DEPARTMENT OF PEDIATRICS College of Medicine-Philippine General Hospi al !

ni"ersi # of he Philippines Manila

INTERNSHIP IN PEDIATRICS A$ %&'%-%&'(

INTERNS) COMMITTEE Chairman: Dr* +i,a Gon,ales Co-Chair: Members: Dr* +eah Arceo-Pl-cena Dr* Mianne Cas or Dr* Mine e Delos Re#es Dr* /-lie Sio-Ag-ilar Dr* Mia +esaca-Medina Dr* .eni Sanche,-Gan

Resident monitors: Dr* Elaine Re#es 0&1%%-2%%3'(14 0&1(%232%&'54 Dr* Angie D-gasan 0&1%%-5'22'314 0&1%%2%78%2&4 Dr* Ni99i /a:es Francisco 0&1%%-28872784 0&1%%238%1%24 Dr* /e hro Macallan 0&1%%-2((71%(4 Nepo:-ceno 0&1(%2828&%&4 Dr* /a,el Manarang 0&1((-5%7%7814 0&1(%(8%27184 Dr* Pe er Rag-indin 0&1%%-287'1384 0&1(%8328&2&4 Dr* <a 0&1%(3&828114 O6=ec

Dr* Trinia As-ncion Dr* Na asha Es e6an Dr* +-isa /oan Go Dr* April Rose Dr* Marc Andre; Pere, Dr* Roche Diana Re#es hleen /o# Taleon

i"es To acquire proficiency in the recognition of diseases in children To acquire more skills in the comprehensive management of common diseases in children To understand the concept of preventive pediatrics To develop the lifelong attitudes and habits of a physician

Ter:inal Co:pe encies (also the coverage for the final and shifting out exams : Mastery of the follo!ing concepts: "#$mmuni%ation &#'ro!th monitoring (#)evelopmental milestones *no! ho! to diagnose+ manage+ prevent and recogni%e !hen to refer the follo!ing disease entities: "# &# (# -# 0# 1# 2# 4# 5# "6# ""# "&# "(# ,cute glomerulonephritis ,cute leukemia ,cute respiratory infections ,llergy./ypersensitivity reaction ,naphylaxis ,plastic anemia 3enign febrile sei%ures 3ronchial asthma Congestive heart failure Cyanosis in the ne!born )engue fever )iarrhea.dehydration /epatic failure "-# "0# "1# "2# "4# "5# &6# disease &"# &&# &(# &-# &0# &1# $ncreased intracranial pressure 7aundice in the neonate 8eonatal sepsis 8eonatal cholestasis 8ephrotic syndrome 9rotein-energy malnutrition Rheumatic fever and rheumatic heart :uppurative meningitis :ystemic lupus erythematosus Tuberculosis Tuberculous meningitis Typhoid fever ;iral hepatitis

Co-rse Descrip ion 2-!eek rotation divided into four sub-rotations (& !eeks each : <9) =ard

LU7 Orientation Manual 02April2012

 OPD "# &# (# -#

8ursery.8$C> ?mergency room Time in: 2:(6 am ,ll <9) interns are required to attend the scheduled conferences until 5,M# 9lease check the bulletin board at the 9edia <ffice for the monthly schedule of conferences# T!o <9) interns !ill be assigned as @early birdsA at the :ick Child Clinic# They !ill not be required to attend the conferences+ instead+ they are expected to start charting ne! patients and perform procedures (gastric ,B3+ etc # The follo!ing is the schedule for <9) clinics: Monday , M ,dolesce nt ,llergy /ematolo gy Tuesday ,dolesce nt ,llergy Cardiolo gy 8eurolog y Renal =ednesda y ,dolescen t ,llergy 'enetics '$8 Thursday ,dolescent ,llergy ?ndocrinol ogy 8eurology Cardiology $8TR<9 Briday ,dolescent ,llergy 9ulmo 8eurology (every other Friday ?ndocrinology

9 M 0# 1#

2# 4# 5# "6# ""#

"&# "(# "-#

$nterns !ill be assigned to the general pediatric (sick child clinic and the subspecialty clinics# $nterns are expected to: Chart all ne! patients at the :ick Child Clinic or :ubspecialty clinic Conduct a clinical intervie! and extract a complete pediatric history )o a thorough physical examination+ complete !ith anthropometrics 3e able to list differential diagnosis relevant to the case Reach a sound assessment :uggest appropriate and cost-effective diagnostic examinations Bormulate a treatment plan !hich includes appropriate medications and recogni%e the need for a subspecialty referral 9rovide proper anticipatory guidance 9resent the case to the consultant or service senior and be able to thoroughly discuss the case The intern is expected to present a case to the consultant on deck at the <9) (or at the subspec clinic # ,t the end of the rotation+ the intern needs to submit an evaluation by a leas one cons-l an > senior residen > and a s-6special # clinic cons-l an ?fello;* ,ll interns should !ear the prescribed uniform and are not allo!ed to !ear slippers or open shoes# $nterns should go on duty as 9edia ?R relievers e"er# ( da#s* )uties at the 9?R s ric l# starts at 3@&&p: o (@&&a: on !eekdays and %@&&p: o (@&&a: on !eekends and holidays# ,ll interns are expected to sign in as soon as they assume post and sign out before they leave their posts# ,ny intern !ho arrives beyond the prescribed time !ill be marked absent# )uty interns at the 9?R !ill be assigned monitoring+ 3?.$; and triage duties# They are not included in the rest periods granted to 9?R interns# 9ost-duty interns !ill go to the ,dolescent or subspecialty clinic in the morning until "& noon then may have the rest of the day off# ,t least one intern should go on duty at the Cancer $nstitute Tuesdays+ =ednesdays and Thursdays from 29M to 2,M#

AARDS 01 AND ''4 '* a# b# c# Responsi6ili es of +!7 S -den s d-ring office ho-rs <ne intern !ill be assigned to a service ('en 9ed "+&+(+-+ /ema-<nco or 8euro !here he.she shall carry out orders+ monitor patients C" and C&+ accomplish paper!ork and attend service activities# C<-)?C*$8' <B :T>)?8T: !ith Resident D required 8umber of patients: 0-2 per service+ number !ill depend on !hether there are E>1 students rotating (Basis: 45 beds per ward, 15 beds each for Neurology and He a!"nco services# $he other %& beds will be divided a ong the 4 'eneral (ediatric services in the two ()* wards#

LU7 Orientation Manual 02April2012

d#

E>2 students should sign the attendance log book# The log book !ill be kept in the residentsF callroom (not in the E>2 callroom # Resident monitor to countercheck the attendance of the E>2 students# Sign in i:e@ 7a: e# :pecific Responsibilities: i# 8otes and Referral Borms "# $ncoming and <utgoing notes on all assigned patients &# <ptional progress notes every ( days as determined by the senior of the service (# >pdated clinical abstract on all assigned patients -# =rite referral forms for interdepartment and intradepartment referrals 0# :anctions if no notes. updated clinical abstract: " st offense !arningG &nd offense Hournal report or case discussion (discretion of senior of service G ( rd offense --hour !ard duty as assigned by the senior of the service ii# )uring office hours+ E>2 student is responsible for carrying out orders+ including 3?.$;+ facilitating and follo!-up of labs+ and doing clinical assessments on his.her o!n patient (not on the other patients in the other services iii# E>2 students should go on rounds !ith the service every day+ update the resident on any significant findings or changes in the patientFs status or abnormal lab results+ and make suggestions on recommendations for evaluation and management of the patient during the rounds (active participation in the patientFs care iv# E>2 students should go on rounds !ith the consultants assigned in the service# v# $n case a patient is admitted at the !ard+ interns are expected to: 'et baseline vital signs 7oin the endorsement bet!een the !ard residents and the 9?R resident vi# $nterns are expected to endorse their patients for close-monitoring to the duty team using the follo!ing format: 8ame.,ge.:ex.=eight of patient 9atientFs length of hospital stay 9atientFs diagnosis 9atientFs problems =hat to !atch out for+ ;: and /gt monitoring schedule %* Responsi6ili ies of +!7 s -den s d-ring ;ard d- ies a# b# )uty starts from 0pm until 2am of the follo!ing day ("- hours 9rimary responsibilities of the E>2 students: i# Clinical assessment of the patients !ho need evaluation every "-& hours (every - hour monitoring should be carried out by the nursesG Resident on duty required to assess those requiring evaluation every - hours at least once or t!ice during their tour of duty # ii# 3?.$; and facilitate other lab !orkup iii# ,ccept endorsements for ,dmissions during tour of duty iv# ?ach patient in the !ard should have an intern-in-charge# :hould the admission happen during duty hours and the intern on duty is not the intern on deck+ a T$C or Temporaryin-Charge should be assigned# The postduty intern is then expected to endorse the patient to the intern-in-charge in the morning# :tations TIME 0pm-"6pm "6pm-(am (am-2am i# ii# iii# .E?IB :tudent , :tudent 3 :tudent C STATION Clinical Assess:en :tudent 3 :tudent C :tudent , Res C :tudent C :tudent , :tudent 3

c#

Rest station !ill only be allo!ed if number of endorsed patients requiring assessment q "-& hours is I "6 patients# <ther!ise+ & students should do the clinical assessment# Rest periods are allo!ed in bet!een clinical assessments and other responsibilities# >se ne! assessment sheets every day )uring the @Rest station+A the E>2 students are not allo!ed to leave the pediatric !ards or pedia complex# <ther!ise+ they !ill be considered out of post and appropriate sanctions !ill be given#

For:al Endorse:en Conferences@ Thursdays 2: (6 am and :aturdays 4:66am are :tudentFs endorsements#

LU7 Orientation Manual 02April2012

9ost-duty interns (including <9) interns !ill present the !ard census for the night# The !ard census should include: ,dmissions+ discharges+ number of beds+ number of vacancies+ patients !ho !ent home against advice+ home per request+ and the number of morbidities and mortalities (of each 'en 9ed and subspecialty service # $nclude only the pertinent: ?xample: =ard 5 ;acancies 0 ("+ 0+ 2+ (&+ :3" ,dmissions & (4+ -0 Morbidities are defined as patients !ho !ere not endorsed but became toxic during the tour of duty Al;a#s read -p on #o-r pa ien s case prior o endorse:en s ,ny of the admissions could be called for presentation so each one should shoud have a compete history and 9? prepared+ along !ith a short discussion as to ho! the diagnosis !as arrived at and ho! the case should be managed 9resenters of admitted cases shall be graded by 9ost-duty 9<)s using the Case 9resentation ?valuation :heet

Precep orials?Case Manage:en Presen a ions@ "# ?ach block of interns !ill form & subgroups (students should come from different services so that during :')+ there !ill still be interns left at the !ards # ?ach subgroup !ill be met by an assigned consultant ;ice during their rotation at the !ards for case management+ !hich !ill be scheduled on =ednesdays.Bridays# /o!ever+ interns shall be notified ahead of time should there be a change in schedule# The students should choose a case upon entry to the !ards and submit to assigned E>2 monitor for approval# They should also confirm the schedule !ith the assigned monitor+ then request for a room at the 9edia office (look for *uya 7un # The presentor is expected to: 9resent a case !ith emphasis on the ,99R<9R$,T? M,8,'?M?8T of the disease :ubmit a brief case protocol (half sheet only+ see attached sample case to the resident or consultant in charge at least & days before the scheduled session for approval# 9rovide at least 0 issues for discussion 'roup members are A++ expected to present divergent vie!s and give additional tips on management <n the day of the preceptorials+ all students are excused from hospital !ork and are expected to be at the specified venue at most "0 minutes before the assigned time# Remind the preceptors to submit grading sheets right after the session to MaFam =eng or to a resident monitor (grading sheets available at the 9edia office Re:inders@ "# =ash hands strictly before and after touching each patient &# >se the carts and tables !hen !riting in charts+ not the top of the beds (# <n giving critical $; meds: )< 8<T push meds on an inotrope line Confirm the patientFs name before giving the medications 9ush meds :E<=EJ especially ;it# *+ )ia%epam+ and 9henobarbital -# =hen monitoring+ kno! the normal vital signs for age so that you !ould kno! !hen to refer# 5* Ahen in do-6 > refer* EBA+!ATION@ For clinical ro a ion@ " service consultant. senior resident+ " Hunior residentG For SGD@ & consultant grades

&# (#

-# 0# 1#

NIC!?N!RSER$ "# &# (# -# , separate orientation !ill be given by the 8$C> fello!s <ne preceptorials is required for the &-!eek rotation (grading sheets available at the 9edia office 9re-duty and post-duty nursery interns are required to attend all scheduled conferences# Clerks have a set schedule !hen they rotate in the CatcherFs area# $t is the responsibility of the E< to kno! the schedule of the incoming clerks and adHust the rotating internsF schedules accordingly# 8o clerk should go on every other duty to compensate for the rotating internsF schedule# =ear appropriate attire !hile in the <R.)R and in the 8$C>

0#

LU7 Orientation Manual 02April2012

EMERGENC$ ROOM Ti:e 2:66 2:(6 4:66-5:66,M 5:66-"&:6688 Time-$n )epartment Conference Monitor patients# ,ssist resident in triaging ne! patients# )o 3?.$; of ?R patients# ,ccompany patients in certain procedures# Monitor patients# ,ssist resident in triaging ne! patients# )o 3?.$; of ?R patients# ,ccompany patients in certain procedures# Pre-D- # D- # Time-in Pos -D- # ?ndorsement to incoming interns-onduty )ept# Conference

<ff

"&nn-2am (the ff# day "# &# (#

-#

0#

)uty interns are excused from department conferences )uties shall be scheduled every ( days+ !ith ( interns going on duty every night+ reinforced by & opd relievers# Responsibilities: $dentifying toxic patients and referring them immediately to R<) Charting (include plan of management 3?.$; :trict monitoring =hen a patient is on the resuscitation table+ make sure at least " intern is attending Triage: logging all patients seen !ith :<,9+ presenting all patients to the R<) for final disposition+ filling up contact forms for all patients !ho are not admitted Reminders: Jou are on &--hour dutyK )uring rest periods+ you are still on call and are expected to stay in the 9?R premises <ut-of-post interns !ill be given sanctions $nterns are NOT A++OAED to dispose patients# ,ll patients should be seen by 9?R R<) prior to discharge# 9ost-duty: attend department conferences then may have the day-off

ReD-ire:en s :ubmit "& grading sheets o OPD@ " consultant+ " senior resident grade+ " subspecialty consultant.fello! grade o AARDS@ " service consultant.senior resident grade+ " Hunior resident grade+ & :') consultant grades o NIC!@ " :') grade+ " fello! grade+ " resident (catcher grade o ER@ " senior resident grade+ " Hunior resident grade 9edia card 9ersonal data card (0x4 index card : name+ age+ med school+ address+ contact numbers !. picture C?3: ,ttendance card 9eer evaluation Infrac ions "# 8o incoming.outgoing notes+ clinical abstract+ other paper !orks (per day L 4 hours of duty at the 9edia ?R &# Eate ("0 minutes after the designated time L - hours of duty at the 9edia ?R per late (# ,bsences: a# excused absences: ":" make-up at the 9edia ?R.!ards b# unexcused absences: ":& make-up at the 9edia ?R. !ards -# <ut of post L &--hour duty in the 9edia ?R.!ards 0# Eate submission of requirements beyond the &-!eeks @grace periodA L - hours of duty per !eek of late submission 1# >nauthori%ed substitution of )uty :chedule: a# Bor the offender L " similar duty b# Bor the substitute L "st offense D !arningG &nd offense D " similar duty 2# Borging of attendance ('R,;? <BB?8:? L for referral to >9 Manila :tudentsF )isciplinary Tribunal

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4# 5#

,EE <T/?R C<EE?'? ,8) /<:9$T,E R>E?: ,99EJ Bor make-up scheduling+ approach the resident monitor-in-charge# ,vail of the official sheets at the 9edia library# "6# Make-up duties shall be done after the 9edia rotation+ provided that there is no conflict !ith the current rotation of the student General Re:inders "# :hould an intern need to be absent or late for any particular post+ the said intern should inform any E>2 monitor in !riting# <ther!ise+ the absence.late !ill be counted as unexcused and !ill be imposed upon corresponding sanctions# ,ll absences or lates not coursed through the E>2 committee !ithin -4 hours of absence.late !ill be considered unexcused# &# ,void revision of prescribed schedules# Corresponding sanctions !ill be given to those !ho formulate schedules different from prescribed schedules# (# ,ll requirements should be submitted in a long bro!n envelope no la er than t!o !eeks after their prescribed rotation# $nterns !ith incomplete requirements =$EE 8<T 3? ,EE<=?) to take the :hifting-out ?xam# Special Case@ !na"aila6ili # of Cler9s )uring times of the year !hen clerks are not available to supplement the number of interns on duty+ the follo!ing rules !ill apply: "# &# The 9?R gets priority in decking <9) intern relievers# $n the !orst case scenario+ at least one reliever should be sent to the 9?R ,t least t!o interns should go on duty at the !ards at any given duty time# :hould the !ard interns need additional reinforcement+ manpo!er !ould come from the <9) interns# ,t least one intern should be sent to relieve to any or both !ards# =ard relievers are expected to be sign in at the attendance logbook at the !ard upon arrival and sign out prior to leaving# =ard reliving hours are from 1:66pm to -:66am# The interns assigned at 8$C> <3,: should obtain the schedule of 9edia resident relievers for the !eeks of their rotation# They may adHust duty schedules based on the presence or absence of 9edia resident relievers# ,t least one 8$C> <3,: intern should go on duty every night+ but he.she should al!ays be accompanied by an extra person (either intern or 9edia resident # $n the !orst case scenario !here an extra 9edia resident nor another intern could go on duty at the 8$C> <3,:+ 8$C> rotators may be asked to relieve at the CatcherFs area# 8$C> Catcher relievers are expected to be sign in at the attendance logbook at the <3,: upon arrival and sign out prior to leaving# 8$C> <3,: reliving hours are from 2:66pm to 0:66am

(#

-#

EBA+!ATION ,# :?R;$C? R<T,T$<8 a# =ard Rotation "0 M b# 8ursery Rotation "0 M c# 9?R "0M d# <9) "0M C,:? M,8,'?M?8T.9R?C?9T<R$,E: :/$BT$8' ?N,M$8,T$<8 9??R ?;,E>,T$<8 B$8,E ?N,M$8,T$<8: 16M

3# C# )# ?#

"6 M "6 M 0M "0M

Grade ED-i"alen s@ 51#0 D "66 M 5( D 51#44#0 D 5&#5 4- D 44#25#0 D 4(#5 20 D 25#26#0 D 2-#5 11 D 26#-5 04 D 10#5 06 D 02#5

L L L L L

"#6 L "#0 L &#6 L &#0 &#20 L L

"#&0 "#20 &#&0 (#6 -#6

LU7 Orientation Manual 02April2012

O06

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LU7 Orientation Manual 02April2012

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LU7 Orientation Manual 02April2012

2nd Week of Rotation

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LU7 Orientation Manual 02April2012