'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda

Journal article

Objective: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda.

Methods: Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data.

Findings: Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’.

Conclusion: We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments.

Authors: Zhao, Y; Mbuthia, D; Gathara, D; Nzinga, J; Tweheyo, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Global Health
• Volume: 8
• Issue: 11
• Article number: e013398
• Publication date: 2023-11-08
• Acceptance date: 2023-10-21
• DOI: 10.1136/bmjgh-2023-013398
• EISSN: 2059-7908
• Pmid: 37940204
• Language: English
• Keywords: internship and residency; qualitative research; FFR; Kenya and Uganda Medical Internship Experience Study Group; clinical competence; Uganda; Kenya