INTERNSHIP ASSESSMENT
INTERNSHIP ASSESSMENT
This blog is my learning experience in medicine posting, which was from 12 December 2022 to 11 February 2022.
ICU ROTATION
My first clinical rotation was in the peripheral postings, of which I started off my medicine posting in the Intensive care unit (ICU) for the first 5 days.
Even though the ICU duty only last for a short amount of time, it is an opportunity to learn a lot of clinical skills. Starting with ICU made me dive head first into the critical care aspect of medicine, and it was a challenge to acclimatise so quickly to a fast paced environment.
However, even though it was initially a struggle, the PGs made it an easy transition, and I was able to learn a lot in my time there.
When I was posted in the ICU, it was a full house, with 7 ICU patient and 9 AMC patients to monitor. I got the opportunity to learn how to draw ABG samples, taking around 15 radial and femoral samples as well as drawing regular blood samples for to send as lab samples.
I learned how to place a nasogastric (ryles) tube, and was able to place it for 4 patients. I also learned how to insert a foleys catheter for both female and male patients in the ICU.
I was able to assist the PGs with the placement of a central line for a nephrology patient that got shifted to the ICU.
I was able to Assist during active management of a patient who went into cardiac arrest.
He was a 65 year old male with CKD on MHD. The patient was shifted to AMC from nephro ward as his blood pressure was around 70/40 mmhg . Norad was connected and dose was being increased as his blood pressure was falling. I checked his BP and it was not recordable and the pulse was feeble. And immediately the patient was shifted to ICU and was intubated. After 20 minutes pulse was not recordable and CPR was done for 30 minutes.
I monitored patients during blood transfusion and learned about transfusion reactions.
I was able to learn properly about blood pressure lower medications in patient with CKD as I had a 25 year old male patient on dialysis for nephrology who was in the AMC. He had continuous BP recording of around 200/100 and I was able to learn the dose and choice medications for these patients.
NEPHROLOGY ROTATION
After ICU, I was placed into nephrology duties for the next five days. Nephrology was by far my most challenging posting, just for the sheer amount of work as well as the condition of the patients.
In nephrology, we are expected to take care of all the ICU/AMC nephrology cases and CKD ward patients who are our inpatients, as well as the patients who come daily for maintenance hemodialysis.
During my nephrology rotation, I monitored 2 PRBC blood transfusions and was able to learn about the use of cross matching samples, figured out donors, and learned about transfusion reactions.
I also assisted Dr Pavani maam in the placement of two central lines.
One of the best opportunities was to sit in for the dialysis sessions and be able to learn how the equipment works and how patients react to hemo dialysis. I monitored around 10 patients in different sessions of hemo dialysis and was able to do vital monitoring, learn about different complications that could arise, the benefits or disadvantages of placing a patient on hemo dialysis etc.
It was a great learning experience, and even though nephrology was an intense posting, I really enjoyed it.
WARD ROTATIONS
My last 5 days of peripheral postings consisted of ward duties. Ward postings were one of my favourite postings, because you get to see patients from all units of general medicine.
During my time there, I was able to see different cases in the ICU/AMC/Ward that were taken care of my other units and was able to take my own history for some patients.
One such example is a case of a 35 year old female who came to casualty with fever and thrombocytopenia who was on ART for the past 10 years.
This is the blog link of the case that I made, and I actually followed this patient from the time of admission into casualty, because I was working a replacement shift in casualty when she got admitted.
https://www.blogger.com/blog/post/edit/7266053451185593900/8734423051916860159
This case also helped me understand the value of doctor patient communication. Due to the casualty being extremely busy that night, the patient had initially only been put on basic medications and was yet to be evaluated around 2 hours after coming to casualty. Naturally, her attender was anxious and threatened to leave the hospital and complain about lack of care. My PG was kind enough to let me talk to the patient and attender and I was able to explain the situation and about how we had done the initial work up and there was nothing to worry about. It was a valuable lesson in an area that is taken for granted, and the value of communication to the patient should never be taken lightly, it can do wonders in reassuring the patient.
Once this case got discharged, we created a PAJR group for follow up complaints and treatment efficacy, as well as to monitor her ART regimen and CD4 counts.
There were other interesting cases like this that I had the opportunity to look at, and the ward duties turned out to be one of my favourite learning experiences because of the amount of patient interaction that I was able to do.
UNIT DUTY
My next 4 weeks included being posted into the main general medicine units. I was placed into first unit under Dr Zain Alam, Dr Raveen, Dr Prachetan and Dr Vivek.
Unit duties mainly consist of OP days, along with looking after casualty cases and overall monitoring and treatment regimens of the patients that get admitted under your care.
These are the blog links of some interesting cases that I saw admitted during my time in unit-
https://www.blogger.com/blog/post/edit/7266053451185593900/7675331806363070209
https://www.blogger.com/blog/post/edit/7266053451185593900/1974888724481598843
https://www.blogger.com/blog/post/edit/7266053451185593900/1130399496037162679
https://www.blogger.com/blog/post/edit/7266053451185593900/4295216962752059433
https://www.blogger.com/blog/post/edit/7266053451185593900/6256725442416046657
https://www.blogger.com/blog/post/edit/7266053451185593900/3146419587355150163
https://www.blogger.com/blog/post/edit/7266053451185593900/7699716032235825193
https://www.blogger.com/blog/post/edit/7266053451185593900/2515093541854982534
Unit duty was a great opportunity to be able to learn how to handle a multitude of patients and about treatment and evaluation of different cases.
Our OP days are on Monday’s, and we see around 80-100 cases per day. We were able to learn how to take patient history and do clinical examinations for many patients.
With the help of our PGs we had the opportunity to look at different clinical cases and do real time application of evaluation and coming to a conclusion about the diagnosis and treatment regimens of the patients.
PSYCHIATRY POSTINGS
My last 15 days of medicine was in the department of psychiatry.
Psychiatry is a subject that I’m very interested in, and it was a great opportunity to be able to look at different cases and watch the PGs evaluate each case, because it’s a different approach than what we’re used to in medicine.
Some cases we saw included schizophrenia, panic attacks, depression etc.
We learnt in detail about classifications of different psychiatric conditions, and the treatment for each case, along with patient compliance and how to follow up different cases.
We also got a chance to observe cases in the deaddiction centre, and see patients undergoing therapy.
Overall, the general medicine posting was a great learning experience, and taught me important clinical and social skills that will hopefully help be better evaluate and treat patients in the future.
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