A course of survival for interns and last year medical students. Chapter one: The General Framework

ADVICE: These recommendations are the personal opinion of the author.  In the medical literature, there are many good textbooks with a practical information. Comments are welcome.


The General Framework

Every year a bunch of young doctors after finishing medical school go to medical centers to follow a specialization.  The external environment for a young doctor in Kenia could be different to the experience of a young doctor in Spain or United Kingdom, but all of them share two main feelings, the desire to learn and practice and, at the same time, a sensation to be lost in the middle of nowhere.

Where to start?

It is difficult to give an unique advice when interns can choose such a wide range of specialties, but I would like to enumerate some items that I consider basic for a good start:

  1. You have to think that you are going to start a “dangerous” work, not only for the patient but for yourself
  2. The principal advice in my opinion to start the medical work is to show a real interest in the patient that can be perceived by the patient and family.
  3. You are now in a team.  Everything that you do has a direct influence in the rest of your colleagues . They can give you help always, if you ask for it.
  4. Take care of your dress, behaves properly once you are inside the hospital, think that there are many persons suffering there and this is not compatible with laughing in the middle of a ward for instance.
  5. Patients are not dolls. They have to give you consent to examine them. Give as much information you can about the cause of his or her symptoms. Be polite also  with another  patient in the room. Make  eye contact with the families around you.
  6. Wash your hands after every  clinical examination.
  7. You have to develop your emotional intelligence abilities, paying attention to the situation of the patient’s relatives, anticipating their needs and showing a real attitude of compassion and respect.
  8. Be curious about the clinical findings and start thinking in terms of differential diagnosis, that is, what different clinical pictures may share that sign or symptom.
  9. Give the patient time to express himself, but help him focus his story on the current problem.
  10. Treat the patient and their family as you would like to be treated. Make it clear that you are going to be the manager of your clinical problem.
  11. Start to learn from your own mistakes and those you observe around you.
The first written sources of information

Interns and last year medical students ask for a written material to start their practice. There are many books and information in internet, but I would recommend three immediate strategies:

1 . Fix in your mind the knowledge of pathophysiology, with special attention to metabolic pictures and renal pathophysiology.

2. Think in terms of “syndrome”, reviewing again the most common of each organ or apparatus.

3. Start to see the body as a structure with many anatomical details and “dark places”

4. Start practicing a mental review following the anatomy of the body of those situations in each anatomical location in terms of the “worst possible scenario”. For example, in the chest, aortic aneurysm, pneumothorax, myocardial infarction, etc.

5. Change the way you study clinical entities. Try to establish the differences and look for differentiating data between processes that may belong to the same syndrome

6. Learn  the concept of “Illness Script” (here)

  • Manual Doce de Octubre (Spanish)
  • UptoDate
  • 100 Cases in Clinical Medicine
  • AuthorDr. Lorenzo Alonso. Medical Oncology.
  • Professor of Medicine.  Málaga Medical School. Spain
  • 2021