchise, he completes his internship and becomes a resident physician.
• Richard Frede's bestselling novel The Interns (1960) told the stories of a large class of interns working at a big city hospital. The book was the basis for the film The Interns (1962), which spawned a sequel, The New Interns (1964), and a 1970–1971 American TV series, The Interns.
• In the first three seasons of the popular television drama Grey's Anatomy, five of the main characters, Meredith Grey, Cristina Yang, Isobel Stevens, Alex Karev, and George O'Malley were surgical interns at the fictional Seattle Grace Hospital, where the series takes place. Also in Seasons 4 and 5, George O'Malley and Lexie Grey are Interns.
• In the first season of Scrubs, J.D. and Elliot are medical interns, and Turk and Todd are surgical interns.
• In Holby City (1999-present), Tom O'Dowd is a House Officer and Maddy Young, a Senior House Officer, is training to be a Registrar or equivalent Resident. Other characters seen at foundation or house officer level include Kirstie Collins, Victoria Merrick, Sam Kennedy, Ed Keating, Sean Thompson, Matt Parker, Dean West, Oliver Valentine, Penny Valentine, Frieda Petrenko, Tara Lo, Arthur Digby, Gemma Wilde, Dominic Copeland, Zosia March, Morven Shreve, Jasmine Burrows, Damon Ford, Meena Chowdury, Nicky McKendrick and Cameron Dunn.
• In the Indian drama Dill Mill Gaye, all the main characters are interns at the Sanjeevani Hospital in Mumbai.
• In the popular Korean medical drama Golden Time (TV series), two of the main characters, Kang Jae-in and Lee Min-woo, are interns at a hospital in Haeundae, Busan.
• In the book The House of God, protagonist Roy Basch is an intern working in the fictitious House of God hospital.
• In the Japanese tokusatsu series "Kamen Rider Ex-Aid", protagonist Emu Hojo is an intern working in the Seito University Hospital.