PROCESS AND TOOLS
PROVISIONAL REGISTRATION OF MEDICAL/DENTAL PRACTITIONERS
Any person who has obtained an approved Medical or Dental Qualification and satisfies the Registrar that he is of good character and he is about to be employed as mentioned in paragraph (a) of sub-section (2) of Section H of the ‘Rules ‘shall, subject to the provisions of Section 17 of the Act, be entitled to be provisionally registered as a Medical Practitioner or Dental Surgeon.
A person who is provisionally registered shall, for the purposes of his employment (at any recognized Institution) with a view to obtaining a certificate of experience, but not for any purpose is deem to be fully registered.
- Speak English more confidently.
- Have a deeper knowledge of the structure of English grammar.
- Better understand spoken English.
- Produce the target structures confidently and accurately.
CERTIFICATE OF EXPERIENCE
- Any person who, after obtaining an approved Medical Qualification, satisfies the conditions specified in sub-section (2) of this section shall be entitled to receive free of charge a certificate on the prescribed form (Section 17 (3) of the Act refers)
- The conditions which a person must satisfy under sub-section (1) of this section include:-
- he must have been employed for the prescribed period at a recognized institution in The Gambia with a view to obtaining a certificate of experience and have resided throughout that period either in the institution or near to it, in accordance with requirements in that behalf specified in the terms of his employment.
- he must have acquired during his employment practical experience under the personal supervision and guidance of one or more fully registered Medical Practitioners in the practice of Internal Medicine, Surgery, Obstetrics/Gynaecology and Paediatrics for such periods as may be prescribed in relation to each of the discipline respectively; and
- the manner in which he carried out the duties of his employment and his conduct during the period of his employment must have been satisfactory,
- Any period spend under sub-section (2) of this section, by a person during his employment in acquiring experience of the techniques for safeguarding and improving the health of children, public health or of the activities carried on in a recognized Health Centre shall be calculated for the purpose of that sub-section as periods in the practice of the particular discipline.
- It shall be the duty of the person in charge of a recognized institution at which a person is employ with a view to obtaining a certificate of experience to ensure that the last-mentioned person is afforded proper opportunities for acquiring the practical experience required for the purpose of sub-section (2) of this section.
- Thereafter, having been employed as mentioned in paragraph (a) of sub-section (2) of this section, at any institution, a person is refused a certificate of experience he shall be entitled,
- to receive from the person in charge of the institution particulars in writing, of the grounds of the refusal; and
- to appeal against the refusal to a Committee of the Council in accordance with rules made by the Council in that behalf (including rules as to the time within which appeal are to be brought); and after duly considering any such appeal, the Committee shall either dismiss the appeal or issue the certificate of experience in question or give such other directive in the matter as it considers just.
- The Council may make regulations to provide for the issuance of certificate of experience in respect of employment at institutions outside The Gambia.
- In this section and in Section G, as well as in Sections 12, 13, 14, 15, 16, 17 (inclusive) of the Act “approved”, “recognized” means approved or recognized for the time being for the purpose of those sections by order of the Council.
The internship period should be seen as an integral phase in the overall development of the mature competent physician, Indeed it is a crucial phase because it is the first opportunity for the budding doctor to take independent decisions, which he/she later defends to his/her supervisors. It is therefore an important time for consolidating in practical terms, the foundations of his/her basic medical education initiated during his undergraduate experience in Medical School.
It is appropriate that its objectives, strategies and indeed modalities of execution and assessment are explicitly examined for the benefit of both trainee and trainer.
With the increasing output of the dental and medical institutions in the country, the internship programmed must perforce include suitably equipped health facilities not previously involved in the process as it necessarily enhances the standard of practice throughout the country. There is the need for a comprehensive review of the entire programme of internship training with a view to ensuring uniformity throughout the health service. The implementation of the structured system that is thus evolved is critical and this can be best achieved through adherence to laid down protocol and documented through the use of log books. This is the mission of this booklet; and it is hoped that it meets the expectation of both the trainer and trainee.
STRATEGIES
Attitudes:
In general the identified desirable attitudes are to be inculcated by the example of supervisors of trainees in the clinics, on the wards as well as the other informal interactions that take place in the hospital practice. Trainers will be reminded periodically of the burden that falls to them in this regard. Additionally, it is planned that at the Departmental and/or unit level in the participating hospitals, particular topics highlighting ethics and attitudes will be formally addressed in a weekly structured programme.
These topics should include:
- Quality Assurance
- Informed Consent
- Patient Counselling
- Living Declaration
- Death Certificate
- Euthanasia
- Drug Trials and Human Experimentation
- Healthy Living
The primary aim is the development of a broad, balanced practitioner with multiple competences, much in tune with, and responding to the needs of the environment and the population that he/she seeks to serve.
This entails the imparting and acquisition of particular attitudes, knowledge and skills.
Attitudinal development would emphasize ethical issues in decision making-in practice, the patient-physician relationship and professional interpersonal relationship, punctuality, appearance and demeanour.
In respect of knowledge acquisition the objective will be ensuring continuing professional education especially in respect of dissemination of information on the common conditions encountered during practice within the country.
Communication skills will receive due emphasis alongside specific skills commonly employed in the major fields of clinical surgery.
Knowledge
Continuing medical education will due emphasis throughout the internship period. The interns will take part in all professional activities mounted in the hospital, in particular, clinical meetings, seminars, morbidity and mortality meetings and clinico-pathological conferences. Documentation of attendance will be reflected in the entire report on completion of his assignment.
Further to this specific professional development sessions will be mounted in a structured programme of seminars by supervising consultants; in these sessions the interns will take turns to address their colleagues and other members of staff on topics in which they had conducted in depth literature research. The structured programmes will consist of weekly sessions of approximately 2 hours, inclusive of discussion time. The following particular topics will be discussed:
- Surgical Infections
- Wound Healing
- Shock
- Fluid and Electrolyte Therapy
- Anaemia
- Blood Transfusion
- Nutrition in Surgery
- The injured Patient
- Head Injuries
- Burns
- Preparation for and Test for Fitness for Surgery
- Pre and Post-operative Care
- Peptic Ulcer Disease and Complications
- Gastro Intestinal Bleeding
- Gastric Cancer
- Colo-rectal Cancer
- Typhoid
- Acute Abdomen
- Appendicitis
- Intestinal Obstruction
- Jaundice
- Portal Hypertension
- Liver Tumours
- Acute Renal Failure
- Inguinoscrotal
- Retention of Urine esp. BPH/Prostate Cancer and Urethral Stricture
- Haematuria
- Breast Cancer
- Cancer Chemotherapy/ Cancer Therapy
- Peripheral Vascular Disease
- Diabetes and its complications
- Chest injuries
- Fracture Management
- Application of P.O.P
- Hand Infections
Skills
Procedures – Three Categorie
To Do
. Establishing Intravenous Access/Venesation Verepuncture Intraosseous Infusions
. Urethral Catheterization
. Preparation for Endoscopy
. Proctoscopy
. Suturing
. Manipulation of Simple Fractures
. Application of Plaster of Paris
. Reading imaging records-ultrasonograms. Radiographs, C.T Films
To Assist
Insertion of Central Venous line
Sigmoidoscopy
Intercostal Tube Drain/Tube Thoracostomy
Laparotomes and other major surgeries
To See
Colonoscopy
Minor Operations
- Incision and Drainage of Abscesses
- Suprapubic Cystostomy
- Herniorrhaphy
- Appendicectomy
- Hydrocelectomy
- Simple Lumps – Excision
- Circumcision
Many of these skills will be imparted on the job with the house officer assisting. It is clear that attendance at the theatres for interns rotating through surgery, obstetrics and gynaecology is crucial. Efforts will be made to relieve interns of the unprofessional tasks of chasing routine Laboratory Reports and collecting units of blood from the Blood Banks, so they can attend and participate fully in operating sessions.
Further to this, as much as possible, interns will be encouraged to attend skills workshops that will be mounted for residents in particular fields of medicine and surgery.
ASSESSMENT
This will be on continuous basis and will be carried out by means of a structured proforma detailing specific test times, both subjective and objective. Provision will also be made foe brief formal summative assessment in the final weeks of internship consisting of some 50 objective questions and structured interview for a duration not exceeding 15 minutes.
As an essential component of the continuous assessment scheduled meetings of trainer and trainee should take place, at least on two occasions, during which matters of concern that may have arisen in the course of the training will be freely and actively discussed. The objective of these sessions will be to correct perceived attitudinal and professional defects before they pose problems in the logbook.
To ensure that the objective of the internship are fully realized, and in particular that the final assessment is fair to all concerned, it is recommended that a formal period of orientation, not exceeding two full days in the department is allowed for the trainers to interact with the Departmental staff and also ensure familiarization with completion of the various sections of the logbook.