Kenya National Guidelines for Medical and Dental Officer Interns 2019 PDF

NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS 2019 NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC FOREWORD Internship training plays...

NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS 2019 NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC FOREWORD Internship training plays a vital role in a doctor’s career. This is a legal requirement that allows a practitioner to acquire critical practical skills that cannot be acquired within the precincts of a lecture room. During university training, an individual will acquire scientific knowledge and skills from various avenues. Internship training therefore provides a platform for the intern to apply the skills learnt in a practical sense under the supervision of a specialist practitioner who is a mentor and a coach. Indeed the attitude of the intern during this period will determine the level of knowledge and skills acquired and subsequently bring out a well-grounded and competent doctor. The Council has designed a log-book for purposes of standardizing internship training with a particular emphasis on core competencies and skills to be acquired during this period. The report of the assessment is a useful feedback to the council, which determines whether or not an intern qualifies for registration as a Medical or Dental Practitioner. These internship training guidelines outline what the Medical Practitioners and Dentists Council (MP&DC) considers to be important areas that must be covered to ensure that adequate knowledge and skills have been acquired. They were developed and compiled by a team of experienced clinicians, teachers and other key stakeholders in medicine and dentistry. The Council has made numerous legal strides to protect all interns during training. The Medical Practitioners and Dentists Act, CAP 253, Laws of Kenya defines internship training and lays down the framework for internship training in Kenya as a mandatory requirement prior to registration as a medical or dental practitioner. It is important to also take note of “The Code of Professional Conduct and Discipline” which outlines the conduct expected of a doctor and subsequent disciplinary action in the event of any transgression of this code. On behalf of the Council, I wish all users of these guidelines an exciting and fruitful time during the internship training period. DR. EVA.W. NJENGA CHAIRPERSON MEDICAL PRACTITIONERS AND DENTISTS COUNCIL NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC ACKNOWLEDGEMENTS The Medical Practitioners and Dentists Council gratefully acknowledges the parties who have worked with dedication and commitment in the development of the National Guidelines and Log Book for Medical and Dental Officer Interns. Appreciation goes to Dr. Eva Njenga, Chairperson MP&DC, Dr. John Masasabi, The Ag. Director General, Ministry of Health, Dr. Nelly Bosire, Chairperson, Training, Assessment, Registration and Human Resource Committee (TAR-HRC), Prof. Okello Agina, Prof. Lukoye Atwoli, Dr. Tonnie Mulli, Dr. Sanjeev Sharma and Dr. Tom Ocholla for providing leadership and technical support in this process. Special recognition goes to Dr. Rose Wangechi for her contribution to the document. In addition, acknowledgement goes to the Members of the Council for their critique and contributions. We thank the following key stakeholders for their valuable contribution and inputs: Deans of medical and dental schools in Kenya, Internship Coordinators from various internship training centres across the country, Medical and Dental Professional Associations, The Kenya Medical Practitioners and Dentists Union and all other Health Regulatory Boards and Councils who were key to this exercise. The Council gratefully acknowledges our key strategic partner, The Kenya Obstetrical and Gynaecological Society, led by the President, Dr. Benjamin Elly Odongo, The Secretary General, Dr. Kireki Onwona and team. The Council also appreciates the immense work put in by the Secretariat: John Kariuki, Sarah Were, John Mburu, Eunice Muriithi, Michael Onyango, Esther Mutheu and the entire staff of The Council for providing logistical and other support during this important exercise. DANIEL M. YUMBYA, MBS CHIEF EXECUTIVE OFFICER MEDICAL PRACTITIONERS AND DENTISTS COUNCIL NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC INTRODUCTION THE MANDATE OF THE MEDICAL PRACTITIONERS AND DENTISTS COUNCIL The Medical Practitioners and Dentists Council is established under Cap 253 of the Laws of Kenya, with the mandate to regulate the practice of Medicine and Dentistry. It has the following roles among others: - 1. Assist the intern to attain full potential during internship 2. Provide the necessary guidance to the intern 3. Liaise with employers and supervisors of the intern to ensure that he or she has enabling work environment. 4. Supervise the process of internship through visits to the internship training centers. 5. Approve new internship training centers. 6. Ensure that the required standards at all internship training centers are maintained. 7. Verify completion of internship training and register those successful as medical and dental practitioners DEFINITION OF INTERNSHIP Internship is a prescribed period of employment during which a medical or dental graduate works under supervision to fulfill registration requirements. During this period, the graduates have an opportunity to consolidate their knowledge, skills and attitudes to enable them to be competent practitioners. DURATION AND CONTENT OF INTERNSHIP Every medical officer intern shall be required to undergo an internship training program for a period of twelve months (12), and an additional one calendar month of paid leave. The rotations are outlined as follows: 1. Internal Medicine including Dermatology - eleven (11) weeks 2. Surgery including ENT and Ophthalmology - eleven (11) weeks 3. Paediatrics and Child Health - eleven (11) weeks 4. Obstetrics and Gynaecology - eleven (11) weeks 5. Mental Health - eight (8) weeks Every dental officer intern shall be required to undergo an internship training program for a period of twelve months (12), and an additional one calendar NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC month of paid leave. The intern shall concurrently acquire skills in the dental disciplines outlined below, throughout the period of internship: 1. Oral and maxillofacial surgery 2. Conservative and prosthetics dentistry 3. Orthodontics and Paediatric dentistry 4. Periodontology Every intern, whether medical or dental, shall participate in community health practice as part of the internship programme. This shall be done every Friday of the week for the entire duration of internship (fifty-two weeks). The interns shall spend eight hours every week (total 416 hours for the year), supervised by the Family Health Physician/Dental Public Health Specialist, providing health services to the community. INTERNSHIP GOALS The interns shall be able to:- 1. Consolidate their knowledge, skills and attitudes to enable them to be competent medical or dental practitioners. 2. Acquire knowledge of commonly used drugs and their rational use, be conversant with the National Essential Drugs List and know the Dangerous Drugs & Poisons Act and its application. 3. Utilize the current Ministry of Health Standard Treatment Guidelines, WHO treatment guidelines and any other relevant standard guidelines in patient management USERS OF THE GUIDELINES These guidelines are intended to provide direction on the execution of the internship training programme. It ensures standardization of internship training in various institutions at different levels of health care in the country. They are intended for use as a reference document by: 1. Internship training centres 2. Intern supervisors 3. Intern coordinators 4. Designated persons in charge of the internship training centres 5. The Ministry of Health 6. Other stakeholders in medical and dental internship training. NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC DISSEMINATION These guidelines shall be disseminated by the Council to the internship training centres, the Intern supervisors and the internship coordinators. The guidelines will be available on the Council website. GENERAL REQUIREMENTS FOR INTERNSHIP TRAINING INSTITUTION REQUIREMENTS 1. All internship training centres shall meet and maintain the minimum requirements as set out by the Council in the Checklist for internship training centres, so as to be gazetted for purposes of internship training. Failure to meet the minimum requirements in a gazette institution shall result in suspension of the training programme and transfer of the interns to other centres with immediate effect. 2. All Internship training centres shall nominate an internship coordinator who shall be duly appointed and gazette by the Council to co-ordinate internship training. The coordinator shall be eligible for a communication and other incidentals stipend as determined by the Council. 3. All internship training centres shall have equipped resource centres with relevant resource material in hard and soft copies for purposes of learning for the interns. 4. All internship training centres shall have a functional internet connection with a bandwith of at least 35mbps with at least one WAP for every 20 users. The internet access shall be accessible in all areas of learning including the clinical areas. 5. The internship training centres for training of medical officer interns must be fully operational on a 24-hour basis, including the accident and emergency unit, diagnostic services and pharmacy. 6. The internship training centre for training dental officer interns must be fully operational during office hours with provision for emergency dental care as necessary, with a supporting dental laboratory 7. The internship training centre shall make arrangements for suitable accommodation for interns. Call rooms shall be set up within the hospital. 8. The internship training centre shall be appropriately staffed with specialists in the relevant specialities who are available for training and mentorship. a) For an internship training centre for medicine, there shall be a minimum of five (5) medical specialists, covering the specialties of NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC  paediatrics and child health, general surgery, internal medicine, obstetrics and gynaecology (reproductive health) and family medicine. b) For an internship training centre for dentistry, there shall be a minimum of two (2) dental specialists, one of whom must be in the oral and maxillofacial surgery specialty and the other in either operative dentistry or paediatric dentistry Any internship training centre that lacks any of the core specialists required as supervisors for a period exceeding four weeks, shall have its internship training programme suspended and the interns transferred to other centres with immediate effect for purposes of continued learning. 9. All internship training coordinators shall regularly update the Council on the status of the internship programme at least once every quarter, by use of the internship portal. The update shall include a list of the interns currently at the centre, their status, the available trainers per rotation at the time of reporting and any challenges that they may be experiencing. NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC INTERN WELFARE These are measures taken to ensure that the intern settles in an internship training centre effectively, is comfortable and safe during the internship year to facilitate adequate learning environment. These shall include: 1. Posting: Interns shall be posted within a month upon successful completion of their training and passing of the final examination, graduation notwithstanding; or passing of Council’s Internship Qualifying Exams 2. Salaries: Their salaries shall be processed and payment commenced within two (2) months 3. Orientation: All internship training centres shall have a structured orientation program which must include: a) Interface meetings with specialists, medical officers and nursing officer in charge b) Orientation within various departments in the centre c) An overview of internship guidelines and in the centre’s rules d) Scope of duties within each rotation e) Election of interns representative 4. Mentorship: The centre shall have an effective mentorship programme. Mentors shall be appointed amongst the specialists in each Department. Each intern shall be assigned a mentor for the duration of the internship training. 5. Work hours: The workload shall be adequate to ensure that the interns are exposed to common conditions that present in the centre. However, the interns shall be accorded adequate rest in between their work schedules to ensure they remain safe in practice. All interns shall be released from work by 12.00 noon following an overnight call. 6. Health and Occupational Safety: the internship shall ensure that interns have: a) Necessary occupational and work place safety including Vaccinations, post exposure management b) Guidance and counselling for those with social and economic challenges NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC GUIDELINES ON THE IMPLEMENTATION OF THE INTERNSHIP PROGRAMME POSTING OF THE INTERN The medical or dental officer intern shall present the following documents to the designated officer in charge of the facility upon reporting to the internship training centre: 1. A posting letter from the Ministry of Health OR an offer letter from the internship training centre for private institutions 2. An internship license 3. A copy of the internship log-book RESPONSIBILITIES OF AN INTERN These include the following:- 1. Clerking patients 2. Performing relevant investigations 3. Guiding patients and relatives with regards to diagnosis, treatment and follow-up. 4. Documenting and regularly updating patients’ notes 5. Writing accurate and informative case summaries. 6. Appropriate handing over patients 7. Presenting cases concisely, coherently and competently during ward rounds, grand rounds or any other appropriate fora. 8. Participating in the development and implementation of community health programmes under supervision 9. Reporting to and consulting with the intern supervisor 10. Participating in continuing professional development activities 11. Maintaining professional demeanor and conduct 12. Performing any other relevant duties assigned by the supervisor 13. Interns will be expected to go on leave upon completion of the twelve (12) months of rotations as outlined, except under special circumstances in which case they will have to compensate for the time away. 14. Providing quarterly reports to the council on the progress of internship on the internship feedback portal: https://forms.gle/mh1BVUQ7MH4R11Hr9 NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC QUALIFICATIONS OF AN INTERNSHIP COODINATOR The internship coordinator shall be a duly recognized Specialist or Senior Registrar working in the internship training centre on a full-time basis, who is duly registered and licensed to practice within the republic of Kenya, with an approachable manner and able to relate well with interns. The appointment of the coordinator shall be gazetted by the Council. ROLE OF THE INTERNSHIP COORDINATOR Each Intern Coordinator will do the following: - 1. Receive interns at the internship centre 2. Ensure there is appropriate orientation for the interns upon reporting to the internship centre 3. Organize minuted monthly progress meetings with interns and their supervisors 4. Ensure interns are given timely feedback on performance and assured of confidentiality 5. Ensure interns give feedback to the hospital 6. Ensure that interns are evaluated and internship logbooks filled appropriately during and at the end of each rotation/quarter. 7. Identify exceptional interns for recognition 8. Recognize the intern experiencing challenges and notify the Council in a timely fashion 9. Participate in disciplinary procedures for any intern experiencing disciplinary challenges 10. Chair meeting of intern supervisors to assess performance of the intern 11. Provide feedback to the Council concerning the programme through the online internship feedback portal: https://forms.gle/Dr9Lj54mEYibcDbp9 12. Brief the designated institution in-charge and where necessary, the Council, on administrative issues touching on interns, intern supervisors or departments within the institution that hinder implementation of the programme 13. Ensure objective and fair assessment of the intern 14. Maintain records of meetings, issues and occurrences 15. Ensure matters concerning interns’ welfare are met 16. Maintain an official email account for formal communication concerning internship programme. NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC QUALIFICATIONS OF AN INTERN SUPERVISOR The intern supervisor shall be a duly recognized Specialist or Senior Registrar working in the internship training centre on a full-time basis and is duly registered and licensed to practice in the republic of Kenya. ROLE OF THE INTERNSHIP SUPERVISOR The intern supervisors shall be responsible for: 1. Receiving the interns in the department and orient them 2. Documenting the duration the intern rotates through the department 3. Allocating duties and responsibilities to the intern during their time in the rotation 4. Providing theoretical teaching and demonstration of practical skills to the intern 5. Supervising the work of the intern in the department alongside the rest of team 6. Mentoring the intern into an all-rounded, moral and ethical professional 7. Ensuring the intern puts in the required time at work and also gets adequate breaks from work to ensure he is well rested and effective at work and safe for the patient 8. Together with the intern coordinator, conduct monthly progress meetings to review intern training 9. Assessing the intern in the course of the rotation and upon completion of the prescribed period and signing the log book as guided 10. Provide feedback to the intern concerning their assessment ROLE OF THE DESIGNATED INSTITUTION IN-CHARGE The institution may be headed by a chief executive officer, a director, a medical director, a medical superintended or any other title as may be deemed appropriate by the institution itself. This designated in-charge is responsible for: 1. Overall coordination, management and provision of resources to facilitate the internship programme 2. Ensuring smooth communication with the Council and with the interns and ensuring a smooth handing over processes when necessary NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC 3. Provide institution contacts and maintain open communication channels at all times 4. Receive and provide official communication for the institution and disseminate the information to the necessary persons 5. Maintain an institutional internship file where all written communication to the interns shall be kept and future reference can be made as and when necessary. 6. Update the Council at all times of administrative changes that may impact on the implementation of the internship programme 7. Apply to the Council for consideration of the institution as an internship centre OR for adjusting the capacity PROCESS OF EVALUATION OF THE INTERN The intern shall be continuously evaluated in the period of internship. This shall be done as follows: 1. Continuous evaluation of the log procedures shall be done by signing of the log book daily 2. Monthly evaluation of overall progress of the intern in knowledge, skills, professional conduct, and communication skills which shall be signed in the log book 3. Verification of compliance with the rotation/quarter requirements. This shall be documented and duly signed by the intern, the immediate supervisor and the intern coordinator in the log book. 4. Overall evaluation of the performance of the intern in the rotation/quarter. This shall be done by the immediate supervisor, the intern coordinator and the medical director/superintendent. OUTCOME OF THE EVALUATION The outcome of the evaluation of the intern may be: 1. Satisfactory: the intern is permitted to progress to the next rotation or quarter 2. Unsatisfactory: an extension of the rotation/quarter in part or in full is recommended. The extension must be completed successfully prior to progressing to the next rotation/quarter NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC 3. Irremediable: This is an intern who, despite repeated and concerted efforts to support them in learning, and a full extension of the rotation, the supervisors find the intern lacking ability to learn. The intern shall be referred back to the Council for further action. SUCCESSFUL COMPLETION OF INTERNSHIP An intern is deemed to have successfully completed internship after having satisfactorily completed all the prescribed requirements of the training. The Medical director/superintendent shall then recommend the intern for registration by signing the internship completion certificate. FAILURE TO COMPLETE THE INTERNSHIP SUCCESSFULLY An intern is deemed to have failed to complete internship if they do not meet the prescribed requirements and hence have unsatisfactory evaluations as described above. Some of the conditions that may contribute to unsuccessful completion include: 1. Professional incompetence which includes:- a. Demonstration of inadequate knowledge in the basic foundations of the science of medicine or dentistry b. Inability to learn and sharpen skills necessary for the practice of medicine or dentistry c. Failure to undertake the key procedures as prescribed in the log book. 2. Professional Negligence and General misconduct including:- a. Negligence in management of patients b. Inappropriate relationship with patients c. Abuse of patient confidentiality and trust d. Lack of a sense of responsibility e. Inappropriate dressing f. Lack of respect for patients, public and /or colleagues g. Indiscipline such as absence from duty without good cause and/or lateness to work h. Intoxication at work 3. Substance abuse NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC The interns is subject to the rules of employment with the relevant authorities under which they work. They will be subject to the usual disciplinary measures applicable in the institution. COMMUNICATION All communication to an intern, following an assessment resulting in failure to successfully complete internship, shall be communicated to the intern in writing, outlining the reasons for the failure. The communication shall include the recommendations made by the assessing team. This may include extension of the rotation, or referral back to the Council. A copy of the communication shall be filed with the designated institution in-charge at all times for future reference. TRANSFER OF INTERNS Transfer of interns from one internship training centre to another is not permissible without approval by the internship placement committee. The intern shall write to the Council, requesting for the transfer and shall attach supporting evidence for the reasons for the transfer. Where approval is granted, the intern shall be granted a release letter from the internship training centre, with a fully updated evaluation up to the time of transfer and this shall be presented to the new placement centre. The Council shall communicate directly in writing to the new internship training centre in writing, about the transfer and shall attach the release letter. The intern shall require to have a new internship license from the council, reflecting the new centre. GENERAL RECOMMENDATIONS 1. All intern coordinators and supervisors are encouraged to have individual official stamps which they shall append upon signing the intern log books at any time for authenticity. NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC  EDITORIAL TEAM: 1. Dr. Nelly Bosire - Chair, Training, Assessment & Registration Committee 2. Dr Sanjeev Sharma - Member, Training, Assessment & Registration Committee 3. Dr. Tonnie K. Mulli - University of Nairobi Dental School 4. Eunice Muriithi - Legal services manager 5. Esther Mutheu - Legal Services officer 6. John Mburu - Human Resource manager 7. Sarah Were - CPD Officer NATIONAL GUIDELINES FOR INTERNSHIP TRAINING OF MEDICAL AND DENTAL OFFICER INTERNS MP&DC