Pediatric DepartmentInternship Rotation: Rules and Regulations

PROGRAM GOALSThe overall goal of the Pediatric Internship Program is to be able to impart the importance

of:  Professionalism Ethical Principles and Practices Pluralism Respect for Diversity Interdisciplinary Collaboration Social and Ethical Responsibility And a sense of responsibility to contribute to the welfare of the profession and society. The Pediatric Department together with the Consultants and Staff is designed to assist the Interns, provide a balance of support and to allow the Interns to be learners through their own strengths and to acknowledge their areas of growth. Throughout the 2-month Pediatric Internship Rotation, Interns will learn how to worktogether, how to communicate with patients and other health care professionals, how tocritically look at a problem and work to solve it, and how to develop the Professionalismexpected of physicians.

ADMINISTRATIVEEach Intern should do one month inside KKUH and one monthoutside in one of the following hospitals:

King Saud Medical City (KSMC) formerly known as Shemaisi King Abdul-Aziz Medical City (KAMC) formerly known as

National Guard King Fahad Medical City (KFMC) King Faisal Specialist Hospital & Research Center (KFSH&RC) Riyadh Military Hospital (RMH) Security Forces Hospital (SFH)

In and Out distribution must be finalized by the chief intern and must be submitted One (1) month before pediatric rotation & emailed to Pediatric Internship Program Secretary.

KKUH ROTA and On Call ROTA must be sent 3 weeks before the start of the rotation.

Interns who want to transfer to another ward will have to get approval from the coordinator first.

No changes will be accommodated once Final list is submitted to the secretary.

Rotations outside our hospital will be in General Pediatrics unless the Intern is in Elective rotation.

KKUH DISTRIBUTION In KKUH we have three Pediatric wards (11A, 11B, and

12B) . More interns can be accommodated in the last two wards.

During rotation in KKUH pediatrics, some of the interns will cover two weeks in subspecialty.

Team Leaders must submit the names of the interns assigned in these areas on the 2nd day of the rotation.

ORIENTATION All interns rotating in pediatrics inside & outside KKUH

must attend the meeting with the Internship Program Coordinator at 8:00 am on the 1st day of the rotation at Dr. Aljarrallah Seminar Room, Pediatric Department, Level 1.

 • The secretary will organize the meeting with the chief

intern.

DAILY M

ORN

ING

ACTIVITY

Interns MUST ATTEND the MORNING ACTIVITY DAILY.

Attendance in the ward station where you are assigned will be done by the S/Registrar and/or Fellow during the Admission Rounds and Post Admission Rounds.

Another separate attendance sheet is provided by the department for the daily morning activity. Attendance signature in the morning activity is until 8:10am ONLY.

Sign – out is strictly starting 3:30 PM. Interview Confirmation Note is

provided in the pediatric department which will serve as attendance if an intern is scheduled for an interview.

ON

- CALL After the On Call sheet is submitted to

the intern secretary by the chief, anyone who wants to change his/her on-call, he/she and his/her replacement must fill-up a special form and both will sign in addition to chief intern. It must be submitted to the secretary’s office & chief intern must make sure to change the names in the boards of each ward with their bleep #’s.

Splitting of on – call shift is not allowed. A random visit will be done by any member of the committee

Two interns will be on call daily including weekends from 8:00 am until the next post admission round with the on call consultant.

One intern will be assigned for admission and one for complaint. Absent On – call intern will result in corrective action as necessary to maintain the quality of patient care, the quality of the Program and the well-being of the intern.

In case the call of the intern is with a different team, he/she must inform the S/Registrar of his/her original team for post admission round.

On call interns must attend the endorsement between the teams to be aware of the patient’s especially during weekends.

On call admission - interns must accompany the resident during admitting patients and discussion of new admissions with the on – call Registrar.

VACATIONS During Eid vacations, work

must be covered appropriately. On-call schedule must be done by the chief intern, as per KKUH Main Internship Office Rule.

Study leave should be applied and approved 2 weeks before the start date of the intended leave. Application of the Study leave should be supported with paid registration in the course/symposium that you are going to attend.

Only five(5) days vacation will be allowed during the two months pediatric rotation if not taken before and must be signed by the chief intern, CTU consultant of the ward and approved by the coordinator before submission to the Main Intern’s Office.

During subspecialty rotation, no one is allowed to take a vacation leave. If urgently needed, the chief intern is to arrange a substitute intern for the subspecialty.

FINAL EVALUATION

Final Evaluation will be the average of the 2 months rotation.

Some hospitals requires intern’s clearance at the end of the rotation. Pediatric Department of the hospital will not release their Evaluation should intern fail to complete the said clearance.

CLINICAL Professional attitude toward patients and family as well as colleagues

and supervisors and the other medical team (nurses, physiotherapists, etc.) is expected, as this is part of your professional evaluation.

Discussions with parents and relatives with regard to prognosis, diagnostic possibilities and definitive treatment plans are the responsibility of the Consultant and his designee. Extreme caution and professionalism is needed in this respect. Major prognostic, diagnostic and therapeutic plans will first be told to the parents by the Consultant and his designee (e.g. Senior Registrar).

Patient’s mother requests (eg. for special food to be brought by the family for exceptions of visiting hours for single rooms etc.) should be referred to the Resident and the Head nurse to address them in accordance with hospital policies.

Interns should avoid management and other sensitive clinical discussions in English assuming the patient’s mother doesn’t know English.

DECISIONS INCLUDING DIAGNOSTIC AND THERAPEUTIC PLANS MUST BE ACCORDING TO THE SPECIFIED JOB DESCRIPTION.

The Intern should show active interest in the diagnostic and therapeutic process with his team and as guided by his/her Supervisors. This includes regular assessment of clinical status and prompt and persistent follow-up of laboratory results and other investigations.

All the interns must see the patients & write progress notes, follow- up results of investigations before the morning round & present their cases to the S/Registrars, Registrars and Consultants. Their progress notes and orders should be counter-signed by the Resident/ Registrar.

The Intern is encouraged to participate and discuss clinical decision making such as:

Planning management in general Treatments including I.V. fluids Discontinuation of treatment or I.V. and change

of doses/volumes/route Prescriptions Admission and discharge decisions Requesting consultation for referral or transfer of

a patient but the final decision is the responsibility of Consultants or supervisory medical staff.

Discharge plans will first be decided and notified by the Consultant or Senior Registrar. The Intern should refrain from discussion of discharge plans with parents unless authorized by his Supervisors.

The Intern should adhere to all hospital and departmental (Ward/Clinic/PICU/NICU/ A&E) regulations. He/She should observe the working hours and the on duty

responsibilities. The appearance and attitude must be professional. No operation

room gowns are to be worn while working in the ward. Personal scrub suits are acceptable.

Respect and observe regulations regarding patient’s privacy e.g. the presence of a nurse is essential when interrogating the mother, examining the patients or performing procedures.

Finish the assignment given to him/her by the Team Leader. Respond to his/her bleep immediately.

PEDIATRIC INTERNSHIP JOB DESCRIPTION

The Intern is expected to take the history, make the physical examination, outline the appropriate differential diagnosis, laboratory investigations and treatment, for all patients admitted to the ward, irrespective of whether an emergency or elective admission.

The Intern is expected to inform and discuss all cases immediately with a senior member of the unit before executing the orders for laboratory investigations or treatment.

Treatment including drugs, fluids, must be countersigned before executing them.

Orders for them should be written in the chart.

All laboratory and X-ray forms should be filled-in clearly by the Intern and the name of the Admitting Consultant should be included.

The Intern has to make sure that blood and other specimens has been extracted/collected and taken to the laboratory.

The Intern has to make sure that results of laboratory and X-rays are being back particularly urgent results such as CSF results for acute cases.

Abnormal results have to be discussed with the seniors and an action has to be planned.

The Intern has to make sure that the expected action is being done for the patient.

Clerking Patients Laboratory Investigations

♣ The Intern is expected to learn some practical routine procedures, such as venepuncture, blood sampling, setting up an infusion drip, giving IV medication, lumbar puncture and immunization.

The Intern is expected to report to the ward at 7:30AM and personally prepare notes for the rounds.

The Intern is expected to attend all ward activities including admission rounds, case presentations, X-ray meeting, journal club and various lectures and seminars, routing ward rounds, the sing-out rounds. He/she should attend late evening rounds with Consultant/or Senior Registrar when he/she is on call.

The Intern is expected to follow-up his patients meticulously, and to write progress notes on each patient, including clinical findings, laboratory investigations, and current management.

Technical Skills Ward Activities

PEDIATRIC WARD GUIDELINES The Head Nurse/Charge Nurse will give you a short orientation talk

when you arrive in the ward. Please ensure you make time to attend. Much valuable information regarding the ward set up, routines, etc. can be gained.

Please make yourself familiar with the whereabouts of forms, files, telephone directory, etc. You may help yourself to such items when required.

Paediatric policy states that “all female watchers should be up and dressed in “Abayya” by 0800 hrs and those curtains should remain open until after the ward rounds”. However, please ensure male interns DO NOT enter patients’ room without a female member of staff.

You may have been assigned to other units in the hospital. However, routines and policies may vary. Please abide by and respect those of our unit.

Nursing staff place patients’ files, x-rays, etc. at the bedside by 0730 hrs ready for the nursing endorsements and doctors rounds. If you need to remove them, please inform the nurse and replace them afterwards. Remember, files, etc. are not to be taken outside of the ward area.

The nursing staffs are accountable for all items of equipment. When not in use, diagnostic sets, stethoscopes, etc. are usually kept in a locked cupboard. When you borrow such equipment, please ensure you do not remove them from the ward or leave them at the bedside. Please return them either to where you found them or to the charge nurse.

Learn how to operate the computer. Knowledge is power. Please make yourself familiar with the nursing documents.

Many different charts are in use e.g. convulsion chart, O2 saturation chart. The nurse may not always be available when you need information.

In order to help avoid errors being made, please ensure you inform the nurse when you write a new order and remain with her while she reviews it. Remember, only KKUH or universally accepted abbreviations may be used.

1130 hrs – 1300 hrs is lunch time and rest time for the patients and watchers. Only emergency procedures/ rounds should take place between these times.

MEMORANDUM

HAND IN HAND WE ARE MAKING A DIFFERENCE IN THE LIVES OF THE CHILDREN…

IF YOU HAVE ANY QUESTIONS YOU CAN CONTACT:

Program Coordinator DR. ALIA AL IBRAHIM Pager #: 3687 E-mails:

aalibrahim@ksu.edu.sa or alia362000@yahoo.com

Deputy Program CoordinatorDR. NOUF ALBACKER Pager #: 5606 Email: dr_nouf@yahoo.com

Pediatric Internship Program Secretary

JOEY Extension #: 91512 E-mail:

pedinterns.kkuh@gmail.com

INTERNSHIP TRAINING PROGRAM COMMITTEE

Dr. Abdulrahman Al Nemri (Pediatric Chairman)Dr. Alia Al Ibrahim (Internship Program Coordinator)Dr. Nouf Albacker (Deputy Internship Program

Coordinator)Dr. Adi Al Herbish (Member)Dr. Khalid Suliman Abu Neim ( Chief Intern Resident Co -

Member)