1. Family Medicine Survival Guide

2. First of all..
It comes to this, na magkakasama-sama na naman tayo as a block in one rotation.. Alam kong namiss na natin ang isa’t isa.. Hindi ba obvious.. haha..
Family Medicine Rotation na! Handa ka na ba? :D
This is your L.O. Nicho

3. The Course Title
FCH 251 Integrated Clinical Clerkship in Family and Community Medicine
A four week rotation
Handled by DFCM
Divided into three clinical areas
Hospice Care Unit (2 weeks) under the Section of Supportive, Hospice and Palliative Medicine (SHPM)
Ambulatory Care Unit (1 week)
Community health center (1 week)

4. People you may want to know..
Dr. Andrew Ang
Our LU6 coordinator
Contact no. –
Ms. Ehla Perez
One of DCFM’s secretary
Contact no. –
The one who will collect our requirements

5. People you may want to know..
Dr. Josephine Dizon
Contact no. –
Faculty coordinator in community medicine
Dr. Consuelo Pumanes
Contact no. –
Faculty coordinator in ambulatory care unit

6. The great divide.. >.<
Now, let me divide the block into 4 groups..
Group A, B, C and D
Each will have their own sequence of rotation as follows:
Week 1
Aug 6-12
Week 2
Aug 13-19
Week 3
Aug 20-26
Week 4
Aug 27-Sept 2
Hospice
A and B
C and D
Ambu C D A B
Community

7. The great divide.. >.<
I will let you pick for your own choice, so that you can schedule your family stuffs, dates, “gala”, out of the country escapades, etc.
Text me your First and Second choice.. Kung may sumobra man, mapipilitan akong magbunutan.. Oki? :D
Deadline: 08/03/12 Friday 7AM :D

8. The great divide.. >.<
Tips! To guide your choice..
Lahat may weekend except Ambu (kung duty ka!)
Advantage naman ng Ambu ay pede kang free ng weekdays kung di ka Duty..

9. So what happens next?
Our FIRST Monday will be dedicated to the following activities:
Time
Activity
Location
08:00AM
Orientation and Courtesy Call in the Manila Health Department Training Office
Sta Mesa, Manila
10:00AM
Courtesy call to Health District V Office
Rosario Reyes Health Center at San Andres
01:00PM
Community Medicine Rotation Orientation c/o Dr. Dizon
Paz Mendoza Bldg. Room 100 or 104
02:30PM
Ambulatory Care Medicine Rotation Orientation c/o Dr. Pumanes
To be announced
03:30PM
Lecture: Common Diseases in Family Practice c/o DFCM resident

10. How to go to the 8AM courtesy call in Sta. Mesa?
Don’t worry.. Magsasabay-sabay naman na tayo.. Just wait for my text regarding this.. Oki? .. This is a map to help us to get there..

11. Still regarding the LOOOOOONG Monday orientation..
The whole block MUST ATTEND and
We are required to be in COMPLETE UNIFORM
Oki? :D

12. Now let me introduce to you the different Clinical Areas
Hospice Care Unit
Ambulatory Care unit
Community Health Center

13. Hospice Care Unit
A long 2-weeks of FAMMED stuff!

14. Hospice Care Unit DFCM Faculty in charge: Dr. Andrew Ang
Coordinator: Dr. Ruth Orillaza-Chi
Each rotator will receive:
“hospice kit”
1 attendance sheet
3 assessment forms (OPD, ward, home visit)
1 copy of schedule
SHPM Kit

15. What does the SHPM Kit contains?
PCEP-PC Modules (Black Book)
contains the basic information that will be discussed by the fellow during your rounds or chit- chats
Patty Wu’s Palliative Medicine Pocket Companion
quick reference for your SHPM meds and rating scales
Child Supportive Care Modules
A manual that contains the modules that will be used for Munting Paraiso sessions

16. What does the SHPM Kit contains?
SHPM Protocol
a must-read fool-proof guide SHPM rotators
The SHPM Assessment Form Walk-through and sample CAF (Comprehensive Assessment Form)
You are expected to accomplish a 6-page CAF for each in-patient referral that will be decked and assigned to you in your two-week rotation
This will be submitted to your fellow-in-charge within hrs after the patient has been endorsed to you.

17. Divided once again..
The 2 groups (8 rotators) will be further divided to 4 pairs
Rotator AB CD EF GH
Dr. Chi will tell each pair on the first Tuesday of Hospice rotation who will be their fellow- in-charge for the rotation
One pair – One fellow
Each pair will assume one post based on the schedule attached (see Proposed schedule)

18. The Four Posts Wards OPD Home Visit Munting Paraiso
SIC work, teaching rounds
OPD
3rd floor SHPM office
Home Visit
Outside PGH
Munting Paraiso
2nd floor, Cancer Institute

19. The “Wards” Your activities in the “wards” depend entirely to your FIC
She may call for a meeting (“table rounds”)
a teaching rounds
a quiz (for Dr. Bacorro’s team); or
she may just let you do your SIC duties like accomplishing your patient’s CAF and progress notes
You are expected to
visit your patient (new and endorsed patients) everyday
give regular updates to your FIC

20. The “Wards” Regarding Progress Notes
There is a separate form for Progress Notes
Some fellows ask for a SOAP-ish sheet instead of progress notes
Ask your FIC about the format and the frequency of submission of accomplished progress notes
For more details, refer to SHPM protocol found in your kit

21. “OPD” experience Refer to SHPM protocol for details
You are expected to
chart and/or examine new or old patients
sometimes interview caregivers

22. “OPD” experience If it’s a new patient If it’s for an old patient
accomplish his or her CAF
If it’s for an old patient
get a Health Management Sheet and chart in an SOAP format
After charting your patients
present your patient to Dr. Chi or other SHPM fellow in the OPD

23. “Home Visits” only MWF 8:00 am -12:00 pm
Meeting place: OPD 3rd floor, 8 am
You will accompany a fellow and/or a resident
Bring your own PE stuff like BP app, stethoscope, and thermometer even if the team has its own Home Visit bag which has those materials and more

24. “Home Visits”
You will visit patients who were scheduled that day for home visit
There is a PGH service ambulance (Yes naman!) which will bring you to the patient’s place
What to expect:
Brief history & PE on the patient
Minor procedures
reinsertion of NGT
wound cleaning, etc.
You will be asked to
identify apparent problems of the patient
propose solution(s) for each identified problem

25. Munting Paraiso only MWF 9:00 am -12:00 pm
Proceed to Cancer Institute’s Pediatric Ward
Get the names of the patients who can join you in your Munting Paraiso session
Borrow the keys in
the admin office - CI 1st floor

26. Munting Paraiso Inside SHPM office (3rd floor OPD)
look for the charts of old patients
check their last module so you would know the child’s next module
refer to the Child Supportive Care manual included in your kit
If there are no charts or if the patient is new
accomplish the two-page form (found in the SHPM office)
perform one of the four modules to your patient and his or her caregiver
You are expected to chart at most two patients (I’ll confirm this to Dr. Chi)

27. Munting Paraiso
There are 4 modules that we will be used for our MP sessions
What to expect:
Play intervention
or simply, have some good times with pediatric patients admitted in CI while giving psychosupportive care to them and their caregivers;
Ask Dra. Chi if there will be some sort of “processing” or feedback session after the MP session

28. Other Important Activities
Journal Club Presentation
Case Management Presentation
EBM and Staff Conferences
Lectures and workshops

29. Journal Club Presentation
You will be divided into two groups (I’ll ask Dr, Chi if this is still the case) and present a journal about a topic of your interest related to the case you handled
Dr. Visperas, advised to FOCUS more on the DISCUSSION of results part (a.k.a. CONTENT)
This session will not follow the format in our EBM conferences

30. Format of presentation (can be modified based on content of the study)
i. Clinical Scenario
ii. Dilemma
iii. PICOM
iv. Process of Journal Searching
v. Relevance
vi. Introduction
vii. Methodology
viii. Validity
ix. Results
x. Discussion
xi. Applicability

31. Case Management Presentation
One case management for the whole group
The groups shall decide and pick the most interesting case from all the patients seen within the first week
Ideally, the reporter should be the person who has seen and managed the patient

32. Suggested Format i. General Data
ii. Diagnosis (this is the case of …… diagnosed with…..)
iii. HPI (pertinent)
iv. Course in the wards (pertinent)
→ Medications given
→ Laboratories done with results
v. Medical History (pertinent)
vi. PE
vii. Pain Assessment
viii. Psycho-social Assessment
→ Family Genogram
→ Family Mapping
→ Family APGAR
→ SCREEM
→ Reaction of Pt to Illness
→ Reaction of Family to Illness
→ Observations
ix. Identified Distressing Physical Symptoms and Psychosocial Issues
x. Medical Management
xi. SHPM Management*

33. For the SHPM management part
discuss the general management principles
then choose a specific aspect of your management plan
look what journal articles have to say about that aspect
For the past block presentation they choose to look for what journal articles say about the factors affecting end-of-life care decisions which will apply to our index patient, who’s still young and with probable Stage IV rhabdomyosarcoma

34. EBM and Staff conference
Attendance will be checked
I will collect all attendance sheets so that a resident monitor sign them
Community rotators are excused for EBM conferences only, except during Thursdays.

35. Lectures and workshops
Check the schedule
Lectures and workshops have a higher priority than
Conferences
OPD
ward works

36. Requirements!! Attendance sheet 3 assessment forms Patient log
Reflection paper
Details and format (to follow)

37. Ambulatory Care Unit
Primary Care strikes back!

38. Ambulatory Care Unit DFCM Faculty-in-charge: Dr. Pumanes
Resident monitor: Dr Alex Legarda
We will be oriented on Monday about this.. So don’t worry.. :D
4 rotators: A B C D
Duty hours D1 D2 D3 D4 D5 D6 D7
9AM-7PM A B C D
8PM-6AM
C D
A B

39. The “Ambu kit”/Requirements
Attendance sheet
4 assessment forms
Patient log
Reflection paper

40. Guidelines for Reflection paper

41. Community Health Center
Experience follows good exposure!

42. COMMUNITY HEALTH CENTER
DFCM Faculty-in-charge: Dr. Josephine Dizon
Area site for Community Medicine Rotation: Fabella Health Center
Activities
start at 8 am in the morning
consultation in the afternoon
usually ends between 3:00 to 4:00 pm
Get to know the personnel of the Health Center
Maximize your time for patient education 

44. Requirements Accomplished Community Feedback Form
Accomplished Comparison matrix
Patient Log
Case protocol – CHAP Case Management
CD compiling brochures/posters, pictures taken in the community orientation