INTERNSHIP - HOW TO WRITE A HOSPITAL INTERNSHIP REPORT FOR MEDICAL STUDENTS

INTRODUCTION
The internship was at the University Teaching Hospital (UCH), Ibadan. It was held between, 3rd January to 31st march for the fulfillment of the Masters program. Maters in Clinical psychology, at the University of Ibadan, Oyo state.

Activities performed
Basically, most of what was done was clerking of patients. There also was going for seminars, organized by other department of the hospital besides the Clinical Psychology department and organizing seminars for staffs. 

There was internal posting to various department of the hospital for understanding of medical disorders in relations to mental disorders. Places like the Clinical Psychology department at the general outpatient department (GOPD), Pediatrics, Hospice and Palliative care…………………………………..

GOPD (general outpatient department)
The clinical psychology section, GOPD is majorly the base for the clinical practicum. It is from this office the internship is planned.

The clinical psychologist, Mr Kolade put us through basic tools to have in practical therapy. Also, topics were discussed and issues were clarified. He also monitors the way clerking is done, how to arrive at diagnosis and what to look out for in clerking.
The clinical psychology office organized a communication skill seminar for staff of GOPD. The presenters were the preceding interns.

Below are cases attended to at the GOPD clinical psychology office,

CASE1
Biodata
Name:    Mrs A.I
Age:     42 years
Sex:     female
Address:      Sango Ota
Marital status:     married
Religion:     Christian (Jehova witness)

Presenting complains,
She complains of stomach pain, which moves to the chest and then the hand. She feels like she has no power anymore, dead limbs, leg pain, crawling sensation on her head, headache, itching of the lower abdomen, hotness in the stomach, hot temperature. She also said after using the toilet her vagina itches, so also the anus. She feels heart pain, heart palpitation, back pain, dryness of the throat and frequent urination.

Family history,
She is from a monogamous home. She has six siblings, two males and four females. Her relationship with them is very cordial. Two older and two younger siblings of hers are married.  

Personal history,
She is a sowing mistress with workers. Her husband is 57 years and a bricklayer. She worries about the fact that there is no sex between her and her husband. Her relationship with her husband has reduced to only greeting, serving him food and talking only when necessary

Medical history,
She had fibroid operation in 2007. According to her husband, anyone that goes through such an operation will have to stay away from sexual intercourse for at least 2years. Because of her present illness she has been to at least five hospitals. 

Psychosexual history,
Since 2007 fibroid operation she has had sex for only two types with her husband. For the past two years there had not being any sexual relation with her husband. She says sex is not enjoyable for her. She also said her husband fears to have sex so that there would not be another reason for operation.

Mental state examination
Appearance and behavior: she wore a neat blue top and skirt. Her behavior has nothing spectacular to it. Mood: she claims to worry a lot about her health, believing that it may be a big deal. Also, there is fear that her illness may lead to another operation which she is scared of. She feels distressed because of her sleeplessness. She worries a lot about her health and used to worry a lot about her lack of sex filled life with her husband.

Diagnostic impression
Axis I:         Somatization co-morbid sexual dyfunction
Axis II:        N.A
Axis III:       Fibroid operation
Axis IV:      Unhappy home, poor communication with husband and daily fight with husband.
Axis V:      75, moderate symptoms. When symptoms are present it is due to psychological stressor. 

Treatment plan
Psycho education
Sexual education
Cognitive restructuring
Relaxation therapy

Follow up treatment
Mrs A.I was asked to come back with her husband two weeks after she came to the clinic. She looked more happy, lively and hopeful. She said the pain reduced to few intermittent pain.

The follow up therapy was basically sex education for the husband, which entails how the sexual organs are, what they functions for, how to seduce and have sex with his wife. These were done since it became apparent that the man has either forgotten how to have sex or does not know how.
Another appointment was scheduled for a month after.

CASE 2
Biodata
Name:    Mrs O
Age:       42 years
Sex:        female
Address:     Ibadan    
Marital status:     married
Religion:     Christian (catholic)

Presenting complains,
She complained of severe headache. Due to this headache she was admitted at a private hospital for two days. She does not sleep well. The headache started after her husband hit her on the head. She feels dizzy, drowsy and there is pain at her neck area. There was itching two days before today. Hooking feeling at the waist then it moves to the knee and she palpitates.

Family history,
She has no parents anymore. There are three of them. The eldest, who brought her to Lagos died two years ago. She is left with her only sister.

Personal history,
She studied to the stage of SSCE and also learnt and practice as an auxiliary nurse. Her husband is a secretary at a seminary. She worked at a hospital but because her boss was not forthcoming with the payment of salary her husband asked her to leave the job which she did.
She says she is naturally friendly but do not easily open up to people about herself.
She has four children, two of which are written SSCE and JAMB.

Medical history,
She wears glasses and had been admitted to a private hospital because of her present severe headache. Also, after the birth of her last child she was admitted. 

Psychological history,
Two years prior now when her elder sister died she had crawling sensation over her body, there was sleeplessness, tonlititis. She was unable to belge and numbness of the left leg

Marital history,
She said that since her marriage she has not been happy. She said her husband is keeping extra marital affair. The husband is stingy at home but generous to outside people. The husband do not give preference to decision they both make at home, he always do come back home to change the initially decided issue. He gets the new advice from his uncle’s wife.

Mental state examination,
Appearance:   she is neatly dressed in Ankara top and skirt.
Mood:    her mood is characterized by excessive worry, unhappiness and thought of hopelessness
Affect:    she is sad and dull.

Diagnostic impression
Axis I:     somatization co-morbid with depression
Axis II:    N.A
Axis III:    Headache
Axis IV: the burden of feeding and catering for the home financially is on her,
Axis V:     75

Treatment plan
Psycho education
Cognitive restructuring
Relaxation therapy

Follow up treatment
Mrs O, came back two weeks after the initial session. She looked better and was lively. She said the headache had reduced to a minimal level but still comes.
Her follow up treatment still involved her search for a job since she had not gotten any and continuation of the relaxation technique. She was given a stressor chart, this is to help us know when the pains come, what happened before and after and how she perceived it.
Another appointment was scheduled for two weeks.

CASE 3
Biodata
Name:    Mr F.G
Age:       31 years
Sex:        male
Address:   Ibadan     
Marital status:    married
Religion:     Christian (winners)

Presenting complains,
Since late 2010, he has had pains at his back, a blocked feeling at the side which has prevented him from running. He feels his two legs go numb; there is intermittent shock feeling at both legs at different times. There is uneasiness to defecate and cannot hold urine.

Family history,
Both parents are still alive, the father is a retired civil servant and his mother is still a teacher. He has two siblings. He has a brother who is 29 years and a banker and he also has a sister, who is 27 years and a pharmacist. His brother is also married.

Personal history
He just got married last year November to his wife. Of all his league of friends he is less successful. His siblings are also more successful than he is.
He is a sport man. He loves running and used to run well before the pain started.
He is done is post graduate.

Medical history
He is asthmatic but do not usually have attacks nor takes drugs.
Mental state examination

Diagnostic impression
Axis I:    pain disordser
Axis II:    N.A
Axis III:    N.A
Axis IV:    his friends and siblings are more prosperous than he is at the moment
Axis V:    80, moderate symptoms.

Treatment plan
Psycho education
Validating complains
Cognitive restructuring
Pain diary and exercise

PEDIATRICS
The pediatric section of the hospital was visited. A week was spent with the department. We were under the supervision of Dr, Mrs Lagunju.
At the pediatrics department the ward round was attended alongside Dr, Mrs Lagunju and other pediatric doctors.

At the ward majorly children with meningitis, tetanus infection, hydro-encephalus and head tumor were seen. Parents were counseled by us on how to care for their children when they are ill, what to do to them and what not to do. Also, immunization is paramount many of these mothers never immunized their children.

Sickle cell clinic
This clinic is held every Tuesday, from 2pm till when all the children are attended to.
The clinic has been on for over two years.  This is due to the fact that it is empirical that children with sickle cell are highly prone to stroke at tender ages. Stroke test is run for them to know who is prone and who is not. Also, pre treatment is given to the children that are prone to stroke. The children are asked to come back a year after each test.
I ran an intelligence test for one of the sickle cell patient;

Case
Name:      master T
Age:          8 years, 10 months
Sex:           male
Address:    Akete, Bashorun
Religion:    Christianity
Class:         PRY 4
School:     Oritamefa school.

Family history,
Master T is the first child of his parents. They are just two children, him and his sister. His mother is 38 years and an Estate surveyor while his father is also 38 years old and a Quantity surveyor by profession. His parents do not have plans for more children. His sister is genotype AA.  

Health history,
He is a sickle cell patient. His crisis started when he was 2 years old. At least he has crisis thrice in a year now. He has been on the stroke test for more than a year.

Result of the I.Q test
The test used is standard progressive matrices sets A, B, C, D and E.
The test was held on the 21st February, 2012. The test is to run for 45minutes but Master T used 42min. is test score is 32 and test grade is 75%.

The test grade is interpreted as “definitely above the average on intellectual capacity”. Young master T is intellectually sound. The test scores correlates with his school performance according to his mom. His environment and the school he goes to also contribute his level of intelligence.

Neuro-pediatric clinic
At the neuro-pediatric clinic, a lot of children were brought in for one neural problem or the other. Majority of the children have seizure (epilepsy) of varying kind, cerebral palsy and so on.

CASE4
Biodata
Name:   
Age:      
Sex:       
Address:     
Marital status:    
Religion:     

Presenting complains
Family history
Personal history
Medical history
Psychosexual history
Mental state examination
Diagnostic impression
Treatment plan
Seminars
Presentation
Meetings
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