How to stay steady when everything is competing for your attention.

Starting a new rotation or stepping into your first role as a doctor can feel like trying to drink from a firehose. There is a lot to take in: new sites, new departments, new teams, new systems, new processes - and all while being responsible for patient care. Even when you are technically coping, it can feel mentally exhausting.

This is cognitive load — and it is real.
 

What is cognitive load?

Cognitive load refers to the mental effort required to process and act on information. As an intern, this can spike due to:

• Managing multiple patients and tasks
• Frequent interruptions (pages, notifications, questions, handovers, MET calls, code blues etc)
• Navigating unfamiliar processes
• Holding ‘mental to-do lists’ across a busy day
• Trying to remember who needs what, and when

You may feel like you are juggling constantly — and afraid you will drop something important. That is because your working memory has limits, and when it is overloaded, errors and stress creep in.

Cognitive Load Theory: Implications for medical education: AMEE Guide No. 86: Medical Teacher: Vol 36 , No 5 - Get Access
 

What you can do: Practical strategies to reduce the load

You cannot remove the complexity of medicine — but you can structure your workday to reduce overwhelm.

1. Get things out of your head early and often

Relying on memory alone is risky when your day is full of interruptions.

• Use a patient list you can scribble on — track jobs, test results, follow-ups, phone calls.
• Carry a ‘job book’ or use Notes app to jot down small tasks and reminders.
• Prioritise writing things down before moving to the next job.

Intern tip: A task is safer on paper than floating in your brain.
 

2. Group and batch where you can

• Batch similar tasks — chase all bloods or imaging at once; make all phone calls in one go.
• Avoid switching between different types of tasks if possible — it reduces mental fatigue.
   

3. Anchor yourself with short reviews

The day moves quickly, and it is easy to lose track.

Build in quick mental resets:

• Morning: What are today’s priorities? What needs chasing before midday?
• Midday review: What have I ticked off? What is still pending?
• End of day: Have I handed over anything that is unresolved?

These anchor points reduce the risk of something slipping through.
 

4. Use structured communication tools

SBAR or ISBAR (Identify / introduction, situation, background, assessment / analysis, response / recommendation) is not just for escalation — it is also a mental template to avoid freezing under pressure.

Use it when:

• Presenting to a registrar or consultant
• Handing over patients
• Calling another service

Structured communication reduces the cognitive effort of figuring out what to say under pressure.

Clinical handover for older people in hospital | health.vic.gov.au

ISBAR Poster | Australian Commission on Safety and Quality in Health Care
 

5. Minimise re-work and re-thinking

• Confirm and clarify instructions immediately — do not assume, ask.
• Double-check results and names before calling someone — it saves you from having to call back.

Mental energy is wasted most on fixing things that were not clear the first time.
 

6. Reduce noise and control interruptions when you can

You cannot stop all interruptions — but you can shape when and how you respond.

• Take 5 minutes to complete a task before answering non-urgent calls — if safe to do so.
• Ask teammates to hold queries that are not urgent while you finish a quick discharge or note.

It is OK to protect your concentration — it is a skill, not selfishness.
 

7. Debrief and download afterward

• After a tough or complex day, take 5 minutes to mentally or physically offload.
• Write down unresolved tasks, questions for tomorrow, or reflections.
• This stops you taking work home in your head.
   

And finally… Be kind to yourself

You will forget things sometimes. You will feel scattered. That is normal. The mental load of internship is high — and it takes time to build systems and confidence.

What matters is that you are learning to manage the load — not carry it all perfectly.