MEDICAL

INTERNSHIP
GUIDE
College of Medicine
King Saud Bin Abdulaziz University for Health Sciences
 MEDICAL
INTERNSHIP
GUIDE
College of Medicine

This Medical Internship Guide for Medical Intern

serves as a tool for the learning and working
environment during MI. It is a steppingstone for
future residency training.
MEDICAL INTERNSHIP GUIDE

1
 Contents
Introduction…………………………………………………………3
Section 1: Medical Internship………………………………………4
Section 2: Medical Internship Governance…………………………5
- Role of Placement Coordinator & Clinical Supervisor ……...6
- Intern’s Responsibilities and Rights…………………………8
- Appling to Medical internship ………………………………10
- Completing Internship……………………………………….11
- Leaves During MI…………………………………………...12
Section 3: Placements’ Objectives…………………………………15

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Section 4: Medical Internship Competencies………………………22
Section 5: Assessment……………………………………………...23
- Portfolio……………………………………………………..25
- Mini Clinical Evaluation Exercise …...……………………..26
- Case-Based Discussion …………………………………..…26
Reference………………………………………………………27

2
 Introduction
Graduating from the medical school is not the end of journey, it is the
start of a career. The graduates of King Saud bin Abdulaziz University
for Health Sciences (KSAU-HS) should be assured that they have
received a high-quality medical education and they should look
forward to receiving some of the best training available in Saudi
Arabia at King Abdulaziz Medical Cities during their Medical
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Internship (MI).

3
Section – 1

Medical Internship

Medical Internship (MI) is a supervised period spent in different

specialties, following the completion of graduation requirements from
the medical school. During MI, the intern should be an active learner,
achieving learning outcomes independently by demonstrating a variety
of learning styles. The learner should also fulfill the essential
educational components of practice-based experiences, feedback and
reflection in practice. As a future competent physician working in a

MEDICAL INTERNSHIP GUIDE

complex health system, an intern needs exposure to a wide range of
medical career options and to develop a variety of professional skills
considered essential for working in the health care system.

Learning Outcomes

At the end of Medical Internship, a medical intern is able to:

• Diagnose and manage diseases by applying the basic medical and

clinical sciences effectively in practice.
• Provide comprehensive management that includes health care and
disease prevention.
• Demonstrate effective role as a team member and apply the principles
of multidisciplinary approach.
• Know when to ask for opinion from clinical supervisors and senior
colleagues.
• Deal professionally with the patient and family.
• Apply effective tools in communication, presentation and leadership.
• Apply the principles of clinical governance. 4
• Demonstrate life-long commitment toward continuing medical
education.
 Section – 2

Medical Internship Governance

Medical internship (MI) is governed by the Medical Internship Unit
(MIU) under the umbrella of Clinical Affairs, College of Medicine,
KSAU-HS. The Associate Dean of Clinical Affairs is the chairperson
of Medical Internship Program. The MIU governs MI based on the
following charges:

• Runs administrative affairs related to medical internship program.

• Deals with issues related to interns.
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• Prepares an ideal training and learning environment.

• Conducts educational activities to enhance intern’s skills.
• Promotes research related to medical internship.
• Orients medical intern for future career choices and opportunities.

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Role of Placement Coordinator

In each specialty, a placement coordinator will report to MIU. The

supervisor of each specialty is expected to:

• Be approachable and easily accessible to medical interns assigned in

the placement and to establish a healthy rapport.
• Be a good communicator and advocate intern’s training.
• Provide counseling and advice for the medical intern in relation to
career planning and dealing with work pressures.
• Be interested in education and enthusiastic about teaching.
 Be able to deal effectively with other staff and specialists that the
intern will need to deal with.

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• Be a good role model and demonstrate commitment to the
development of the profession.

The placement coordinator is encouraged to receive feedback from

rotating medical interns on the following aspects:

• The range and effectiveness of teaching methods.

• The usefulness and effectiveness of teaching and clinical support
provided.
• The degree of collaboration with the supervisor in planning learning
outcomes and program of supervision.
• The degree of support in the provision of information on further
training opportunities.
• The degree of support on addressing performance issues and conflict
resolution.

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 Role of Clinical Supervisor
Clinical supervisor is defined as a clinician in the teaching hospitals
who has been given the responsibility to organize and supervise the
training of medical interns. He serves a liaison role between junior
doctors, administration and senior colleagues. The position of the
clinical supervisor is seen as a key component in the training structure
of medical interns and requires a senior clinician with special skills as a
teacher, innovator, adviser and diplomat.

The role of a clinical supervisor in clinical teaching includes a range of

responsibilities such as direct observation, discussions on clinical
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problems and interesting cases, joint consultations, formal teaching on

specific topics, demonstrations and participation in clinical procedures.
Small group discussions with other members of the practice might be
sometimes employed. The clinical supervisor should discuss overall
education with
the intern, as well as perceptions of clinical strengths and weaknesses.
Discussions with the medical intern must be based on the principles of
constructive feedback. This will include frank discussion on progress-
to-date and possible variation of the program to meet new needs as they
arise.
The supervisor is required to offer support to the intern in the following
aspects:

1. Provide orientation to the practice ensuring that the intern is:

• Introduced to all members of staff and the stage of training and
7
responsibilities of the intern is known by all.
• Be aware of the location of educational resources.
2. Provide supervision to the medical intern at a level appropriate to
their level of training as indicated below:
• Medical intern should not take the principal responsibility of
individual patient.
• The clinical supervisor or the designee must be physically present in
the workplace at all times whilst the intern is providing clinical care.
• If the supervisor is absent from the medical practice, his/her duties
should be delegated to a colleague after coordinating with the
coordinator.

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3. The Clinical Supervisor will provide professional education and
clinical training of interns including ethical issues, career guidance,
self-education, etc.

Intern’s Responsibilities and Rights

Medical Intern is responsible for their learning, assessment and
attendance at structured learning sessions in their placements. They
will maintain an up-to date portfolio. Each activity is an opportunity to
learn something new such as a competency or a clinical skill. Some
competencies can be learned from nurses or other health care workers.
The precise arrangements and responsibilities will vary by specialties.
There will be emphasis on gradual increasing responsibilities for
patient
care that facilitates the progress from being supervised to
independence. 8
 During MI, each intern is expected to:

• Be a professional and effective team member.

• Provide safe patient care.
• Conduct a history and perform a physical examination.
• Prepare a list of differential diagnoses, working diagnoses,
appropriate investigations, and a management plan.
• Seek approval from the clinical supervisor prior to executing the
management plan.
• Follow and document the management plan, results of investigations,
and any changes in the patient’s condition.
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• Adhere to the rules and regulations of the assigned department.

• Apply modern methods of teaching e.g. Microskills.

Medical Intern rights include:

• Training under the supervision of a faculty staff.

• Availability of a rich training and academic environment.
• Receiving proper and professional treatment.
• Enjoying leaves as per College of Medicine policy and procedures.
• Awareness of assessment and evaluation in different placements.
• Any dispute should be brought to the attention of the placement
supervisor or MIU.

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Applying to Medical Internship

During the clinical clerkship (clinical years of the curriculum), each

medical intern will be requested to apply in order to start MI.
Completion of all graduation requirements is a pre-requisite for MI.
Placement will start at the beginning of a Gregorian month. Once the
rotations are officially released, no changes will be allowed unless
reviewed and agreed by MIU. Once MI is successfully completed, a
graduation certificate will be released.

To ensure high quality training and proper supervision, medical interns

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are encouraged to spend the training at teaching facility of the
university. The assignments of placements will depend on the latest
available cumulative GPA to ensure fair distribution.

The placements during MI includes:

• Medicine 2 months
• Surgery 2 months
• Pediatrics 2 months
• Obstetrics and Gynecology 1 month
• Emergency Medicine 1 month
• Family Medicine 1 month
• Elective 3 months
(Request for elective placement should be submitted at least two
months in advance)

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 Starting Medical Internship
Before the commencement of the first placement, there will be an
orientation course for the MI program. This will include information
about the hospital, timetable and further information. Any delay or
interruption of MI will be subject to the College of Medicine policy
and procedures.

Completing Medical Internship program

At the end of MI, the intern will be issued Medical Internship
Completion Certificate. Based on this certificate, the Medical Intern
will be eligible to receive the M.B.B.S certificate. The following
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should be available prior to issuing MI completion certificate:

• All end of placement “Intern Competency Assessment” forms
• Complete portfolio
• Complete separation clearance

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Leaves during Medical Internship

Medical Intern is entitled for the following leaves, per the College of
Medicine policy and procedures:

1. Annual leave (AL)

Medical intern is entitled to 20 days annual leave divided as follows:

• Routine annual leave – 15 days

Annual leave must be submitted at least 30 days ahead of requested
dates; the Medical intern is not allowed to apply for more than 5 days

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Annual in one placement. A request should be filled and then signed
and approved by the Undergraduate Education Director (UCE) Co-
Director and Internship unit. No requests will be approved if submitted
to Internship Unit after the 14th of the preceding month of the
requested dates. Annual Leave cannot be taken as Urgent Leave.

• Urgent leave (UL)– 5 days

This type of leave is limited for urgent and justifiable reasons. These
days can be used at any time. UL requires approval of UCE Co-
Director (should not interfere with on-call duties) and Internship Unit.
The medical intern is not allowed to take more than 2 days per
placement. Unused urgent leave can be used as Annual Leave in the
last 2 months of internship year.

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 2. Eid Holiday - 5 days

The Medical Intern is entitled to 5 working days during either Ramadan

or Hajj holiday as per the hospital calendar. If the medical intern was
not able to use the Ramadan or Hajj holiday and he/she was obliged to
report for work, he/she will be compensated as long as there is a letter
of justification coming from the placement concerned. If the Medical
intern is working in a department, he/she is obliged to take Ramadan or
Hajj holiday. The medical intern must complete a request for record
purposes.
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3. National Day - 1 day

23 September is the Saudi Arabia National Day. The holiday is

declared by the government and according to hospital policy.

4. Educational Leave - 7 days

The Medical intern is entitled to 7 days educational leave.
A request should be submitted at least 30 days in advance of the
requested dates, along with proof of registration, including payment
receipt, a commercial brochure, program, poster or advertisement.

5. Maternity and sick leaves

will be compensated after the end of the Internship.

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6. Sick leave
• If sickness/illness occurred during working hours, he/she should
go to the Employee Health Clinic. A request must be completed and
submitted with the attached sick leave report for the approval of UCE
Co-Director and submitted to the Internship Unit for final approval.

• If sickness/illness occurred after working hours, he/she should go

to the Emergency Department. A request must be completed and
submitted with the attached sick leave report, for the approval of UCE
Co-Director and submitted to the Internship Unit for final approval.

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• A sick leave report coming from a private hospital will be subject to
the rules and regulations of the college.

7. A request must be completed and submitted for the approval of

UCE Co-Director and Internship Unit for any type of leave.

8. Any leave that exceeds 50% of the working days of any placement
will necessitate the placement to be repeated or compensated based on
the combined decisions of UCE Co-Director and Internship Unit.

9. The medical intern is not allowed to take more than 2 types of leave
in the same placement to a maximum of 7 working days.

10. Any non-approved absences from the program will be subjected to

disciplinary actions. Any non-approved on-call absences will be
subjected to the repetition of placement/rotation. 14
 Section – 3

Objectives
Internal Medicine
At the completion of this placement, the medical intern will be able to:

• Undertake a competent clinical assessment of a patient with an

undifferentiated presentation of common medical conditions.
• Have a systematic approach to the evaluation of a patient with multi-
system illnesses, including the ability to prioritize the different
problems present.
• Be familiar with the diagnostic patterns used in the evaluation of
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patients with common medical conditions.

• Be familiar with common medical emergencies and trauma.
• Complete Basic Life Support (BLS) and preferably Advanced
Cardiac Life Support (ACLS).
• Order and interpret the results of the main tests relevant to the
investigation of the presentation of common medical problems.
• Make recommendations for the initial phases of management of
common medical conditions.
• Maintain comprehensive records of care provided to patients,
including regular updates.
• Demonstrate the ability to maintain a professional relationship with
patients during the course of their illness, including the provision of
full explanation and support to both patients and their families or care
providers.
• Demonstrate the ability to obtain informed consent for invasive
procedures.

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Surgery
At the completion of this placement, the medical intern will be able to:

• Undertake a competent clinical assessment of a patient with an

undifferentiated presentation of common surgical conditions, including
conditions related to the breast, neck, abdomen, testis, joints and bone,
brain and spine etc.
• Be familiar with common surgical emergencies and trauma.
• Complete Basic Life Support (BLS) and preferably Advanced
Trauma Life Support (ATLS).
• Have a systematic approach to the evaluation of a patient with multi-

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system illnesses, including the ability to prioritize the different
problems present.
• Understand the management and possible complications, including
hernia, testicular problems, common endocrine conditions, breast, and
common surgical emergencies.
• Evaluate common co-morbid conditions in patients with a surgical
condition, including diabetes mellitus, hypertension, asthma.
• Be familiar with the diagnostic patterns used in the evaluation of
patients with common surgical conditions.
• Order and interpret the results of the main tests relevant to the
investigation of the presentation of common surgical problems.
• Make recommendations for the initial phases of management of
common surgical conditions.
• Maintain comprehensive records of care provided to patients,
including regular updates.
• Demonstrate the ability to maintain a professional relationship with
patients during the course of their illness, including the provision of
full explanation and support to both patients and their families or care
providers. 16
• Demonstrate the ability to obtain informed consent for invasive
procedures.
 Obstetrics and Gynecology
At the completion of this placement, the medical intern should be able
to:
• Undertake a competent clinical assessment of a patient with an
undifferentiated presentation of common obstetrical and gynecological
conditions, including pregnant women, menstrual history etc.
• Demonstrate sensitive communication with female patients.
• Be familiar with common surgical emergencies and trauma.
• Complete Basic Life Support (BLS) and preferably Advanced
Trauma Life Support (ATLS).
• Have a systematic approach to the evaluation of a patient with multi-
system illnesses, including the ability to prioritize the different
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problems present.
• Acquire knowledge and skills of a woman in labor and delivery.
• Acquire skills to assess fetal well-being.
• Demonstrate ability to use Pinard stethoscope and take CTG.
• Understand the management and possible complications, including
abnormal labor and delivery, abnormal postnatal care, vaginal bleeding,
incontinence and prolapse, treatment of infections.
• Evaluate common co-morbid conditions in patient with a pregnancy
condition, including diabetes mellitus, hypertension, asthma.
• Be familiar with the diagnostic patterns used in the evaluation of
patients with common obstetrical and gynecological conditions,
including urinary pregnancy test, quantitative HCG assessment, routine
antenatal screening investigations, use of ultrasound techniques,
abnormal CTG traces, Pap Smear.
• Make recommendations for the initial phases of management of
common obstetrical and gynecological conditions.
• Maintain comprehensive records of care provided to patients,
17 including
regular updates.
• Demonstrate the ability to maintain a professional relationship with
patients during the course of their illness, including the provision of
full explanation and support to both patients and their families or care
providers.
• Demonstrate the ability to obtain informed consent for invasive
procedures.

Pediatrics
At the completion of this placement, the Medical Intern will be able to:

• Obtain a full history and perform physical examination for a pre-

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school and school-aged child.
• Obtain a full history and perform physical examination for an
adolescent.
• Seek further relevant information related to differential diagnosis.
• Demonstrate awareness of issues in examination of child and
adolescent at risk.
• Take a child’s temperature and record on chart demonstrating correct
use of different methods/sites.
• Perform ear examination using the otoscope.
• Measure blood pressure (including use of non-electronic
sphygmomanometer) and plot on chart for infant and older child.
• Perform urinalysis.
• Measure and plot on chart head circumference, weight and height for
an infant, older child and adolescent
• Measure blood glucose using a glucometer demonstrating correct use
of stylet.
• Observe and assess on performing lumbar puncture.
• Measure peak expiratory flow and understand principles of 18
spirometry.
 • Collect specimens for microbiological examination such as urine,
throat swabs, nasopharyngeal aspirates and skin swabs.
• Interpret results of full blood count and blood film.
• Interpret results of blood biochemistry report.
• Interpret results of arterial blood gas report recognizing normal and
abnormal findings.
• Interpret microbiological analyses of specimens of urine, blood, stool,
sputum, nasopharyngeal aspirate and cerebrospinal fluid.
• Interpret and discuss plain x-rays of the chest, abdomen, skull and
musculoskeletal system in a child.
• Acquire the basic knowledge in the management and therapies of
common general pediatric problems and of the different subspecialties.
• Calculate and chart a pediatric drug dosage correctly using weight or
MEDICAL INTERNSHIP GUIDE

surface area. Recognize and use sources of recommended dosages and

chart correctly.
• Instruct a child and/or parent in the use of a variety of age appropriate
devices for asthma medication delivery, demonstrating knowledge of
medication appropriate devices, conveyed in appropriate language to
parent/caregiver and child.
• Convey information about investigations required and investigation
results in appropriate language and with accuracy based on evidence
and verify patient/ parents/caregiver understanding.
• Convey information to parents about immunization schedule,
indications and contraindications.
• Perform routine immunization confirming appropriate site, equipment
and technique.
• Perform Pediatrics Advanced Life Resuscitation (PALS) in children
of all ages.
• Provide information to parents and caregivers of chronically ill and
disabled children.
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• Provide explanations of common conditions to parents and children
such as asthma, croup, gastro intestinal illness, febrile seizures, otitis
media and upper respiratory tract infections.
• Demonstrate ability to communicate effectively and accurately
regarding ongoing care, management plans and responsibilities.
• Understand responsibilities regarding notification of children at risk.
• Demonstrate awareness of the issues in ongoing care for children of
families living in rural and regional areas and the medical management
difficulties for these families.

Emergency Medicine

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At the completion of this placement, the medical intern will be able to:

• Recognize critically ill patients (impending or actual circulatory,

respiratory and renal failure and situations that are likely to lead to
them).
• Initiate immediate management as needed.
• Assess the trauma patient.
• Understand the disturbed physiology reflected in critical care
situations.
• Demonstrate the ability to recognize and assess acutely ill patients,
arrange appropriate urgent investigations and initiate immediate
management.
• Understand the principles of triage.
• Understand indications for change to a palliative approach to
management.
• Be able to participate in more advanced life support.
• Be able to practice safe airway management and to have skills for
basic CPR, such as secure a patent airway, apply oxygen therapy, 20
conduct external cardiac massage, bag valve mask ventilation, conduct
defibrillation and identify conditions requiring urgent referral.
 • Assess patients with potential threat to airway, ventilation or
circulation.
• Gain an understanding of the common medical surgical emergencies
and the approach to these patients.
• Interpret basic clinical investigations in their clinical context such as
cervical spine x-ray, ECG, chest x-ray, arterial blood gases.
• Understand the importance of working in a multi-disciplinary team in
the Emergency Department.
• Recognize which illnesses require/do not require hospital admission
for either therapy or investigation.
• Know the immediate management of life-threatening illnesses.
• Communicate bad news to patients and relatives.
• Demonstrate strategies for dealing with uncooperative patients and
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relatives.
• Be familiar with information systems used in the Emergency
Department.
• Understand the importance of time management.
• Prioritize issues when dealing with patients in the Emergency
Department.
• Be familiar with common Procedural Skills: airway management,
chest tube insertion, BLS, ACLS, and PALS management,
venipuncture and venous cannulation, blood gas collection, urinary
catheterization, suturing, application of Plaster of Paris.

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Section – 4

Medical Internship Competencies

Box 1: General Pre-set Competencies

1- Clinical Management
• Acquires clinical knowledge
• Takes History and perform Physical Examination
• Constructs differential diagnosis
• Plans appropriate investigation and management
• Applies SOAP in follow-up of patients
• Maintains quality medical records

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• Recognizes and assesses acutely ill patients

2- Medical Practice
• Demonstrates evidence of self-learning
• Gives comprehensive case presentation
• Provides appropriate patient instructions
• Maintains regular attendance
• Demonstrates required technical skills

3- Professionalism
• Manages time appropriately
• Practices the principles of patient safety
• Applies principles of medical ethics
• Demonstrates self-confidence
• Acknowledges own limitations and seeks assistance

4- Communication Skills
• Maintains professional practice
• Communicates well with patient and/or family
• Communicates effectively with the team and others 22
 Section - 5

Assessment
The medical intern will be assessed with multiple tools against
standards of competencies at a level of a first year resident in any
specialty. The assessments are clinically oriented, directly observed,
and work based. be a set of generic competencies applied for all
placements. Twenty competencies in four domains are identified. The
score will range from 1–10 with a total score of 100. The four domains
are clinical management, medical practice, professionalism,
communication skills (Box 1). Each medical intern should review
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his/her assessment form and sign it. Signing this form indicates that the
intern is informed but does not necessarily mean that they agree with
the assessment. A score of less than 60% indicates that the performance
is below average. The chairperson of the MIU may advise to repeat the
rotation or part of it after conducting appropriate consultations. Any
disciplinary action or grievance should be submitted to MIU where it
will be discussed in the MI Committee. This will follow the College of
Medicine policy and procedures for MI program.

23
The collection of evidence during the MI will be in the form of an
Educational Portfolio. The portfolio and its components represent a
higher level of assessment of clinical competencies as represented in
Miller’s triangle (Figure 5-1).

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Maintaining up-to-date portfolio will allow optimum assessment in
each student.
The final score during MIP will be weighted based on the duration of
each placement:

• Medicine ___________________(8% x 2) 16 %
• Surgery ___________________(8% x 2) 16 %
• Pediatrics___________________(8% x 2) 16 %
• Obstetrics and Gynecology _____(8% x 1) 8 %
• Emergency Medicine __________(8% x 1) 8 %
• Family Medicine ____________(8% x 1) 8 %
• Elective ___________________(6% x 3) 18 %
• Review of portfolio __________________10 %

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 Educational Portfolio
The educational portfolio reflects performance, assesses clinical
competencies, and professional development. It contains a collection of
with self-appraisal, mandatory formative assessment (MFA), evidence
of summative assessment and achievements that reflect the clinical
experiences and new competencies acquired by the intern during MI
(Box 2). Educational portfolio will be gradually built throughout MI to
reflect the acquired clinical experiences and new competencies. At the
end of each placement, intern will show evidence of mandatory
formative assessment.

In addition to the MFA, the portfolio will also include any record of
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achievements throughout MI. It may also include evidence of these

achievements e.g. summary of presentations, summary of procedures,
presented research, etc. It is the intern’s responsibility to keep it up to
date. The medical intern is responsible for organizing his/her
assessments. This includes finding a suitable case or procedure and
organizing the session with a clinical supervisor or an experienced
colleague. This should take
no more than one hour a month. All completed mandatory
assessment forms should be kept in the educational portfolio,
regardless of the outcome.

Box 2: Minimal Requirements for Educational Portfolio

• Personal professional development plan including career planning.

• End of placement assessment.
• Mandatory formative assessment: Mini-CEX and CBD.
• Evidence of achievements in each placement with descriptive
statement.
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Mandatory Formative Assessment

The Mandatory Formative Assessment (MFA) reflects the progress of

medical intern. It is designed to assess the clinical competence at a
level of first year resident in any postgraduate program. It is also
designed to allow the intern an opportunity to regularly receive direct
and immediate feedback from an experienced senior colleague.[24]
Passing this evaluation is not the aim, performing it with immediate
feedback and lessons learnt are the ultimate goals. Therefore, this
assessment will not be approached as if it is an examination.

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MFA includes the following tools: Mini Clinical Evaluation Exercise
(Mini-CEX), Case-Based Discussion (CBD), Directly Observed
Procedural Skills (DOPS).

Mini Clinical Evaluation Exercise

Mini Clinical Evaluation Exercise (Mini-CEX) provides the intern with

an opportunity to receive immediate feedback on skills essential to
provide good clinical care by observing an actual clinical encounter. It
reflects the performance of clinical skills, routinely considered part of
patient encounters

Case-Based Discussion

Case-Based Discussion assesses clinical judgment, decision-making

and the application of knowledge in relation to patient care. It allows
the application of clinical reasoning in practice. This may include 26
discussing ethical and legal framework of practice and facilitate
feedback in order to guide learning.
 REFERENCE

)61,2y,yram 201A(
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