PASIG CITY GENERAL HOSPITAL Department of Pediatrics

1. PASIG CITY GENERAL HOSPITALDepartment of Pediatrics Clinical Clerkship SY 2011-2012

2. Objective: PCGH ROTATION OF YL8 ATENEO STUDENTS (CLERKS ) 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.

3. Duration of Rotation: 8 weeks The Medical City 2wks Community Pediatrics (Ilugin Health Center, Pasig City) 2 wks Pasig City General Hospital 2wks Philippine Children’s Medical Center 2wks • 1 wk NICU • 1 wk ER/OPD

4. PCGH • a tertiary government hospital • 150 bed capacity • locally funded by City government of Pasig • Deficiencies/Limitations of PCGH • Limited supplies (budget depends on city hall) • Inadequate equipment/Facilities • Lack of adequate manpower ( medical and non-medical)

5. PCGH Accredited Departments • Department of PediatricsLevel 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

6. PCGH Services: • ER • OPD • Subspecialty Clinics • Monday Nephro Clinic • Tuesday Neuro/ Well Baby ( immunization) • Wednesday Pulmo/Hema Clinic • Thursday Neonatology (Sick Babies) • Friday Cardio • NICU • WARDS • PICUIsolation/Newborn Ward • Pulmo Ward Miscellaneous Ward • PaywardPhilhealth ward

7. PCGH Consultant Staff

8. Medical Director Paulo A. Castro, Jr. MD Asst. Medical Director Anthony A. Marquez, MD Department Chairman Rosario G. Isada, MD Training Officer Jorge C. Licsi, MD Research & Dev’t Gloria DL Poblete, MD Internal Affairs Jorge C. Licsi, MD Bioethics Finance Socio-Cultural Research Residency Training Services Amalia C. Bulaon, MD Out-Patient In-Patient a. Community Health Education b. Ambulatory General Pediatrics Rosario Isada, MD Gloria Poblete, MD Jorge Licsi,MDAmaliaBulaon, MD Rowena Ong, MD Subspecialties Loretta Alano, MD NepthalieOrdonez,MDJeannaPles, 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,MDAmaliaBulaon, MD Rowena Ong, MD Subspecialties Loretta Alano, MD NepthalieOrdonez,MDJeannaPles, MD Arleen Galvez, MD Carmina Delos Reyes, MD Neva Batayola, MD Edwin Rodriguez, MD Imelda Tan, MD Jonadav Martinez, MD Organizational Chart DEPARTMENT OF PEDIATRICS

9. ASMPH FACULTY Gloria DL Poblete, MD, FPPS AmaliaBulaon, MD, FPPS Rosario G. Isada, MD, FPPS Chairman Carmina Delos Reyes, MD, DPPS Rowena Ong, MD, DPPS

10. NON ASMPH FACULTY Senior Consultants ACTIVE CONSULTANTS Loretta Stephanie Alano, MD, DPPS Neonatologist Neva Luna Batayola, MD, DPPS Pediatric Intensivist Jorge C. Licsi, MD, FPPS Training Officer Jonadav Martinez, MD, Pediatric Surgeon Arleen Galvez, MD, DPPS Pediatric Nephrologist

11. NON ASMPH FACULTY Senior Consultants ACTIVE CONSULTANTS NepthalieOrdoñez, MD, FPPS Pediatric Pulmonologist JeannaPles, MD, DPPS Pediatric Cardiologist Edwin Rodriguez, MD, DPPS Pediatric Hematologist Imelda Tan, MD, FPPS Pediatric Neurologist

12. NON ASMPH FACULTY VISITING CONSULTANTS Consuelo Sumayao, MD MylahTuazon, MD JUNIOR CONSULTANTS ArlynBaconawa, MD Sophia Mata, MD

13. PEDIA RESIDENTS Irish Cayton, MD Chief Resident Kate Callanga, MD 2nd yr Resident JinkyBorromeo, MD 2nd yr Resident Marigold Bajar, MD 1st yr Resident Jennifer Manzano, MD 1st yr Resident Amor Mia Cruz, MD 1st yr Resident NorhynTamano, MD Pre=Resident

14. Prerequisites: PCGH ROTATION OF YL8 ATENEO STUDENTS (CLERKS ) • 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

15. MUST SEE CASES: • 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 /SeborrheicDermatitis, 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 • Newborn Care and Discharge • TTNB / RDS • Sepsis Neonatorum • Hyperbilirubinemia • Dehydration/Shock • Seizures/Febrile seizures • Respiratory distress Nursery Rotation OPD Rotation

16. MUST DO Procedures (Skills Log): BP measurement 10 Otoscopy 10 IV insertion 5 IV injection/push 5 NGT insertion 1 Gastric lavage 1 Venipuncture/blood extraction 1 Blood culture sampling 1 Heel prick for newborn screening 1 Cord care and dressing 1 Skin testing and reading 1 Urine output monitoring 5 Immunization procedure 2 each (intramuscular, intradermal,subcutaneous) Assist in umbilical cannulation1 Assist in lumbar tap 1 Assist in endotracheal intubation 1

17. Logbook of Cases:

18. Instructional Activities: • 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

19. Schedule of ASMPH Consultants:

20. Schedule of ASMPH Consultants:

21. NICU ROTATION

22. 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

23. Duties and Responsibilities of NICU Rotator • Attendance logbooks should be signed by the clerk rotator and countersigned • by the resident • NICU rotator will go on 24hrs duty every 3 days • Endorsement 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 clerk • NICU Rotators should be in scrubsuits while in the NICU

24. NICU Rotator: Pre -Duty • 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

25. NICU Rotator: 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

26. 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.

27. OPD / ER ROTATION

28. Duties and Responsibilities of 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

29. Duties and Responsibilities of 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

30. 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.

31. 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

32. 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.

33. Summary of Requirements of ASMPH Clerks • 2 Preceptorial / SGD / AdCon evaluation by ASMPH Faculty • 1 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 rotation • 4 Patient Encounter Form during NICU rotation • 5 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

34. Scope of Quizzes NICU • Newborn Care / P.E. of the Newborn • Non-Infectious Ds of the Newborn Hyperbilirubinemia TTN HMD • Infectious Ds of the Newborn Sepsis Pneumonia OPD/ER • BFC (guidelines) • Dengue Fever / DHF • PTB (guidelines) • PCAP (guidelines) • AGE (WHO)

35. Breakdown of Evaluation:

36. 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.

37. Summary of Evaluation: • 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

38. 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.

39. 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

40. 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) (?)

41. 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.(?)

42. Sanctions: • 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.

43. 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. (?)

45. LEC 8

46. LEC 8