AIC

KIJABE HOSPITAL

MEDICAL
OFFICER
INTERN
HANDBOOK












Updated 2018
ashirk@gmail.com


TABLE OF CONTENTS

GENERAL EXPECTATIONS ........................................................ 2
WEEKLY SCHEDULE ................................................................. 3
CORE VALUES ......................................................................... 4
CALL SCHEDULE ...................................................................... 4
LEAVE ..................................................................................... 5
SPIRITUAL CARE ..................................................................... 5
RESEARCH AND CONFERENCES ............................................... 5
INDUSTRIAL ACTION ............................................................... 6
OBSTETRICS AND GYNECOLOGY ROTATION ............................ 7
PEDIATRICS ROTATION .......................................................... 12
TEMPLATE FOR PRESENTATION ON MEDICINE AND
PEDIATRICS(SOAP) ................................................................ 18
MEDICINE ROTATION ............................................................ 20
SURGERY AND ORTHOPAEDIC ROTATION .............................. 29
IMPORTANT PHONE NUMBERS/EMAIL ADDRESSES ............... 35

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GENERAL EXPECTATIONS
Welcome to Kijabe Hospital! We are excited to have you
join us for this pivotal year of your medical training. You are
joining generations of physicians that have trained here
(many of whom will be your consultants and the residents
you work with) in a tradition of health care excellence.

We hope, as you learn and grow with us, that you will
redefine medicine as a calling and realize the holy privilege
it is to walk with patients at their most vulnerable moments
– to point them to the cross of Christ and have them leave
here not just healed, but whole.
This book lays out the general schedule, expectations for
rotations, contacts, and other things you may need to know
to guide your time in Kijabe.

Thanks so much!

Evelyn Mbugua, Director of Graduate Medical Education
Arianna Shirk, Internship Director
Loise Muindi, Medical Education Assistant

THE PRACTICE OF MEDICINE IS

AN ART, NOT A TRADE; A
CALLING, NOT A BUSINESS; A
CALLING IN WHICH YOUR HEART
WILL BE EXERCISED EQUALLY
WITH YOUR HEAD.

-WILLIAM OSLER

WEEKLY SCHEDULE
Monday 8am Prayer
1pm Ob/Gyn Lecture

Tuesday 7am Surgery Skills Conference
(Mandatory)

1pm Medicine Lecture


Wednesday 8 am Chapel
1pm Pediatrics lecture

Thursday 1pm Medicine lecture


Friday 7am Hospital Wide Audit (Mandatory)*
1pm Case Presentation



*Audit attendance will be tracked and 85%
attendance necessary for graduation, for every 5%
below 80%, 1 week will be added to the end of
intern year




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CORE VALUES

• Show compassion, love, empathy for patients.
• Show integrity, character, and respectful attitude to
fellow colleagues, nurses, patients and support
staff.
• Demand excellence and high standard of care to
and for patients.
• Promote teamwork – unity of purpose among
members towards one goal.
• Arrive on time to conferences, rounds, and other
clinical duties

CALL SCHEDULE
à Every night, medicine, surgery, OB, and Pediatrics
call should be covered by a MO intern & CO intern
à Your team leaders will be responsible for making
the call schedule and dividing weekends, weekdays,
and holidays.
à You will average around every 3-4th night call
during your intern year
à If illness or family emergency prevents a colleague
from covering a call, you will be responsible for
rearranging your schedule to cover the call. If
possible, that call should be paid back by the person
who was covered.
à On call, you should be available by phone at all
times to the coverage nurse, nurses covering your
patients, and the clinical officers and consultants
with whom you are taking call.

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LEAVE/SICKNESS

à If you need to be released from clinical duties for any
reason (family emergency, visa/paperwork, wedding,
etc.) then you must notify and get permission from
o The department head in which you are rounding
o The consultant with whom you are rounding
o Dr. Arianna Shirk
à If you are unwell:
o You need to be seen by a consultant in either
private clinic (family medicine consultants are
there daily) or in OPD and get a note excusing
you from clinical duties.
o Then, inform your team leaders to help arrange
coverage for your calls and duties for that time
if you are not able to do it yourself

SPIRITUAL CARE

à You will have a Bible study curriculum over the course
of your year to help you grow in your understanding of
your faith and Jesus’s love for you
à You will appoint a spiritual leader to figure out the best
time (typically Wednesday night) and work with Pastor
Benjamin to set the curriculum

DRESS
à Maintain professional dress at all times.
à Scrubs for theatre must be different than scrubs for
call/services.
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RESEARCH AND CONFERENCES
à We encourage you to work with a consultant or
resident in your area of interest to carry out research
throughout the year
à If your research is accepted for presentation:
o You need to arrange coverage of assigned
duties and call with your co-interns to be
able to go
o The GME office may be able to help with
fees and travel on a case by case basis.

INDUSTRIAL ACTION

AIC Kijabe Hospital recognizes and respects the constitutional
right to Industrial action. Including strikes, by aggrieved persons,
against the Employer or other targeted person/institution. While
at AIC Kijabe Hospital, you will be a trainee seconded from the
Ministry of Health Service. You are therefore an employee of the
AIC Kijabe Hospital for the duration of your training, and will be
expected to adhere to the standards of Conduct at this
institution. Unless an industrial action is called against the AIC
Kijabe Hospital therefore, you will not be expected to take part
in strikes that are directed at the government or government
institutions during your training. Participation in any
unauthorized or unprotected strike will amount to a breach of
the code of conduct and interpreted as gross misconduct. It
would also result in significant interruption of your training at
our institution and this may require you to find an alternative
center to complete your training.

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OBSTETRICS AND GYNECOLOGY ROTATION
CORE VALUE – to be a leader in providing excellent
health care in Sub-Saharan Africa to God’s glory.

RESPONSIBILITIES
Be proactive
à Attend CME (1-2pm)
à Attend Audits (Friday 7am)
à All are expected to have finished pre-rounds and
formulating plans on your patients to join
consultants in Team 1 to formally round by 8:00. *
8:30 on Wednesdays and Fridays*
After formal rounds, we will split into our respective
patient care area.
à Hand-over rounds at 5PM daily – MOI to MOI in
consultation with consultant on call.
à CO intern is your assistant and you are responsible
for overseeing their management
à Pulls audit data for deliveries (SVD and CS). Work
with OB team medical officer in compiling
information.

Our unit is divided into 3 main care-giving areas
1. Theatre
2. Ward (team 1 and team 2)
3. MCH

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OBS GYN INTERN IN THEATRE
WEEKLY SCHEDULE (Rounds with consultant at 7:30 to be
in theatre by 8:15)
à Weekend before – go through the scheduled cases
for the week and understands the indications for
surgery and surgical steps
à Mondays, Wednesdays, Thursdays– Theatre, be
there by 8:15.
à Tuesdays – Admits CS/GYN pts for theatre
à Fridays – goes to GYN clinic
à See surgical patients when they are admitted to ensure
pre-op evaluation is complete
à Prepare discharge summaries and give
instructions/danger signs to patients prior to D/C
à Know all the patients on the theatre list and have them
prepared for theatre by ensuring their pre-op
assessment (medical clearance) and prep is done
(consent, pre-op hemoglobin, blood as needed)
à Read about the medical condition and have an
understanding about the surgery.
à Be present until all cases on the list are finished (unless
on call for another service)

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INTERN COVERING WARD (TEAM 1/2)
à Pre-rounds on team 1 patients
à Responsible for patients in team 1
o Review each patient minimum Q4hrs and writes
a note in the file with every review
o Discuss plan and progress with consultant
o Call consultant for every emergency in labor
ward
o Be proactive to do at least 5 deliveries a week
à Liaise with nursery staff about patients at risk for
preterm delivery/neonatal sepsis/meconium
à Follow-up on necessary tests for patients on team 2
o On Friday – responsible for theatre cases as the
MOI on theatre is in GYN clinic

INTERN IN MCH/HRC (ALSO COVERS CASUALTY
& OPD)
à Prepare discharge summaries and give
instructions/danger signs to patients prior to D/C
à Monday, Wednesday, Friday – needs to be in MCH
by 11 am
o Review patients with consultant
o Stays until all patients have been seen –
does not hand over patients that have not
been seen to the on call team unless it only
involves following-up tests
o Sees high-risk patients in HRC
Tuesdays/Thursdays with the consultant
o Sees consults in casualty and reviews with
consultant
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OBS GYN LEARNING OBJECTIVES

MCH/ANTENATAL
o Dating a pregnancy
o Antenatal profile and routine antenatal visit schedule
o Management of 1st trimester bleeding/Sab
o Rhesus negative management
o Management of 3rd trimester bleeding
o GDM screening
o Management of hypertension in pregnancy (gestational
versus pre-eclampsia)
o Management of decreased fetal movement for preterm
and term patients
o Management of pregnancy loss

OBSTETRICS
à Bishop scoring
à Management of labor – labor curve, intrapartum
à Read FHR tracings
à Cardinal movements of delivery and managing a
normal delivery/cesarean section
à Management of complicated deliveries – shoulder
dystocia, prolonged 2nd stage
à Perineal repair
à Management of postpartum hemorrhage
à Management of pre-eclampsia/eclampsia

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GYNECOLOGY
à Perform pelvic examination and pap screening
à Family planning counseling
à Management of fibroids
à Management of abnormal uterine bleeding (AUB)
à Diagnosis and treatment of pelvic inflammatory
disease (PID)
à Initial work-up of infertility
à Pelvic anatomy and steps of a hysterectomy
à Management of ectopic pregnancy
à Perform marsupialization of abscess
à Placement of cervical cerclage (MAC stitch)
à Management of ovarian cysts/pathology

EVALUATIONS

WE WILL PERFORM MONTHLY ASSESSMENTS

(INDIVIDUAL AND GROUP).

THERE WILL BE A FINAL, END-OF-ROTATION

ASSESSMENT ALONG WITH A CLINICAL WRITTEN
EXAM.

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PEDIATRICS ROTATION
The pediatric patient in Kijabe is < 16yrs old.
(anyone before their 16th birthday)

THE TEAM
à Full time consultants (5)
à Full time pediatric clinical officers (8)
à Visiting consultants/residents/medical students

THE SERVICES
à Newborn unit for babies born in Kijabe
o Premature Babies
o Term babies with O2 requirement and/or fluid
needs
à Bethany Kids Ward
o Newborns born outside Kijabe
o All other pediatric medical patients
o Pediatric surgical patients. Includes
neurosurgery, orthopaedic surgery, plastic
surgery and ENT.
à HDU and PICU within BKKH ward
o All patients needing continuous monitoring
à Family clinic
o all children 5yrs and below are seen as
outpatient department

Rotation will be divided to ensure adequate exposure in all
these areas.

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EXPECTATIONS
KEEP TIME always
o Read your protocols and read around your patients
o CONSULT on everything. And on all your patients.
o Prepare for classes.
o TEAMWORK is key. Be part of the team at all times,
day and night.

PEDIATRICS DAILY PROGRAM

8:30-9:00AM- Morning Presentation
Monday: Nursery Presentation
Tuesday Mock Code
Wednesday Chapel
Thursday: Ward Presentation
Friday: Mortality review or ICU presentation

M/Th/F Morning Reports are case-based & prepared by interns.

9:00AM promptly- Ward rounds will begin on all services.
Pre-rounds MUST be completed before 8:30AM daily

11:30AM- those assigned to MCH should leave for MCH.
o Consult the CO for any patients seen.
o Consultant in BKKH is available for phone consults/
reviews.

11:30-1:00PM- Finishing rounds, teaching, ward work

1:00-2:00PM- common class and lunch break.
o Make effort to attend all sessions.
o Seek permission from your consultant and CO if rounds
is not over or some work is pending

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2:00-4:00PM Follow ups and afternoon teaching
o Pediatric CO's have class on Wednesday from 2-4pm.

4:00PM- handover to the night/ on-call team.
o MO intern is responsible for Nursery, Deliveries, and
HDU patients and covers casualty with the CO intern
o CO intern on call is responsible for BKKH and OPD along
with covering casualty with the MO intern
o Handover is intern to intern and day coverage continues
until 5PM.
o Handover document must be passed to the night intern
and passed back to the day intern the next morning.

CALL
o Coverage of casualty is by both CO and MO intern.
Both must see all patients coming through casualty.
o Newborn unit/deliveries and HDU is primarily
covered by MO intern.
o OPD and BKKH is primarily covered by CO intern
o Call ends at 8:00AM - any patient arriving to
hospital before 8:00AM is the responsibility of the
call team.
o There is always a CO and a consultant on call with
you. Consult on ALL admissions, any patient change
in status, and any other concerns.

PROCEDURES
Interns are responsible for lumbar punctures, urinary
catheterization, attempting difficult cannulations, and
drawing of stat labs

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PEDIATRICS LEARNING OBJECTIVES

NEONATAL
à Initial resuscitation and care of premature infant
à Initial resuscitation of term infants
à Feeding & fluid requirements in term & preterm infants
à Diagnosis & Management of neonatal
hyperbilirubinemia
à Management of neonatal seizure
à Prevention and management of birth asphyxia
à Differential and management in neonatal oxygen
requirement (RDS, congenital heart disease, MAS,
apnea)
à Diagnosis and management of neonatal sepsis
à Diagnosis and management of hypernatremic
dehydration
à Setup and use of CPAP in the neonate

PEDIATRICS GENERAL CARE

à Fluid management in children
à Normal vital signs in children and management of
anomalies (fever, hypothermia, hypertension, etc.)
à Diagnosis & management of seizing pediatric patient
à Management of dehydrated patient
à Diagnosis & management of severe acute malnutrition
à Diagnosis & management of malaria in children
à Diagnosis & treatment of Rickets
à Differential of respiratory distress & management in
children (asthma, severe pneumonia, congestive heart
failure, apnea)
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à Treatment of bacteremia, UTI, & meningitis in children
à Diagnosis & treatment of tuberculosis in children
à Diagnosis & treatment of HIV in children
à Differential, & management of severe anemia
à Diagnosis & management of sickle cell anemia & crisis
à Differential and management of children with
developmental delay and congenital anomalies
à Management of chronic heart, liver, and kidney disease
à Diagnosis and management of constipation
à Diagnosis and management of diabetes/DKA
à Differential, diagnosis, and management of pediatric
skin conditions (eczema, scabies, viral exanthema, etc)
à Pediatric vaccinations & vaccine preventable conditions
à Differential and management of acute poisoning

PEDIATRIC ICU CARE

à Resuscitation and code of pediatric patient (PALS)
à Care of SVT, VTACH, PEA arrest
à Airway stabilization in a pediatric patient
à Management of pediatric patient in septic shock
à Management of pediatric patient in hypovolemic shock
à Management of pediatric patient in cardiogenic shock
à Ancillary management of pediatric surgical patients
(abdominal pain and abdominal mass, congenital
malformations)
à Indication and use of pressors in pediatric patients
à Management of neurologic emergencies in pediatrics

PROCEDURES

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à Triage
à Vascular access
à IM and IV injections
à Lumbar puncture
à Pleural or peritoneal aspirate
à Bone marrow aspirate (observe)
à Collecting blood specimen (broken needle technique)
à Urine catheterization and specimen collection
à Blood transfusion
à Perform and interpret mantoux and BCG tests
à Read and interpret stool. Urine, sputum and CSF results
à Estimate levels of hemoglobin, glucose, bilirubin in
blood
à Interpret routine radiograph
à Exchange transfusion
à Post mortem examination

EVALUATION
o Demonstrate appropriate communication and
counseling skills
o Demonstrate ethical behavior in line with the code of
professional conduct and ethics
o Demonstrate appropriate hand over appropriately
o Attend at least 80% of all teachings
o Posttest done in May and November (pass mark of
60%)
o At least 5 clinical presentations during morning
handover and teachings
o Log book must be completed at end of rotation

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TEMPLATE FOR PRESENTATION ON
MEDICINE AND PEDIATRICS(SOAP)

(S)UBJECTIVE AND (S)UMMARY STATEMENT:

1. [Age ] [Gender] Hospital day[#] {current problems &
diagnosis}
2. Overnight Events (i.e. transfer/deterioration/new symptoms)

(O)BJECTIVE
1. Vital Signs (with weight for pediatrics) with Tmax and HR/BP/RR
ranges on O2 requirement
2. Ins and Outs if recorded
3. Pertinent Physical Exam – no unremarkable!
4. New lab results / pending labs

(A)SSESSMENT AND (P)LAN

(by system with problem differentials)
RANK BY ORDER OF PROBLEM IMPORTANCE
ADD ENDOCRINE, GI, INFECTIOUS DISEASE, PHYSIO/MSK AS
NEEDED WITH SAME FORMAT
1. Cardiovascular (CVS)
a. What is wrong? (Symptom, ie tachycardia, hypotension,
etc.)
b. Why? (differential diagnosis, ie Acute MI vs/ CHF vs/
Congenital, etc)
c. Plan? (ie xray, oxygen, lab tests, diuresis, etc.)
2. Neurological (CNS)
a. What is wrong? (Symptom ie altered mental status,
weakness, paralysis etc.)
b. Why? (differential dx ie Stroke vs/cerebral palsy vs/
meningitis, etc.)
c. Plan? (ie CT vs neurosurgery consult, LP, neuro checks,
etc)

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3. Respiratory
a. What is wrong? (symptoms ie. Hypoxia vs/ chest wall
indrawing vs/ tachypnea)
b. Why? (Differential dx ie Pneumonia vs/ CHF vs/ TB vs/
Asthma vs/ Bronchiolitis)
c. Plan? (Oxygen wean, xray, chest physio, suctioning, etc)
4. Renal
a. What is wrong? (sxms: elevated cr vs electrolyte
1
abnormality , decreasedUOP)
b. Why? (Differential Dx: AKI vs/ dehydration vs/ nutritional
deficiency vs/ CKD, etc)
c. Plan? (lab tests, electrolyte supplementation, ultrasound,
consult, dialysis, etc.)
5. Fluids, Electrolytes and Nutrition (FEN)
a. What is wrong? (sxms: malnutrition, obesity, diabetic diet,
low salt, NPO, etc)
b. Why? (Differential dx: poor intake vs/ increased losses vs/
TB vs/ neglect, etc)
c. Plan? (nutrition consult, TB Test, special diet, change in
fluid rate, etc)
6. Spiritual/Psychosocial
a. What is wrong? (sxms: orphan/vulnerable child, single
mother, poor social support, refugee, unreached, etc.)
b. Why? (Differential dx: poor community support, no
resources, etc)
c. Plan? (chaplaincy consult, NHIF, needy fund assessment,
family training, etc.)

HANDOVER: SUMMARY STATEMENT

1. Age, Hospital day
2. Main problem list
3. Recheck/follow up items overnight

19

MEDICINE ROTATION

PRIMARY LEARNING OBJECTIVE

During your ward and on call time on Intern medicine, your
primary learning objective is to become comfortable with
getting a full UNDERSTANDING of the patients story and
exam, then ASSESSING their problems in detailed fashion
(making Diagnosis when possible), and the PLANNING their
further diagnostic and therapeutic interventions.

GMAIL ACCOUNT AND ACCESS TO FOLDERS
Most of our departments shared documents are available
on Google Drive. You will need to be able to access these
while working with our department. If you do not have a
gmail account, you can sign up for one at
https://accounts.google.com/signup?hl=en
à Once you have a Google account “request access” to
these folders:
https://drive.google.com/drive/folders/0B_axjoe8uY6O
b2cxcnpIcXpvdmM.
à Kijabe IM teaching material: Contains ward
protocols and ward teaching materials (ECG, CxR,
SAAG, etc)
à ICU Curriculum Folder Shared with Learners
à MED TEACHING – TRAINEE Read-Quest – contains
core and non-core lunch teaching session material
and reading material and question you must
complete prior to each medicine core teaching
session.

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WEEKLY CLINICAL ASSIGNMENT
Week of ICU/Salome Wairegi Salome
HDU Ward/HDU
Mon-Fri Mon-Sat M-Sat
Daily 9am ICU 8:30 am 8:30 Am Barnabas
Rounds rounds Barnabus (M,T,Th,F)
(M,T,Th,F)
9:30 Rounds (M-F,
11:30 ICU 9:30 Rounds (M- variable start on
lectures F, variable Sat) Sat)

3:30 PM Sign 3:30 pm Sign out
3:30PM Sign Out
out
Intern 7AM 7AM 7AM
Lectures 1PM 1PM 1PM
Ø Medicine Lectures are Tuesday/Thursday

CALL
à You are expected to consult for all admission and
present to the consultant on call, aiming for the
understand/ assess/ diagnose format.
HDU
à All HDU patients should be rounded on by medicine
every day (M-Sun) including all surgical patients.
à The exceptions are:
o Regular ward patients housed in HDU because
of bed availability
o Any surgery patient who is stable and medicine
has signed off on
à All trach patients, even if stable, should be followed in
HDU by medicine for additional layer of preparedness
for trach problems
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ROUNDS
à The IM service uses Education Model of Patient Care to
maximize both current patient outcomes and future
professional capacity
à Major objective of rounds is helping trainees develop
excellent and holistic approach to patients
à PRAYER: A core part of care at Kijabe is having someone
on the team pray with or for each patient on rounds
daily
ADMISSIONS
à After notification from Casualty (or OPD) of a possible
admission, the patient should be clerked within 1 hour
and admission decision made and orders written within
2 hours.
TRANSFERRING PATIENTS
Do these three things when moving a patient between
wards
1. Verbally handover to the team on the receiving
ward and notify the primary team (if not medicine)
that the patient has been moved
2. Update the appropriate Wunderlist patient list
3. Move the patient to the appropriate folder on
Wunderlist. If Medicine is signing off, move to the
Signed Off Consults folder.

DISCHARGE PLANNING
As soon as you have a tentative plan for patient discharge,
please get and complete the PINK DISCHARGE PLANNING
SHEET and place in the front of the chart.

22

WEEKENDS
WAIREGI WARD/HDU AND SALOME WARD
à Saturday –The consultant assigned to the ward during
the week is responsible for rounds on the Saturday
Morning. These can be brief though still thorough. The
ward RCO does not work on Saturdays. Arrange a start
time for Saturday rounds with your team ahead of time
à Sunday - The consultant on weekend call for Medicine
rounds with the MOI on call for medicine on Wairegi
HDU patients and and ward patients identified or
handed over for follow-up on Sunday morning.
ICU/SALOME HDU
à Saturday – The consultant on ICU call for the weekend
is responsible for rounds on both Sat/Sunday. There is
generally an ECCCO officer pus MO intern and resident
rounding on Saturday
à Sunday – There is generally an ECCCO on duty to round
with on Sundays.

MO INTERN CASE PRESENTATION GUIDELINE

à Present a case from a patient that you have managed
inpatient or outpatient.
à Include case presentation with learning topics
à Needs approval by consultant for topic/case-please
inform/email Dr. Sarah Wandia with topic so that it can
be listed on Tuesday/Thursday lecture schedule.
à Powerpoint presentation format with time for
questions
à Complete presentation in 40-50 minutes

23

à Evaluation Criteria:
o Met criteria for presentation
o Presentation reflects up-to-date information
o Concise/Clear Points with practical clinical value
o -Slides or handouts easily
readable/understandable/valuable
o Effective case presentation
o Presented in a clear fashion-including
speech/volume/organization of material
o Grasp of subject matter

INSTRUCTIONS FOR WUNDERLIST
à When you are on the internal medicine service, you will
be using Wunderlist to keep track of patients.
à You will need access one of the free WiFi access points
at the hospital. (Please DO NOT use cellular phone
connection for Wunderlist.) The very first time you
connect to one of these routers, you will need to enter
a password: 0a1b2c0a1b.
à After you access the router, you need to connect to
https://192.168.2.254:4100.
à This will take you to a log in screen. Obtain individual
username and password from the IT department.
à Download the free Wunderlist app onto your
smartphone or tablet. You can also use a computer or a
laptop.
à Someone who already has access to the 9 patient lists
will need to invite you to join these lists via your email
address: ICU List, Wairegi HDU List, Wairegi Wards List,
Salome HDU List, Salome Wards List, Signed Off

24

Consults List, Died in ICU List, Died in HDU or Wards
List, Discharged Alive List
à Once you start using the app, most of this will become
very intuitive but you are responsible for entering and
maintaining following types of information about each
patient.

Patient List In the “List” section of the app, enter basic
identifying information in the following format:
Bed #; Name; Age/Gender; Hospital #.
ICU 3 Samuel Karanja 30M 111234
Problem List In the “Free Text” section of the app, enter each
and medical problem separately and add
Management the management plan for each specific problem.
plan e.g.
Diabetes – HbA1C 10. On Mixtard 20 AM and 10
PM. Needs diabetic education.
Acute Kidney Failure – Baseline Cr 0.8. On
Admission 3.0. Received 5 L of NS over past
2 days. Await Cr tomorrow.
Chest Pain – Sounds noncardiac by history. EKG
normal. CXR normal. On omeprazole.
HTN – On Lisinopril 10 qd and Nifedipine 30 bd.
Etc.
To Do List In the “Subtask” section of the app, enter each
to-do item in an actionable format.

e.g.
Call patient’s wife 0555667788
Call Surgery Consult
Na, K, Cr tomorrow
HIV result, Etc.
Files Using the “clipboard” icon, add relevant patient
files such as ECGs, x-Rays, etc.

WUNDERLIST GENERAL RULES
25

à Before you start work, please connect to WiFi to sync
Wunderlist.
Before rounds, please make sure the list is
accurate. Move any old patients to the appropriate
list, e.g. “Discharged Alive List,” etc. Make sure all
new patients have accurate information
à During or after morning rounds, update the list
including the to-do list for the day.
à Before sign out rounds, update the list including the to-
do list so that the on-call-intern will have accurate
information.
à Handover to the intern-on-call using Wunderlist and
assign any unfinished to-do items to the on-call intern.
à Protocols and other Learning materials (ECGs, CXRs
tutorials etc) are available in Google Docs.

WARD EXPECTATIONS

One of our goals on your medicine rotation is that you will
learn how to “Understand, Assess/Diagnose, and Plan” for
each patient. The great temptation is to skip
Assessment/Diagnostic thinking and jump right to planning
for today (e.g. “we will continue IV fluids at 125 ....”
etc). Unfortunately, our not thinking or diagnosing correctly
eventually causes problems for our patients.
If you don’t understand your patient's full story, you can’t
diagnose their problems well.
If you don’t make the correct diagnosis, you can’t make
good and thorough plans.

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UNDERSTAND
“History is everything. Never trust the history.”

First, make “understanding the patient story” your top priority. Then:
à Paint a Picture for others that gives them a good feel for where
this patient has been and what has happened.
à Don’t do this: “She presented with a 3/7 history of cough.” This
doesn’t give you or anyone else an understanding of what her
baseline function is.
à Rather, start your thinking with “this lady was completely well
until...”
à (e.g 1) – She was working, completely without symptoms until
she developed a cough and some mild DOE 6 weeks ago. Then
she ....”;
à (e.g. 2) - She was well until 2007 when she had a stroke. She
has been able to ambulate around the house with minimal
assistance and otherwise well until she developed a cough and
some mild DOE 6 weeks ago. Then she ....”

Second, Understand your patient’s data :
à Have their chart organized
à Vitals sheets all organized chronologically. Vital sign patterns
are absolutely vital.
à Med Sheet reviewed - what meds are they on today. Have all
be given?
à Labs ALWAYS all on green sheet. If you only have time to write
the results on the green lab sheet or in your note, choose the
green lab sheet :).
à Glucoses all on glucose sheet, along with Mixtard doses;
à Warfarin bridging on AntiCoagulation Sheet
à You should NEVER have to look at a lab slip more than once,
and never while on rounds. Write the results on the lab sheet
the first time you see the result.

For Objective Measures, Assessment, and Plan approach, see the
Template for Presentation on Medicine and Pediatrics above.


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CLASS EXPECTATIONS

80% attendance is expected to complete the Medicine
rotation
The sign up sheet for the lunch time classes will be
withdrawn at 1:05 PM

It is expected that interns have pre-read the material
shared on the Google drive and made an attempt to
answer the questions on a piece of paper to be handed in
at the start of the class

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SURGERY AND ORTHOPAEDIC ROTATION

TEAM
à Kijabe has a big surgical department consisting of
general surgery, paediatric surgery, neurosurgery,
plastic surgery, orthopaedic surgery, urology, head and
neck/ENT unit.
à You shall have 8 weeks of general surgery rotation and
4 weeks of orthopaedic rotation.
à Team in both general and orthopeadic surgery consists
of consultants and residents (registrar) and interns.

RESPONSIBILITIES
ROUNDS
à Interns are expected to round on patients allocated to
them by the senior most resident in the team.
(including those on other wards where the surgery
service has been consulted) every day.
à Each patient is to be evaluated by talking to the patient
and the nursing staff about events of the past 24 hours,
reviewing the bedside chart and lab tests or X-Rays or
other results, and examining the patient and viewing all
incisions or wounds.
à A note for each patient should be entered into the
chart in the SOAP note format. The plan for each
patient should be determined in conjunction with the
Consultant and Chief Resident.
à Orders that are needed for the patient should be
documented and discussed with the nursing staff.
Interns must keep a running list of the orders and
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action items (lab tests, studies, procedures results, etc.)
that need to be followed up on during the day for each
patient.
à Pre-Rounds 0600hrs -0700hrs. This is done in
conjunction with the residents. All patients should be
reviewed daily with the Chief Resident or Consultant.
à Evening or late afternoon rounds should be made with
the Residents. Any post op patient or patients with
active issues should be reviewed. Issues discovered on
afternoon rounds should be communicated to the Chief
Resident or Consultant.
à Interns should maintain a daily list of all surgical
patients by ward. The list (google sheet document)
should include patient name, location, diagnosis,
operation, and current issues and items that require
follow up. This list will assist with reviewing patients
with the Consultant or Chief Resident. This list should
be used to “turn over” to the night call staff any patient
issues to be aware of during coverage.
à Remember that the chart is the medical legal record of
the patient’s hospital stay. This is the mechanism for
ensuring that the plan of care is carried out and
understood by all care givers. Take care to document
well and legibly to ensure excellent patient care.
à Notes to be included in the chart (written by the
Resident) include history and physicals with an
assessment and plan, daily SOAP notes and orders, Pre-
op notes, Post-op notes, Procedure notes, and notes of
any event or issue (codes, transfer to ICU, decreased
UOP, etc.)

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à Any preoperative patient admitted for surgery should
be reviewed with the Resident/consultant in the team
before admission.
CLINIC
à Interns will be assigned one day of clinic per week.
While in clinic, the intern should see patients,
determine the history and surgical issues, examine the
patient, and review the patient with the Consultant.
à A plan of care will be developed with the Consultant
and communicated to the patient. Ensure that each
patient fully understands the plan and that patient
questions are answered.
à Notes should reflect the nature of the patient issue,
associated problems, pertinent positives and negatives
of history, patient physical exam, and plan of care.
à The Consultant should add a note to the intern’s note
or the intern should document which Consultant saw
the patient.

CALL
à While on call, notify the junior most resident of any
surgical /orthopaedic patient. The Resident should call
the Consultant on call to discuss the plan of care for
each patient (prior to the patient’s admission). If a
patient is obviously critical in nature, do not delay
calling the Consultant – even if you are waiting on lab
or X-Ray results. Early notification and intervention –
especially in trauma patients- can sometimes make a
difference in life or death.

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à The intern will scrub in on each case that is performed
on his/her call night.
à Always feel free to call the resident/Consultant with any
questions regarding patient care. It is expected that
you will call with anything that you are concerned
about or feel uncertain as to the best treatment.
à Patient care must come first and it is always best to
seek advice early rather than delay an intervention that
could have improved a patient’s outcome.
à
THEATER
à Intern should have their own scrubs, theater shoes and
hat in readiness for the rotation.
à Intern is expected to scrub in as many cases as possible
à Intern should know the operative cases before hand
à Should have passed though the simulation basic
surgical skills training before getting to operate.

TEACHING SCHEDULE
à There is a teaching conference of some kind every
morning at 0700- 0800HRS. The schedule will be
distributed in advance.
à Attendance is mandatory at all of these conferences.
See the schedule below for details.
à Tuesday Basic surgical skills practical /lectures are
MANDATORY for all interns irrespective of the rotation
they are in.

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WEEKLY SCHEDULE
Day of the week Time Event
Monday 6.00 – 7.00 AM PRE-ROUNDS
7:00 – 8:00 AM WEEKEND REPORT
8:00 – 8:30 AM WARD ROUND
8:30 – 5:00 PM clinic/Theater (depends on
5:00 – 5:30 PM service)
Exit ward round
Tuesday 6.00 – 7.00 AM PRE-ROUND
7:00 – 8:00 AM Basic surgical skills/lecture
8:00 – 8:30 AM Ward round
8:30 – 5:00 PM Clinic/theater (depends on
5:00 – 5:30 PM service)
Exit ward round
Wednesday 6.00 – 7.00 AM PRE-ROUNDS
7:00 – 8:00 AM Spiritual curriculum
8:00 – 8:30 AM Ward round
8:30 – 5:00 PM Clinic/theater (depends on
5:00 – 5:30 PM service)
Exit ward round

Thursday 6.00 – 7.00 AM PRE-ROUNDS
7:00 – 8:00 AM Schwartz conference
8:00 – 8:30 AM Ward round
8:30 – 4:00 PM Clinic/theater (depends on
5:00 – 5:30 PM service)
Exit ward round
Friday 6.00 – 7.00 AM PRE-ROUNDS
7:00 – 8:00 AM Hospital audit (mandatory)
8:00 – 8:30 AM Ward round
8:30 – 4:00 PM Theater
4:00 – 5:30 PM Exit ward round

Saturday 8.00-9.00 AM Ward round
Emergency call

Sunday 8.00 -9.00 AM Rounds on critical patients

Emergency call

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LEARNING OBJECTIVES
à Initial evaluation and work up of common surgical
conditions including:
ü Perianal conditions
ü Neck masses
ü Breast pathologies
ü Chronic wounds
ü GI pathologies
ü Prostate pathologies
ü Hernias
ü Vascular pathologies
ü Fractures
ü Surgical consent taking
ü Other as stated in the KMPD hand book
à Initial evaluation and work up of emergency surgical
conditions including:
ü Trauma patient
ü Acute GI bleed
ü Acute abdomen
ü Sepsis from any surgical source
ü Basic surgical skills
ü Theater etiquette
ü Sutures and needles, basic surgical instruments
ü Knots, hand ties and suturing technique, tissue
handling
ü Bowel anastomosis
ü Chest tube insertion, suprapubic punctures, I & D,
debridement
ü Orthopaedic splints
ü Others as stated in the medical board handbook

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IMPORTANT PHONE NUMBERS/EMAIL
ADDRESSES

Dr. Evelyn Mbugua 0734 087 567
GME director Mededdir.kh@gmail.com

Dr. Arianna Shirk 0786 528 577
Director of Medical ashirk@gmail.com
Internship

Loise Muindi 0711 684 195
Mededdirassist.kh@gmail.com

Pastor Benjamin 0727 209 170

Coverage Nurse 0787 145 122

Dr. Richard Davis 0734 696 315
Director of Clinical Services meddir.kh@gmail.com

Dr. Sarah Muma 0734 546 328
Head of Pediatrics sarahmuma@gmail.com

Dr. Sarah Wandia 0739 389 409
Head of Medicine Rotation drwandia1@gmail.com

Dr. Beryl Akinyi 0727 139 476
Head of Surgical Rotation

Dr. Lilian Mameti 0723 989 643
Head of OB rotation

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