So you think getting through the ERPM exams was stressful? Think again.

Doing your medical internship in Sri Lanka will be one of the most challenging and stressful years of your life, but the pay off is definitely worth it. This post will be about my experience with internship and I’ll be posting my internship survival tips in the next post! Remember that the ultimate goal of the year is to SURVIVE.

Where do I end up?

At the induction ceremony held by the Ministry of health you will find your station according to your ranking. The ceremony only happens a few days before you are supposed to report to the station so be prepared (i.e. get your saris ready, bed sheets, ties/shirts/whatever etc).

On finding out I had got Base Hospital Embilipitiya I was quite disappointed because even though all foreign students are ranked behind local and KDU graduates in terms of ranking, my ranking on the foreign student list was within the top 5. Only on getting to the hospital did I find out that it was a District General Hospital (a higher ranked hospital).

An additional plus point was that the hospital was laid-back in terms of sari wearing. Otherwise I would have had to go for a different training session just for that.

Going into the picking I wanted to do Medicine and Surgery, but Medicine and GynObs are the most sort after appointments so I ended up with Surgery and Paediatrics.

Blood, alcohol, sweat and tears.

Initially surgery was like a bomb explosion for me, a whole new world. I only found out later that it was the busiest unit and the male ward was insane, constantly running a patient occupancy rate of more than 90% (most of the time it was between 110-130% – I have avurudhu to thank for that).

I kept my head down for the first month and just focused on getting the work done. I was so traumatised the first month that I absolutely hated it. The only thing getting me through it was the countdown I had in my head. Trauma is huge in Embilipitiya and so the male ward is full of never ending road traffic accidents, assaults and head injuries. Never ending blood, alcohol, sweat and tears. Hence my trauma resuscitation skills are definitely on point now (trauma basic skills blog coming soon!).

Consultants & SHOs

The Consultants have different personalities, you got the shouty ones, the bossy ones, and the silent ones. First impressions definitely count and so you don’t want to get off on the wrong foot. Remember that your consultants need to sign you off after the 6 month placement, but more importantly they can make your life a living hell. To save yourself from all the drama, keep your head down and do your work!

The surgical SHOs (Senior House Officer) were initially very intimidating and because my Sinhalese speaking skills were pretty bad at the beginning I thought they would really stress me out, but I ended up having some pretty amazing seniors to learn from. As long as you work hard and efficiently, you will be fine. In the few hours you have free (when you aren’t sleeping or eating) read up on some management so that when you get quizzed you have something logical to say.

My duties as a surgical HO

• Transfers – The most annoying duty of an HO, especially if you get car sick. Working in a busy trauma unit with no CT machine means constant head injury and trauma transfers for CT scans or orthopaedic/vascular opinion. Even if you don’t get travel sick, just know that ambulance drivers drive like there is no tomorrow and legally you cannot use the highways which means longer drives, a lot of braking and tons of near misses. As you are risking your life, you can also claim money for the transfers so make note of the ambulance vehicle number, date and transfer destination. Prior to going on transfers make sure you inform the hospital you’re transferring to, know your patient (so when you get quizzed you know something) and take all the equipment you need (sucker machine and tubes, meds to keep the patient sedated if intubated e.tc.).
• Ward work and on-calls – This needs to be decided between you and your co-HOs, but basically someone has to be there at all times. Surgical was long hours – 7:00 a.m. till 6-8 pm. Depending on the number of co-HOs you will probably do a night once every other day or every 2 days. If you’re lucky enough to work in a unit that has casualty/non-casualty days, your days on-call would be much less. Usual ward work consists of doing your ward round, ward round with the SHO/Consultant, clerking, writing discharges and dealing with the emergencies as they come in. Common ward work in the surgery unit also included putting POP/casts, urinary catheters, 4 layer compression dressings, IC drain removals, proctoscopy e.t.c. We were also required to assist the consultant in the clinic once a week.
• Theatre roster – There is absolutely no point doing a surgical appointment and not doing theatre time. So come up with a roster with your co-HOs and get in the theatre. Now is the time to perfect your suturing skills and to learn to do appendectomies and other small operations. I was lucky to have an amazing SHO who gave me the opportunity to do my 1st solo hernia repair. Whilst in theatre use the opportunity to learn some anaesthetics such as intubation, making anaesthetic drugs and recovering patients.
• Morbidity/mortality and MDT meetings – Our unit ran monthly mortality meetings and MDT meetings which require a lot of organization and co-ordination.

Blog on common surgical admissions and management coming soon!

Cry. Poop. Feed. Repeat.

I was always scared of dealing with kids. So many questions ran through my brain prior to my paediatrics appointment. How will I deal with kids dying? Can I remember all these drug doses? Will I go deaf from all the crying?  6 months later and who knew, but paediatrics was definitely a good fit for me.

Paediatrics at my hospital was way more chilled than my surgical training. There were 2 wards in the paediatrics unit which worked with casualty and non-casualty days so we did not take in emergencies/admissions everyday. This meant less on call nights and way more downtime.

Consultants & SHOs

I was assigned to a stern consultant who although I was initially petrified of, taught me to be meticulous, organised and to think before I act. I definitely learnt to be rationale in my drug management and to always treat the patient and not the CRP (C-reactive protein). Again work fast and work carefully because remember you are dealing with children – all drug doses have to be calculated to bodyweight! My consultant was very picky with our history taking and examination, so CHDRs have to be checked for growth and immunisation records double checked. My consultant would also bring us discharge cards where we’ve written wrong doses/diagnoses, which helped us learn from our mistakes.

Again the SHOs are great to learn from especially for clinical skills. Detecting murmurs is a skill that comes with practice, but my consultant would definitely call me out if I missed it so getting my SHO to double check any possible murmurs was very useful.

My duties as a paediatric HO

• Transfers – With paediatrics most of the patients need a doctor to accompany them on transfers, but the number of transfers I went on were much less compared to the surgical unit. If the child has fits, remember to take the appropriate drugs and a sucker machine.
• Ward work and on-calls – The problem with paediatrics is the three times a day ward rounds which both HOs have to be present for. On casualty days, an HO has to be in the ward at all times so the night on-call HO would get a break from after the afternoon ward round till the night round (only a few hours rest). The other HO would therefore take the break between themorning and afternoon ward round. On non-casualty days, ward work started around 7ish and we would get a small break after finishing the work and discharges after each ward round. Between all the HOs in the 2 paediatric wards we decided that the HO present in the casualty ward would also cover the non-casualty ward. This means that as HOs we have way more downtime. As an HO you also can learn to do lumbar punctures and burn umbilical granulomas. We were also required to clerk all the new admissions in the paediatric clinic once a week.
• Postnatal ward and NICU – Unfortunately my batch had too few HOs and so we did not get a chance to work in the NICU (funny story as I’m now doing my post-internship year in the NICU). We did have to work in the PNS ward which was such a drag purely because we had to do 24/7 on-calls everyday for a month (again due to a shortage of HOs). Even though you become way more confident in handling new borns and emergencies related to them, the annoying thing is that you can never sleep without having that internal panic that there would be an emergency. Good opportunity to insert umbilical venous catheters and to try intubating neonates. This is also the best place to perfect your murmur hearing skills!
• Neonatal mortality meetings – In our hospital these happened once every 2 months and all the neonatal deaths are discussed.

Leave

As an intern you are not entitled to leave. You have to work 24 hours a day, 365 days of the year. However, everyone realises that this is unrealistic including the consultants so depending on how many co-HOs you can decide amongst yourself how to take leave. During both my surgical and paediatric appointments, the consultants only gave us leave after the 1st month and then every 4 – 5 weeks we got one weekend off. Normally you can leave after the morning ward round on friday and you have to be back by the morning ward round on monday. Again, according to our internship laws, we as interns our not entitled to leave unless its sick leave (which you get 2 weeks off providing a medical certificate of course!).

So that’s the gist of my internship year (thank god it’s over!).

I may have accidentally forgotten certain facts so this blog post will probably be updated continuously. For tips on how to conquer internship, do check out my next blog post next week 🙂

As usual, I would love to hear from you! Comment below or use the contact sheet!

** Update – Something I did forget to mention was that you do get to rank hospitals where you would like to do your internship (you rank about 25!) a few days before the appointment ceremony. A list of hospitals available to do your internship with the number of vacancies at each hospital is released on the day you are supposed to rank your choices at the venue you are supposed to mark it. Allocated time slots are given according to your rank in order to avoid congestion at the location. You need to take  certain documents with you (confirm with the ministry!) and they will be checked at the location.  – Thanks to Dr. Keshab for his suggestion!