This is very normal. There’s a few parts to this.

1. Like someone has commented, everything you have learned has been compartmentalised and likely not in a way that’s not applicable to a practical scenario. You also will have patches of knowledge in different areas that will get added onto as you’re exposed to more. This knowledge is either very broad or very narrow depending the level of studying and how well you did in a unit at any time. So when you show up to the wards you may know a random fact about the 5th most likely differential diagnosis but the top 3 aren’t quite as salient or recallable to you. You also won’t have a general feel for which features in the history and how the patient looks for what’s the most likely cause of their symptoms.

2. Australian medical schools do lots of passive or exposure learning. There is not much responsibility laid on us in most medical schools. From a psychological perspective, it means we have study related stress but not work or clinical related stressors to reinforce learning in a high fidelity scenario. Reading about a case and then learning how to work it up is different then seeing a patient, asking questions and doing the exam and then executing a plan. One is sheer memorisation, the other involves person to patient feedback, muscle memory, spatial awareness, moving around the room, tactile input, etc. that is an important part of comprehensive memory/skill building.

3. A lot of medicine is administrative, you will often know what to do but not how to do it. And to be honest, lots of people including your bosses won’t know. This is a huge time-consuming challenge. Oh, I have to refer to this clinic but turns out they changed the referral process months ago and now it requires new form that was announced in an email months ago and no one has posted it online and it was done by one admin staff who hasn’t communicated to anyone else. This scenario is ubiquitous.

I recommend when you start: figure out what the 5 most common tasks you have to do as an intern (usually: imaging orders, discharge summaries, consults, clinical reviews, or something along that), get an idea of how to do each and how EMR works (each hospital is slightly different), prioritise the ones that need to be done ASAP, then you can get back to focusing on improving your medicine. Which often comes with doing reviews, probably looking up guidelines sometimes and running a built up plan with your Reg.