GUIDEBOOK To Clinical Optometry Internship 2016

2016
Community & Hospital

Optometry
An Internship Protocol
Doctor of Optometry
Davao Doctors College Inc.
TABLE OF CONTENTS
DAVAO DOCTORS COLLEGE INC.

Institutional Mission Statement
Vision, Mission & Goals
Motto
DOCTOR OF OPTOMETRY
Philosophy
Departmental Objectives
Motto
Republic Act 8050
COMMUNITY AND HOSPITAL OPTOMETRY
An Introduction
Objectives
10
General Objectives
10
Educational Objectives10
10
Learning Objectives
11
COMMUNITY AND HOSPITAL OPTOMETRY I (INTERNSHIP PROGRAM)
12
Course Code & Credit, Contact Hours, Pre-requisites, Placement
12
Course Description
12
COMMUNITY AND HOSPITAL OPTOMETRY II (EXTERNSHIP PROGRAM)
13
Course Code & Credit, Contact Hours, Pre-requisites, Placement
13
Course Description
13
TABLE OF CONTENTS
POLICIES & IMPLEMENTING GUIDELINES: THE INTERNSHIP PROTOCOL
14
I.
Eligibility
15
II.
Pre-internship Requirements
15
III.
Grooming and Appearance
17
IV.
Duties and Responsibilities
18
V.
Proper Decorum
19
VI.
Attendance and Punctuality
21
VII.
Make-up or Extension Duties
24
VIII.
Internship Offenses
25
IX.
Incident Reports and Discipline
27
X.
Sanctions
28
XI.
Merits and Demerits
29
XII.
Monthly Revalida
31
XIII.
Performance and Evaluation
32
XIV.
Portfolio of Learning Experiences
33
XV.
Post-Internship Recognition and Pinning Ceremony
34
XVI.
Awards and Recognition
35
XVII.
Commencement Ceremony
37
CLINICAL INTERNSHIP FORMS and TEMPLATES
38
Conforme Sheet and Waiver
39
Internship Clinical Evaluation Form
40
Internship Clerical Evaluation Form
42
Record of Demerits Form
44
Case Presentation Form
46
PROFILE OF AFFILIATION CENTERS
47
3
TABLE OF CONTENTS
CLINICAL INTERNSHIP JOURNALS

ROTATION NO. 1
ROTATION NO. 2
ROTATION NO. 3
66
67
67
- Lorem Ipsum
67
ROTATION NO. 4
68
ROTATION NO. 5
68
ROTATION NO. 6
68
CLINICAL EXTERNSHIP JOURNALS
70
ROTATION NO. 1
71
ROTATION NO. 2
71
ROTATION NO. 3
71
ROTATION NO. 4
72
ROTATION NO. 5
72
ROTATION NO. 6
72
EVALUATION OF STUDENT-INTERN EXPERIENCES
73
EVALUATION TOOL for STUDENTS
74
EVALUATION TOOL for PRECEPTORS
75
REFERENCES
76
VISION
that provides quality health and wellness education in Mindanao and the East
ASEAN Growth Area.
MISSION
Davao Doctors College is committed to produce highly competent
graduates imbued with the core values of excellence, service, integrity,
empowerment and commitment.
GOALS
To achieve its vision and mission, Davao Doctors College aims to:
1. provide innovative, balanced and relevant education for lifelong learning
of the global Filipino;
2. provide community outreach services through comprehensive general wellbeing projects;
3. promote passion for continuous improvement by upgrading facilities,
strengthening research culture, intensifying partnerships and linkages;
4. promote environmental concern and community awareness by maintaining
a sustainable and environment-friendly institution and implementing
activities that help nurture the environment, and
5. achieve organizational efficiency and financial stability through competent
management and governance.
MOTTO
Through Excellence We Shall Lead
INSTITUTIONAL MISSION STATEMENT
Davao Doctors College is a premier non-sectarian academic institution
PHILOSOPHY
The study of Doctor of Optometry affirms the motto of Davao Doctors
Commission on Higher Education as a regulating body.
Individuals have the right to quality eye care through highly educated
and well-trained primary eye care providers. The Department of Optometry
readily prepares a learning environment that support and advance an individual
to this professional discipline. This ideal is translated into a students
experience to ethically deliver service by addressing each persons specific
needs.
The faculty commits to provide the best foundation necessary for
students to fully assume the role of a professional which encompasses practice,
pursuit of clinical expertise, commitment to academic and clinical teaching and
facilitation of research.
The Department believes that any individual who aspires to be Doctor of
Optometry is endowed with a foundation for lifelong learning, committed to
give eye care, ethically bound in the realm of practice and recognizes the value
of service in a dynamic quality health care environment.
DEPARTMENTAL OBJECTIVES
The Optometry Department aims to produce an Optometrist who has:
1. acquired and developed the knowledge and skills essential to the practice of
Optometry.
2. developed a high level of competence needed to deliver the full spectrum of
Optometric services: which consist of prevention, examination, evaluation,
diagnosis, management, and rehabilitation of disorders, dysfunctions and
diseases of the visual system, the eye and its associate structures.
3. developed the qualities, attitudes and values essential to the delivery and
promotion of eye care services to the Filipino people.
4. developed the desire to improve Optometry by advancing knowledge, skills
and values of the profession.
DOCTOR OF OPTOMETRY PROGRAM
College Through Excellence We Shall Lead and the recognition of the
5. developed professional attitudes conducive to inter-professional understanding and cooperation.
MOTTO:
Envisioning Your Future With Us
Optometry is the science and art of examining the

human eye, analyzing ocular functions, prescribing and
dispensing ophthalmic lenses, prisms, contact lenses and
their accessories and solutions, low vision aids, and
similar
appliances
exercises,
vision
and
devices,
training,
conducting
Orthoptics,
ocular
installing
prosthetics, using authorized diagnostic pharmaceutical

agents (DPA), and other preventive and corrective
measures
or
procedures
for
the
aid,
correction,
rehabilitation or relief of the human eye or to attain

maximum vision and comfort.
(RA 8050, sec. 3)
REPUBLIC ACT 8050
R EPUBLIC A CT 8050

Optometry
I ntroduction
The COMMUNITY AND HOSPITAL INTERNSHIP / EXTERNSHIP PROGRAM is a 10months clinical rotation scheme in which is offered in the fourth year proper of the Doctor
of Optometry degree. It provides an intensive, challenging, educational training for
students in a unique and individualized experience in Optometric care in the context of
the total health and eye care.
The internship program enhances the interns clinical knowledge and skills through
intensive clinical experience. It provides quality exposure in diverse clinical settings
including government and private hospitals with optometry or ophthalmology centers,
referral centers, military bases, HMOs, urban family clinics, hospital clinics and Health
Center Service facilities.
Student interns will have the opportunity to work with different patients and
doctors and will be able to formulate their own individual style of practicing Optometry as
a result of these experiences.
Objectives
G ENERAL O BJECTIVES:
The intent of the Internship Program is to provide the Optometry student with an
opportunity to be trained by outstanding practitioners in the science of primary and/or
secondary care Optometry. It is an integral part of the curriculum designed to transform the
optometry student into a complete health care professional who can apply scientific
knowledge tempered by clinical insight and overall concern for the patient.
E DUCATIONAL O BJECTIVES:
1. To develop the student's ability to apply knowledge of vision and basic sciences to
prevent and/or solve problems of the vision system.
2. To develop the student's ability to utilize knowledge in the behavioral, social and
other health sciences to alleviate human problems.
3. To develop a high level of competence in the use of modern optometric techniques,
instruments and problem solving roles.
4. To engender high standards of professional competence and responsibility.
5. To develop the students ability to work and communicate effectively with other
health professionals and ancillary personnel in meeting patient needs.
10
Objectives
L EARNING O BJECTIVES:
1. To demonstrate to the student the art of the practice of optometry as evidenced by the
attending doctor/practitioner.
2. To widen the student's understanding of the spectrum of optometry by showing the
student the clinical conditions (mental, physical and social, both acute and chronic) and
their interaction with each other that make up the wide variety of health conditions in the
community.
3. To demonstrate where legal, the use of common diagnostic and therapeutic procedures
involved in the problem solving stages of the delivery of eye care.
4. To demonstrate the conscious and purposeful use and development of the doctor-patient
relationship.
5. To demonstrate the comprehensive care of the family from infancy to the aged,
particularly in highly susceptible groups.
6. To demonstrate the effect of an individual vision problem on the entire family.
7. To demonstrate the role of the "health team" in patient management and continuity of
care including relationships with other health professionals and agencies.
8. To demonstrate preventive optometry and the importance of early diagnosis of ocular
and vision anomalies, including ocular-related disorders.
9. To demonstrate the practical approach of the primary care optometrist to health
maintenance.
10. To demonstrate the role of the optometrist in patient education.
11. To demonstrate the changing patterns of optometric care and familiarize the student with
emerging patterns of eye care delivery.
12. To provide practical experience in the office management and business aspects of
optometric practice.
13. To demonstrate the civic involvement a professional owes to his community.
11

Optometry 1
COURSE NO.
CS 111
COURSE CREDIT
6 Units (1 unit Lec/ 5 units Clinic)
CONTACT HOURS :
270 Hours (1 Hour Lec /15 Hours Clinic/week)
PRE-REQUISITE
ALL Professional subjects prior to this
PLACEMENT
Fourth Year Proper; First Semester
COURSE DESCRIPTION
The COMMUNITY AND HOSPITAL OPTOMETRY INTERNSHIP PROGRAM is a 1semester rotating type of service training program scheduled for 5 months commencing from
June to October of the Davao Doctors College academic calendar. It provides fourthyear
Optometry Proper interns with the opportunity to rotate through different off-campus clinical
sites, each of which lasts for at least a minimum of 18 weeks.
It is intended to provide Optometry interns with opportunities to be trained by
outstanding practitioners in each of their specialty fields. Said interns will have a clinical
exposure to areas of general ophthalmology practice, pre and post refractive surgery,
cataract management, glaucoma screening, retinal diseases, low vision rehabilitation and
other ocular disease management.
In the said facility, students are assigned to various areas within the clinic where,
under direct clinical faculty supervision, they participate in the provision of primary care
optometric services to clinic patients. The experience at internship sites promotes the interns
skills as a primary care provider and develops his or her ability to deliver quality care in
accessible healthcare facilities.
The clinical preceptor participates not only at their respective facilities, but also shares
their expertise through mini lectures, presentations and continuing education programs. They
are responsible for the supervision, training and evaluation of interns studying at off-campus
sites.
12

Optometry 2
COURSE NO.
CS 112
COURSE CREDIT
15 Units (1 unit Lec/ 14 units Clinic)
CONTACT HOURS :
756 Hours (1 Hour Lec /42 Hours Clinic/week)
PRE-REQUISITE
ALL Professional subjects prior to this
PLACEMENT
Fourth Year Proper; Second Semester
COURSE DESCRIPTION
The COMMUNITY AND HOSPITAL OPTOMETRY EXTERNSHIP PROGRAM is a 1semester rotating type of service training program scheduled for 5 months commencing from
November to March of the Davao Doctors College academic calendar. It provides fourthyear
Optometry Proper interns with the opportunity to rotate through different off-campus clinical
sites, each of which lasts for at least a minimum of 18 weeks.
This course provides Optometry externs an opportunity to work with a variety of
patients and doctor practitioners. They are assigned to various Optometry clinics where, under
direct Clinical Instructor supervision and Preceptor, they participate in the provision of
Optometric services to a variety of patients with ocular health problems and other optical
services.
Student externs will be able to formulate their own individual style of practicing
Optometry as a result of these experiences. They will have the opportunity to explore different
areas of specialty within the practice of contemporary Optometry such as:
1. Cornea and Contact Lens
2. Vision Training and Orthoptics
3. Pediatrics and Binocular Vision
4. Low Vision and Rehabilitation
5. Geriatric Optometry
6. Optometry Management
7. Ocular Prosthesis
13
Policies &
Implementing
Guidelines:
the
Internship
Protocol
14
Eligibility
To be eligible for admission to the Community and Hospital
Optometry Internship/Externship Program, a student must be at least
least 18 years of age and must have:
1.1 Completed ALL professional and academic requirements for Doctor of Optometry
from first year to fifth year. (CMO No. 38, S.2007)
1.2 Completed ALL the patient requirements during the fifth year.
Pre-Internship Requirements
Prior to internship duties, an Intern must comply with the following:
2.1 Health Clearance

2.1.1 Complete Physical/Laboratory Examinations including chest X-ray
2.1.2 Medical Clearance duly signed by a Physician in a healthcare facility duly
accredited by DOH (CHED Memo 26, series 2009)
2.1.3 Hepatitis B screening and vaccination as per school/ hospital policy
2.1.4 Mental Health Certificate issued by DDC Guidance center.
2.2 Pre-internship Orientation
2.2.1 Attendance to this orientation with a parent/guardian is a MUST. No intern
shall be allowed to go on duty without orientation.
2.2.2 In case an intern fails to attend this orientation, a fee of P250 should be
paid to the Accounting office and the official receipt must be presented to the department for a
Special Orientation to be arranged.
15
Pre-Internship Requirements
2.3 Conforme Sheet and Waiver
2.3.1 Every intern should read, understand and abide by the existing Policies &
Guidelines of the Clinical Internship/Externship Program, series of 2016.
2.3.2 Once understood, the Conforme Sheet and Waiver (attached herein) must
be duly signed by the student intern. parent/guardian, Clinical Coordinator, Program Chair
and a notarized copy must be submitted to this department.
2.4 Submit an evidence of enrollment for that particular internship/externship period.
2.5 Review of Fundamentals
A 5-day review of ALL Optometry procedures, skills & competencies wherein an
incoming intern shall have to perform and pass before an assigned CI.
2.6 Team Building Activity
This is a goal setting activity wherein incoming interns and clinical instructors
come together to build rapport, level expectations, foster camaraderie, develop respect and
cooperation. It is an avenue to bridge the gap and settle the differences between and
amongst them so that they are able to transcend and take this relationship to a more
professional level as a preparation for their rotation duties outside of the school.
2.7 Clinical Low Vision Training
This is a 2-days seminar-training/workshop on clinical low vision handled by
Resources for the Blind Inc. (RBI) as a requirement prior to internship duty in the said
facility. Its objective is to prepare and strengthen the competencies of interns in assessing
patients with learning disability and visual impairments.
2.8 Basic Life Support Training (BLS)
As an added competency, all incoming interns are required to undergo a Basic
Life Support Training. Its aim is to further equip members of the allied health profession to
save lives or provide first aid during emergency situations. BLS training fee is P2,500.
16
Grooming and Appearance
Optometry clinical interns are required to be well groomed,

practice good hygiene and maintain a highly professional appearance at
all times.
For FEMALES
3.1 Hair should be neatly combed and clipped or tied up if long. Outlandish hair color
is prohibited.
3.2 Wearing of jewelries is NOT allowed, except for wristwatches and stud earrings of
NOT more than 5mm. NO dangling earrings are allowed.
3.3 Fingernails should be kept short, neatly trimmed and free of colored nail polish.
For MALES
3.4 Hair should be according to the prescribed length and style as stipulated in the
Student Handbook.
3.5 Only simple accessories such as a watch will be allowed.
3.6 Wearing of earrings of any sort are prohibited.
3.7 Face should be cleanly shaven and should be free of any unwanted hairs such as a
mustache or goatee.
3.8 They must wear the prescribed internship uniform when reporting for duty.
Official uniform includes:
3.8.1 White blazer on top of the prescribed duty uniform
3.8.2 Black closed shoes with at least one (1) inch heel
3.8.3 Nameplate
3.9 Nameplates must be worn and visibly displayed at all times.
3.10 Non-compliance means being marked ABSENT for that day and the sanction for
absences shall apply.
17
Duties and Responsibilities

As a future professional, it shall be the resolve of a senior intern
to abide by the rules and regulations of the school and his/her
respective affiliation center. Each center is unique and is governed by its
own individual company policies, and so it shall be the responsibility of an intern to:
4.1 Obey governing rules and regulations of the school and assigned affiliation
center
4.2 Report for duty on time:
15 hours/week (1st Semester) Mondays to Fridays
42 hours/week (2nd Semester)- Mondays to Saturdays
4.3 Complete the internship period of 270 hours for the first semester; and 756
hours for the second semester, including all the sanctions and extension duties incurred.
4.4 Maintain a professional relationship with the affiliation center staff at all times.
4.5 Review the patients history before starting any examinations.
4.6 Perform examinations applicable to patients condition under the supervision of
an Optometrist inside the clinic or center.
4.7 Report to the school once a week on a given schedule and comply with all
requirements to be checked weekly by the Clinical Coordinator.
4.8 Pass the monthly Written Revalida to be given in the school every 2nd Monday
of the month or during scheduled periodic examinations, whichever comes first.
4.9 Submit a Portfolio of Learning Experiences weekly by email and a hard copy
(with pictures taken inside the center as evidence) at the end of each semester.
18
Proper Decorum
All student interns are expected to show respect towards authority

and practice courtesy when dealing with fellow interns, doctors, staff,
clinical instructors, coordinators, other personnel and patients. Professional ethics must be
observed at all times. Equally important in the practice of Optometry is not just knowledge
and skills, but attitudes as well. One must conduct oneself in a manner befitting of a future
Doctor of Optometry.
Hence, an intern should:
5.1 Strictly adhere to the Code of Ethics for Doctor of Optometry.
5.2 Observe the proper conduct & decorum when on duty.
5.3 Obey the protocol set by their corresponding Affiliation Center.
5.4 Respect authority and show courtesy when dealing with patients, fellow interns &
staff.
5.5 Observe professional ethics at all times.
5.6 Handle patients information with utmost confidentiality
5.7 Work harmoniously with fellow interns/externs and other personnel.
5.8 Avoid undue familiarity and intimacy with patients, staff and co-workers.
5.9 Refrain from bringing expensive gadgets such as laptops, tablet or iPad inside the
affiliation centers.
5.10 Minimize use of cellular phones while on active duty.
5.11 Bring the necessary Opto paraphernalia during duty such as:
5.11.1 OR Set / Trial Lens Set (as needed)
5.11.2 Penlight
5.11.3 Occluder
5.11.4 Small Notebook/ Ballpens
5.11.5 Punch Cards or DTR
19
An intern should NOT:

5.11 Engage in vandalism, fighting, smoking, gambling, stealing or any other form of
illegal activities such as possession of illegal drugs and/or its paraphernalia.
5.12 Report for duty under the influence of alcohol or prohibited drugs.
5.13 Carry deadly weapons.
5.14 Be involved in any sexual harassment case.
5.15 Eat when on duty unless allowed to do so.
5.16 Entertain visitors except during emergencies.
5.17 Conduct any form of business such as selling or networking during duty.
5.18 Show public display of affection, which is contrary to acceptable moral standards.
5.19 Use words in which may be offensive, vulgar, scandalous, indecent and
blasphemous.
5.20 Sleep during duty hours.
5.21 Display inappropriate behavior inside any affiliation center.
Violation of any of the above shall be ground for DISCIPLINARY ACTION as

may be recommended by the Optometry Department and/or School Disciplinary
Committee.
20
Attendance and Punctuality

Schedule of rotations shall be furnished to the intern and
corresponding affiliation center. It shall also be posted at the Optometry
Clinic and/or the Department bulletin board. Completion of duty hours and
punctuality are important elements of clinical internship hence, an Optometry intern is

expected to report for duty on time.
6.1 Duty Hours
6.1.1 Interns should follow the scheduled duty hours of their respective
affiliation centers. Swapping of schedules will NOT be allowed.
10:00 am 1:00 pm
Mondays to Fridays (1st Semester)
10:00 am - 12:00 nn
Mondays to Saturdays (2nd Semester)
1:00 pm 6:00 pm
Mondays to Saturdays (2nd Semester)
6.1.2 Interns on duty are NOT allowed to leave the affiliation center without
permission from their Preceptor or the Optometrist On- Duty.
6.1.3 Tardiness of 30 minutes and beyond is considered absence for that day
and sanctions for unexcused absence shall apply.
6.1.4 Duty hours during official holidays shall be specified by the affiliation
centers. However, if the clinical rotation is in the malls or any commercial centers, the intern
should render his/her corresponding duty hours.
6.2 Recording of Attendance
6.2.1 Tampering of punch cards is strictly prohibited.
6.2.2 Timing in or out for other interns is not allowed.
6.2.3 In the absence or failure of a bundy clock, Preceptor-in-charge shall be
the one to sign the students DTR.
6.2.4 DTR should be as clean or neat as possible, free from any unnecessary
marks, superimpositions, mutilations or tears.
6.2.5 An intern is accorded a one (1) hour break for lunch, and a 30-minute
break for snacks.
6.3 Tardiness and absences shall be subject to the following extension /sanction:
TARDINESS
30 mins. or more = One (1) day extension

Less than 30 mins. = Demerit (Community Service)
21
ABSENCES
First Semester (1 day = 3 hours) Second Semester (1 day = 7 hours)
(1:1) 1 excused absence
= 3 hrs extension
7 hours extension
(1:3) 1 unexcused absence = 9 hrs extension
21 hours extension
6.4 Absences shall be considered excused if due to any of the following:

6.4.1 Severe illness, accidents and/or hospitalization
6.4.2 Critical illness or death of an immediate family member,
6.4.3 Fortuitous events (e.g. fires)
6.4.4 Force majeur (e.g. earthquakes, storms, floods, tsunami)
6.4.5 Transportation strikes
6.4.6 Threats of civil war
6.4.7 Attendance to any school-related or co-curricular activity
6.5 In case of illness, a Medical Certificate duly signed by the attending physician
with telephone numbers written on it and an excuse letter from the parents or guardian
must be submitted upon returning to duty.
6.6 Official Pull-out from Duty
In any event that the presence of interns may be needed, they may be officially
pulled out from duty as deemed necessary by the department or school. Affiliation center
will be duly notified through an official communication from the Optometry Department.
6.7 These are the activities in which an official pull-out from duty are allowed:
6.7.1 Institutional activities (e.g. Foundation Celebration, Club Fairs, etc)
6.7.2 In-house seminars, trainings & workshops
6.7.3 Co-curricular activities
6.7.4 Research Forum (departmental, institutional, regional, national)
6.7.5 Community Outreaches
6.7.6 Basic Life Support (BLS) Training
22
6.8 Activities Outside the School

For activities held outside of the school not mentioned above, a Letter of Approval
must be submitted to the Program Chair and a certificate /proof of attendance must be
presented as soon as the intern resumes duty. Failure to comply with the above
requirements shall make the absences unexcused and sanctions for unexcused absence
shall apply.
6.9 Cutting of Duty Hours
Any intern who, after reporting for duty, leaves his area of assignment without
permission, shall be considered out of post and shall be subjected to one (1) day extension
duty.
6.10 Termination of Duty
Only three (3) excused absences will be allowed during one (1) cycle of the rotation.
A clinician who has incurred more than five (5)-days unexcused absences in a specific
affiliation center will be deemed terminated from that center. No grade (or evaluation) shall
be given for that rotation and the clinician will be required to wait for the next assignment.
6.11 Dropping
A clinician who has accumulated absences (whether excused or unexcused) of 20%
or more of the total number of required duty hours will automatically be dropped from the
internship subject. Said intern will be advised to repeat or re-enroll the internship subject.
23
Make-up or Extension Duties

All extensions and/or make-up duties will be served at any
affiliation center at the END of the regular internship/externship period.
7.1 Fees
Regardless of the number of hours or days, an intern with extension duties shall be
charged P300.00 per day payable to the schools Accounting office. Receipt must be
presented to the Clinical Coordinator or Program Chair prior to the commencement of
make-up duty.
7.2 Inclusion of Fees
ONLY extension duties for unexcused absences, tardiness and demerits are
applicable. However, excused absences shall be exempted from the extension fees.
7.3 Limitation to the Number of Make-up Duties
Make-up and/or extension duties should not exceed more than 20% of the total
required duty hours. If this happens, the student intern shall be advised to re-enroll the
subject.
24
Internship Offenses
Enumerated herein is a list offenses and its classification.
MINOR OFFENSES:
8.1 Habitual tardiness (3x or more)
8.2 Non-observance of prescribed uniform or dress code
8.3 Playing games using electronic gadgets while on duty
8.4 Extending more than their prescribed breaks-lunch or snack breaks.
8.5 Loitering or roaming around while on duty (out of post)
8.6 Sleeping while on duty.
8.7 Cutting of duty hours.
8.8 Leaving the affiliation center without permission.
8.9 Reading of materials not related to Optometry such as pocketbooks, comics,
magazines, kindle, etc.
8.10 Wearing of the internship uniform inside bars or movie houses.
8.11 Sporting an earring for males and multiple earrings for girls and other similar
body piercing.
8.12 Having a visible tattoo while on active duty.
.
.
25
MAJOR OFFENSES:
8.13 Repetition of minor offenses (5x or more)
8.14 Public display of affection
8.15 Uttering offensive words and making dirty signs inside the affiliation center
8.16 Littering and/or spitting within the vicinity of the center
8.17 Modifying computer settings and security hacking of the affiliation centers
computer system
8.18 Engaging in cybersex or viewing pornographic sites while on active duty.
8.19 Circulating or divulging sensitive information regarding the affiliation center, its
doctors, staff and respective clients
8.20 Acts of disrespect towards authorities whether in the school or affiliation center
8.21 Smoking and gambling within 200 meters of the assigned affiliation center.
8.22 Rendering of duty apart from the assigned affiliation center
8.23 Stealing or asking money from the staff inside the affiliation center
8.24 Engaging in a fight while on duty
8.25 Reporting for duty under the influence of alcohol or drugs
8.26 Vandalism or rendering intentional damage to the center.
8.27 All forms of cheating or plagiarism
8.28 Falsification of academic records, tampering of attendance cards and forging of
documents found in the affiliation center
8.29 Any form of bullying, whether physical, mental or cyber bullying.
8.30 Any form of remarks in which is discriminatory to ones gender, nationality,
culture or race, mental or physical disability
8.31 Inappropriate behavior inside the affiliation center such as use of foul language
even in the form of jokes, shouting, playing, terrorism, and all acts deemed improper.
26
Incident Reports and Discipline

The VP of Academic Affairs, the Dean of the College of Allied
Health Sciences, the Optometry Program Chair and the Clinical
Coordinator reserves the right to review and revise the existing policies of
the Optometry Clinical Internship Program.
9.1 Any incident that concerns the intern in the affiliation center should be
reported to the Clinical Coordinator both verbally and in writing within 24 hours after the
incident has occurred.
9.2 The written report shall describe in details the incident that occurred, the
people involved and other pertinent data. The Clinical Coordinator countersigns this
report and submit it to the PC.
9.3 For minor offenses, the Clinical Coordinator may enact appropriate disciplinary
action and inform the Program Chair regarding the sanction.
9.4 For major offenses, a Disciplinary Committee shall be created, which may
consist of the Program Chair, Guidance Counselor, members/head of the Student
Personnel
Services,
fellow
intern,
department
organization
officer
and/or
any
representative of the affiliation center to conduct investigation of a reported incident.

9.5 Any violation of the rules and regulations governing the Internship Program as
stipulated in the Internship/Externship Policies and Implementing Guidelines, DDC
Student Handbook and affiliation center policies shall be subject to disciplinary action.
.
.
27
10
Sanctions
Enumerated herein are the Offenses and its corresponding
Sanctions.
For MINOR OFFENSES:

10.1 Submission of incident report to the Clinical Coordinator within 24 hours.
10.2 Written reprimand
10.3 Oral and written apology to the concerned parties
10.4 Payment of actual damages incurred
10.5 Extension of duty hours
10.6 Referral to the Guidance Center for counseling
For MAJOR OFFENSES:

10.7 Submission of incident report to the Clinical Coordinator within 24 hours.
10.8 Oral and written reprimand
10.9 Oral and written apology to the concerned parties
10.10 Payment of actual damages incurred
10.11 Extension of duty hours
10.12 Failing grade for that particular rotation
10.13 Referral to the Guidance Center for counseling
10.14 Suspension with compulsory services
10.15 Denial of graduation privileges
10.16 Dismissal from the internship program
10.17 For grave offenses, expulsion from the program
10.18 Other sanctions as deemed proper by the Clinical Coordinator, Program Chair,
College Dean, Prefect of Discipline and/or the VP of Academic Affairs
28
Merits and Demerits
11
11.1
Merits and demerits shall be computed at the end of every

clinical rotation and shall be applicable to ALL internship programs.
Merits
Merits may be earned as a reward for a job well done. It shall be made as a
recommendation by the staff, personnel or preceptor of affiliation center. It shall be
validated by the Clinical Coordinator and approved by the Program Chair. It may be
earned in any of the following cases:
11.1.1 Volunteer work as officially requested by the affiliation center
beyond interns duty hours as approved by the department.
11.1.2 Volunteer work in the school during an institutional activity.
11.1.3 As a delegate or representative of the school in any competition or
events.
11.2
Demerits and Sanctions
A student intern while on duty may demonstrate inappropriate behavior or

misdemeanor. As such, demerits may be earned in any of those situations or cases and
shall serve its corresponding sanction /extension duty. A tabulation of demerits is found
on the succeeding page.
.
.
29
Table 1. Demerits and Sanctions

SANCTIONS /
NO
DEMERITS
EXTENSION DUTY
Out of post
1 day
Not in proper prescribed uniform
1 day
Failure to submit portfolio at the end of the week
1 day
Using cellular phones, tablets & other gadgets inside affiliation center
2 days
Entertaining visitors inside the center during duty hours
2 days
Insubordination (disrespect / discourtesy towards superiors, CI)
2 days
Sleeping/eating/smoking during clinic hours
2 days
Conducting business, recruitment or any type of networking
2 days
Vandalism, stealing, fighting inside the affiliation center
Suspension
10
Taking home of patients charts
Suspension
11
Gambling during duty & within the premises of the assigned center
Suspension
12
Loss of patients chart
Suspension
13
Being involved in a sexual harassment case
Dismissal
14
Alteration /Tampering of doctors orders
Dismissal
15
Breach of confidentiality
Dismissal
16
Falsification of documents (clinic forms. etc.)
Dismissal
17
Intoxication within the premises of the assigned center
Dismissal
18
Reporting for duty under the influence of prohibited drugs.
Dismissal
19
Carrying deadly weapons, drugs or drug paraphernalia
Dismissal
20
Loss of center-owned property
21
Damage of center-owned property
Replacement
Replacement/
Repair
For sanctions that merit suspension and dismissal, policy as stated on Articles IX and
X of this Guidebook shall apply.
30
Monthly Revalida
12
As an enhancement program of the department for graduating interns,

a written Revalida will be given monthly. This program aims to help them in
preparation for the incoming Optometry Licensure Examination (OLE).
12.1 Proficiency Examination

The proficiency examination shall consist of 100-items in Multiple Choice Question
(MCQ) format to be administered within a two-hour period. Schedule of subjects will be as
follows:
First Semester
12.1.1
12.1.2
12.1.3
12.1.4
Ocular /Visual Biology

Physiological Optics / Binocular Vision and Perception
Ocular Diseases and Ocular Emergencies
Ocular Pharmacology
Second Semester
12.1.5 Theoretical /Practical Optics, Ophthalmic Dispensing/ Contact Lens Optics
12.1.6 Primary Care and Refraction
12.1.7 Clinical Optometry: Low Vision, Contact Lens, Ocular Prosthesis, Pediatric
Opto, Geriatric Opto, Neuro-Opto, Occupational/Industrial Opto, Public Health Opto, Sports
Vision
12.1.8 Ethics and Jurisprudence, Practice Management
12.2 Any intern who arrives 15 minutes late for the Revalida will NOT be allowed to
take the examination and will receive a failing grade for that specific exam.
12.3 Said Revalida will be given for interns with excused absences. Policy on absences
stated earlier will apply.
12.4 Passing Grade
A passing grade of at least 75% is required. An intern who receives a grade below the
passing mark of 75% will be pulled-out from duty to retake the proficiency examination. Pullout from duty will be considered as an excused absence equivalent only to one (1) day
extension duty.
12.5 Failing Grade
A maximum of 3 takes shall be accorded to an intern. In case of failure on the third take, that
intern will receive a grade of 5.0 for that particular subject. The intern has to take and pass the
said exam again by the end of the internship rotation. Passing ALL of the exams is a
requirement for internship clearance.
31
Performance and Evaluation
13
Every student intern shall be graded by the Clinical Preceptor in

accordance with a set of criterion based on his/her performance
inside an assigned affiliation center.
13.1 Evaluation Forms

An internship evaluation form is provided for every rotation. It contains a set of
criterion based on knowledge, skills acquired and personal attributes.
13.1.1 Internship Clinical Evaluation Form
This is used for hospital, eye centers and optical rotations.
13.1.2 Internship Clerical Evaluation Form
This is used for rotations in the school wherein each intern is assigned to areas
where management and office skills are learned.
13.2 Performance and evaluation shall be computed as follows:
INTERNSHIP ROTATION:
60%
Preceptor Evaluation
60%
40%
100%
WRITTEN REVALIDA:
40%
Weekly Quizzes/Monthly Revalida
80%
Decorum
10%
Attendance
10%
100%
PERIODIC GRADE
____
100%
13.3 Final Clinical Internship Grade

The final clinical internship grade is computed as the grade average of the four
Grading periods:
PRELIM + MIDTERM + PREFINAL + TENT. FINAL
4
32
14

This portfolio is a narrative report in which contains rich
experiences, activities and personal insights by an intern inside the
affiliation center. Experiences, activity and observations inside the
affiliation centers should be done objectively and with tact.

14.1 Requirement
An electronic copy shall be submitted to the Clinical Coordinator weekly.
14.2 Content
The portfolio must contain the following:
14.2.1 Learning experiences
14.2.2 Profile of the affiliation center
14.2.3 Background of patients/clients served
14.2.4 Description of the clinical practice
14.2.5 Interests from the internship experience
14.3 Final Activity Portfolio
A final copy in hardbound (for the entire class) must be submitted at the end
of each semester. It shall contain photos taken inside the affiliation centers as evidence and
shall be used for documentation by the department in future inspection and monitoring
visits by CHED, PACUCOA and PRC.
14.4 Format
14.4.1 Font
Arial 11
14.4.2 Margins -
Top, bottom, left & right margins is 1 inch
14.4.3 Spacing -
1.5
14.5 The activity portfolio is included in the interns computation of grades and also a
requirement for clearance.
33
Post-Internship Recognition &
15
Pinning Ceremony
At the end of the clinical internship/externship period, a
culminating activity is held wherein student interns shall receive their Certificates of
Completion and qualified interns shall be awarded for their exemplary performance in each
of their assigned affiliation centers.
15.1 Attendance
ALL student interns shall be required to attend the Post-Internship
Recognition & Pinning Ceremony together with their respective parents or guardians.
15.2 A Certificate of Completion and Optometry Pin shall be given to an intern who
has completed his/her clinical rotation within the prescribed period.
15.3 An intern who is still serving make-up or extension duties shall be given the
Optometry Pin, while the Certificate of Completion shall be given only AFTER completion of
the said make-up or extension duties.
34
16
Awards & Recognition

Optometry interns who demonstrated exemplary performance
during their rotation inside their respective affiliation centers are
rewarded for a job well done. The following awards are given:
DEPARTMENTAL AWARDS:
16.1
BEST IN ATTENDANCE
Certificate of Recognition for having Complete Attendance (no record of absences nor
tardiness) during the 10-month Clinical Internship/Externship period
16.2 OUTSTANDING INTERN (in selected affiliation center)
Certificate of Recognition for garnering the highest grade in the different affiliation centers
16.2.1 Qualifications
To achieve the abovementioned departmental award, an intern must have:
16.2.1.1 Garnered the highest average internship evaluation during
the internship period in an affiliation center.
16.2.1.2 No incurred unexcused absences of more than 5% of the
total required duty hours.
16.2.1.3 No record of any disciplinary action involving minor or major
offenses.
16.2.2 TIE-BREAKER
Should two or more interns garner an equal grade percentage of evaluation, the
recognition shall be given to the intern with:
16.2.2.1 No record or least record of tardiness
16.2.2.2 No record of unexcused absences
16.2.2.3 No record of any form of misdemeanor or misconduct during
the clinical rotation
35
INSTITUTIONAL AWARDS:
16.3
MOST OUTSTANDING OPTOMETRY INTERN

This honor is given to a student intern who has shown exemplary performance in
clinical duties and is consistently topping the proficiency examinations during the 10months internship period, thereby obtaining the HIGHEST OVER-ALL GRADE for Internship
16.3.1 Qualifications for the Most Outstanding Optometry Intern
To achieve this award, an intern must have:
16.3.1.1 Garnered the highest average internship grade during the 10months internship period.
16.3.1.2 No incurred unexcused absences of more than 5% of the
total required duty hours.
16.3.1.3 No record of any disciplinary action involving minor or major
offenses either at the SPS or in this department.
16.4
BEST IN CLINICAL OPTOMETRY

This award is given to a student intern who has excelled and exhibited an
outstanding performance thereby obtaining the highest over-all grade in terms of clinical
Optometry subjects such as Clinical Contact Lens, Clinic and Conference, Clinical NeuroOptometry, Clinical Orthoptics and Pediatric Optometry, Clinical Low Vision and Geriatric
Optometry.
16.5
TIE-BREAKER
Should two or more interns garner an equal grade percentage in the
abovementioned institutional awards, the recognition shall be given to the intern with:
16.5.1 No record or least record of tardiness
16.5.2 No record of unexcused absences
16.5.3 No record of any form of misdemeanor or misconduct during
the clinical rotation.
36
17
Commencement Ceremony
After completion of the six years Optometry curriculum, a
student is now ready to receive his/her diploma and be conferred the
baccalaureate degree of Doctor of Optometry in a prestigious and solemn
graduation ceremony.
17.1 Eligibility
To qualify for Graduation, a student must have:
17.1.1 Satisfactorily completed ALL the academic and non-academic
requirements from first year to sixth year.
17.1.2 Satisfactorily completed ALL the requirements of the Clinical
Internship/ Externship Training Program. This includes patient requirements, reports,
research paper, case presentations and portfolio of learning experiences.
17.1.3 Been fully-cleared from ALL obligations (e.g. financial, library) to
the school and affiliation centers. An intern with unsettled financial obligation with the
school will NOT be allowed to march during the Commencement Exercises.
17.1.4 Accomplished and finished ALL extension duties one (1) DAY
before the Commencement Exercises.
17.2 Cut-off Time
Cut-off time for submission of ALL academic and non-academic requirements,
financial obligations and any extension duties shall be at 3:00 pm one (1) DAY before
graduation. An intern who is unable to comply will NOT be allowed to march during the
Commencement Exercises.
37
Clinical Internship
Forms
&
Templates
38
CONFORME SHEET and WAIVER
This is to certify that I have read and fully understood the Policies and
Implementing Guidelines governing the Optometry Clinical Internship/ Externship
Program of Davao Doctors College Inc. I attest that I am participating in the said
program in partial fulfillment of my requirements for the degree Doctor of Optometry.
Therefore I freely and voluntarily obligate myself to abide by the Policies and
Implementing Guidelines of both the school and affiliation centers where I will be
assigned. I shall do my best to act responsively in my capacity as an Optometry
intern of Davao Doctors College Inc.
With My Conformity:
_______________________________
Students Signature over Printed Name
_______________________________
Parents Signature over Printed Name
_________________
Date
_________________
Date
Witnessed by:
MYRA O. DE LEON, OD
Clinical Coordinator
ERLYN B. HIPOLITO, OD, FIACLE, MAEd-HPE

Optometry Program Chair
JOSHUA P. SERO, RRT, MAEd-HPE

Dean, College of Allied Health Sciences
39
40
41
42
43
44
45
46
PROFILE of
AFFILIATION
CENTERS
47
48
LEARNING OUTCOMES @ EYE LASER CENTER
At Eye Laser Center, DDC-Optometry Clinical interns will:

1. Have an opportunity to be trained by an outstanding practitioner in the person
of Dr. Raul Tolentino whose practice is into refractive surgery, cataract
management such as phaco-emulsification and management of retinal diseases.
2. Be exposed on latest trends in eye diagnostic procedures and instruments such
as:
a. Ocular Coherence Tomography (OCT)
b. Yag Laser
c. Perimetry
d. Aberrometer
e. Corneal Topographer
f. Non-contact Tonometer
3. Learn how to interpret findings from the instruments mentioned above.
4. Have the opportunity to watch an actual cataract phaco-emulsification
procedures inside the operating room.
5. Participate in the provision of Optometric services such as refraction and visual
acuity taking under the direct supervision of an in-house Optometrist.
6. Experience the use of common diagnostic and therapeutic procedures involved
in the problem solving stages of the delivery of eye care.
49
50
LEARNING OUTCOMES @ RESOURCES FOR THE BLIND
At Resources for the Blind Inc., DDC-Optometry Clinical interns will:

1. Assess patients with low vision problems through the assistance of low vision
practitioners.
2. Be assigned to various areas of the facility and help provide assistance to
pediatric patients with low vision problem during their training.
3. Be exposed to patients with visual impairment who are learning how to use
low vision devices and Braille in order to read.
4. Be assigned a particular case and prepare a case presentation or report.
5. Design an appropriate activity plan for patients with visual impairment.
6. Outline a patient management plan and rehabilitation.
51
52
LEARNING OUTCOMES @ DAVAO EYE CENTER
At Davao Eye Center, DDC-Optometry Clinical interns will:

1. Experience an exposure and observations on the following diagnostic
procedures:
a.
b.
c.
d.
e.
f.
g.
h.
Fluorescein Angiogram (FA)

Ocular Coherence Tomography (OCT)
IOL Master (Non-contact)
Biometry (Contact)
Perimetry (Octopus 101)
B-scan
Yag Laser for non-invasive eye surgeries
Argon Laser for patients with diabetes, vein/artery occlusion and
glaucoma
i. Minor Operating Procedures
2. Experience clinical exposure to areas of general ophthalmology procedures.
3. Have an understanding of the role of a "health team" in patient management
and continuity of care including relationships with other professionals in the
field of eyecare.
4. Experience how preventive eyecare plays an importance role in an early
diagnosis of ocular and vision anomalies, including ocular-related disorders.
5. Develop the ability to respect other professionals involved in eyecare.
6. Develop the habit of updating oneself in the field of eyecare by attending
seminars and forums given by residents or practitioners in their own fields of
expertise.
53
54
LEARNING OUTCOMES @ DR. GESTUVO EENT CLINIC
At Dr. Gestuvo EENT Clinic , DDC-Optometry Clinical interns will:

1. Experience clinical exposure to areas of general ophthalmology practice, such
as management of simple ocular diseases.
field of eyecare.
5. Develop the ability to respect other professionals involved in eye care.
6. Appreciate the eye and vision as part of a composite system or senses in
relation to hearing, taste and smell.
55
56
LEARNING OUTCOMES @ MORADA CATARACT AND EYE DISEASES

CLINIC
At Morada Cataract and Eye Diseases Clinic, DDC-Optometry Clinical interns will:
1. Experience clinical exposure to areas of general ophthalmology practice, such
as cataract management and anterior ocular diseases.
2. Participate in the provision of Optometric services such as refraction, visual
acuity taking and external eye procedures under the direct supervision of an inhouse Ophthalmologist.
field of eyecare.
6. Develop the ability to respect other professionals involved in eye care.
7. Develop the attitude and passion for continuous reading for updates regarding
vision and eyecare.
57
58
LEARNING OUTCOMES @ IDEAL VISION CENTER (IVC)
At Ideal Vision Center, DDC-Optometry Clinical interns will:

1. Be exposed to the changing patterns of Optometric care and familiarize with
emerging patterns of eye care delivery in a commercial setting.
2. Have hands-on-experience with actual patients on clinical procedures in
Optometry such as contact lens fitting, refraction and patient dispensing.
3. Have practical experience in office management and business aspects of
Optometric practice.
4. Experience how to trouble shoot problems encountered with patients and
realize the role of Optometrists in patient education.
5. Learn how to do marketing strategies to boost sales.
6. Familiarize with current trends in Optometric practice, latest eyewear, lens
products and new technologies in relation to vision care.
59
60
LEARNING OUTCOMES @ DELOS REYES OPTICAL
At Delos Reyes Optical, DDC-Optometry Clinical interns will:

Optometry contact lens fitting, refraction and patient dispensing.
6. Review on benchwork procedures from frame selection, pattern making, cutting,
edging and final lens mounting to dispensing procedures.
61
62
LEARNING OUTCOMES @ VISUAL SENSE OPTICAL CLINIC
At Visual Sense Optical Clinic, DDC-Optometry Clinical interns will:

Optometry contact lens fitting, refraction and patient dispensing.
63
64
LEARNING OUTCOMES @ GEORGE OPTICAL CLINIC
At George Optical Clinic, DDC-Optometry Clinical interns will:

2. Have hands-on-experience with actual patients on clinical procedures in Optometry
contact lens fitting, refraction and patient dispensing.
3. Observe and participate during cycloplegic refraction procedures.
5. Experience how to troubleshoot problems encountered with patients and realize
the role of Optometrists in patient education.
8. Familiarize with current trends in Optometric practice, latest eyewear, lens products
and new technologies in relation to vision care.
65
Clinical Internship
Journals
2015
66
ROTATION 1
Affiliation:_____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
ROTATION 2
Affiliation:_____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________________________
___________________________________________________________________________
ROTATION 3
Affiliation:_________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________ 67
ROTATION 4
Affiliation:___________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
ROTATION 5
Affiliation:___________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_______________________________________________________________________________
__________________________________________________________________________
ROTATION 6
____Affiliation:_________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________ 68
Clinical Externship
Journals
2015
69
ROTATION 1
Affiliation:_____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
ROTATION 2
Affiliation:_____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________
ROTATION 3
Affiliation:_____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________
70
ROTATION 4
Affiliation:____________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
ROTATION 5
Affiliation:____________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_______________________________________________________________________________
__________________________________________________________________________
ROTATION 6
Affiliation:____________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________________________________________
71
EVALUATION OF
STUDENT-INTERN
EXPERIENCES
72
DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City 8000
Tel. Nos.: (082) 222 - 0850 to 53 Fax: 221-1074
E-mail: ddc@davaodoctors.edu.ph
Web: www.davaodoctors.edu.ph
EVALUATION TOOL
Department: _____________________
Course & Year____________________
Name: __________________________
Semester / Term __________________
Please give us your views so that training/practicum quality can be improved. You are encouraged
to be frank and constructive in your comments. Kindly encircle the number that corresponds to
your view.
5- Strongly Agree
No.
4- Agree
3- Uncertain 2- Disagree
1- Strongly Disagree
ITEMS
A. PERSONNEL
1
The staff, preceptors and doctors in the eye centers are caring and
helpful.
The staff, preceptors and doctors are fair in their treatment to student
2
interns and to the clinical instructor.
3
Administrators/ supervisors are available to hear the clinical instructors

and student interns concerns.
Clinical instructors and student interns feel welcome in the institution.
The staff, preceptors and doctors readily guide or advise student interns
on some procedures in the absence of clinical instructors in a certain
time.
B. SERVICES
1
Gives orientation to student interns
Implements the Optometry affiliation guidelines in dealing with student

disciplinary procedures.
Provides exposure to help student interns to achieve performance goals
Accords student interns the opportunity to handle special cases
Provides opportunity for special area/s of assignment
C. FACILITIES
Provides safe and secure area and facilities for student interns.
1
2
Provides adequate and safe location for student interns to stay
5
5
4
4
3
3
2
2
1
1
Allows access and use of needed facilities for learning

Provides adequate facilities that enhance students intern competencies
4
5
Provides facilities for training and other related activities
73
D. Additional core questions: Please answer briefly and honestly.

1. Did you gain additional knowledge from the exposure in the affiliation center? Explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________
2. Did you develop the necessary skills intended to be learned during the exposure? Explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________
3. Did you develop the right attitudes necessary for the practice of the profession? Explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________
4. How did the teaching skills of your clinical instructors and preceptors affect your learning?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________
5. Was the atmosphere in the training center helpful to your training? Explain.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________
Thank you very much!
mds/mlfv/maccp/jps/lbb
74
EVALUATION TOOL
Preceptors name: _______________________________
Affiliation Center: ________________________________
Date: _________________
Please give us your views so that training quality can be improved. You are encouraged to be frank and
constructive in your comments. Please answer briefly and honestly.
A. Students Performance
(Dealing & handling patients, dealing with Supervisors & staff)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
B. Internship Program Processes
(Training program, Duties & responsibilities)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
C. Clinical Instructor
(Attendance, dealing with supervisors & staff)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
75
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vulputate.
R
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F
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R
E
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egestas, lacus
quis interdum
ornare, risus felis
porta arcu, at
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CHED CMO.38 s 2007

CHED CMO.26 s.2009
DDC Student Handbook 2014 edition
Policies, Standards and Guidelines for Optometry Program
http://www.blind.org.ph
http://brokenshire.org/bmh
http://www.ddh.com.ph
http://www.delosreyesoptical.com.ph
https://www.facebook.com/pages/Eye-Crafter-Optical-Clinic
https://www.facebook.com/pages/Maria-Lalaine-Dumangas
http://www.idealvisioncenter.com.ph
http://www.georgeoptical.com.ph
77

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GUIDEBOOK To Clinical Optometry Internship 2016

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2016

Community & Hospital

Davao Doctors College Inc.

DAVAO DOCTORS COLLEGE INC.

Vision, Mission & Goals

Republic Act 8050

COMMUNITY AND HOSPITAL OPTOMETRY

COMMUNITY AND HOSPITAL OPTOMETRY I (INTERNSHIP PROGRAM)

Course Code & Credit, Contact Hours, Pre-requisites, Placement

COMMUNITY AND HOSPITAL OPTOMETRY II (EXTERNSHIP PROGRAM)

Course Code & Credit, Contact Hours, Pre-requisites, Placement

Grooming and Appearance

Duties and Responsibilities

Attendance and Punctuality

Make-up or Extension Duties

Incident Reports and Discipline

Merits and Demerits

Performance and Evaluation

Portfolio of Learning Experiences

Post-Internship Recognition and Pinning Ceremony

Awards and Recognition

CLINICAL INTERNSHIP FORMS and TEMPLATES

Conforme Sheet and Waiver

Internship Clinical Evaluation Form

Internship Clerical Evaluation Form

Record of Demerits Form

Case Presentation Form

PROFILE OF AFFILIATION CENTERS

CLINICAL INTERNSHIP JOURNALS

CLINICAL EXTERNSHIP JOURNALS

EVALUATION OF STUDENT-INTERN EXPERIENCES

EVALUATION TOOL for STUDENTS

EVALUATION TOOL for PRECEPTORS

INSTITUTIONAL MISSION STATEMENT

Davao Doctors College is a premier non-sectarian academic institution

DOCTOR OF OPTOMETRY PROGRAM

College Through Excellence We Shall Lead and the recognition of the

5. developed professional attitudes conducive to inter-professional understanding and cooperation.

Envisioning Your Future With Us

Optometry is the science and art of examining the

prosthetics, using authorized diagnostic pharmaceutical

rehabilitation or relief of the human eye or to attain

REPUBLIC ACT 8050

Community & Hospital

Community & Hospital

6 Units (1 unit Lec/ 5 units Clinic)

270 Hours (1 Hour Lec /15 Hours Clinic/week)

ALL Professional subjects prior to this

Fourth Year Proper; First Semester

Community & Hospital

15 Units (1 unit Lec/ 14 units Clinic)

756 Hours (1 Hour Lec /42 Hours Clinic/week)

ALL Professional subjects prior to this

Fourth Year Proper; Second Semester

2.1 Health Clearance

Grooming and Appearance

Optometry clinical interns are required to be well groomed,

Duties and Responsibilities

All student interns are expected to show respect towards authority

An intern should NOT:

Violation of any of the above shall be ground for DISCIPLINARY ACTION as

Attendance and Punctuality

punctuality are important elements of clinical internship hence, an Optometry intern is