LU6 Blueprints 2010-11 New

8/13/2019 LU6 Blueprints 2010-11 New

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FCH 251 (LU 6) blueprints

Department of Family and Community Medicine

College of Medicine-Philippine General Hospital – UP Manila

Foreword

The Family and Community Medicine Learning Unit 6 (LU 6) rotation is subdivided into three sub

rotations: a two week Supportive, Palliative and Hospice Care (SHPM) rotation, one week Community

Medicine rotation and one week for the Ambulatory Care unit rotation. Each of which has its own

instructional design which will be presented individually in this report.

Supportive, H ospice and Palliative Medicine (SHPM ) Rotation

Course Description: This is a two week rotation which will focus on clinical practice in the provision of Palliative and HospiceCare to patients and their families in the hospital and home care setting.

Pre-requisites: Must have satisfactorily passed LUC 5

Setting of Learning Experience: SHPM ambulatory clinic (3rd floor OPD bldg), Hospice unit at Cancer Institute, Child-Family Supportive

Care Program at the UP-PGH Cancer Institute and Community Home visits

General Objective: “To provide exposure and training in the care of terminally/chronically ill patients and their families in the

context of primary health care”



LEARNING OBJECTIVES CONTENT LEARNING

ACTIVITIES

EVALUATION RESOURCES

Given an actual patient, a student

under supervision is expected to

demonstrate the following

competencies:

Apply the principles of Hospice

and Palliative Care in the

management of chronically andterminally ill patients.

Specific objectives

1. Perform adequate assessmentof terminally ill patients and

their families

Hospice and Palliative Care:

the history and concept

Review of:

Trajectory of illness

Impact of illness

History taking

Health beliefs

Family assessment tools

APGAR

Genogram

SCREEM

Physical examination in the

context of terminal/chronic

illness

Biomedical/BiopsychosocialAssessment

Attend orientation

Random interview with

hospice personnel

Small group discussion

Independent reading

Pre-exposure activities

Bedside demonstration

Actual patient exposure

Rounds with

resident in charge

and fellow in charge

Independent reading

(review of previous

lectures/readings OSI I)

Attendance

Global rating scale for

direct observation

Consultant/Resident

evaluation

Reflection paper

Chart review

Patient feedback

End of rotation

examination

Reference c/o

hospice library ,

venue, schedule,

resource persons,

wards

Lecture notes from

OSI I (family

assessment tools)



2. Prioritize and manage

common conditions identified.

Clinical

Pain control

Symptom control

Nutrition

Immobilization

Psychosocial

Caregiver fatigue Depression

Co-dependence

Collusion

Dealing with difficult

patient/relatives

Basic pathophysiology

Basic principles in the

management of chronically

and terminally ill patients

Principles of drug use

Symptom management in

palliative care

Evidenced based medicine

Basic communication skills

Active listening skills

Counseling

Family meeting

Ethics in palliative care

Legal medicine

Direct observation

Bedside demonstration


Independent learning

Demonstration

Clip showingRole-play

Lectures

Bedside rounds

Self and peer evaluation

Patient feedback

Formative evaluation Demo tapes

TV. VHSLCD

Laptop

Facilitator(s)

3. Identify the indications foradmission to:

hospice unit at the cancerinstitute

home visit /home care

Guidelines for admission atthe hospice unit/home visit Orientation



Formative evaluationusing student’s reflection

paper

Examination

Handouts



program Bedside rounds

4. Refer patients to the proper

specialty /services

Referral forms

Indication for referral

Health linkages/networking

with other hospices, Madre de

Amor and Bulacan Hospice

Coordinating/Communicating

with other subspecialty in the

care of patient

Preparation and follow up

of referrals

Home visit to madre de

amor and bulacan hospice

Chart review

Progress notes

Feedback from

Specialties/services

5. Maintain complete, legible

and updated patient records

Data recording

Record keeping

Quality assurance

Update chart entries Chart review

Progress notes

Patient charts

6. Provide instructions prior to

discharge or transfer of patients

Transfer of care

Communication skills

Home instructions

Preparation of clinical

abstract and discharge summaries

Patient and caregiver

Feedback from patient

and caregiver

Direct observation using

checklist or Rating scale

Patient charts



Discharge PE

Patient/caregiving

Instruction

Networking

training


Patient charts

7. Perform common

tasks/procedures both foradmitted patients and home care

Basic procedures

IV insertion

Administering oxygen

Administeringcommon medicines:

oral, IM, SC

Nebulization NGT insertion

Foley catheter

insertion

Nutrition planning

Blood extraction

Bedsore/colostomy

/tracheostomy care

Family meetings

Demo and return demo

home visit with hospice

team




Rating scale

Checklist

Video tapes

Dummies for demo purposes

Skills laboratory



8. Communicate effectively with

other hospice team members

Giving and receiving

feedback


Role-play

Carry out tasks



Formative feedback

Direct Observation usingrating scale

Preceptors

Feedback forms

9. Provide end-of-life care and

comfort to terminally ill patientsand their families

End of life care


Counseling skills

Bereavement care

Medical ethics

Religion and philosophy

Case discussions

Family meetingsBedside rounds



Debriefing

Patient/family feedback


Student

logbook/diary/Census

Student logbooks

Patient/clientfeedback forms

Conference rooms

Preceptors

List of must knows and nice to know topics: Hospice and Palliative Care principles

Adequate assessment of terminally ill patients



Common signs and symptoms seen in terminally ill patients and basic management

Communication (breaking bad news, counseling skills)

Medicines commonly used in hospice (Morphine myths and fallacies)

End of Life care

Medical Ethics

Class schedule/blueprint of activities:

1st week

Monday Tuesday Wednesday Thursday Friday

A.M. A.M. A.M. A.M. A.M.

General Orientation of the

LU6 course

Orientation with fellow of

the month with consultant

Students hour

Palliative Care team

meeting

DFCM Staff conference Palliative Care team

meeting

Case ManagementMeeting (9am – 10:30) SHPM patient care and

tasks (Home visit/Ward

rounds/OPD

Child-Family Supportive

Care Program rotation)

SHPM patient care and

tasks (Ward rounds/OPD)



rounds/OPD



P.M. P.M. P.M. P.M. P.M.

Students hour withconsultant

SHPM patient care andtasks (Ward rounds/OPD at CI 108)

Family counseling/psychodynamics

Junior Journal Club(student evidence based presentation)

SHPM patient care and SHPM patient care and SHPM patient care and



tasks (Ward rounds/OPD) tasks (/Ward rounds/OPD) tasks (/Ward rounds/OPD)

2nd week




meeting

Students hour: Pain and

common symptoms in

hospice lecture (Dr. Ang)


meeting


meeting



rounds/OPD


Care Program rotation

Case Management

Meeting (9am to 10:30)



rounds/OPD







rounds/OPD


Care Program rotation) P.M. P.M. P.M. P.M. P.M.

Students hour : End of Life

(Dr. Bausa)

Students hour with

consultant

Students Didactic session

with Senior Resident

Family counseling

/psychodynamics

Junior Journal Club

(student evidence based

presentation)

SHPM patient care andtasks (Ward rounds/OPD)


SHPM patient care andtasks (Ward rounds/OPD

CI 108)



3rd

week


A.M. A.M. A.M. A.M. A.M.Orientation with fellow of

the month and consultant

Students hour with

consultant


meeting


meeting




meeting SHPM patient care and


rounds/OPD

Child-Family SupportiveCare Program rotation)





rounds/OPD




rounds/OPD



Case Management

Meeting (9am – 10:30)




Students hour with

consultant

Students Didactic session

with Junior Resident

Family counseling

/psychodynamics

Junior Journal Club

(student evidence based

presentation)




tasks (Ward rounds/OPD

at CI 108)





4th

week



Palliative Care teammeeting

Students hour Palliative Care teammeeting

DFCM Staff conference Palliative Care teammeeting

Case Conference/Grand

rounds SHPM patient care and


rounds/OPD






rounds/OPD




rounds/OPD



Students hour with Students hour with Students Didactic session Family counseling Junior Journal Club



consultant (Dr. Bausa) consultant with Senior Resident /psychodynamics (student evidence based presentation)






tasks (Ward rounds/OPD

at CI 108)





Course faculty:

Andrew Ang, MD

Agnes Bausa-Claudio, MD

Manuel Medina, MD

Rachel Rosario, MD

Community M edicine Rotation

Course Description: Community Medicine component of FCH 251; a one-week rotation seeking to provide students

with the opportunity to conduct and learn Community Medicine work with vulnerable sectors and

integrate into the health referral system.

Learning Objectives:

At the end of the 1-week rotation, each Year Level-6 student must be able to:



I. Demonstrate clinical capacities as a primary care physicians.

1. Perform history taking and physical examination with patients seeking consult at the local health center, NGO clinic, community /

barangay health posts.2. Formulate a diagnosis and a diagnostic & treatment plan with the patients seeking consult at the communities, local outpatient clinic

and a secondary hospital.

3. Demonstrate skills in patient education: Demonstrate skills & attitude in discussing with a patient and her / his caregiver the patient’sillness and the basis for the diagnostic & therapeutic options.

4. Appropriately refer patients for further treatment to better equipped facilities with better skilled health professionals.

5. Appropriately refer patients and their families to community resources and partners in health care.

II. Demonstrate skills & attitude as a health program manager.

A. Analyze local, national, and global determinants / factors that affect the health of a population group and individual patients.

1. Identify gaps in health care

2. Define vulnerable, marginalized population groups

3. Describe why these groups are vulnerable or/and marginalized.

4. Describe the health status of a specific marginalized population.

5. Analyze the social determinants affecting health of populations.

6. Define globalization and its positive and negative effects on health

B. Describe local, national, global efforts to address health and social issues of a specific marginalized population.

1. Describe elements of health programs and systems management

2. Participate in program implementation and management to address health and health-related needs.

3. Analyze how the intervention/s address/es needs of the identified population group/s



Concept Map: SOAP: Problem Solving Paradigm

GLOBAL / NATIONAL SITUATION

Global / National Health Situation

UPCM V-M-G

Hospital-BasedPrograms Community-BasedPrograms

*Primary Health Care Philosophy*Rights-Based Approach to

Development

LOCAL HEALTH SYSTEMS DEVELOPMENT, Partnership

and Referral

HEALTH

REFERRAL SYSTEM

1* 2* 3* Health Facilities

GAPS IN HEALTH CAREThe Health of Vulnerable

Population Groups:

Street Children

Persons w/ HIV-AIDS

Economic

Political

Socio-cultural

Environmental

Geographic

DETERMINANTS

Local

National

Global

RESOURCES



List of must-know and nice to know topics

Session Faculty Topic

1 Portia Marcelo Bridge – review of Community Medicine topics in previous years1. The Philippine Health Care System

2. The Public Sector

3. The Voluntary Sector

Achieving equity in health, the PHCA

2 Edelina DelaPaz,

RPP

Health of Vulnerable Population Groups

Social Determinants of Health, Globalization

3 Alumna/-us Experiences from the Field: Community Medicine as a Career Option

4 * ELEMENTS: Essential/ Basic Health Services / Programs: IMCI {EPI, CARI, CDD, Nutrition}, NTP,

Maternal Health {Antenatal and Post-Partum Care}

*

Portia Marcelo

Edelina Del Paz

Christian Gomez

others

Preceptorials in the Local Health Center, NGO clinic & field sites

1. Clinical case management

2. Clinic management

3. Special Features for emphasis:

1. The Local Health Center

2. Health NGO and Field Sites

5* * Comparative Health Care Delivery Systems and Elements of Health Program / Services Management

ComMed Rotation Evaluation



Clinical Clerks Guide to Duties at the Pasay Health Centers

I Introduction

This segment of FCH 251 has the same learning objectives [and evaluation parameters] in a different venue, i.e. a stand-alone public primary care health center. This aims to expose the students to resources and issues related to managing a local primary health facilityand its component public health programs.

II Expected behavior among Clinical Clerks - the bases of your performance evaluation in this rotation.

Courtesy to Health Center Staff and Patients.Introduction to the Health Center Staff: Introduce yourselves to the Doctor-and- Clinic-and Health Programs Manager, and his/her staff [sign in

their logbook]. Get to know the Center Staff, including the BHWs. Observe their assigned duties. Learn about the processes, materials and

activities in running a health center.

Report to Dr. Armand Lee and Ms. Luz Dino {Malibay HC} as well as our DFCM resident physician Dr. __, everyday at 8:00 am.

Take the initiative to set up “your” consultation room – put the room, tables and chairs in order; while totally impossible, try to arrange the

furniture for comfort and privacy. Set up your computer and log into CHITS.

Reminder: Be courteous, every time, every day! Take the initiative to greet all the Health Center staff; you are entering their “home”, their

turf. They do not know you; though they could be busy with the businesses for the day, they expect a greeting with a smile from each of you all

the time. Be respectful to the patients. Observe and immerse into their “lifestyle”; as newcomers, you are EXPECTED to respect their

processes. {There will be another venue for constructive critique.}

Be intellectually prepared. Review

■ Care of well child, pregnant women; health promotion across ages.■ Diagnosis and management of common illnesses among ambulatory patients: IMCI [includes ARI, AGE, EPI, malnutrition, etc

based on WHO-UNICEF protocols]; dermatoses, dyspepsia, hypertension and TB (review the WHO-DOH-NTP/National TB

Program protocol).

■ how to compute for appropriate dosages of common antibiotics and drugs for children



■ Your notes on the patient flow in the Health Center, to avoid delays.

■ Your notes on logging into and recording patient transactions in CHITS.

Every morning, check what are the available medicines and preparations in the Health Center pharmacy. Use the list to guide your

choice of drugs and how to compute for correct doses. Remember, prescribing appropriate and available drugs improve patient

adherence to therapy. Be prepared to discuss any of your patients with your resident and/or consultant. Make sure all your patients will be seen by any of

them.

What to bring, what to wear.

ALL THE TIME Bring YOUR OWN basic MD stuff: stethoscope, sphygmomanometer [great if you have a pedia cuff], pen light

[with working batteries], measuring tape, clipboard and pens, neurologic hammer, gloves, calculators and PNDF/ National Drug

Formulary {or MIMS or PDR – commercially available).

ALL THE TIME per pair, Bring YOUR OWN laptop and diagnostic set {ophthalmoscope and otoscope).

Good to have your own set of tongue depressors, they run out fast.

Bring your own personal stuff- water to drink, umbrella to protect you from the rain and sun, candies to stave off hypoglycemia andkeep you smiling.

What to wear: Clean white uniforms and nameplate, closed shoes. Leave unnecessary jewelry and valuables at home. Be

responsible, keep your money / wallet and mobile phones in your pocket at all times.

III Learning Activities

1. Opportunities for Patient Education: 1. Observe the “Pre-con”, pre-consultation lecture [a.k.a. Public Health Lecture in UPCM-PGH parlance], and “Post-con”, post-

consultation discussion to be given by the Center staff. Note also the posters, flyers given to patients and other strategies for patient

education. COMPARE this with how you did these kinds of health education in the past – in LU3, 4, 5 [including your monthly

COME activities teaching the BHWs].2. When assigned in the “Wellness Clinic” - where infant immunization and prenatal care happens, observe the “Post-Con” - how nurses

and midwives iterate the physician's advise (both about medication intake, supportive care, date of follow-up).

2. CHITS – Community Health Information and Tracking System – Data for decision making / Evidence-based decision-making: use



electronic medical records for health information management, i.e. data collection, collation, retrieval, analysis and information for

decision-making

3. Observe / learn about how basic health services subsidized by the government are implemented in a typical health center. Note

the following:1. Division of labor among the different types of health professionals2. Health records/ data management via CHITS

3. EPI {Expanded Program for Immunization, including cold chain management}4. Essential drugs provision

5. Maternal health {Pre- and post-natal care, including vaccinations, breastfeeding advice, nutrition monitoring and family planning

counseling}

6. Malnutrition among children

7. Management of common illnesses / injuries

8. TB case management based on the NTP – visit the UPMASA-supported TB-DOTS Clinic

9. others

4. Patient care: Each day, assign 1-2 students

III. To see sick patients,

IV. To assist wellness consults with nurses and midwives {EPI on MW, Prenatal Care on TTh}. Each patient needs to be presented to the

resident and/or consultant BEFORE you discharge them. Make sure you get to experience both sections of the health center.

V. As in the ER-Ambulatory Section, see all patients seeking consult at the Local Health Center. Keep a log of your patients using the

format initially prescribed during your Course Orientation, similar to the one below:

VI. This will be used in the analysis of case mix,

and over all evaluation of clinic management at the

end of your Community Medicine rotation in FCH260. Be prepared to discuss with the consultant on duty any of the cases of patientsyou attended to. [You need not ask the patients to stay behind unless you think they need further evaluation.]

III HOMEWORK : TO BE SUBMITTED ON MONDAY OF after your FCH 251 rotation. Complete the Comparative Health Care

Systems matrix D, using the basic guide questions listed:

Patient’s

NameAge Sex Bgy Chief

ComplaintDiagnosis Disposition



What are the common clinical cases seen in the health center? How do they compare with patients in the PGH? In private practice? What are the activities in the health center? PGH? In the clinic of private practitioners? In the NGOs? What resources does the Health Center have? PGH? Clinic of private practitioners? The NGOs?

What is the experience of a patient seeking consult at the health center? PGH? Clinic of private practitioners? In the NGOs?Characterize the relationships among the clinic staff in the local health center? PGH? Clinic of private practitioners? In the NGOs?



Clinical Clerks' Guide to Fieldwork with Health NGOs

Street children and the ChildHope Asia Philippines,

I Introduction: Rationale

This session with Childhope Asia Philippines is an opportunity for a personal encounter with street children in their setting. This provides practical experience of the discussions on health of vulnerable groups, enfleshing issues, putting faces to the problem; it is a first-hand

experience in evaluating the health of street children. Childhope Asia is an international non-profit, non-sectarian, non-political organization

whose primary purpose is to advance the cause of street children throughout the world. Rotary Club of Honolulu, a partner, donated a mobile

clinic with state-of-the-art medical equipment; medical supplies are continuously provided by other partners from the private and voluntary

sectors. Childhope Asia Philippines also works with the national (Department of Social Welfare and Development) and local (city) governments

in order to converge efforts towards ultimately getting the children off the streets.

This learning activity with Childhope Asia Philippines has the same learning objectives and methodology as that of your tour of duty at the

ambulatory clinics in PGH of the Department of Family and Community Medicine, i.e. 2B05 at the OPD and the Ambulatory Care Section of the

ER. However, this is held in a different venue – a mobile clinic amidst where street children amass and run primarily by a private volunteer

organization. It aims to hone your clinical skills, and expose you to social determinants that greatly affect the health of the kids. For the target

children, this would be their (perhaps only) chance to receive proper and thorough care. It provides opportunity for you to critique systems in

order to improve them. The formal health care system, in both government and private sectors, has rendered itself socially, financially and

culturally inaccessible because of the issues that beleaguer street children. In the context of service-learning, this is UP's part in contributing its

capacities to improve health systems, uphold children's rights and make it more responsive to the needs of vulnerable sectors.

II Methodology

Report to the site where the Childhope mobile clinic will set up, noting physical arrangements and available medical supplies that you may need

in patient care. A thorough clinical history and physical examination is expected of you, please note them carefully in your notes. Dr. Harvey

Carpio / Dr. Cheryl Magbanua, UPCM'06, and the assigned DFCM resident and/or consultant will supervise your work, and discharge the

patients from your care with finality. You're expected to be on site from 230-5pm.



What to bring: (1) basic MD stuff- stet, sphygmomanometer [great if you have a pedia cuff], flashlight, diagnostic set per group, measuring tape,

neurologic hammer, gloves; (2)clipboard and pen; (3) personal stuff- water to drink, umbrella to protect you from the rain and sun, candies to

stave off hypoglycemia and keep you smiling.

What to wear: Be in uniform, with nameplate, closed shoes [when in the Childhope or RAF clinic].



Community Medicine Discussion Series #2

Health of Vulnerable Population Groups1

I Objectives: At the end of the session, students should be able to

1. Define vulnerable, marginalized population groups from a health and 'power' perspective.(a) Describe why these groups are vulnerable or/and marginalized.(b)Describe local, national, and global determinants / factors

2. Describe the health status of a specific marginalized population.3. Describe local, national, global efforts to address health and social issues of a specific marginalized population.

(a) Analyze how the intervention/s address/es needs of the identified population group.

4. Reflect and describe concept/s previously discussed that is of personal and professional relevance to the students.

II Guide questions:

a) Describe the vulnerable, marginalized population group. Why are they vulnerable, marginalized?

b) What is the health status of this specific population? Why – what factors affect their health?

c) Describe local, national, global efforts to address health and social issues of a specific marginalized population.

d) Do these efforts rationally address the needs of the population concerned? Do the interventions uphold principles of Primary Health Care?

1 Marcelo,PF and EP delaPaz. July 2005. Health of Vulnerable Population Groups. Revised June 2007




Social Determinants of Health, Globalization and Health2

References:

1. WHO Commission of the Social Determinants of Health. March 2005. Action on the Social Determinants of Health: Learning fromExperiences

2. Whitehead, M and G Dahlgren. 2006. Leveling up [part1]: Discussion Paper on Concepts and Principles for Tackling Social Inequities

in Health3. Renewing Primary Health Care in the Americas: Position Paper of the PAHO/WHO. March 2007

4. United Nations Millennium Development Goals: Health Related Goals.2000

5. Werner and Sanders, 2000 Chapters 3 and 4. Questioning the Solution: The Politics of PHC

6. Walsh and Warren, 1979. Selective PHC as an Interim Strategy

2 EPDelaPaz, version3_June2007, Poverty, Social Determinants, Globalization and Health



Community Medicine Discussion Series #4:

Experiences from the Field: Community M edicine as a Career Option 3

Objectives: At the end of the session, students should be able to

Describe the work of the Community Medicine practitioner1. Describe features of the area where our guest-alumnus/a practices2. List health and health related issues in the area of work of the Community Medicine practitioner

3. Define how these issues were addressed.1. Analyze the intervention/s using the PHC framework

Describe factors that influenced the career choice/s of our guest-alumnus/a

Reflect and describe concept/s previously discussed that is of personal and professional relevance to the students.

Community Medicine Discussion Series #5:

ELEMENTS: Essential Health Services and Programs: [IMCI, TB, Maternal Health]4 Objectives: At the end of the discussion, students should be able to

1. Analyze and diagnose clinical conditions [i.e. TB, childhood illnesses, care of pregnant women] using the ecological model.

1.1. Analyze and diagnose clinical conditions using the force field theory of analysis.

2. Define solutions to clinical issues using an ecological approach to health.

2.1. Describe national government programs [i.e. TB, childhood illnesses, care of pregnant women] as these are implemented in an

urban local health center.

2.2. Describe private sector involvement in these concerns.

3 Marcelo, PF. July 2005. Experiences from the Field: Community Medicine as a Career Option

4 PFMarcelo. June 2004- structured learning materials prepared for TB-- see SIM on TB Modules 1-5; IMCI and Maternal Health discussed during orientation to Pasay HC

duties; updated June 2005. ELEMENTS: Essential Health Services and Programs




Comparative Health Care Delivery Systems and

Elements of Health Program / Services Management5

I IntroductionThis discussion is scheduled towards the end of the students' tours of duty at the PGH Family Medicine Clinic - Ambulatory Care Section/ERand the Pasay local health center, a private practice clinic, clinics and field sites of health NGOs, and the Pasay City General hospital.

II Objectives: At the end of the discussion, students should be able to

1. Describe the public and private health care delivery systems

2. Describe the function and rationale of elements of health care delivery: policies / programs systems, people [patient base, health

providers, managers and policymakers], IEC/ Information-education-communications [opportunities for patient education, medical

records management through CHITS], equipment, supplies and facilities [waiting room, clinics, diagnostic, therapeutic supplies],

financing of services.

3. Describe and contrast elements of health care delivery

3.1. in different primary care settings: PGH Family Medicine Clinic - Ambulatory Care Section/ER, the Pasay local health center, a

private family practice clinic, field sites of health NGOs

3.2. in a primary care setting and a public tertiary, teaching hospital

4. Reflect and describe concept/s previously discussed that is of personal and professional relevance to the students.



Course Faculty:

Portia Marcelo, MD, MPH (Course Segment Coordinator)

Edelina dela Paz, MDChristian Gomez, MD

Ramon P. Paterno, MD MPH



Ambulatory Care Uni t rotation

Course description: This is a 1-week clinical rotation in the Ambulatory Care Unit within the area of the PGH

Department of Emergency Medical Services.

The rotation in the Ambulatory care unit (AMBU) setting covers primarily non-trauma adult

and pediatric ambulatory cases usually triaged as “non-emergency/urgent cases”. Students will

be trained in the context of fi rst-contact care physicians dealing with the more common clinical

conditions found in the general population, delivering basic services and performing simple

interventions usually performed by generalist physicians in an ambulatory setting.

Patients in this area may present with acute medical problems that may be of new onset,

exacerbations of chronic conditions, with either protean manifestations or frank symptoms

pointing to specific organs that may eventually need specialist referral.

In between duty days, students will have opportunities to joi n staff conferences and casepresentations , do independent readings , refl ect on the possible areas of futu re professional

practice and deal wi th personal issues in the context of work-l if e balance.

Pre-requisites: Students must have successfully passed all the requirements of LU5. They are also expected to

know and apply the principles of Family Medicine, the biopsychosocial approach, pharmacology of

medications used in the ambulatory care section, common morbidities seen in the emergency room

(with special note of the Ambu statistics).

Description of training area: The DEMS-Ambu section takes care of adult and pediatric patients initially triaged by the DEMS to

be non-emergency. As such, the cases seen may be considered as urgent or non-emergent. While the

section deals primarily with non-trauma patients, patients needing outpatient procedures (such astetanus prophylaxis) may also be sent to this area.

Required number of duties/student: 5 duties (total of 40 hours)



General objective: To provide the LU6 student with the appropriate clinical exposure as first-contact care physician managing

the most commonly encountered acute cases encountered in family practice / generalist setting.

Learning Objectives Content Activities Resources AssessmentGiven actual patients in the

DEMS Ambulatory Care Unit,

an LU6 student should :

1. Conduct primary surveyGeneral assessment:vital signs Patient identification Ambulatory care unit Performance evaluation

of patients with potentially Principles of triaging Taking vital signs Actual patients (adult (to be filled by supervising

life-threatening condition Brief history and pediatric) resident/consultant)

2. Elicit a complete history

History-taking:

Pediatric and History-taking PGH patient records Report of Activities

adult history

(biopsychosocial

Recording PE

findings

history/psychiatrichistory) as indicated Reflection paper /

Feedback form



3. Perform a complete physical

examination, with special

attention directed on abnormal

findings

Physical examination

(adult & Conducting physical Stethoscope, weighing

pediatric)Examination(adult/pedia) scale, BP apparatus,

Patient-doctor

relationship

Recording PE

findings thermometer, diagnosticConfidentiality;

bioethics set, neurologic hammer,

tongue depressor

4. Formulate a working

diagnosis Differential diagnosis Critical thinking References: Harrison's

Common morbidities Principles of Internal

Medicine, Textbook of

5. Formulate a management

Common diagnostic

procedures Critical thinking Pediatrics, Medicine

plan for the patient Pharmacology Bluebook, Compendium

Clinical Practice

guidelines for of Philippine Medicine

the most common

conditions PGH morbidity statistics

Supportive

managementPrinciples of

prevention



6. Perform simple procedures

usually done in a generalist

setting

Common procedures:

Blood

Obtaining, handling

and transporting

Syringes, gloves,

alcohol,

extraction,

nebulization, intra- specimens, while cotton balls, tourniquet,muscular/intravenousinjections; observing universal KY gel, neb set,

NGT. Foleycatheterization Precautions plaster, gauze

Principles of

universal pre-

Cautions

7. Correctly interpret basic

CBC, basic radiology,

blood chemistries,

EKG

interpreting and

correlating lab tests

laboratory tests

8. Refer appropriatelyManagementguidelines Writing referrals PGH referral forms



9. Provide patient and family

Basic

pathophysiology Bedside education Educational materials

education about the illness Basic pedagogy Printed visuals/prompts

Preventive strategies

Basic counselingskills: CEA,

motivational

counseling

10. Address relevant biopsychosocial

Biopsychosocialapproach Bedside education Family medicine lecture

issues that may affect

Family assessment

tools Counseling notes

Adherence

11. Identify community

PGH-community

referral system

Providing referrals

that Listing of health centers,

resources and linkages that DOH programs

include history,

reason hotlines

patients and families may

Philhealth / health

insurance for referral Hospital directory

utilize for the management of

the illness PCSO, NGO



12. Demonstrate the

Principles of adult

learning

Perform critical

appraisal Computer with internet Reflection paper

attributes of an ADULT

Evidence-based

medicine of relevant literature access Learner portfolio (report of

LEARNERCommunication andcritical

Participation ingroup Appraisal guides activities, etc)

thinking skills Discussions

13. Demonstrate the desired

Communication

skills

Patient-doctor

consultation Books, hand-outs Performance evaluation

characteristics of aValues and professional ethics Consultant and resident Patient feedback

health professional and Health economics

Readings and

reflection as role models Report of activities

Decent human being Work-life balance

Small group

discussions

Self-careInterpersonalcommunication

Spirituality, EQ. AQ

Giving and receiving

feedback

Organization and

management



List of must-know and nice to know topics:

“The Case for a New Philippine Health Referral System”. UP Manila Bagumbayan.

“Real-life drama in the emergency room”. The Philippine Star. July 11, 2000.

“An Evidence-Based Update on NSAIDs”. CM & R. March 2007

“Emergency medical care in developing countries: is it worthwhile?” Bulletin of the WHO, 2002.

“The Occupational Hazards of Emergency Physicians”. Bulletin of the WHO.2002.

“Underestimation of Case Severity by Emergency Department Patients” Implications for Managed Care”. American journal of

Emergency Medicine. May 2000.

“The Short-stay Emergency Observation Ward is Here to Stay”. American Journal of Emergency Medicine. September 2000.



Class schedule/blueprint of activities:

A. Ambu duties

Schedule Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 76:00 AM-2:00 PM Orientation 3 2 1 4 3 2

2:00 PM-10:00

PM 1 4 3 2 1 4 3

10:00 PM-6:00

PM 2 1 4 3 2 1 4

Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14

6:00 AM-2:00 PM 5 8 7 6 5 8 7

2:00 PM-10:00

PM 6 5 8 7 6 5 8

10:00 PM-6:00PM 7 6 5 8 7 6 Off

*Duty

hrs/student: 40 hours

B. Weekday Department Conferences:

7:00 AM -8:00 AM Endorsement conferences (with residents and Interns)

*EBM conference - every Thursday

8:00 AM -9:00 AM Conferences for special topics (TBA)*Department Staff Conference – Thursday (starting 8:00 AM)

1:00 PM -2:00 PM Conferences for special topics (TBA)



C. Special conferences

UPCM (TBA) Tuesday 8:00-10:00

Pharmacology modules (TBA)

List of Faculty member/s for Ambulatory care rotation: MARIA CONSUELO BALITA-PUMANES, MD, MHPEd ( Course SegmentCoordinator)

Prepared by: Andrew E. Ang, MD, FPAFP

LU6 Department of Family and Community

Medicine Coordinator

LU6 Blueprints 2010-11 New

Documents