Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.

1. Approach to Internship:
Daily Duties of an INTERN DOCTOR
Soft and Hard Skills you need to EXCEL at Internship
 How to break bad news
 Daily job life of an intern
 Managing F/O, Handover and Follow-up
 Being efficient
 10 MUST-HAVE Necessary Skills for future career
Presenter:

2. Most daunting
experience of
your life

3. Soft and Hard
skills
Soft skills Hard skills
• Patient education and
communication
• Counselling and breaking
bad news
• Empathizing
• Keeping a healthy and pro-
active attitude
• Maintaining interpersonal
relationship with colleagues
• History taking
• Examination
• Procedures
• Death declaration
• CPR
• Prescribing
• Managing acute and
common illnesses

4. Follow BMDC
Internship
logbook

5. 5 tips on How
to be efficient
Be Pro-active, RELIABLE andTIME-
ATTENTIVE
Learn your cases thoroughly before round
DOCUMENTATION and ORGANIZATION
Single-minded approach for learning
Be curious, ask questions

6. Communication
is the Key
 Communication, partnership, and health promotion are
improved when doctors are trained to KEPe Warm
 • Knowing—the patient’s history, social talk.
 • Encouraging—back-channeling (hmmm, aahh).
 • Physically engaging—hand gestures, appropriate
contact, lean in to the patient.
 • Warm up—cooler, professional but supportive at the
start of the consultation, making sure to avoid
dominance, patronizing, and non-verbal cut-offs (i.e.
turning away from the patient) at the end.

7. Breaking Bad
News -SPIKES
S –
Setting
 Arrange for some privacy
 Involve significant others
 Sit down
 Make connection and establish rapport with the patient
 Manage time constraints and interruptions.
P –
Perception
of
condition/ser
iousness
 Determine what the patient knows about the medical condition or what he suspects.
 Listen to the patient’s level of comprehension
 Accept denial but do not confront at this stage.
I – Invitation
from the
patient to give
information
 Ask patient if s/he wishes to know the details of the medical condition and/or treatment
 Accept patient’s right not to know
 Offer to answer questions later if s/he wishes.

8. K –
Knowledg
e: giving
medical
facts
 Use language intelligible to patient
 Consider educational level, socio-cultural background, current emotional state
 Give information in small chunks
 Check whether the patient understood what you said
E - Explore
emotions
and
sympathize
 Prepare to give an empathetic response:
1. Identify emotion expressed by the patient (sadness, silence, shock etc.)
2. Identify cause/source of emotion
3. Give the patient time express his or her feelings, then respond in a way that demonstrates you
have recognized connection between 1 and 2.
S –
Strategy
and
summary
 Close the interview
 Ask whether they want to clarify something else
 Offer agenda for the next meeting
eg: I will speak to you again when we have the opinion of cancer specialist.
Breaking Bad
News -SPIKES

9. Patient
Education
components
Educating Patients Enhances Care
Received
 • Explanation: discuss the benefits and risks of taking and not-taking
medication. Some patients will prefer not to be treated and, if the patient has
capacity and understands the risks, such a decision should be respected.
 • Problems: talk through the patient’s experience of their treatment—have
they suffered side-effects which have prompted non-concordance?
 • Expectations: discuss what they should expect from their treatment. This is
important especially in the treatment of silent conditions where there is no
symptomatic benefit, eg antihypertensive treatment.
 • Capability: talk through the medication regimen with them and consider
ways to reduce its complexity.
 • Reinforcement: reproduce your discussion in written form for the patient to
take home. Check how they are managing their medications when you next
see them.

10. Daily job life of
an Intern –SIX
THINGSYOU
MUST DO

11. Daily job life of
an Intern –SIX
THINGSYOU
MUST DO

12. Follow-up:
SOAP Protocol

13. Checking
investigations
 Maintaining an Investigation chart will literally save lives – both
yours and the patient’s. Below is a common protocol for inv. chart
Investigation Findings
Blood test 1. CBC
2. S. electrolytes
3. ….
Urine test 1. Urine R/M/E
2. S. Cr
Liver/cardiac enzymes
Metabolics(Urea, ABG)
Radiology 1. X-ray
2. ECG
3. USG
Specific Investigations

14. Ward Round
-
Documentation
matters most
ALWAYS DOCUMENT EVERYTHING YOU
DO, AND SIGN YOUR NAME AFTER
 BEFORE ROUND STARTS COMPLETE THE FOLLOWING-
1. Follow-up chart
2. Investigation check
3. Working diagnosis on top of the chart
 IF pt has any risk of exposure(COVID+/HBV+) mention at the heading
 • BODEX: Blood results, Observations, Drug chart, ECG, X-rays. Look at
these. If you think there is something of concern, make sure someone else
looks at them too.
 Document what information has been given to the patient and relatives.
 Make sure patients who need senior consultation are managed first.

15. 7 tips for Fresh
order
1. Ideally Each pt. should be delivered a fresh order daily
2. Clearly mention the name, date at the beginning and sign your name
at the end
3. Always START with intake – posture, diet and IV fluids
4. NEXT mention the most important drugs – usually if any need for
oxygen/IV saline/IV antibiotics/other life saving drugs
5. CLEARLY MENTIONTHE ROUTE, DOSE AND DURATION
6. Always check S/E of each drug and how you can address that
7. END with output – monitoring vitals and urine output, instruction
about any tubes

16. Common
symbols in the
notes

17. Prescribing
drugs
Remember primum non
nocere : first do no harm.
The more minor the illness,
the more weight this
carries.
Overall, doctors have a
tendency to prescribe too
much rather than too little.
Consider the following when prescribing any
medication:
1. The underlying pathology.
2.Is this prescription according to best evidence?
3. Drug reactions.
4. Is the patient taking other medications?
5. Alternatives to medication.
6. Is there a risk of overdose or addiction?
7. Can you assist the patient?
8. Future planning.

18. Referral Note
SBAR Protocol
 • Have the clinical notes, observation chart, drug chart, and investigation
results at hand. Read them before you call for referral.
 •
 •
 Anticipate: urine dip for the nephrologist, PR exam for the gastroenterologist.
S Situation
(who you are, who the patient is, the reason for the call)
B Background
A Assessment of the patient now
R Reason for referral

19. Handover
Critical pts should be
mentioned first
Mention the name, sex, bed no.
and diagnosis for correct
identification
CLEARLY mention what needs
to be done (e.g.
inv/vitals/medication needs to
be checked)
NEVER RELY ONVERBAL
COMMUNICATION ONLY
4 traits of Good
Handover Practice

20. Things you must
carry with you
always
 An apron
 Pen and Paper
 Pen-torch, hammer and
key
 Two app- Medscape and
DIMS

21. Death
Declaration –
Most junior
doctors don’t
know how
1. Confirming cardiorespiratory arrest
You should observe the patient for a minimum of five minutes to confirm irreversible
cardiorespiratory arrest has occurred:
• Listen for heart sounds in two places, for one minute in each place(total two minutes),
then
• Palpate over a central artery (carotid/femoral) for one minute, then
• Listen for breath sounds in two places, for one minute in each place (total two minutes).
2. Confirming the absence of motor response
After five minutes of continued cardiorespiratory arrest confirm the absence of motor
response in the patient:
• Absence of the pupillary response to light; the pupils will often be dilated and they should
not change when exposed to a bright light source (eg pen torch)
• Absence of the corneal reflex; passing rolled up cotton wool over the edge of the cornea
should not elicit a blinking response
• Absence of any motor response to supra-orbital pressure; applying firm supra-orbital
pressure should not elicit any motor response.

22. CPR on adults
If you have been
trained in CPR,
including rescue
breaths, and feel
confident using
your skills, you
should give chest
compressions with
rescue breaths.
If you're not
completely
confident, attempt
hands-only CPR
instead.
 Hands-only CPR
 To carry out a chest compression:
1. Place the heel of your hand on the breastbone at the centre of the person's chest. Place your
other hand on top of your first hand and interlock your fingers.
2. Position yourself with your shoulders above your hands.
3. Using your body weight (not just your arms), press straight down by 5 to 6cm (2 to 2.5 inches) on
their chest.
4. Keeping your hands on their chest, release the compression and allow the chest to return to its
original position.
5. Repeat these compressions at a rate of 100 to 120 times a minute until an ambulance arrives or
you become exhausted.
 CPR with rescue breaths
1. Place the heel of your hand on the centre of the person's chest, then place the other hand on top
and press down by 5 to 6cm (2 to 2.5 inches) at a steady rate of 100 to 120 compressions a
minute.
2. After every 30 chest compressions, give 2 rescue breaths.
3. Tilt the casualty's head gently and lift the chin up with 2 fingers. Pinch the person's nose. Seal
your mouth over their mouth, and blow steadily and firmly into their mouth for about 1 second.
Check that their chest rises. Give 2 rescue breaths.
4. Continue with cycles of 30 chest compressions and 2 rescue breaths until they begin to recover
or emergency help arrives.

23. 10 HardSkills
you should
MASTER
before
completing
Internship
 Fluid and electrolyte management
 Antibiotic guideline
 Pre-op and post-op management, assisting OT, stitch, wound and DT
management
 Procedures- NG tube insertion, catheterization, cannulation, checking
RBS
 Managing Hypertension and Diabetes (Insulin regimen), COPD and
Asthma
 Managing a pregnant patient(follow-up, Inv., danger signs, counselling,
identifyingAPH, PPH, PROM, Eclampsia), managing FP options
 Managing common acute medical and surgical presentations(recognizing
MI, stroke, Hypoglycemia, shock, IO andAbdominal perforation)
 CPR, Death declaration, Heimlich andValsalva manouevre
 Common outdoor skin, STD, pediatric and gynecological presentation
 Interpreting common chest X-ray and ECGs

24. WEWISH YOUA HEALTHY AND MEANINGFUL
INTERNSHIP
“Medicine is learned by the bedside and not
in the classroom. Let not your conceptions of
disease come from the words heard in the
lecture room or read from the book. See and
then reason and compare and control. But
see first.” – WILLIAM OSLER