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WESTERN VISAYAS MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE

WESTERN VISAYAS MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE MANUAL OF TRAINING PROGRAM 1

MANUAL OF TRAINING PROGRAM

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TABLE OF CONTENTS

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  • 1. Mission-Vision of the Hospital

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  • 2. Mission-Vision of the Department of Medicine

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  • 3. Objectives of the Training Programs

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  • 4. Entry Requirements

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  • 5. Residency Training Program

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  • 6. Organizational Chart of the Hospital and the Department of Medicine

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  • 7. List of officers of the Hospital and the Department of Medicine

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  • 8. Brief History of the Institution’s Residency Training Program in Internal Medicine

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  • 9. Responsibilities of the Department Head

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  • 10. Responsibilities of the Training Officer

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  • 11. Year Level Competencies

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  • 12. Training Program Competencies

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  • 13. Standard Operating Procedures

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  • 14. General Guidelines for Specific Training Areas

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  • 15. Guidelines for Sub-specialty Rotation

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  • 16. Departmental Policies

  • 17. Training Manual for the MRSS Rotation

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WESTERN VISAYAS MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM WESTERN VISAYAS MEDICAL CENTER VISION:

WESTERN VISAYAS MEDICAL CENTER

DEPARTMENT OF INTERNAL MEDICINE

RESIDENCY TRAINING PROGRAM

WESTERN VISAYAS MEDICAL CENTER

VISION:

Evolve into a Center of Excellence for Tertiary Health Care.

VISION STATEMENT:

Develop and provide a comprehensive, compassionate, affordable, culture friendly effective, efficient and integrated health care system for the region. Be a reasonable member of the community and assume leadership in the developing sound health care programs and practices consistent with the Department of Health.

MISSION:

The Western Visayas Medical Center is dedicated to develop and provide the highest quality health care, training, research and public health program for all people of Region VI. It will provide services to the paying public at its lowest price possible consistent with long term financial needs and provide subsidized care to the identified community to the extent resources will permit.

DEPARTMENT OF INTERNAL MEDICINE

VISION:

To be a department of excellence and leadership in service, training and research in Internal Medicine in Western Visayas.

MISSION:

To lead in providing holistic, quality medical care that is accessible and affordable to all members of the community;

To train resident physicians to be general internists, pass the PSBIM, become highly competent, committed to leadership in service and possess integrity;

To establish a respected research program that is recognized as a source of pioneering, relevant and high caliber scientific research that addresses the health issues that concern the region and the country.

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OBJECTIVES OF THE TRAINING PROGRAM A. General Objective The residents should be able to practice the

OBJECTIVES OF THE TRAINING PROGRAM

  • A. General Objective The residents should be able to practice the art and science of medicine as a specialty both in the rural and urban setting after completion of the training program.

  • B. Specific Objectives

The residents should specifically be able to:

  • 1. Diagnose and manage medical problems with skill and competence.

  • 2. Conduct medical investigation and research.

  • 3. Conduct oneself within the acceptable standards of professional ethics with social consciousness and civic mindedness.

  • 4. Prepare residents for specialization in internal medicine.

  • 5. Qualify as medical specialist and certified by the accreditation committee of the Department of Health and the Philippine College of Physicians.

  • 6. Impart knowledge to medical and paramedical students, post graduate interns and in- service training residents.

  • 7. Handle administrative functions and responsibilities.

ENTRY REQUIREMENTS FOR THE RESIDENTS

  • 1. General Requirements:

    • 1. A graduate of a recognized medical school in the Philippines.

    • 2. Must be a citizen of the Philippines.

    • 3. Must not be more than 35 years of age at the time of appointment.

    • 4. A duly licensed physician.

    • 5. Must be in good physical and mental condition and of good moral character.

  • 2. Credentials and Other Requirements to be Submitted:

    • 1. Letter of application for Residency to the Chief of Hospital with 2X2 pictures (2).

    • 2. Official transcript of academic record authenticated by the school registrar.

    • 3. Board rating and diploma.

    • 4. Certificate of licensure R.A. 1080.

    • 5. Letter of reference by 2 physicians of good standing in their community.

  • 3. The applicants will be evaluated by the Training Core members.

  • 4. The applicants who will pass the written and oral examinations must undergo Neuro-psychiatric and Physical Examination.

  • 5. The qualified applicants will be recommended to the Chief of Hospital to be officially accepted as residents-in-training.

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    APPOINTMENTS
    APPOINTMENTS
    • 1. Residents are appointed for a period of one (1) year and renewable every year upon the recommendation of the Department Head and the Chief of Hospital.

    • 2. The renewal will be recommended after evaluation of the performance of residents bi-annually (June and December) using the DOH Performance Evaluation System and the standard evaluation criteria prescribed by the PCP.

    • 3. Certificates will be granted upon successful completion of the requirements of the Residency Training Program.

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    RESIDENCY TRAINING PROGRAM The residency training program of the Western Visayas Medical Center Department of Internal

    RESIDENCY TRAINING PROGRAM

    The residency training program of the Western Visayas Medical Center Department of Internal Medicine is structured based on the PCP guidelines. The PCP defined requirements must be met at the end of the third year of residency training.

    The effectiveness of the residency training program is dependent on the training curriculum, program of activities, the competence of the consultants and the adequacy of training staff supervision.

    The department has always strived to provide the residents with the benefit of a supervised and structured training. This helped facilitate the attainability of specific and year level training objectives. It is a must for the consultant staff to provide residents of the preceptorial guidelines in respective training areas and sub-specialty rotations. Consultant coordinators were assigned in different training areas (Ward, ER, OPD, and ICU). Also, consultants are scheduled on a rotational basis in these various training areas and are assigned with training activities. They are expected to supervise and provide teaching-learning and decision- making interactive sessions with the residents.

    The organized committees (Research Committee, Training Area Coordinators) have further strengthened the implementation of the training program. The different committees have the responsibility of overseeing the training and evaluation of residents by the consultant staff assigned in particular rotations.

    The department chairman and the training officer are responsible of monitoring the compliance of the consultants and residents of their respective responsibilities and assignments. Quarterly staff meetings were scheduled to facilitate evaluation and feedback and to eventually attain the training program objectives. Regular feedback on a group or on an individual basis were conducted by the Core Training Staff for the residents to realize potentials, correct deficiencies and strengthen weaknesses.

    Furthermore, residents are encouraged to develop their personal skills and talents, master the art of medicine and enable to assume and perform their responsibilities. Accordingly, as the residents are observed to demonstrate ability to recognize the signs and symptoms, diagnose the problem and master the management, increasing level of reliance is placed on their judgment. They are given more opportunities for greater participation in patient care as well as in the teaching-learning process of the training program.

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    TRAINING PROGRAM ORGANIZATION DEPARTMENT HEAD TRAINING CHIEF RESEARCH OFFICER RESIDENT COORDINATOR EMERGENCY DEPARTMENT OUT-PATIENT DEPT COORDINATOR

    TRAINING PROGRAM ORGANIZATION

    DEPARTMENT HEAD
    DEPARTMENT
    HEAD
    TRAINING CHIEF RESEARCH OFFICER RESIDENT COORDINATOR EMERGENCY DEPARTMENT OUT-PATIENT DEPT COORDINATOR WARD ICU COORDINATOR COORDINATOR
    TRAINING
    CHIEF
    RESEARCH
    OFFICER
    RESIDENT
    COORDINATOR
    EMERGENCY
    DEPARTMENT
    OUT-PATIENT DEPT
    COORDINATOR
    WARD
    ICU
    COORDINATOR
    COORDINATOR
    TRAINING PROGRAM ORGANIZATION DEPARTMENT HEAD TRAINING CHIEF RESEARCH OFFICER RESIDENT COORDINATOR EMERGENCY DEPARTMENT OUT-PATIENT DEPT COORDINATOR

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    WESTERN VISAYAS MEDICAL CENTER

    DEPARTMENT OF INTERNAL MEDICINE Mandurriao Iloilo City

    TRAINING COMMITTEE

    Medical Center Chief

    Chief Medical Prof. Staff Chief Training Officer Department Head Training Officer

    Training Core Members

    Research Committee

    JOSEPH DEAN NICOLO, MD, FPCS, FPSGS, MPA

    MA. CRISTINA VC-WOO, MD, FPPS, FPSNBM, MHA

    GUADALUPE V. MATEJKA, MD, FPCS JOY GULMATICO, MD, FPCP, FPSN LAVERNIE JACOBO, MD, FPCP, FPCC

    FELICE MOLINA, MD, FPCP, FPAS MAT MARIA LUNA Y. PARREÑO, MD, FPCP JOY M. GULMATICO, MD, FPCP, FPSN LAVERNIE JACOBO, MD, FPCP, FPCC DIANA MARIE CACHO, MD, FPCP FEL ANGELIE COLON, MD, FPCP, FPCCP, FACCP LEMUEL UMAHAG, MD, FPCP, FPCCP, FPSCCM KATHRYN JOYCE GORRICETA, MD

    GLYNIS TONGZON, M.D., FPCP, DPSN (CHAIR) FEL ANGELIE P. COLON, MD, FPCP, FPCCP, FACCP DIANA MARIE J. CACHO, MD, FPCP RYNDELL G. ALAVA, MD, FPNA MARIA LUNA PARREÑO, FPCP

    Training Area Coordinators

    Emergency Room Out- Patient Department Intensive Care Unit Infectious Wards Non Infectious Wards

    KATHRYN JOYCE GORRICETA, MD DIANA MARIE J. CACHO, MD, FPCP MARCELINO FELISARTA, MD, FPCP, FPCC LEMUEL UMAHAG, MD, FPCP, FPCCP, FPSCCM JOY M. GULMATICO, MD, FPCP, FPSN

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    CURRENT LIST OF CONSULTANTS

    ENDO

    DIANA MARIE J. CACHO, MD, FPCP ARETHA ANN LIWAG, MD, FPCP, FPSEPM, MSC

    NEURO

    RYNDELL ALAVA, MD,FPNA EUFEMIO SOBREVEGA, MD, FPNA DUREZA ABAD, MD, FPCP, FPNA

    INFECTIOUS

    FELICE G. MOLINA, MD, FPCP, FPAS, MAT MARIA LUNA PARREÑO, MD, FPCP

    NEPHRO

    JOY M. GULMATICO, MD, FPCP, FPSN GLYNIS TINGZON, MD, FPCP, DPSN

    GENERAL INTERNIST

    KATHRYN JOYCE GORRICETA, MD, FPCP CECILIA CERCADO, MD, FPCP MAYBEL ARENO, MD, FPCP RODEL GEDALANGA, MD, FPCP

    GERIATRIC MEDICINE

    GRACE FERNANDEZ, MD, RPCP, FPCGM, MHM

    DERMA

    REMA JOY CEJAR, MD, FPDS

    RHEUMA

    CAROLINE ARROYO, MD, FPCP, FPRA AIME FABILA, MD, FPCP, DPRA

    TOXICOLOGY

    ANECITO MONSALE, M.D.

    PULMO

    MARIAN C. CELIS, MD, FPCP, FPCCP FEL ANGELIE COLON, MD, FPCP, FPCCP, FACCP LEMUEL UMAHAG, MD, FPCP, FPCCP, FPSCCM RHEA ANN CELIS, M.D., FPCP

    GASTRO

    DANILO VALENCIA, MD, MA. CECILIA FLORETE, MD, FPCP, FPSG, FPSDE MIGUEL SOTOMIL, MD, FPCP, FPSG ELVIE VICTONETTE RAZON- GONZALEZ, MD, FPCP, FPSG

    CARDIO

    LAVERNIJACOBO, MD, FPCP MARCELINO FELISARTA, MD, FPCP CORNELIO BORREROS II, MD, FPCP, FPCG RHODELYN ALMEÑANA, MD, FPCP CATOTO, JAMES, M.D., FPCP

    ONCO

    CHERRY PINK A. VILLA, MD, FPCP, FPSMD ANTOINETTE PUNJALE, MD,FPCP

    ALLEGO & IMMUNO

    CHRISTOPHER REY DE GUZMAN, MD, FPCP, FPSAAAI RAEL DULLANO, MD, FPCP

    CURRENT LIST OF CONSULTANTS ENDO DIANA MARIE J. CACHO, MD, FPCP ARETHA ANN LIWAG, MD, FPCP,

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    DEPARTMENT OF INTERNAL MEDICINE HISTORY

    It has been thirty- nine years since the department has been founded. At the onset, it was 1975 when the hospital started to become departmentalized and training was started for physicians who aimed to hone their skills for self-employment and to uplift service to the people.

    The Department of Internal Medicine Training Program started with only few resident physicians namely Dr. Lucita Depakakibo- Jalbuena, Dr. Gloria Valdez- Anduyan, Dr. Alberto Cruz, Dr. Cecilia Cercado, Dr. Nelson Flotilde, under the chairmanship of Dr. Juana Jardiolin and then the acting senior resident Dr. Muriel Danucop. Voluntary Consultants were Dr. Benjamin Mombay, Dr. Gregorio Tirador, Dr. Eugene Lim and Dr. Cecilia Suarez.

    The Department of Internal Medicine worked its way to formalize the training program in our institution. The Department earned its first 5- year accreditation in 1987 under the chairmanship of Dr. Rosario Aceron. From then onwards, the Department lived to its vision- mission as a training ground for the residents under the guidance and leadership of the following chairpersons: Dr. Cecilia Cercado, Dr. Marian Celis, Dr. Edgar Salinas, and Dr. Diana Marie Cacho.

    In cooperation with the Hospital Center for Wellness Program the following organizations were established with the support of Internal Medicine Residents.

    In 1994, The National Cardiovascular Disease Prevention Program was established in view of the continuing rise in cardiovascular cases in the country. The program functions include health promotion and disease prevention alongside efforts geared at upgrading curative and rehabilitative care.

    In 1995, The Western Visayas Medical Center Diabetic Clinic was started as regular consultation clinic held every Wednesday for Diabetic patients as well as non-diabetics. Patients undergoing capillary glucose determination and medical evaluation are given diabetes education by the diabetes team. The services of the diabetes clinic now have broadened to include lectures to patients and relatives about preventive and health promotive aspects of diabetes mellitus.

    Also, in this year, the Western Visayas Medical Center Asthma Club was launched which aimed to promote awareness and to promote patient education through information dissemination and to established partnership with their families, health care providers and the community. The Club is a recipient of the Wellness Excellence (innovative) Citation is acknowledge of its efforts to upgrade its services and transform the institution into a Dynamic Center of Wellness in 1997.

    A significant proportion of TB cases seek assistance from the hospitals. Recognizing the important role of hospitals in identification and management of TB cases the DOTS was established in June of 2007 and later became the first government- based PPMD unit in Western Visayas in May 2008.

    Preventive Nephrology Program was started to promote health education campaign on renal patients and their relatives in prevention and management of acute and chronic renal diseases.

    The old kidney unit was opened in 1998 to cate the patients in need of dialysis. In 2005, the new Kidney Unit was opened so as to serve greater number of clients. As the number of patients grew the Kidney Club was opened so as to serve greater number of clients. As the number of patients grew the kidney club

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    was established to help dialysis patients and their families in understanding and dealing the disease as well to established camaraderie among themselves and the Kidney Unit Staff.

    As Barack Obama once said: “Making a mark in the world is hard. It makes patients and commitment and plenty of failures along the way. The point is not whether you avoid this failure because you won’t but whether you let it.” So for now the Department is moving forward making past mistakes and experiences as stepping to attain excellence and be of service to others especially the less privileged.

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    LIST OF CHAIRMAN AND TRAINING OFFICER

    CHAIRMAN

     

    TRAINING OFFICER

     

    ROSARIO ACERON,MD, FPCP, FPSN

    EDGAR SALINAS, MD, FPCP

     

    MARIAN CELIS, MD, FPCP, FPSN

    EDGAR SALINAS, MD, FPCP

     

    CECILIA CERCADO, MD, FPCP

    EDGAR SALINAS, MD, FPCP

     

    EDGAR SALINAS, MD, FPCP

    DIANA MARIE CACHO, MD, FPCP

     

    MARIAN CELIS, MD, FPCP, FPSN

    DIANA MARIE CACHO, MD, FPCP, FPCCP

    DIANA MARIE CACHO, MD, FPCP

    JOY GULMATICO, MD, FPCP, FPSN

     

    JOY GULMATICO, MD, FPCP, FPSN

    MARIA LUNA PARREÑO, MD, FPCP

     

    DIANA MARIE CACHO, MD, FPCP

    LEMUEL

    UMAHAG,

    MD,

    FPCP,

    FPCCP,

    FPCCM

    JOY GULMATICO, MD, FPCP, FPSN

    LAVERNI, JACOBO, MD, FPCP, FPCC

     

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    LIST OF CHAIRMAN AND TRAINING OFFICER Muriel Dañucop, MD Cecilia Cercado, MD, FPCP Lucita Jalbuena, MD,

    LIST OF CHAIRMAN AND TRAINING OFFICER

    Muriel Dañucop, MD Cecilia Cercado, MD, FPCP Lucita Jalbuena, MD, FPCP, FPCC Rosario Aceron, MD, FPCP, FPSN Jun Aristorenas, MD Nelson Flotilde, MD Marian Celis, MD, FPCP, FPCCP Edgar Salinas, MD Mary Rose Aplasca, MD Danilo Valencia, MD Gracita Lanada, MD Olivia Perez, MD Fred Guillergan, DM, FPCP Gil Lazaro, MD, Non-practicing (USA) Vicente Albacete, MD, Private practive (Maasin, Iloilo) Janus Alejo, MD, Non-practicing (USA) Joemarie Lopez, MD, Private practive (Passi City, Iloilo) Bobby Yoro, MD, Chief of Hospital (Guimaras) Anecito Monsale, MD (MO4) Raffy Tayco, MD, FPCP Nelson Belandres, MD Peter Que, MD, Non-practicing (USA) Debbie Layson, MD (IDH) Ramon Pasaporte, MD (Iloilo City) Edgar Divinagracia, MD, (Barotac Nuevo, Iloilo) Louella Araza, MD (Iloilo City) Ma. Victoria Masculino, MD (Iloilo City) Ma. Rebecca de Asis, MD Leonor Villareal, MD, FPCP, Iloilo City Jean Rico- Tenefrancio, MD, FPCP, FPCC (Roxas City) Joy Gulmatico, MD, FPCP, FPSN (Iloilo City) Eleno Magtulis, MD, FPCP (Expired) Lavernie Jacobo, MD, FPCP, FPCC (Iloilo City) Milagros Cañonero- Cariño, MD (Alimodian Iloilo) Noni Lopez, MD, (Guimaras) Quindialem Deano- Villanueva, MD,

    (Dingle Iloilo) Liza Fermeza, MD, Non-practicing (USA) Judel Jaritiza, MD, FPCP Esther Legaspi, MD (Expired) Agnes Gulmatico- Belleza, MD, FPCP, FPCC (Iloilo City) Fe Dofitas, MD, ( Alimodian District Hospital) Elly Justalero, MD, (Guimaras) Owen Porral, MD, (Sta. Barbara, Iloilo) Jane Rodriquez, MD, Non-practicing (USA) Amalia Jaspe Fernandez, MD, PHIC Noel Camique, MD, FPCP, FPSN (North Cotabato) Donna Gwen Dimaclid, MD, (Mindanao) James Albacete, MD, Non-practicing Judy Ann Nebit, MD, FPCP (Antique) Vincent Jury Lauron, MD, FPCP (Roxas City) Cecile Jancilan, MD, Non-practicing Lemuel Umahag, MD, FPCP, FPCCP (Iloilo City) Maria Luna Parreño, MD, FPCP Maybel Areno, MD, FPCP (Barotac Nuevo) Grace Cageria- Castigador, MD (Calinog Iloilo) Mylene Alontaga- Mombay, MD (Guimaras) Mitzi Banate, MDFPCP, FPCCP (Iloilo City) Zaida Lacorte- Ali, MD (Kalibo Aklan) Joveno Galvez, MD, FPCP Ian Libarios, MD Andre Val Sucro, MD, Kalibo Aklan Leonardo Java, MD, Oton, Iloilo Wendel Articulo, MD (Barotac Nuevo, Iloilo) Concristine Dignomo-Legislador, MD (Iloilo City) Rodel Gedalanga, MD, FPCP (San Joaquin) Alvin Casono, MD, FPCP Fria Mae Manejero, MD (Singapore) Sheryl Grace Vallar- Trumpeta, MD, FPCP (Non-practicing, USA) Joemarie Loberiza, MD, FPCP, Oncology Fellowship Training Emelyn Buenacosa MD, FPCP, Oncology

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    Fellowship Training Stephen Segumalian, MD, Doctors without borders (Pakistan) Kathryn Joyce Gorriceta, MD, FPCP (Iloilo City) Lester Dimzon, MD, FPCP (MO4) Yuely Capileño, MD, FPCP Glynis Tingzon, MD, FPCP, DPSN

    Ivy Marie Suarez, MD, FPCP (Senior House Officer AFP Hospital) Dyna Cardiel, MD, FPCP Rosejanne Camoro, MD, FPCP Mary Joy de la Mota, MD, FPCP, ID Fellowship training San Larazo Hosopital Andrea Dimagiba, MD, FPCP MO4

    Rhea Ann Celis, MD, FPCP MO4 Hervin Saber, MD M04 Ellen Grace Balinas, MD, FPCP, ID Fellowship training San Lazaro Hospital Charisse Marie Toledo, MD, Non-practicing, USA Kaya Sharley Cercado, MD MO4 Christine Ena Carado, MD, (Iloilo City) Anne Gigare, MD, (Iloilo City) Rufino Abonado, MD MO4 Myleene Erola- Fuentes, MD, Neurology Training Gwen Gigare, MD, (Iloilo City) Iris Joyce Aron, MD, (Private practice Kalibo Aklan) Roger Mission Jr., MD MO4 Ralph Gregor Leono, MD MO4

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    RESPONSIBILITIES OF THE DEPARTMENT HEAD 1. Planning The primary responsibility of the department head is to

    RESPONSIBILITIES OF THE DEPARTMENT HEAD

    • 1. Planning

    RESPONSIBILITIES OF THE DEPARTMENT HEAD 1. Planning The primary responsibility of the department head is to

    The primary responsibility of the department head is to determine the best way to attain the goals of the program and the desired outcome relevant to the organization’s mission/vision. It also involves defining directions to attain the goals, and strategies to achieve program objectives. The processes in planning include analysis of the organizational situations, recognition of modifiable and non-modifiable factors, evaluation of the program’s strengths and weaknesses and identification of external opportunities and threats. Accordingly, propositions for alternatives or choices and decision on the best choice and contingencies are reflected in the management action plan.

    • 2. Direction

    Direction is achieved by conducting annual planning at the start of every year. Delegation of assignments and affirmation of commitment to the training of the consultant staff is a very crucial responsibility. Direction also includes identification of the members of the organizational structure; communication of the training goals, objectives, and strategies; motivation and guidance of both the trainors and trainees; exercise good judgment in decision making and delegation to the Training Officer and other members of the consultant staff.

    • 3. Control

    Control within the program include monitoring of deviations from plans and provide for timely corrective feedbacks.

    • 4. Representation

    The chairman represents the department to the administration or institutional management by reporting plans, budget requirements, presenting concerns, problems, issues and discuss opportunities.

    RESPONSIBILITIES OF THE TRAINING OFFICER

    • 1. Coordination Coordinating facilitated by orchestrating the implementation of plans and by communicating strategy-tactics (supervision), demonstrating ways of improving performance and delegating to year-level coordinators the operational tasks.

    • 2. Evaluation This is gathering valid objective data regarding adherence to and compliance with plans, discussing with the Department Head significant deviations from plans and reporting periodically the status of program implementation.

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    YEAR – LEVEL COMPETENCIES
    YEAR – LEVEL COMPETENCIES
    YEAR – LEVEL COMPETENCIES
    • I. YEAR LEVEL I (First Year Resident)

    • A. OPD new cases

    • a. Entry Objectives:

    Before start of residency, the 1st year resident must:

    • 1. Possess knowledge of basic Medical Sciences.

    • 2. Demonstrate the ability to obtain complete and accurate history and perform a systematic and thorough physical examination.

    • 3. Be able to do comprehensive medical record keeping.

    • 4. Have knowledge on common diseases.

    • 5. Exhibit good communication skills.

      • b. Terminal Objectives:

    By the end of the year, given a patient at the OPD the 1st year resident will:

    • 1. Obtain a problem-oriented history, as recorded in the chart.

    • 2. Perform systematic and pertinent PE, as recorded in the chart.

    • 3. Correlate relationship of history and PE to arrive at a working diagnosis.

    • 4. Entertain possible differential diagnosis based on history and PE.

    • 5. Determine the appropriate diagnostic work-up and present to patient.

    • 6. Discuss with the patient the different treatment options and implement treatment plan based on available evidences, resources and patients preference.

    • 7. Ensure follow-up to evaluate response to treatment.

    • 8. Determine the need for referral to subspecialty or to clinical supervisor.

      • B. WARDS

      • a. Entry Objectives:

    At the start of rotation, given a case in the ward, the 1st year resident will:

    • 1. Obtain a clinical history and perform physical examination and document the data in the patient’s history form.

    • 2. List possible differential diagnosis and decide on a most probable diagnosis. (if possible)

    • 3. Select laboratory tests based on working diagnosis and differential diagnosis.

    • 4. Present and explain different diagnostic options to patient and relatives.

    • 5. Recognize the need for and implement necessary empiric, symptomatic and supportive management of the patients’ immediate problem.

    • 6. Interpret and analyze laboratory results in support of the working diagnosis.

    • 7. Perform basic ward procedures and assist senior residents in the performance of more complex procedure needed by the patient.

    • 8. Plan the specific treatment of the disease.

    • 9. Document the progress of patient’s condition in a problem oriented form.

      • b. Terminal Objectives:

    At the end of ward rotation, given a case, the 1st year resident will:

    • 1. Obtain a comprehensive, complete and accurate history and PE and document the data gathered in the patients’ history form within 24 hrs.

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    2.

    Integrate the history and PE findings with the etiology and pathophysiology of disease and formulate the differential and working diagnosis.

    • 3. Identify and decide essential laboratory test and ancillary procedures appropriate for the patient’s condition.

    • 4. Institute appropriate symptomatic and supportive management while awaiting laboratory test results.

    • 5. Interpret, analyze and correlate laboratory test results with clinical findings to arrive at a final diagnosis.

    • 6. Decide on the most appropriate and cost effective specific treatment for the disease.

    • 7. Discuss diagnostic and therapeutic options and facilitate decision making between physicians, patient and family members.

    • 8. Perform procedures properly necessary to for the diagnosis and management of patient’s condition.

    • 9. Monitor, evaluate and document patient’s response to management.

      • 10. Decide on proper disposition of the patient. (i.e., whether to discharge, transfer to other units or hospital or refer to a subspecialty.)

      • 11. Advise patient on post-discharge instructions (home medication, diet, lifestyle modification, follow-up visit)

    II. YEAR LEVEL 2 (Second year resident)

    • A. EMERGENCY ROOM

    • a. Entry Objectives:

    At the start of the ER rotation the 2nd year resident must:

    • 1. Have attended BLS/ACLS

    • 2. Be able to recognize emergency life threatening and potentially disabling diseases.

    • 3. Be able to perform basic emergency procedures.

      • b. Terminal objectives:

    At the end of Emergency Room (ER) rotation, given a case; a 2nd year resident will

    • 1. Recognize life threatening and potentially disabling situations and classify severity of the problem.

    • 2. Administer basic/emergency measures.

    • 3. Prioritize and interpret urgently needed laboratory tests and results.

    • 4. Obtain adequate history and PE within a limited period of time.

    • 5. List and analyze differential diagnosis and select a primary diagnosis.

    • 6. Continue appropriate treatment and monitor clinical outcome.

    • 7. Discuss with relatives/patients matters pertaining to clinical state, diagnosis, prognosis and possible expenses.

    • 8. Decide where to admit patient (ward or ICU), or to properly coordinate transfer to other institution.

    • 9. Properly endorse patient. (ward, ICU or other institution)

    SUBSPECIALTY

    • a. Entry Objectives:

    At the start of subspecialty rotation, given a case; a 2nd yr resident must be able to:

    • 1. Obtain a problem directed history and physical examination for a suspected disease, as written in the chart.

    • 2. Recognize different diseases with common manifestations.

    • 3. Arrive at a specific clinical diagnosis.

    • 4. Apply management principles according to CPG’s and available protocols.

      • b. Terminal Objectives:

    At the end of the 2nd yr, given a subspecialty problem, a resident will:

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    1.

    Obtain accurate and comprehensive disease-directed history and PE.

    • 2. Enumerate or list differential diagnosis.

    • 3. Establish the correct diagnosis.

    • 4. List the appropriate diagnostic tests and decide and prioritize which one will be done.

    • 5. Explain the diagnostic test to the patient and allow for patient preference.

    • 6. Determine immediate need for supportive treatment

    • 7. Explain the treatment plans and options to patients and allow for patient preference.

    • 8. Initiate appropriate treatment for the proven diagnosis, using CPGs and available protocols.

    • 9. Evaluate treatment outcome.

      • 10. Determine the need for further referral if treatment outcome is not satisfactory.

      • 11. Explain to patient the reason for referral and allow for patient preference.

      • 12. Formulate appropriate discharge plans.

    III. YEAR LEVEL III (Third year resident)

    A.

    ICU

    a.

    Entry Objectives:

    The 3rd year resident upon entry to ICU must:

    1.

    Have a functional knowledge of the principles of ICU management.

    2.

    Be able to identify patient for critical care management based on standard recommendations and accurately record it.

    b.

    Terminal Objectives:

     

    At the end of the 3rd year ICU rotation, given a case; the resident will;

    1.

    Obtain a problem-directed, disease- associated history/PE as recorded in the chart.

    2.

    Determine the tests needed to confirm diagnosis of the problem and if needed, list further the test and decide which to request.

    3.

    Correctly interpret available diagnostic test results.

    4.

    Institute appropriate and timely treatment of diagnosed causes of the problem.

    5.

    Formulate plans for monitoring the result of treatment.

    6.

    Treat anticipated and recognized acute complications of the disease and consider possible chronic complications of the disease, as well as complication of treatment.

    7.

    Explain confidently and competently the medical condition, planned treatment options and prognosis to patient and relatives in order to guide them in decision making.

    8.

    Properly and adequately endorse patient to receiving residents/nurses.

    9.

    Evaluate treatment satisfaction and identify unrecognized problems.

    10.

    Facilitate ethical decision making on end of life issues.

    11.

    Decide when to discharge patient from ICU.

    12.

    B.

    CHRONIC RECURRENT DISEASE

     
    • a. Entry Objectives:

    At the start of the rotation of the 3rd year resident, at the OPD, the resident must:

    • 1. Have knowledge of the complications and undesirable sequelae of chronic and recurrent diseases.

    • 2. Be able to supervise junior residents in the management of uncomplicated illnesses in the OPD.

      • b. Terminal Objectives:

    At the end of the rotation of the 3rd year resident, given a case, at the OPD, the resident will:

    19

    1.

    Obtain a chronic disease-directed history and PE.

    • 2. Determine tests needed to monitor progression of disease and emergence of known complications and explain to patient and relatives the need for the test and other options for patients’ preference.

    • 3. Facilitate plan for monitoring disease progression and development of complications.

    • 4. Treat anticipated and recognized chronic complications of the disease as well as possible complication/s of treatment.

    • 5. Explain competently the medical condition, planned treatment and options to the patient/relatives.

    • 6. Advise patients on long term care and give instructions with regards to the medications, laboratories needed and follow-up.

    1. Obtain a chronic disease-directed history and PE. 2. Determine tests needed to monitor progression of

    20

    TRAINING PROGRAM COMPETENCIES

    A. KNOWLEDGE AND SKILLS TO BE LEARNED AND ACQUIRED

    First Year

    • 1. Proper approaches in interviewing patients and in history taking in the in-hospital and outpatient setting.

    • 2. Perform complete physical examination, including good neurological evaluation.

    • 3. Perform funduscopic examination.

    • 4. Perform paracentesis, lumbar tap, thoracentesis, cut down, etc.

    • 5. Skills in insertion of venoclysis, blood transfusion and insertion of gastric and nasogastric tubes.

    • 6. Diagnosis and treatment of common medical disorders seen in the outpatient setting.

    • 7. Diagnosis and treatment of common medical disorders seen in the in hospital setting.

    • 8. Must be able to properly refer cases to the consultant in charge, taking note of consultant’s suggestions, but evaluating proper course of action based on his own verified scientific knowledge and judgment.

    • 9. Must be able to maintain organized and accurate medical records.

      • 10. Basic knowledge in interpreting radiological examination of the chest.

      • 11. Knowledge on interpreting ECG tracing.

    Second Year

    • 1. Medical and cardiopulmonary evaluation of surgical patients.

    • 2. Increasing knowledge in the diagnosis and treatment of common medical disorders.

    • 3. Expertise in the management of complicated and/or “subspecialty” diseases and disorders seen in Internal Medicine, particularly in the acute setting (at the emergency room).

    • 4. Must be able to recognize cases which need immediate intervention, and must be able to recognize cases which need to be referred to a particular subspecialty.

    • 5. More advanced knowledge in pathophysiology, biochemistry, special diagnostic procedures and therapeutic skills in the different specialties. He should be able to at least do the following:

      • a. Cardiology able to read ECG, stress test, cardiac series and do cardiac clearance, CVP insertion, and adequately diagnose, manage and refer when necessary cardiac emergencies such as acute coronary syndromes, hypertensive crisis, pericardial tamponade, etc.

      • b. Gastroenterology able to read GB series, upper GI series, and barium enema, and know how to do proctosigmoidoscopy and gastroscopy; adequately diagnose, manage and refer when necessary GI emergencies such as upper GI bleeding, acute abdomen, fulminant hepatitis, hepatic encephalopathy.

      • c. Nephrology interpret urinalysis and blood chemistries and be able to perform and know the technique of peritoneal dialysis and hemodialysis with guidance; adequately diagnose, manage and refer when necessary renal emergencies such as acute renal failure with emergent indication for dialysis (e.g. severe metabolic acidosis, volume overload, electrolyte imbalance, etc.)

      • d. Pulmonary read chest X-ray and interpret blood gas results and pulmonary function tests; adequately diagnose, manage and refer when necessary pulmonary emergencies such as acute respiratory failure, tension pneumothorax, etc.

      • e. Infectious disease handle common infectious and tropical diseases.

    21

    • f. Neurology handle routine CVD cases and adequately diagnose, manage and refer when necessary pulmonary emergencies such as impending herniation due to increased ICP, etc.

    • g. Endocrinology diagnose and treat diabetes mellitus and common thyroid disorders, and diagnose, manage and refer when necessary endocrine emergencies such as DKA, HNKS, hypoglycemia, adrenal insufficiency, etc.

    • h. Hematology diagnose common hematologic conditions and be able to know how to do routine hematologic procedures including the techniques of performing bone marrow aspiration with guidance. Be able to interpret laboratory results.

    • i. Dermatology able to know how to diagnose common dermatological problems and identify dermatologic manifestations of systemic diseases.

    • 6. Must be able to maintain organized and accurate medical records.

    Third Year

    • 1. Mastery of knowledge in pathophysiology, biochemistry, special diagnostic procedures and therapeutic skills in the different specialties as enumerated above.

    • 2. Expertise in clinical problem solving and decision making for patients with chronic diseases and disorders seen in Internal Medicine ambulatory practice, and management of more complex problems in the critical care setting.

    • 3. Must be able to supervise junior residents in managing cases seen at the OPD and managed in the wards, setting end points for patient’s hospital confinement and criteria for discharge.

    • 4. Must be able to teach junior residents and interns regarding the diagnosis and treatment of common medical cases.

    • 5. Must be able to maintain organized and accurate medical records.

    • 6. Administrative function and responsibilities. *A Chief Resident is chosen among the residents after thorough evaluation and recommendation by the members of the training core of the Department.

    • B. RESIDENTS’ ASSIGNMENTS / ROTATIONS:

    (Pls. see attached schedule for the year and see attached SOP’s for residents on specific rotations)

    LEVEL I:

    At least 80% of their patient exposure should be at the General wards and Out-Patient setting Wards at least 5 months

    OPD

    at least 5 months

    ER

    1 month (transition period)

    LEVEL II:

    Primary responsibility for Medical ER cases

    ER

    - at least 4 months

    Subspecialty Rotations

    22

    Category I - at least 2 months rotation (Cardio, Pulmo, ID,) Category II, III, IV - at least 1 month rotation in each subspecialties (May be taken together with rotation in other subspecialty if manpower is not enough to cover all areas of responsibility)

    LEVEL III:

    Primary responsibility for ICU/CCU cases; OPD, ward, ER (supervisory)

    ICU (primary) - at least 4 months OPD 2 months (supervisory) Ward 2 months (supervisory) ER 2 months (supervisory) Minor Subspecialties at least 1 month

    C. METHODOLOGY

    • 1. At the start of training, the resident will receive:

      • a. A copy of year-level competencies for the 3 years of Residency Training

      • b. A list of diseases/disorders seen in Philippine Internal Medicine Practice

      • c. An outline of the components of clinical problem-solving and decision-making

  • 2. The Resident will use the above as guides for his clinical performance in managing patient- problem. His immediate Senior Resident will serve as his clinical supervisor on a daily basis; including recordkeeping.

  • 3. The Resident will present Resident-managed cases to Consultants for education supervision, towards development of clinical competence.

  • 4. The Consultant will use the format for the supervision process. At the end of each supervision, the Consultant will provide feedback to the Resident regarding his needs for improving clinical reasoning in problem solving and decision-making.

  • 5. Daily Activities:

  • a.

    Endorsement is done twice daily, in the morning and afternoon. Morning endorsements are

    conducted by the consultant on call during the previous 24 hour duty or the chief and senior resident.

    b.

    Bedside rounds on the admitted patients are done with the respective consultant and senior

    resident.

    c.

    The post duty residents are required to give a census of the admission during their tour of duty to

    the consultant.

    d.

    After bedside rounds, they are required to fill up progress notes detailing their diagnosis and

    management of the patients, and consultant’s input for each case.

    e.

    Follow-up of cases previously admitted under the consultant’s service is also done during bedside

    rounds.

    Afternoon endorsements are done between residents, supervised by the Chief Resident and the Senior Residents.

    f.

    • 6. Emphasis is also placed on conferences, case discussions and lectures. All residents are required to attend at least 50% of the scheduled conferences and lectures.

    a) Weekly departmental conferences are done scheduled as follows

    SCHEDULE

    CONFERENCE

    1 st Tuesday of the month

    Grand Rounds

    23

    2 nd Tuesday of the month 3 rd Tuesday of the month 4 th Tuesday of month 1st Thursday of month 2 nd Thursday of month 3 rd Thursday of month

    Case Management Morbidity & Mortality Journal report/CAT, Research Grand Rounds Case Management Morbidity & Mortality

    4 th Thursday of month Note: Harrison’s Club is Scheduled 3 PM

    Journal report/CAT, Research

    3 times a week

    • b) Bi-monthly conferences:

    PCP Inter-hospital grand rounds

    • c) Mid-year Research Conference (Update on progress of researches)

    • d) Yearly Research Workshop

    • e) Yearly Resident’s Research Presentation

    • 7. Medical residents are encouraged to join the inter-hospital competitions as set by the PCP.

      • a) Yearly PCP Inter-hospital Research Contest

      • b) PCP Quiz Bowl

      • c) Annual Inter-hospital Clinico-pathologic Conference

  • 8. Medical Staff meeting done quarterly

  • 9. Community Outreach Program on selected Barangay and District Hospitals

  • D. TEACHING-LEARNING ACTIVITIES

    The various teaching-learning activities shall be aligned and congruent with the year level competencies, duties, and responsibilities.

    • 1. Bedside Rounds The Bedside Rounds are conducted at the different areas of the hospital (Emergency Room, Wards, ICU, OPD).

      • a. The bedside rounds are conducted by the consultant in-charge among difficult to manage patients

    referred by resident in-charge in specific areas. b. Effective bedside teaching is patient-based and patient-oriented.

    • c. The bedside rounds should prepare residents for the extent of work in managing the patients and

    the responsibility as a clinician.

    • d. The consultant should show residents how a clinician uses their clinical and generic skills.

    • e. The consultant should be aware of not just the learner but also the welfare of the patient.

    • f. Bedside rounds should be an effective venue for “role-modeling”.

      • 2. Conferences

    (Grandrounds, Case Presentation, Mortality & Mortality and Journal reports)The conferences are

    venues for teaching-learning activities between residents and consultants.

    • 3. Lecture Series/ Seminar / Workshops Lecture series seminar and workshops are additional venues for Teaching learning activities.

    • 4. Role modeling

      • a. Role modeling is another teaching- learning tool for training faculty and consultants.

      • b. The consultants can impart their knowledge, skills and values to the residents and their peers.

    24

    c. An effective role model should possess Clinical competence, teaching skills, positive personal qualities and professionalism.

    5. Self-Study

    Contestants to the Quiz Bowl were allowed to have off the floor for one week prior to the PCP Inter- hospital Quiz Bowl

    E. EVALUATION (see attached evaluation forms)

    1. EVALUATION CRITERIA

    • a. Cognitive Evaluation

    i. Summative Evaluation

    Clinical reasoning Data gathering Long Exams/Quizzes Grandrounds/M&M/Conferences RITE Year-end Evaluation Research

    ii. Formative Evaluation

    Clinical reasoning Data gathering Attitude Psychomotor Skills Research

    • b. Attitudinal Competence

    • c. Psychomotor Skills

    • 3. SCHEDULE AND MODE OF EVALUATION:

      • A. Formative Evaluation

    This evaluation is not graded and focuses on identifying areas for improvement of the resident with substantial feedback on the performance and advice on how to improve with follow-up assessment on his/her progress. The evaluation is conducted every last week off the month.

    Evaluation

    Timing

    Data gathering

    Monthly

    Clinical reasoning

    Monthly

    25

    B.

    Summative Evaluation

     

    Clinical competence of residents should be evaluated periodically and documented using standard evaluation forms prescribed by PCP. Standard evaluation forms will be used to assess the data gathering skills and clinical reasoning (problem-solving, decision-making). The summative evaluation is conducted every quarter.

     

    Evaluation

     

    Timing

    Data gathering

     

    Quarterly

    Clinical reasoning

     

    Quarterly

    Long Exams

     

    Every 6 months

    Quizzes

     

    Monthly

    Case Presentations (Grandrounds/M&M)

    Monthly

    Year-end evaluation

     

    Once a year

     

    RITE

    YL I ,YL II and YL III residents

    Research(Journal/CATS/Proposals/outputs)

    Research Activities Schedule

    C.

    Psychomotor Skills Evaluation

     
     

    There are minimum required technical skills for the residents to develop and be evaluated

    per year level. Every consultant is required to evaluate at least two residents for an

    assigned technical skill pertaining to the consultant’s specialization at least four times a

    year. A PCP prescribed evaluation form is utilized to assess the psychomotor and technical skills of the residents.

    D.

    Attitudinal Assessment

     

    The self-evaluation on attitude will be compared with the evaluation done by other training core faculty or consultants. Any discrepancies identified should be discussed with the resident concerned. The evaluation tool enumerates the attitudes expected of an internist as defined by PCP. A PCP designed tool will be utilized and the evaluation will be done bi- annually.

    B. Summative Evaluation Clinical competence of residents should be evaluated periodically and documented using standard evaluation

    GENERAL PERFORMANCE EVALUATION

    26

    Criteria for evaluation and Performance

    Criteria

    Percentage

    A. Clinical Competence

    50

    • 1. Data Gathering

    10

    • 2. Clinical Reasoning

    10

    • 3. Technical Skills

    10

    • 4. Medical Records Review

    10

    • 5. Performance in Conference

    10

    • B. Professionalism

    20

    • 1. Punctuality and Attendance

    4

    • 2. Social Maintenance

    4

    • 3. Inter Personal Relationship

    4

    • 4. Doctor Patient Relationship

    4

    5. Completion of Medical Record

    4

    • C. Written Exam

    15

    • D. Research Output

    15

    Note: Adopted during the Workshop, Nov. 15/17, Cebu City.

    The department’s Promotional Board Committee together with the department chairman and

    training officer will convene at the end of the year to review performance status of each residents.

    Residents will then be qualified as candidates for promotion if they fulfill the following criteria:

    • a. Rating of 70% and above based on the criteria mentioned above.

    • b. Completion of research requirement for specific year level.

    F. RESEARCH

    Research requirements:

    Level I Option 1: Critical Appraisal CAT on Therapeutics - 2 CAT on Diagnostics - 2 Option 2: Case Report or Case Series Option 3: New or updated Meta-Analysis or Systematic Review (maximum of 3 residents to a paper) Option 4: Descriptive Study (maximum of 3 residents to a paper)

    Level II Option 1: Critical Appraisal CAT on Therapeutics 2 CAT on Diagnostics 2 CAT on Prognosis 2 Option 2: Completed Research Protocol

    27

    Level III Option 1: Critical Appraisal CAT of Meta- analysis 2 With or without CAT on Clinical Practice Guidelines 2 Option 2: Completed Research

    Level III – Option 1: Critical Appraisal CAT of Meta- analysis – 2 With or without

    SECTION A:

    • 1. 6:00-8:00 A.M. - Post duty medical resident makes rounds on the patients admitted during their tour of 24 hours duty together with the medical intern. He writes down progress notes and records significant changes in physical diagnosis and laboratory results. He sees to it that stat laboratory requests had been done and results are duly posted in the chart, and whether medications are adequate or not. The intern must be ready to make suggestions when he makes rounds with the resident.

    • 2. 8:00-9:00 A.M. - ENDORESEMENT TIME. The previous 24hr-duty resident and interns endorse to the members of the medical department in the presence of the scheduled medical specialist and residents all admissions, mortality and morbidity cases. Discussions of important cases endorsed may be made. Topics assigned for discussion will be taken up during this period.

    3:00-4:00 P.M. Ward residents and interns endorse to 24 hour duty residents and interns all serious cases in the wards.

    • 3. 9:00 A.M. MEDICAL DEPARTMENT ROUNDS. Consultants on call the previous day makes bedside rounds with the residents and interns. Residents and interns must be ready to report on the progress of the patients under their care. Resident must study and discuss the ward course of the patients and management being done with the consultant. At 9:00 A.M., the OPD residents reports to the OPD, the rest of the members of the Medical Department proceeds with the rounds. Residents and interns leave the wards if they are called at the ER during the rounds.

    • 4. All residents and interns are required to attend all conferences from Monday Saturday.

    • 5. Residents of the Medical Department are enjoined to attend at least 50% of the scheduled conferences of the other departments (especially when cases presented have been co-managed with the department).

    • 6. All residents and interns of the Medical Department (except those on 24-hours duty) are required to attend monthly PCP Inter Hospital Grand Rounds.

    SECTION B. DUTIES OF RESIDENTS ON ER ROTATIONS:

    • 1. Stations will be at the ER. He attends to all emergency cases from 8:00 A.M. to 4:00 P.M.

      • a. Gets the history and medical examination

      • b. Requests for the needed laboratory aid

      • c. Institutes emergency measures needed

      • d. Call the consultants for help if needed

      • e. Informs the consultant on call of all cases admitted

  • 2. May relegate seatwork of minor procedures to his interns but only under supervision.

  • 3. Must involve his interns in the examination and management of the cases and teach the intern all there is to know about the case.

  • 4. Countersign all prescriptions and orders written by the intern.

  • 5. Under no condition must the patient in the ER be discharged without the knowledge of the ROD.

  • 6. Checks that stat laboratories and special procedures requested are done.

  • 29

    7.

    Checks history and PE made by the intern.

    • 8. Must refer all ER cases to the consultant on call. Must give the consultant a rundown of the admissions at the end of the day and present the admission to the consultant during bedside rounds the following day.

    • 9. Must endorse all morbid cases still at the ER and awaiting ward admission to the incoming residents on duty at 4:00 P.M.

      • 10. DOA cases must be reported to the City Health Office of the Provincial Health Office during working days and to the Integrated National Police during holidays and Sundays.

      • 11. Death within 48hours of admission must be worked for autopsy. Residents in charge of the case will always be present during the autopsy and should follow up cases for autopsy.

    SECTION C. DUTIES OF RESIDENTS AND INTERNS ON WARD ROTATION:

    • 1. Responsible for medical care of ward patients during office hours. Ward resident must properly endorse his patients, especially those who require close monitoring, to the resident on duty during the afternoon endorsements.

    • 2. Ward resident supervises all minor medical and surgical procedures to be done by ward interns or intern in charge.

    • 3. Ward resident and intern answer all referrals, ward and interdepartmental, during office hours. CP and medical clearances requested during office hours will be the responsibility of the second or third year ward resident.

    • 4. The First year ward resident refers cases with dilemma in terms of diagnosis, management, or disposition to the senior ward resident and then to service consultant.

    • 5. The senior ward resident supervises first year resident in management of cases. He must conduct regular rounds to review management of cases by the first year, guiding the latter in terms of diagnosis and management of complicated cases and appropriate disposition of long standing patients. He must be aware of the cases that need immediate referral to the service consultant.

    • 6. The ward residents must update the service consultant on the status of the patients under the consultant’s service during bedside rounds after the daily endorsement conducted by the consultant.

    SECTION D. DUTIES OF RESIDENTS AND INTERNS ON OPD ROTATION: (see attached OPD policies)

    • 1. OPD hours is 8:00AM-5:00PM Mondays thru Fridays and 8:00-12:00P.M. Saturdays No OPD on Saturday afternoon, Sundays and Holidays.

    • 2. All assigned to the OPD must be there at the above stated time.

    • 3. Residents consult OPD patients and do the proper examination and treatment.

    • 4. Residents supervise the interns during consultations at the OPD and must countersign all prescriptions or medications suggested by the intern if he agrees to them.

    30

    5.

    Residents must refer all patients for pre-operative clearance and difficult cases to the assigned OPD consultant.

    • 6. The junior OPD resident is in charge of the OPD census at the end of the day. All cases seen for the day must be logged and classified whether they are new or follow-up cases. He must summarize the census at the end of the day. OPD resident assigned there on the last OPD day of the month must summarize the census for the month.

    • 7. Senior OPD resident must coordinate with OPD consultant-in-charge regarding OPD activities for the month. (Schedule of review of pre-op cases, journal report on OPD cases, etc.)

    SECTION E. DUTIES OF RESIDENTS OF ICU ROTATION

    • 1. Responsible for medical care of ICU patients during office hours. ICU resident must properly endorse all ICU patients to the resident on duty during the afternoon endorsements.

    • 2. Evaluate patients referred for ICU admission from the ER and the wards and prioritizes admissions according to need for ICU care.

    • 3. Facilitates transfer of patients from ICU to the wards when patient no longer require critical care.

    • 4. Updates the service consultant on the status of the patients under the consultant’s service during bedside rounds after the daily endorsement conducted by that consultant as needed.

    SECTION F.

    DUTIES OF RESIDENTS ON SUBSPECIALTY ROTATION (AS PRESCRIBED BY

    SUBSPECIALTY CONSULTANT)

    SECTION G. DUTIES OF THE RESIDENT ON 24 HOURS DUTY

    • 1. Residents go on duty every three to four days.

    • 2. They are assigned either as mainly ER or mainly WARD residents on duty but they must station themselves at the ER when on duty. (The WARD resident must reinforce the ER resident at the ER while awaiting ward calls).

    • 3. The ER ROD is in charge primarily of the ER cases.

    • 4. The Ward ROD is in charge of all patients in the medical wards and answers all ward referrals and monitors serious patients. He answers all referrals from other departments and does emergency evaluation. He must report his findings to the senior resident or consultant before making it final.

    • 5. Senior resident on 24 hour duty do intra-op monitoring, mans the dialysis unit and assist junior residents with problematic cases.

    SECTION H. DUTIES OF INTERNS:

    • 1. Interns on Duty

    a.

    Sees and

    examines all patients that come in to

    the ER preferably with

    the ROD.

    Patients seen and admitted by him alone must be endorsed to the ROD personally.

    • b. Writes admitting notes of all patients admitted during his tour of duty.

    31

    • c. Writes complete history and PE and fills up laboratory request for patients admitted.

    • d. Follow-up patients in the ward after office hours together with his ROD.

    • e. Inform ROD of referrals in the wards especially the critical patients.

    • f. Must not leave the ER without informing the nurse on duty and writes down his exact whereabouts.

    • 2. General

      • a. Under supervision of his resident, writes down prescription orders and do minor procedures. All prescription he writes must be countersigned by the resident.

      • b. Discharge summaries or important cases must be written by the intern in charge in duplicate, one copy of which should be attached to the chart and another copy to be given to the patient.

      • c. Checks all necessary preparations for x-ray procedures, blood chemistries, and other special examinations to be done early in the morning should have been duly accomplished before patients are sent for these special procedures.

      • d. Must inform senior resident or any resident or staff nurse of his whereabouts.

    SECTION I. ADMISSION AND ASSIGNMENT OF CASES:

    • 1. Admitting interns and resident automatically take charge of the cases admitted by them. Ward resident in charge will be held responsible for the follow-up of the case in the wards. Patients in the subspecialty section will be followed up by the resident assigned in that subspecialty.

    • 2. Patients for transfer of service will be taken charge of by the resident who first saw the patient. Interns on duty during transfer takes charge of the patient with that resident.

    • 3. Resident may if he chooses assign cases to interns “on deck” system depending upon the number of interns available.

    • 4. If there are no interns available, the resident is responsible for doing all seatwork necessary for completion of records.

    • 5. Patients referred from or to be transferred from other departments shall not be admitted by the Medical Resident on duty without prior notice and approval from the Consultant on call for the day.

    SECTION J. REFERRALS

    • 1. All serious cases and cases of questionable diagnosis must be referred to the consultant of the department and suggestions to be noted down either on the consultant’s referral slip or in the progress notes.

    • 2. Interdepartmental referral is encouraged. It can be on a resident to resident or consultant to consultant basis. Referral slip must be duly filled out and handed personally to the consultee concerned.

    Result of such consultation must all be duly written down either on the consultation sheet or in the progress notes. When the opinion of the consultant of the other department is desired, it must be with the knowledge or consent of the consultant of the medical department.

    • 3. CP or medical Preoperative Evaluation request for cardiopulmonary or medical preoperative evaluation for elective operative procedures should be referred in at least 24 hours before operation with complete laboratory work up. Preoperative evaluation for elective cases will be done by designated 2 nd and 3 rd year residents.

    32

    4.

    All discharged patients should be given referral slip/discharge summaries to corresponding rural physicians or with health officer or district hospital for follow-up.

    • 5. Interdepartmental referrals in the wards are to be answered according to urgency of the cases, upon receipt of written or oral referral. To facilitate speedy action, it is encouraged that the most senior resident available will answer the referral. Referrals of critical cases from other departments should be seen immediately by the most senior resident of the answering department.

    • 6. Emergency Medical Service (EMS) referrals will follow EMS rules.

    4. All discharged patients should be given referral slip/discharge summaries to corresponding rural physicians or with

    WESTERN VISAYAS MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE

    GENERAL GUIDELINES FOR SPECIFIC TRAINING AREAS

    I. OUT-PATIENT DEPARTMENT

    33

    • a. An OPD training coordinator is assigned to supervise and direct the teaching-learning activities

    and programs of the area (Dr. Diana Marie Cacho)

    • b. YL I residents are assigned monthly to cater to new walk-in OPD consultation and OPD referrals

    from other departments and their subsequent follow-up consultations.

    • c. Another YL III resident is assigned to do Medical and Cardio-pulmonary evaluation prior to

    surgery referred by other department.

    • d. An OPD consultant in-charge is assigned every month. OPD general medicine cases referrals

    are directed to the consultant. However, OPD subspecialty referrals are directed subspecialist on deck.

    • d. OPD training competencies consistent to YL status of residents are given to residents upon

    entry to training and reiterated during every OPD assignment.

    • e. Teaching-learning activities and programs at the OPD are also conducted like case

    presentations and didactics involving common and uncommon OPD cases encountered.

    • f. OPD census are also recorded by the residents and summary are presented during mortality and morbidity conference.

    • g. OPD programs like Diabetes Club, Asthma Club etc. are being spearheaded and facilitated by

    the resident coordinator and also the resident assigned at the OPD.

    • h. Evaluation of the OPD resident is conducted by the assigned consultant at the end of every

    month.

    II. EMERGENCY ROOM.

    • a. An ER training coordinator is assigned to supervise and direct the teaching-learning activities

    and programs of the area (Dr. Kathryn Joyce Gorriceta)

    • b. YL II residents are assigned monthly to cater to ER patients both walk-in and referral cases from

    other hospitals.

    • c. Another YL III resident maybe assigned at the ER to do supervision and receive referrals of the

    YL II resident. In case that no YL III resident is assigned referrals of the ER YL II resident may be

    directed to the chief resident or the assigned consultant.

    • d. An ER consultant in-charge is assigned every month. ER general medicine and subspecialty

    cases referrals are directed to the assigned general medicine consultant. ER subspecialty cases that needs subspecialty opinion are directed to subspecialist on deck at the discretion of the resident as conferred with the general medicine consultant.

    • d. ER training competencies consistent to YL II status and ER rotation of residents are given to

    residents as guidelines upon entry to training and is reiterated during every ER assignment.

    • e. Teaching-learning activities at the ER are also conducted like case presentations and didactics

    involving common, uncommon and critical cases encountered.

    • f. The consultant-on-duty must do bedside rounds of admitted patients together with the residents

    with emphasis on proper history taking, physical examination and decision making at the ER.

    34

    • g. ER census are also recorded and submitted by the residents and summary are presented during

    mortality and morbidity conference every month.

    • h. Evaluation of the ER resident is conducted by the assigned consultant at the end of every

    month.

    II. INTENSIVE CARE UNIT

    • a. A training coordinator is assigned to supervise and direct the teaching-learning activities and

    programs of the area (Dr. Marcelino Felisarta)

    • b. YL III residents are assigned monthly to make rounds and do daily follow-up of patients status,

    laboratories and management at the ICU.

    • c. An ICU consultant in-charge is assigned every month. ICU general medicine and subspecialty

    cases referrals are directed to the assigned general medicine consultant. ICU subspecialty cases that needs subspecialty opinion are directed to subspecialist on deck at the discretion of the resident and as conferred with the general medicine consultant.

    • d. ICU training competencies consistent to YL III status and ICU rotation of residents are given to

    residents as guidelines upon entry to training and is reiterated during every ICU assignment.

    • e. Teaching-learning activities at the ICU are also conducted like case presentations and didactics

    involving common, uncommon and critical cases encountered.

    • f. Teaching-learning activities at the ICU are also conducted during bedside rounds with general medicine and subspecialty consultants.

    • g. The assigned consultant must do bedside rounds of admitted patients together with the

    residents with emphasis on critical care management and decision making.

    • h. ICU census are also recorded and submitted by the residents and summary are presented

    during mortality and morbidity conference every month.

    • i. Evaluation of the ICU resident is conducted by the assigned consultant at the end of every month.

    II. GENERAL WARDS

    • a. Training coordinators were assigned to supervise and direct the teaching-learning activities and

    programs of the area (Dr. Joy Gulmatico and Dr. Felice Molina)

    • b. YL I residents are assigned monthly to make rounds and do daily follow-up of patients status,

    laboratories and management of patients at the wards.

    • c. Specific ward consultant-in-charge are assigned every month as general medicine consultant.

    Referrals from their specific wards must be directed to them by the ward resident-in-charge.

    • d. Subspecialty cases referrals are directed by the ward resident to the assigned subspecialty

    resident and subsequently referred by the latter to the subspecialty consultant.

    • d. Ward training area competencies consistent to YL I status and YL II along with their respective

    ward training and subspecialty training competencies respectively are given to residents as guidelines upon entry to training and are reiterated during every ward or subspecialty assignment.

    35

    • e. Teaching-learning activities at the wards are also conducted like case presentations and

    didactics involving common, uncommon and difficult to manage cases encountered as scheduled with the department’s activities.

    • f. Teaching-learning activities at the wards are also conducted during bedside rounds with general medicine and subspecialty consultants.

    • g. The assigned consultant must do bedside rounds of admitted patients together with the

    residents with emphasis on general medicine management for YL residents and subspecialty

    management with YL II residents respectively.

    • h. Ward census must recorded and submitted by the residents and summary are presented during

    mortality and morbidity conference every month.

    • i. Data gathering and clinical reasoning skills are also assessed by individual consultants during bedside rounds or during scheduled evaluation of the resident.

    • i. Attitude and professional demeanor of the residents are also observed during bedside rounds by the consultant.

    • i. Psychomotor evaluations are also conducted at the wards during scheduled procedures at the supervision of the senior resident and/or the consultant.

    • i. Evaluation of the ward resident rotator is conducted by the assigned consultant at the end of every month.

    e. Teaching-learning activities at the wards are also conducted like case presentations and didactics involving common,

    WESTERN VISAYAS MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE

    • I. ROTATION IN CARDIOLOGY

    • A. DURATION OF TRAINING ROTATION: Minimum of Two Months

    • B. REQUIREMENTS:

      • 1. Medical residents assigned to rotate in section of cardiology must have completed the YL I residency training.

      • 2. She/he is free from ward assignment during the duration of the training.

      • 3. He will continue his 24 hours duty as scheduled by the Chief resident.

      • 4. 4. Must be evaluated by the consultant at the end of each rotation.

  • C. OBJECTIVES

    • 1. To provide subspecialty exposure and hands-on experience on handling cardiology cases to

  • medical residents on their second year of training.

    • 2. To discuss the epidemiology, pathogenesis, clinical manifestations, treatment, prevention

    and control of common and uncommon cardiac diseases.

    • 3. To correlate the pathogenesis and clinical presentation of common and uncommon

    cardiology diseases.

    • 4. To familiarize with the different diagnostic procedures and laboratory test, rational use of

    appropriate tests and interpret the significance of their results.

    • 5. To recognize potential complications of cardiac diseases, reactions and outcome of

    treatment and prognosis.

    D. STRATEGIES

    • 1. Each medical resident should have at least two months rotation under the section of cardiology during his/her second year of training.

    • 2. The resident rotator must be in constant coordination with the subspecialty consultant to update for the cases managed and to communicate the activities of the subspecialty.

    • 3. The residents other than the cardiology resident rotator of the month must also participate in the didactic activities of the section.

    • 4. There should be actual exposure and learning especially in ECG, 2-D-Echo, and stress and other diagnostic and therapeutic procedures.

    • 5. Should be able to do basic cardio-pulmonary resuscitation and utilize equipment’s like AED and understand the principles of the use of this equipment’s.

    E. DUTIES AND RESPONSIBILITIES

    CARDIOLOGY RESIDENT ROTATOR OF THE MONTH

    37

    1.

    Do history, physical examination and formulate a rational clinical impression of all cardiology referrals from the emergency room, wards, other medical subspecialties and departments.

    • 2. Personally inform and update the cardiology consultant of all referrals.

    • 3. Resident shall be responsible to receive referrals, make rounds, follow-up and refer to

    consultant in cardiology.

    • 4. Will be present to observe and assist during special procedures such as 2-D

    Echocardiograph, Stress test, ECG, etc performed by the Consultant In-Charge of the specialty.

    • 5. Makes follow-up results of all diagnostic tests done and reflect findings on progress notes

    for all cardiology patients assigned.

    • 6. Prepare a protocol and present an assigned case for conference.

    • 7. Collect specimen for blood studies and other laboratory studies properly.

    • 8. Do researches on cardiology topics under the supervision of the cardiology consultant as

    needed.

    • 2. To be able to assist or perform basic diagnostic and therapeutic cardiology procedures like pericardiocenthesis and cardioversion.

    • 3. Log all cardiology referrals daily and submits census at the end of the month rotation.

    • 9. Endorse all patients properly to the next cardiology rotator at the end of the one- month

    rotation.

    OTHER RESIDENTS

    • 1. Attend all cardiology conferences and didactics.

    • 2. Refer accordingly difficult to manage cardiology cases to cardiology rotator.

    II. ROTATION IN GASTROENTEROLOGY

    A. OBJECTIVES

    • 1. PRIMARY OBJECTIVE

    a. To train medical resident in the field of Gastroenterology

    • 2. SECONDARY OBJECTIVE

    38

    • a. To develop competent internist in diagnosis and management of common

    gastrointestinal diseases.

    • b. To develop the skills of medical residents in performing the different diagnostic

    procedures

    • c. Must be evaluated by the consultant at the end of each rotation.

    • B. CURRICULUM

      • 1. A thorough knowledge and understanding of the following:

        • a. gastrointestinal tract normal anatomy and physiology

        • b. Pathogenesis and pathophysiology of common disorders such as:

          • - Esophagitis, esophageal carcinoma, motility disorders, peptic ulcer, - - stress ulcer, drug induced ulcer, gastritis, carcinoma

          • - H. pylori infection, intestinal tuberculosis, irritable colon

          • - Amoebic ulcerative colitis, diverticular disease, ascites

          • - Portal hypertension, cholelithiasis, cholecystitis, biliary ascariasis

          • - Hepatobiliary TB, pancreatitis and peritonitis. Diagnostic

          • - Therapeutic principles for gastrointestinal tract diseases and their complications.

  • 2. Development of sufficient skills:

    • a. Diagnosing gastrointestinal tract illnesses

    • b. Choosing appropriate laboratory and diagnostic tools

    • c. Developing competencies in performing the following procedures:

      • - read GB series, upper GI series and barium enema

      • - know how to do proctosigmoidoscopy, colonoscopy and upper GI Endoscopy

      • - Paracentesis

      • - Aspiration of liver abscess

      • - Liver biopsy

  • III. INFECTIOUS DISEASES SECTION

    • A. AIM

    To provide subspecialty exposure and hands-on experience of handling infectious and tropical disease to medical residents from the second year until their final year of training.

    • B. OBJECTIVES

    39

    1.

    To discuss the microbiologic nature, epidemiology, pathologenesis, clinical manifestations,

    treatment, prevention and control of common and uncommon infectious diseases.

    • 2. To discuss the principles of rational antibiotics use

    • 3. To familiarize with the different diagnostic microbiologic studies and be able to interpret the

    significance of their results

    • 4. To recognize potential sources of nosocomial infection and how these could be controlled

    • C. STRATEGIES

      • 1. Each medical resident should have at least one month rotation under the section of infectious diseases yearly from his second year training until his senior year.

      • 2. Resident other than the infectious diseases resident of the month will participate in the didactic activities of the section.

      • 3. There should be hands-on activities of specimen collection and smear preparation for the

    infectious resident of the month.

    • 4. Must be evaluated by the consultant at the end of each rotation.

    • D. DUTIES AND RESPONSIBILITIES

    INFECTIOUS DISEASES RESIDENT OF THE MONTH

    • 1. Do history, physical examination and formulate a rational clinical impression of all infectious

    referrals from the emergency room, other medical subspecialties and departments.

    • 2. Personally inform and update the Infectious Diseases consultant of all referrals.

    • 3. Make daily bedside rounds, follow-up results of all microbiologic studies done and reflect

    findings on progress notes for all infectious patients assigned.

    • 4. Prepare a protocol and present an assigned case for conference.

    • 5. Collect specimen for microbiologic studies properly.

    • 6. Do at least one gram stain and one acid fast smear.

    • 7. Do surveillance study under the supervision of the Infectious Diseases as needed.

    • 8. Log all referrals daily.

    • 9. Endorse all patients properly at the end of one-month rotation

    OTHER RESIDENTS

    • 1. Attend all infectious Diseases conferences

    • 2. Present assigned didactics topic

    40

    ACTIVITIES

    ACTIVITY

    RESIDENT

    Infectious Diseases Case Conference

    Admitting Resident and Infectious Diseases Resident of the Month

    Didactics/Updates

    First year resident

    Antibiotics hour

    Second year or Third year resident

    Tour of the Bacteriology and Microscopy Sections (Laboratory)

    Infectious Diseases Resident of the Month

    Gram stain, AFB smear, specimen collection

    Infectious Diseases Resident of the Month

    Surveillance

    Infectious Diseases Resident of the Month

    IV. GUIDELINE FOR ROTATION IN NEPHROLOGY

    I. OBJECTIVES

    1. General Objective

    41

    • a. To gain knowledge, understanding and clinical skills in the diagnosis and management

    of common acid-base and electrolyte problems and renal disease both in the inpatient and outpatient department.

    2. Specific Objectives

    • a. To develop competent internists in diagnosis and management of common renal

    diseases.

    • b. To correlate clinical presentation with diagnostic examinations, give differentials to be

    able to arrive at a valid diagnosis.

    • c. To carry out a comprehensive, continue effective and long term management plan for

    the different nephrologic disorder.

    • d. To display punctuality, intellectual honesty, inquisitiveness and thoroughness in

    performing duties and responsibilities.

    • e. To demonstrate proper attitude, sensitivity decorum towards patient and their families

    with emphasis on the psychosocial and financial problems of patients with chronic renal failure.

    B. CURRICULUM

    1. Thorough knowledge and understanding of the kidneys

    • a. Normal anatomy and physiology of the kidneys

    • b. Pathogenesis and Pathophysiology of renal diseases and its complications

    • c. Diagnostic and Therapeutic principles in renal diseases and its complications

    • d. The basic principles in renal replacement therapy (RRT):

    hemodialysis, peritoneal dialysis

    2. Development of sufficient skills in:

    • a. Obtaining an accurate and thorough nephrological history and physical examination

    • b. Choosing appropriate laboratory and diagnostic/ ancillary tools

    • c. Integrating, interpreting and analyzing data to establish a diagnosis and management of:

    acid-base disorderes, fluids and electrolytes, renal disease

    • d. Clinical exposure on hemodialysis

    • e. Development of the following attitudes:

      • a. Integrity, respect and compassion for patients and their families

      • b. Desire to learn and update knowledge and kills

      • c. Dedication to duty and commitment to patient care

      • d. Consistent demonstration of high standard of moral and ethical behavior

    42

    • C. ACTIVITIES

      • 1. Actual Patient Care

        • a. ER

        • b. ICU

        • c. In patient

        • d. Out patient

        • e. Hemodialysis

        • f. Skills- AV fistula cannulation

  • 2. Clinical Rounds

  • 3 . Didactic Lectures- resident on rotation lectures on different topics in Nephrology

    • 4. Case Presentation- an interesting case encountered in the ward or outpatient department is

    presented. The discussion encompasses the basic etiophysiology of the disease, its clinical

    manifestations, complications, treatment and prognosis.

    • 5. Journal Report

    • D. DUTIES AND RESPONSIBILITIES OF ROTATING RESIDENTS

      • A. In Patients

        • 1. The resident on rotation must know all renal cases admitted.

        • 2. Make initial notes on all new referrals.

        • 3. Shall make daily rounds of the patients and follow-up on the progress of the patients and attends to the immediate problems. He/she must report any eventuality to the consultant. He/she must known all latest results of laboratory/ancillary procedures of the patients and update the consultant.

        • 4. Make recommendations regarding the management of the case, with emphasis on acid-base and fluid and electrolyte disorders, recognition of drugs and interventions with nephrotixic potential, assessing patients for possible dialytic therapy and perioperative management and the common medical disorders in pregnancy

        • 5. Endorse all referrals to the next nephrology rotator.

  • B. Hemodialysis

    • 1. All hemodialysis patients are seen anytime during the duration of the session.

    • 2. The resident shall take a brief interval history and necessary medications and laboratory requests shall be ordered accordingly.

  • 43

    3.

    The resident shall update the consultant about the progress/changes in the patients as well as changes/adjustments in their medications or ancillary/laboratory procedures.

    • 4. For emergency cases or unstable patients, the resident must stay at all times in the unit until hemodialysis is terminated.

    • 5. The resident manages dialysis complications as per ordered in the SOP for treatment of dialysis complications.

    V. ROTATION IN PULMONOLOGY

    A. AIM

    44

    To provide subspecialty exposure and hands-on experience on handling pulmonary disease cases to medical residents on their second year of training.

    B. OBJECTIVES

    • 1. To discuss the epidemiology, pathogenesis, clinical manifestations, treatment, prevention and

    control of common and uncommon pulmonary diseases.

    • 2. To correlate the pathogenesis and clinical presentation of common and uncommon pulmonary

    diseases.

    • 3. To familiarize with the different diagnostic procedures and laboratory test, rational use of

    appropriate tests and interpret the significance of their results.

    • 4. To recognize potential complications of pulmonary diseases, reactions and outcome of

    treatment and prognosis.

    C. STRATEGIES

    • 1. Each medical resident should have at least two months rotation under the section of pulmonary medicine during his/her second year of training.

    • 2. The resident rotator must be in constant coordination with the subspecialty consultant to update for the cases managed and to communicate the activities of the subspecialty.

    • 3. The residents other than the pulmonology resident rotator of the month must also participate in the didactic activities of the section.

    • 3. There should be hands-on activities of ABG extraction, ventilator setting, ventilator trouble shooting, proper nebulization, chest physiotherapy, endotracheal intubation, appropriate suctioning and other procedures and competencies.

    • 4. Must be evaluated by the consultant at the end of each rotation.

    • A. DUTIES AND RESPONSIBILITIES

    PULMONOLOGY RESIDENT ROTATOR OF THE MONTH

    • 1. Do history, physical examination and formulate a rational clinical impression of all

    pulmonology referrals from the emergency room, wards, other medical subspecialties and

    departments.

    • 2. Personally inform and update the Pulmonology consultant of all referrals.

    • 3. Make daily bedside rounds, follow-up results of all diagnostic tests done and reflect findings

    on progress notes for all pulmonology patients assigned.

    • 4. Prepare a protocol and present an assigned case for conference.

    • 5. Collect specimen for blood studies and other laboratory studies properly.

    • 6. Do researches on pulmonology topics under the supervision of the pulmonary consultant as

    needed.

    45

    7.

    Log all pulmonology referrals daily and submits census at the end of the month rotation.

    • 8. Endorse all patients properly to the next pulmonology rotator at the end of the one-month

    rotation.

    OTHER RESIDENTS

    • 1. Attend all pulmonology conferences and didactics.

    • 2. Refer accordingly difficult to manage pulmonology cases to pulmonology rotator.

    ACTIVITIES

    ACTIVITY

    RESIDENT

    Pulmonary Case Conference

    Admitting Resident and Pulmonology Resident of the Month

    Didactics/Updates Interpret Chest radiographs Chest CT Scan Ventilator setting and troubleshooting Thoracenthesis and other procedures TBDC

    Pulmonology Resident All residents All residents All residents Pulmonology Resident

    VI. GUIDELINES FOR ROTATION IN NEUROLOGY

    A. OBJECTIVES

    46

    1.

    Primary Objective

    • a. To train Medical Residents in the field of Neurology.

    • 2. Secondary Objectives

      • a. To be able to train Medical Residents to recognize signs and symptoms of neurologic

    disorders and correlate with pathophysiology of diseases.

    • b. To develop competent internists in diagnosis and management of common and

    uncommon neurologic diseases.

    • c. To be able to train Medical Residents to do proper physical examination and perform

    common procedures like lumbar puncture.

    • d. To be able to train residents to interpret diagnostic test like CT scan and CSF analysis

    • B. CURRICULUM

    1. Thorough knowledge and understanding of the Neurologic System

    • a. Normal anatomy and physiology of the CNS

    • b. Pathogenesis and Pathophysiology of neurologic diseases

    • c. Diagnostic and Therapeutic principles in neurologic diseases and its complications

    • 2. Development of sufficient skills in:

      • a. Obtaining an accurate and thorough neurological history and physical examination

      • b. Choosing appropriate laboratory and diagnostic/ ancillary tools

      • c. Integrating, interpreting and analyzing data to establish a diagnosis

      • d. The management of common and uncommon neurologic conditions.

  • 3. Clinical exposure in:

    • a. Performance of lumbar puncture

    • b. Observation during EEG and CT Scan

  • 4. Development of the following attitudes:

    • a. Integrity, respect and compassion for patients and their families

    • b. Desire to learn and update knowledge and kills

    • c. Dedication to duty and commitment to patient care

    • d. Consistent demonstration of high standard of moral and ethical behavior

    • C. ACTIVITIES

    1. Actual Patient Care

    • a. ER

    • b. ICU

    • c. In-patient (Wards)

    47

    • d. Out patient

    • e. Skills- Comprehensive Neurologic Exam

    • 2. Clinical Rounds with Neurology Consultant

    • 3. Didactic Lectures- resident on rotation lectures on different topics in Neurology

    • 4. Case Presentation- an interesting case encountered in the ward or outpatient department is presented.

    The discussion encompasses the basic etiophysiology of the disease, its clinical manifestations, complications, treatment and prognosis. Problems encountered in the recognition and diagnosis of the case as well as controversies in the management are discussed. Literature search is presented by the discussant.

    • 5. Journal Report

      • D. DUTIES AND RESPONSIBILITIES OF ROTATING RESIDENTS

    In Patients

    • 1. The resident on rotation must see all patients referred to neurology service.

    • 2. Shall make daily rounds of the patients and follow-up on the progress of the patients and attends

    to the immediate problems of patients referred to the neurology service. He/she must report any

    eventuality to the consultant. He/she must known all latest results of laboratory/ancillary procedures of the patients and update the consultant.

    • 3. Attends consultant rounds.

    • E. PERFORMANCE EVALUATION

    Performance evaluation of the resident on rotation shall be done monthly at the end of the rotation. The evaluation will based on medical knowledge, clinical judgment, clinical skill on history and physical examination, medical care, attitude/professional behavior and academic interest.

    VII. ROTATION IN ENDOCRINOLOGY

    DURATION OF TRAINING ROTATION: Minimum of One Month

    REQUIREMENTS:

    48

    1.

    Medical residents assigned to rotate in section of endocrinology must have completed the YL I

    residency training.

    • 2. She/he is free from ward assignment during the duration of the training.

    • 3. He will continue his 24 hours duty as scheduled by the Chief resident.

    • 4. Must be evaluated by the consultant at the end of each rotation.

    OBJECTIVES:

    • 1. To provide subspecialty exposure and hands-on experience on handling endocrinology

    cases to medical residents on their second year of training.

    • 2. To discuss the epidemiology, pathogenesis, clinical manifestations, treatment, prevention

    and control of common and uncommon endocrine diseases.

    • 3. To correlate the pathogenesis and clinical presentation of common and uncommon

    endocrinology diseases.

    • 4. To familiarize with the different diagnostic procedures and laboratory test, rational use of

    appropriate tests and interpret the significance of their results.

    • 5. To recognize potential complications of endocrine diseases, reactions and outcome of

    treatment and prognosis.

    STRATEGIES

    • 1. Each medical resident should have at least two months rotation under the section endocrinology during his/her second year of training.

    • 2. The resident rotator must be in constant coordination with the subspecialty consultant to update for the cases managed and to communicate the activities of the subspecialty.

    • 3. The residents other than the endocrinology resident rotator of the month must also participate in the didactic activities of the section.

    • 4. Must facilitate or coordinate with the activities of the Diabetes Club.

    DUTIES AND RESPONSIBILITIES

    ENDOCRINOLOGY RESIDENT ROTATOR OF THE MONTH

    • 1. Do history, physical examination and formulate a rational clinical impression of all

    endocrinology referrals from the emergency room, wards, other medical subspecialties and departments.

    • 2. Personally inform and update the endocrinology consultant of all referrals.

    • 3. Resident shall be responsible to receive referrals, make rounds, follow-up and refer to

    consultant in endocrinology.

    • 4. Makes follow-up results of all diagnostic tests done and reflect findings on progress notes

    for all endocrinology patients assigned.

    49

    • 6. Prepare a protocol and present an assigned case for conference.

    • 7. Collect specimen for blood studies and other laboratory studies properly.

    • 8. Do researches on endocrinology topics under the supervision of the endocrinology

    consultant as needed.

    10. Log all endocrinology referrals daily and submits census at the end of the month rotation.

    • 9. Endorse all patients properly to the next endocrinology rotator at the end of the one- month

    rotation.

    OTHER RESIDENTS

    • 1. Attend all endocrinology conferences and didactics.

    • 2. Refer accordingly difficult to manage endocrinology cases to endocrinology rotator.

    VIII. ROTATION IN ONCOLOGY

    • A. DURATION OF TRAINING ROTATION: Minimum of One Month

    • B. REQUIREMENTS:

    50

    1.

    Medical residents assigned to rotate in section of oncology must have completed the YL I

    residency training.

    • 2. She/he is free from ward assignment during the duration of the training.

    • 3. He will continue his 24 hours duty as scheduled by the Chief resident.

    • 4. Must be evaluated by the consultant at the end of each rotation.

    C. OBJECTIVES

    • 1. To provide subspecialty exposure and hands-on experience on handling oncology cases to

    medical residents on their second year of training.

    • 2. To discuss the epidemiology, pathogenesis, clinical manifestations, treatment, prevention

    and control of common and uncommon oncology diseases.

    • 3. To correlate the pathogenesis and clinical presentation of common and uncommon

    oncology diseases.

    • 4. To familiarize with the different diagnostic procedures and laboratory test, rational use of

    appropriate tests and interpret the significance of their results.

    • 5. To recognize potential complications of oncology diseases, reactions and outcome of

    treatment and prognosis.

    D. STRATEGIES

    • 1. Each medical resident should have at least two months rotation under the section oncology during his/her second year of training.

    • 2. The resident rotator must be in constant coordination with the subspecialty consultant to update for the cases managed and to communicate the activities of the subspecialty.

    • 3. The residents other than the oncology resident rotator of the month must also participate in the didactic activities of the section.

    E. DUTIES AND RESPONSIBILITIES

    ONCOLOGY RESIDENT ROTATOR OF THE MONTH

    • 1. Do history, physical examination and formulate a rational clinical impression of all oncology

    referrals from the emergency room, wards, other medical subspecialties and departments.

    • 2. Personally inform and update the oncology consultant of all referrals.

    • 3. Resident shall be responsible to receive referrals, make rounds, follow-up and refer to

    consultant in oncology.

    • 4. Makes follow-up results of all diagnostic tests done and reflect findings on progress notes

    for all endocrinology patients assigned.

    • 6. Prepare a protocol and present an assigned case for conference.

    51

    7.

    Collect specimen for blood studies and other laboratory studies properly.

    • 8. Perform and give chemotherapy medications.

    • 8. Do researches on oncology topics under the supervision of the oncology consultant as

    needed.

    10. Log all oncology referrals daily and submits census at the end of the month rotation.

    • 9. Endorse all patients properly to the next oncology rotator at the end of the one- month

    rotation.

    OTHER RESIDENTS

    • 3. Attend all oncology conferences and didactics.

    • 4. Refer accordingly difficult to manage oncology cases to oncology rotator.

    7. Collect specimen for blood studies and other laboratory studies properly. 8. Perform and give chemotherapy

    52

    POLICY ON ADMISSION

    In addition to the rules and policies of the institution in administering an applicant must be:

    • 1. A doctor of Medicine degree holder.

    • 2. With good moral character (certificate from our institution or from an individual he/she had work with.

    • 3. Willing to be trained and devote his/ her time in the residency training.

    • 4. Satisfactorilly employed with the 2 months pre-residency training.

    • 5. Able to past the Internal Medicine Administrative Test (IMAT).

    • 6. Submitted the following original & in certified true copy:

      • a. Transcript of Records

      • b. Licensure Exam Grade

      • c. PRC Certificate

      • d. PGI Certificate

      • e. NBI Clearance

  • 7. Able to pass the Medical / PE / Character exam

  • 8. Able to pass the interview

  • 9. Able to pass the history taking & PE Skills (Data Gathering Skills)

  • POLICY ON ADMISSION In addition to the rules and policies of the institution in administering

    53

    POLICY ON PROMOTION

    1. The Resident has satisfactorily met with the expectations for the level of training as to knowledge, skills & attitude for all rotations during the year.

    Criteria for Evaluation and Performance

    Criteria

    Percentage

    • A. Clinical Competence

    50

    • 1. Data Gathering

    10

    • 2. Clinical Reasoning

    10

    • 3. Technical Skills

    10

    • 4. Medical Records Review

    10

    • 5. Performance in Conference

    10

    • B. Professionalism

    20

    • 1. Punctuality and Attendance

    4

    • 2. Social Maintenance

    4

    • 3. Inter Personal Relationship

    4

    • 4. Doctor Patient Relationship

    4

    • 5. Completion of Medical Record

    4

    • C. Written Exam

    15

    • D. Research Output

    15

    Recommendation for promotion shall be based on the summary of evaluation using the evaluation tools as endorsed by the Training Officer with the approval of promotional board, Hospital Training Officer and the Chief of the Medical Professional Staff.

    54
    54

    POLICY FOR GRADUATION

    A resident is deemed or graduate from the residency training if he/ she:

    • 1. Has successfully completed the requirements of the department per year level

    • 2. Has presented and submitted his/ her final research paper to the hospital research committee (Technical Review Committee and Ethical Review Committee)

    • 3. Has satisfactory met the expectation for the level of training as for knowledge, skills and attitude.

    55
    55

    POLICY ON TERMINATION

    • 1. Gross insubordination, it could be in the form of:

      • a. Deliberate disobedience to set rules & regulations of the department.

      • b. Physical attack on person of authority

      • c. Verbal abuse on person of authority

  • 2. Criminal and civil liabilities leading to imprisonment.

  • 3. Gross sexual and moral misconduct such as proven substance abuse disorders (drug dependence, alcoholism) promiscuity, adultery etc.

  • 4. Psychiatric illness disabling the individual to perform his duties as a resident physician

  • 5. Unauthorized extension of leave or AWOL

  • 6. Unsatisfactory or does not fully meet the expectation for the level of training

  • 56

    Training Manual for the MRSS Rotation Competencies The following are the objectives at the different areas

    Training Manual for the MRSS Rotation

    Competencies

    The following are the objectives at the different areas where the residents will rotate.

    • A. Critical Care Area, 1 month rotation

      • a. Entry Objectives:

    • 1. Have a functional knowledge of the principles of ICU management.

    • 2. Be able to identify patient for critical care management based on standard recommendations and accurately record it.

      • b. Terminal Objectives:

    • 1. Obtain a problem-directed, disease- associated history/PE as recorded in the chart.

    • 2. Determine the tests needed to confirm diagnosis of the problem and if needed, list further the test and decide which to request.

    • 3. Correctly interpret available diagnostic test results.

    • 4. Institute appropriate and timely treatment of diagnosed causes of the problem.

    • 5. Formulate plans for monitoring the result of treatment.

    • 6. Treat anticipated and recognized acute complications of the disease and consider possible chronic complications of the disease, as well as complication of treatment.

    • 7. Explain confidently and competently the medical condition, planned treatment options and prognosis to patient and relatives in order to guide them in decision making.

    • 8. Properly and adequately endorse patient to receiving residents/nurses.

    • 9. Evaluate treatment satisfaction and identify unrecognized problems.

      • 10. Facilitate ethical decision making on end of life issues.

      • 11. Decide when to discharge patient from ICU.

    • B. ER Complicated Cases, 1 month rotation

      • a. Entry Objectives:

    • 1. Have attended BLS/ACLS

    • 2. Be able to recognize emergency life threatening and potentially disabling diseases.

    • 3. Be able to perform basic emergency procedures.

      • b. Terminal objectives:

    • 1. Recognize life threatening and potentially disabling situations and classify severity of the problem.

    • 2. Administer basic/emergency measures.

    • 3. Prioritize and interpret urgently needed laboratory tests and results.

    • 4. Obtain adequate history and PE within a limited period of time.

    • 5. List and analyze differential diagnosis and select a primary diagnosis.

    • 6. Continue appropriate treatment and monitor clinical outcome.

    • 7. Discuss with relatives/patients matters pertaining to clinical state, diagnosis, prognosis and possible expenses.

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    8.

    Decide where to admit patient (ward or ICU), or to properly coordinate transfer to other institution.

    • 9. Properly endorse patient. (ward, ICU or other institution)

    C. Subspecialty Complicated Cases in the ward, 1 month rotation

    • a. Entry Objectives:

    • 1. Obtain a problem directed history and physical examination for a suspected disease, as written in the chart.

    • 2. Recognize different diseases with common manifestations.

    • 3. Arrive at a specific clinical diagnosis.

    • 4. Apply management principles according to CPG’s and available protocols.

      • b. Terminal Objectives:

    • 1. Obtain accurate and comprehensive disease-directed history and PE.

    • 2. Enumerate or list differential diagnosis.

    • 3. Establish the correct diagnosis.

    • 4. List the appropriate diagnostic tests and decide and prioritize which one will be done.

    • 5. Explain the diagnostic test to the patient and allow for patient preference.

    • 6. Determine immediate need for supportive treatment

    • 7. Explain the treatment plans and options to patients and allow for patient preference.

    • 8. Initiate appropriate treatment for the proven diagnosis, using CPGs and available protocols.

    • 9. Evaluate treatment outcome.

      • 10. Determine the need for further referral if treatment outcome is not satisfactory.

      • 11. Explain to patient the reason for referral and allow for patient preference.

      • 12. Formulate appropriate discharge plans.

    Knowledge and Skills

    • A. Schedule of Conferences

    SCHEDULE

    CONFERENCE

    1 st Tuesday of the month 2 nd Tuesday of the month 3 rd Tuesday of the month 4 th Tuesday of month 1st Thursday of month 2 nd Thursday of month

    Grand Rounds Case Management Morbidity & Mortality Journal report/CAT, Research Grand Rounds Case Management

    3 rd Thursday of month 4 th Thursday of month Note: Harrison’s Club is Scheduled 3 PM 3

    Morbidity & Mortality Journal report/CAT, Research

    times a week

    Teaching Learning Activities

    • A. Bedside Rounds

    The Bedside Rounds are conducted at the different areas of the hospital (Emergency Room, Wards, ICU, OPD).

    a. The bedside rounds are conducted by the consultant in-charge among difficult to manage patients referred by resident in-charge in specific areas. b. Effective bedside teaching is patient-based and patient-oriented.

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    • c. The bedside rounds should prepare residents for the extent of work in managing the patients

    and the responsibility as a clinician.

    • d. The consultant should show residents how a clinician uses their clinical and generic skills.

    • e. The consultant should be aware of not just the learner but also the welfare of the patient.

    • f. Bedside rounds should be an effective venue for “role-modeling”.

    • B. Conferences

    (Grandrounds, Case Management, Mortality & Mortality and Journal Reports)The conferences are venues for teaching-learning activities between residents and consultants.

    C. Evaluation

    I. Criteria

    • i. Cognitive Evaluation

    ii.

    Summative Evaluation

    • 1. Clinical reasoning

    • 2. Data gathering

    • 3. Long Exams/Quizzes

    • 4. Grandrounds/M&M/Conferences

    • 5. RITE

    • 6. Year-end Evaluation

    • 7. Research

    iii. Formative Evaluation

    • 1. Clinical reasoning

    • 2. Data gathering

    • 3. Attitude

    • 4. Psychomotor Skills

    • 5. Research

    II. Attitudinal Competence III. Psychomotor Skills

    • D. Schedule

    Formative Evaluation

    This evaluation is not graded and focuses on identifying areas for improvement of the resident with substantial feedback on the performance and advice on how to improve with follow-up assessment on his/her progress. The evaluation is conducted every last week off the month.

    Evaluation

    Timing

    Data gathering

    Monthly

    Clinical reasoning

    Monthly

    59

    B.

    Summative Evaluation

    Clinical competence of residents should be evaluated periodically and documented using standard evaluation forms prescribed by PCP. Standard evaluation forms will be used to assess the data gathering skills and clinical reasoning (problem-solving, decision-making). The summative evaluation is conducted every quarter.

     

    Evaluation

    Timing

    Data gathering

    Quarterly

    Clinical reasoning

    Quarterly

    Long Exams

    Every 6 months

     

    Quizzes

    Monthly

    Case Presentations (Grandrounds/M&M)

    Monthly

    Year-end evaluation

    Once a year

     

    RITE

    YL I ,YL II and YL III residents

    Research(Journal/CATS/Proposals/outputs)

    Research Activities Schedule

    C.

    Psychomotor Skills Evaluation

    There are minimum required technical skills for the residents to develop and be evaluated

    per year level. Every consultant is required to evaluate at least two residents for an

    assigned technical skill pertaining to the consultant’s specialization at least four times a

    year. A PCP prescribed evaluation form is utilized to assess the psychomotor and technical skills of the residents.

    D.

    Attitudinal Assessment

    The self-evaluation on attitude will be compared with the evaluation done by other training core faculty or consultants. Any discrepancies identified should be discussed with the resident concerned. The evaluation tool enumerates the attitudes expected of an internist as defined by PCP. A PCP designed tool will be utilized and the evaluation will be done bi- annually.

    E. Standard Operating Procedure

    See the attached Manual of Training Program

    F. General Guidelines for Specific Training Program

    See the attached Manual of Training Program

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    MRRS ROTATION GRID 2018 MRRS RESIDENT Hospital JAN FEB MAR APR MAY JUN JUL AUG SEP

    MRRS ROTATION GRID 2018

    MRRS

    RESIDENT

    Hospital

    JAN

    FEB

    MAR

    APR

    MAY

    JUN

    JUL

    AUG

    SEP

    OCT

    NOV

    DEC

    LEONO

    Roxas Memorial

               

    CRITICAL

    ER

    SUBSPECIALTY

         

    Hospital, Roxas

    CARE

    COMPLICATED

    COMPLICATED

    City

    CASES

    CASES, WARD

     

    Angel Salazar

                           

    ABANGAN

    Memorial

    Hospital, Antique

    CRITICAL

    ER

    SUBSPECIALTY

     

    CARE

    COMPLICATED

     

    COMPLICATED

    CASES, WARD

    CASES

     

    61