Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

The Medical Internship: Your

Download as pptx, pdf, or txt
Download as pptx, pdf, or txt
You are on page 1of 47

Saudi Arabia Chapter

Council of Young Physician (CYP)

The Medical Internship : your


first step into the medical career
Fadel A. AlRowaie , MD ,FACP ,FNKF
Chair Person ,Council of Young Physician – ACP
Assistant Professor of Medicine ( KSAU-HS)
Consultant Nephrologist (KFMC)
16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
Outlines
• What is an internship ?
• What is job description of the intern?
• How to plan your clinical/ elective rotations ?
• Documentation
• Characteristics of successful intern
• Advices for successful internship
• Introduction to next lecture
• Q&A
16 / 10/ 2012 The medical internship
What is the internship ?
• A medical intern is a term used for physician
in training who has completed medical school.

• An intern has a medical degree, but does not


have a full license to practice medicine
unsupervised.

16 / 10/ 2012 The medical internship


16 / 10/ 2012 The medical internship
Internship in KSA
• 1 years of supervised and paid training .
• It usually includes rotation in : IM , G.S ,
Pediatrics , Obs/gyn + ER and elective
• MBBS certificate will be given only after
successful completion of the internship .
• Intern considered part of the medical team
and his/her name is usually the first one in the
on-call schedule

16 / 10/ 2012 The medical internship


16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
Job description of the intern
• To participate as a member of a multi-disciplinary team in the hospital to take care of patients.

• Interns are responsible for treating patients under appropriate supervision. They have to ensure
that their functions are carried in a good manner and more priority is given for the patient' s
safety.

• Check the patients while they are getting admitted or discharged and fill in the right details about
them. To order and interpret diagnostic tests is one of the duties which are carried by intern
doctors. They are the one who initiate and monitor the treatments given to the patients.

• Communication with patients and their relatives is essential. Intern doctors are the ones who
take responsibility for communicating with them and other hospital clients. These doctors also
attend meetings at their work place that are related to any particular complicated case.

• They co-operate with investigations, audit, or enquiries that are related to the provision of
health. They do take a daily round through all the patients for their regular check up and
assistance regarding any health issue.

16 / 10/ 2012 The medical internship


Summary
• As an intern, you'll have all of the experiences that a
resident would have, but without as much
responsibility.

• You won't be expected to make major decisions, but


you will more than likely get to watch how others make
these decisions.

• This will help you be prepared for an upcoming job


where mistakes are not easily forgiven.
16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
Role Model

16 / 10/ 2012 The medical internship


How to plan your clinical / elective rotations ?

16 / 10/ 2012 The medical internship


How to select your future
speciality ?
16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
Speciality selection
An analysis of the 1993 graduating medical school
class found that the following factors were the most
influential in choosing a specialty:

• The type of patient problems encountered,


• The opportunity to make a difference in people’s
lives and to help others, and
• The intellectual content of the specialty

16 / 10/ 2012 The medical internship


Other factors
1. Generalist , specialist , or none of the above
2. Intellectual content and clinical issues
3. Amount of patient contact
4. Type of patients encountered
5. Prestige , status , and social expectations
6. Life style considerations
7. Length of residency training
8. Difficulty of obtaining a residency or fellowship position
9. Future income and earning potentials
10.Job opportunities and predictions about the specialist workforce

16 / 10/ 2012 The medical internship


Application
Internship for Residency
residency

Medicine
or elective
( Medicine )

Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Medicine
Medicine
(1 October 2013 )
(1 October 2013 )

• Know the speciality


• Get people to know you
• Get recommendation letters
• Know the place you are interested to
work in

16 / 10/ 2012 The medical internship


Internship site
1. Hospital that you want to work in
2. Bench mark hospital in teaching /training
3. Hospital with higher rate of acceptance rate

16 / 10/ 2012 The medical internship


Documentation

• Documents : Admission ( H&P), admission


order , progress note , consultation, discharge
summary ,physician orders , consents , death
summary and others .
• Time and dates .

• Signature or stamp .
16 / 10/ 2012 The medical internship
Physician progress note
• Use SOAP format for physician progress note.
• Always start with seen with or end with plan
discussed with your seniors.
• Add any updates to patient condition or any
new ( lab or radiological )investigation

16 / 10/ 2012 The medical internship


Subjective
Objective
SOAP
SOAP
Assessmen Plan
t

16 / 10/ 2012 The medical internship


16 Oct 2012
14:00

• Subjective :
Still c / o cough and yellow sputum but no more chest pain or SOB and no more vomiting
• Objective :
 Tem ( 38 °C to 40 °C , BP 125 / 55 mmHg , HR 90 BPM ,RR 12 / m , O2 sat 99 % on 2 L Oxy ( was on 4 L )
Gen. exam : not pale or jaundice and no respiratory distress
Resp :normal chest expansion , dullness on the left lung base with reduced breath sound , bronchial
breathing and coarse crepitation
Rest of exam unremarkable
Labs : WBC 8 ( 14 on admission) , blood & sputum culture grew strept. Pneumonia that is pan-sensitive
• Assessment :
A 34 Y O M with CAP ( pneumococcal ) , responding to Abx therapy
• Plan :
Stop azithromycin and continue ceftriaxone
Stop IVF as patient has no more vomiting and tolerating oral intake
Encourage mobilization
Possible discharge tomorrow
Dr. AlRowaie
ID 59050
Patient seen with Dr.Arshad and agreed on the above plan Pager 3232
16 / 10/ 2012 The medical internship
16 Oct 2012
14:00
Admission order
• Admit to MMW under care of Dr Arshad , IM section
• Diagnosis : CAP others : DM , HTN
• Allergy : NKA
• Vital signs : Q 4-6 hours ( if DM add gluco check)
• Activity: As tolerated
• Diet : Regular
• Investigation: CBC , Electrolyte , LFT , blood and sputum G.S and culture , CXR ( done in
ER )
• Medication:
 Oxy to keep sat above 94 %
 IVF , D5NS @ 100 cc / hr
 Paracetamol 500 mg every 6 hours PRN for pain and fever
 Ceftriaxone 2 g IV OD
 Azithromycin 500 mg OD for 3 days
 Enoxaparin 60 mg subcut OD Dr. AlRowaie
ID 59050
16 / 10/ 2012 The medical internship Pager 3232
Discharge summary
• Patient demographic data
• Diagnosis ( discharge or admission diagnosis)
• Other Diagnoses :
• CC, HPI , PMH ,FH ,SH, Allergy and BT hx
• Systematic review
• Investigation ( labs , radiology , pathology etc )
• Hospital course
• Discharge medication
• Discharge plan Dr. AlRowaie
ID 59050
16 / 10/ 2012 The medical internship Pager 3232
Consultation
• Before calling, be sure you understand why
you’re calling a consult .
• Always start by introducing your self
• Never say we just wanted to get you on board.
• Never call the consultant directly .
• Prepare and document all related labs ,
investigations , reports , medication list .

16 / 10/ 2012 The medical internship


16 / 10/ 2012 The medical internship
Consultation to Cardiology
• From : Dr.Arshad ( IM ) to : Dr. Ahmad Cardiology ( Pager # 5555 /
date & time )
• Reason for referral : ACS for transfer to ICU and further
management.
• Summary : a 65 years old ,male ,DM , HTN , smoker with prior
history of AMI treated with thrombolytic therapy ( 2 years ago),
admitted under IM last Saturday with CAP. Now c/o stabbing left
sided chest pain associated with sever SOB ,orthopnea and
PND ,BP 75 mmHg ,sat 89 % on 10 L , JVP high with S3 gallop and
bilateral basal crepitation . Trop is high and ECG showing ST
elevation in anterior lead , giving ASA , Enoxaparin ,Morphin but
no NTG because of low blood pressure. Dr. AlRowaie
ID 59050
16 / 10/ 2012 The medical internship Pager 3232
Characteristics of successful intern

• Reliable
• Bring energy and enthusiasm
• Dress well
• Balance self-sufficiency with asking questions
• Participate
• Stay flexible
• Pay attention to detail
• Network
16 / 10/ 2012 The medical internship
16 / 10/ 2012 The medical internship
Advices for successful internship

16 / 10/ 2012 The medical internship


Morning Round /
On-Call
report Clinic

16 / 10/ 2012 The medical internship


Try to present in the morning report

16 / 10/ 2012 The medical internship


• If you are not ready , do not present .
• Always discuss with your seniors, to take their
support
• Read very well about your case and be ready
for any question
• Do not feel offended if criticized

16 / 10/ 2012 The medical internship


16 / 10/ 2012 The medical internship
Daily round

16 / 10/ 2012 The medical internship


• Try to go to the floor before the morning report
• Collect all the labs and examine your patients before you round with your senior
• Be the first one on the floor at the time of round
• Always read about your cases and be ready for any question
• Special attention to medication ( mechanism of action , interaction and major side
effect )
• Try to be active , show your motivation by generating questions higher than your level
• Try to attend clinics / ambulatory ( consultation )
• Learn as much as you can of medical / surgical procedures ( ABG ,Injections , LP ,
aspiration …etc )
• Always endorse your sick patient to the on-call team
• Appropriate documentations
• Participate in section or departments educational activities
• Start or complete your research project

16 / 10/ 2012 The medical internship


16 / 10/ 2012 The medical internship
On-calls

16 / 10/ 2012 The medical internship


Floor ER
16 / 10/ 2012 The medical internship
Floor
• Start seeing the sicker patient
• Do not hesitate to ask for help from your senior
• Never ignore any patient complains
• You can give orders for minor complains e.g for
headache , vomiting and pain
• Always go and examine the patient , inform your
senior and document that in patient chart

16 / 10/ 2012 The medical internship


ER
• Be the first one to see the patient
• Take full history and perform complete physical exam
• Utilize the EMR / patient old chart
• Come with your own differential diagnosis and plan
• Act promptly in certain situation ( investigation /
medication )
• Read about your case
• Discuss it with your senior
• Ask to present the case in the morning report
16 / 10/ 2012 The medical internship
Next lecture ( application for residency
program )
• What is residency ?
• Choosing specialty
• Application process ( CV / recommendation /
statement of purpose)
• The entry exams ( SLE , USMLE , CCE)
• The interview

16 / 10/ 2012 The medical internship


fadelrowaie@yahoo.com
falrowaie@kfmc.med.sa

16 / 10/ 2012 The medical internship

You might also like