Contents

Introduction 2
Participation and Observations 3
Practical Skills Acquired 6
Use of Equipment and Interpretation of Investigations 10
Conclusion 14
Introduction
Clinical practical training is a critical component in the professional development of every future
doctor. It bridges the gap between theoretical knowledge and real-life application, allowing medical
students to immerse themselves in the day-to-day workings of a clinical setting, interact with real
patients, and begin to develop their clinical judgment and bedside manner.

As part of my medical education, I completed a 2 week practical training in the medical ward of
King's Hospital, Colombo, Sri Lanka. This period provided a structured exposure to working directly
with patients in a hospital environment outside the classroom. Under the guidance of experienced
consultants and medical officers, I was able to observe and participate in the care of patients with a
wide range of medical conditions. This included respiratory, cardiovascular, gastrointestinal,
neurological, and infectious diseases.

The ward setup in Sri Lanka is busy and resource-conscious, which gave me a realistic view of
medical practice in a public healthcare setting. It also helped me appreciate the importance of
clinical skills in situations where advanced investigations may not always be immediately available.
From taking comprehensive histories to conducting system-based physical examinations and
interpreting basic investigations such as ECGs and X-rays, each day presented new learning
opportunities.

In addition to technical skills, the practical also emphasized the importance of communication,
teamwork, and patient empathy. Presenting cases to consultants, listening to their feedback, and
learning from both their corrections and clinical demonstrations was one of the most valuable
aspects of the experience.

The primary objectives of this practical training were:

● To strengthen my ability to take accurate and detailed medical histories.

● To learn and apply correct techniques for physical examination across different body
systems.
● To observe clinical signs in real patients and relate them to underlying pathologies.
● To understand the diagnostic approach to common medical presentations.
● To observe the process of treatment planning, including the use of medications and
investigations.
● To gain insight into patient management in a real hospital ward setting.

Overall, this practical was an important milestone in my clinical education. It gave me the confidence
to approach patients, improved my understanding of clinical processes, and reinforced my desire to
pursue internal medicine with deeper commitment.
Participation and Observations

Throughout the 10-day clinical training in the medical ward, I actively participated in a wide range of
patient care activities, which allowed me to gain valuable insight into real-world hospital practice.
Each day was structured around ward rounds, clinical teaching, hands-on practice, and patient
interactions, all under the supervision of consultants and medical officers. My involvement gradually
progressed from passive observation to active participation in both history taking and clinical
examination.

Patient History Taking

One of the key areas of focus during the practical was the art of taking a comprehensive medical
history. I was given multiple opportunities to interview patients independently and in small groups. I
took full histories from patients with conditions such as stroke, bronchial asthma, gastritis, and
infectious diseases like leptospirosis, dengue, and chikungunya. After each interview, I organized the
information using a standard format (chief complaint, history of present illness, past medical history,
personal and family history, etc.) and presented the case to the consultant or supervising doctor.
Their feedback helped me improve the structure, relevance, and clarity of my presentations.

One notable case was a patient with a stroke, from whom I was able to take a full neurological
history and then correlate the symptoms with clinical signs and CT findings. Another was a patient
with asthma, where I documented a history of chronic exacerbations and observed wheezing on
auscultation. These experiences helped me better understand how history alone can guide a
diagnostic impression before investigations are even reviewed.

Clinical Examination

We received daily clinical teaching on physical examination techniques for different systems. The
consultant demonstrated examination methods on real patients while explaining the relevance of
each step. We then practiced under supervision. I learned and performed:

General examination – including assessment of vital signs, pallor, icterus, cyanosis,

lymphadenopathy, and edema.

Respiratory system examination – including inspection, palpation, percussion, and auscultation. I

was able to identify clinical signs such as wheezing, crepitations, dull percussion, and reduced breath
sounds in patients with asthma, pleural effusion, and pneumonia (consolidation).

Cardiovascular system examination – I examined patients with valvular heart diseases such as mitral
stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation. Under supervision, I
auscultated and recognized different types of murmurs, learned to describe their timing, location,
radiation, and intensity.

Abdominal examination – Practiced on patients with gastritis and infectious diseases that presented
with abdominal discomfort. I palpated for organomegaly and percussed for ascites in relevant cases.

Neurological examination (CNS) – I performed cranial nerve assessments and motor/sensory exams
of the upper and lower limbs. In stroke patients, I learned how to identify facial asymmetry,
hemiparesis, and speech difficulties, and correlate them with anatomical localization.

Case Presentations and Consultant Feedback

Each day, we were encouraged to present at least one case to the supervising consultant. This
process involved summarizing the patient’s history, examination findings, and suggesting a
differential diagnosis. Our presentations were followed by a detailed discussion where the
consultant corrected our mistakes, challenged our reasoning, and encouraged evidence-based
thinking. This feedback was extremely valuable in refining our approach and learning how to
prioritize clinical information.

Observation of Investigations and Diagnostic Procedures

In addition to history and examination, we observed and interpreted several diagnostic tests:

Electrocardiograms (ECGs) – We were taught how to identify abnormalities such as ST elevation

(STEMI), non-ST elevation (NSTEMI), left and right bundle branch blocks, P mitrale, and P pulmonale.
We discussed the clinical context of each and observed how ECG interpretation is integrated into
acute patient management.

Chest X-rays – We saw images showing pleural effusion, consolidation, and cardiomegaly, and
learned to match radiological findings with clinical signs.

CT brain scans– We reviewed scans of stroke patients and observed how findings like cerebral
infarction, midline shift, or ischemic changes correlated with the patient’s symptoms.

These experiences helped us appreciate the value of combining clinical skills with diagnostic
evidence.

Exposure to Medical Management

While students were not permitted to prescribe medications, we observed how consultants chose
appropriate treatments for various conditions. This included the use of:

Bronchodilators (e.g., salbutamol, ipratropium) in asthma attacks.

Steroids (e.g., prednisolone) for inflammatory conditions.

Antibiotics for infectious diseases.

Antiplatelets and anticoagulants in patients with cardiovascular risk.

IV fluids, antipyretics, and analgesics as supportive care.

We learned how comorbidities and clinical severity influence the selection and adjustment of drug
therapy.
Practical Skills Acquired

Over the course of ten intensive days in the medical ward, I was able to significantly enhance both
my theoretical understanding and hands-on clinical skills. While we were not expected to perform
invasive procedures independently, the practical offered a broad foundation for developing the
essential core competencies of medical practice — from communication to physical examination,
and clinical interpretation to clinical reasoning.

These skills were not acquired all at once, but rather, in layers — with each day adding confidence,
depth, and fluency to what I could do, understand, and explain. Below is a breakdown of the key
areas of skill development.

1. History Taking and Clinical Communication

One of the most fundamental skills I strengthened was the ability to take a complete and structured
patient history. Initially, this involved following a set format: identifying data, chief complaint,
history of present illness, past medical and surgical history, family history, social history, and review
of systems.

But as the days progressed, I began to focus more on clarity, efficiency, and relevance — learning to
tailor questions to the patient’s complaints, pick up subtle clues, and guide the conversation toward
clinical utility.

Some specific growth points:

● Learning how to communicate sensitively with elderly stroke patients and obtain collateral
histories from caregivers.
● Knowing when to pause and rephrase questions for patients who were in discomfort or
distress.
● Practicing open-ended questioning, then narrowing down based on key symptoms.
● Understanding the art of empathy: how listening itself is therapeutic, and how patients
open up when they feel heard.

By the end of the practical, I could confidently take full histories on my own and present them in a
concise, clinically relevant way to consultants and medical officers.
2. Physical Examination Techniques

I significantly improved my ability to conduct system-specific physical examinations, guided at first

by demonstration and later honed through repetition and correction.

a. General Examination:

I learned how to assess pallor, icterus, cyanosis, lymphadenopathy, clubbing, pedal edema, and
hydration status.

Assessed vital signs including pulse, respiratory rate, blood pressure, temperature, and oxygen
saturation.

b. Respiratory System Examination:

Practiced inspection for symmetry, use of accessory muscles, and respiratory pattern.

Percussion to detect areas of dullness (e.g., pleural effusion) or hyper-resonance.

Auscultated for wheezing, crepitations, bronchial breath sounds, and reduced air entry, and learned
to interpret their diagnostic value.

c. Cardiovascular System Examination:

Located the apex beat, identified parasternal heave, and listened at standard valve areas.

Recognized murmurs and practiced describing their timing, pitch, radiation, and clinical significance.

Correlated murmurs with specific valvular pathologies — e.g., mid-diastolic murmur in mitral
stenosis.

d. Neurological Examination:

Performed cranial nerve assessments, including testing for pupil reflexes, visual fields, extraocular
movements, facial symmetry, and hearing.

Assessed motor function of upper and lower limbs (tone, power, reflexes, coordination).
Performed sensory examination, including testing for pain, vibration, and proprioception.

Detected hemiparesis, facial nerve palsy, and other signs in patients with stroke.

Integrated findings into an anatomical and pathological understanding of neurological deficits.

e. Abdominal Examination:

Practiced inspection for distension, surgical scars, and movements.

Palpated for tenderness, guarding, rebound tenderness, and organomegaly (especially liver and
spleen).

Percussed for ascites using shifting dullness and fluid thrill.

Auscultated for bowel sounds and bruits in relevant patients.

Each of these techniques became more fluent with repetition. What began as checklist-style
performance turned into integrated, flowing examinations guided by clinical suspicion.

3. Clinical Reasoning and Case Presentation

A major area of personal growth during the practical was the development of clinical reasoning —
the ability to connect symptoms and signs to form a differential diagnosis. I practiced:

● Synthesizing patient histories into a coherent clinical picture.

● Selecting the most likely diagnoses while considering alternative possibilities.
● Presenting my findings logically, with a strong narrative flow.
● Responding to consultant questions about pathophysiology, management, and investigation
planning.

Case presentation is a skill that blends knowledge, structure, confidence, and communication — and
I had the privilege of sharpening all four through near-daily practice.

4. Observation and Interpretation of Investigations

Though I did not perform investigations myself, I actively participated in reviewing and interpreting
them:
Interpreted ECGs, identifying common abnormalities like ST elevation, bundle branch blocks, atrial
enlargement, and tachycardia.

Reviewed chest X-rays, identifying signs of consolidation, effusion, and cardiomegaly.

Observed CT brain scans in stroke patients and discussed infarct locations, prognosis, and treatment
options.

These sessions improved my ability to look beyond numbers and images — to interpret what they
mean in the context of the patient’s overall condition.

5. Exposure to Medication Use and Treatment Planning

I gained exposure to the practical aspects of prescription writing and pharmacological decision-
making:

Learned commonly prescribed medications in internal medicine (bronchodilators, corticosteroids,

antibiotics, antihypertensives, anticoagulants).

Understood routes of administration, dose titration, and monitoring parameters.

Observed how co-morbidities, patient compliance, and drug interactions influence prescribing
decisions.

Became familiar with emergency drugs like salbutamol, prednisolone, aspirin, and enoxaparin, and
their roles in real-time management.

Though not prescribing myself, I gained an understanding of why each drug was chosen, and how
clinical judgment and guidelines are applied in patient care.

6. Professionalism, Teamwork, and Patient Interaction

Finally, beyond the technical, I learned a great deal about the soft skills of medicine:

● How to work respectfully and collaboratively within a team — including doctors, nurses,
support staff, and fellow students.
● How to communicate with empathy and clarity, especially with anxious or critically ill
patients.
● The importance of confidentiality, consent, and ethical decision-making — even in the
smallest of actions.
● The emotional complexity of patient care: seeing suffering, uncertainty, recovery, and
resilience — often all in a single day.

These lessons are not always taught in textbooks, but they are some of the most important tools a
future doctor can carry.
Use of Equipment and Interpretation of Investigations

Although the practical was conducted in a general medical ward rather than an emergency or
procedural setting, I had the opportunity to observe and engage with several types of diagnostic
equipment and tools used in day-to-day inpatient care. While I did not operate machinery
independently, I was actively involved in reviewing results, discussing clinical relevance, and
observing how these investigations informed management decisions. This experience helped me
appreciate the integration of clinical examination and investigative support, especially in
environments where resources must be used wisely.

1. Electrocardiography (ECG)

One of the most frequently used bedside investigations in the ward was the ECG — a simple yet vital
tool in assessing patients with cardiovascular symptoms. Under supervision, I reviewed numerous
ECGs and learned how to interpret:

Normal sinus rhythm and its variations.

ST-segment elevations and depressions, particularly in STEMI and NSTEMI.

Bundle branch blocks (left and right).

Signs of atrial enlargement such as P mitrale and P pulmonale.

T-wave inversions, prolonged QT intervals, and tachyarrhythmias.

In each case, I was guided to not only identify abnormalities but also to relate them to the patient’s
symptoms, history, and biochemical markers. For example, one patient with chest pain had an ECG
showing ST elevation in the inferior leads, prompting a discussion about right coronary artery
involvement and acute infarction management. Another patient with dyspnea had signs of left atrial
enlargement and possible mitral stenosis, which we confirmed with auscultation and
echocardiographic planning.

This hands-on ECG exposure demystified what had previously felt like a technical and intimidating
subject. Now, I understand how ECG is not just a line tracing — it’s a snapshot of the heart’s
function, and a window into life-saving decisions.
2. Chest X-rays

Another key investigation I encountered during the practical was the chest X-ray (CXR). While
radiologists formally report the films, students were encouraged to view and interpret X-rays with
the consultant.

I reviewed X-rays showing:

Pleural effusions (evident by blunting of the costophrenic angle and fluid layering).

Lobar consolidation in pneumonia (classically in right middle and lower lobes).

Hyperinflated lungs in asthma and COPD.

Cardiomegaly, especially in patients with valvular heart disease.

Pulmonary edema in congestive heart failure.

Learning how to correlate these findings with physical signs — such as dullness to percussion,
bronchial breath sounds, or crepitations — added a layer of depth to every case. It also helped
reinforce the principle that investigations are not standalone entities; they must be read in the
context of the whole patient.

3. CT Imaging (Brain)

In patients presenting with neurological deficits, especially those with suspected stroke, we had the
opportunity to view CT brain scans. These were essential for:

Confirming ischemic infarcts.

Identifying hemorrhagic stroke, which alters management entirely.

Assessing for midline shift, brain swelling, or old infarcts.

One case that stood out was a middle-aged man with sudden-onset right-sided hemiplegia and
slurred speech. Clinically, we suspected a left middle cerebral artery infarct. The CT scan showed a
clear hypodense area corresponding with our suspicion. This reinforced the process of clinical-to-
radiological correlation — an invaluable habit in medical diagnostics.

Additionally, these cases opened discussions about window periods for thrombolysis, the role of
stroke units, and long-term secondary prevention strategies.
4. Routine Bedside Tools and Monitoring

Apart from major investigations, I became more familiar with routine tools used in patient
monitoring, which are no less critical:

Sphygmomanometers for measuring blood pressure.

Pulse oximeters for assessing oxygen saturation.

Glucometers used in patients with diabetes or altered mental status.

Thermometers (both digital and mercury-based) for fever assessment.

I assisted in using these tools during examinations and learned how trending vitals — not just
isolated numbers — are central to decision-making in hospital care. For instance, a gradual drop in
SpO₂ led to escalation of oxygen therapy in a dengue patient with rising pleural effusion.

These small but vital details helped me develop a sense of situational awareness in the ward —
knowing what to monitor, when to escalate, and how to recognize deterioration early.

5. Nebulization and Oxygen Therapy

I observed nebulizer use in patients with asthma and COPD exacerbations. Nebulized salbutamol and
ipratropium bromide, sometimes with systemic steroids, were used to relieve bronchospasm. I saw
firsthand how patients went from visibly struggling to breathe to being calm and stable post-
treatment.

I also learned the indications and setup for oxygen therapy, including:

Nasal prongs for mild hypoxia.

Face masks and non-rebreathers in more acute cases.

Adjusting flow rates and monitoring response through SpO₂ levels.

The simplicity and effectiveness of these interventions reminded me that even in resource-limited
settings, prompt basic care saves lives.
6. Laboratory Investigations

While we didn’t handle lab tests ourselves, we routinely reviewed patient blood results and
discussed:

Complete blood counts (CBC) – for infection, anemia, or platelet trends in dengue.

Liver function tests (LFTs) – altered in leptospirosis or dengue hepatitis.

Renal function – especially in elderly or septic patients.

Troponins – in suspected acute coronary syndromes.

Serology and antigen tests – for infections like dengue and leptospirosis.

I learned how trend monitoring is often more important than a single abnormal value, and how
these labs fit into the larger clinical picture.

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Conclusion of the Section

Exposure to these investigations and tools has not only made me more familiar with hospital
processes, but also improved my ability to think clinically, critically, and integratively. I have begun to
understand how to ask the right questions, choose the right test, and most importantly — interpret
results in the context of the patient’s story.

These experiences have laid a strong foundation for future clinical rotations and prepared me to take
on more active roles as I progress in my medical education.
Conclusion
The 10-day clinical practical training in the medical ward was an incredibly valuable chapter in my
journey as a medical student. It not only solidified my theoretical knowledge but also transformed
the way I understand and approach real patients. It was a time of immersion, growth, and reflection
— a period where I witnessed firsthand the complexities and nuances of internal medicine and
began to feel, perhaps for the first time, like a part of the clinical team.

Throughout the practical, I had the opportunity to engage actively with a wide range of patients
suffering from diverse medical conditions — from asthma and pneumonia to myocardial infarction,
stroke, and tropical infections like dengue and leptospirosis. This variety deepened my clinical
exposure and helped me build confidence in recognizing patterns, performing focused examinations,
and considering differential diagnoses.

One of the most profound realizations during this period was the power of the patient narrative. I
came to understand that behind every lab report and radiological image lies a human being with a
story, fears, and expectations. Taking patient histories no longer felt like an academic task but rather
a conversation with purpose — a way to build trust, uncover crucial information, and begin the
process of healing.

The ward environment in Sri Lanka, though often busy and resource-limited, was rich in clinical
teaching and collaborative care. I learned how doctors adapt to real-world constraints, make
decisions with limited information, and balance urgency with compassion. These were lessons not
taught in lectures, but absorbed through observation, interaction, and experience.

Another major takeaway was the importance of clinical reasoning and judgment. While physical
examination remains the cornerstone of bedside assessment, I saw how investigations like ECGs, X-
rays, and CT scans complement and confirm what the hands and ears detect. The ability to correlate
signs, symptoms, and tests into a cohesive diagnosis is an art — one I have only just begun to
appreciate and practice.

I also witnessed the professionalism, patience, and empathy displayed by the consultants and
medical officers. Their dedication to teaching, their clarity in explanations, and their example in
handling complex situations taught me not just how to be a doctor, but how to carry myself as one.
Their mentorship inspired me to hold myself to higher standards and strive for both competence and
compassion in all that I do.
Above all, this experience reaffirmed my decision to pursue medicine. It reminded me that medicine
is not just a science, but also a deeply human endeavor — one that requires continuous learning,
emotional resilience, and the courage to face the unknown alongside the patient.

As I move forward in my medical training, I carry with me the many skills, insights, and stories I
gathered during this practical. They are now part of my foundation as a future clinician — one I will
continue to build on with gratitude, curiosity, and dedication.