P. Ravi Shankar

Key words: India, Internship, Kerala, medical college, medical students

The filter coffee was aromatic and strong and the masala dosa stuffed with a mix of potatoes and beetroot crisp and tasty. We were at the Indian Coffee House (ICH), a venerable institution at the temple town of Thrissur, in the Southern Indian state of Kerala. The time was around one in the afternoon and we had just finished rounds and essential ward work in the department of Obstetrics and Gynecology (OB-GYN). There were three OB-GYN units and we were attached to the second unit known as O2; Dr Paily, the unit head was a well-known gynecologist. After ward rounds, the entire unit used to head to ICH for much needed refreshments.

I was reading about the important role residents play as teachers and how being closer in age to medical students they are more easily accepted as preceptors. Residents play an important role in teaching clinical skills and patient care. We, the sixth batch of students at the Government Medical College did not have any residents (postgraduates) while doing our internship. In India, all students after completing their undergraduate medical course (MBBS) do a year of compulsory rotating internship.

When we meet these days as middle-aged men and women, our consensus is that not having residents overall, worked in our favor. We could play a more direct role in patient care and management. The institution was still in its infancy and operated from two campuses. The college and the medical specialties (except Pediatrics) were located in Mulangunathukavu, about fourteen kilometers away while all other departments were located at the District Hospital in Thrissur town.

As there were no residents, our faculty members (associate and assistant professors) took turns of duty in the Emergency Department (ED). In the town ED, a surgeon, orthopedist, and ENT surgeon were always available. A psychiatrist and ophthalmologist were on call. The specialty of Emergency Medicine was not yet known. A pediatrician was available 24/7 in the Pediatrics ward and an OB-GYN specialist in the labor room. There was an age gap of at least eight to ten years between us and the youngest faculty. Some faculty were more reserved while others were friendlier. We sometimes enjoyed a coffee together at the milk booth near the hospital gate.

The town hospital was old and had seen better days. There were separate duty rooms for male and female doctors to try and catch some sleep, if the situation permitted. Some of our postings especially Medicine, Surgery and OB-GYN were longer (two months) and we developed close working relationships with our teachers. We got the opportunity to do a number of procedures under supervision including catheterization, intubation, ascites tap and lumbar puncture. Of course, we became experts at starting intravenous lines. We did not have central venous lines those days.

We had a two-month posting in Community Medicine. One month was spend in a rural primary healthcare center. We (my colleague and I) worked under the supervision of the health center doctor. We had a heavy daily outpatient clinic which often reached 150 to 200 patients. We worked mostly on our own and consulted the doctor only if we had a problem. We began relishing our role as ‘doctors’ and enjoying the attendant privileges.

Those days there were no simulation centers and patients were more accepting and less demanding. The internet and smart phones were still in the future. Mobile phones were non-existent. Sometimes, I feel guilty that we ‘practiced’ and ‘learned’ on these individuals who were from the lower strata of society. Prolonged sickness wreaked havoc on some families as their breadwinners were frequently in the hospital. A social security net was absent.

On Sundays and holidays, we sometimes volunteered at blood donation camps. The Kerala Blood Donors Society was very active and most requirements for blood at the hospital were met by ‘voluntary’ donors. I enjoyed the opportunity to interact with and educate the general public. We also conducted free blood grouping and collected blood donation from those who were willing. We stressed the importance of knowing one’s blood group.

Not having residents was a mixed bag. We got more opportunities and learned more. But we did miss the close camaraderie and friendship and the practical tips which only someone who was in our position two or three years before could provide. As an optimist I always see the cup as half full rather than half empty!

Author bio: Dr. Shankar is a medical educator and a clinical pharmacologist with a keen interest in small group learning, the health humanities, rational use of medicines and pharmacovigilance. He is a creative writer, hiker and photographer. He has facilitated student learning in different medical schools in Nepal and the Caribbean. He is a faculty member at the IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia. He is a research adviser at the Oceania University of Medicine, Apia, Samoa. You may contact him at: ravi.dr.shankarATgmail.com