A new study has unveiled alarming details about the quality of the medical internship program in Kenya, raising concerns about the state of the critical profession that demands skill, extensive knowledge, and the ability to apply complex information under intense pressure to save lives.
Conducted between 2021 and 2022 by researchers from the KEMRI-Wellcome Trust Research Programme, the University of Oxford, the University of Warwick, and King’s College London, the study revealed that medical interns transitioning from school to the field are struggling under immense pressure to keep pace with seasoned professionals.
One such instance is when interns are left alone in the hospital while senior colleagues take breaks, leaving them overwhelmed by nursing calls, questions from anxious family members, and a daunting stack of patient files.
The pressure mounts on the intern, who, in their desperation, may resort to Google or YouTube for guidance and rely on their instincts to perform surgeries—often with negative outcomes.
“You go and operate on a patient, you make an incision until you cut intestines, because you don’t know how much pressure to put,” said one medical intern who performed a Caeserean Section on a patient.
This was just one example out of 121 interns, most of whom were newly graduated medical doctors and nurses who participated in the survey to test the impact of liminality, which is the transitional period between training and practicing as health professionals.
Kenyan health trainees are required to complete a one-year supervised internship before being registered to practice. The study has shed light on the quality of this internship program, revealing significant shortcomings that further jeopardize the preparedness of future medical professionals.
One doctor intern described the transition from medical student to practicing doctor as “confusing” and “terrifying.”
“You are taught about the decisions [as a medical student], but you never really make the decisions. Then, one morning, you wake up and it is like: ‘Daktari (doctor), what do we do? ‘Actually, I was terrified’,” the intern said.
The interns noted that, ironically, more experienced health workers expected them to handle critical tasks competently without support, while simultaneously viewing them as inexperienced and unqualified.
“When I came [into internship], I was left with an entire ward on my own, I didn’t even know how to manage it,” said one nursing intern.
Some nurse interns observed that senior staff violated nursing practice standards. For instance, one nurse intern noted that senior colleagues administered excessive doses of oxytocin to induce labor, contrary to doctors’ prescribed guidelines. This was done to expedite the birth process, allowing the supervising nurse to leave for home or catch some sleep during the night shift.
Many interns felt demeaned and undervalued, as their input on patient care was frequently ignored by more experienced colleagues who treated them as if they were still students.
Degree nurse interns described how their advanced formal knowledge was perceived as a threat by experienced nurses trained to the diploma level.
The interns described acquiring skills to navigate and overcome the challenges associated with varying levels of professional status and expertise.
“Nurses can really mess you up … but once you approach people as equals, they are able to get to your level. Some of them have been in the profession for, like, thirty years … You are seeing it for the first year,” one medical intern said.
However, being thrust into the deep end was beneficial for some, as a number of degree nurse interns described how they learned to collaborate effectively with their diploma-trained colleagues in the workplace.
“Convince them in a good way like: ‘You know Sister, while you do this and this, research says this and that and the current protocol says this’. Most of them will buy your idea,” said one intern.
Kenya places nearly 5,000 health interns each year, but the evolving demands of the medical sector, combined with insufficient resources, equipment, and diagnostics in hospitals, have significantly hindered these program, putting the future of these medical professionals at risk.
