1. Department of Pediatrics Clinical Clerkship May 17- July 11 3PM

2. CLERK’S ORIENTATION – May 16, 2010 I) Department of Pediatrics – Who are We? II) Objectives – What do we want you to achieve? I) Logistics/Process Flow – How do we go about it?

3. Who are we? The Department of Pediatrics

4. DEPARTMENT OF PEDIATRICS Who Are We? Vision A center of excellence in Pediatric health care, training, education, and research recognized and respected in the Philippines and in the global community Mission To provide customized and specialized healthcare services to respond to the special needs of its pediatric patients To provide world class training, education and research in pediatrics

5. DEPARTMENT OF PEDIATRICS Who are we? 116 Consultants General Pediatrics Ambulatory/ER Pediatrics Pediatric Cardiology Pediatric Gastroenterology Pediatric Pulmonology Developmental and Behavioral Pediatrics Pediatric Endocrinology Pediatric Neurology Pediatric Infectious Diseases Pediatric Critical Care Neonatal Pediatrics Pediatric Oncology & Hematology Pediatric Allergology & Immunology Adolescent Pediatrics Pediatric Rheumatology Pediatric Dermatology Pediatric Toxicology 39 Residents in Training 14 First year residents 12 Second year residents 13 Third year residents *Pediatric Radiology *Pediatric ENT/Ophtha *Pediatric Orthopedics *Pediatric Surgery

6. Pediatric Consultants

7. Organizational structure Department of Pediatrics Chair Dr. Elizabeth Palmero Reyes Education Division Head Dr. Carlos Paguio Patient Care Dr. Cynthia Aguirre Operations Dr. Romeo Santos

8. Organizational Structure ASMPH YL8-Pediatrics ROTATION COORDINATOR Dr. Edna Sarah Morada TMC – CONSULTANT CLERK’S MONITOR Dr.Edna Sarah Morada CLINICAL FACULTY Dr. Carlos Paguio Dr. Kaye Napalinga Dr. Adelaida Pedraja RESIDENT CLERK’S MONITOR Dr. Jeanne Dy PCGH- CONSULTANT CLERK’S MONITOR Dr. Rosario Isada CLINICAL FACULTY Dr. Gloria Poblete Dr. Amalia Bulaon Dr. Neva Batayola COMMUNITY- CONSULTANT CLERK’S MONITOR Dr. Alma Bie CLINICAL FACULTY Dr. Margarita Alfonso Dr. Alma Bie

9. Chief Resident Dr. Laurice Malinao

10. 1 st year residents

11. 2 nd year residents

12. 3rd YEAR RESIDENTS

13. What do we want you to achieve? GOALS/OBJECTIVES

14. OBJECTIVES What Do We Want You To Achieve? 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 To provide a good foundation for those students who elect to specialize in the study of the health care of infants, children, and adolescents.

15. Learning Objectives - Knowledge KNOWLEDGE Diagnose common diseases from a comprehensive/focused clinical history and physical examination. Discuss the appropriate diagnostic and/or confirmatory laboratory tests and ancillary procedure for the common diseases. Deduce a clinical impression/diagnosis and differential diagnosis after taking a thorough history and physical examination. Manage common pediatric conditions and diseases. Provide age-appropriate anticipatory guidance to families and caregivers in each health supervision visit. Plus community pediatrics (see separate ID)

16. Learning Objectives - Skills SKILLS Elicit a complete and accurate history taking Perform a thorough physical examination of pediatric patients from newborn to adolescents, including anthropometric measurements.

17. Learning Objectives - Skills Perform the following procedures/skills: BP measurement, otoscopy, IV insertion, IV injection/push, NGT insertion, gastric lavage, venipuncture/blood extraction, blood culture sampling, heel prick for newborn screening, cord care and dressing, skin testing and reading, urine output monitoring, and immunization procedure (intramuscular, intradermal and subcutaneous) on pediatric patients.

18. Learning Objectives - Skills Assist in doing the following procedures: umbilical cannulation and lumbar tap. Demonstrate good communication skills with patients, their families, and hospital staff. Perform health supervision visit screening procedures: PPD, visual acuity, hearing. Access, utilize, and assess educational resources and material to obtain reliable and accurate information relevant to clinical questions at hand. Critically appraise available information, applying the principles of evidence-based medicine.

19. Learning Objectives - Attitude ATTITUDE At the end of the rotation in Pediatrics, the student must be able to: Establish rapport with and show empathy for patients and their families. Demonstrate good working relations with peers, healthcare personnel, and hospital staff.

20. Learning Objectives - Attitude Practice counseling skills regarding preventive pediatric health issues. Value a healthy relationship with consultants and facilitators. Follow existing hospital policies, local government ordinances, and national legislations in health and healthcare delivery e.g. breastfeeding, newborn screening test, etc. Plus community pediatrics (see separate ID)

21. How do we go about it? LOGISTICS/PROCESS FLOW

22. LOGISTICS How do we go about it? DURATION – 8 weeks (May 17- July 11, 2010) SCOPE The Medical City  OPD/ER, Wards (2weeks)- May 17-Jun 14 Community (Ilugin Pasig)  (2 weeks)- May 17 – Jun 14 Pasig City General Hospital  OPD, ER, Wards, NICU (4 weeks) Jun 14 – Jul 11 GROUPINGS 2 groups rotating in Pediatrics (May-July) – LEC 5 & LEC 6 6 students per group 3 students per rotation

23. Things To Bring Stethoscope Penlight Diagnostic set (Otoscope/Ophthalmoscope) Calculator Measuring tape Neuro hammer Tickler notebook

24. MAY 17-JULY 11 2010 WEEK 1 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 17-May1819202122 TMC-OPD/ER CHAVEZ/ COKEHYENG/ EVANGELISTA TMC-WARD LOPEZ/ PAAYAS/ UY, Justine COMMUNITY ABAD/ IMPERIAL JAVATE/ PALMA UY, Raymonde/ VALENCIA

25. WEEK 2 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 23242526272829 TMC-OPD/ERCHAVEZ/ COKEHYENG/ EVANGELISTA LOPEZ/ PAAYAS/ UY, Justine TMC-WARDLOPEZ/ PAAYAS/ UY, Justine CHAVEZ/ COKEHYENG/ EVANGELISTA COMMUNITYABAD/ IMPERIAL JAVATE/ PALMA UY, Raymonde/ VALENCIA

26. WEEK 3 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 30311-Jun2345 TMC-OPD/ERLOPEZ/ PAAYAS/ UY, Justine ABAD/ IMPERIAL/ JAVATE TMC-WARDCHAVEZ/ COKEHYENG/ EVANGELISTA PALMA/ UY,Raymonde/ VALENCIA COMMUNITYABAD/ IMPERIAL LOPEZ/ PAAYAS/ UY, Justine JAVATE/ PALMA CHAVEZ/ COKEHYENG/ EVANGELISTA UY, Raymonde/ VALENCIA

27. WEEK 4 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 6-Jun789101112 TMC-OPD/ERABAD/ IMPERIAL/ JAVATE PALMA/ UY,Raymonde/ VALENCIA TMC-WARDPALMA/ UY,Raymonde/ VALENCIA ABAD/ IMPERIAL/ JAVATE COMMUNITYLOPEZ/ PAAYAS/ UY, Justine CHAVEZ/ COKEHYENG/ EVANGELISTA

28. WEEK 5 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 13141516171819 TMC-OPD/ERPALMA/ UY,Raymonde/ VALENCIA TMC-WARDABAD/ IMPERIAL/ JAVATE PCGH OPD (7am- 5pm) PALMA/ UY,Raymonde/ VALENCIA PCGH ER (Duty) ABAD/ IMPERIAL/ JAVATE PCGH-NICU (Duty) LOPEZ/ PAAYAS/ UY, Justine PCGH-WARD (Duty) CHAVEZ/ COKEHYENG/ EVANGELISTA COMMUNITYLOPEZ/ PAAYAS/ UY, Justine CHAVEZ/ COKEHYENG/ EVANGELISTA

29. WEEK 6 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 202122-Jun23242526 PCGH OPD (7am- 5pm) PALMA/ UY,Raymonde/ VALENCIA CHAVEZ/ COKEHYENG/ EVANGELISTA PCGH ER (Duty)ABAD/ IMPERIAL/ JAVATE PALMA/ UY,Raymonde/ VALENCIA PCGH-NICU (Duty)LOPEZ/ PAAYAS/ UY, Justine ABAD/ IMPERIAL/ JAVATE PCGH-WARD (Duty) CHAVEZ/ COKEHYENG/ EVANGELISTA LOPEZ/ PAAYAS/ UY, Justine

30. WEEK 7 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 272829301-Jul23 PCGH OPD (7am- 5pm) CHAVEZ/ COKEHYENG/ EVANGELISTA LOPEZ/ PAAYAS/ UY, Justine PCGH ER (Duty)PALMA/ UY,Raymonde/ VALENCIA CHAVEZ/ COKEHYENG/ EVANGELISTA PCGH-NICU (Duty)ABAD/ IMPERIAL/ JAVATE PALMA/ UY,Raymonde/ VALENCIA PCGH-WARD (Duty) LOPEZ/ PAAYAS/ UY, Justine ABAD/ IMPERIAL/ JAVATE

31. WEEK 8 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 456-Jul78910 PCGH OPD (7am- 5pm) LOPEZ/ PAAYAS/ UY, Justine ABAD/ IMPERIAL/ JAVATE PCGH ER (Duty)CHAVEZ/ COKEHYENG/ EVANGELISTA LOPEZ/ PAAYAS/ UY, Justine PCGH-NICU (Duty)PALMA/ UY,Raymonde/ VALENCIA CHAVEZ/ COKEHYENG/ EVANGELISTA PCGH-WARD (Duty) ABAD/ IMPERIAL/ JAVATE PALMA/ UY,Raymonde/ VALENCIA

32. WEEK 9 SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAY 11121314151617 PCGH OPD (7am- 5pm) ABAD/ IMPERIAL/ JAVATE PCGH ER (Duty)LOPEZ/ PAAYAS/ UY, Justine PCGH-NICU (Duty) CHAVEZ/ COKEHYENG/ EVANGELISTA PCGH-WARD (Duty) PALMA/ UY,Raymonde/ VALENCIA

33. The Medical City – WARD DUTY DUTY SIGN IN 7am (Pedia office) MORNING ENDORSEMEN T 730am MORNING ROUNDS DAILY PROGRESS NOTES At Pedia office Cut off at 7:15am At Pedia office Cut off at 7:15am Must have own census Listen to endorsements & note down current px status, diagnosis, labs & ongoing plan 9 th /10 th floor Accompany duty group (1 st year resident buddy) Rounds on ALL inpatients & w/ ALL consultants MUST join ALL CODES Log ALL admissions (name, age/sex, dx) May be pulled out for SGD w/ consultants Shd NOT leave resident buddy except when allowed Help in VS monitoring / follow up laboratory results/ errands concerning patients On 2 assigned patients - assigned by Resident Clerk’s Monitor SOAP format Will follow through on these patients until discharge Change of case only once discharged

34. The Medical City – WARD DUTY DUTY LUNCH BREAK 12nn-1pm AFTERNOON ROUNDS/SGD AFTERNOON ENDORSEMEN T 430PM DINNER 8pm- 9pm *ON CALL Only where PAGING is heard: Pedia office 2 nd Flr Bridgeway Hospital Canteen NOT allowed outside hospital premises 9 th /10 th floor Accompany duty group (1 st year resident buddy) Rounds on HIGH RISK (“TOXIC”) inpatients & w/ ALL consultants MUST join ALL CODES Log ALL admissions (name, age/sex, dx) May be pulled out for SGD w/ consultant Should NOT leave resident buddy/assigned floor except when allowed to Help in VS monitoring, follow up laboratory results, errands concerning patients *ON CALL Only where PAGING is heard: Pedia office 2 nd Flr Bridgeway Hospital Canteen NOT allowed outside hospital premises Must have own census Listen to endorsements & note down patient status, current labs, latest orders, plan

35. The Medical City – WARD DUTY DUTY EVENING ROUNDS REST after 12MN EARLY AM ROUNDS 4am CENSUS 6am AM ENDORSEMENT 730AM 9 th /10 th floor Accompany duty group (1 st year resident buddy) Rounds on ALL inpatients & Rounds w/ ALL consultants MUST join ALL CODES Log ALL admissions (name, age/sex, dx) Should NOT leave resident buddy/assigned floor except when allowed to Help in VS monitoring, follow up laboratory results, errands concerning patients *ON CALL 1-2hour rest time only Temporary rest area at Pedia office Bring own sleeping bag 9 th /10 th floor Accompany duty group (1 st year resident buddy) Rounds on ALL inpatients & Rounds w/ ALL consultants MUST join ALL CODES Log ALL admissions (name, age/sex, dx) Should NOT leave resident buddy/assigned floor except when allowed to Help in VS monitoring, follow up laboratory results, errands concerning patients Help resident follow up laboratory results Help in hospital errands regarding patient concerns/nee ds Must have own census Endorse to incoming duty group latest vital signs and laboratories SUBMIT log of ALL admitted patients & progress notes to Resident monitor for signature & checking OFF after AM endorsements until 12 noon

36. The Medical City – WARD PRE-DUTY PRE-DUTY SIGN IN 7am MORNING ENDORSEMENT 730am MORNING ROUNDS PROGRESS NOTES At Pedia office Cut off at 7:15am At Pedia office Cut off at 7:15am Must have own census Listen to endorsement s & note down current diagnosis & ongoing plan 9 th /10 th floor Accompany PRE-duty group (1 st year resident buddy) MUST ACCOMPANY all patients for procedures MUST join ALL CODES May be pulled out for SGD w/ consultant Sld NOT leave resident buddy except when allowed Help in VS monitoring / follow up laboratory results/ errands concerning patients On 2 assigned patients - assigned by Resident Clerk’s Monitor SOAP format Will follow through on these patients until discharge Change of case only once discharged

37. The Medical City – WARD PRE-DUTY PRE-DUTY ACCOMPANY ALL PROCEDURES LUNCH 12 nn-1pm AFTERNOON ENDORSEMENTS OFF at 5PM Accompanies ALL patients for procedures along with an intern or resident (depending on the case) LOG all patients accompanied for the day May be pulled out for SGD with consultants *ON CALL Only where PAGING is heard: Pedia office 2 nd Flr Bridgeway Hospital Canteen NOT allowed outside hospital premises Endorse all patients who underwent procedures to the DUTY group Submit log of all patients accompanied for procedures to Resident Clerk Monitor

38. The Medical City – WARD FROM DUTY FROM SIGN IN 7am MORNING ENDORSEMENT 730am OFF * (until 12noon) SGD with Consultants At Pedia Office Cut off 7:15AM Must have own census Endorse to incoming duty group latest vital signs and laboratories SUBMIT log of ALL admitted patients & progress notes to Resident monitor for signature & checking OFF after AM endorsements until 12 noon Required to attend ALL SGD’s with consultants

39. The Medical City - ER/OPD DUTY DUTY SIGN IN 7AMER POST MORNING INCOMING PATIENTS LUNCH 12nn- 1pm At Pedia Office Cut off 7:15AM Go directly to Pedia-ER Join ER Resident Buddy (2 nd year resident) Accompany ER 2 nd year resident or ER consultant when interviewing & examining patients MUST attend to ALL BED 1 cases Help in VS monitoring, bedside monitoring, follow up of labs, errands concerning patients May be pulled out for SGD with consultants LOG at least 5 must see cases *ON CALL Only where PAGING is heard: 2 nd Flr Bridgeway Hospital Canteen NOT allowed outside hospital premises

40. The Medical City – ER/OPD DUTY DUTY AFTERNOON INCOMING PATIENTS DINNER 7PM- 8PM EVENING INCOMING PATIENTS REST after 12MN DUTY EARLY AM INCOMING PATIENTS ATTEND AM ENDORSEMENT AT 730AM OFF till 12noon ATTEND INTERN’S LECTURES AT OPD Submit LOG of all interesting cases seen at the ER (age/sex/dx) Required to attend ALL SGDs with consultants Required to attend all Intern’s lectures with OPD consultants

41. The Medical City - ER/OPD DUTY DUTY SIGN IN 7AM OPD POST OPD PATIENTS LUNCH 12nn-1pm INTERN’S LECTURE OFF 5PM At Pedia Office Cut off 7:15AM Go directly to OPD post Join OPD Resident Buddy (1st year resident) Do history and PE on all OPD patients LOG all patients seen *ON CALL Only where PAGING is heard: 2 nd Flr Bridgeway Hospital Canteen NOT allowed outside hospital premises REQUIRED to attend all OPD lectures with interns May be pulled out for SGD with consultants SUBMIT Log of all patients seen at the OPD to Resident monitor

42. Grading and evaluation CriteriaEvaluation Clinical Competence50% Final Exam30% Skills20% Professionalism10% Total100% The passing score of the final exam is 75%. If you fail during the 1 st try, you can take it again. If you fail a second time, it is equivalent to repeating the rotation. The rest will be graded through the evaluation sheets that you would give to your resident/consultant. A total of at least 5 of each kind and a total of at least15 should be submitted to the consultant clerk’s monitor (CCM) at the end of your rotation.

43. MERITS/SANCTIONS (Granted by Consultant Clerk’s Monitor/Clinical Faculty) Competence/Performance Professionalism Tardiness Out of Post Undertime Absences Absences without official Leave: Absences that are excused Unexcused absences

44. SANCTIONS Failure to accomplish Clinical and Academic duties warrant sanctions: First Offense: Warning plus completion of deficiency within 24 hours Second Offense: 12 hours extra duty Third Offense: 2 days extension of rotation (to be served at the end of the year)

45. Sanctions For Tardiness: First Offense: Warning Second Offense: 4 hours extra duty Third Offense: 24 hours extension Note: All sanctions for tardiness must be served within 48 hours For Out of Post: First Offense: 1 week extension Second Offense: 2 weeks extension Third Offense: 1 month extension For Absences without Official Leave First Offense: 1 week extension Second Offense: 4 weeks extension Third Offense: Dismissal

46. Pediatric Residents