G

GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

1
 G
OG
OO
“Enhancing the quality and safety of medical care by focused and cost-
effective human resource development.” DO
Focused on: D
 Preparedness as first on-call doctors I
 Good first impression as first contact doctors NI
 A safe doctor as first contact
 Good warden for in-ward patients TN
 Good ambassador for better reflection
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E
ISSN 2536-8842

2
 G
GO
OO “There is a lot to learn from Good Intern
OD Programme”
Hon. Maithripala Sirisena
D
I (Minister of Health in 2014 and former His
Excellency the President of Sri Lanka)
IN
NT
TE
ER “Good Intern Programme is the best CPD

RN
programme I have seen in the region”
VidyaJothi Prof. Arjuna Aluwihare
N (Emeritus Professor of Surgery)
P
PR
RO
OG “Good Intern Program is a unique and an
GR innovative program for medical interns”

RA Dr.Palitha Mahipala

AM (Former Director General of Health Services)

MM
ME
E “Our goal is to enhance the quality and safety of
medical care by focused and cost-effective human
resource development”
Dr. Anuruddha Padeniya
(Founder, Good Intern Programme)

3
 G
OG
OO
DO
D
I
“It was a wonderful experience to work with a dedicated team”
Dr. Anuruddha Padeniya (Founder, Good Intern Programme)
NI
TN
ET
RE
NR
N
P
Dr. Dineshan Ranasinghe Dr. Chandika Epitakaduwa Dr. Prasad Colambage RP
OR
GO
RG
AR
MA
MM
Dr. Buddhika Mahesh Dr. Sameera Senanayake Dr. Rashan Haniffa
EM
E

Dr. HP Aluthge Dr. HND Soysa Dr. Samantha 4

Ananda
 G
GO
OO
OD
D
I
IN Dr. Anuruddha Padeniya

NT
TE
ER
RN
N Dr. ADTMS Dr. chandika Dr. Senal Fernando
P Tennakone Epitakaduw

PR
RO
OG
GR
Dr. CS Dharmaratne Dr. HND Soysa
RA
Dr. S. Ananda

AM
MM
ME
E
Dr. S. Athapatthu Dr. H. P. Aluthge Dr. WIN Wijesooriya

Dr. Udayi Dr. Sarada Dr. G. Thangaraja

Gunawardana Kannangara
 G
OG
OO
DO
D
I
NI
TN
ET
Dr. D.R.K. Dr. D.W.Y.L.
RE
Dr. T.G.
Dharmapriya Dehigaswaththe Nanayakkara NR
N
P
RP
OR
GO
RG
Dr. R.A.Y.E. Dr. M.R.U.N. Dr. H.A.P.S. AR
Rathnayaka Navodanie Newamali
MA
MM
EM
E

Dr. H.P.M.Lasantha Dr. Deshan Dr.Thejani

Walallawita Danthanarayana
6
 G
GO
OO
OD
D
I
IN
NT
Dr. A.M.C.C Dr. A.A.S.D Dr. D.C.
Adikaranayaka PERERA Ranasinghe
TE
ER
RN
N
P
PR
RO
OG Dr. Charuki Dr. H. H. Dr. G.K.H .C.
GR
Wijesooriya Malavipathirana Chandrarathna

RA
AM
MM
ME
E

Dr. W.S.S. Dr. R.M.K.N Dr. B.A.M.

Wijeyeratne Rathnayake Sasankani

7
 G
OG
OO
DO
D
I
NI
TN
Dr. J.S.R De Saram Dr. W.M.P. M.Wijerathna Dr. W.W.K.S. Dututissa
ET
RE
NR
N
P
RP
OR
Dr. D.D Goonawardane Dr. S.Madurapperuma Dr. Chathurika Sagara GO
RG
AR
MA
MM
EM
E

Dr. Sathya Udara Miss. Manasi Dayarathne Miss. Dinukshi Balasuriya

Design & Page Setting by - Mrs. H.A.D.P. Dulanjali

 G
GO
OO
OD All of us serving in the health sector can be rightfully proud about that fact
D that, Sri Lankan health system has been continuously successful in achieving
excellent health indicators comparable with developed countries, in a
I background of limited resources and albeit receiving a relatively modest

IN
percentage from the GDP, thus providing a fine example to rest of the world.

NT
Especially, at a time when the entire world is fighting a pandemic, and when
many rich and powerful nations are failing with thousands of deaths, Sri
TE Lankan health system could withstand and control the pandemic with zero
community spread and minimum deaths in the region. Towards achieving
ER these remarkable achievements, the pivotal role played by the doctors in

RN
government service is tremendous and is highly admirable and appreciated.

GMOA has always been working in the frontline for many national scale issues
N while improving the welfare of Medical Officers, finding solutions to their
P grievances and achieving their financial stability as top priorities. Along with
achieving financial stability, it is crucial and seminal that the quality and
PR safety of the service aspect be improved to meet international standards.

RO According to scientific evidence, the internship is an important period that

OG
determines the quality of human resources of the medical profession.
Nonetheless, over the years, the full potential of an intern was not adequately
GR appreciated in order to receive the maximum outcome. Hence, having
identified this deficiency, the GMOA pioneered a program to bridge this gap
RA with the vision of “generating self-satisfied Intern Medical Officers having

AM
competence, compassion and delivering optimum patient care” and our team
coined this as the “Good Intern Programme”.
MM Thus, the Good Intern Program-2020 marks the eighth consecutive year of
ME the successful implementation of the Good Intern program which was first
launched in 2013 with the broad aim of improving the quality of medial
E internship and thereby strengthening the building blocks of the health
system.

We hope that this program will make you a better Intern Medical Officer with
a strong foundation. We would highly appreciate your constructive criticism
and comments in order to improve this programme. We believe your
response will go a long way in improving the patient care in the country.

9 Dr. Anuruddha Padeniya,

President,
Government Medical Officers’ Association
 G
OG
OO
DO
Among many determinants related to the quality of health care, the
standards of human resources comes as a baseline factor particularly D
because medicine is not just a field with knowledge but more of a complex I
integration of skills, competencies and an humanistic approach at its best.
Therefore, Human Resource Management and Development is invariably NI
useful to improve efficiency, effectiveness, productivity, quality and safety TN
of any healthcare delivery system in the world. Here, the focus should be
set upon to develop a competent individual with necessary knowledge, ET
skills, attitudes, values, beliefs and creative abilities, so that health care
system can accomplish its goals in providing optimum care to the patients. RE
Therefore, ultimate benefit of Human Resource Development in health NR
sector goes to the people of this country. Specially in a era with enhanced
medical problems and increased patient expectations improving the N
human resource capacity linked to health is of paramount importance. P
Of these available human resources of various levels, intern medical RP
officers play a significant role because they have an unique place as a first
contact person, gate keeper of health and coordinator of care. To OR
accomplish these, it is worthwhile to have an targeted training and an GO
orientation for them with adequate exposure on soft skills such as
communication, working with peers, superiors and subordinate staff, RG
maintenance of professionalism and adherence to the health
administrative guidelines of the country. These soft skills should be
AR
enhanced to prevent unwarranted issues in their future career and to MA
provide productive, quality and safe health care delivery for the people of
this country. MM
EM
Therefore, this “Good Intern Program – 2020” is a much welcomed human
resource development initiative in the current context of our health system E
and it is my pleasure to send my sincere appreciation to the Education,
Training and Research Unit of Ministry of Health and the Government
Medical Officers’ Association for organizing this noble event.
.

Dr. Anil Jasinghe

Director General of Health Services
Ministry of Health
10
 G
GO
OO
OD In the current health system, the medical officers have a significant role as
D the key health officials to maintain and uplift its quality and its standards.
I In this process, the Medical Internship is a climacteric phase, as it marks
the entry point of these doctors in to the health system. It is a training
IN attachment offered as a foundation to the local and foreign medical

NT
graduates, prior to their recruitment to the healthcare system of Sri Lanka.
For the maximum yield during this internship, these medical graduates
TE who will soon become the backbone of the health system in the country,
should be ideally oriented to their working environment before
ER commencing their service in respective stations. This will allow the

RN
optimum utilization of these young professionals who are fresh to the
health system, while guiding them for their initiatives and actions during
N their journey as intern doctors. Moreover, they should be enriched with
P essential qualities such as kindness, courteousness and empathy towards
patients especially as doctors are said to be the voice of the poor and the
PR sick.

RO Given all these, training these young professionals through this “Good

OG
Intern Program” is a timely and much needed initiative for the betterment
of the health system of the country. The collaboration of the Government
GR Medical Officers’ Association in this noble mission is encouraging and is
admirable as they have gone beyond traditional trade union concept to
RA uplift the medical profession.
AM Herewith, I would like to express my sincere gratitude and appreciation to
MM all those who worked hard for this “Good Intern Program – 2020”. Finally,

ME
I wish to acknowledge the contribution of the Education, Training and
Research unit of Ministry of Health for their effort to make this program a
success.
E

Dr. Sanjeewa Munasinghe

Secretary
Ministry of Health

11
 G
OG
Part – A Introduction to the Good Intern Programme………..12
OO
Different roles of a Medical Intern………………………………. 14 DO
Executive Summary ……………………………………………….16
What is expected of the Good Intern Programme ……………...18
D
Evolution of the Good Intern Programme..…………………….. 19
I
Memories of the GIP……………………………………………….23 NI
TN
Part – B Basic facts about Internship …………………………...29
Role of Internship in Professional Development of an Intern
ET
Medical Officer….……………………………………………….....30 RE
Role of Internship in Health Sector Development……………...31 NR
Necessity of the Good Intern Program…………………………..32
N
Part – C Structure of the…………………………………………..35 P
Structure of the Good Intern Program 2020……………………..36 RP
Module 1: Residential second-language training program for
11days……………………………………………………………….37
OR
Module 2: Improving essential clinical skills and knowledge...40 GO
Module 3: 02-day workshop that covers aspects of “Good RG
Medical Practice” in an Intern Medical Officer………………… 43
GOOD INTERN PROGRAMME 2020 (Day 01) – 05th September
AR
2020, Saturday …………………………………………………….. 44 MA
GOOD INTERN PROGRAMME 2020 (Day 02) - 06th September MM
2020, Sunday……………………..………………………………… 46
Parallel projects .…………………………………………………...48
EM
Log Framework matrix of GIP-2020 ……………………………..67 E
Part – D ……………………………………………………………. 68
Selected findings of the research projects of The Good Intern
Program……………………………………………………………..68
Acknowledgements.………………………………………………. 78

12
 G
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

13
 G
OG
OO
DO
D
I
NI
TN
ET
RE
NR
“The Good Intern Programme”: a novel concept
N
It is said that “A good doctor understands responsibility better than P
privilege and practices accountability better than business”. RP
Being a doctor is an enormous responsibility, but still is an opportunity
OR
only a few can achieve to do a real service and to cause a real impact for GO
the society. Hence, the medical profession is regarded as one of the most RG
trustworthy, fulfilling, caring and respected professions worldwide. The
AR
medical internship is the entrance for this noble profession and the
starting point of the journey in the health care system. MA
MM
Medicine is a highly dynamic field and is constantly evolving in parallel to
EM
multiple regional and international trends such as demographic
transitions, new disease patterns and emerging infections, technological E
advances, and new discoveries. So the medical profession by nature is
linked to many diversities and intricacies that need prompt recognition,
evaluation and intervention. Within this field of medicine, intern medical
officers have an irreplaceable role with several incumbencies and different
roles as mentioned in Figure 1.

14
 G
GO
OO
OD
FIRST FIRST WARDEN AMBASSADOR
D ON- CALL CONTACT TO DURING THE
I PATIENTS HOSPITAL
STAY

IN
NT
TE
Should Provides the Communicati For better
ensure first on and other reflection
ER preparedness impression of
the unit and
life skills
should be
RN the health sharpened
system and
N the profession
P
PR Figure 1: Roles of a medical intern

RO To achieve these various roles, medical interns should work in close liaison
OG with other health professionals of various levels as a team leader and a

GR coordinator of care. Due to this vast spectrum of the expectations by the

RA
healthcare system, they invariably face an extremely challenging period
especially at the beginning of their internship. Since the overall
AM performance of the intern doctors reflect upon the quality of care, if these
MM expectations are not met by the interns, the unit they are attached as well

ME
as the health system, experiences a vulnerable period. Thus, preparation
and orientation of these intern medical officers allowing a gradual
E transition for their internship is of paramount importance.

Nonetheless, for decades there has been a deficiency of a comprehensive

programme that provides a systematic guidance with regard to these
aspects in Sri Lanka, except for few ad hoc attempts from time to time.
Furthermore, documented findings of comprehensive audits or research
15 on intern medical officers’ performance were not commonly found until
2013.
The GMOA identified this timely requirement, and to bridge this gap
G
between the medical graduation and the internship, the concept of OG
establishing a comprehensive preparatory programme was developed and OO
enhanced by Dr. Anuruddha Padeniya with Dr. Rashan Haniffa, Dr.
DO
Sameera Senanayake, Dr. P.K. Buddhika Mahesh, Dr. Dineshan Ranasinghe
and Dr. Chandika Epitakaduwa. Along with them the Executive Committees D
of the GMOA too, have contributed immensely for the continuous I
successful evolution of this initiative. The programme was coined as the NI
Good Intern Programme and was implemented for the first time in 2013.
TN
It was pioneered with the broad aim of improving the quality of the ET
internship and a worthy investment for the present and the future of the
RE
intern medical officers, their patients, as well as for the health system. By
today, the programme had been conducted successfully for seven years NR
helping thousands of pre interns each year. This is the eighth consecutive
N
year the Good Intern Programme is being conducted. P
The collaboration of the Ministry of Health in all the activities of this RP
programme is greatly appreciated. OR
GO
RG
AR
MA
MM
EM
E

16
 G
GO
OO Today, the field of medicine is facing an era of rapid transformation with

OD
new challenges and intricacies upon both the healthcare sector and the
medical profession. The emerging global trends and technological
D advances together with increasing patient expectations warrant dynamic
I changes in the healthcare sector. As of today, the whole world is facing a
IN pandemic of COVID – 19, with virtually no region left untouched. The speed

NT
of the spread and the alarming death rates have made many countries and
jurisdictions rethink their standards of medical profession. The Sri Lankan
TE health sector is also becoming more demanding day by day, with
ER government policies of uplifting its quality analogously to the post war

RN
development of the country. At the same time, the number of doctors is on
the rise. Given all these, restructuring and updating our health sector to
N meet these national and international trends is challenging, but is a timely
P requirement.

PR Within that process, improving the standards of the medical internship is

RO a top priority because of the vital role in the current health setup. Hence
OG more emphasis is needed in quality development of the future intern

GR medical officers including enhancement of their soft skills and filling the

RA
gaps in the transition from undergraduate education to medical internship.
For all these, a programme named “Good Intern Programme” was
AM introduced in 2013, which is well structured, well focused and demand
MM oriented;

ME Well structured: The programme was designed in three modules so

E that it will deliver the inputs needed for pre-interns
in a structured manner. Pre-interns were trained in
both small and large groups as the resources
permitted during these modules.

Well focused: During the program, areas that haven’t been focused
17 on in the undergraduate education were given more
weight and a multi-modality knowledge delivery
 system was adapted such as short dramas, video
G
assisted learning, and focused lectures with OG
symposia. Role models were invited as resource OO
personnel and as chairpersons to guide the future
DO
doctors of the country. Supplementary booklets
were distributed among pre interns. D
Demand oriented: The gaps between the current context and the I
existing demand were identified by both qualitative NI
and quantitative studies with focus on knowledge of
the pre interns on administrative issues, future
TN
medical career, attitudes on medical career and ET
resources available. RE
NR
Moreover, it was planned to be executed with minimum funding to achieve
a cost-effective outcome. Further issues on funding was resolved with the N
collaboration of the Ministry of Health. From the process of online
P
registration most of the organising and administrative issues were handled RP
with new innovations that were particularly demanded by the new social OR
requirements of COVID-19 prevention guidelines this year.
GO
It should be appreciated that this programme was primarily focused on
RG
vital but often neglected aspects of internship such as second language
training, communication, documentation, teamwork, ethics, continuous AR
professional development, planning future careers and essential clinical MA
skills. The programme is an annual event with new improvements every MM
year, based on feedback from the participants and other stakeholders.
EM
What is unique about the Good Intern Programme: E
 A low-cost timely intervention
 A well-focused program aimed to improve patient safety & quality of care
 Demand oriented
 National role models were used to inspire the budding doctors
 Films, dramas, videos, discussions & lectures were used as teaching materials
 Collaborated with appropriate stakeholders
18
 G
GO
OO
OD Concept
D
I Medical internship marks the blossoming of a medical graduate emerging
from the medical faculty. Hence improving the quality of internship
IN becomes a worthy investment for the present and the future of the intern
NT medical officers, their patients as well as for the health system.

TE
ER
Vision

RN “Enhancing the quality and safety of medical care by focused and demand
oriented human resource development in a cost-effective manner”
N
P
Mission
PR
RO To prepare the pre-interns and empower the interns for an internship
period with a culture of “Good Medical Practice”
OG
GR Objectives of Good Intern Programme

RA 1. Optimisation of the medical professional

AM 2. Enhancing standards in health care

MM
3. Human resource development
4. Health system development
ME 5. Ensuring patient safety
E 6. Upgrading the quality of patient care delivery
7. Creating a culture of research and innovations
8. Enhancing equity
9. Enhancing accountability

19
 G
OG
OO
2013  The necessity of improving the quality of the DO
April medical profession was highlighted by the
President of the GMOA. D
 Discussions were held with the Secretary of I
Health to discuss the best solutions. The
necessity of a structured orientation programme
NI
was highlighted at these discussions. TN
2013  Discussions were held with the Attorney General,
May Mr. Palitha Fernando, to improve the
ET
documentation skills of the doctors. RE
 Decided to have a 10-day programme for the pre
interns. NR
2013  A needs assessment for planning purposes was
June conceived, research areas were identified, and N
ethical clearances were obtained. P
2013  A draft programme was developed and RP
July distributed for comments to all consultants and
university academics. OR
 Amendments were made according to the
comments.
GO
2013  Due to logistic reasons, the 10-day programme RG
August was reduced to 4 days.
 A supplementary handbook for the interns was AR
published. It was comprised of the areas which MA
were not covered during the GIP.
 An expanded programme consisting of 3 main MM
modules and 10 parallel and associated projects EM
was planned.
 Secretary of Health Ministry approved the project
and agreed to provide funds for the programme.
E
2013  Discussions were held with DDG (ET&R).
September  Data collection for the research programme
commenced.
2013  www.medicalintern.lk website was launched.
October  The four-day programme was finalized

20
 G 2013  The “Handbook for Medical Interns” booklet was
GO
November finalized.
 The groundwork to develop an intern support
OO centre was initiated.

OD
2013  Module 03 of the inaugural “Good Intern
November Programme” was conducted in Colombo.
D
I 2014  The planning process for the Good Intern Program
April 2014 was initiated.
IN  Groundwork for the 3 modules and the parallel
projects was started.
NT 2014  The “Handbook for Medical Interns” was revised.
TE September

ER 2014  Web-based registration and Module 02 were

RN
October commenced. An island wide five-day training
programme on clinical skills for the doctors was
N conducted.
P 2014  Module 03 of the 2nd “Good Intern Programme”
13th commenced in Colombo.
PR November
2014 
RO
Post-evaluation of the Good Intern Programme
December (GIP) was carried out.
OG 2014  Module 01 of the 3rd “Good Intern Programme”
GR December commenced.
RA 2015  Module 02 of the 3rd “Good Intern Programme”
AM January was planned for two phases: simulation training

MM
session and a ward-based clinical training
program.
ME 2015  Research on medical documentation and
February qualitative research on the necessity of the GIP
E was planned.
2015  Web-based registration and Module 02
March commenced.

2015  The objectives of Module 3 were updated.

July

21 2015  Web-based registration and Module 03

August commenced.
 2015  Module 03 (workshop covering aspects related to
G
October 5th Good Medical Practice) of the Good Intern OG
Program commenced.
2016  Tamil Training Programme renamed as Native
OO
January Language Training Programme DO
2016  Registration for the Native Language training for D
February the Pre intern medical officers commenced I
2016  Module 02 Phase I – Registration for a 2-day NI
March programme on Essential Hand of skills program TN
commenced
ET
2016  Registration for Module 02 phase II, 6-day skills
June programme commenced.
RE
NR
2016  A 6-day skills programme commenced
July N
P
2016  Registration for a 3-day workshop commenced
September  Resource persons were invited RP
OR
2016  GIP 2016
November GO
2017  Registration for the Module 01, Native Language RG
April training-2017 commenced AR
2017  Module 02 Phase I – Registration for a 2-day MA
May programme on Essential Hand of skills
programme commenced.
MM
2017  Discussions on improving the quality of the EM
July programme were carried out
E
2017  Module 03 of Good Intern Programme developed
August to a 2-day workshop and registration
commenced.
2017  A 6-day skills programme commenced
September

2017  Module 03 of Good Intern Programme, workshop

November covering aspects related to Good Medical 22
Practice was held at Colombo
 G 2018  Registration for the Native Language training for
GO
Feb the Pre intern medical officers commenced

OO 2018  GIP 2018

OD
May

D 2019  Registration for the Module 01, Native Language

I Feb training-2019 commenced

IN 2019  Registration for Medical Documentation and

communication skills programme commenced
NT
March

TE 2019 July  Module 03 of good intern programme developed

to a 2 – day workshop and registration
ER commenced
RN 2020  Registration for Medical Documentation and
communication skills programme commenced
February
N
P 2020  Registration for the Modified Good Intern
Programme commenced
PR
February

RO
2020  Registration for Medical Documentation and
August Communication Skills Programme commenced
OG

GR
2020 A 6 day Clinical Skills programme commenced
August
RA
 Module 03 of the Good Intern Programme
AM
2020
September developed to a 2 – day workshop and
MM
registration commenced

ME
E

23
 G
OG
Good Intern Programme-2013 OO
DO
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

24
 G Good intern Programme-2014
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

25
 G
Good intern Programme-2015 OG
OO
DO
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

26
 G Good intern Programme-2016
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

27
Good intern Programme-2017
G
OG
OO
DO
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

28
 G Good intern Programme-2018
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

29
Good intern Programme-2019
G
OG
OO
DO
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

30
 G
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

31
 G
OG
OO
DO
Within the medical profession, the medical internship marks a climacteric D
phase, where medical graduates are exposed to various challenges and I
intricacies that allows them to develop essential clinical and other related NI
knowledge and skills to become an independent doctor in the future. It is TN
the shift from theory to a practical setup, and its successful completion is
recognized by SLMC registration.
ET
RE
Internship; NR
 Consolidates and upgrades theoretical knowledge
 Develops professional judgment N
 Develops technical, clinical, personal, and professional skills P
 Helps to develop strategies to deal with the professional and RP
personal pressures you may encounter OR
 Helps to explore personal career goals and expectations
GO
 Teaches an intern to work within an ethical and legal framework
 Trains an intern to contribute to a multidisciplinary health care team RG
 Trains an intern to take increasing responsibility for patient care AR
MA
However, albeit their critical role in the health care delivery team, in the
MM
Sri Lankan context, interns are often being neglected with no audit or
governance processes for the systematic evaluation of their role. EM
E

32
 G
GO
OO
OD A health system is a network of organizations, institutions, and resources
D that makes arrangements to provide equitable, comprehensive and
I integrated health services to the community. It serves to enhance the

IN health of the population in the most effective manner possible in light of

NT
available resources and competing needs, and it holds the accountability
for the clinical and economic outcome related to health in the community
TE it serves.
ER
RN
The World Health Organization (WHO) has introduced analytical
framework for the health systems using a model structure that
N disaggregate it into 6 building blocks (Figure 2).
P
PR
RO
OG
GR
RA
AM
MM Figure 2: Health system building blocks (Source WHO)
ME
E Intern medical officers have a pivotal role that spans across all the 6
building blocks identified by the WHO as being essential to ensure health
care access, coverage, patient safety and quality.

33
 G
OG
OO
DO
As mentioned above, in the journey of becoming a competent and
independent medical practitioner, the medical internship is a transitional D
period and a crucial milestone to improve knowledge and skills, as well as
I
for professional development. NI
The field of medicine is changing
TN
ET
With the rapid modernization of the world, the medical filed has also
become highly dynamic in parallel to the changes in technology and RE
sociodemographic characteristics. The public perception of health care NR
and their expectations have mounted tremendously owing to increasing
accessibility to the latest knowledge. Hence, they justifiably seek and N
demand the best care possible.
P
RP
To cater for those demands, patient care is thus obliged to evolve and OR
improve rapidly. Consequently, it has branched out into specialties,
GO
subspecialties, and super-specialties, with a vast knowledge and scientific
material accumulated. Evidence-based practice is the accepted mode of RG
patient care delivery today and in addition to knowledge, the skills and AR
competencies must also improve to meet the standards of care. MA
Evolution of Internship MM
In the early years, the traditional role of the Intern Medical Officer was EM
limited only as a service provider, as a part of the health care service
delivery team. However, dynamics of the health sector have evolved in
E
such way that, in the current context, interns, like other health care
professionals are expected to function in many roles with numerous
incumbencies and responsibilities. In summary, they include -

 Maintaining a good doctor-patient relationship

 Maintaining a good personality and professionalism 34
 Having concern for ethical issues
 G  Working in a team and maintaining good interpersonal

GO relationships

OO
 Communication skills
 Continuous professional development
OD  Medical research
D  Administrative processes
I  Medico-legal aspects

IN
 Medical Documentation
 Planning for future career prospects
NT
TE
Drawbacks in the current setup

ER In many countries around the globe, there is a gradual transition from

RN
medical undergraduate to the internship. However, in Sri Lanka, there is a
lack of this gradual takeover process - with a compulsory shadowing
N period in the wards between departing and arriving interns - as in other
P countries. Even in those countries, overall patient outcomes have been

PR
proven to be poor with the junior medical officers’ changeover. Thus, the
abruptness of the transition from medical curriculum to the internship in
RO Sri Lankan health system is invariably detrimental for the overall quality
OG standards.
GR
RA
Furthermore, for the maximum yield, the internship should ideally
commence soon after the completion of the medical degree without any
AM time lapse. This will ensure familiarity and will allow better cultivation of
MM clinical knowledge & shaping of skills of the graduates. Nonetheless, in the

ME
Sri Lankan context, there is a delay of more than 10 months from the
completion of the medical degree to the commencement of internship,
E which is not ideal.

In addition, intern recruitment and the placement system in the Sri Lanka,
does not allow interns to get a prior opportunity to identify the hospital or
their specialty until just before the commencement of their internship. This
allows very little preparation and orientation for internship. As a result of
35 all the above factors, the internship poses many restrictions for maximum
outcome and may have significant adverse effects on patient care.
Emerging challenges for Interns
G
OG
The financial stability of medical professionals has shown a substantial
improvement over the past few years and for the first time in Sri Lankan OO
history doctors are eligible for a 6-figure salary. However, there is a DO
significant debate among both patients and within the medical profession
itself, on an analogous improvement of the standards of quality patient
D
care and the professionalism of doctors.
I
NI
Particularly, major deficiencies have been identified with regard to TN
communication skills, medical documentation and safe prescribing. As
ET
highlighted above, this may be due to the fact that knowledge, skills, and
attitudes of the medical professionals are not developing in the required RE
manner or possibly due to heightened awareness of patients and media, or NR
a combination of the above.
N
Bridging the gaps of medical professional development P
Internship is the entrance for medical graduates to become medical RP
professionals and the concluding step before licensing them as doctors. OR
However, there have been significant deficiencies in the process of
GO
internship.
RG
The beginning of internship has been linked with high levels of anxiety, AR
burn down, stress and uncertainty for an unguided Intern Medical Officer. MA
Given the need for safe and effective patient care, the intern medical
MM
officers’ wellbeing is especially important. However, up to 2013, there was
no mechanism to systematically orient pre-interns for the internship EM
following their completion of the MBBS degree.
E
To bridge this gap, annually from 2013, the Good Intern Programme was
successfully conducted. The programme expects to orient every batch of
pre-interns and prepare them for a high-quality internship. It is updated
every year through research and feedback from interns and medical
professionals.
36
 G
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

37
 G
OG
OO
Main Programme
DO

Module 1: D
Residential second-language training program for 11 days I
Module 2: NI
Phase I: Medical Documentation workshop
Phase II: Hospital-based clinical training programme of six days
TN
Module 3: ET
A 2-day training program covering aspects of “Good Medical Practice” RE
in relation to an Intern Medical Officer
NR
Parallel projects
N
1. Strengthening of the “Internship supporting centre” P
2. Publishing the 3rd edition of the “Handbook for medical interns”
3. Updating of the website www.shri.lk RP
4. Strengthening of the adverse event reporting system OR
5. Conduction of researches on medical internship
GO
6. Familiarization of the research culture to the pre-interns
7. Facilitation of IT based educational resources and Continuous online RG
medical education. AR
8. Publishing the 3rd edition of “Handbook on Communication Skills for
medical interns” MA
9. Publishing the booklet on “Effective use of laboratory services” MM
10. Distribution of a booklet on “Emergency obstetric management”
EM
11. Standardizing the Competency on Tobacco & Alcohol among doctors
in Sri Lanka (TAP Q Project) E
12. Continuation of website www.saukya.lk
13. Continuation of “Doctor Tips” SMS service
14. Standardizing the competency among pre-intern doctors regarding
Prevention, Detection, and Management of Tuberculosis in Sri Lanka.
15. Production of a mobile app for National Emergency National Protocol
16. Diagnosis card writing simulation programme
17. Malaria awareness programme for interns
38
 G
GO
OO Module 1: Residential second-language training program for
11days
OD
Background
D Effective doctor-patient communication is a central clinical function, and
I the resultant communication is the heart and art of medicine and a central
IN component in the delivery of health care irrespective of the culture or

NT
race. Hence, the fluency of the second language is essential for the medical
officers to deliver quality health care. Overall, this is valuable to all
TE Government Officers to maintain an efficient public service, to ensure that
ER all citizens have access to public services irrespective of cultural or

RN language differences, and for national reconciliation.

N Having identified this need, the government introduced the “National

P Language Policy” by PA circular 2007/7, where the proficiency in the
second language was made compulsory for all government servants
PR including doctors. It included a second language examination with written
RO and verbal components and government servants who fail the examination
OG would have the disadvantage of losing all their promotions and

GR
increments.

RA Interestingly, in the past, medical officers have proven their ability to

AM provide patient care adequately in both native and second language,

MM
enabling an island-wide service, even during the war, with minimal
language barriers. Nevertheless, this proficiency in the second language
ME was mainly gained through their personal commitment and no proper
E training programs were there for their support.

Deficiencies of the National Language Policy

 As majority of patients are managed initially by Intern Medical

Officers, the second language proficiency is a crucial element for
39 interns. However, the policy did not include them.
  Second language is vital for all the steps of exchanging information
G
including history taking, clinical examination, and explanation to the OG
patient. All medical and paramedical correspondence takes place in OO
English. As such, oral proficiency in the second language is essential as
DO
a potential source to help regulate patients' emotions, facilitate
comprehension of medical information, and allow for better D
identification of patients' needs, perceptions, and expectations. I
 The deficiency of a formal training programme in second language NI
proficiency was a major obstacle for doctors to gain the required
language proficiency.
TN
 The proposed second language programme interfered with post ET
graduate training of doctors. RE
NR
The GMOA took the initiative in discussing the above issues with a special
committee appointed by the Ministry of Public Administration. As a result N
a well-planned training programme was developed specific to doctors at P
pre intern level. RP
The Second-language training program for pre interns OR
This residential program of 11 days is being conducted with the GO
collaboration of the Ministry of Health as well as the Ministry of National RG
Language and Social Integration. This has been an immense success and AR
was appreciated by the higher officials of Sri Lanka as well as foreign
delegates. Module 1 of the GIP has facilitated interns to become closer to
MA
the Tamil speaking patients. MM
EM
Table 1 summarizes the output of this Module since 2013
2013 2014 2015 2016 2017 2018 2019 E
No. of courses 12 8 7 5 6 12 2
Conducted

No. of pre- 790 469 432 399 422 851 150

interns/medical
officers
participated
40
Table 1: Output of the Module 1 of GIP
 G
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

41
Module 2: Improving essential clinical skills and knowledge
G
OG
The second module of the Good Intern Programme aimed to develop OO
essential clinical skills and knowledge of the pre-interns. This included two DO
phases:
Phase I: Medical documentation - one-day workshop D
Phase II: Hospital-based clinical training programme - six days
I
With the inputs from a panel of experts, all the essential and nice-to- NI
accomplish skills that are needed to be addressed were identified. The TN
registration process of the pre-interns for the program was facilitated
ET
online through the uploaded web-based registration form and they were
requested to select the preferred station for the training of 06 days. RE
NR
Phase I- One day workshop on Medical Documentation N
P
Medical documentation facilitates diagnosis and treatment, communicates
RP
pertinent information to other caregivers to ensure patient safety, reduces
medical errors, and serves an important medico-legal function in risk OR
management. Hence, accurate documentation in the field of medicine is GO
vital for delivering safe patient care by ensuring the continuation of care, RG
certification of the status of the patient, and monitoring of the condition of
the patient.
AR
MA
This is a programme that was conducted by Government Medical Officers MM
Association in collaboration with Society for Health Research and
EM
Innovation, Ministry of Health and Anti-Malaria Campaign. This prompted
a valuable opportunity to train with precise medical documentation E
discipline and proper communication skills.

Table 1: Topics covered by different learning methods

Medical Documentation
Diagnosis card writing in Surgical and Gyn & Obs appointments
Diagnosis card writing in Medicine and Paediatric Appointment
Role of the Intern prevention of re-introduction of Malaria 42
Breaking Bad News
 G Active Listening in Communication skills

GO
Notification of Disease
Stress management during internship
OO Time management during internship

OD
D The programme was held on the 15th of August 2020 at the LRH
I auditorium and trained 100 pre-interns.

IN
Phase I was evaluated using a pre-course and post-course assessment and
NT participant feedback was also collected to improve the content of the
TE programme.
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

43
Phase II- Six Day Hospital-based clinical training programme
G
OG
This phase was conducted in collaboration with the College of OO
Anesthesiologists of Sri Lanka and the Ceylon College of Physicians. DO
Teaching hospitals (n=3), Provincial General Hospitals (n=1), District
General Hospitals (n=10) or Base hospitals (n=7) were selected covering D
all 9 provinces. The pre-interns were assigned to stations of their I
preference for the 6-day training program. NI
TN
During the program, thirty (30) skills-related procedures were primarily
focused. For the monitoring purposes, a logbook was prepared which had ET
to be certified by the relevant consultant after they perform the procedures RE
and this was given to each pre-intern medical officer (Figure 4). NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
Figure 4: Log book on updating clinical skills
E

44
 G Module 3: 02-day workshop that covers aspects of “Good
GO Medical Practice” in an Intern Medical Officer

OO The curriculum of the training programme was developed using the four

OD
domains of “Good Medical Practice” as a framework. Additionally, the
“internship guidelines” of other countries and the “system building blocks”
D framework of the WHO were reviewed.
I
The content material was customized to be applicable to the Sri Lankan
IN setting with the guidance of a panel of experts that included clinicians and
NT professionals. The duration required was weighted according to the

TE
priorities identified by the panel of experts (Table 4 and Figure 5).

ER Domain Number of minutes

RN Domain 1: Knowledge, skills and 640

performance
N Domain 2: Safety and quality 435
P Domain 3: Communication, partnership and 720
teamwork
PR Domain 4: Maintaining trust 565
RO Table 4: GMP Domain analysis of the GIP-2019

OG
GR
RA
AM
MM
ME
Figure 5: GMP Domain analysis of the GIP-2019
E
In presenting the output, the feedback given by the previous year’s
participants were of extreme value.

45
GOOD INTERN PROGRAMME - (Day 01) – 5th of September 2020
G
OG
Time Theme of the Chairperson/s Speakers Topic
Symposium OO
06.30-07.55 REGISTRATION
07.55-09.30 Inauguration Programme DO
09.30-09.50 Dr.Anuruddha “A Good Intern”
Vidyajyothi Prof. Padeniya D
Getting the
Maximum
Arjuna Aluwihare
Emeritus Professor
Paediatric Neurologist,
LRH
I
out of Your
09.50-10.10
Internship
of Surgery Dr.Gominda
Ponnamperuma
"Importance of
internship in
NI
Vidyajyoth iProf.
Lalitha Mendis
Professor in Medical
Education,
medical carrier"
TN
Former Director,
PGIM
Faculty of Medicine,
Colombo
ET
10.10-10.30 Dr. Padma Gunaratne
Consultant
"From Good
Intern to
RE
10.30-11.10 Tea
Neurologist,NHSL Good Doctor"
NR
11.10-11.15
11.15-11.45 Maintaining Deshamanya
Introduction to Professionalism
Vidya jyothi "The Medical
N
Professionalis Vidyajyothi Prof.Rohan W Professional" P
m during Dr. J B Peiris Jayasekara
Internship Senior consultant Emeritus Professor of RP
neurologist Anatomy Medical
Genetics OR
Prof.Vajira
11.45-12.05
Dissanayake
Dr.Palitha Abeykoon
Senior Adviser, World
“Introducti
on to GO
Dean Faculty of develop a
Medicine
Health Organization
Professiona RG
University of l CV”
Colombo AR
12.05-01.05 Lunch MA
01.05-01.10 Intorductory video on Importance of
Communication among Ward staff MM
Utilizing
01.10-1.30
communication
Prof.Surangi
Yasawardhana
Dr. Rimaza Niyas
Registrar in
“Importance
of EM
during Dean, Faculty of Community Medicine Communicati
internship and
communication
Medicine
University of
on among
Ward Staff”
E
01.30-02.00 with ward staff Jayawardhanapura Dr.Anura “Importanc
Sandanayaka e of Active
Dr. K.D.A. Ruwan Registrar in Medical Listening
Ferdinando Administrative during
Consultant patient
Community manageme
nt”
Physician
Deputy
Director(Training)
46
 G 02.00-2.40 Role of Intern Dr.Priyanganie Dr. M. M. M. Muzrif “Role of

GO
prevention of Silva Consultant Community Intern
re-introduction Medical Officer Physician-Anti Malaria prevention
of Malaria of re-

OO
AMC- Training & Campaign
Teaching introductio
n of

OD 02.40-03.00 Dr.Nalin Kithulwatta

Malaria”
"Communicatio
Consultant
D 03.00-.3.15 Dr.Sanjeewa
Pediatrician, LRH
n during
Emergencies"
I Munasinghe Dr.Namal Bandara “Transfusion of
Handling Secretary Ministry of Consultant Blood and Blood

IN
Transfusion
Emergencies health Physician Product”
3.15-3.35 within the ward Dr.Thamasi "The essential

NT Dr.Hemantha
Rahapaksha
Makuloluwa
Consultant
clinical
procedure during
TE Consultant
Anesthetist
Anesthesiologist internship "

ER
3.35-3.55 Dr.Shanika “Managing
Vitharana hematological
Consultant emergencies”
RN
Hematologist
3.55-4.15 Dr. Sakunthala “How to
Wijerathna recognize
N Senior Register in critically ill
P Emergency Medicine patient during
intern ward

PR
round “
4.15-4.20 Introduction to Surgery Appointment

RO
Prof.Jayindra
4.20-4.45 Dr. "What is
The Role of the Fernando
SujeewaThalgaspitiy Expected of an

OG
Intern in President,
a Intern Within
Surgery The College of the Ward and
Head, Department of

GR
Appointment surgons Sri Lanka Investigating a
Surgery
Faculty of Medicine Surgical Patient

RA
University of "
Dr.D.C.Rajapaksha
Rajarata

AM
Consultant Surgeon
4.45-05.05 Prof. Aloka Pathirana "What is
Prof.in surgery Expected of an

MM
Department of Intern Outside
Surgery ,Faculty of the Ward"

ME
Medical Sciences,
University of Sri
Jayewardenepura
E

47
GOOD INTERN PROGRAMME (Day 02) - 6th of September 2020
G
OG
Time Theme of the
symposium
Chairperson/s Speakers Topic OO
07.30-08.00 Interactive video session DO
08.00-08.20 Communication Mr. S. Anura Dr.Anura “Communication
with Relatives
and Public
Kumara
Asst. General
Sandanayaka
Registrar in Medical
with Relatives and
Public Relationship” D
Relationships Manager Administrative I
Electronic banking
center ,BOC NI
8.20-8.25 Vidyajyothi Prof. Introduction to Medicine Appointment
The Role of the Rezvi Sheriff TN
08.25-08.45 Intern in the Senior Professor of Dr.Upul Dissanayake "What is
Medicine Medicine Consultant Physician, Expected of an ET
Appointment NHSL Intern Within
the Ward" RE
08.45-09.05 Dr. Prasad Dr. Uditha "What is Expected of
Katulanda Bulugahapitiya an Intern Outside NR
Senior Lecturer, Consultant the Ward"
Dept. of Clinical
Medicine, Faculty of
Endocrinologist
CSTH
N
09.05-09.25 Medicine, Colombo Dr.Vindya “ Non communicable P
Kumarapeli disease”
Director -NCD RP
Consultant
Community OR
Physician
09.25 - Dr.Anil Dr.Dilantha GO
Administrative
09.45
Issues Related to
Jasinghe
Director
Dharmagunawardana
Consultant in Medical Interactive Session RG
Department of
09.45-10.05 Health
General of
Health
Administration
Dr. Linton
on "Administrative
issues & Disciplinary AR
Services Matters"
Padmasiri
Former Director of
MA
Dr.
Uthpala
LRH
Colombo
MM
Indrawan
sa EM
Chairman,

10.05-10.25
SPMC
TEA
E
10.25-10.45 New “New Development
Development of of COVID-19
COVID-19 Infection”
Infection
10.45-11.05 Dr. Amila Isuru “Tobacco effects
Lokuge and marketing
Dr.Samadhi Consultant Psychiatrist strategies used by
Capacity W.Rajapaksha industries”
11.05 - Building of Chairman, NATA Dr. Medhani “Some issues related
48
11.20 Interns on the Hewagama to Alcohol”
Consultant Psychiatrist
 G 11.20 - Prevention of Senior Adviser, Dr. Dhanuja Mahesh “ Becoming a good

GO
11.40 Tobacco and World Health Consultant intern and
Alcohol Organization Psychiatrist questioning the so

OO
called effects of
alcohol and the

OD
concept of addiction,
for changing the
behavior”
D
I 11.40-12.00
Relevance of
Hon.Dappula De Mr.Sarath Jayamanna “How an Intern
Livera Senior Additional Doctor can be Sued

IN
Ethics and President’s Councel Solicitor General during the
Litigation to The Attorney General Internship”

NT
12.00-12.20 Internship Sri Lanka Prof. "Application of
H.M.Senanayake Medical Ethics in the

TE
Mr. Kalinga Ward Setting"
Indratissa Professor in

ER
President’s Counsel Gyn&Obs,
President ,Bar
Faculty of Medicine,

RN
Association of Sri Colombo
Lanka
12.20- Introduction to Paediatrics appointment
N 12.25 The Role of the Prof.Vasantha
Devasiri
P 12.25-
12.45
Intern in the
Paediatric
Dean, Faculty of
Medicine,
Dr. R.M. Surantha
Perera
"What is Expected of
an Intern Within the
University of Ruhuna

PR
Appointment Consultant Ward”
Dr. Maxie Paediatrician

RO
Fernandopulle
12.45- Consultant Dr. B.J.C. Perera “What is Expected of
01.05 Pediatrician Consultant an Intern Outside

OG
Paediatrician the Ward”
01.05-02.00 Lunch

GR 02.00-02.30
Dr.Mizaya Cader
Introduction to National Programme for
Tuberculosis control and Chest Diseases

RA Tubercu
losis in
Consultant
Community
Dr. Bandu Gunasena
Consultant
“Role of intern in
control and
AM Sri
Lanka
Physician- TB
Campaign
Respiratory Physician,
National Hospital
prevention of
Tuberculosis in Sri

MM for Lanka”

ME
2.30-2.35 The Role of the Dr.Hemantha Introduction to Obstetrics &Gynecology
Intern in the Perera Appointment
2.35-2.55 Gynecology and Consultant Dr.Sarada " What is Expected
E Obstetrics
Appointment
obstetrician and
Gynecologist
Kannangara
Consultant
of an Intern
Within the Ward"
Gynaecologist and
Dr.Gamini Perera Cancer Surgeon,
Consultant Apeksha hospital
2.55-3.15 obstetrician and Dr. Mohamed ”What is Expected
Gynecologist Rishard of an Intern
Senior Lecturer, Dept. Outside the Ward"
of Obs & Gyn. Faculty
of Medicine Colombo
49
 G
OG
1. Internship Supporting Centre OO
DO
From the background surveys done on the post-interns and the current
interns, it was found that an internship support center is a much welcomed D
initiative. I
For instance:
NI
 >75% post-interns believed that an internship support center is
essential
TN
 >30% of post-interns stated that during internship they faced an ET
unbearable stressful event RE
NR
These findings highlight the extreme value of such a center, which would
alert, guide, advice, and support the interns when needed. In addition, this N
would be an excellent mentor for some interns who may otherwise be lost P
from the medical profession. RP
The Internship support center is not meant to be a “complaint-collecting
OR
center”. On the contrary, it would be a mentor, companion, and advisor for GO
the interns, as and when they need. It can provide positive energy and RG
direction to minimize their negative experiences.
AR
The concept was brought forward in 2013 and was launched in 2014. As MA
two of the welfare activities, a personal-loan system and a credit card MM
facility has been offered to pre-interns with a lower interest. EM
E

50
 G 2. Handbook for Medical Interns
GO The “Handbook for Medical Interns” was formulated as a part of the “Good
OO Intern Programme 2013” with the objective of providing a concise guide to
OD be referred during the internship period. The book aimed to assist interns
to manage common problems and issues encountered.
D
I The 2nd edition included the additions on “Blood transfusion related”

IN
inputs and was published in 2014. The 3rd edition which was further
updated is being offered to the pre-interns this year.
NT
The Handbook for Medical Interns covers the following aspects of
TE internship;
ER Section 1- Things to know before starting

RN
internship
Section 2 -Things to know after starting
internship
N Section 3 -Soft skills that an intern should
P possess
Section 4 -Handling difficult situations
PR Section 5 -Medical Documentation
RO Section 6 -Recording diagnoses and

OG
introduction to ICD- 10
Section 7-What you should know about

GR
nutrition
Section 8-Legal aspects
RA Section 9-Administrative aspects

AM Section 10 -SLMC Registration

MM
Section 11 -Ethical issues
Section 12 -Adverse Event Surveillance
ME Section 13 -Important emergency situations
E for the intern
Section 14-Blood transfusion
Section 15 - Continuous Professional
Development
Section 16 - Future career prospects

51
 3. Website www.shri.lk
G
OG
The www.shir.lk website was launched in 2013 with the vision of OO
trilingually competent Sri Lankan Medical Officers with a culture of Good
DO
Medical Practice.
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

52
 G 4. Adverse event reporting system
GO
OO
Adverse event reporting plays an important role in supporting a culture of
safety. Hence adverse event reporting systems have been developed in
OD many countries as a source to learn from such events and identify trends
D that may reveal organizational, systemic, and environmental problems.
I There is a need for a methodical and comprehensive strategy for adverse
event surveillance related to clinical practice in Sri Lanka as well. The
IN launching of the Adverse Event Reporting System will fill that gap and
NT provide valuable data for improving patient safety and health care quality.

TE The portal will be kept open for both drug and non-drug related events.

ER Retrieved reports will be conveyed to the appropriate institutions for

RN investigation and remedial action, as necessary. The mechanism
N encourages a no-blame culture and will be monitored by the associated
P support center. With the reporting terminals linked to the medicalintern.lk
website, this provides a faster and more comprehensive reporting of the
PR adverse events that would directly or indirectly enhance the quality of the
RO Sri Lankan health system.

OG
GR
RA
AM
MM
ME
E

53
 5. National research on internship
G
OG
The following baseline researches have been carried out in 2013, 2014, OO
2015 and 2016 along with the GIP.
DO
1. Awareness on administrative issues related to the Department of
Health (2013, 2014 ,2015 and 2016) D
2. Awareness on the future medical career among pre-interns (2013, I
2014 ,2015 and 2016) NI
3. Perceptions on “internship” and preparation for it among pre-interns
(2014,2015 and 2016)
TN
4. Perception on level of clinical skills among pre-interns (2013 ET
2014,2015,2016 and 2017) RE
5. Challenges faced by the Intern Medical Officers within the wards
NR
(2013)
6. Resources available for Intern Medical Officers (2013) N
7. Communication skills of pre-interns (2014 and 2015) P
8. Quality of medical documentation (2015) RP
9. Qualitative analysis of the necessity of the Good Intern Program
(2015)
OR
10. Knowledge among pre-intern medical graduates regarding tobacco GO
and alcohol prevention. (2016 and 2017) RG
11. Knowledge and attitudes among pre-intern doctors on nutritional
AR
assessment and counseling. (2016 and 2017)
12. Prior training, self-perceived competency and training needs among MA
pre-intern medical graduates on medical documentation- 2017 MM
13. pre-interns’ perceptions of prospective medical career (2017)
EM
14. Knowledge and attitudes among pre-intern doctors on prevention,
detection and management of Tuberculosis. (2017) E
In 2015, 2016 and 2017 in addition to the paper-based data collection,
audio-visual material and web-based questionnaires were used as data
collection instruments. The study findings helped in identification of the
strengths as well as areas to be strengthened. The dissemination of these
studies by scientific publication would provide the evidence needed for
policy planning processes. 54
 G 6. Introduction of the research culture
GO
OO
Research is the keystone on the advancement of the field of medicine and
it is at the forefront of patient care irrespective of the specialty.
OD Therefore, similar to the GIP-2013 - 2015, one specific objective of the
D Good Medical Programme-2020 is to inculcate a research culture in
I internship; hence, it would be in-built among the prospective medical
professionals.
IN
NT As a first step of this broad aim, pre-interns will be initially exposed to the

TE concept by being participants of these studies. All the workshop sessions

ER
of module 3 will be held in the form of “symposia”, thus setting the scene
of a scientific session within the pre-interns. In addition, module 03
RN includes some sessions on research and innovations. This will provide the
N foundation for a research culture and examples of a few interventions (e.g.
P rearrangements in the clinic setting) will be introduced.

PR These would benefit the health system by setting a driving force and
RO introducing new directions on the improvement of medicinal field for the

OG betterment health care. Furthermore, it would be easier for the interns

GR
when they become eligible for the “Research allowance” to plan a study.

RA
AM
MM
ME
E

55
7. Facilitation of IT based educational resource.
G
OG
The emerging role of IT has created a huge impact on Healthcare. It OO
enhances the quality of care, increases the patient security and data
DO
protection, and reduces operating & administrative cost.
Nonetheless, research conducted parallel to the GIP 2013 concluded that D
the availability of IT facilities and the access to the internet were I
unsatisfactory within the wards where interns work. It was decided to NI
universally enable the interns to the potential benefits of the
www.medicalintern.lk website as well as other benefits of advancing
TN
technology. During the registration procedure for the program, a web- ET
based survey was conducted to assess how many do not have such access. RE
NR
To address this issue as an initiative, provision of technological devices at
a reduced price was planned after a series of discussions with the relevant N
service providers. Further payments were facilitated in the form of P
installments. It is further intended to have prospective discussions with RP
the donor agencies and arrange a maximum number of installments to be
settled by them for the benefit of the interns.
OR
GO
As another step, an initiative of establishing a platform for e-based learning RG
will be launched. This would mark the beginning of a generation of first
AR
contact medical officers who will provide service delivery which is updated
with the newest developments, with self-satisfaction. MA
MM
EM
E

56
 G 8. Handbook on Communication Skills for Medical
GO Interns

OO The practice of good communication skills in the medical profession is

OD integral for the development of a meaningful and trustworthy
D relationship between the doctors and patients and, thus, is beneficial to
I both. Its value is reflected by the fact that one of the 04 domains in “Good

IN
Medical Practice” being “communication, partnership and teamwork”.
Ensuring the quality of communication would directly or indirectly
NT strengthen all the building blocks of the health system named by the
TE World Health Organization.

ER This handbook includes topics that are described under the 03 main
RN themes of:
N
P  Clinical communication skills

PR
 Communication skills as a professional
 Personal communication skills
RO
OG The content covered in each theme would provide a practical orientation

GR
for the medical interns on all the aspects of communication.
These inputs would facilitate the communications during medical
RA internship and beyond:
AM
MM  in healthcare delivery

ME
 when functioning as a leader
 in Continuous Professional Development
E  in preventing litigations

And more importantly, in generating self-contentment in medical care.

57
 9. Handbook on “Effective use of laboratory services”
G
OG
Laboratory information enables physicians and other healthcare OO
professionals to make appropriate evidence-based diagnostic or
DO
therapeutic decisions for their patients. They have a direct impact on many
aspects of patient care including, but not limited to, length of stay, patient D
safety, resource utilization, and patient satisfaction. I
NI
Intern Medical officers are involved in rendering laboratory services to
patients in many ways. Following the initial consultation with the patient,
TN
the intern medical officers should order the necessary investigations. For ET
that, they fill the request forms of the investigations and are also involved RE
in deciding on and tracing of urgent reports.
NR
As the first contact service providers they should also provide necessary N
advice to the patients regarding preparation of the patients for the P
different investigations. The validity of the investigation results may RP
totally dependent on the advices that were given.
OR
This booklet would include necessary details and guidelines for the GO
intern medical officer on: RG
AR
 rational selection of the investigations
 proper advising of patients MA
 correct storage and sending of samples to the laboratory MM
 basics in interpreting the investigation results
EM
 clinical waste management in relation to laboratory sampling
 Immediate measures to be done in unexpected occurrences in E
sampling of specimens (e.g. needle prick injuries, spillage of blood
etc.)

This can be regarded as an investment for the health system in the long
run.

58
 G 10. Booklet on “Emergency obstetric management” and
GO “set of cards on acute medical and paediatric
management guidelines”
OO
OD In an opinion survey done in relation to the GIP-2013, it was revealed that
62% of the interns perceived the beginning of the obstetric appointment
D
I as stressful. To address this issue a booklet would be distributed among
pre-interns on “Emergency Obstetric Care” courtesy of Dr (Mrs) TRN
IN Fernando.
NT
TE
Management of emergencies during internship particularly at the
beginning of the appointment is a challenge for many interns. This booklet
ER would help the pre-interns in preparation for internship. Furthermore,
RN these would help them in decision making when they are doing the
internship.
N
P 11. Standardizing the Competency on Tobacco & Alcohol
PR
Prevention among doctors in Sri Lanka (TAP Q Project)

RO Concept- Dr. Anuruddha Padeniya

OG
Introduction
GR
RA
Today, tobacco and alcohol stand out strongly as serial killers linked to
AM many proven disadvantages, not only related to health, but also to the
MM economy and the society as a whole, with very high worldwide prevalence

ME rates yet hard to control. Their use has spread throughout the globe
becoming deeply rooted in various and numerous settings, hence causing
E multiethnic and multireligious concerns urging the authorities for
suitable steps. According to World health organization (WHO), tobacco
kills more than 8 million people each year, and of them, more than 7
million are the result of direct tobacco use, while around 1.2 million are
the result of non-smokers being exposed to second-hand smoke. As for
the Centers for the Disease Control and Prevention (CDC), in 2018, 13.7%
59 of all adults (34.2 million people) currently smoked cigarettes with 15.6%
of men and 12.0% of women. Alcohol use is the same, and worldwide in
2016, 2.348 billion people (43% of the population) were current drinkers
G
and in the same year, total alcohol per capita consumption (APC) in the OG
world’s population of 15 years of age or older amounts to drinking on OO
average 6.4 litres of pure alcohol per year, which translates into 13.9
DO
grams of pure alcohol per day.

This situation is also similar in Sri Lanka, and throughout many years
D
I
tobacco and alcohol has been a substantial social threat despite many
hard efforts of various people and organizations to control it. For NI
example, it was reported that around one fourth of the adults (25.8%) TN
were current users of any form of tobacco (smoked or smokeless tobacco)
ET
and it was much higher among men (45.7%) when compared to women
(5.3%). Overall, 15% of the adults were estimated to be current smokers,
RE
with 10.2% being daily smokers of which the highest prevalence was seen NR
in the age category of 45-59 years (75%).
N
High prevalence of alcohol use also recorded in a survey done by the P
Health Ministry in Sri Lanka in 2015 with 34.8 % of Sri Lankan males RP
consume alcohol. However, the NATA (National Alcohol and Tobacco
Authority) statement in 2016 indicates that 40 % of Sri Lankan males
OR
consume alcohol. Fortunately, the prevalence among Sri Lankan females GO
is only 0.5%, and mostly involves the upcountry tea estate workers. RG
According to World Health Organization (WHO), per capita alcohol
AR
consumption in 2016, was recorded as 18.9 liters for males and 6.7 liters
for females. MA
MM
The notorious effects of them on health, economy and society has been
enormous and has become a major liability of Sri Lanka, hence it is EM
essential to develop a concrete action plan to address those effectively.
E
Elimination of exposure to tobacco and alcohol has shown a significant
reduction in NCDs. A recent systematic review concluded that the
cessation of tobacco smoking has significantly reduced the progression of
atherosclerotic disease and improved the respiratory function among
those who were affected with chronic respiratory diseases. A meta-
analysis of prospective studies conducted in 2012 concluded that the risk
of metabolic syndrome is reduced with the cessation of smoking. A French 60
study found that the cessation of smoking is associated with the risk
 G reduction of head and neck cancers reaching the level of non-smokers in

GO 20 years.

OO There is high quality evidence suggesting that the doctors have a pivotal

OD role in the reduction of alcohol and tobacco consumption among patients.

Brief physician advice for problem drinkers has been associated with
D sustained reduction of alcohol consumption in randomized controlled
I clinical trials. Similarly, simple interviews by doctors have shown an
IN effective reduction, and long-term abstinence from smoking among the

NT
patients. Effectiveness of such interventions may invariably depend on
the doctors’ knowledge, perceptions towards smoking and alcohol
TE prevention, and their competency in conducting such interviews. A few
ER international studies have found that the knowledge, skills and attitude

RN towards alcohol and smoking among medical students and doctors are
inadequate. Intern doctors are the first contacts of most of the patients.
N Hence, improving the skills and competency in directing patients towards
P quitting of alcohol and tobacco among pre intern doctors is crucial. Thus,
PR the Government Medical Association intended to launch a comprehensive

RO
and integrated programme to assess and develop the knowledge,
perceptions and skills towards cessation of smoking and alcohol among a
OG nationally representative cohort of Sri Lankan pre-intern doctors through
GR the Good Intern Programme 2016.

RA Objective:
AM To Standardize the Competency on Tobacco & Alcohol among doctors in

MM Sri Lanka.

ME
E

61
Proposed Circular for TAP Q Project
G
OG
General Circular No.: ……………. My No.: ################# OO
Ministry of Health
DO
“Suwasiripaya”
Rev. Baddegama Wimalawansa Mw. D
Colombo 10 I
##. ##.201# NI
Provincial Health Secretaries
TN
Provincial Directors of Health Services ET
Regional Directors of Health Services RE
Deputy Director Generals and Directors of Ministry of Health
NR
Directors and Medical Superintendents of Hospitals
Medical Officers in Charge of Divisional Hospitals N
Other Heads of institutions P
RP
Streamlining the detection and management of patients with the
risk factors of Tobacco and Alcohol use
OR
GO
There has been a worldwide concern of the epidemic of Non- RG
Communicable Diseases which account for more than 60% of global
AR
mortality. Sri Lanka too is currently experiencing a rising burden of both
acute and chronic Non-Communicable Diseases. Use of tobacco and MA
alcohol have been identified as two major risk factors significantly MM
influencing this disease burden.
EM
It has been shown that the elimination of these risk factors would result E
in favorable outcomes for the patients as well as for the health system.
The importance of addressing this issue has been highlighted in many
global initiatives including the targets of goal no.03 of “Sustainable
Developmental Goals”.

Experts who are rendering their services in this regard have highlighted
62
the necessity of having a comprehensive management strategy of the
 G users of these risk factors. Hospital setup has been identified as an ample

GO opportunity in intervening for these. Detection of patients who are using

OO
alcohol and tobacco is been recognized as a vital component in this
strategy.
OD
D The Ministry of Health has decided to implement the following steps in
I streamlining the detection and management of patients with the risk
factors of Tobacco and Alcohol.
IN
NT 1. A rubber stamp (Annexure 1) which has to be pasted on the admission

TE sheet on all the Bed Head Tickets (BHTs) and on all Clinic books/Cards of

ER
all patients above 16 years (named as TAP Q). All Directors/Medical
Superintendents should provide the rubber stamps to the admission
RN office as well as the registration areas of clinic settings.
N All admitting officers and officers of clinic registration settings to paste
P the stamp on above mentioned pages.

PR 2. All first contact medical officers are instructed to fill the TAP Q seal and
RO follow the management guidelines attached herewith. (Annexure 2)

OG The management guidelines (annexure 2) and the introductory brochure

GR
(Annexure 3) should be displayed on notice boards of all relevant wards
and clinics.
RA
AM Dr. Palitha Mahipala

MM
Former Director General of Health Services
Ministry of Health
ME
E

63
 G
OG
OO
DO
TAP Q Seal D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

64
 G First version of the Guideline – Prepared by experts in the field

GO
OO
Is there a Serious Risk?

OD
Deterioration of physical health (Cirrhosis, COPD,
Lung Carcinoma)
Deterioration of Mental health (Depression, Psychosis,
D Suicide/ homicide, Child/Wife abuse)
I
IN
NT YES NO

TE
ER
Refer to a Educate the patient regarding;
relevant 1. Causative relationship of Tobacco and alcohol with

RN specialist prevailing consequences in the patient

2. Possible consequences that would arise with continuous
N consumption.
P 3. The immediate and long-term benefits from cessation of

PR
Tobacco and alcohol consumption.
4. Possible obstacles that might be encountered by the

RO cessation of tobacco and alcohol consumption

OG
Empower the patient;
1. Provide an individualized action plan*

GR
2. Setup goals (“SMART”- specific, measurable, achievable,
realistic, time bound)

RA Review the patient with at least two follow up visits

AM
MM RESOURCE PERSONNEL:

ME
If no improvement following 2 follow up visits
Dr Palitha Abeykoon
by going through the TAP Q seal
Chairman- National Authority on
E Tobacco and Alcohol (NATA)
Adviser- World Health Organization
Refer to specialist
1st review - after one month
Prof. Diyanath Samarasinghe
Professor in Psychiatry 2nd review- 2 months from the first visit
Dr. Mahesh Rajasuriya (First review should be done at least within
Consultant Psychiatrist one month)

This Project is coordinated by Team of Good intern Programme-2016 with help of

65
Ministry of Health, NATA, GMOA & SHRI.
 G
12. Continuing of website www.saukya.lk (ස ෞඛ්‍ය.lk)
OG
Currently Sri Lanka hosts more than 1 million active internet users. OO
Addressing this population, a web site was decided to provide DO
accurate, reliable, timely and unbiased health related information, in
Sinhala, as articles containing medium length descriptions. The D
relevant information will be formulated in a socially & culturally I
acceptable manner, suitable for any age group. This website will not NI
be engaged in any unethical advertising of milk & pharmaceutical TN
products and will be maintained as a free service to the General Public.
ET
RE
13. Continuing of “Doctor Tips” SMS service (සුවපනිවුඩ NR
සේවාව)
N
Sri Lanka is a country having 23 million mobile phone users which
P
outnumbers its total population. This service will deliver reliable RP
health related information as short text messages daily in all three OR
languages (Sinhala, Tamil & English). This service will be available to GO
all Dialog customers on a subscription basis.
RG
AR
14. Standardizing the competency among pre-intern doctors
MA
regarding prevention, detection and management of
MM
Tuberculosis in Sri Lanka.
EM
As the first on call doctor in the wards and the first contact of most of
the inward patients, it is essential that intern Medical Officers have a E
thorough knowledge to suspect a patient with Tuberculosis. In the
wards, Intern Medical Officers are actively involved in patient care
and he/she is the one who does notification of the identified cases as
well. Thus, improving skills and competency in detection and
management of tuberculosis among pre intern doctors is crucial. Most
importantly internship period is the beginning of the career of a 66
doctor where he/she is exposed to clinical environment throughout
 G the period with good learning environment. Hence, building
GO competency among pre-intern Medical Officers just before they start

OO
their internship on tuberculosis control and management can make
considerable impact on their knowledge, practices, and skills on
OD controlling Tuberculosis in this country.
D
I Hence innovative project started in collaboration with National
Programme for Tuberculosis Control and Chest Diseases (NPTCCD) to
IN build competency and positive attitude on prevention, detection, and
NT management of tuberculosis among pre-intern doctors in Sri Lanka

TE for the first time in 2017.

ER
RN 15. Production of a mobile app for National Emergency
N National Protocol.
P
Today, the technology is changing the landscape of the world and
PR leading us towards a sophisticated technical world. The mobile
RO devices have become more user friendly and is used by a huge
OG population around the world. Similarly, doctors, medical students are

GR using smartphone applications for learning and clinical practices. New

RA
evidences reflect that this trend is because with minimal logistic
knowledge can handle the smartphone applications and it is a
AM portable device can use easy even in managing emergency situations
MM to have quick catch up guidance. It is important to understand of how
ME doctors choose to utilize the smartphone in clinical environment and
it is crucial to use the smartphone technology in the hospital setting.
E
Thus, moving away from the traditional pocket emergency card our
effort was to introduce a mobile app for National Emergency
Management Protocol with ease access and availability.

67
 16. Medical Documentation programme
G
OG
Medical documentation facilitates diagnosis and treatment, communicates OO
pertinent information to other caregivers to ensure patient safety and
DO
reduce medical errors, and serves an important medical-legal function in
risk management. Hence, accurate documentation in the field of medicine D
is vital for delivering safe patient care by ensuring the continuation of care, I
certification of the status of the patient and monitoring of the condition of
NI
the patient.
TN
Therefore, this programme has been introduced in 2017 along with ET
GIP and it was carried out to improve the ability and competency of RE
diagnosis card writing before commencement of the internship.
NR
Furthermore, it will be easier to interns to write a proper diagnosis
card within few minutes with their busy work schedule. N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

68
 G
GO
OO
OD
D Narrative summary Indicator Source and Assumptions
I means of

IN
verification
Goal A generation of self- Evaluation Review meetings
NT satisfied Intern
Medical Officers
by the
Doctors,
and day to day
reporting
TE with competence,
compassion and
other stake
holders,
ER care providing health

RN
optimum patient system
care indicators
Objective To prepare and Self- Pre and post Maximum
N empower the pre- evaluations assessments participation
P interns for an of the including self- of the pre-
internship period participants awareness and interns in the
PR with a culture of and evaluations of program

RO
good medical evaluation by the other stake
practice other staff holders

OG
and patients
Output Main program with Success of Number of Necessary
GR 03 modules the participants funding is

RA
09 Parallel projects implementati Number of obtained
on of the learning

AM
programs activities done
Feedback of the
MM participants

ME Activities Research projects Resources: Costs: Research

Logistics Experts, Budget report activities
E Program Questionnair progress
Communication es, prior to the
Specifying the Research program
content area assistants,
Planning of the Resource Consensus
project personnel, reached on
Teaching teaching
materials, materials
Guidelines,
69
Well-wishers
G
OG
OO
DO
D
I
NI
TN
ET
RE
NR
N
P
RP
OR
GO
RG
AR
MA
MM
EM
E

70
 G Prior training, self-perceived competency and competency among

GO
pre-intern medical graduates on medical documentation- 2017

OO
OD
Table 1: Whether any prior training received on medical documentation
Frequency Percentage
Yes 121 62.4
D No 73 37.6
I Total 194 100.0

IN Table 2: Place where they received knowledge

NT
Frequency Percentage
As a lecture in undergraduate curriculum 77 92.8
TE (medical faculty)
As a workshop by a professional college 1 1.2
ER As a workshop in undergraduate curriculum
(medical faculty)
3 3.6

RN By working in the wards as a medical student 1 1.2

Working in wards as a medical student 1 1.2
N
P Total 83 100

PR Table 2: Current level of competency in medical documentation

Frequency Percentage
RO Excellent competency 1 0.5

OG
Good competency 25 12.9
Satisfactory competency 124 63.9
GR Poor competency
Not competent at all
42
2
21.6
1.0
RA Total 194 100

AM
MM
ME
E

71
 Selected findings on Pre-Interns Perceptions of Prospective
G
Medical Career - 2017 OG
Table 1: Current perceptions on retaining in Sri Lanka after internship OO
Perception Frequency Percentage
Will retain in Sri Lanka 450 88.9 DO
Will out-migrate to another country 11 2.2
Not decided yet 44 8.7 D
Total 505 100.0 I
Table 2: Current perceptions on retaining in government sector if retained NI
in Sri Lanka
Perception Frequency Percentage TN
Will retain in government sector
Will join the private sector
490
1
96.8
0.2
ET
Not decided yet 14 2.8 RE
Total 505 100.0
NR
Table 3: Current perceptions on engaging in post-graduate studies
Perception Frequency Percentage N
Wish to engage in post-graduate studies
Will not engage in post-graduate studies
400
3
79.1
0.6
P
Not decided yet 102 20.2 RP
Total 505 100.0
OR
Table 4: Specialties in which post-graduate studies are preferred
Specialty Frequency Percentage
GO
Medicine 101 20.9 RG
Pediatrics 52 10.8
Surgery 47 9.7 AR
Gynecology and Obstetrics 25 5.2
Psychiatry 22 4.6 MA
Anesthesia 17 3.5
Dermatology 14 2.9 MM
Ophthalmology 10 2.1
Other 53 10.9
EM
Not decided yet 142 29.4
Total 483 100.0 E
Table 5: Self-perceived awareness on what is meant by continuous
professional development
Response Frequency Percentage
Aware 364 71.9
Not exactly aware 141 27.1
Total 505 100.0
72
 G Knowledge among pre-intern medical graduates regarding tobacco

GO
and alcohol prevention-2016

OO Gunawardhana MDUB1, Dissanayaka BSK1, Mathangasinghe Y1, Madhushan N1,

Madhushan G1, Jayawardhana HANC3, Fernando WAS3, Padeniya A1, Ranasinghe
OD D3, Mahesh B1

D Objective:
I To describe the existing knowledge among pre-intern medical graduates
regarding the tobacco and alcohol prevention.

IN Method
NT A descriptive cross sectional study was done among pre-intern medical graduates
who were awaiting the medical-internship from August to November 2016. A
TE web-based self-administered questionnaire was used. The questionnaire was
developed with expert-guidance and was judgmentally-validated. The responses
ER to selected questions were presented with the frequency and the percentage.

RN Results
A total of 721 pre interns were included in the study. Of them 94.6% (n=682) were
N concerned on substance consumption of the patients and 96.4 %( n=695) stated
P that it was necessary to include substance-use-history in clinical history taking.
More than 95% (n=681) stated they have a role in ceasing substance-use among
PR patients while 3.3% (n=24) thought that it was not their role. Of the participants,

RO
82.8% (n=597) answered as being capable of identifying stages of substance-use
while 15.7% (n=113) thought that they were not. Nearly 70 % (n=506) answered

OG
that advising a patient once, to stop substance-use has no significant impact and
28.3% (n=204) thought that it has. More than 80% thought that there is a safe-
GR limit of alcohol consumption (n=595) while only 16% (n=115) stated that a safe
limit does not exist. More than half (52%, n=379) thought anxiety as the
RA commonest psychiatric disorder which leads to consume alcohol. Nearly 41%
(n=295) stated that nicotine-replacement therapy is available in government
AM sector as an effective safe treatment option. Appearance of withdrawal symptoms

MM
(96.7%, n=697), continuous alcohol consumption by a cirrhotic patient (84.9%,
n=612), neglecting alternative pleasures and recreational activities (93.8%,

ME
n=676), inability to control no of cigarettes smokes per day (89.9%, n=710) and
consuming same amount of alcohol in every weekend (12.6%,n=91) were
recognized as features of substance dependence by pre-interns.
E
Conclusion
There are inadequacies of the knowledge on selected aspects of tobacco and
alcohol prevention among pre-intern medical graduates. A comprehensive, well-
planned orientation using effective teaching methods on these aspects prior to the
commencement of medical internship would be beneficial for the patient
management.

73
Availability of essential facilities for intern medical officers-2013
G
Jayawardhana HANC3, Padeniya A2, Ariyarathna N3, Udawaththa HK,
OG
Widanapathirana ND3, Soyza HND3, Arnold SM3, Vallipuranathan M3 OO
Objective: DO
To describe the availability of essential facilities for the intern medical officers
(IMOs) of the Western and North-Western provinces in 2013.
D
Design, setting and methods: I
A descriptive cross sectional study was done in September 2013, in the above
provinces in hospitals with MOs. A self-administrated questionnaire was utilized. NI
Results:
TN
Total of 240 responded. A ward-computer was not available in 62.5% (n=150) of ET
wards. Where it was available, internet facility was found only in 30%. In 32.1%
(n=77) of wards, reference books were not available in 37.5% (n=90) adequate RE
number of BNFs were not available. A rest room within the ward was not available
or the condition of it was not satisfactory in 62.9%. A quarters within the was not NR
available in 7.5% and of the ones who got quarters 44% dissatisfied with its
condition. A hospital canteen was not available in 16.3% (n=39). Of the places N
where a canteen was available 27.5% (n=66) were dissatisfied with the hygienic
condition, 52.5% (n=126) with the variety of available foods and 65.9% (n=158)
P
with the availability of food on night or public holidays. In emergency, 35.8% felt RP
that the efficiency of telephone exchange was unsatisfactory.
OR
Conclusion:
A substantial proportion of IMOs have no access to satisfactory essential facilities. GO
Establishment of a monitoring center for the facility-based requirements of the
IMOs, would improve their quality of life and work satisfaction.
RG
AR
MA
MM
EM
E

74
 G
GO
Perceptions on challenges faced by the intern medical officers
during ward-work-2013
OO Nanayakkara AM, Padeniya A2, Ariyarathna N3, Widanapathirana ND3, Soyza
OD HND3, Arnold SM3, Vallipuranathan M3

D Objective:
I To describe the challenges faced during ward work, by the Intern Medical
Officers (IMOs) of the Western and North-Western Provinces in 2013

IN Methods:
NT A descriptive cross sectional study was done in September 2013, in the above
provinces at the hospitals in which IMOs were allocated. A self-administered
TE questionnaire was utilized.

ER Results:

RN
Total respondents were 240 and of them 40% were males and 60% females.
Among the participants 48.3% (n=116) stated that they feel stressed during
ward rounds with the consultant in the first appointment and 29.2% (n=70)
N during the second. The figures were 36.3% (n=87) and 30.4%(n=73)
P respectively for the communications for personal requirements. Of the
participants, 65% (n=156) and 49.6% (n=119) assumed that the consultant
PR would have helped them had they face a challenge within the ward. More than

RO
half stated that they were humiliated within the ward for a reason which they
perceive as unreasonable. Proportion of respondents that were unsatisfied

OG
about support of other staff categories in relation to selected aspects were;
preparation of BHTs for ward rounds (32.5%), accompanying during ward
GR round (40%), and being chaperons (40.4%). First internship appointment was
thought as too stressful by 49.6% and 21.7% had cried inside the ward while
RA 35.8% had cried secretly due to a stressful incident. Figures were respectively
36.7%, 10% and 22.9% respectively for the second half. More than 75%, felt the
AM necessity of a “internship-supporting center”.

MM Conclusions:

ME
IMOs face substantial challenges while working in the wards. Establishment of an
“internship supporting center” would be a worthy investment.
E

75
Practices and the quality on essential skills among the Intern
G
Medical Officers-2013 OG
Fernando WAS1, Padeniya A2, Ariyarathna N3, Widanapathirana ND3, Soyza OO
HND3, Arnold SM3, Vallipuranathan M3, Jayawardhana HANC3
DO
Objective
To describe the self-perceived level of competency of some selected essential D
skills of the Intern Medical Officers
I
Methods NI
A descriptive cross sectional study was carried out among intern-medical officers
within the Western and North-Western provinces in June 2013. A self- TN
administered questionnaire was used to assess the self-perceived level of
competency of some selected essential clinical and non-clinical skills. The scale ET
ranged from 1 to 10, with 10 being “Highly competent”.
RE
Results
A total of 240 pre-interns were included in the study with 59.2% being females.
NR
Of those who have done a medicine appointment (n=122), lumber puncture
(4.9±3.1) and intubation (4.3±2.9) had the lowest mean score. Of the 107 who N
had done surgery, blood cross matching had the lowest mean score (7.25±3.0). P
Forceps delivery had the lowest mean score (3.3±2.8) among those who had done
obstetrics (n=107). Supra pubic aspiration of urine had the lowest mean score RP
(4.7±3.4) among those who had done a paediatric appointment (n= 92).
Of the non-clinical skills, dealing with an uncompliant patient (7.36±1.6) and OR
dealing with an aggressive patient (7.0±1.7) were ranked lowest.
Forty-four (18.3%) stated they would cover up a mistake done by a colleague,
GO
even if that mistake would harm the patient. RG
Conclusion AR
Pre interns lacked self-perceived competency in certain clinical and non-clinical
skills. It is important that medical educationists and the consultants formulate a MA
mechanism which will enable all the pre-interns to acquire the most important
skills. MM
EM
E

76
 G Attitudes on future medical career among post-intern medical

GO
officers-2013

OO Fernando WAS1, Padeniya A2, Ariyarathna N3, Fernando WKBSN1,

Widanapathirana ND3, Soyza HND3, Arnold SM3, Vallipuranathan M3
OD
D Objective:
I To describe the attitudes on future medical career and the associated factors
among medical officers who received their post-intern appointments in October

IN
2013

NT Methods:
A descriptive cross sectional study was done at the awarding ceremony of the
TE post-intern appointments. A pre-tested self-administered questionnaire was
utilized and 740 participants responded.
ER
RN
Results:
Of the respondents, 79.3% (n=584) wished to remain in Sri Lanka with 38(5.2%)
planning to leave the country and 15.5% (n=114) not decided. 94.5% (n=552)
N of the first category wished to be in government sector while 5.5% (n=32)
P intended to quit. Positive experiences like contentment during internship
(p<0.05), employment in the government sector (p<0.001) promotes attitudes
PR on remaining in Sri Lanka and while experiences like having to cry due to stress

RO
(p<0.05) promote negative attitudes. A majority of 88.9% (n=638) had
intentions of following post graduate (PG) studies. Most strong influencing

OG
factors for PG studies were personal preference (71.2%), job satisfaction
(49.8%) and role model inspirations (46.1%). Main popular PG specialties were
GR medicine (n=136,22.4%), Surgery (n=123,20.3%) and Paediatrics

RA
(n=88,14.5%). Problems in relation to PG training included: a single PGIM
(n=508, 68.7%) inadequate PG courses (n=410,55.4%), inadequate selections

AM
exams (n=420, 56.8%) and inadequate pass rate (n=537,72.6%).

MM Conclusions:
A substantial number of doctors have negative attitudes on remaining in Sri Lanka
ME and in government sector. Promoting positive experiences during internship
would be a possible area for intervention. Demand for PG qualifications are high
E and the opportunities must be increased.

77
Knowledge and attitudes among pre-intern doctors on nutritional
G
assessment and counseling. - 2016 OG
Mathagasinghe Y, Thuvarakan P, Yapa YHST, Padeniya A OO
Introduction and Objectives: DO
Nutritional assessment and counseling are core clinical skills expected from a
medical graduate. Our objective was to describe the knowledge and attitudes on
nutritional assessment and counseling among the pre-intern doctors of Sri Lanka.
D
I
Methods:
A descriptive cross sectional study was conducted from August to October 2016.
NI
All pre-intern doctors of Sri Lanka participating in the Good Intern Programme
2016 were invited for the study. An online self-administered questionnaire was
TN
used. Knowledge and attitudes on nutrition were measured using a validated ET
modified 17-item Nutrition in Patient Care Survey questionnaire. All analyses
were conducted on SPSS version 22 with a priori alpha of .05. RE
Results: NR
Of 616 respondents, 57.8% (n=356) were females. The mean age was 26.2±0.8
years. Forty-four (7.1%) had participated in some kind of special project in N
nutrition. A total of 317 (51.5%) had close friends/relatives with a medical P
condition which needed greater than normal attention to nutrition. Median
knowledge score was 65% (IQR-=58%-73%). Median positive attitudes score was RP
65% (IQR = 60%-70%). Although 68.7% (n=423) agreed that nutritional
assessment should be included in any routine consultation, 80.8% (n=498) OR
agreed that most pre-intern doctors are not adequately trained to discuss
nutrition issues with patients. Spearman’s rank correlation coefficient test found GO
a positive correlation between positive attitudes and self-reported knowledge
(rs=.204, n=616. P=.000). Mann Whitney U tests did not show significant
RG
differences of knowledge or attitudes depending on sex (p˃.05). Those who AR
participated in some kind of special projects in nutrition had a higher knowledge
(U=9499.5, p=.007, r=0.109) and attitudes (U=9267.0, p=.003, r=0.120) scores. MA
Those who had a close friend/relative with a medical condition which needed
greater than normal attention to nutrition had higher attitude scores (U=42099.0, MM
p=.014, r=0.099) but there was no significant difference in the knowledge scores
(U=43726.0< p=0.096, r=0.067). The internal consistency of the scale (Cronbach’s EM
alpha) was 0.82.
E
Conclusion:
Perceived knowledge and positive attitudes on nutritional assessment and
counseling are inadequate among pre-intern doctors.

78
 G Preparing medical graduates in Sri Lanka for a productive
GO internship and beyond: the “Good Intern Programme”

OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

79
 G
Rational Distribution of Personal Protective Equipment within a
Health Care Institution
OG
OO
Introduction- The current global stockpile of Personal Protective Equipment
(PPE) are insufficient to face current global pandemic. Surging global demand DO
driven not only by the number of COVID-19 cases but also by misinformation,
panic buying, and stockpiling will result in further shortages of PPE globally. D
Therefore, PPE should be used based on the risk of exposure and the transmission
dynamics of the pathogen. The overuse of PPE will have further impact on supply
I
shortages. There are WHO recommendations for rational use of PPE. The NI
distribution of PPE is done through Medical Supplies Division (MSD) in Sri Lanka.
The major bulk of stocks has distributed to Tertiary care hospitals and Provincial TN
General Hospitals. The rest of the products were distributed among base hospitals
and other rural hospitals. Therefore, Base hospitals (eg: Base hospital, Panadura) ET
had to deal with very limited number of stocks. The demand for PPE are increased
among health care workers. Therefore, the hospital coordinators had to face
RE
challenging situation to plan out a strategy to distribute the number of
stocks.Objective of this is to develop a mechanism to distribute the PPE according
NR
to the absolute risk of the units in Base Hospital, Panadura.
N
Methodology-The assessment was conducted using qualitative assessment. Two P
Registrars in Community medicine developed a risk stratification index of COVID-
19 after reviewing the literatures. The list of generated items was circulated RP
among a panel of experts adopting a Modified-Delphi technique through emails.
After taking the percentage agreement for the items, the scores for each risk factor OR
were taken.
GO
Results-According to the first round of technique each person agreed to stratify
risk according to below 5 main factors including; contact time per patient,
RG
environment (Open/ Closed), Initial Contact, whether aerosol generating or not
and exposure of duration for patients. According to the percentage agreements,
AR
aerosol generating procedure, for close contact, the closed environment and MA
exposure duration more than 15 minutes were scored an average of 80% each.
Contact time of 5-15 minutes was scored 50% and less than 5 minutes was scored MM
20 %. For the item of contact, 80% was given for index case, 50% for the first
contacts and 35% for the second line contacts. For the exposure time, if the unit EM
staff have to work more than 12hrs per day considered as high risk with the score
of 80% and from 8-12hrs, 60%, 40% for 4-8 hrs and 20% for less than 4 hours. E
Conclusion-The total risk for the unit was taken by multiplying each five risk
factors for each unit and the risk of each unit was categorized. The PPE were
distributed among the units according to that risk stratification.

Key words: Personal Protective Equipment, pandemic, risk stratification

80
 G Risk stratification index of distributing Personal Protective Equipment

GO
within a Health Care Institution

OO
Dineshan Ranasinghe *(1)(3) , Dulanjali Rathnayake (2), Eranga Pathirana (1)(3),
Nayani.Umesha Rajapaksha. (4)

OD
1. Society for Health Research and Innovations
2. Medical officer BH Horana
3. Medical officer BH Panadura
D 4. Post Graduate Institute of Medicine Colombo
I
Background: The current global stockpile of Personal Protective Equipment
IN (PPE) are insufficient to face current global pandemic. Surging global demand

NT
driven not only by the number of COVID-19 cases but also by misinformation,
panic buying, and stockpiling will result in further shortages of PPE globally. The

TE
demand for PPE’s are increased with irrational usage among health care workers.
But WHO recommendations for rational use of PPE. The major bulk of Sri-Lankan
ER stocks has distributed to Tertiary care hospitals and Provincial General Hospitals
with minimum stocks to base hospitals. Therefore, the Base hospital coordinators
RN had to face challenging situation to plan out a strategy to distribute the number of
stocks.
N Objective: To develop a mechanism to distribute the PPE according to the
P absolute risk of the units in Base Hospital, Panadura.

PR Methods: The assessment was conducted using qualitative assessment. Two

RO
Registrars in Community medicine developed a risk stratification index of COVID-
19 after reviewing the literatures. The list of generated items was circulated

OG
among a panel of experts adopting a Modified-Delphi technique through emails.
After taking the percentage agreement for the items, the scores for each risk factor
GR were taken.

RA Results: According to the first round of technique each person agreed to stratify
risk according to below 5 main factors including; contact time per patient,
AM environment (Open/ Closed), Initial Contact, whether aerosol generating or not
and exposure of duration for patients. According to the percentage agreements,
MM aerosol generating procedure, for close contact, the closed environment and

ME
exposure duration more than 15 minutes were scored an average of 80% each.
Contact time of 5-15 minutes was scored 50% and less than 5 minutes was scored
20 %. For the item of contact, 80% was given for index case, 50% for the first
E contacts and 35% for the second line contacts. For the exposure time, if the unit
staff have to work more than 12hrs per day considered as high risk with the score
of 80% and from 8-12hrs, 60%, 40% for 4-8 hrs and 20% for less than 4 hours.
The total risk for the unit was taken by multiplying each five risk factors for each
unit and the risk of each unit was categorized.

Conclusions & recommendations: A risk stratification index can be effectively

used to rationally distribute PPE.
81

Key words: Personal Protective Equipment, pandemic, risk stratification

Issues in methodological rigor and ethics in research projects submitted to
G
Ministry of Health Sri Lanka for salary incentives OG
Background:Following a government directive in 2012, Ministry of Health Sri
Lanka introduced a salary incentive (“research allowance”) for its employees
OO
conducting research. Each research proposal needs approval from one of 26 DO
Ministry-recognized Ethics Review Committees (ERC) either in universities or
health care institutions (HCI) around the country. Although the ERC review is
expected to carefully assess scientific rigor and ethical soundness of these
D
research proposals, the process appears to considerably vary across ERCs in its I
scientific approach and objectivity. Given that the National Health Research Ethics
Committee under the National Health Research Council Act is yet to be established
NI
to streamline the review process of ERCs as one of its functions, it’s prudent to
review the same proposals objectively at the ministry level along with the
TN
recommendations of the ERC recommendations. ET
Aim:To review proposals submitted to qualify for research allowance for RE
methodological rigor and ethical soundness.
NR
Method: A panel of experts reviewed all research proposals (250) submitted to
the Ministry in 2016, independent of ERC reviews.
N
Results: Majority of proposals (65.6%) reviewed by University ERCs and 47.2% P
were associated with postgraduate degrees. A total of 17.6% (44/250) had issues
(mostly, poorly-formulated objectives and methodological deviations); 4.2% of RP
proposals reviewed by University ERCs and 45.3% by HCI. Quality of letters
issued by the ERCs was poor in 5.6%. OR
Conclusions & recommendations: Variation in the review outcome between GO
university-based and HCI-based ERCs was significant (p<0.05) and needs
attention for remedial intervention. The process of recognition of ERCs may need
RG
re-evaluation. AR
MA
MM
EM
E

82
 G Title :A SUSTAINABLE PROGRAM FOR THE INNOVATIONS TO COMBAT

GO
COVID19 PANDEMIC IN SRI LANKA

OO
Authors: Dr.Padeniya A1, Dr.Colombage P2, Dr. Samarasinghe H3, Dr.Silva
TEUND4, Dr.Aluthge H5, Dr.Fernando S6, Dr.Soysa ND7, Dr.Ananda S8 ,

OD
Dr.Lanerolle ND9, Dr.Navodanie MRUN10

D
I 1President – Government Medical Officers’Association.
2CEO- Society for Health Research and Innovation

IN
3 Consultant Cardiologist – Teaching Hospital Karapitiya
4 Consultant Pediatrician – Teaching Hospital Anuradhapura.
NT 5 Secretary - Government Medical Officers’Association
6 Assistant Secretary - Government Medical Officers’Association
TE 7 Assistant Secretary - Government Medical Officers’Association

ER
8 Assistant Secretary – Government Medical Officers’Association
9 Ministry of Health and Indigenous Medicine

RN
10 Government Medical Officers ‘Association

Abstract
N
P Introduction and objectives: The COVID19 pandemic, is consuming both health
and non-health sector facilities in the world. In a situation where the requirement
PR of a lower middle-income country such as Sri Lanka has increased, this program
aims to bring about innovations and systems catered for Sri Lanka by Sri Lankan’s
RO in a sustainable manner in the local setting.

OG Methods: The Government Medical Officer’s Association together with the Society

GR
for Health Research and Innovations initiated a program aiming to support
innovators in order to build a common platform where the innovations would be

RA
evaluated.

AM
In phase one of the program the innovations were guided by an expert panel and
provided with feedback to improve their products in order to proceed. In the

MM
second phase these were assessed by a Research and Development Committee
which comprised of individuals from various sectors. In phase three they were
ME assessed against the minimum requirements for each product. In addition, a fund-
raising program was initiated with the support from a volunteer company to
E provide financial backup. This program creates an opportunity to further develop
their products whilst ensuring catering for the health sector needs.

Results: As a result of the program 30 groups of innovators are being supported

and developing their products.

Conclusion: A sustainable program for development and manufacturing of

innovations whilst helpful during this period of COVID-19 pandemic, will continue
to be useful in the post-pandemic era.
83
 G
OG
OO
We would like to extend our gratitude to;
DO
 Hon. Gotabaya Rajapaksa - His Excellency President of Sri Lanka
D
 Dr.Sanjeewa Munasinghe Secretary Ministry of Health Nutrition I
& Indigenous Medicine NI
 Dr. Anil Jasinghe -Director General of Health Services TN
ET
 Dr.Razia Pendse- WHO Representative to the Sri Lanka
RE
 Dr. Palith Abeykoon, Senior consultant to the WHO NR
 Dr.Hematha Herath- Director, National Programme for N
Tuberculosis Control and Chest Diseases. P
 Dr.Prasad Ranaweera- Acting Director of Anti Malaria Campaign RP
Sri Lanka OR
 Mr. Prasath Herath - Director General, National Institute of GO
Language Education & Training RG
and other Ministry officials for their guidance and extensive support AR
MA
We are thankful to all who contributed in various capacities to make
this program a success. MM
EM
E

84
 G
GO
OO
OD
D
I
IN
NT
TE
ER
RN
N
P
PR
RO
OG
GR
RA
AM
MM
ME
E

85