Internship assessment-online learning protfolio
Hii !
I'm Navya, medical undergraduate from India.
Here I would like to share my journey and learning experiences in the General Medicine Department.
Throughout my 5.5 years of journey in the field of Medicine,it has always fascinated me with each and every case i came across...involving a lot of integration.
Research based learning can make a huge impact in one's own learning in medicine which is imbibed into us by our proffessor and my mentors.
I have always learnt something new and added new perspectives through every case that i came across with the case history and disease process and their outcomes.
Note:-This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
It was challenging without having a direct in person contact with the patients for history taking, but we had telephonic conversations with the patients to take their history and subsequently document elogs.
•••Well to begin with, the very first case i came across when I was in 3rd year , A 70 yr old male with fever, sob and cough and this is the very first case that i took which introduced me into the detailed history taking.He was diagnosed with viral pneumonia secondary to covid 19 and a past history with DM, HTN and psoriasis and he was on medications for which he was receiving the medications.I have understood the importance of consent taking before history taking and examination.
Here is the link to my blog of this case:-
In my subsequent year (final year of Mbbs) I was excited for the fact that now I can have in person detailed history taking opportunity and to communicate directly with the patients and their attenders.
Let me share you about the another case I have came across and taken history and here I had the opportunity for examining the patient in person under the guidance.
•••It was a case of 40 year old male who came to us with pedal edema and decreased urine output since 3 months and he had sob since 3 days.
Pedal edema was of pitting type and uptil ankle....immediately after seeing that a lot of differentials struck my mind like right sided heart failure, nephortic syndrome, ckd .
He also had sob which was grade 4 and i learned grades of sob here and i thought the cause could be pulmonary edema secondary to ckd.
Here I could be able to learn all the systemic and general examination.
He was finally diagnosed with ckd for which he had to undergo hemodialysis.
•••And this was a case back in 2022,Jan 9th which gave me experience of applying the clinical knowledge on a real case scenario.This was a 29 year old female with bilateral joint pains in upper and lower limbs and generalised weakness since 10 months and she had itchy lesions over face,upper aspect of chest,neck and back of the neck and upper trunk with dark coloured lesions over knuckles since 10 months.She used to take tab.Hydroxychloroquine for joint pains.
Here I could able to notice the named lesions such as Heliotrope rash, shawl sign, Hosleir sign and Gottrons papules.This is a classic case of Dermatomyositis.
She had undergone symptomatic treatment.
*I have started my Medicine posting in internship from 14/4/23 to 12/6/23.
••• Posted in peripherals for 15 days •••
(from 14/04/23 to 28/04/23)
*ICU/AMC duty:-
Monitoring for all the icu and amc cases.
Drawn ABG samples.
Drawn Venous samples.
Assisted in Central line.
Procedure of Ascitic tap.
Ryles tube insertion.
Foleys catheterization.
*Nephrology:-
Hemodialysis-seen how it works and monitored patients during dialysis.
Blood transfusion monitoring.
Assissted in Central line.
*ward:-
Followed up on patients shifted to ward
Refferals and investigations of those cases
Helped my cointerns in updating soap notes.
••• Posted in unit duties for one month •••
(from 29/04/23 to 28/05/23)
I have been posted in unit 4 under Dr.Nithin, Dr. Venkat Sai, Dr.Sushmitha(SR) for one month.
I had Op and casualty during unit duties & used to look after the cases which got admitted at that time.
*In OP:-
• We usually get 50-60 OPs during day and i have learned brief history taking and examination of the patient in the OP.
•I also got to know about the essential investigations ordered and treatment done for the patient.
*In CASUALTY:-
• In casualty I have got opportunity to see a various spectrum of cases like pancreatitis, gastritis, headache, pain abdomen, fever, dehydration.
•I have learned the initial emergency management of the patients who come to casualty.
•I have seen a case with acute exacerbation of copd case with unstable vitals and monitored that case entire day in the casualty.
*Admitted cases:-
•For admitted cases, in ICU and AMC we used to take detailed history and examination and run investigations ordered for that cases and used to take for refferals of those patients from other departments and created elogs and pajr groups for the respective cases.
Following are the cases which I have seen during my unit postings and my learning points regarding the same.
•This was a 50 yr old female with fever a/w vomitings and she had persistent tachycardia and drowsy which raised suspicion of hyperthyroidism and her TSH values were 0.1 for which she underwent USG and i could visualize the inflammed thyroid gland.
••I could able to appreciate the clinical symptomatology of the thyrotoxicosis in the patient.
••Initially FNAC was advised for this patient, but soon it was contraindicated. It was then that made me curious about the procedure and it's indications and i could get insight into the indications of FNAC.
•There was even an insight into emegence of thyroid storm i/v/o performing FNAC but then upon looking up for articles published, there was no single evidence regarding the same.
••From this case i got to learn about the management of the Hyperthyroidism.
~I have understood the importance of following up with the patient even after disharge with the help of pajr groups.
•I have came across a 25 year old male in causality with fever and generalised body pains.
Positive for Dengue NS1 antigen and he has been treated symptomatically.
••I understood the importance of fluid management in this case after I got a hands on experience of keeping a canula on right hand of the patient under the guidance of a nurse.
•This was a case of 45 year old female with multiple joint pains, neck pain and generalised weakness since 4 years and RA factor was positive in this case.
•• I could get an insight into how to clinically differentiate rheumatoid arthritis from osteoarthritis
•• I have gained knowledge about the autoimmune pathology of RA having multisystem involvement.
•This a case of 65 year old female with sob since 5 days, and 15 days back she had fever which was low grade, continuous type.There was history of usage of NSAIDs for 15 years as she had knee pain and she was diagnosed as AKI on CKD secondary to NSAIDS abuse.
*Due to high creatinine levels she had to undergo hemodialysis.
••I gained knowledge about the various renal pathological changes in CKD due to deranged creatinine levels
••This case gave me an opportunity to brush through the mechanism of action of various diuretics in clinical settings
••I even observed anemia in this patient, the reason for which goes around the decreased production of erythropoietin levels due to involved kindey pathology.
•This was a case of 63 year old male with bilateral knee pain since 2 years and diagnosed as osteoarthritis of b/l knee joint
••I have learnt about the etiology and pathogenesis of osteoarthritis.
•• I could able to interpret the x ray findings in this case with the help of my mentors.
•This was a case of 68 year old female with altered sensorium since 2 days ,back then(2 weeks ago) she had 5 episodes of vomitings with loss of appetite and generalised weakness and since then altered senorium worsened.patient even complained of burning micturtion.
••I have learnt the algorithm of management of patient with dehydration with electrolyte imbalance.
••I could clearly appreciate the symptomatology of dehydration in this patient presenting with dry tongue and decreased skin turgor.
••I have learnt the electrolyte disturbances occuring during dehydration and it's effect on mental status.
••• Posted in Psychiatry for 15 days •••
(from 29/5/23 to 12/6/23)
*I got opportunity to see the following cases in psychiatry OP
1.Alcohol dependent depressive episodes.
2.Depression
3.Panic attack
4.Schizophrenia
5.Psychosis
*In deaddiction centre I have seen alcohol dependence syndrome and tobaccoo dependence syndrome cases.
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