a diary

internship diary

________________________________

(type of practicum: educational internship, on-the-job training)

Student of medical faculty

Student’s Full Name ______________________________

Surname, first name, patronymic (if any)

Specialty ________________________________

Year of study_________________Group_______________

Practicum Instructions

Student’s Full Name ______________________________________________________

Surname, first name, patronymic (if any)

is assigned to _______________________________________ practical training

(type of practical training: filed, hospital)

in _________________________ _______________________________

city hospital

Duration of practical training from_________________________till______________________________

Manager (UlSU)

__________________________________________________________________________________

seal here Dean of the department_____________________

(signature)

seal here Arrived at hospital

«_____»______________________20______г._____________________

(signature)

Preceptor

______________________________________________________________________

(position held, surname, first name and patronymic)

is assigned ___________________________________________________

(Order number, date)

seal here Left hospital

«_____»______________________20______г._____________________

(signature)

resource pack of information

Basic provisions for practical training

Before practical training the Manager (UlSU):

instructs the students;
gives each student an internship diary, personal tasks for practical training and two copies of practical skill list per group (one for students and one for the preceptor).

On arrival at the place of internship the student is obliged:

to come to the organization where he/she is to do an internship strictly in accordance with the terms of practical training and the order of the rector;
the student who voluntarily changed the place of internship is considered to be absent;
to meet the person who is responsible for practical training at the organization;
to submit a health permit to practical training;
to submit a program of practical training and a practical skill list;
to get an understanding of the workplace and equipment operating rules;
to get through workplace-related training;
to set up a schedule, which should be held at the place of work.

During the internship, the student is obliged:

to comply fully with the rules of internal regulations of the organization where the practical training is held;
to leave the workplace, only after notifying the Preceptor and the Manager (UlSU);
to submit an internship diary for review on demand of the Preceptor/ Manager (ULSU); the diary is the main student’s document during the practical training, he/she should write down all the work performed, in accordance with the program of practical training; the diary is held at the workplace;
during practical training, the student is obliged to master at least 80-90 % of the practical skills specified by the program of practical training;
to follow the rules of deontology;
to participate in scientific and rationalization activity in accordance with the personal task.

Internship results summarizing:

At the end of the practical training, the student is obliged to submit a completed internship diary and records on the practice for signature to the Preceptor and the Group manager, who also write a final report and evaluate the training practice results.

The report on the practical training and submission of the internship diary are held at the Department immediately on completion of internship. Then the student is to submit his/her internship diary and records to the Department.

A student who has not completed the internship program, or received a negative feedback about his/her work, or interrupted it without permission, or received a low grade, is sent to practical training again or can be expelled from the institution because he/she has unfulfilled program requirements as written in local University regulations.

The graded test (differential pass-fail exams) is considered to be the end-of-the-course result. Training practice grade is taken into account when summarizing the overall student’s performance.

II. General rules for keeping the internship diary

1. The internship diary is the main student’s document during the internship.

2. During practical training, the student briefly writes down in his/her internship diary everything that he/she has done over a certain period of time and describes the completion of practical training program and personal tasks.

3. The student is to submit an internship diary for review on demand of the Preceptor/Manager (ULSU). The Preceptor and Manager (ULSU) sign the internship diary, make their comments and give students additional tasks.

4. On completion of internship the internship diary and the report should be reviewed by the Preceptor/ Manager (ULSU). The Preceptor and Manager (ULSU) also write a final report and sign the internship diary.

Work schedule (plan) and internship dates

Work period	Student’s work place
	Department:




	R&D abstract topic




	Work in diagnostic (imaging) rooms



	Duty shifts:

Signature:

Manager (UlSU) _________________________________

Preceptor _________________________________

Personal tasks for practical training

The content of the personal task and the anticipated results

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature:

Manager (UlSU) _________________________________

Approved:

Preceptor _________________________________

I have read and acknowledged the internal regulations, requirements of labor protection, safety and fire safety in _____________________________________________________________

(the name of the organization and the workplace)

_______________________________________________________

Student ___________________________________________

(signature, name, date)

The briefing was conducted by the Preceptor _____________________________________________________________

(signature, name, date)

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

LIST OF PRACTICAL SKILLS, WITH THE LEVEL OF DEVELOPMENT

№	Practical skill	Observed	Assisted	Performed independently

LIST OF PRACTICAL SKILLS, WITH THE LEVEL OF DEVELOPMENT

№	Practical skill	Observed	Assisted	Performed independently

Preceptor review on student’s internship

Practical skills are fully, incompletely or partially mastered.

(underline as applicable)

The rules of deontology are fully, incompletely or partially mastered.

(underline as applicable)

Preceptor

Signature ______________

Surname, first name, patronymic _____________________________

Manager review on student’s internship

Theoretical knowledge and practical skills are fully, incompletely or partially mastered.

(underline as applicable)

Research work: the student demonstrated such personal qualities as sociability, initiative, responsibility, personal interest

Internship reprimands ________________________________________________

_____________________________________________________________________

Credit grade _____________________________________________________________

«____»_____________________20___г.

Manager (UlSU)

Signature______________

Surname, first name, patronymic _________________________________

«____»_____________________20___г.

internship diary

________________________________

(type of practicum: educational internship, on-the-job training)

Student of medical faculty

Student’s Full Name ______________________________

Surname, first name, patronymic (if any)

Specialty ________________________________

Year of study_________________Group_______________

Practicum Instructions

Student’s Full Name ______________________________________________________

Surname, first name, patronymic (if any)

is assigned to _______________________________________ practical training

(type of practical training: filed, hospital)

in _________________________ _______________________________

city hospital

Duration of practical training from_________________________till______________________________

Manager (UlSU)

__________________________________________________________________________________

seal here Dean of the department_____________________

(signature)

seal here Arrived at hospital

«_____»______________________20______г._____________________

(signature)

Preceptor

______________________________________________________________________

(position held, surname, first name and patronymic)

is assigned ___________________________________________________

(Order number, date)

seal here Left hospital

«_____»______________________20______г._____________________

(signature)

resource pack of information

Basic provisions for practical training

Before practical training the Manager (UlSU):

instructs the students;
gives each student an internship diary, personal tasks for practical training and two copies of practical skill list per group (one for students and one for the preceptor).

On arrival at the place of internship the student is obliged:

to come to the organization where he/she is to do an internship strictly in accordance with the terms of practical training and the order of the rector;
the student who voluntarily changed the place of internship is considered to be absent;
to meet the person who is responsible for practical training at the organization;
to submit a health permit to practical training;
to submit a program of practical training and a practical skill list;
to get an understanding of the workplace and equipment operating rules;
to get through workplace-related training;
to set up a schedule, which should be held at the place of work.

During the internship, the student is obliged:

to comply fully with the rules of internal regulations of the organization where the practical training is held;
to leave the workplace, only after notifying the Preceptor and the Manager (UlSU);
to submit an internship diary for review on demand of the Preceptor/ Manager (ULSU); the diary is the main student’s document during the practical training, he/she should write down all the work performed, in accordance with the program of practical training; the diary is held at the workplace;
during practical training, the student is obliged to master at least 80-90 % of the practical skills specified by the program of practical training;
to follow the rules of deontology;
to participate in scientific and rationalization activity in accordance with the personal task.

Internship results summarizing:

The graded test (differential pass-fail exams) is considered to be the end-of-the-course result. Training practice grade is taken into account when summarizing the overall student’s performance.

II. General rules for keeping the internship diary

1. The internship diary is the main student’s document during the internship.

Work schedule (plan) and internship dates

Work period	Student’s work place
	Department:




	R&D abstract topic




	Work in diagnostic (imaging) rooms



	Duty shifts:

Signature:

Manager (UlSU) _________________________________

Preceptor _________________________________

Personal tasks for practical training

The content of the personal task and the anticipated results

Signature:

Manager (UlSU) _________________________________

Approved:

Preceptor _________________________________

I have read and acknowledged the internal regulations, requirements of labor protection, safety and fire safety in _____________________________________________________________

(the name of the organization and the workplace)

_______________________________________________________

Student ___________________________________________

(signature, name, date)

The briefing was conducted by the Preceptor _____________________________________________________________

(signature, name, date)

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

Date	Working records

LIST OF PRACTICAL SKILLS, WITH THE LEVEL OF DEVELOPMENT

№	Practical skill	Observed	Assisted	Performed independently

LIST OF PRACTICAL SKILLS, WITH THE LEVEL OF DEVELOPMENT

№	Practical skill	Observed	Assisted	Performed independently

Preceptor review on student’s internship

Practical skills are fully, incompletely or partially mastered.

(underline as applicable)

The rules of deontology are fully, incompletely or partially mastered.

(underline as applicable)

Preceptor

Signature ______________

Surname, first name, patronymic _____________________________

Manager review on student’s internship

Theoretical knowledge and practical skills are fully, incompletely or partially mastered.

(underline as applicable)

Research work: the student demonstrated such personal qualities as sociability, initiative, responsibility, personal interest

Internship reprimands ________________________________________________

_____________________________________________________________________

Credit grade _____________________________________________________________

«____»_____________________20___г.

Manager (UlSU)

Signature______________

Surname, first name, patronymic _________________________________

«____»_____________________20___г.

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