Program Guidelines
   Internship Program  
Program Guidelines
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PROGRAM GUIDELINES

INTERNSHIP PROGRAM

The Mount St. Johnís Medical Centre (MSJMC) Internship Program is a rigorous 1-year training experience designed to give you a solid foundation in clinical medicine that will prepare you for full licensure and independent general practice.

Rotations include Medicine, Pediatrics, Obstetrics/Gynecology and Surgery with sub rotations in other sub specialties. The curriculum for each rotation emphasizes the six competencies of: Patient Care, Medical Knowledge, Practice Based Learning and Improvement, Professionalism, Interpersonal and Communication Skills and System based Practice. Our program emphases frequent feedback and evaluation so that you are ensured to have a solid training experience.

The Consultant Faculty is dedicated to house staff training and professional development. Your training experience will be enhanced by problem based learning, bedside teaching and case presentation. To succeed and ultimately fulfill the objectives of the program you will need to demonstrate personal accountability, professionalism and an intense desire to learn. Self directed learning will be required in addition to the above.

Without the successful completion and graduation of the Internship Program, you potentially cannot be fully registered as a doctor in Antigua and Barbuda. This structured training is very important for another reason Ė it helps to ensure youíre trained properly for your medical career. In medicine, nothing is black and white Ė your opinions are what ultimately determine a patientís course of action. If you are wrong, you could seriously injure a patient, sometimes even causing death. As an Intern, you can complete many medical tasks, but youíll be helped by Senior Staff and Consultants who will supervise you directly in your work at the hospital, so to reduce the risk of injury to patients and improve outcomes.

As an Intern you will be obligated full-time and the program will require maximum personal and professional commitment on your part. As an Intern, youíll be required to stay at the hospital when on call. Call can be as often as every other day or over an entire weekend and holiday period. When youíre on call, you will have access to a room for sleeping, but youíll have to respond to any and all calls to your assigned service and you cannot leave the hospital when on call.

THE DUTIES OF AN INTERN AT MSJMC

Education

Guidance on Internship training

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must:

  • Make the care of your patient your first concern
  • Protect and promote the health of patients and the public
  • Provide a good standard of practice and care
    • Keep your professional knowledge and skills up to date
    • Recognize and work with the limits of your competence
    • Work with colleagues in the ways that best serve patientsí interest
  • Treat patients as individuals and respect their dignity
  • Treat patients politely and considerately
  • Respect patientsí rights to confidentiality
  • Work in partnership with patients:
    • Listen to patients and respond to their concerns and preferences
    • Give patientsí right to reach decisions with you about their treatment and care
    • Support patients in caring for themselves to improve and maintain their health
  • Be honest and open and act with integrity:
    • Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
    • Never discriminate unfairly against patients or colleagues
    • Never abuse your patientsí trust in you or the publicís trust in the profession

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

Good Medical Practice
Good clinical care
Doctors must:

  1. Demonstrate that they recognize personal and professional limits, and ask for help from senior colleagues and other health and social care professionals when necessary.
  2. Know about and follow our guidance on the principles of Good Medical Practice and the standards of competence, care and conduct expected of doctors at MSJMC.
  3. Demonstrate that they are taking increasing responsibility, under supervision and with appropriate discussion with colleagues, for patient care, putting the patient at the centre of their practice by:
    1. Obtaining an appropriate and relevant history and identifying the main findings.
    2. Carrying out an appropriate physical and mental health examination.
    3. Using their knowledge and taking account of relevant factors including physical, psychological and social factors to identify a possible differential diagnosis.
    4. Asking for and interpreting the results of appropriate investigations to confirm clinical findings in a timely manner.
    5. Establishing a differential diagnosis where possible and considering what might change this.
    6. Demonstrating knowledge of treatment options and the limits of evidence supporting them.
    7. Learning to ask for patientsí informed consent (under supervision) in accordance with MSJMC protocol and forms
    8. Helping patients to make decisions on their immediate and longer-term care (including self care) taking into account the way the patient wants to make decisions (through shared decision making, or by the doctor explaining the options and the patient asking the doctor to decide, or by the doctor explaining the options and the patient deciding).
    9. Using medicines safely and effectively (under supervision) including giving a clear explanation to drugs.
    10. Demonstrating an understanding of the safety procedures involved in prescribing controlled drugs.
    11. Keeping (or arranging for the keeping of) accurate and clear clinical records that can be understood by colleagues.
    12. Demonstrating that they can perform core clinical and procedural skills safely. These core clinical and procedural skills are set out in the xxx and by each department (Appendix 1).
    13. Demonstrating knowledge and application of the principles and practice of infection control to reduce the risk of cross-infection.
  4. Demonstrate that they are recognizing and managing acutely ill patients under supervision. This includes showing that they are able to manage a variety of situations where a patient requires resuscitation.
  5. Demonstrate that they promote, monitor and maintain health and safety in the clinical setting
  6. Demonstrate knowledge of systems of quality assurance, including clinical governance. They must be able to demonstrate an application of the principles of risk management to their medical practice. This includes knowledge and explanation of the procedure for reporting adverse incidents and the procedures for avoiding them. This also includes following safe practices relating to dangers in the workplace.
  7. Manage their own time under supervision, and develop strategies with other healthcare workers to maximize efficient use of time.
  8. Demonstrate that they are able to take appropriate action if their own health, performance or conduct, or that of a colleague (including a more senior colleague), puts patients, colleagues or the public at risk.
  9. Demonstrate that they can recognize and use opportunities to promote health and prevent disease and show that they are aware of worldwide health priorities and concerns about health inequalities.

Maintaining Good Medical Practice
Doctors must:

  1. Develop a portfolio that includes a variety of evidence (including workplace-based assessments, involvement in educational and clinical teaching sessions, and reflections on experiences with patients and colleagues) to demonstrate:
    1. Identify, document and meet their educational needs.
    2. Learn through reflection on their practice.
    3. Show knowledge of the theory of audit, including change management.
  2. Be able to explain how to contribute to audit and how the results of audit can improve their practice and that of others.
  3. Internalize the importance of continuing professional development and self-directed learning and demonstrate this through the assessment process. This will include the need to respond constructively to appraisals and performance reviews.

Teaching and training, appraising and assessing
Doctors must:

  1. Teach their peers and medical and other health and social care students under guidance, if required to do so, using appropriate skills and methods.
  2. Contribute to the appraisal, assessment or review of students and other colleagues they work with.

Relationships with patients
Doctors must:

  1. Demonstrate knowledge of the theory and demonstrate the ability to ensure that effective relationships with patients are established and maintained. This includes creating an environment where the doctor can encourage and support the patient to share all information relevant to the consultation.
  2. Introduce themselves to patients and colleagues with appropriate confidence and authority ensuring that patients and colleagues understand their role, remit and limitations.
  3. Demonstrate that they recognize that patients are knowledgeable about themselves and the effect their health has on their daily life. They should use this expertise to encourage and support patients to be involved in their own care. Relatives, or other caring for those with long-term health conditions, are often knowledgeable in this area too. Doctors should be aware that care-givers, supporters and advocates (who speak on behalf of patients) often have to be included in the information given to patients. In the case of people with communication difficulties or difficulties processing information, care-givers, supporters and advocates must be kept informed about diagnosis and medical care, subject to MSJMC guidance on confidentiality.
  4. Demonstrate that they encourage and support effective communication with people, both individually and in groups, including people with learning disabilities and those who do not have English as their main language.
  5. Demonstrate that they are sensitive and respond to the needs and expectations of patients, taking into account only where relevant, the patientís age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.
  6. Demonstrate that they respect and uphold patientsí rights to refuse treatment or take part in teaching or research.
  7. Demonstrate sound knowledge concerning confidentiality (including MJSMC guidance on confidentiality).

Working with colleagues
Doctors must:

  1. Work effectively as a member of a team, including supporting others, handover and taking over the care of patients safely and effectively from other health professionals.
  2. Demonstrate respect for everyone they work with (including colleagues in medicine and other healthcare professions. Allied health and social care workers and non-health professionals) whatever their professional qualifications, age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.
  3. Demonstrate that they can communicate in different ways, including spoken, written and electronic methods. They must use communication methods that meet the needs and context of individuals patients and colleagues, including those within the team, or I other disciplines, professions and agencies where appropriate.
  4. Share appropriate information, where necessary, with a patientís permission, with other members of the healthcare team to provide the best possible information and treatment.
  5. Demonstrate that they listen to and take into account the views of other health professionals and agencies and, where appropriate, share information with other professionals and agencies in accordance with MSJMC guidance on consent.

Probity
Doctors must:

  1. Be honest in their relationships with patients (and their relatives and careers), professional colleagues and employers.
  2. Be able to complete or arrange for the completion of legal documents correctly such as those certifying sickness and death (or arranging for these documents to be filled in) and liaise with the coroner or procurator fiscal where appropriate.
  3. Demonstrate knowledge of and be able to apply relevant legislation to their day-to-day activities.

Health
Doctors must:

  1. Demonstrate knowledge of their responsibilities to look after their health, including maintaining a suitable balance between work and personal life, and knowing how to deal with personal illness to protect patients.
  2. Take responsibility, in line with good medical practice, for their own health in the interest of public safety. If they know, or have reasons to believe, that they have a serious condition which could be passed on to patients, or that their judgment or performance could be significantly affected by a condition or illness (or its treatment), they must take and follow advice from a consultant in occupational health or from another suitably qualified doctor on whether, and in what ways, they should change their clinical contact with patients. They must not rely on their own assessment of the risk to patients.

DIRECTIONAL SUPERVISION

The Intern is at all times under the direct doctorial supervision of the Attending Consultants, through the Senior House Staff. The Consultant will confer on a regular basis with the Intern to evaluate the performance of the Intern and to review the status of the Internís skills progress. The Consultant will at the end of each Rotation decide if the Intern has met the requirements and successfully fulfilled the training. Should the Intern fail to meet the expectations of the Consultant, the Intern can be required to extend the Rotation and/or be removed from the program.

Core clinical and procedural skills for provisionally registered doctors

These are some examples but must be combined with the specialty specific skills that will be required to pass the Internship Program.

  1. Venepuncture
  2. IV cannulation
  3. Prepare and administer IV medications and injections
  4. Arterial puncture in an adult
  5. Blood culture from peripheral sites
  6. Intravenous infusion including the prescription of fluids
  7. Intravenous infusion of blood and blood products
  8. Injection of local anaesthetic to skin
  9. Injection Ė subcutaneous (e.g. insulin or LMW heparin)
  10. Injection Ė intramuscular
  11. Perform and interpret an ECG
  12. Perform and interpret peak flow
  13. Urethral catheterization (male)
  14. Urethral catheterization (female)
  15. Airway care including simple adjuncts (e.g. Guedal airway/or laryngeal masks)

PROGRAMME ACCEPTANCE

By signing below, you acknowledge and fully accept the programís requirements. You understand and accept that you can be removed from the program at any time for:

  • Poor clinical performance
  • Poor academic performance
  • Lack of professionalism
  • Failure to respond when called for patient care
  • Failure to report to duty without permission
  • Negligence or sub-standard patient care
  • Poor communication
  • Poor Customer Service skills
  • Refusing to comply with Medical Staff By-Laws
  • Other reasons set out by Medical Staff Executive Committee

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