Interns

INTERN (from Latin internus - internal), physicians attached to medical-sanitary institutions for a considerable period (2-3 years) for improving their qualifications or studying a specialty and receiving a certain stipend during their attachment. The internship as a method of planned training of specialist physicians in various branches of preventive and therapeutic medicine plays a major role. In the prerevolutionary period, specialist personnel were trained either through an internship in the clinics of medical faculties or, mainly, through an externship. After the revolution, if the first method retained its significance, the second had to be gradually eliminated for a number of reasons. The externship does not make it possible to regulate quantitatively the number of specialists being trained in a planned manner, does not provide any guarantees of their quality, since it is not limited to a specific period and methodological plan and is accessible only to well-off physicians. Meanwhile, the number of interns in various specialties can be precisely coordinated with the need for a specific planned period; the intern completes his internship according to an established program in both the theoretical field and in acquiring the necessary practical skills; providing the intern with a stipend for the entire duration of the internship makes it possible to replenish the ranks of interns from the proletarian milieu, which frees them from the need to engage in other work for the purpose of earning a living, and finally allows state organs to properly distribute those who have completed their internship, since each intern is obligated to serve a period equal to the time he received the stipend for the position of intern. In the USSR, the institution of the internship was organized recently. In the RSFSR, its beginning was laid by a resolution of the Council of People's Commissars of the RSFSR of November 8, 1927 ("On measures to ensure medical personnel for medical-sanitary institutions in the localities and to attract unemployed physicians to service"). According to the instruction of the People's Commissariat of Health of the RSFSR (of November 17, 1928), interns are attached beyond the established staffing to scientific institutes or to specialized medical-sanitary institutions. Physicians not older than 40 years of age, with at least three years of practical medical experience, are enrolled as interns, with preference given to physicians working in districts when enrolling. Enrollment in the internship is carried out by special commissions consisting of representatives of health authorities and the Medsantrud trade union. The internship period is generally set at three years, but in individual cases, depending on the special training of the intern, it can be reduced to 2 years. Concurrent employment for physician-interns is generally not permitted. If the intern does not fulfill the rules and order of studies established for him, he may be dismissed before the expiration of the internship period. Upon completion of the internship, the physician receives an appointment to a position in his specialty from the health authority under whose jurisdiction he was. In case of dismissal before the term, he serves a period equal to the time he received the stipend for the position of intern, but in this case, appointment to a position in his specialty is not mandatory for health authorities, and the physician may be assigned to general medical work (e.g., to a district). In the union republics, the rules for enrollment, completion, and service for the internship are basically almost analogous to those adopted in the RSFSR. In the Ukrainian SSR, the internship period for all disciplines is set at two years, with the exception of internships in sanitation, sanitary education, and pathological anatomy, for which the period is set at one year, and in orthopedics-3 years; the service period for the internship is set at the rate of 1½ years of service per year of internship. In the Byelorussian SSR, a physician-intern detached from a district continues to remain on the service rolls of the latter and receives his stipend from there. Abroad, the institution of the internship found particularly clear expression in France, from which essentially the very term used by us was taken. The internship in France represents a continuation of the externship, and the meaning of these concepts differs considerably from that accepted in the USSR. In France, to obtain a position as an extern and intern in the large hospitals of university cities, it is necessary to pass a rather serious examination. Students entering their fourth year can compete for positions as externs. An intern can only be a person who has completed the externship, passed all credits and examinations for five years of university study, and presents a certificate from the director of the medical institution where the externship was completed, stating that the intern was punctual, conscientious, and of good behavior. A candidate for the position of intern undergoes very serious examinations in succession before two competitive juries. Interns are elected for 4 years and receive substantial training. In a number of other countries, there are institutes that to a certain extent correspond to the internship in their nature. In Italy, this institute is organized in the form of a "school of specialization" (scuola di perfezionamento) at medical faculties. Young physicians are admitted to these schools, and upon completion receive a "specialist diploma". The duration of the course varies depending on the specialty-from 5 years for surgery to 1 year for the protection of motherhood and infancy (puericultura) and occupational hygiene (medicina del lavoro). A similar institute exists at some English and American universities (the so-called "post-graduate instruction").