MUST KNOWS FOR FEU-NRMF CLERKSHIP
Disclaimer: This document is shared to you for the intention of guiding you on your tasks as you rotate in each department. Disclaimer: Changes regarding duty schedules are subject to change; and are under the discretion of each department. Expect that you will looked DOWN as the “lowest form” form” in the hospital. You might have misunderstandings with other medical staff, but it’ it ’s best to always extend your patience. More often, nurses would get in your nerves. While some of them are really nice, there are, unfortunately, a bunch who would boss you around to get you to do things for them. Always keep in mind that you’ you’re only going to be an expensive monitoring machine for a year, so just bear with it. Always try to be polite, but know when to stand up for yourself when you know that you ’re right. One year will pass by quickly, trust me. Good luck, and enjoy clerkship! Make the most out of each experience, learn as much as you can, and perform procedures to enhance your skills. Bring a little notebook with you, notes can come in handy anytime! If you are not sure of something, you can always ask your PGI’s before consulting your residents. I’m sure my batch mates would gladly teach you what they know.
SCHEDULE: The usual schedule is duty every THREE days. However, some rotations have duties every four or five days, sometimes even every other day. Pre-Duty: The day before you go on duty. You go to the hospital for 8-10 hours. The tasks for pre duty status vary per rotation. * (24 hour duty is subject to change) Duty: The Duty: The day you spend >24 hours in an institution. Example, in the base hospital (FEU) Duty starts at 7:00 am t he present day, until 7:00 am the following day. From-Duty: The remaining hours of the day after your 24-hour tour of duty. From duty status can be From-Duty: once relieved (meaning once the duty people people are in, you guys could leave),or sometimes until 12 noon, noon, if you’re lucky, usually until 4-5 in the afternoon, and sometimes, when you are really, brimming with luck, the latest is 6-8 in the evening. (Are you counting the hours already? ) For those areas with duties every 4 or 5 days, there are statuses such as Pre(3) or Pre(2) Duty. Hours are basically the same as those on Pre -Duty.
THINGS TO BRING: It depends on the rotation. If you can, always bring an extra uniform or scrub suit when you are on duty. You never know when you might need one. Whenever you’re rotating OUTSIDE, please take care of your things, esp your cardio stethoscopes, Welch Allyn bp app’s… Thieves have an eye for the expensive things. Never leave your valuables unattended. Worst case scenario: whole bag gets stolen (This happened in JR). So avoid using your expensive bags as well when rotating outside. It’s handy to have a belt be lt bag or sling bag with you during outside rotations so you always have your valuables and other paraphernalia with you.
TERMS TO FAMILIARIZE YOURSELF WITH: – whether you are pre, duty, or from, as explained above Status – whether – base hospital, a.k.a. FEU Inside – base – a penalty; number of hours you get for a certain offense Demerit – a – reward; number of hours you get for getting a job done; this c an make-up for your lates and Merit – reward; demerits | l
SHO – Senior House Officer who checks the attendance whenever you are in duty. Whenever you are on DUTY inside, don’t forget to sign the logbook located at the information counter in the hospital lobby. Attendance will be checked at night (be alert for the page, or have someone text you when they hear it), however sometimes they check attendance twice, or even thrice, so be careful not to get out-of-post! (NCH also has a SHO). Out of Post – not being at your post regardless of status (pre, duty) This is equivalent to 5 days or (40 hours) make-up JIOD – Junior Intern On Duty: The leader of the group. This only applies to the Inside departments of Pedia, Surgery and IM. Roles will be discussed later on. JIIC – Junior Intern In Charge of a certain service patient/s. Ka-back – a.k.a. “co-JIIC” / Whenever you’re rotation is Ward/Servce inside, you will always have a “kaback” or partner for each duty day who will be responsible to take care of your service patients when you are not within the hospital premises anymore, and likewise, you are responsible for their patients as well Endorsement – morning discussions of what happened during the 24-hour tour of duty with residents and consultants; you are expected to know the cases that will be endorsed Bedside – when you have to monitor patient’s vital signs q15 (such as B T or Chemo) De-bulking – converting toxic monitoring (q2 to q4, q1 to q2) with your resident’s permission (or sometimes your own judgment, just be 100% sure that your patient is stable) Make – up – The number of hours you need to cover for your lates, absences, and demerits. They can be th started once you are on your 6 month of clerkship. However there are departments that only allow three clerks at a time to do their make-up, so reserve your make-up slot early, on the day you plan to do your make-up.
BASIC RULES: 1. 2. 3. 4.
DO NOT FALSIFY VITAL SIGNS MONITORING AVOID SIGNING ATTENDANCE FOR GROUPMATES/FRIENDS NEVER LEAVE YOUR POST WITHOUT ASKING FOR PERMISSION ALWAYS KNOW WHEN TO REFER – when a patient’s vital signs seem to be deranged, double-check it, refer immediately to your resident! 1. ) 5. ATTEND THE REVIEW EVERY SATURDAY as much as you can (They usually tolerate up to two absences, but never more than that)
THE GOLDEN RULE IN CLERKSHIP: Be fair to your prime mates
|
l
WHAT YOU MUST KNOW FOR EACH ROTATION – Let’s get started!
ELECTIVES (Psych, ENT-HNS, Ophthalmology)
Psych Inside: >Things to bring: Stethoscope, BP app, laptop, ipad, whatever gadgets can get you through the night > Attendance: The attendance sheet is inside the IM office. > Duty Schedule: Every 3 days (not sure if they changed it to 4) for two weeks > Posts: Blood Bank, OPD (sometimes when the IM department gets really toxic, I heard that they used to pull-out Psych JI’s.) >This is the most benign rotation, ever. You get to enjoy the lounge, get complete bed rest as well. Btw, it’s your duty to get the water containers used for drinking refilled (just split the expenses among your prime mates), and your duty to answer the phone inside the female JI lounge >From status: once relieved, except when there’s reporting >Be prepared to do a complete psychiatric history and mental status exam whenever there’s a service patient referral who’s under the service of Dra. Yumul. Consultants you’ll meet in the OPD: Dr. Atanacio, Dr. Tan Chio-Chiong , Dra. De Castro Psych Outside: NCMH (National Center For Mental Health) >Things to bring: BP apparatus and stethoscope, thermometer, penlight (other PE essentials), carbon paper, lots of bond paper, clipboard, mosquito repellant lotion, alcohol > Environment: It’s hot and humid in NCH especially in summer. Bring a portable fan if you can, and hydrate yourself! For car parking: Arrive at least before 7:30 and you’d still have a good parking spot. They do charge a FIXED parking fee, I just can’t remember how much. > Attendance: Time in: 8:00 am General attendance is in Pavilion 1, and your respective pavilions. > Duty schedule: Every four days (not sure if t his is still the rule)for two weeks Pre duty: 8-5pm From status: 5pm > Posts: ER/ACIS, Pavilions > Other reminders: Keep track of the requirements you’ve passed. They usually hand out a clearance form, accomplish it, and make sure you take a picture of it before completing your rotation (just in case you have questionable deficiencies). You also have to take an exit exam. Ophthalmology >Things to bring: OPHTHALMOSCOPE! BP apparatus and stethoscope, thermometer, penlight, scrub suit, cap and masks (if on duty) > Attendance: 7-7:30 am attendance at the OPD > Duty schedule: Every four days (not sure if t his is still the rule) for two we eks > Posts: OPD, ward if duty, OR, RR (So bring scrub suits – but you’ll only get to observe) > Other reminders: Expect a lot of patients at the OPD! Assessing each patient can take a long time because you have to thoroughly perform visual acuity tests. Prepare for reporting. When a patient is scheduled for OR, be there at least 30mins-1hr before the procedure. ENT-HNS >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suits, cap and mask > Attendance: 7-7:30 am at the OPD | l
> Duty schedule: Every four days (not sure if t his is still the rule) for two we eks > Posts: OPD, ward, OR, RR > Other reminders: There would be a designated “Washer” at the OPD, whose task is to clean the tongue depressors, etc and other paraphernalia used in the OPD. Grab the chance to perform an aural toilette if allowed by your residents! Also prepare for reports. You would usually observe surgeries performed at the OR. *ENT-HNS residents are really, really nice and super cool! Just don’t abuse them and don’t be disrespectful. They are very considerate and they really get well along with JI’s. Expect an ENT vs. OPHTHA showdown at the end of your rotation
|
l
PEDIATRICS Pedia Inside >Things to bring: BP apparatus and stethoscope (PEDIA CUFFS! Fo r baby, toddlers, school age children), thermometer (AXILLARY), penlight, TAPE MEASURE, otoscope, ophthalmoscope, laptop, THERAPEUTIC INDEX, CALCULATOR, name STAMP > Attendance: STRICTLY 7:00 am at the conference room They are very strict about coming in early, so avoid getting late! And the department’s clock is around FIFTEEN minutes earlier than the rest of the hospital so be early! > Duty schedule: Every three days > Posts: OPD (7 days) – weekdays from 7-4pm SERVICE: (2 weeks) Pre-duty: 7-4pm From duty usually goes home in the after noon, usually after reporting NICU (7days) Pre duty: 7-4pm From duty: Once relieved status > Other reminders: SERVICE Assign a JIOD for each duty. JIOD duty will only include studying the admissions, discharges during the 24 hour tour of duty. STUDY THE CASES! *Pedia endorsement is the MOST TOXIC and UNNERVING*. During endorsement, you are expected to know everything about the patient by HEART, starting from the history, even the laboratory results, etc. You are not allowed to have a copy of the history with you during endorsement. Memorize everything. Be prepared for the bed side endorsement. During De Vega rounds, the JIIC must be prepared for the endorsement as well. He can ask basically anything, even the discharges or admissions the previous days. So just know your patient. The department is very strict with their monitoring, so never miss a monitoring on a patient. Always do your SOAPing and update your paperworks. Prepare good reports for merits. NICU Coordinate with your OB co-JI when asking about the maternal history. You would need that for the endorsement. Assign a JIOD for e ach duty, who will also possibly endorse the next day. Whenever Dr. Becina is around, and he asks you to touch the baby, WASH YOUR HANDS first before anything else! OPD Bring complete paraphernalia’s for assessing patients. Examine your patients in the examining table. Be systematic with your PE, the department is strict with their OPD charts. Do not use abbreviations. Have someone assigned as your “logger” so he/she could start logging patients as early as 2pm, or even after lunch so you could avoid going home late. Pedia Outside JRRMMMC (Jose R. Reyes Memorial Medical Center) >Things to bring: BP apparatus with PEDIA CUFFS and stethoscope, thermometer, penlight, tape measure, scissors, tape (though you could get/hoard lots of micropore from the station or ER), mosquito repellant lotion, alcohol, SCRUB SUIT (green), MASKS – always wear them! > Environment: It’s hot and humid too! |
l
> Attendance: 7:00 am at the pedia office (If you’re going to bring a car, go in early, before 7am so you could get a parking spot. There is no parking fee) > Duty schedule: Every three days for two weeks > Posts: WARD/ER for one week, OPD/NICU for one week > Other reminders: NICU – Bring your own caps and masks. Pre-duty tasks include monitoring, and running errands (esp when you need to go outside and you have to change back to your uniforms. Smock gowns are not allowed). Pre duty can also be assigned to the OPD. DUTY – In charge of all deliveries, and making sure the tackle box is always complete with the necessary paraphernalia. Your cue on an ongoing delivery is a buzzer. You also have to take the maternal history and relay it to your residents. The census is accomplished by your PGI’s. From duties can go home after endorsement. ER/WARD – Expect this rotation to be toxic and exhausting. ER post is usually from 8am-5pm. You can go to the ward once your PGI arrives, if there are no other pending tasks or if the ER is not toxic. Ask permission from your resident first. In the ward, you do EVERYTHING -- Monitoring, weighing all babies, history and PE, discharge summaries and clinical abstract, extractions, insertions, ambu-bagging, CPR, obtaining initial readings from the radio department, send specimens to the lab, etc. Do as much procedures as you can. Pre-duties are the ones usually assigned to do the paperwork and monitoring before they go home, so that the from-duties can rest. From duty can go home 12noon, as long as there are no afternoon conferences. *Whenever you’re in JR, go the DOH cafeteria. The food is good yet it’s cheap. NCH (National Children’s Hospital) > Things to bring: BP apparatus with PEDIA CUFFS and stethoscope, thermometer, penlight, tape measure, scissors, tape, mosquito repellant lotion, alcohol, SCRUB SUIT (any color), MASKS – always wear them! > Environment: It’s hot and humid in NCH especially in summer. Bring a portable fan if you can, and hydrate yourself! > Attendance: STRICTLY 8:00 am in the neuro ward Pre-duty: Until 4-5pm From status: OPD in the afternoon (during nephro, cardio, hema award) > Duty schedule: Every three days for two weeks > Posts: WARD > Other reminders: Monitoring can be toxic and tiring. Always refer to your residents for any deranged values. Get the opportunity to do lumbar tap while in the neuro ward. Be prepared for codes. Attend le ctures and conferences. Expect reporting, and always be with your residents during bedside rounds. Parking spots are limited in the area. Always report for sho, and you can change your into your scrub suits after SHO.
|
l
SURGERY Surgery Inside >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suit, cap and mask > Attendance: Time in: 7:00 am (S TRICTLY) > Duty schedule: Every three days for one month > Posts: Pre-duty: OPD Duty: Ward, OR, RR, ICU > Other reminders: For OR patients, you are expected to be at the OR an hour before the scheduled procedure. The department is not too strict about the monitoring. Closely monitor patients for the first 24 hours after their OR. The from-duties may go home as long as there are no assigned reporting/lectures/conferences for the day. Be careful from being marked as “out-of-post”, so always ask permission from your residents if you are allowed to go home. Two JI’s are required to scrub-in an OR for a service patient. Surgery Outside
MMC BP app, steth, smock gown, scrub suit any color), jacket, pillows, blanket, food 7:00 am at the resident’s office DUTY-FROM for one week (From status til 12 noon)
POC BP app, steth, scrub suit (any color)
JR BP app, steth, scrub suit (green), micropore, scissors
7:00 am at the ER complex DUTY FROM for one week (From status is once relieved)
7:00 am the ER complex
Posts
OR, ER
Other reminders
-Don’t forget to claim your meal stubs (Food from the caf are expensive but you can always buy outside) - From duties are expected to scrub in for OR’s occurring until 12 noon -NO MONITORING IN THIS HOSPITAL!!!! (This
ER, (Ward only to insert NGT’s, etc), ambulance conductions - Move quickly! Focus on the pertinent examination findings on your patient. Patients can pile up any time and they may come in waves. - Focus on NOI, TOI, POI, DOI (Nature, Time, Place of Injury) - NO MONITORING!
Things to bring
Attendance Schedule
PRE – paperworks and procedures in the ward; ambu-bagging in the SICU; scrubbing in the OR (which happens rarely) DUTY – ER complex only FROM – discharge summaries ER, WARD
- This is one of the most toxic rotations. During duty, be prepared for all procedures – extraction, insertion, abg, follow up of initial radiologic findings or laboratory results. Be prepared to deal with VA and burn patients in the ER, also brace |
l
is relatively a benign post except for long hours at the OR) -Be sure to have your infamous rooftop photos and with the Lap God, Dr. KST. -Overnight parking in the open area near the hospital costs Php 100 and above. The parking fee inside the hospital is EXTREMELY expensive! - You are expected to help (CPR, ambu bag) during CODES occurring within the ER complex. - Don’t lock yourselves in the lounge, go out from time to time and help your PGI’s in the ER.
- You don’t have to worry about the food, it is always provided by the respective team on duty. JI’s always eat together with residents - For ambucons: know the case of the patient - You can park our car if you arrive early, however, slots are limited, and there is a parking fee.
yourself for drunk, demanding patients who come in for medico-legal purposes.
|
l
OBSTRETRICS AND GYNECOLOGY OB Inside >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suit (green), cap and mask, TAPE MEASURE, bond paper (lots), clipboard folder with margins (1 inch on all sides —as a guide for your histories), scrub suits, cap and mask > Attendance: Time in: 7:00 am (STRICTLY) > Duty schedule: Every three days for one month > Posts: Pre-duty: OPD Duty: Ward, OR, RR, BEDSIDE (BT, Chemo), (ICU – on rare cases) > Other reminders: You will learn a lot from this rotation. Prepare yourself for tons of handwritten paperwork. Be patient with the labor watch, and closely monitor all patients endorsed. Never self de-bulk your patient monitoring. Do your paperwork immediately so they can be checked by the residents asap for quick revision. Be prepared for the reporting, oral and written revalida. Refer asap to your residents for any deranged vital signs. Attend lectures and endorsement, they would often check the attendance. If you are unsure about the fetal heart tones, refer to your resident immediately! Girls – tie your hair during grand rounds! OB Outside
Things to bring
Attendance Schedule
Posts Other reminders
RMC BP apparatus and stethoscope, thermometer, penlight, scrub suit (any color), smock gown, cap and mask, TAPE MEASURE 7:00 am at the ER DUTY FROM for two weeks FROM status – 12 noon
DR/WARD/OR/ER -No sleeping allowed during duty hours, during wee hours in the morning. Keep yourself awake! -Expect mass deliveries: be quick and be ready to do successive insertions, extractions, catheter insertions, and deliveries. Avoid “baby-out” (babies delivered in the bed/stretcher), this corresponds to a demerit. Update your vital signs monitoring and do your labor watch meticulously. -Be prepared for an exit exam -You may be called as a first assist
JRMMMC BP apparatus and stethoscope, thermometer, penlight, scrub suit (green), cap and mask, TAPE MEASURE 7:00 am at the DR PRE 7-5 at the OPD DUTY FROM for two weeks FROM status until 12 noon unless there are conferences in the afternoon, and be sure to endorse to the duty residents before going home OPD/ER/WARD/DR OPD: designate a JI for vital signs taking, for abdominal girth measurement, etc. You are only allowed to leave at 5:00 pm. WARD: monitoring, paperwork, extractions, ALL errands, scrub in to CS procedures and other OR procedures DR: deliveries, labor watch ER: this post is toxic! History/PE of the patient, extraction, insertion
|
l
during emergency CS cases -Pre duty task: Monitoring, insertion in the ward, extractions, discharge summaries and clinical abstracts From: paper works (but the preduties would usually accomplish everything so the from duties can take their rest)
|
l
COMMUNITY AND FAMILY MEDICINE
Things to bring
Attendance Schedule
Posts
Other reminders
ER BP app, steth, thermometer, penlight
WARD BP app, steth, thermometer
7:00 am CFM office, ER logbook Every three days (20 days) FROM: attend morning endorsements and lectures, then come back in the afternoon for lectures ER OPD – Pre-Duty
7:00 am CFM office
Bring your own masks which you can use for ambu-bagging Your task is to do q15 monitoring, ambubagging and CPR; it is not your task to take the vital signs in the triage area
COMMUNITY BP app, steth, thermometer, ophthalmoscope, TD, umbrella 7:00 am CFM office
Every four or five days (20 days) OFF on pre duty days that fall on a week end FROM: must attend lectures
7:00-5:00 am weekdays only (20 days)
Community – Vital Signs/Triage; Immunization; Extraction Take note of your immunization/extractions. Prepare for endorsements with Dra. Samaniego Monitor patients (usually two or three only) Accompany Dr. Joves during rounds and you’ll learn a lot!
Community – Patient history, assessment and management Take note of all the patients you see in the community
This is one of the benign rotations because you get to have weekends off, and you’ll experience the “classroom” setting again. However, it gets busy during the second month as you prepare you papers for the community and family presentation, so manage your time wisely. Always attend Dr. Joves’ lectures! You will learn a lot of basics in this rotation. Avoid loitering outside the classroom, if you get caught you will be given an out of post! Do not get left by the bus!
|
l
INTERNAL MEDICINE IM Inside
Service >Things to bring: BP apparatus , Steth, penlight, thermometer (all PE essentials including neuro bag), > > Attendance: Time in: 7:00 am in the IM office > Duty schedule: Every three days for one month > Posts: Ward Pre-Duty: q4 monitoring of respective assigned station, history until 3:00 pm, discharge summaries and clinical abstract; prepare for possible endorsement the following day. Don’t forget to get the history you’ve written before going to the morning endorsement From duty: can go home after conferences Be present during lectures, attendance is always checked. > Other reminders: JIOD: patient and chart rounds, in charge of keeping the nook clean (All demerits are group demerits, times three to the JIOD) Monitor your patients, relay all those vital signs that need to be relayed! Refer asap when needed. FLOATERS: BT, chemo, q15 and q30 FOR SERVICE PATIENTS: Always know your patient and your co-JIIC’s patient. Accomplish referrals on time. Always check your charts for any updates. Don’t forget to do your patient’s and your co-JIIC patient’s SOAPing. Update your discharge summaries and clinical abstract daily. Good reports are given merits, as well as good endorsement. Tips: DO YOUR HISTORY and PE METICULOUSLY. They give demerits for crappy morning endorsements.
ICU/CCU >Things to bring: BP apparatus, Steth, penlight, thermometer (all PE essentials including neuro bag), scrub suits ICU door codes: 1214# or 1213# > Attendance: Time in: 7:00 am in the ICU > Duty schedule: DUTY FROM for one week FROM status: Once relieved after endorsement > Other reminders: Bring a laptop – for paperwork needed for service patients Avoid Dra. Yumul during endorsement. Learn as much as you can from the residents Monitor patients q15 and relay any deranged values immediately. Prepare for morning endorsement if you have service patient admission OPD >Things to bring: BP app, Steth, pe nlight, thermometer (all PE essentials including neuro bag) > Attendance: Time in: 7:00 am in the IM office and OPD logbook > Duty schedule: 7-4pm everyday for one week > Other reminders: Prepare for reporting, learn as much as you can from yo ur residents. If there are too many patients, start logging early |
l
IM outside
Things to bring Attendance Schedule Posts Other reminders
RMC BP app, steth, mask, thermometer, penlight, extra uniform 7:00 am at the IM ward DUTY-FROM for one week (From status til 12 noon) ER, WARD You will do ward work (extractions, insertion, monitoring, mannitol drips, CTT bottle change) FROM status: 12 noon; in charge of discharge summaries and clinical abstracts ER: history, PE, prescribe medications, do ECG Grab the opportunity for intubation Parking: thirty pesos FIXED rate*
EAMC BP app, steth, mask, thermometer, penlight, extra uniform 7:00 am at the IM office PRE DUTY FROM for one week WARD, ambulance conduction WARD - Monitoring, extractions, discharge summaries, clinical abstract, carry out orders of your respective teams (prescribe medications, fill out laboratory request forms) - From status: usually 5-6pm. You can go home once your team is done with their rounds are you are finished carrying out their orders - PHILHEALTH/CF3 forms require a DAY by DAY course in the ward Parking Fee: 100 pesos for overnight parking Grab the opportunity for intubation and thoracentesis
|
l
Comprehensive Examinations - Most questions are lifted from the lectures so attend as much lectures as you can. - You would find it impossible, or at times hard to find time to study for the comprehensive e xams while being on duty and having something else to study about. So don’t feel bad when you fail the first exam. Chances are, you’d still pass the removals exam. Just avoid taking post -promo removals. SOAPING FORMAT This is only a SAMPLE format
S> Patient seen and examined on his/her ____ hospital day, (__day of illness), ___ day afebrile, with the following subjective complaints: No or with fever, etc (other signs and symptoms) For pedia patients: ask about bowel movement, urine output, and activity
O>
General: conscious, coherent, afebrile, not in cardio respiratory distress with the following vital signs: BP CR RR Temp Pink palpebral conjunctiva, anicteric sclera, no nasoaural discharge, no tonsillopharyngeal congestion (Pedia version: *use what only applies*: normocephalic, anterior and posterior fontanel is open/closed and measures, pink palpebral conjunctiva, white sclera, ear canal is patent wit h whitish material partly occluding the canal, intact tympanic membrane, moist/dry lips, pink buccal mucosa, nonhyperemic pharyngeal walls)
Neck is supple, no neck vein engorgement, no cervicolymphandenopathy Chest: symmetrical chest expansion, no retractions, no lagging, clear breath sounds (Pedia version: include air entry whether good, fair or poor; be specific about the location of retractions, whether intercostals or subcostal)
Heart: Adynamic precordium, normal rate, reg ular rhythm, no murmurs Abdomen: globular/flabby/flat, normoactive bowel sounds, soft, non-tender Extremities: no gross deformities, full and equal pulses, no cyanosis, no edema, CRT <2 secs Skin: no active dermatoses *Include laboratory findings in your “O”. A> Working Diagnosis P> Diet, Diagnostics, Drugs, Disposition
|
l
