Manual Training Program Wvmc-Im Revised June 2018

WESTERN VISAYAS MEDICAL CENTER
DEPARTMENT OF INTERNAL MEDICINE
MANUAL OF TRAINING PROGRAM
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TABLE OF CONTENTS
Page
1. Mission-Vision of the Hospital 3
2. Mission-Vision of the Department of Medicine 3
3. Objectives of the Training Programs 4
4. Entry Requirements 4
5. Residency Training Program 6
6. Organizational Chart of the Hospital and the Department of Medicine 6
7. List of officers of the Hospital and the Department of Medicine 8
8. Brief History of the Institution’s Residency Training Program
in Internal Medicine 8
9. Responsibilities of the Department Head 9
10. Responsibilities of the Training Officer 9
11. Year Level Competencies 10
12. Training Program Competencies 13
13. Standard Operating Procedures 20
14. General Guidelines for Specific Training Areas 25
15. Guidelines for Sub-specialty Rotation 28
16. Departmental Policies
17. Training Manual for the MRSS Rotation 43
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RESIDENCY TRAINING PROGRAM
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.
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 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
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
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 OUT-PATIENT DEPT WARD ICU

DEPARTMENT
COORDINATOR COORDINATOR COORDINATOR
COORDINATOR
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Mandurriao Iloilo City
TRAINING COMMITTEE
Medical Center Chief JOSEPH DEAN NICOLO, MD, FPCS, FPSGS, MPA
Chief Medical Prof. Staff MA. CRISTINA VC-WOO, MD, FPPS, FPSNBM, MHA
Chief Training Officer GUADALUPE V. MATEJKA, MD, FPCS
Department Head JOY GULMATICO, MD, FPCP, FPSN
Training Officer LAVERNIE JACOBO, MD, FPCP, FPCC
Training Core Members 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
Research Committee 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 KATHRYN JOYCE GORRICETA, MD

Out- Patient Department DIANA MARIE J. CACHO, MD, FPCP
Intensive Care Unit MARCELINO FELISARTA, MD, FPCP, FPCC
Infectious Wards LEMUEL UMAHAG, MD, FPCP, FPCCP, FPSCCM
Non Infectious Wards JOY M. GULMATICO, MD, FPCP, FPSN
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CURRENT LIST OF CONSULTANTS
ENDO PULMO
DIANA MARIE J. CACHO, MD, FPCP MARIAN C. CELIS, MD, FPCP, FPCCP
ARETHA ANN LIWAG, MD, FPCP, FPSEPM, MSC FEL ANGELIE COLON, MD, FPCP, FPCCP, FACCP
LEMUEL UMAHAG, MD, FPCP, FPCCP, FPSCCM
NEURO RHEA ANN CELIS, M.D., FPCP
RYNDELL ALAVA, MD,FPNA
EUFEMIO SOBREVEGA, MD, FPNA GASTRO
DUREZA ABAD, MD, FPCP, FPNA DANILO VALENCIA, MD,
MA. CECILIA FLORETE, MD, FPCP, FPSG, FPSDE
INFECTIOUS MIGUEL SOTOMIL, MD, FPCP, FPSG
FELICE G. MOLINA, MD, FPCP, FPAS, MAT ELVIE VICTONETTE RAZON- GONZALEZ, MD, FPCP, FPSG
MARIA LUNA PARREÑO, MD, FPCP
CARDIO
NEPHRO LAVERNIJACOBO, MD, FPCP
JOY M. GULMATICO, MD, FPCP, FPSN MARCELINO FELISARTA, MD, FPCP
GLYNIS TINGZON, MD, FPCP, DPSN CORNELIO BORREROS II, MD, FPCP, FPCG
RHODELYN ALMEÑANA, MD, FPCP
GENERAL INTERNIST CATOTO, JAMES, M.D., FPCP
KATHRYN JOYCE GORRICETA, MD, FPCP
CECILIA CERCADO, MD, FPCP ONCO
MAYBEL ARENO, MD, FPCP CHERRY PINK A. VILLA, MD, FPCP, FPSMD
RODEL GEDALANGA, MD, FPCP ANTOINETTE PUNJALE, MD,FPCP
GERIATRIC MEDICINE ALLEGO & IMMUNO

GRACE FERNANDEZ, MD, RPCP, FPCGM, MHM CHRISTOPHER REY DE GUZMAN, MD, FPCP, FPSAAAI
RAEL DULLANO, MD, FPCP
DERMA
REMA JOY CEJAR, MD, FPDS
RHEUMA
CAROLINE ARROYO, MD, FPCP, FPRA
AIME FABILA, MD, FPCP, DPRA
TOXICOLOGY
ANECITO MONSALE, M.D.
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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 (Dingle Iloilo)

Cecilia Cercado, MD, FPCP Liza Fermeza, MD, Non-practicing (USA)
Lucita Jalbuena, MD, FPCP, FPCC Judel Jaritiza, MD, FPCP
Rosario Aceron, MD, FPCP, FPSN Esther Legaspi, MD (Expired)
Jun Aristorenas, MD Agnes Gulmatico- Belleza, MD, FPCP, FPCC
Nelson Flotilde, MD (Iloilo City)
Marian Celis, MD, FPCP, FPCCP Fe Dofitas, MD, ( Alimodian District Hospital)
Edgar Salinas, MD Elly Justalero, MD, (Guimaras)
Mary Rose Aplasca, MD Owen Porral, MD, (Sta. Barbara, Iloilo)
Danilo Valencia, MD Jane Rodriquez, MD, Non-practicing (USA)
Gracita Lanada, MD Amalia Jaspe Fernandez, MD, PHIC
Olivia Perez, MD Noel Camique, MD, FPCP, FPSN
Fred Guillergan, DM, FPCP (North Cotabato)
Gil Lazaro, MD, Non-practicing (USA) Donna Gwen Dimaclid, MD, (Mindanao)
Vicente Albacete, MD, Private practive James Albacete, MD, Non-practicing
(Maasin, Iloilo) Judy Ann Nebit, MD, FPCP (Antique)
Janus Alejo, MD, Non-practicing (USA) Vincent Jury Lauron, MD, FPCP (Roxas City)
Joemarie Lopez, MD, Private practive Cecile Jancilan, MD, Non-practicing
(Passi City, Iloilo) Lemuel Umahag, MD, FPCP, FPCCP (Iloilo City)
Bobby Yoro, MD, Chief of Hospital (Guimaras) Maria Luna Parreño, MD, FPCP
Anecito Monsale, MD (MO4) Maybel Areno, MD, FPCP (Barotac Nuevo)
Raffy Tayco, MD, FPCP Grace Cageria- Castigador, MD (Calinog Iloilo)
Nelson Belandres, MD Mylene Alontaga- Mombay, MD (Guimaras)
Peter Que, MD, Non-practicing (USA) Mitzi Banate, MDFPCP, FPCCP (Iloilo City)
Debbie Layson, MD (IDH) Zaida Lacorte- Ali, MD (Kalibo Aklan)
Ramon Pasaporte, MD (Iloilo City) Joveno Galvez, MD, FPCP
Edgar Divinagracia, MD, (Barotac Nuevo, Iloilo) Ian Libarios, MD
Louella Araza, MD (Iloilo City) Andre Val Sucro, MD, Kalibo Aklan
Ma. Victoria Masculino, MD (Iloilo City) Leonardo Java, MD, Oton, Iloilo
Ma. Rebecca de Asis, MD Wendel Articulo, MD (Barotac Nuevo, Iloilo)
Leonor Villareal, MD, FPCP, Iloilo City Concristine Dignomo-Legislador, MD (Iloilo City)
Jean Rico- Tenefrancio, MD, FPCP, FPCC Rodel Gedalanga, MD, FPCP (San Joaquin)
(Roxas City) Alvin Casono, MD, FPCP
Joy Gulmatico, MD, FPCP, FPSN (Iloilo City) Fria Mae Manejero, MD (Singapore)
Eleno Magtulis, MD, FPCP (Expired) Sheryl Grace Vallar- Trumpeta, MD, FPCP
Lavernie Jacobo, MD, FPCP, FPCC (Iloilo City) (Non-practicing, USA)
Milagros Cañonero- Cariño, MD (Alimodian Iloilo) Joemarie Loberiza, MD, FPCP, Oncology
Noni Lopez, MD, (Guimaras) Fellowship Training
Quindialem Deano- Villanueva, MD, Emelyn Buenacosa MD, FPCP, Oncology
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Fellowship Training Rhea Ann Celis, MD, FPCP –MO4
Stephen Segumalian, MD, Doctors without Hervin Saber, MD –M04
borders (Pakistan) Ellen Grace Balinas, MD, FPCP, ID Fellowship
Kathryn Joyce Gorriceta, MD, FPCP (Iloilo City) training –San Lazaro Hospital
Lester Dimzon, MD, FPCP (MO4) Charisse Marie Toledo, MD, Non-practicing, USA
Yuely Capileño, MD, FPCP Kaya Sharley Cercado, MD –MO4
Glynis Tingzon, MD, FPCP, DPSN Christine Ena Carado, MD, (Iloilo City)
Anne Gigare, MD, (Iloilo City)
Ivy Marie Suarez, MD, FPCP (Senior House Rufino Abonado, MD –MO4
Officer –AFP Hospital) Myleene Erola- Fuentes, MD, Neurology Training
Dyna Cardiel, MD, FPCP Gwen Gigare, MD, (Iloilo City)
Rosejanne Camoro, MD, FPCP Iris Joyce Aron, MD, (Private practice –Kalibo
Mary Joy de la Mota, MD, FPCP, ID Fellowship Aklan)
training –San Larazo Hosopital Roger Mission Jr., MD –MO4
Andrea Dimagiba, MD, FPCP –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 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
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
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.
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
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
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.
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
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.
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
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.
At the end of the rotation of the 3rd year resident, given a case, at the OPD, the resident will:
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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.
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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.
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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.
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.
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
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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.
f. Afternoon endorsements are done between residents, supervised by the Chief Resident and the
Senior Residents.
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
1st Tuesday of the month Grand Rounds
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2nd Tuesday of the month Case Management
3rd Tuesday of the month Morbidity & Mortality
4th Tuesday of month Journal report/CAT, Research
1st Thursday of month Grand Rounds
2nd Thursday of month Case Management
3rd Thursday of month Morbidity & Mortality
4th Thursday of month Journal report/CAT, Research
Note: Harrison’s Club is Scheduled 3 PM
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.
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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.
GENERAL PERFORMANCE EVALUATION
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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
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Level III – Option 1: Critical Appraisal
CAT of Meta- analysis – 2
With or without CAT on Clinical Practice
Guidelines – 2
Option 2: Completed Research
STANDARD OPERATING PROCEDURE

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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.
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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.
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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 2nd and 3rd 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.

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.

GUIDELINES FOR SUBSPECIALTY ROTATION
36
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.
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 Infectious Diseases Resident of the

Microscopy Sections (Laboratory) 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.
4. To recognize potential complications of pulmonary diseases, reactions and outcome of

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.
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.
A. DUTIES AND RESPONSIBILITIES
PULMONOLOGY RESIDENT ROTATOR OF THE MONTH

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.
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 Pulmonology Resident

Interpret Chest radiographs Chest CT Scan All residents
Ventilator setting and troubleshooting All residents
Thoracenthesis and other procedures All residents
TBDC 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.
OBJECTIVES:
1. To provide subspecialty exposure and hands-on experience on handling endocrinology

cases to medical residents on their second year of training.

and control of common and uncommon endocrine diseases.

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

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

endocrinology referrals from the emergency room, wards, other medical subspecialties and
departments.
2. Personally inform and update the endocrinology consultant of all referrals.
consultant in endocrinology.
for all endocrinology patients assigned.
49
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.
C. OBJECTIVES
1. To provide subspecialty exposure and hands-on experience on handling oncology cases to

medical residents on their second year of training.

and control of common and uncommon oncology diseases.

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

D. STRATEGIES
1. Each medical resident should have at least two months rotation under the section
oncology during his/her second year of training.
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.
consultant in oncology.
for all endocrinology patients assigned.
51
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.
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)
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
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
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 where the residents will rotate.
A. Critical Care Area, 1 month rotation
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.
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
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.
57
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
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.
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
1stTuesday of the month Grand Rounds
2nd Tuesday of the month Case Management
3rd Tuesday of the month Morbidity & Mortality
4th Tuesday of month Journal report/CAT, Research
1st Thursday of month Grand Rounds
2nd Thursday of month Case Management
3rd Thursday of month Morbidity & Mortality
4th Thursday of month Journal report/CAT, Research
Note: Harrison’s Club is Scheduled 3 PM 3
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.
58
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
60
MRRS ROTATION GRID 2018
MRRS
RESIDENT Hospital JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Roxas Memorial CRITICAL ER SUBSPECIALTY

LEONO Hospital, Roxas CARE COMPLICATED COMPLICATED
City CASES CASES, WARD
Angel Salazar
Memorial
ABANGAN CRITICAL ER SUBSPECIALTY
Hospital, Antique
CARE COMPLICATED
COMPLICATED CASES, WARD
CASES
61

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WESTERN VISAYAS MEDICAL CENTER

DEPARTMENT OF INTERNAL MEDICINE

MANUAL OF TRAINING PROGRAM

1. Mission-Vision of the Hospital 3

2. Mission-Vision of the Department of Medicine 3

3. Objectives of the Training Programs 4

5. Residency Training Program 6

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

7. List of officers of the Hospital and the Department of Medicine 8

8. Brief History of the Institution’s Residency Training Program

9. Responsibilities of the Department Head 9

10. Responsibilities of the Training Officer 9

11. Year Level Competencies 10

12. Training Program Competencies 13

13. Standard Operating Procedures 20

14. General Guidelines for Specific Training Areas 25

15. Guidelines for Sub-specialty Rotation 28

16. Departmental Policies

17. Training Manual for the MRSS Rotation 43

RESIDENCY TRAINING PROGRAM

WESTERN VISAYAS MEDICAL CENTER

DEPARTMENT OF INTERNAL MEDICINE

The residents should specifically be able to:

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

ENTRY REQUIREMENTS FOR THE RESIDENTS

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

2. Credentials and Other Requirements to be Submitted:

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

EMERGENCY OUT-PATIENT DEPT WARD ICU

Training Core Members FELICE MOLINA, MD, FPCP, FPAS MAT

Research Committee GLYNIS TONGZON, M.D., FPCP, DPSN (CHAIR)

Training Area Coordinators

Emergency Room KATHRYN JOYCE GORRICETA, MD

GERIATRIC MEDICINE ALLEGO & IMMUNO

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

Muriel Dañucop, MD (Dingle Iloilo)

The chairman represents the department to the administration or institutional management by

RESPONSIBILITIES OF THE TRAINING OFFICER

I. YEAR LEVEL I (First Year Resident)

A. OPD new cases

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

II. YEAR LEVEL 2 (Second year resident)

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

III. YEAR LEVEL III (Third year resident)

The 3rd year resident upon entry to ICU must:

B. CHRONIC RECURRENT DISEASE

A. KNOWLEDGE AND SKILLS TO BE LEARNED AND ACQUIRED

1. Medical and cardiopulmonary evaluation of surgical patients.

h. Hematology – diagnose common hematologic conditions and be able to know how to do

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

1. Mastery of knowledge in pathophysiology, biochemistry, special diagnostic procedures and

B. RESIDENTS’ ASSIGNMENTS / ROTATIONS:

Primary responsibility for Medical ER cases

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

ICU (primary) - at least 4 months

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

a) Weekly departmental conferences are done scheduled as follows

8. Medical Staff meeting done quarterly

9. Community Outreach Program on selected Barangay and District Hospitals