Introduction: Many newly qualified doctors struggle to cope with the challenging transition to internship, raising a concern over whether they are adequately prepared with the competencies they need for legitimate practice. This study aimed to explore the reality of the internship role, the types of competencies that form the basis of achievement in this context, and the perceived readiness of newly qualified doctors to demonstrate these competencies.

Methods: A qualitative study, using focused ethnography, was undertaken in a regional public hospital in Johannesburg. 15 first year internship doctors volunteered to take part. Data was gathered over a seven-week period through participant observation and shadowing and informal conversations. Semi-structured interviews were recorded with 13 of the participants to further explore emerging themes. The data were analysed using a reflective thematic analysis with additional analysis using the Legitimation Code Theory (LCT) specialisation dimension coding framework.

Results: Interns are the ‘engine room’ of the hospital, facing long hours and the responsibility for a high workload. Some interns cope well, while others become overwhelmed, negatively impacting their wellbeing. Competency in teamwork, organization, efficiency, and communication provides the basis for legitimate practice, all attributes not highly valued by the undergraduate curriculum.

Discussion: To thrive, newly qualified doctors need to demonstrate both confidence in their clinical knowledge and skills as well as the attributes that form the basis of achievement in internship. To achieve this we need holistic competency based medical education that meaningfully values the personal and social competencies that are critical for legitimate practice.