INTERNSHIP ASSESSMENT

INTERNSHIP ASSESSMENT

M.Anurag 

Roll no: 84

INTERN.

This blog is my learning experience in my general medicine department postings during my internship , which was from 12 February 2023 to 13 April 2023.

LEARNING PORTFOLIO:

UNIT DUTIES : 

I was posted in Unit-6 under the guidance of Dr. Sushmitha , Dr. Shasikala, Dr. Keerthi, Dr. Nishitha, Dr. Nithin, Dr. Ajay. 

Our unit duties started off with a sunday as our first day where we had to attend the rounds and checkup on our patients. On the very first day of our general medicine department it was inspiring for us to watch that a competent clinician does not get a holiday from patient care. 

Then we had to take care of the patients admitted under our unit and attend the OP's on our OP day that was a saturday. 

These are the some of the intresting cases which i have come across in my time under the unit and some of the questions that i asked myself while evaluating the cases.

1. 

https://anuragreddy72.blogspot.com/2023/02/38-year-old-female-with-burning.html

A. What causes the recurrence of urethral stricture lining? 

B. What are the causes of Iron deficiency anemia?

C. What are the oral drugs given for the treatment of iron deficiency anemia

2. 

https://anuragreddy72.blogspot.com/2023/02/42-year-old-male-patient-with-yellowish.html

This case is a very closely related to me as i had taken up this patient for counselling by Dr. Rajkumar

The patient is a 42 year old male who was a chronic alcoholic. Upon the advice of my pg's i had taken up this case to Dr. Rajkumar for counselling to quit alcohol abuse. This was the first demonstration i had of how a psychiatric counselling works. 

We had initially tried to know the root of the problem as to why the patient consumes alcohol chronically. Then we tried to counsell the patient to make him understand the problem which the body is facing due to his alcohol abuse and we also counselled him to join the deaddiction centre.

This was my first instance into understanding a person's journey into alcohol abuse/substance abuse and how through proper counselling the patient can be guided into a path which would make him come out of this dependance. I would thank Dr. Rajkumar for helping me understand the importance of communicating with the patient.

A. Causes of chronic liver disease? 

B. Pathology of alcoholic hepatitis? 

C. Steps of alcohol deaddiction?

3. 

https://anuragreddy72.blogspot.com/2023/02/65-year-old-female-patient-with.html

A. Causes of viral pyrexia?

B. Medications given in viral pyrexia?

C. Why cystitis is more common in females as compared to males? 

4. https://anuragreddy72.blogspot.com/2023/02/71-year-old-female-patient-with.html

A. Mode of treatment of diabetic ketoacidosis?

B. What are the different types of diabetes apart from type 1 and type 2 ? 

C. Is there a correlation between fever and diabetes ? 

D. What is more dangerous hyperglycemia or hypoglycemia

5. https://anuragreddy72.blogspot.com/2023/02/70-year-old-female-patient-with.html 

A. Causes of right heart failure and left heart failure

B. Different signs to ellicit right heart failure and left heart failure

C. Causes of reduced ejection fraction? 

6. https://anuragreddy72.blogspot.com/2023/04/13-year-old-female-patient-with.html

A. Causes of neutropenia ? 

B. Treatment modalities in viral pyrexia? 

7. https://anuragreddy72.blogspot.com/2023/04/m-anurag-84-intern.html

A. Various signs seen in acute pancreatitis?

B. Causes of acute pancreatitis? 

C. How does chronic pancreatitis develop? 

The unit duties were a very interesting attempt at understanding how we directly impact the health of the patient admitted under us and how our interventions help the patient in bouncing back to his healthy self.

During the unit duties we have learnt the different medications given for different conditions in our patients, how different investigations are sent for different conditions and how to interpret these investigation reports. 

During this time we had also taken active part in the OPs which were scheduled for our unit on saturdays. We would help the pgs by doing the initial assessment for the patients and then sending them to the pgs for a in depth evaluation of the case. During this time we have learnt how to read and understand an ECG , Chest Xrays , investigation reports of different cases.

Also during this time w.e were posted on night duties on saturdays where we would help treat the emergency cases which would come to the casualty. This was a very interesting duty for my which increased my interest towards the department as during this time i have learnt multiple things: 

I have put a ryles tube to 3 patient

I have placed a foleys catheter in 4 patients

I have learnt how to take an ABG sample in an emergency situation where the saturations were dropping and we had to send ABG samples.We tried to get the sample from both the radial artery and also from the femoral artery and finally got it from the femoral artery. This was a very exhilarating experience for me. 

I have taken samples for various cases which have come to the casualty

I have put iv cannulae for many cases which needed iv fluids and medications.

Sometimes during the course of treatment the patient would give us a history of complaints of which were to be evaluated by other departments. This helped me to understand the importance of multi-speciality approach to a case and the necessity for all the departments to work in coordination.

PSYCHIATRY POSTINGS 

I was posted in the department of psychiatry for period of 15 days.

Psychiatry was a subject which was very foreign to us in terms of assessing a case and in the way we interact with a patient.This gave us a lot of opportunity to understant how to interact with a patient and earn his trust so that he would be willing to tell us his story.

A few cases I saw included schizophrenia, delusions, panic attacks, depression, bipolar disorder, substance abuse .

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 observed the deaddiction centre and understood how a routine helps us in treating the patient.

Psychiatry postings helped me gain a new perspective into patient care and also i beleive this helped me to grow into a more sensitive and caring clinician.

WARD DUTIES : 

I was placed for ward duties under Dr. Lohith and Dr. Deepika who guided me in this duties.

I was posted into ward duties after the psychiatry postings where the stable cases were admitted and were put for evaluation. It was interesting to know each patients story and how the diseases impacted the routine of their lives.

During this time i had actively participated in the rounds which would happen and learned a lot through the various questions put forth by the HOD and the Senior residents of the various units. This immensely increased my knowledge in various aspects of the subject.

Ward duties were intresting as we saw cases related to different systems and how multiple systems interacted with each other. 

During this time we helped the sister in administration of medications via various routes and thus learnt how to give IV, IM and S/C route of administration of drugs. 

We got to know drug dosage of different drugs given to our patients routinely

During this time i learnt the importance of maintaining different PaJR groups which would help us stay actively in touch with our patients even when we were not in the hospital.

During this period the Undergraduate students had their final year practical examinations so ward interns were also placed on Exam duties where we helped the examination process by recording the viva tests taken by our internals and external professors so that we would have video recordings which would be sent to the University administration. It was cool to be sitting on the other side of the examination process for once. 

ICU ROTATION: 

I was placed in ICU rotations for the next 5 days during which i was under the guidance of Dr. Nishitha , Dr. Pavan, Dr. Kranthi, Dr. Prachethan and Dr. Ajay.

I can say that the ICU postings were the most tedious postings i had till date with hourly monitoring and repeated samples to be taken of the patients.

This gave a reality check into how much monitoring of a patients is necessary for severely unstable cases. This also gave me a first hand experience of several unstable cases.

I distinctly remember 3 cases which i would like to share here:

1. There was a 25year old male patient who was brought to the hospital after being struck by lightning and was in a vegetative state. This showed me how difficult it was to take care of such a patient and how severely it affected his life and the lives of the family members around him.

2. There was 75 year old female patient who had sudden increase and decrease in the blood sugar levels from 550mg/dl to 45 mg/dl. That day was very intresting as i got to know the various clinical symptoms and signs a patient presents in during hypoglycemia and how to manage such a patient. 

3. I also got to experience a  Z positive case of a 55 year old male patient who was admitted on account of alcohol delerium and i learnt what were the precautions a doctor has to take while dealing  with such cases which might be contagious to the patient. But the patient attenders later decided to leave against medical advice ( LAMA ) due to personal reasons despite giving good counselling about the patient's condition.

All in all the icu rotations gave me a ground reality check of the patients and their lives while dealing with a severe illness and how much effort it takes to control the disease. 

During this rotation i got to perform several procedures: 

1. Took ABG samples for 4 patients.

2. Places a foleys catheter to 2 patients. Placed a baloon catheter for another patient.

3. Took blood samples to be sent for various investigations.

4. Got to assist in a intubation for a patient

5. Got to assist a tracheostomy procedure done by the Neurosurgeon for a case which was my first time experience of such a procedure. 

6. Got to learn how to deal with severe hypertension as in a patient was constantly getting a BP of 180/120. 

NEPHROLOGY ROTATION:

After ICU, I was placed into nephrology duties for the next five days under Dr. Pavan and Dr. Govardhini. 

In this postings the main process was the dialysis procedure of the several patients who came to the nephrology department. During this period i got to learn how to dialysis machine works. The different mechanics which happen in the dialysis instrument and the various indications of dialysis and also complications which the patient gets after multiple dialysis. 

During this time I assisted Dr Pavan sir in the placement of two central lines which was an amazing experience. 

IMPRESSION OF MY TIME IN GENERAL MEDICINE DEPARTMENT:

Thus i have worked really hard during medicine postings but i really felt like it ended really soon as i was really immersed in the work i was doing. I guess time flies by when you love what you do. I got to learn and experience a lot of new and interesting things during my general medicine rotation.I really do miss the adrenaline rush of being a general medicine intern. 

I really thank Dr. Rakesh Biswas , all the Senior Residents and all the pg's for guiding me on the path of becoming a better clinician.