Opinion
Medical Internship: Fuss and Fact
By Dr. Ouma Oluga.
Focused Professional Practice Evaluation, often 12 months, is done for several reasons such as to ascertain or award privileges for medical practice. It basically spotlights competence and behavior.
Medical Internship is regarded worldwide as a framework for Evaluating Professional Practice in a focused way.
Practice means these interns have to see patients and perform procedures. Now that is serious. Practice is real work – a lot of technical and complex work that initiates the perofessional into a world of doctor(ship). In our case in Kenya, 27% of all medical work is done by medical interns. You will never notice who is an intern and who is not. It is not education. It is not training. And it is not volunteering. And it is not supervision per se (entirely). 90% of intern work is unsupervised at the time they deliver the service. They are alone with patients, making life and death decisions. Those decisions are evaluated not less than 8 hours later or when the intern calls on the superior.
What an internship policy should do is to define the conditions for which an intern can make decisions by self and those for which the intern MUST call a superior. Internship policy should not talk about pay. So do we understand the difference between evaluation of performance by specialists and supervision or training or volunteering?
The term medical intern has several nomenclature in different countries. In USA, they are house officers. In UK, they are junior drs. In Kenya, Public Service Commission/Department of Personnel Management used to call ‘us’ Medical Officer 2 or Dental Officer 2 or Pharmacist 2. Much of Africa calls them interns. A term not existent in developed world as far medical career is concerned.
In August 2016 when I led the development of first ever the schemes of service for doctors, we retained the names Medical/Dental/Pharmacist 2 as appearance on the payslip. The IPPD – which is the official Kenya Government pay structure – has the terms Medical/Dental/Pharmacist Officer 2. Medical Intern does not appear on the payslip.
For the CBA, We were very clear about the term intern just so that no one mischeaviously plays around it in the future. And 7 years have proven us right. Yet we also tied the payment evidence to the naming used in scheme of services. The PSC graduated the schemes sometime 2019 and called them career guidelines. Still retaining the temr Medical/Dental/Pharmacist Officer 2.
To summarize, you get no certificate after completion of internship and no qualification more than what you got in med school after completion. But if evaluated positively you get registered (permanently in the roll), not licensed. The interns are already licensed. And every year every doctor must be licensed anyway as long as they are still practising. So internship gains you entry for registration as a doctor.
Let us say more about licensing. Licensing is a temporary permit to make medical decisions. And yes it is temporary for all doctors. Whether you are a neurosurgeon or an intern. It lasts exactly 12 months in all countries on earth. Interns get theirs too for one year. Not different from any doctor.
Medical Internship is healthcare regulation in all definitions. And medical internship is work. It is labour and it is service in all definitions. It is employment. In the USA for example, hospitals get reimbursed by government based on numbers of house officers and residents they have.
There is need for us to have a deeper view around what makes healthcare regulation. And what constitutes labour. Internship is both. We must fulfill both obligations.
The writer is a former KMPDU Secretary General.
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