Registration Form - Good Intern Programme 2015
Good Intern Programme 2015 is a skills training programme for pre interns who are awaiting internship and this will be conducted in collaboration with
Deputy Director General of Education, Training and Research (ET&R), Ministry of Health,
Government Medical Officers’ Association (GMOA)
Society for Health, Research and Innovation (SHRI)
Faculty of Medicine, University of Colombo
and NICS Training.

This will consist of three phases as follows.
Phase 1 - A 2 day skills training programme
Phase 2 - Ward based skills programme
Phase 3 - Four day workshop

The course is designed to uplift the clinical skills of Pre-Intern Doctors in assessment and management of critically ill patients to reduce medical errors and improve patient survival. The programme contains Lectures, Skills stations, Scenarios and Demonstrations targeting Basic and Advanced Life support, Systematic approach to patients during assessment and management of critically ill patients and Case scenarios to give a remarkable practical experience for the candidate to use these in everyday clinical practice during the whole medical career.

This will be an ongoing registration system. Candidates will be registered in the first come-first serve basis.

Participants can register for all three courses by using this form.


For more details - visit http://nics-training.com (NICS training Web page)
https://www.facebook.com/NICSTraining?fref=ts (Facebook Page)
http://www.gmoa.lk/index.php/skills/good-intern-doctor/good-intern-programme-2014-gip/


For any other information regarding phase 1 Contact -NICS training
(Dr. Tharindu Weerasinghe/ Dr. Manavi Deshani)- 0713241523
Email - training@nicslk.com


For any other information regarding phase 2 and 3 Contact -GMOA
( Dr. DIlini Ruwanthika)- 0777599280



Applicant details
Please select which batch you belong to *
Registration information
Please fill in the following required fields.
Email Address *
Please enter your email address. This helps us to keep you updated
Your answer
Initials *
Please enter the your initials
Your answer
Refundable Deposit for Phase 1
Your participation should be confirmed for the Phase 1 (Two day Programme) by a refundable deposit of 3000.00SLR to NICS account number 1030017017 at Commercial Bank, Foreign Branch and a scanned copy or a photo of the bank slip should be sent to training@nicslk.com.

You will receive a confirmation of your registration via email, after you have submitted both the completed registration form as well as the copy of bank slip.

Please note that If a candidate dose not turn up on the first day of Phase 1, the deposit will be transferred to Ministry of Health, Sri Lanka and will become non-refundable.
Last name *
Please enter your surname
Your answer
Please re-enter you contact telephone number *
Your answer
Contact telephone number *
Your answer
Gender *
Please select the gender
Please re-enter your email address *
Your answer
Registration Number
Please enter your faculty registration number
Your answer
Please select the Faculty of Medicine to which you belong *
Please state your meal preference *
Select from the below
I would like to partcipate in the 5 day skills programme *
Registration for Ward based skills programme (Phase 2)
It's a programme of 6 days for pre interns to acquire essential clinical skills and knowledge. It will be conducted in an operating theatre setting and ETU/PCU of Teaching hospitals, General/Provincial hospitals and Base hospitals under the supervision of a Consultant Anaesthetist/Physician. The preferred date ranges and venues will be informed by GMOA. Consultant in-charge will decide the 5 days, from your preferred week, according to his convenience

An administrative fee of RS.500 should be deposited to "Society for Health Research and Innovation" account number 77412924 at Bank of Ceylon, Torrington Branch and a photo of the bank slip should be sent to secretary@shri.lk/shrigip4@gmail.com
Please state your preferred location for this 5 day training *
Mark your first choice.
Please state your 2nd preferred location for this 5 day training *
After mark your first choice above then please select from the following choices and note that your first preference may not always be possible.
If yes, please state your preferred date range- Clinical skills will be given by the consultants in any 5 days of the following week *
Please state your first choice here
Please select your current level of competence in the following skills *
1-Performs skill competently without supervision
2-Perfoms skill competently with supervision
3-Not able to perfom skill but has observed skil
4-Not able to perfom skill and has not observed skill
Suturing
Cannulation
NG tube insertion
Catheterization
Setting up an IV drip
Infusion pump setup
Blood and blood products Transfusion
Venepuncture 
Venupuncture for blood culture
Pleural tap
Peritoneal Tap
Removal of an Intercostal Tube
Injections-SC/IM
Lumbar Puncture
GCS monitoring
CPR
Defibrillation
Arterial puncture for ABG
Wound dressing
Suture removal
Bandaging
Venous cut down
Glucometer use
Nebulization
Connecting to a ECG monitor
Intubation
Airway maneuvers
CVP line  insertion
IC tube insertion
Please select your current level of competence in the following skills *
1-Performs skill competently without supervision
2-Perfoms skill competently with supervision
3-Not able to perfom skill but has observed skil
4-Not able to perfom skill and has not observed skill
Suturing
Cannulation
NG tube insertion
Catheterization
Setting up an IV drip
Infusion pump setup
Blood and blood products Transfusion
Venepuncture 
Venupuncture for blood culture
Pleural tap
Peritoneal Tap
Removal of an Intercostal Tube
Injections-SC/IM
Lumbar Puncture
GCS monitoring
CPR
Defibrillation
Arterial puncture for ABG
Wound dressing
Suture removal
Bandaging
Venous cut down
Glucometer use
Nebulization
Connecting to a ECG monitor
Intubation
Airway maneuvers
CVP line  insertion
IC tube insertion
Please select your current level of competence in the following skills *
1-Performs skill competently without supervision
2-Perfoms skill competently with supervision
3-Not able to perfom skill but has observed skil
4-Not able to perfom skill and has not observed skill
Suturing
Cannulation
NG tube insertion
Catheterization
Setting up an IV drip
Infusion pump setup
Blood and blood products Transfusion
Venepuncture 
Venupuncture for blood culture
Pleural tap
Peritoneal Tap
Removal of an Intercostal Tube
Injections-SC/IM
Lumbar Puncture
GCS monitoring
CPR
Defibrillation
Arterial puncture for ABG
Wound dressing
Suture removal
Bandaging
Venous cut down
Glucometer use
Nebulization
Connecting to a ECG monitor
Intubation
Airway maneuvers
CVP line  insertion
IC tube insertion
Registration for Four day work shop (Phase 3)
It is a programme of 4 days,from 8am to 5pm, held in Ananda College. The scheduled dates are 5th-8th October

An administrative fee of RS.1000 should be deposited to "Society for Health Research and Innovation" account number 77412924 at Bank of Ceylon, Torrington Branch and a photo of the bank slip should be sent to shricommunicationskills2015@gmail.com.
Would you like to attend the 4 day workshop? *