Table 2 Illustrative quotations for major themes

Theme One: A steep learning curve

 I3P1 It’s an incredibly steep learning curve, it’s – you can say the same at any workplace – it’s any new job, any new role, it’s going to be vastly different to what you’ve done as a student, but I think it’s – it was a huge learning curve and it was a huge shock to the system when – everyone that I’ve talked to, it was a huge learning curve for everyone.

 I1P2 It’s long hours and you’re tired and trying to find time to sleep and exercise...also just have (sic) a clear mind on a really foggy head is a challenge and just getting used to the demands physically, emotionally for sure, mentally with this job.

 I4P1 There’s incredible self-doubt when you become an intern that you don’t have as a medical student. So I think going from being the top of your game as a medical student to the absolute bottom of the ladder as an intern is a huge transition emotionally in terms of ego and it’s a big knock to your confidence.

 I5P2 Some of the biggest challenges would be I guess taking care of sick patients. So you’re a junior doctor, it’s your first year practising, you can get very nervous when a patient’s blood pressure drops, they look very sick and unwell.

Theme Two: Relationships and team

 I5P3 A lot of the times you will have registrars and consultants who are quite over bearing and might be quite aggressive and harsh in terms of their criticisms and how they want you to do things. I think the only way really to deal with that is just to take it. Because I mean these guys are your bosses, they’re going to be the ones deciding whether you get into a certain college or anything like that and you really need to build a resilience to that and just take any criticism. There’s no need to talk back or argue back.

 I6P2 Sometimes other professionals, like nursing on occasion or allied health, will maybe disagree or raise concerns with a plan that we have and what I’ve found is that it’s very easy for their concerns to be raised with us, but when we as junior – because we are junior doctors – have concerns about perhaps the way other professions are managing our patients, I find it challenging to find the right avenues...I’ve had experiences where my concerns have been dismissed and I feel like I’ve not been listened to in terms of the thing that I was worried about....you’re both at the bottom and somewhere up in the middle of the food chain at the same time because you are making decisions and directing patient care, but at the same time you’re at the very, very bottom of that chain, so that’s a bit of a confusing situation to be in especially when you have disagreements with other staff.

 I5P1 As a resident you are relaying the information about your patients to numerous teams and numerous different professionals every single day and if that’s a skill that’s not up to scratch, you’ll have a lot of difficulty organising anything for your patients, or getting anything done it will be very difficult...you need to be prepared and you need to have a way of sending your message succinctly and to the point.

 I3P1 Working in a team, it’s something that you have to learn to do, it’s something that you don’t do well to begin with and something you have to learn to do because no matter what you do in a hospital setting you’re going to be part of a bigger team...and you have to learn to work with a lot of different personalities and a lot of different work ethics and things like that, which is not something that can be taught as easily and it’s something that comes more with experience and time in just being in that setting.

Theme Three: Responding to challenges and seeking help

 I5P1 The most challenging times will come when you’re on ward call or you’re on - doing anything that’s by yourself...and the most important thing that you should be thinking about is, when do I need to escalate this problem that I have with a patient to someone more senior.

 I3P1 The advice that I would give is don’t be afraid, everyone is there to help you and everyone is there to guide you along, don’t be afraid to ask questions because ultimately it’s all in the best interest of the patient.

 I2P1 Internship is extraordinarily stressful and I think it brings out a lot of issues that people have, and I think some of those issues could be dealt with much earlier on....If they’re having a difficult time even in school, it’s likely that they’re going to have a difficult time in internship as well.

 I1P3 The state medical boards will want to know if you ever sought mental health treatment, so that’s a huge barrier. My insurance, if I were to seek medical mental health assistance, a lot of that would be through here which are people I work with which isn’t necessarily ideal. And there is a stigma, it’s like you’re not hard enough, you’re not able to carry your weight and having to take – and there’s also very real fact of the matter is if I’m sick or I need to take time off or something there’s other people that’s going to have to carry my weight while I’m gone, so you do have that pressure to keep pushing forward, keep pushing forward no matter what.