Educational Objectives

The Committee on Internship (CIC) approved and adopted the Guidelines for the Internship Year for Hong Kong, and the recommendations and requirements contained therein will serve as guidelines to assess and evaluate the suitability of hospital units for the purpose of recognising intern posts.


General Clinical Training

 

  • General clinical training should enable the interns to:
  1. understand the nature of medical problems presented to doctors, and to develop practical knowledge about disease processes, and to make appropriate clinical decisions;
  2. improve their skills in history taking, clinical examination and diagnosis, and learn how to exercise the skills within the constraints of practice;
  3. investigate the patients’ clinical presentations, plan and carry out treatment, including rehabilitation when appropriate;
  4. apply their knowledge of science and logical thinking to clinical problems and be able to assess the reliability of evidence;
  5. use laboratory and other diagnostic services effectively;
  6. communicate effectively, both in verbal and in writing, with patients and their relatives, doctors and other healthcare professionals involved in helping patients in the hospital, or in primary medical care and in the community;
  7. learn about patient safety including the key risks of health care and how to manage them, how to recognize adverse events and hazards, report and analyse them;
  8. adopt safe practice in relation to radiation protection and handling blood products, body fluids and tissues in the ward and laboratory with due regard for the safety of patients and others;
  9. develop and maintain appropriate clinical attitudes such as showing respect for the dignity of the patient and concern for the relatives, being aware of legal and ethical issues and of the importance of professional confidentiality;
  10. participate in the processes of audit and peer review;
  11. learn and participate in the team-work and understand the principles of corporate responsibility;
  12. engage in activities if any for disease prevention and health promotion;
  13. be aware of their own limitations and be ready to seek help; and
  14. continue their self-education.


The Content of the Training

  • Posts must offer breadth and diversity of experience. In combination they must always include a core of general experience in medicine and surgery. CIC may recognize posts in medical, surgical and other specialties, provided that each post affords good general experience.

 

Skills which must be developed during general clinical training

  • Clinical and procedural skills: Intern is expected to acquire the basic skills of practicing medicine. Interns should be able to take a proper history, to carry out both physical and psychological examination, to recognize the indications for particular diagnostic and therapeutic tests, and to arrive at a diagnosis after going through the information. Interns should be proficient in conducting simple procedures, including prescription and administration of drugs, according to the good practices.
  • Dealing with common medical emergencies: In particular Interns must develop skills in cardio-pulmonary resuscitation and in dealing with shocked patients.
  • Effective use of resources: Interns should learn the principles in using resources effectively, in terms of selecting drugs for prescription, requesting appropriate investigations and time management for clinical work.
  • Knowledge of the importance of psychological and social factors: Interns should be able to appreciate that there are many factors affecting the patients including their values. Two areas require special attention:
  1. Pain relief: They should learn about the pain and its relationship to personal distress, and about the pharmacological and psychological ways in relieving pain.
  2. Care of the dying patient: Interns should learn from clinical examples for adopting a sensitive approach to dying patients and their families. They should gain experience in breaking bad news, in managing patients’ anxieties and in recognizing the various stages of bereavement.
  • Effective use of resources: Interns must learn to use resources effectively, in terms of which drugs to prescribe, what investigations to request and the use to be made of their own and other’s time. 
  • Ethical aspects of medical practice: Interns should have chance to engage in discussion including ethic issues arise in their practice, especially in patient communication and confidentiality. Interns should appreciate the need to provide a proper explanation to patients when obtaining the necessary consent from them for the investigation or treatment proposed.
  • Professional conduct: All doctors should be aware of their individual responsibility for upholding the reputation of the medical profession and of the potential pitfalls of medical practice. Guidance is provided in the Hong Kong Medical Council’s red booklet “Warning Notice” which is issued by the Council to every provisionally registered doctor.
  • Legal aspects: Interns should be aware of the statutory duties of medical practitioners, particularly in relation to its various kinds of notification and certification, and of the need to keep up to date with such matters. It is important that Interns understand the implications of the legal aspects with respect to medical records. Other legal matters, e.g., concerning organ transplantation or termination of pregnancy, should be discussed when they are relevant to particular patients. Interns should appreciate the risks of litigation including claims of negligence, which frequently stem from incomplete record keeping or failure to obtain valid consent.
  • Evaluation of the quality of care: Interns should participate in audit undertaken by the teams of which they are members.
  • Teamwork: As well as working with the other doctors in their team, Interns should recognise the essential roles played by non-medical colleagues and the importance of securing mutual co-operation in the interests of patient care. Due attention should be paid to continuity of care and to the importance of adequate ‘hand-over’ procedures.
  • Record keeping and information retrieval: Interns should learn how to keep good clinical records to transmit information appropriately and to operate information storage and retrieval systems effectively.
  • Prevention of illness and promotion of health: Although Interns are principally concerned with people who are already ill, they should take advantage of opportunities to promote good health, for example, by enabling patients to recognise the consequences of abuse of tobacco, alcohol or drugs. They should concentrate their attention on those in the age groups most at risk.
  • The advancement of medicine: Interns should be aware that the practice of medicine is constantly advancing and that many of these advances stem from careful observation alertness, and the routine recording of change. If research is being conducted in their unit they should be encouraged to take an interest and to contribute where this is appropriate.


Departments in HA Hospitals

  • The following qualifying criteria are mandatory for any department offering internship training: 
  1. Interns are assigned a reasonable number of beds / cases as recommended for various specialties and are able to practice continuity of care for the patients.
  2. For both emergency and clinical admissions, interns should be assigned to take a proper history, to carry out both physical and psychological examination, to recognize the indications for particular diagnostic and therapeutic tests, and to arrive at a diagnosis after going through the information.
  3. Interns are exposed to on average of at least one session of operative procedures per week during each surgical rotation.
  4. Interns attend outpatient clinics at least once a week on average.
  5. Interns are on call no more than once every three days.
  6. During each three-month posting, interns may be rotated to subspecialties under each specialty as registered in the Academy of Medicine and MCHK. If such a rotation takes place in a subspecialty ward or area structurally independent from the main specialty, however, each intern may only spend a maximum of six weeks in one of such subspecialties during every three-month posting.
  7. At all times of the day and night, a consultant or other members of staff senior to the Intern must be available at the hospital/clinic to provide cover and help. No other arrangement is acceptable. Interns must never be in the position where their only appropriate source of help is outside the hospital.
  8. Interns are compensated for services rendered on statutory holidays.
  9. Time during contracted hours should be set aside for educational purposes: there should be at least 4 hours of protected time per week scheduled for interns for specific teaching and education activities (including Practice-Tips Workshops, grand rounds, departmental meetings, case presentations, journal clubs, clinical audit meetings, etc.) with attendance record.
  10. Interns should be encouraged to attend pathology and radiology demonstrations, and cross- specialty meetings concerning topics of general interest, and any appropriate lectures or courses organized by clinical tutors. They should attend autopsies and biopsy presentations, especially where these concern their own patients, and be involved in case conferences.
  11. Sufficiently advanced notice on educational programmes should be given to interns and relevant Chiefs of Service in the hospital and to those in other hospitals should such programmes be jointly conducted by more than one hospital.
  12. Interns should have the opportunity to suggest topics for inclusion in their educational programmes.


Intern Allocation and Placement

  • According to MCHK and MRO, internship training should include 6 months in a medical post recognized as providing good general experience and 6 months in a surgical post similarly recognized.
  • Posts must offer breadth and diversity of experience. In combination they must always include a core of general experience in medicine and surgery. CIC may recognize posts in medical, surgical and other specialties, provided that each post affords good general experience.
  • CIC determines the intern allocation methodology and post for approved specialties and hospitals for intern allocation. University will assign the graduate interns to the posts according to the preferences of interns and other consideration. The University would provide final recommendation to CIC on individual intern arrangement. CIC would examine the recommendation, decide and approve posting for subsequent employment and placement. Swapping of post will not be considered after the commencement of internship except in very special circumstance with recommendation from the Universities / Licentiate Committee and approval by CIC.
  • During each three-month posting, interns may be rotated to subspecialties under each specialty as registered in the Academy of Medicine and MCHK (see Annex X). If such a rotation takes place in a subspecialty ward or area structurally independent from the main specialty, however, each intern may only spend a maximum of six weeks in one of such subspecialties during every three-month posting.
  • Part-time internship training would be considered on a personal basis to interns whose health or disability precludes fulltime training. In such cases, the University / Licentiate Committee should be responsible to decide if the condition is justified enough for part-time internship training. The equivalent of 12 months’ whole time training including sufficient night duty and on-call service should be recommended by the University / Licentiate Committee for CIC approval. Sufficiency should be determined by the quality of the experience, not solely by the number of hours worked.

 

Supervisors in Training Departments

  • Each post provides a single educational experience. For this reason, interns must be supervised in each post by a named specialist, who is formally designated the educational supervisor, and who understands the duties of that role.
  • Supervisors must be aware of the educational objectives of the internship year, and of the CIC recommendations. The supervisor should also be aware of the intern’s individual needs and help interns with both professional and personal development.
  • The supervisor has to give each intern individual attention and should personally undertake, and should not delegate, certain tutorial functions:
  1. at the beginning of the post, discussion about the duties of the post, and it is advisable to provide the intern with a written record of these;
  2. supervised ward rounds/ case consultation with interns at least three times a week and preferably on a daily basis;
  3. supervise discharge summary/ consultation notes writing by interns and is done on average of 5-30 times per week;
  4. regular monitoring and discussing the intern’s progress with him/her (at least once per month). These discussions should be informal and interns should be informed about their progress. A formal meeting with interns is required in the middle of each rotation period, e.g., after working for around six weeks in the department concerned if it is a three-month rotation, after working for around 3 weeks in the department concerned if it is a one and half month rotation, especially before making the assessment of interns. They should also be invited to comment on the training and when problems are identified to discuss about them;
  5. ensure interns regularly perform ward/clinic procedures other than blood-taking, initially under supervision and later independently after assessment of competency by supervisor;
  6. checking with the assistance of others that the intern’s performance is adequate with regard to the following skills: technical, administrative and organizational, and that any problems in respect of communication, medical ethics and etiquette have been overcome;
  7. facilitating and encouraging the intern’s attendance at educational programmes; and
  8. ensuring that the intern receives appropriate career guidance.
  • The supervisor should ensure that the intern is not overwhelmed by clinical commitments, overburdened by responsibilities inappropriate to the experience acquired, or undergoing an excessive on-call commitment.
  • Duties of other medical staff working with the intern: the teaching and guiding the intern and for providing feedback on clinical progress may be extended to other doctors working in the same team and it is important that they give the supervisor early warning of any deficiencies that they note in the intern’s performance.
  • Should the intern perform unsatisfactorily, as evidenced by adverse comments by the supervisor in the Intern Assessment Report, that intern could be required to repeat that portion of the internship, as recommended by the Universities / Licentiate Committee for CIC endorsement. Remedial training would be posted at one of the HA hospitals with coaching and counseling to be provided by corresponding Hospital and Departmental Intern Coordinator. Universities / Licentiate Committee will monitor closely on the performance of the intern concerned.

 

Roles and responsibilities of the bodies concerned with general clinical training

Hospital Authority (HA)

  • HA would offer employment and internship posting for all interns as recommended by the Universities / Licentiate Committee.
  • HA would provide clinical training, supervision and support for interns to undergo training in approved hospitals. HA would make performance assessment, monitor on the progress of interns and provide the Intern Assessment Report to the Universities / Licentiate Committee.

University / Licentiate Committee

  • The Universities / Licentiate Committee are responsible for defining the education objectives and training requirement of internship training with regards to the relevant provisions of MRO in Hong Kong.
  • The Universities should assess the standard of intern posts basing on the education objectives and training requirements in collaboration with HA.
  • The Universities / Licentiate Committee should guide and assist graduates/overseas doctors who passed the licentiate examination in selecting suitable combinations of posts for fulfilling the internship training requirement as stipulated under the MRO, and make recommendation to CIC for placement of interns.
  • The Universities / Licentiate Committee should ensure the list of medical graduates/overseas doctors who passed the licentiate examination to HA for employment as interns are being eligible for taking up internship training. HA would ensure the interns who are provisionally registered with the MCHK on offering of employment.
  • The Universities / Licentiate Committee should review the Intern Assessment Report, provide support to interns and monitor the progress of interns in training. For any intern with unsatisfactory performance in the Intern Assessment Report, the Universities / Licentiate Committee should provide guidance to interns on the clinical standards for the purpose of full registration. Universities and Licentiate Committee should make recommendation on if any remedial training for local graduate and overseas graduates respectively. HA would offer placement of the remedial training either in the same unit or in another unit as deemed necessary, for CIC endorsement.
  • The Universities / Licentiate Committee should make the final assessment of the interns and grant the COE if the interns’ performance is satisfactory during the internship.

(September 2017)