Post-medical interns' reflections on medical internships in South African state training hospitals.

Medical interns occupy a pivotal role in public healthcare systems. The existing South African literature base on this population group is relatively small and reveals a paucity of qualitative studies. This study aimed to gain insight into medical interns' experience of the two-year medical internship programme in South Africa, and to identify sources of stress and coping mechanisms used. This research was contextualised in terms of South Africa's public healthcare system. The study was exploratory and as such, a qualitative research design was applied. Semi-structured, individual interviews were conducted with ten post-medical interns working in three academic training hospitals in Johannesburg, South Africa. This allowed medical interns an opportunity to provide a richer account of their internship experience. A thematic content analysis method was utilised to derive themes relating to the subjective experience of the medical internship. Results indicated that medical interns generally felt unprepared for the medical internship both academically and psychologically. There were many different sources of stress which impacted negatively on interns' physical, mental and psychological wellbeing. Long working hours remains a prominent source of stress for interns. However, contextual factors and problems at a level of management have been identified as significant contributors to the stress experienced by South African medical interns. It was identified that medical interns were at a high risk for burnout. Medical interns made use of a variety of coping mechanisms, with family and social support being the most important. However, maladaptive coping mechanisms were also identified in terms of severe emotional detachment. Opportunities for personal growth were few and support from the workplace was notably poor. The findings reveal that the experience of the medical internship for South African interns is more complex than previously found. Thus more research is necessary to identify ways of improving the medical internship programme and making the experience more gratifying for medical interns.