Internship (medicine)

A medical intern is a physician in training who has completed medical school and has a medical degree but does not yet have a 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 before they receive full registration. This year of conditional registration is called the intern year.^[1] 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 years, depending on the University in question) are the internship. During this time, students work extensive hospital hours and do basic hospital work while supervised by residents and staff. This period is usually divided among internal medicine, surgery, gynecology and obstetrics, pediatrics, emergency medicine, family medicine, and a final elective period in which the student chooses an area for further experience. On conclusion of the internship, the student becomes a doctor and may work unsupervised or enter a residency program to gain a specialty.

Chile

After high school, a medical education in Chile takes seven years—five years as a medical student and two years as an intern, earning the degree of Médico Cirujano (equivalent to general practitioner in the USA). Internships minimally include the four basic specialties (internal medicine, general surgery, gynecology and obstetrics, and pediatrics). 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 two-year 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 may apply to medical school. Medical school generally consist of six years of medical school. The final year is an internship, in which students rotate through surgical and clinical specialties. Completing the program earns the student the title of Médico Cirujano (equivalent to general practitioner in the USA). Additionally, a doctor must complete one year of community medicine to obtain a medical register and license from the Public Health Ministry (MSP). After this, the MD may enter a residency or apply to a specialty.

Egypt

After graduating from medical school, students undergo one year of internship or clerkship training in a university or teaching hospital. During this year, a graduate must complete two-month rotations in each of general surgery, internal medicine, pediatrics, and obstetrics-gynecology. They also must complete one-month rotations in a sub-specialty of their choice in each of surgery, internal medicine, anesthesiology and emergency medicine. On completion of the internship they are licensed to practise.

Germany

Legal qualification as a doctor in Germany, from 1988 to 2004, required that students serve as “Arzt im Praktikum” (physician in internship) for 18 months. In 2004, Germany repealed this regulation. Since then doctors of medicine, who successfully finish their medical studies received legal qualification and the status of assistant doctor immediately when taking up a medical occupation. However, they cannot enter private practice or work unsupervised until they receive a 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 month rotations each in medicine, surgery, obstetrics and gynecology and pediatrics, in no particular order. Alternatively, a houseman may opt to do a rotation in anesthesia or psychiatry in place of one of the traditional four rotation areas. During this period the houseman (intern) holds provisional registration status with the Ghana Medical and Dental Council. After the student successfully completes the housemanship, they receive full registration status and the rank of Medical Officer (M.O.).

India

After four-and-a-half years of medical school (MBBS degree) every doctor in India must complete a one-year compulsory rotatory internship in various specialities to get permanent registration from the Medical Council of India (MCI) as a physician. After permanent registration with MCI, a person is licensed to practice medicine as a primary care doctor throughout India.

Indonesia

Every medical graduate from an Indonesian public or private university, or from an overseas-approved institution, after an adaptation process, must apply for internship registration to the Indonesian Medical Council (Konsil Kedokteran Indonesia (KKI)).^[2] After the council approves their application, an intern must apply to the Ministry of Health (MoH) for an internship position. After the MoH accepts the application,^[3] the intern serves supervised rotations in a hospital emergency department, hospital inpatient/outpatient and public primary healthcare. After completing the internship, they receive an Internship Completion Certificate (Surat Tanda Selesai Internsip, STSI) from the MoH—which is the requirement for full registration in the KKI. A full registered doctor can practice as a general practitioner or pursue postgraduate education for a specialty and sub-specialty.

Iran

In Iran, a seven-year medical education ends with an 18-month internship in a university hospital. On completing the internship, a person may work independently as a Medical Doctor (MD) or take the National Comprehensive Residency Exam and continue studies in a specialty. If they decide to work as a General Practitioner, they must first complete compulsory service in areas the Iranian Ministry of Health has designated as under-served. The internship rotates through all major and minor specialties, including emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, surgery, dermatology, ophthalmology, otorhinolaryngology, infectious diseases, and psychiatry.

Iraq

In Iraq, graduates of a six-year medical program start a two-year internship in a hospital. The first year is divided into three months in specialties: internal medicine, obstetrics and gynecology, surgery, and pediatrics. In the second year, students must finish various-length courses in sub-specialties (radiology, ophthalmology, psychiatry, etc.). After the two-year internship, doctors may practice independently. At that point, they must practice in under-served areas for one year—after which they may apply to study a specialty. (This information is in accordance with the Graduation Law for Medical Professionals of the Iraqi Ministry of Health for 2019)

Ireland

To register fully with the Medical Council of Ireland as a doctor, graduates must complete twelve months of training in an approved public hospital. Internship comprises at least one surgical and one medical rotation. Interns must spend at least two months and not more than three months in another speciality, including emergency medicine, general practice, obstetrics and gynaecology, paediatrics, psychiatry, anaesthesia, and radiology.

After completing the internship, doctors obtain a certificate of satisfactory service. On receipt of the certificate, the Medical Council permits the provisionally registered doctor to apply for full registration in the General Register of Medical Practitioners.^[4]

Israel

In Israel, medical graduates must complete a one-year internship in an accredited hospital before they receive full registration.^[5] After completing the intern 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 two months in surgery, two months in pediatrics, one month in emergency medicine, and six consecutive months (the second half of the year) in a chosen specialty.
• Rotating internship offers a schedule that rotates through all major specialties—including three months of internal medicine, two months of pediatrics, two months of surgery, one month of emergency medicine, one month of anesthesiology and intensive care, and two elective months.

In both programs, 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 an M.D. degree, but may only practice medicine after they work in a hospital for 12 months. After they complete the year of hospital work, they are licensed to work as a general practitioner.

Lebanon

In Lebanon, universities like the American University of Beirut (AUB), the University of Balamand (UOB), or the Lebanese American University (LAU), follow a curriculum similar to that of universities in the US. The Beirut Arab University (BAU) on the other hand, follows a six-year program like in Europe, with an internship as a post graduate 7th year.

Other universities, like Universite Saint Joseph (USJ), follow the French curriculum. This excludes, for example, pre-medical studies (e.g., a BS in science). Instead, students enroll directly in a seven-year program of science and medicine.

Malaysia

Every medical graduate, from a Malaysian public or private university, or from an overseas-approved university or college, must apply for provisional registration with the Malaysian Medical Council.^[6] Once the council approves 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 government accepts the application (through an interview and government servant compulsory course), the Council registers them as a Medical Graduate Officer with a Provisional Registration Number, which allows them to serve as house officers (called H.O. for short), also known as housemen, working in major government hospitals only (ones with adequate consultants of each specialty or department).

Interns must complete six four month rotations in:

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

This adds up to 24 months of housemanship. They are then “Fully Registered” by the Malaysian Medical Council. Government service is compulsory for every medical graduate who wants full registration with the Malaysian Medical Council—after which, they may practice independently.

Sometimes the council extends the 24-month housemanship due to incompetency or health reasons. A fully registered doctor (called medical officer, MO) may choose to work in the government sector or private sector. Consultants in this country, largely, refers to a doctor with completed specialty and sub-specialty training and a Master or PhD degree, approved by the council.

Mexico

To become a physician in Mexico, one must study 12 years of elementary and high school before entering medical school.^[7] Medical education includes:

• Five years of medical school (10 semesters) that include basic sciences and clinical rotations
• One year of rotating internship to become gradually responsible to work without supervision. Clinical areas included: pediatrics, surgery, internal medicine, obstetrics and gynecology, emergency department, and communitary medicine.
• One year of social service, whether the medical school is private or public

After completing medical school, the medical student may obtain a license to work as a general physician and may opt to train in a specific field such as pediatrics, internal medicine, orthopedic surgery, etc. The doctor must complete a residency of three to seven years (depending on the field) to get a specialist license.

Nepal

After four and half years of medical/dental school (degree of MBBS or BDS) every doctor in Nepal must complete a one-year compulsory rotatory internship in various specialities and pass a medical licensing examination conducted by the Nepal Medical Council (NMC) to get Temporary registration in Nepal Medical Council as a physician or dental surgeon. The internship should be completed through their medical/dental college, as recommended by the NMC. Only after registration with the NMC is one licensed to practice medicine or dentistry as a primary care doctor or dental surgeon.

The Netherlands

The Netherlands historically had a four-year pre-clinical phase leading to a master-equivalent pre-doctoral degree (doctorandus), followed by a two-year internship with responsibilities similar to a U.S. intern. The two-year training lead to an M.D. degree with license for independent practice on 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 eight medical schools to consist of a three-year bachelor and a three-year master program. The bachelor phase is almost exclusively pre-clinical. The master includes internships, skills training, refresher courses, and 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 pre-vocational medical training, also known as the intern training programme. It is also undertaken by doctors who obtained registration based on a pass in the New Zealand Registration Examination (NZREX Clinical). During postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2), house officers complete a series of 13-week clinical attachments as part of their pre-vocational medical training. From 2020, one of these attachments must be community-based.^[8]

Nigeria

The internship program (housemanship) is a one-year period in most hospitals in Nigeria. After an internship program under the supervision of qualified licensed doctors each house officer must complete a one-year program in the National Youth Service Corp (NYSC). During this period, they must have a provisional license from the Nigeria Medical & Dental Council to practice, temporarily with little or no supervision. The residency program is available to any medical doctor who wants 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 must complete a year of training at a teaching hospital, rotating through various departments. After they complete this mandatory training period, a candidate may begin residency (specialty) training.

Peru

In Peru, a medical intern is a seventh year medical student who must complete the specialties of internal medicine, obstetrics and gynecology, surgery, and pediatrics. Some universities include mental health in the seventh year curriculum. Some hospitals pay interns. Universidad Peruana Cayetano Heredia has an internship program and externship program—in which the latter acts as an apprentice of the former, thus the medical student has two years of medical practice.

Philippines

After earning their Doctor of Medicine (M.D.) degree through a four-year post-baccalaureate program, medical graduates are required to complete one year of internship in authorized hospitals and health centers.^[9] The program is supervised and monitored by the Association of Philippine Medical Colleges (APMC), and its completion is a requirement for the Physician Licensure Examination (PLE).^[9][10]

Poland

In Poland internship starts after six years of medical school. During thirteen months interns have to attend rotations in internal medicine, general and trauma surgery, anesthesiology and intensive care, emergency medicine, pediatrics and neonatology, gynecology and obstetrics, psychiatry, family medicine and additionally few courses: medical law, bioethics, etc. After finishing the internship and passing medical exam young doctors can start residency to earn chosen specialty or work as a doctor without specific medical specialty.

Slovenia

In Slovenia, medical graduates, after six-years of medical school, must complete a six-month paid internship at a medical institution. During the internship, they rotate through internal medicine, surgery, pediatrics, OB/GYN, ENT, ophthalmology, emergency medicine, and anesthesiology—with emphasis on emergencies in each department. Completing the internship is a condition for taking the professional medical exam, passing which earns a doctor a license to practice medicine in Slovenia and apply for a specialty.

South Africa

An internship is a compulsory requirement for newly qualified medical doctors who are registered with the Health Professions Council of South Africa in order to obtain a medical license to practice. They work in designated hospitals under supervision for two years. They may work independently in specified medical disciplines, and for periods of time designated by the HPCSA. They are employed by the institution they work at, and this option is generally only available to South African citizens or permanent residents. Foreign-qualified doctors who have recently qualified and do not have the required medical experience to register with the HPCSA may be told to do an internship to qualify for full registration. They may intern in their country of origin 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 (three to six months) to gain experience in a different medical context. They work under supervision, mentored by experienced doctors. It is primarily a learning experience. They cannot work independently, and must register with HPCSA if they are a foreign student.^[11]

Sweden

The Swedish equivalent to an internship is the allmäntjänstgöring (AT, "general practice"), which is required for obtaining a medical license. It takes at least 18 months, but usually lasts longer—21 months in most cases. Students must fulfill at least nine months in medicine and surgery (at least three months of each, but mostly six + six months), three months in psychiatry, and six months as a general practitioner. After the allmäntjänstgöring, the students must complete a test from the National Board of Health and Welfare (Socialstyrelsen), to receive a medical license. This is followed by specialisttjänstgöring (ST, "specialization practice"), 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, many clinicians still use the term house officer. (The term "senior house officer" or SHO is still used to refer to a tier of doctors that may include both those 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 and usually begins on July 1. Internships are of two types: transitional and specialty track. After a physician completes an internship and Step 3 of the USMLE or Level 3 of the COMLEX-USA, they may practice as a general practitioner. However, most 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" (Post-Graduate Year 1, or PGY-1).^[12]

Venezuela

Venezuela has two internship types: a two-year postgraduate internship and a one-year compulsory pre graduation internship.

• The postgraduate internship is an elective two year postgraduate internship in type III or IV hospitals. It is required for obtaining a medical license (the other option is one-year in a rural location). The intern must complete for four month each of the specialties of internal medicine, obstetrics, surgery (general surgery and orthopedics surgery), and pediatrics. Also, there is a six months externship in a city setting outpatient clinic.
• Pre graduation internship: Venezuela mandates two types of medical studies for a medical degree. The program for a degree of "Médico cirujano" or "Médico Integral Comunitario" ^[13] 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 undergo basic hospital work. The intern must complete eight weeks each of the specialties of internal medicine, obstetrics and gynecology, general surgery, orthopedics, surgery, and pediatrics. There is also an eight-week externship in a rural outpatient clinic.

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