In medical training, the internship represents a crucial step: it is the moment when the student moves from theory to practice, from the understanding of pathophysiological processes to active participation in patient care. The organisation of these activities presents both virtuous examples and structural difficulties, which significantly influence the quality of learning. The challenge is to make this a truly formative experience, despite organisational difficulties, inhomogeneities between venues and the constraints imposed by often limited resources.
The challenge is to make this a truly formative experience, despite organisational difficulties, inhomogeneities between venues and the constraints imposed by often limited resources.
With the evolution of medicine and health technologies, internship activity cannot be considered merely a requirement for obtaining training credits. It must become a true immersive experience, useful for understanding the complexity of the “health system” and acquiring the necessary skills to exercise the medical profession responsibly.
In particular, hospital facilities and university laboratories welcome hundreds of students from the various medical degree courses every year, with an organisational load that requires rigorous planning.
An effective internship is based on clear and consistent organisation. The allocation of students to facilities must take into account the availability of departments and laboratories, specific training objectives and, where possible, student preferences. It is essential that each student is placed in a context where there are trained tutors available to guide him/her through the course. Time plans and shifts must be defined in advance, in accordance with the needs of the host facilities and the academic calendar. This makes it possible to distribute the training load in a balanced manner and to guarantee a continuous and non-fragmented experience.
In this context, a liaison figure is needed to ensure consistency between the degree course objectives and the internship experience, to collaborate with the facilities' contact persons, organise information briefings and resolve any organisational criticalities. Similarly, the figure of the tutor must always be present, who accompanies the student on the daily course, acting as a guide, example and point of reference for doubts or in-depth information.
Where internships work: elements of good practice
There are contexts in which the internship is highly formative. Some hospital departments offer students clear planning, with specific learning objectives, motivated tutors and active involvement in daily clinical activities. In these contexts, the student is not limited to passive observation, but is guided in the collection of medical history, clinical assessment, participation in multidisciplinary discussions and, when possible, in simple diagnostic or therapeutic manoeuvres.
Good practice also exists on the laboratory side: in pathological anatomy, microbiology or molecular biology laboratories, some internship courses allow students to observe analytical phases directly, to confront themselves with technicians and teaching staff, and to develop a concrete understanding of the relationship between laboratory data and the clinical picture.
The presence of dedicated tutors, who see training as an integral part of their professional role, makes a substantial difference. Where tutoring is well-structured, students perceive a marked improvement in the quality of the experience.
The criticality of the laboratory data and the clinical picture is also evident.
Recurring criticisms: unevenness and passivity
There is no shortage of criticism, however: many students still report unrewarding or poorly formative experiences. A major problem is the inhomogeneity between locations: not all hospital wards or laboratories offer the same level of reception and involvement for students. Assignments are often made automatically, without any real matching between the student's preferences, the workload of the facilities and the training objectives.
Another critical node is the passivity of the experience: in the absence of clear assignments or a reference figure, the student risks remaining a silent observer. In the laboratories, without a dedicated guide, the experience is reduced to a fleeting visit, while in the wards, staff overload makes it difficult to find the time to devote to teaching.
The experience is also a "learning experience".
To this is added the lack of tools to objectively evaluate learning: many activities are not tracked, and a structured final feedback moment is often missing. The risk is that the training experience will be perceived more as a bureaucratic fulfilment than as a real opportunity for growth.
How can we improve the learning experience?
How to improve: coordination, tools and innovation
Making apprenticeships more effective does not necessarily require large investments, but rather a shared vision and a few key tools.
The first element is the coordination of the apprenticeships.
The first element is an effective central coordination, capable of planning rotations, monitoring the load of facilities and ensuring equity of access. Some universities are adopting digital platforms for the management of internship rotations and the structured collection of feedback from students. These digital tools allow not only a more efficient and transparent scheduling, but also a continuous monitoring of training activities, facilitating the identification of critical issues and the improvement of training courses.
The second point concerns the use of the digital platform for the management of internship shifts.
The second point concerns the training and recognition of tutors: investing in the didactic preparation of healthcare professionals involved in training is crucial. A trained tutor knows how to involve the student, assign him/her increasing responsibilities and evaluate his/her competences constructively.
The second point concerns the training and recognition of tutors.
The third element is the use of clinical and laboratory simulation: in times when access to facilities is limited, or to supplement specific technical skills, simulation centres are a valuable teaching resource. They are not a mere fallback, but an opportunity to learn in a controlled environment, where error has a formative and not a clinical value. Several universities are investing in these tools: Sapienza University and Tor Vergata University have set up advanced simulation centres with high-fidelity dummies and modules dedicated to emergency management; Campus Bio-Medico offers integrated courses that combine simulation with early clinical practice. The European University of Rome (EBU), more recently, has introduced interprofessional simulation modules, in collaboration with local clinical realities, to foster collaborative learning and communication between professionals. In addition, the EBU is preparing to open its own advanced simulation centre, intended both for the training of medical students and for the continuous training of healthcare personnel, thus reinforcing its commitment to innovative and interdisciplinary teaching.
The feedback from the EBU has been very positive.
The feedback from students to this new approach is very positive, especially in terms of increased confidence, mastery of basic techniques and ability to deal with complex situations. Teachers also recognise the value of simulation as a targeted preparation tool before the actual placement, reducing the gap between the classroom and the lane.
Finally, to improve the practical traineeship experience, it would be useful to introduce a continuous evaluation system: for instance, a digital logbook where students can record their activities, receive concise feedback and reflect on their progress would contribute to a more conscious and goal-oriented practical traineeship.
Internship as an investment in the health system
The clinical and laboratory internship is not only a compulsory step in the university curriculum: it is also a fundamental training ground to train professionals capable of facing the challenges of the health system with competence and responsibility. Improving its quality means investing not only in training, but in the quality of the healthcare of the future.
The potential is high: there are centres of excellence, motivated professionals and prepared students. However, it is necessary to create the conditions for these resources to come together in a systematic manner, with appropriate tools, clear organisational models and a training culture that values the internship as a founding moment of the medical profession.
Ultimately, doing it right is a matter of doing it well.
In the final analysis, doing an internship well is not just a student's right, but a responsibility shared by the entire training and health system.
