These section gives further information on YOUR National Intern Teaching Programme
These section gives further information on YOUR National Intern Teaching Programme
Many congratulations on your graduation and welcome to the medical workforce. Most doctors have good and happy memories of their internship year and hopefully your experience will be no different.
In signing this National Intern Education and Training Agreement (NIETA) you and the Medical School, University College Cork (the administrative body for the South Intern Training Network) commit to the education and training principles contained therein. Each Intern is being asked to sign the agreement at the commencement of internship. Please note that this NIETA does not relate to employment matters, which are governed by the NCHD Contract 2010, between the Intern and their individual employer(s).
Interns should consult the National Intern Training Programme (NITP): Education and Training in the Intern Year, approved by the Medical Council in May 2011, which outlines the professional competence requirements for interns. The NITP is appended to this Agreement in Appendix A (beware this link will download a large file - pdf).
The South Intern Training Network is responsible for the provision and coordination of this training programme and is accredited by the Medical Council (of Ireland) for this purpose. In the South Intern Network University College Cork is the body responsible for the administration of the programme. Each Intern Training Network is led by a consultant-grade Intern Network Coordinator who, in collaboration with the Intern Tutors, is responsible for overseeing intern training in their Network. The contact details for the Intern Network Coordinator, the Intern Tutors and the Administrative office in the South Intern Network are provided in Appendix B.
The 12-month internship in the South Intern Training Network comprises predominantly 4 x 3-month rotations. The South Intern Training Network is committed to supporting you throughout the year. If difficulties do arise you should seek support, in the first instance, from your designated specialist Trainer, next your Intern Tutor and, if necessary, the Intern Network Coordinator.
The purpose of intern training is to educate and train the newly qualified medical graduate to a level which will lead to being awarded a Certificate of Experience by the Medical Council of Ireland. The granting of a certificate of experience is dependent on the intern satisfactorily completing the education and training programme. The Intern Network Coordinator will recommend interns to the Medical Council for the award of the Certificate of Experience based on the intern’s progression through the Intern Training Programme, including the completion of mandatory and other training elements and the completion of assessments to the required standard as outlined below. The issuance of the Certificate of Experience by the Medical Council testifies that the Intern has satisfactorily completed the Intern Training Programme.
The areas that will be included in the assessment of each intern’s overall performance include:
*The ACLS is funded by the HSE. Payment is made upon receipt of certification.
National Intern Training Programme (NITP): Education and Training in the Intern Year approved by Medical Council on 31st May 2011).
The intern year is a supervised year of transition from medical student to doctor. The Programme for Intern Training is designed to ensure that on completion of the intern year every intern will be able to practice medicine in a competent and safe manner and that patients whom they treat will receive the best possible care.
The Curriculum (Section B) is based upon the Medical Council of Ireland’s Eight Domains of Good Professional Practice, National Committee of Medical Education and Training Suggested Core Competencies for Intern Year and the Guide to Professional Conduct and Ethics for Registered Medical Practitioners (Medical Council Ethical Guide) 1-3.
Internship, the first year of postgraduate training, is the period of transition from medical student to registered medical practitioner. An intern is a medical doctor who has completed their medical degree and is registered to practice medicine in supervised training posts; the intern year is the first level of postgraduate medical training and is an essential step in every doctor’s career. The intern year should provide a balance between education, training and clinical responsibility, enabling interns to develop the professional and personal competencies that result in good patient care and provide a foundation for lifelong learning.
The Medical Practitioners Act 20075 states that the Medical Council of Ireland is responsible for defining the role and responsibilities for internship. Internship is normally of 12 months duration during which the intern trains in clinical practice and spends time in different clinical placements across a range of specialties that can also include elective areas in hospitals and other clinical sites recognised by the Medical Council.
Recent reforms to the intern year have led to the establishment of Intern Training Networks that are based around the existing medical schools in Ireland (Figure 1). Within each of these networks, the regional Medical School and the Postgraduate Training Bodies are charged with the responsibility for delivering the National Intern Training Programme. Each Intern Network is centred around an existing Medical School and is led by an Intern Coordinator who is responsible for organising and overseeing intern training within their network and ensuring the provision of the appropriate, agreed educational programmes for interns.
After satisfactory completion of the intern year, interns are awarded a Certificate of Experience by the Medical Council4, 5 (Appendix 1). This certificate entitles the intern doctor to apply to the Trainee Specialist Division or General Division of the Register of Medical Practitioners maintained by the Medical Council and, therefore, to proceed with a medical career in the Irish health service. The Certificate of Experience is also required by most other competent authorities in order to register in other countries.
Internship should provide a period of clinical practice that enables the transition from medical student to medical doctor. Clinical practice is based around the traditional working week during which the intern works in a supervised environment. While clinical duties and responsibilities, graded according to their level of experience, are at the core of internship it must be balanced with an education and training programme that enables the intern to learn the knowledge, skills and attitudes that are necessary to provide safe medical practice.
Clinical service takes place within the contract of employment between the intern and employing authority (i.e. Health Service Executive (HSE), HSE-funded hospitals such as voluntary hospitals, General Practices and possibly accredited specialist and private hospitals. Most commonly, interns work as part of a multidisciplinary team where the intern is the most junior doctor of a hospital based medical or surgical team. The intern works in a supervised structure with their senior house officer (SHO), registrar, specialist/senior registrar and consultant guiding and overseeing their work. Interns also work with other allied health professionals as part of the multidisciplinary team. During this time the intern will learn to make clinical decisions in a supervised environment and have direct responsibility for patient care, the extent of this responsibility being monitored and graded according to their level of experience.
Clinical Training: clinical training incorporates both formal teaching of clinical skills and the more informal training that occurs as part of clinical service. It is through this combination that the intern gains the necessary skills such as basic life support (BLS), appropriate clinical note keeping, phlebotomy, cannulation, obtaining informed consent.
Clinical Education: medicine is an extensive subject and it is important that the Intern continues to learn and expand their knowledge base. Through a structured clinical education programme the intern will learn important practical knowledge such as the management of acute medical problems but also learn equally important matters such as the importance of infection control, communication and gain an appreciation of evidence based medicine.
The ‘Standards for Training and Experience required for the granting of a Certificate of Experience to an Intern’ and the ‘Guidelines on Medical Education and Training for Interns’ have been approved by the Medical Council and are outlined in Appendices 1 and 2.
Following reform of the intern year and the establishment of Intern Training Networks, it was agreed that the Intern Training Networks would work together to provide a nationally agreed intern educational programme. This curriculum is the result of collaboration between the Intern Coordinators from each Network in conjunction with those involved in intern training within their network, the Postgraduate Training Bodies and the other stakeholders represented on the Medical Council’s Intern Training Sub-Committee.
The programme is fully consistent with the aims and objectives of internship as outlined above; in addition, the Medical Council’s Eight Domains of Good Professional Practice (Figure 2) have been incorporated into 3 overlapping and interdependent modules each of which emphasises specific aspects of Intern Core Competencies and the Guide to Professional Conduct and Ethics for Registered Medical Practitioner adopted by the Medical Council (Figure 3). From these three modules each Intern Network will take responsibility for devising content for specified modules which will then be available to all networks, forming the basis of the NITP. This will be centred around 12 months of clinical service and training supported by a structured education and training programme that will allow interns to become competent independent doctors providing high quality and safe medical care to patients.
Good clinical judgement is central to safe patient care and describes the process through which clinical decisions are made; patient care comprises of a series of clinical decisions, each clinical decision being based on a combination of clinical information and clinical knowledge. Clinical information is gained through detailed history taking, physical examination and investigations while clinical knowledge merges theoretical knowledge, understanding of disease processes and clinical experience.
During the intern year, the intern embarks on a process of lifelong learning in a supervised environment where interns will work to develop, improve and enhance their clinical judgement. This will combine learning of clinical skills, continuing the process of scholarship begun as an undergraduate, undertaking responsibility for patient care so that interns will become competent independent practitioners with knowledge and understanding to inform and maintain best practice.
The principal components to clinical judgement are:
By the end of the intern year the intern must understand the importance of clinical history, physical examination and appropriate investigations to determine clinical diagnosis and management. The intern must be able to:
The possibility of pregnancy should be considered in all women of reproductive age undergoing surgery, anaesthesia and procedures involving ionising radiation; similarly the possibility of pregnancy should be considered when prescribing medication.
Clinical assessment of a patient often involves a physical examination as well as relevant history-taking. Interns should explain what this examination will entail and seek permission from the patient before making a physical examination.
Where an intimate examination is necessary, interns should explain to the patient why it is needed and what it will entail. Interns should also let the patient know that they can have a chaperone present if they wish.
By the end of the intern year, the intern should be able to:
Over the course of the intern year, and in particular when rostered “on-call”, interns will have to respond to patients who are acutely unwell. The intern is expected to perform an immediate assessment, initiate resuscitation, formulate a differential diagnosis, select the relevant urgent investigations and call for help if necessary; the intern should also be able to accurately interpret the results of urgent investigations, initiate a management plan and reassess the patient as required.
The following are common medical emergencies that the intern is expected to be able to manage in a safe and competent manner by the end of intern year:
To prescribe drugs safely an intern must:
To prescribe blood and blood products safely an intern must:
Interns should read the Medical Council’s current Ethical Guide Section C (Medical Records and Confidentiality).
The ability to communicate is essential to clinical practice; medical practitioners must have effective verbal and written communication skills to enable the exchange of information between patients and their families as well as with clinical and non-clinical colleagues.
To ensure good communication interns must at all times:
Certain features of communication that are critical in providing safe patient care and that are more specific to medical practice include:
Clinical notes are critical in providing safe patient care, are often the only reliable means of charting a patient’s progress and may also be used as a legal document. Considering this, on completion of the intern year, the Intern must understand both the clinical and medico-legal importance of good note keeping including that all clinical notes:
At the end of the intern year an Intern should understand the appropriate procedures to obtain informed consent including the following:
Interns are advised to read the Medical Council’s current Ethical Guide Section D (Consent to Medical Treatment) and Appendix A (Information for patients prior to giving consent) 3.
All medical practitioners must demonstrate a commitment to fulfilling professional responsibilities and duties; the Medical Council of Ireland has outlined these duties in its Ethical Guide. Throughout the intern year, interns are expected to understand their professional and personal responsibilities as doctors both as they relate directly to their intern year but also to their professional career as a whole.
The major professional and personal duties expected of interns are:
The Medical Council of Ireland is statutorily responsible for granting Certificates of Experience to medical practitioners who have successfully completed a period of internship7. To ensure that all interns are adequately trained each Intern Network will provide and oversee an Intern Training and Education Programme. This programme will comprise of on-site clinical training, formal curricular elements and e-learning elements7.
Each intern will be expected to satisfy the Medical Council’s criteria for the granting of a Certificate of Experience, in accordance with requirements set by the Medical Council. The relevant Intern Network Coordinator will formally sign-off for each intern in a dual capacity as Intern Network Coordinator and a registered specialist affiliated to their Postgraduate Medical Training Body.
The Intern Training Curriculum comprises of three fundamental elements; Clinical Judgement; Communication and Professional Development (Figure 3b) which are derived from the Eight Domains of Good Professional Practice (Figure 2). Each intern will need to demonstrate a competence in all three elements. While each Intern Network will vary in the exact method of assessment the major tools used to assess intern progress and capability will include:
Each year a small number of interns are likely to have behavioural, performance or educational difficulties; remediation is the process of addressing such difficulties. Effective remediation requires the prompt recognition of underperformance in a structured and transparent manner. This allows an accurate definition of problems which can then be managed appropriately. Through assessment, investigation, review or appraisal, remediation aims to enable interns in difficulty to practice safely.
Interns are subject to the grievance and disciplinary procedures in place in their employing authority. In the case of HSE hospitals and services, details are provided in the “HSE Employee Handbook” and “Disciplinary Procedures for the Employees of the Health Service Executive”, which is available online and from the employing hospital8,10. Interns employed in voluntary hospitals/services and private hospitals will be subject to the grievance and disciplinary procedures in place in that hospital/service, a copy of which should be sought from the HR department in the hospital/service. In the case of interns in General Practice, interns will ordinarily be contracted through the “base” hospital for the period of the GP rotation and will be subject to procedures in place in that hospital8,9,10.
The NITP seeks to establish a single robust remediation process that will enable the prompt identification and support of interns in difficulty. The support offered will include simple advice, formal mentoring, further training, re-skilling and rehabilitation. This process is currently under development.
Patient safety and quality of patient care should be at the core of the health service delivery that a doctor provides. A doctor needs to be accountable to their professional body, to the organisation in which they work, to the Medical Council and to their patients thereby ensuring the patients whom they serve receive the best possible care.
Good medical practice is based on a relationship of trust between doctors and society and involves a partnership between patient and doctor that is based on mutual respect, confidentiality, honesty, responsibility and accountability.
Medical practitioners must demonstrate effective interpersonal communication skills. This enables the exchange of information, and allows for effective collaboration with patients, their families and also with clinical and non-clinical colleagues and the broader public.
Medical practitioners must co-operate with colleagues and work effectively with healthcare professionals from other disciplines and teams. He/she should ensure that there are clear lines of communication and systems of accountability in place among team members to protect patients.
A medical practitioner must understand how working in the health care system, delivering patient care and how other professional and personal activities affect other healthcare professionals, the healthcare system and wider society as a whole.
Medical practitioners must systematically acquire, understand and demonstrate the substantial body of knowledge that is at the forefront of the field of learning in their specialty, as part of a continuum of lifelong learning. They must also search for the best information and evidence to guide their professional practice.
Medical practitioners must demonstrate a commitment to fulfilling professional responsibilities by adhering to the standards specified in the Medical Council’s “Guide to Professional Conduct and Ethics for Registered Medical Practitioners”.
The maintenance of Professional Competence in the clinical skills domain is clearly specialty-specific and standards should be set by the relevant Post-Graduate Training Body according to international benchmarks.
These standards have been drawn up in fulfilment of the Medical Council’s responsibilities under Part 10 of the Medical Practitioners Act 2007 to specify and publish in the prescribed manner the standards for training and experience for interns which is required for the granting of a certificate of experience (section 88 (3) (d)).
Training and experience must comply with the Medical Council’s policy on length of internship and approved rotations; that is, a minimum of a total of twelve months, which should normally be consecutive, of which at least three months must be spent in Medicine in general and at least three months in Surgery in general. As part of this twelve-month period, an intern may also be employed for not less than two months and not more than four months in the following specialties:
The training site must be affiliated with a medical school and/or a postgraduate training body/network and/ or health system which is accredited by the relevant regulator. The responsible body for organising, coordinating, managing and assessing the training setting and the training process on the site must be clearly identified.
The intern year must comprise a combination of formal and informal training in an integrated manner, including theoretical learning, and practical training during service delivery. There must be:
There must be effective overarching supervision of the intern’s training and clinical practice by an identified clinician(s) of appropriately senior level, normally a specialist doctor who is recognised as a specialist by the relevant regulatory authority of the host country. The intern’s clinical practice should always be appropriately supervised by a medical practitioner of at least SHO level or equivalent.
There must be evidence of regular and constructive feedback and assessment by the supervisor/trainer who has knowledge of the intern’s development and performance and can verify their satisfactory progress. The supervisor/trainer must meet any requirements set by the Medical Council regarding the policy and process of final assessment and sign-off.
The intern must achieve a satisfactory performance in any assessment required by or administered by Council. This includes any assessment of communication skills required by or administered by Council. If, in a jurisdiction outside Ireland, there is an exit examination or other summative assessment at the end of the intern year, the intern must pass it.
The training environment must emphasise professionalism and the development and maintenance of the relevant knowledge, skills, attitude and behaviour, including communication skills, integrity, compassion, honesty, adherence to professional codes, respect for patients and their families, colleagues and self-care. The intern must be aware of, and comply with, the Medical Council’s “Guide to Professional Conduct and Ethics for Registered Medical Practitioners”, and the training should support these ethical standards.
The training site must have:
The number of interns on a site should be appropriate to the resources of that site, including its staffing at all levels while at the same time having due regard for patient care and comfort. The training site must emphasise the primacy of patient safety, and interns must be encouraged to raise concerns about ethical issues, should they arise, with their mentor, clinical supervisor and/or the hospital authorities. The intern must have access to appropriate advice and counselling should it be required.
Approved by the Medical Council 9th September 2010 and Revised by the Medical Council 14th April 2011
Guidelines on Medical Education and Training for Interns.
These guidelines have been drawn up in fulfilment of the Medical Council’s responsibilities under Part 10 of the Medical Practitioners Act 2007 to prepare and publish in the prescribed manner guidelines on medical education and training for interns (section 88(3) (b)).
These guidelines should be read in conjunction with the Medical Council’s “Standards for Training and Experience Required for granting of a Certificate of Experience” (click here) and “Part 10 rules in respect of the duties of Council in relation to Medical Education and Training (Section 88)” (click here) (please note that Rule 3 is the relevant rule for intern training).
Intern rotations must comply with the Medical Council’s policy on duration of internship and approved rotations. That is, internship must comprise a minimum of twelve months, which should normally be consecutive, of which at least three months must be spent in Medicine in general and at least three months in Surgery in general. As part of this twelve-month period, interns may also be employed for not less than two months and not more than four months in the following specialties:
The intern training site must be affiliated with a medical school and/or a postgraduate training body/network and/ or health system which is accredited by the relevant regulator; in Ireland, this is the Medical Council. The responsible body for organising, coordinating, managing and assessing the training setting and the training process on the site must be clearly identified.
The intern year must comprise a combination of formal and informal training in an integrated manner, including theoretical learning, and practical training during service delivery.
Interns must have regular, pre-arranged/scheduled formal education and training sessions, with learning opportunities that may include lectures, small group teaching, tutorials, case presentations and case-based discussions, participation in clinical audit, and attendance at relevant external courses.
Formal training for interns must include instruction in:
A programme for personal professional development must be part of the intern’s training year.
Interns must have, and utilise, appropriate resources and opportunities for self-directed learning.
The content of intern training and an intern syllabus / curriculum must be consistent with the "Eight Domains of Good Professional Practice"” approved by the Medical Council.
There must be effective overarching supervision of the intern by an identified clinician(s) of an appropriately senior level, normally a specialist doctor who is registered as a specialist or otherwise recognised as a specialist by the relevant regulatory authority.
Intern training sites must have the resources to support the education and training requirements specified in these guidelines.
Approved by the Medical Council 19th October 2010 and Revised by the Medical Council 14th April 2011
Dress code is an important aspect to professional practice and forms part of a doctor’s professional responsibilities as described by the Irish Medical Council. Appropriate professional dress should be maintained throughout all aspects of professional duties including regular working day, on-call, attending education and teaching and where possible should be adhered to when on the hospital campus. Although, most hospital and institutions will have their own specific Dress Code the following is a guide to appropriate professional dress:
The following clothing is not recommended:
Intern Assessment Form are currently utilised by all Intern Networks, the form is completed by the Supervising Consultant at the end of each intern post/clinical attachment and is signed by both the Supervising Consultant and Intern. It addresses the key elements needed to deliver safe and effective patient care and is used to monitor progress and address and deficits in knowledge and skill. Using all currently available forms, the National Intern Training Programme has devised this standardised form to encompass all the necessary essentials.
(beware - large file)
|Intern Network Coordinator:||Prof Paula O'Leary|
|Ms Geraldine McNamee
|BGH||Dr. Peter Wieneke|
|Bon Secours||Dr. Lucina Jackson|
|CUH||Dr. Íomhar O'Sullivan|
|KGH||Dr. Tom Higgins|
|Dr. Declan Herlihy|
|MUH||Prof. Terry O' Connor|
|MGH||Dr. Neil Cronin|
|Dr. Tony Heffernan|
|SIVUH||Mr. Patrick Sheahan|
|Clonmel||Dr. Niall Colwell|
Please note that this is an incomplete list.
Note: Some of the training courses and workshops listed above are financed by the intern training and education fund.