Internship business requirements

1. Ward work

(1) Ward rounds

1. Enter the ward in advance to learn about familiar patients situation, especially the changes in condition and treatment of critically ill patients at night. Conduct preliminary examinations of patients in charge and complete necessary examinations and treatments.

2. Before ward rounds, prepare past laboratory tests and various inspection reports and information, such as X-rays, electrocardiograms, etc. for discussion reference.

3. Report the changes in condition, treatment process and efficacy to the superior physician during ward rounds. Report the medical records of newly admitted patients, put forward diagnosis and treatment opinions, and listen to the analysis and treatment opinions of superior doctors on the condition.

(2) Observe the condition and manage the ward

1. After the handover, you should familiarize yourself with the medical records as soon as possible, understand the condition, and write down the handover record.

2. Go deep into the ward to understand and observe changes in the patient's condition, implementation of medical orders, and treatment effects at any time. For newly admitted patients, under the guidance of the superior physician or individually, inquire about the medical history, perform a physical examination, and write a complete medical record , propose a diagnostic treatment plan.

3. When encountering a sudden change in condition, promptly report to the superior physician for instructions and participate in rescue work.

4. Answer questions to patients and family members with caution, and respond to questions about treatment and prevention after consulting the superior physician.

5. Be familiar with the medical and nursing routines and precautions of each department, and understand the implementation status.

6. Obey the unified leadership of the head nurse and the physician in charge, and assist in nursing and health work.

(3) Medical records and course records

1. Newly admitted patients should complete their medical records within 24 hours of admission, and critically ill patients should complete their medical records immediately.

2. The medical record should include: general items, chief complaint, current history, past history, personal history, family history, physical examination of the whole body, important laboratory tests and special examinations, diagnosis and treatment plans, and detailed information for each department. The medical records should be completed as required.

3. Medical records should be concise and accurate, with clear handwriting, describing the rapid onset, possible causes of the disease, the time of occurrence of the main symptoms and their subsequent development and evolution, the diagnosis and treatment process, and their The effects, etc. are recorded in detail in key points. Although each point in the differential diagnosis during the consultation is negative, it has diagnostic significance and should be recorded. At the same time, attention should be paid to the overall situation and the internal relationship between each symptom. On the basis of detailed questioning, after Analyze, prioritize and focus on writing a complete, systematic, concise and accurate medical history record.

4. The physical examination should be comprehensive and systematic, and positive findings should be described in detail.

5. The medical history and various examinations required by each department should be recorded in detail.

6. The diagnosis should be consistent with the medical history and examination. The treatment plan includes examination, diet, nursing, drugs, surgery, etc.

7. Be familiar with the order of medical records, writing methods and treatment principles.

8. The content of the course record includes: the superior physician’s analysis and treatment opinions of the condition, the process and effects of various examinations and treatment measures, changes in the condition (the occurrence and disappearance of symptoms and signs), and consultation records. Critically ill patients should be detailed.

9. Fill in various forms: such as critical illness notice, discharge medical record, pathological examination form, consultation application form, operation record, anesthesia record, transfer record, foxglove application observation form, diabetes treatment observation form wait.

10. Fill in the discharge or death record: It should be filled in item by item according to the prescribed format and signed by the superior physician. The discharge record should be filled in within 24 hours before discharge, and the death record should be filled in within 24 hours after death. .

(4) Surgery, diagnostic operations and laboratory examinations

1. Under the guidance of superior doctors, perform surgeries and diagnostic and treatment operations. Before operation, you should understand the indications, contraindications and operations of surgery. Methods, steps and precautions should be prepared before the operation, and close observation and care should be taken after the operation.

2. After the patient is admitted to the hospital, the necessary laboratory tests must be issued according to regulations, the results must be obtained in a timely manner, the normal values ??of commonly used laboratory tests must be mastered, and various laboratory tests must be reviewed according to the patient's condition.

2. Outpatient and emergency work

1. Under the guidance of superior doctors, mainly diagnose and treat first-time patients and be familiar with the handling of follow-up patients.

2. Arrive at the clinic in advance before going to work and make preparations.

3. Have a kind attitude and considerate service. Answer questions to patients carefully and answer unfamiliar diagnosis and treatment questions after consulting the superior physician.

4. Outpatient medical records should be focused and concise. The medical history and physical examination should mainly include positive symptoms and signs, as well as relevant personal and family histories. Difficult diseases should be inquired and examined in detail. The diagnosis and treatment opinions need to be reviewed and signed by the superior physician. For patients admitted to the hospital, hospitalization orders must be issued after being reviewed and signed by the superior physician.

5. Prescriptions, laboratory test orders, various application forms, admission certificates, leave slips, diagnosis certificates, operation orders, etc. must be signed by the superior physician.

6. Patients staying in the observation room or emergency room should observe changes in their condition in a timely manner, and write disease course records that are more detailed than ordinary outpatient medical records.

7. When necessary, escort the patient to the radiology department, electrocardiogram room, etc. for examination.

8. Patients receiving treatment due to traffic accidents, suicides, homicides, etc. should be reported to their superiors in a timely manner.

3. Internal Medicine

Internship content and requirements

1. Through internship, learn to inquire about medical history, perform formal, comprehensive and systematic physical examinations, fill in various forms and Record, be familiar with various laboratory tests and special examination results and their clinical significance, write a complete hospitalization medical record, and propose diagnosis and treatment opinions.

2. Master the causes, pathogenesis, diagnostic standards and treatment routines of common and frequently-occurring diseases in internal medicine. Such as acute and chronic bronchitis, bronchial asthma, pneumonia, tuberculosis, lung cancer, pulmonary heart disease, lung abscess, bronchiectasis, respiratory failure, pneumothorax, acute gastroenteritis, chronic gastritis, gastric and duodenal ulcer, liver Cirrhosis, primary liver cancer, hepatic coma, liver abscess, acute pancreatitis, intestinal parasitic diseases, upper gastrointestinal bleeding, tuberculous pleurisy, rheumatic heart disease, heart failure, arteriosclerosis, coronary heart disease, arrhythmia, myocarditis, Cardiomyopathy, hypertension, hypertensive heart disease, pericardial disease, anemia, leukemia, bleeding disorders, rheumatism (systemic lupus erythematosus, rheumatoid arthritis), nephritis, kidney disease, urinary tract infection, uremia, thyroid Hyperfunction, diabetes, cerebrovascular accident, epilepsy, neurosis and acute poisoning, etc.

3. Master the operating methods, indications, contraindications and clinical significance of commonly used diagnostic and treatment techniques in internal medicine, and perform operations under the guidance of superior physicians. Master during the internship: oxygen administration, nasogastric feeding, gastric lavage, intradermal testing, subcutaneous, intramuscular and intravenous injection, infusion, blood transfusion, femoral vein, femoral artery puncture, thoracentesis, bone marrow puncture, lumbar puncture, abdominal puncture, urinary catheterization, Enema, artificial respiration, use of three-lumen tube, intracardiac injection, cardiac massage and other operations.

4. The dosage, pharmacological effects and usage of commonly used internal medicine drugs. Medication forms, dosages, and methods of use must be accurate when writing treatments and medical orders.

5. Understand the differential diagnosis and treatment principles of common symptoms in internal medicine. Such as fever, coma, headache, edema, shock, heart failure, hemoptysis, hematemesis, hepatomegaly, splenomegaly, jaundice, acute abdominal pain, diarrhea, gastrointestinal bleeding, hematuria, oliguria and anuria, anemia, purpura, etc.

4. Surgery

Internship content and requirements

1. Master the diagnostic methods and steps of surgical diseases, and correctly write various forms, records and medical records.

2. Master the diagnosis, differential diagnosis, treatment principles and first aid measures of common surgical diseases and frequently-occurring diseases. Such as: general infections, burns, common soft tissue bones and joints, waist, brain, urinary system and other injuries, shock, massive bleeding, thyroid tumors, breast diseases, appendicitis, intestinal obstruction, abdominal hernia, complications of ulcer disease, cholelithiasis, Cholecystitis, obstructive jaundice, liver cancer, chest injury, lung cancer, common fractures, dislocations, bone and joint tuberculosis, osteomyelitis, bone tumors, impacted phimosis, hydrocele, tuberculosis, stones and tumors of the genitourinary system, etc.

3. Master the clinical significance, methods and precautions of commonly used surgical diagnosis and treatment techniques. Such as digital anal examination, anus speculum, peritoneal puncture, prostate massage, preoperative hand washing, disinfection, the role of sterile towels and common instruments, incision and hemostasis, suturing, collection of biopsy specimens, dressing changes, injections, fluid rehydration, and blood transfusions , various drainage, local anesthesia and closure therapies are used under surgery.

4. Understand common surgical diseases and frequently-occurring surgical indications, contraindications, local anatomy, surgical methods, steps and precautions, preoperative preparation, and postoperative treatment. Under the guidance of a superior physician, participate in surgeries or minor and medium-sized surgeries, such as incision and drainage, phlebotomy, biopsy specimen collection, debridement, superficial tumor resection, circumcision, sheath inversion, and external abdominal hernia repair Surgery, vasectomy, plaster bandage, skin and bone traction, gastric ulcer perforation repair, enterostomy, chest closed drainage, cystostomy, etc.

5. Be familiar with dressing changing techniques.

6. After the operation, the patient should be escorted to the ward, write down the operation record, observe the changes in the condition after the operation, and master the principles of prevention and treatment of postoperative complications.

5. Obstetrics and Gynecology

Internship content and requirements

(1) Gynecology

1. Master the gynecological examination and its precautions , be familiar with the anatomy and physiology of female reproductive organs, and write complete medical records.

2. Master vulva and vaginal disinfection and catheterization techniques.

3. Master the preparation before and after gynecological surgery.

4. Master the principles of diagnosis and treatment of common diseases, such as: reproductive organ inflammation, ovarian tumors, uterine fibroids, cervical cancer, pregnancy loss, menstrual disorders, etc.

5. Master the methods and clinical significance of commonly used special examinations in gynecology, such as mold, trichomonas examination, cervical scraping, posterior vaginal fornix smear, basal body temperature measurement, etc.

6. Under the guidance of superior physicians, perform diagnostic dilation and curettage, cervical biopsy, electric ironing of cervical erosion, and common diagnostic and treatment techniques.

7. Be familiar with aseptic techniques, incision, hemostasis, suturing, infusion, blood transfusion, dressing change, etc.

8. Understand the indications and precautions for tumor chemotherapy.

9. Perform necessary gynecological surgeries under the guidance of superior physicians.

10. Understand the principles of diagnosis and treatment of gynecological emergencies. Such as ovarian tumor pedicle torsion, dysmenorrhea, acute adnexitis, acute abnormal vaginal bleeding, advanced cervical cancer, etc.

(2) Obstetrics

1. Master the characteristics of obstetric medical history, and be able to write complete and correct obstetric outpatient and inpatient medical records, intrapartum records, postpartum records, neonatal records and labor processes Figure depicts.

2. Be familiar with the structure and main diameters of the pelvis and the clinical significance and examination methods of prenatal examination.

3. Understand the mechanism of normal delivery, master each stage of labor and the treatment of newborns, and Apgar’s scoring method.

4. Understand the normal physiology of newborns and the rescue measures for fetal distress and neonatal asphyxia.

5. Be familiar with the principles of prevention, diagnosis and treatment of pregnancy complications. Such as various miscarriages, late pregnancy poisoning, pregnancy complicated by heart disease, late pregnancy bleeding, abnormal fetal position, dystocia, postpartum hemorrhage, postpartum infection, etc.

6. Understand the maternal physiological changes and precautions during the puerperium period.

7. Understand the principles of diagnosis and treatment of obstetric emergencies. Such as ectopic pregnancy, uterine rupture, dystocia, etc.

8. Under the guidance of superior doctors, episiotomy, laceration suturing, artificial rupture of membranes, breech midwifery, etc. can be performed.

(3) Family planning

1. Promote the importance of family planning and be familiar with family planning measures.

2. Understand the use of oral contraceptives and their side effects.

3. Under the guidance of superior doctors, perform circulatory implantation, artificial abortion, etc.

6. Pediatrics

Internship content and requirements

1. Be familiar with taking and writing medical records of pediatric outpatient and inpatient medical records, and pay attention to the characteristics of pediatric diseases. Correctly use and fill in various pediatric records, forms and application forms.

2. Be familiar with the methods, procedures and records of pediatric physical examinations, be familiar with the physiological and anatomical characteristics of various pediatric systems, and pay special attention to respiration, heart rate, pulse and blood images of each age group.

3. Master the principles of diagnosis, treatment and prevention of common pediatric diseases and frequently-occurring diseases. Such as influenza, bronchitis, dyspepsia, intestinal parasitic diseases, rickets and tetany, characteristics and care of immature children and newborns, malnutrition, malnutrition anemia, acute nephritis, encephalitis, toxic digestion Adverse diseases, pediatric convulsions, neonatal scleredema, neonatal tetanus, neonatal intracranial hemorrhage, neonatal sepsis, nephrotic syndrome, hemorrhagic diseases, etc. Understand: congenital heart disease, myocarditis and leukemia, characteristics of rheumatic heart disease in children, cretinism, thrush, bacillary dysentery, tuberculosis in children, etc.

4. Master the operation methods, precautions and clinical significance of common pediatric diagnosis and treatment techniques. Such as intravenous, intramuscular, subcutaneous injection, oxygen administration, tuberculin test, scalp needle, intravenous blood transfusion, lumbar puncture, bone marrow puncture, femoral vein and jugular vein puncture, etc.

5. Understand the dosage, pharmacological effects, usage methods, and side effects of commonly used pediatric drugs, and be able to prescribe correct prescriptions and medical instructions. Master water and electricity balance and fluid therapy in children.

6. Be familiar with and understand children's health care work, health examinations, nutritional guidance, health publicity, and disease prevention.

7. Electrocardiogram

Internship content and requirements

1. Through internship, you can further become familiar with normal electrocardiogram images and master the clinical application scope and clinical significance of electrocardiogram.

2. Basically master the tracing and operation techniques of electrocardiogram, the analysis of normal electrocardiogram, and the shape and measurement of each wave.

3. Preliminarily master the following common clinical abnormal ECG characteristics: left and right atria, ventricular hypertrophy, insufficient coronary blood supply, myocardial infarction, left and right bundle branch block, premature beats, tachycardia, atrial fibrillation, atrial fibrillation, Ventricular block, pre-excitation syndrome, digitalis drug poisoning, electrolyte disorders such as hypokalemia, myocarditis, pericarditis, etc.

8. Radiology Department

Internship content and requirements

1. Understand the routine work system of the radiology department and the main components of the X-ray machine, and the occurrence of X-rays , X-ray protection.

2. Be familiar with X-ray fluoroscopy operations (mainly chest fluoroscopy), and write fluoroscopy reports under the guidance of superior physicians.

3. Understand the photography operating procedures and darkroom operating routines. Master the formal writing method of radiography consultation form and report form.

4. Preliminarily master imaging examination procedures for common diseases and rationally select various examination methods (including various imaging examinations).

5. Understand the normal X-ray manifestations of the respiratory system, circulatory system, skeletal system, digestive system, urinary system, etc. and initially identify typical X-ray signs. And be able to make preliminary diagnoses for those with typical signs of common diseases and write correct diagnostic reports.

(1) Lung diseases: tuberculosis, pneumonia, lung cancer, lung abscess, bronchiectasis, bronchial obstruction and pleural diseases, etc.

(2) Cardiac and macrovascular diseases: rheumatic heart disease, congenital heart disease, high heart disease, pulmonary heart disease, cardiomyopathy, pericarditis, etc.

(3) Digestive diseases: ulcer disease, esophageal cancer, gastric cancer, cholecystitis, cholelithiasis, etc.

(4) Urinary system: stones, tuberculosis, tumors and obstructive lesions, etc.

(5) Skeletal system: bone trauma, osteomyelitis, bone tuberculosis, bone tumors and joint lesions, etc.