PASIG CITY GENERAL HOSPITAL Department of Pediatrics

PASIG CITY GENERAL HOSPITALDepartment of Pediatrics

Clinical ClerkshipSY 2011-2012

To acquire the basic knowledge, skills, and attitudes appropriate for the practice of pediatrics that serves as a foundation for providing competent child health care in whatever field of medicine the student pursues.

Objective:PCGH ROTATION OF YL8 ATENEO STUDENTS

(CLERKS )

The Medical City 2wks

Community Pediatrics (Ilugin Health Center, Pasig City) 2 wks

Pasig City General Hospital 2wks

Philippine Children’s Medical Center 2wks

Duration of Rotation: 8 weeks

1 wk NICU1 wk ER/OPD

a tertiary government hospital 150 bed capacity locally funded by City government of Pasig

PCGH

Deficiencies/Limitations of PCGH Limited supplies (budget depends on city hall) Inadequate equipment/Facilities Lack of adequate manpower ( medical and non-medical)

PCGHAccredited Departments Department of Pediatrics Level 1 Accredited training by PPS Department of OB-GYN Department of Surgery Consortium with Mary Chiles Hospital Department of Emergency Medicine

Non-accredited Departments Department of Internal Medicine Department of Radiology Department of Anesthesiology Department of Pathology

PCGHServices: ER OPD Subspecialty Clinics Monday Nephro Clinic

Tuesday Neuro/ Well Baby ( immunization)Wednesday Pulmo/Hema ClinicThursday Neonatology (Sick Babies)Friday Cardio

NICU WARDS PICU Isolation/Newborn Ward

Pulmo Ward Miscellaneous WardPayward Philhealth ward

PCGH Consultant Staff

Medical DirectorPaulo A. Castro, Jr. MD

Asst. Medical DirectorAnthony A. Marquez, MD

Department ChairmanRosario G. Isada, MD

Internal AffairsJorge C. Licsi, MD

Bioethics Finance Socio-Cultural

Research & Dev’tGloria DL Poblete, MD

Out-Patient In-Patient

a. Community Health Education b. Ambulatory

General Pediatrics

Rosario Isada, MD Gloria Poblete, MD Jorge Licsi,MD Amalia Bulaon, MD Rowena Ong, MD

Subspecialties

Loretta Alano, MD Nepthalie Ordonez,MD Jeanna Ples, MD Arleen Galvez, MD Carmina Delos Reyes, MD Neva Batayola, MD Edwin Rodriguez, MD Imelda Tan, MD Jonadav Martinez, MD

General Pediatrics

Rosario Isada, MD Gloria Poblete, MD Jorge Licsi,MD Amalia Bulaon, MD Rowena Ong, MD

Subspecialties

Loretta Alano, MD Nepthalie Ordonez,MD Jeanna Ples, MD Arleen Galvez, MD Carmina Delos Reyes, MD Neva Batayola, MD Edwin Rodriguez, MD Imelda Tan, MD Jonadav Martinez, MD

DEPARTMENT OF PEDIATRICS

Training OfficerJorge C. Licsi, MD

Research Residency Training

ServicesAmalia C. Bulaon, MD

ASMPH FACULTY

Rosario G. Isada, MD, FPPS Chairman

Rowena Ong, MD, DPPS

Carmina Delos Reyes, MD, DPPS

Amalia Bulaon, MD, FPPS

Gloria DL Poblete, MD, FPPS

NON ASMPH FACULTY

Jorge C. Licsi, MD, FPPS Training Officer

Senior Consultants

Loretta Stephanie Alano, MD, DPPS Neonatologist

Arleen Galvez, MD, DPPS Pediatric Nephrologist

Jonadav Martinez, MD, Pediatric Surgeon

Neva Luna Batayola, MD, DPPS Pediatric Intensivist

ACTIVE CONSULTANTS

NON ASMPH FACULTYSenior Consultants

Nepthalie Ordoñez, MD, FPPS Pediatric Pulmonologist

Jeanna Ples, MD, DPPS Pediatric Cardiologist

Edwin Rodriguez, MD, DPPS Pediatric Hematologist

Imelda Tan, MD, FPPS Pediatric Neurologist

ACTIVE CONSULTANTS

NON ASMPH FACULTY

Consuelo Sumayao, MD Mylah Tuazon, MD

Arlyn Baconawa, MD Sophia Mata, MD

VISITING CONSULTANTS

JUNIOR CONSULTANTS

PEDIA RESIDENTS

Irish Cayton, MD Chief Resident

Jinky Borromeo, MD 2nd yr Resident

Kate Callanga, MD 2nd yr Resident

Jennifer Manzano, MD 1st yr Resident

Amor Mia Cruz, MD 1st yr Resident

Marigold Bajar, MD 1st yr Resident

Norhyn Tamano, MD Pre=Resident

Stethoscope (preferable a pediatric stethoscope) Penlight Tape measure Diagnostic set (Otoscope/Ophthalmoscope) BP apparatus (anaeroid type) Neurologic hammer Digital thermometer or thermoscan Calculator Watch with seconds hand Tongue depressor

Prerequisites:PCGH ROTATION OF YL8 ATENEO STUDENTS

(CLERKS )

MUST SEE CASES:Nursery Rotation

OPD Rotation

Newborn Care and Discharge

TTNB / RDS Sepsis Neonatorum Hyperbilirubinemia

• Immunization • Anticipatory Guidance growth and dev’t• Pulm Tuberculosis • Acute Resp Infection Otitis/Pharyngitis• IMCI Fever, Diarrhea, Immunization, Pneumonia, Breastfeeding• Common infectious conditions:

Roseola, Viral Exanthem, Measles, Varicella

• Common dermatologic conditions: Atopic / Seborrheic Dermatitis,

Scabies, Carbuncle/Furuncle, Cellulitis/Abscess/Impetigo, Fungal skin infections, Eczema

• Common cardiologic conditions: RHD, CHD

• Common nephrologic conditions: UTI, AGN, NS

• Common developmental and behavioral conditions: MR, ASD, ADHD

• Common hematologic conditions: IDA / Leukemia

ER Rotation

• Dehydration/Shock• Seizures/Febrile seizures• Respiratory distress

BP measurement 10Otoscopy 10IV insertion 5IV injection/push 5NGT insertion 1Gastric lavage 1Venipuncture/blood extraction 1Blood culture sampling 1Heel prick for newborn screening 1Cord care and dressing 1Skin testing and reading 1Urine output monitoring 5Immunization procedure 2 each (intramuscular, intradermal, subcutaneous) Assist in umbilical cannulation 1Assist in lumbar tap 1Assist in endotracheal intubation 1

MUST DO Procedures(Skills Log):

Case Patient Age/Sex Date Noted

Noted by

Hospital Seen

1.2.3.4.5.

Logbook of Cases:

Clinical Preceptorials Small Group Discussions (Endorsement/Bedside rounds/Admitting Conference) Case presentation (NICU) Nelson Club with residents MMEI (Grandrounds & CPC) PPS scientific meetings Perinatal Conference Lectures

Instructional Activities:

Schedule of ASMPH Consultants:

NICU Consultants OPD/ER Consultants

Dr. PobleteDr. BulaonDr. Ong

Dr. IsadaDr. Delos Reyes

Monday Tuesday Wednesday

Thursday Friday Saturday

Dr. Isada Dr. Bulaon Dr. Delos Reyes

Dr. Poblete Dr. Ong Dr. Isada

Schedule of ASMPH Consultants:

NICU ROTATION

PCGH - 1 Week NICU Schedule

DAILY SCHEDULE: 7:30 - 8:30 Endorsement with residents 8:00 - 9:00 Direct Patient Encounter 9:00 - 10:00 Writing Progress Notes and others 10:00 - 12:00 AdCon /SGD 1:00 - 3:00 Direct Patient Encounter 3:00 - 4:00 Writing Progress Notes and others 4:00 – 5:00 Endorsement with residents

Attendance logbooks should be signed by the clerk rotator and countersigned by the resident

NICU rotator will go on 24hrs duty every 3 daysEndorsement rounds (Bedside rounds) with the residents will be at 7:30am

and 4:00 in the afternoon

Attend all conferences, lectures and other instructional activities of the department

Clerks should be in the NICU at all times except during conferences, meetings or lunchbreak. Residents should be informed of the whereabouts of the clerkNICU Rotators should be in scrubsuits while in the NICU

Duties and Responsibilitiesof NICU Rotator

Time-in at 7am; time-out at 5pm

Catch /Do admission history on babies delivered from 7am to 5pm (to be checked by the pedia resident)

Do, assist or observe procedures on assigned patients

Follow up endorsements from post duty clerk’s patients

Endorse own patients to Clerk on duty by 5 pm

NICU Rotator:Pre -Duty

Time-in at 7am

Receive endorsements from outgoing clerks by 7:30am

Respond to DR call and admit patients with residents-on-duty during his/her tour of duty

Catch /Do admission history on babies delivered from 5pm to 7am ( to be checked by the pedia resident)

Do, assist or observe procedures on assigned patients

Follow up endorsements from co-clerks

NICU Rotator:Duty

NICU Rotator:From Duty

Finish work-ups (laboratory procedures) for patients by 7 am

Endorse patients to Pre-duty clerk by 7:30 am

Attend conferences up to 5 PM

Do NBS and discharge PE with the pedia resident-in charge at OB ward

Do progress notes (SOAP format) on all babies at the pathologic room.

OPD / ER ROTATION

Duties and Responsibilitiesof ER Rotator

Time in is 7:00am for incoming and pre-duty Attendance logbooks should be signed by the clerk rotator and countersigned by the resident ER rotator will go on 24hrs duty every 3 days Postduty clerks will be off at 12nn unless there is a scheduled conference or lecture in the afternoon Pre-duty clerks will be required in the hospital from 7:00am -5:00pm Endorsement rounds (Bedside rounds) will be at 7:00am Attend all conferences, lectures and other instructional activities of the department

Duties and Responsibilitiesof OPD Rotator

Time in is 7:00am to 5:00 pm OPD Clinic hours is from 9:00am -12:00nn and 1:00pm – 4:00pm ( Mon to Fri) except holidays Attendance logbooks should be signed by the clerk rotator and countersigned by the resident The clerk rotator may attend ward endorsements at 7:30am Attend all conferences, lectures and other instructional activities of the department

ER / OPD Rotator:Pre -Duty

Report for work at 7 am- 4 pm at the OPD

Do history taking and PE on assigned patients

Do, assist or observe procedures like immunization,anthropometric / BP measurements, etc.

ER / OPD Rotator:Duty

Report for work at 7 am to 7 am the following day at the Emergency Room

Receive endorsements from co-clerks by 7am

Do history taking and PE of assigned patients

Do, assist or observe procedures on assigned patients

ER / OPD Rotator:From Duty

Report for work at 7 am- 12 pm at the OPD (unless there is a scheduled lecture/conference in the afternoon

Do history taking and PE on assigned patients

Do, assist or observe procedures like immunization,anthropometric / BP measurements, etc.

Summary of Requirementsof ASMPH Clerks

2 Preceptorial / SGD / AdCon evaluation by ASMPH Faculty1 NICU Rotation ( Dr. Poblete/ Dr. Bulaon/ Dr. Ong)1 OPD/ER Rotation ( Dr. Isada / Dr. Delos Reyes)

1 Case Presentation - NICU (Dr. Poblete/Dr. Bulaon/Dr. Ong)4 Patient Encounter Form during ER/OPD rotation4 Patient Encounter Form during NICU rotation5 Professionalism evaluation (Residents or Junior Consultants)

5 Skills Evaluation (Residents or Junior Consultants)

2 Quizzes

*** Deadline for submission of Patient Encounter Form 5 pm the following day

Scope of Quizzes

NICU Newborn Care / P.E. of the

Newborn Non-Infectious Ds of the Newborn

HyperbilirubinemiaTTNHMD

Infectious Ds of the NewbornSepsisPneumonia

OPD/ER BFC (guidelines) Dengue Fever / DHF PTB (guidelines) PCAP (guidelines) AGE (WHO)

Breakdown of Evaluation:

Percentage

40% 10% Case Presentation30% Preceptorial/Adcon

5% Written Reports / Logbooks

5% Quizzes

10% Skills

10% Professionalism

30% End Rotation Exam

ASMPH Clerkship Requirements for Pediatrics

Completion of MUST SEE CASES in any rotation of pediatrics. (TMC/COMPEDS/PCGH/PCMC)

Completion of Skills log and charts in the respective areas.(WARD/ER/OPD/NICU)

All requirements and projects are due on the Sunday of your last day of rotation.

End of Rotation exam will be given on the last Saturday of the pediatrics rotation.

Attendance to department conferences/small group discussions is a priority. Out of hospital conference is at the discretion of Consultant Clerks Monitor.

Direct Observation of history taking, physical examination and skills

Rating scale for SGD, case presentation, professionalism, skills

Completion of Technical skills Logbook/Individual Booklet

Quizzes End-rotation Exam OSCE Final exam (at the end of clerkship) Attendance

Summary of Evaluation:

Grading and Evaluation: The passing score of the final exam is 75%. If you fail during

the 1st try, you can take it again and if passed, the score given is 75% irrespective of the raw score. If you fail a second time, it is equivalent to repeating the rotation.

The rest will be graded through the rating scale that you would give to your resident/consultant. You are responsible to give the grading sheets to them.

Sanctions:

For Tardiness: First Offense: Warning Second Offense: 4 hours extra duty Third Offense: 24 hours extra duty Fourth Offense: 1 Sunday duty Fifth Offense: 2 Sunday duties

For Out of Post: First Offense: 1 week extension Second Offense: 2 weeks extension Third Offense: 1 month extension Fourth Offense: Repeat Rotation

Sanctions: For Absences

◦ Excused Absences are made up on a 1:1 basis (one day absence = one day make up) as long as a letter addressed to the Consultant Clerks Monitor with the reason for the absence and a medical certificate is submitted the next day the absence was incurred.

For Absences (Unexcused)◦ First Offense: 1 week extension (?)◦ Second Offense: 4 weeks extension (?)◦ Third Offense: Dismissal

*** Unexcused absences are made up on a 1:2 basis (one day absence = 2 days make up) (?)

Sanctions: For deficiencies in Requirements

– For every deficiency in requirements - 4 hours make-up. For every day that a requirement is still not submitted, an additional 4 hours of makeup will be added.• If the total make up of hours exceeds the number of

hours spent in a rotation, it is equivalent to a repeat rotation.

– For every deficiency in professionalism grading – 4 hours makeup.(?)

For noncompletion of LOGBOOKS, SKILLS LOG and MUST SEE CASES– Each case missed must be seen and completed within

the pediatric rotation, otherwise a written report regarding the missed case must be submitted.

– Each skill missed must be done and completed within the pediatric rotation. Routine procedures (?) must all be completed. For special procedures(?), a written report regarding the procedure must be submitted.

Sanctions:

End of Rotation Exam. The passing score of the final exam is 75%. A repeat exam will be given on the next scheduled end of rotation exam for those who fail the first time. Failure on the repeat exam is equivalent to a repeat rotation.

No clearance will be given if you still have incomplete logbooks, deficiency in requirements or pending make up. Your final grade will be submitted as INCOMPLETE until all deficiencies and make up have been completed.

Make Ups: To schedule make ups, inform Resident Clerks’ Monitor at least one day in advance. ◦ Have the senior resident on duty sign an index card with

the following information; name, LEC #, date of makeup, hours spent. (?)

Sanctions:

Monday Tues Wed Thur Fri Sat SunWEEK 1 8-Aug 9-Aug 10-Aug 11-Aug 12-Aug 13-Aug 14-AugPCGH chua chua chua chua chua chua chua

de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz

joaquin joaquin joaquin joaquin joaquin joaquin joaquin

rayel rayel rayel rayel rayel rayel rayel

redota redota redota redota redota redota redota

teo teo teo teo teo teo teo

uy uy uy uy uy uy uy

WEEK 2 15-Aug 16-Aug 17-Aug 18-Aug 19-Aug 20-Aug 21-AugPCGH chua chua chua chua chua chua chua

de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz

joaquin joaquin joaquin joaquin joaquin joaquin joaquin

rayel rayel rayel rayel rayel rayel rayel

redota redota redota redota redota redota redota

teo teo teo teo teo teo teo

uy uy uy uy uy uy uy

LEC 8

Monday Tues Wed Thur Fri Sat SunWEEK 1 8-Aug 9-Aug 10-Aug 11-Aug 12-Aug 13-Aug 14-Aug

PCGH NICU PCGH OPD/ER

chua chua chua chua chua chua chua

de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz

rayel rayel rayel rayel rayel rayel rayel

teo teo teo teo teo teo teo

redota redota redota redota redota redota redota

uy uy uy uy uy uy uy

joaquin joaquin joaquin joaquin joaquin joaquin joaquinWEEK 2 15-Aug 16-Aug 17-Aug 18-Aug 19-Aug 20-Aug 21-Aug

PCGH NICU PCGH OPD/ER

redota redota redota redota redota redota redota

uy uy uy uy uy uy uy

joaquin joaquin joaquin joaquin joaquin joaquin joaquin

chua chua chua chua chua chua chua

de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz de la cruz

rayel rayel rayel rayel rayel rayel rayel

teo teo teo teo teo teo teo

LEC 8