INTERNSHIP ASSESSMENT 

NAME- RACHANA GANGULA 
ROLL NO- 117 

This blog is my learning experience in medicine posting which was from 14/4/23 to 12/6/23 

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. Spending time in the ICU afforded me to experience a wide range of what medicine has to offer; from simply keeping the heart and lungs functioning, to managing complex neurological disorders, to counseling entire families during the most difficult moments, there was no shortage of moments to learn from. And it left me a ton of crazy medical experiences. 

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  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. 

UNIT DUTY 

My next 4 weeks included being posted into the main general medicine units. I was placed into third unit under Dr Nikitha, Dr Pavan, Dr Ajay. 

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://caseopinionsbyrollno110.blogspot.com/2023/06/50-year-old-female-with-chronic-heart.html

https://caseopinionsbyrollno110.blogspot.com/2023/06/36-year-old-male-with-high-grade-fever.html

https://caseopinionsbyrollno110.blogspot.com/2023/05/65-year-old-female-with-cough-4-months.html

https://caseopinionsbyrollno110.blogspot.com/2023/04/70-year-old-male-with-ckd-on-mhd.html

https://caseopinionsbyrollno110.blogspot.com/2022/01/48-year-old-male-with-bipedal-edema.html

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 Wednesday, and we see around 60-80 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.