Mindanao State University

College of Medicine Medical Clerks Manual SY 2012-2013

2012/HGC

A maximum of 30 days / 240 hours extensions for the whole year per student is allowed. Extensions beyond 30 days would already be considered FAILURE.

1. Course Description 1.1. The Clerkship Training Program is an academic experience designed to provide the student fundamental training in preparation for general practice (Internship). 1.2. The goal of Clerkship Training Program is to introduce the student to the principles of caring for the patient. This goal is accomplished by allowing the student to participate in the care of patients in the various stages of evaluation and treatment. These stages include but are not limited to the outpatient / clinic visit, inpatient admission, operative procedure and outpatient recovery. Through this exposure, the student will begin to understand the general process of the application of therapy to patients in a wide variety of stages. The clerkship is structured upon the principle that learning is an active process which can be accomplished only by the student. The role of the faculty and house staff is to provide guidance, stimulation and example. 1.3. Clerkship starts April 9, 2012 to March 13, 2013. Four to five medical clerks would be assigned for 56 days in 6 different departments which include, Pediatrics, Medicine, Surgery, OB-GYNE, Community Medicine and Ancillary services (Pathology, Rehabilitation Medicine, Radiology, EENT, Anesthesia, Dermatology). 1.4. Clerkship training would include 24 hour duties, ward works and out-patient service duties in Gregorio T. Lluch Memorial Hospital, Mindanao Sanitarium and Hospital, Mercy Community Hospital, St. Marys Maternity and Childrens Hospital, barangay health centers and designated private clinics. Other services included are: teaching rounds with the Chairman and / or Chief of Section, ward rounds with the consultants and residents, lectures, audiovisual presentations, hands-on demonstrations on surgical procedures by consultants and residents.

8. Schedule of Activities (discretion of each department) 8.1. 8.2. 8.3. 8.4. 8.5. 8.6. 8.7. Teaching / ward rounds Endorsement rounds Case discussion Grand Rounds Morbidity and Mortality Clinico-pathologic conference Journal club

9. Specific Duties & Responsibilities of Clinical Clerk (discretion of each department) 9.1 9.2 9.3 9.4 9.5 Admitting History and PE Daily Progress notes OR technique Discharge Summary OPD All reports shall be legibly written in duplicate (carbon copies), the original to be inserted in the chart, the duplicate to be retained by the clerk for his/her personal files for verification purposes.

1.5. At the end of each rotation, each student is evaluated accordingly and their grades and extensions are submitted within 15 days to the Medical Clerks Adviser by the Chairman of each department. 1.6. General Clerkship Objectives 1.6.1 Knowledge regarding ethical decision making. Students may have the opportunity to witness and participate in end of life discussions with patients and their families. Additionally, there should be ample opportunity for the student to observe in the informed consent process. Compassionate patient care and respect for the privacy and dignity of their patients. Patients who are sick and hospitalized face unique psychological and social stresses. It is imperative that the students exercise compassionate care and respect for patients privacy throughout this period. It is important not to discuss their case in areas of the hospital where the discussion might be overheard by friends or families of the patient. Honesty and integrity in all interactions with patients families, colleagues, and others with whom physicians must interact professionally. The student is expected to wear a clean white uniform with name tag at all times except in the operative suite. All patients are to be addressed as Mr., Mrs., etc. Any discussion of diagnosis, management, or prognosis with the patient or family should be first cleared with the house staff or attending physician.

1.6.2

1.6.3

Failure to follow-up laboratory result 1 day / 8 hours within 12 hours Not wearing prescribed uniform, . 1 day / 8 hours scrub suit, cap, mask, slippers Entering sterile area without proper .. 1 day / 8 hours aseptic technique Late during operations or delivery 1 day / 8 hours Out of post during clerkship hours ........... 3 days / 24 hours Poor knowledge of the case in the ward ....... day / 4 hours Smoking or eating in the ward / sterile areas ........ 1 day / 8 hours Leaving serious patient unattended .... 3 days / 24 hours without appropriate authorized arrangement Failure to report to OPD when assigned ........ 2 days / 16 hours without notice Bringing out patients chart or any part ..... 2 days / 16 hours of the chart out of the hospital w/o permission Clerks negligence resulting in patients ........ 6 days / 48 hours demise or morbidity Failure to make a report / journal / lecture ........ 3 days / 24 hours Loss of surgical specimen ..... 3 days / 24 hours Destruction of hospital property, ....... 3 days / 24 hours lost charts, or x-ray plates Insubordination ..... 6 days / 48 hours Unprofessional, unethical conduct or cheating .... 12 days / 96 hours Gambling, or drinking alcoholic beverages ..... 12 days / 96 hours within hospital premises Falsification of documents (tampering with logbook) .. 12 days / 96 hours Forging signature of residents or consultants ...... 24 days / 192 hours Using or possessing dangerous drugs or firearms .... suspension within hospital premises

7. Standard rules on Extensions 7.1 Absences are equated as follows: Excused absence (1 day) Unexcused absence (1 day) Holiday absent 24-hour duty absent (excused) 24- hour duty absent (unexcused) Tardiness ( 2 lates >15 minutes) .. Conference / teaching rounds absence 1 day / 8 hours 2 days / 16 hours 2 days / 16 hours 3 days / 24 hours 6 days / 48 hours 1 day / 8 hours day / 4 hours

1.6.4. An understanding of, and respect for, the roles of other health care professionals, and of the need to collaborate with others in providing care for individuals and populations. Medicine has become a very sophisticated science, and collaboration with other health care professionals can be expected. 1.6.5. The capacity to recognize and accept limitations in ones knowledge and clinical skills. Medical management typically produces extreme results. Positive outcomes are extremely rewarding but negative outcomes are immediate and devastating to the patient and humbling to the doctor. The best application of the most current medical therapy does not guarantee positive outcomes. This situation should result in reflection on the part of all members of the medical team. Sometimes, ideas that arise after failure result in progress in knowledge. 1.6.6. Knowledge of molecular, biochemical, and cellular mechanisms underlying the pathology of disease. The student will have the opportunity to correlate his or her preclinical basic science knowledge with the care of the patient. 1.6.7 Knowledge of pathologic changes in the structure and function of organ systems as a result of disease. The student can detect findings on physical examination, view radiographs and then be able to see and directly palpate the patients pathology. Responsibility for making this possible is shared among the students, residents and consultants. Knowledge of mechanisms of drug action, pharmokinetic parameters, pharmacodynamics and pharmacotherapeutics. Students will have an opportunity to see a number of medications used. This should be an excellent opportunity to review the pharmacology of many antibiotics, analgesics, anesthetics, etc.

Absences either excused or unexcused totaling more than 20% of the rotation merits a no grade and a repeat service to the rotation. Absences excused or unexcused totaling half or more than half of the shift would automatically be considered failure.

7.2 Violations and extensions are equated as follows: Failure to accomplish admitting history ..... 1 day / 8 hours within 24 hours Failure to accomplish discharge summary .... 1 day / 8 hours within 24 hours Failure to make daily progress notes ....... 1 day / 8 hours within 24 hours Failure to make operative technique ........ 1 day / 8 hours within 24 hours Performing invasive diagnostic procedure ... day / 4 hours without supervision or approval of the consultant/resident Doctors order in the chart not carried out ..,.... 1 day / 8 hours

1.6.8

1.6.9

Skills for life-long learning. It is expected that clerkship will be one of the most rigorous and demanding experiences of the students medical school educational experience. One misconception that leads to problems is that some students believe that they should only study when away from the hospital. Instead, the student must develop a strategy that allows them to read and study during any free opportunity during the working hours. Developing this skill will also be useful to the student during residency training, and in future post-training practice.

6. Evaluation and Grading 6.1. Clerks are graded during their stay in each department by the residents and consultants of the department. Grades are based on the criteria set by the department. 6.2. At the end of the rotation, comprehensive written examination will be given which consists mainly of clinical problems rather than simple recall of questions. 6.3. Grades will be reported by the supervisor or Chief of Section following the approval of the department Chairman to the Medical Clerks Adviser within 15 days after the completion of the rotation. 6.4. Complaints regarding grading and extensions must be presented in writing to the Medical Clerks Adviser within 30 days after having been released. No complaints filed after this deadline will be entertained. Grades will be in percentage. The passing mark is 75%. 6.5. Grades below 75%, i.e., grades 70-74% will be reported as is, equivalent to conditional. A remedial or removal examination will be given to the clerk. Grades below 70% is equivalent to failure which will mean repetition of the rotation in the same department. 6.6. A written note from the Medical Clerks Adviser is an absolute requirement for make-up on extensions, without such an authorization, the make-up duties shall be nullified. Extensions may only be served from March 14, 2013 to April 30, 2013.

1.6.10 The ability to perform both a comprehensive and organ system specific examination. The student will gain experience with a comprehensive physical examination during each rotation. Additionally, the student may have an opportunity to learn a very detailed examination of specific organ systems. This will vary according to the specific nature of the students rotations. 1.1. The ability to perform routine technical procedures ( eg, nasogastric tube insertion, venipuncture, intravenous catheterization, urinary catheterization, suturing,etc). Students frequently fail to recognize the opportunity to perform procedures on patients in the operating room. Doing procedures in this environment minimizes patient discomfort and allows the student to learn to do a procedure under supervision. The ability to interpret the results of commonly used diagnostic test with recognition of their limitations. The student should inquire frequently as to why specific tests have been ordered. Knowledge of the most frequent clinical laboratory, radiologic, and pathologic manifestations of common maladies. The students should be willing to review the imaging studies in relation to the pathologic evaluation of tissue that has been removed.

1.2.

1.3.

4. Requirements for clerkship

4.1 official prescribed uniform, black socks and black shoes 4.2 official prescribed scrub gown, cap and mask 4.3 a pair of clean rubber slippers 4.4 complete minor surgical set and stitch scissors 4.5 sphygmomanometer and stethoscope 4.6 penlight, percussion hammer 4.7 surgical gloves at least 10 pairs

Agustero, Jarred G Gurar, Mohammad Salman L. Manapat, Kristine M. Usman, Usmaima F. Alfeche, Abigail A.

Hollanes, Steffi Grace B. Turqueza, Dana Janizza B. Disomangcop, Sahar U. Gumera, Leo Ritche C.

Ati, Amerah Madiha M. Erfe, Ellaine Jean J. Guiuo, Gerrah Marie F. Serad, Maulana, M.

5. Rotation of Clerks
April 9 May 6 GT M LM S H H Pediatrics Medicine Ancillary Surgery OB-GYN ComMed 4A 5A 4 B 5 B 6 1 1A B 2 2A B 3 4 B 5 B 4 A 5 A 3 A 4 A 3 B 4 B 5 May 7June 3 G T M L S M H H 1 1 B A 2 2 B A June 4July 1 G T L M H 6 A 1 A M S H 6 B 1 B 2 3 B 4 B 3 A 4 A 2 A 3 A 2 B 3 B 4 July 2July 29 G T M L S M H H 6 6 B A 1 1 B A July 30Aug.2 6 G T M L S M H H 5 5 A B 6 6 A B 1 2 B 3 B 2 A 3 A 1 A 2 A 1 B 2 B 3 Aug. 27Sept. 23 G T M L S M H H 5 5 B A 6 6 B A Sept. 24Oct. 21 G T M L S M H H 4 4 A B 5 5 A B 6 1 B 2 B 1 A 2 A 6 A 1 A 6 B 1 B 2 Oct. 22Nov. 18 G T M L S M H H 4 4 B A 5 5 B A Nov. 19Dec. 16 G T M L S M H H 3 3 A B 4 4 A B 5 6 B 1 B 6 A 1 A 5 A 6 A 5 B 6 B 1 Dec. 17Jan. 16* G T M L S M H H 3 3 B A 4 4 B A Jan. 17Feb.1 3 G T M L S M H H 2 2 A B 3 3 A B 4 5 B 6 B 5 A 6 A Feb.14 -Mar. 13 G T L M H 2 B 3 B M S H 2 A 3 A

1.6.14. The ability to reason deductively in solving clinical problems. The students should be able to explain how they have arrived at a diagnosis and developed plans. 1.15. The ability to construct appropriate diagnostic and management strategies for patients with common medical and surgical conditions. This applies to both the conditions that the student actually encounters in patients and those only read about in textbooks.

1.6.16. Knowledge about relieving pain and ameliorating suffering. There are a variety of ways to relieve pain, and the student should be familiar with these options. 1.6.17. The ability to communicate effectively with patients, their families, and members of the healthcare team. Effective communication is important in guiding a patient, and his or her family, through stressful situations. The students will witness this process. 1.7. General Instructional Objectives: 1.1. 1.2. 1.3. To obtain and record an adequate medical history. To make a complete and systematic physical examination. To develop awareness and skill regarding recognition of signs and symptoms of common medical conditions and their corresponding therapy and management.

1
B

Balbosa,karen Kris H. Said, Saidameer L. Sendad, Abner asser A. Taray, Sarah Jean M. Yap, Jenelyn C. Abonawas, Sahara T. Daigdigan, Rachel mae T. Estoista, Heidi Paola B. Turaja, Marlon C.

2
B

Cabatchete, Xian D. Batalo, Amor Leah O. Umpa, Melanie A. Badelles, Ariel O. Navarro, Charity C. Abdulraouf, Salma Majeedah S. Lopoz, Normina E. Navales, Decie J. Razo, Siegfried Hector B.

*with 3-day break (Dec. 24, 25, 26) Herrera, Toni Rose C. Marohom, Mabelle M. A Simbajon, Honnil Louel R. Sumpingan, Sittie Hafizah M. Vergabera, Hartzyll B. 3 Alegado, Nina Carissa L. Esberto, Angelo Miguel A. B Maratas, Johanna Michelle V. Sarip, Ruffaida M.

4 A

Ababa, Milfe A. Achacoso, Juan Paulo D. Ali, Sittie Ainah B. Coronado, Karen Mae A. Lomansoc, Jade Kenneth G

5 A

Balbosa, Aldwin Mark H. Comaradang, Asmin M. Ferolin, Shirley Kristine N. Rodriquez, Vikki Darl R. Salong, Amel Khan M.

6A

Agustero, Jeno G. Baser, Ajquizar T. Pajo, Azalea T. Pundogar, Sittie Rohana D. Zamora, Stephanie Grace S.

1.4. 1.5. 1.6.

To perform simple diagnostic procedures and to assist in complicated procedures under direct supervision of the resident/consultant.. To carry out proper patient care. To develop skill in performing simple surgical procedures and to assist in difficult ones.

a note should be presented properly signed by the resident or consultant, otherwise they will be marked absent for the activity. 2.4. Exchange of duties is only allowed on official basis and upon proper arrangement and approval of the Chairman / Chief of Section. 2.5. There should be a reliever if the medical clerk will be absent from 24-hour duty. All absences must be explained to the Chairman / Chief of Section for proper action. 2.6. The clerks room are expected to be clean and orderly at all times. No visitors shall be entertained at any time inside the clerks room or quarters. 3. Rules of Conduct 3.11General rule of conduct clerks are expected to behave like professionals at all times, that they should do their duties promptly and cheerfully and that they must respect hospital properties and exercise economy in the use of supplies. 3.2. Wearing of the official clerks uniform is strictly enforced. Violators will be sent out of the ward and marked absent. 3.3. Acceptance of fee or any form of compensation for the service rendered by a medical clerk during his/her rotation is strictly prohibited. 3.3. Smoking and alcohol drinking are prohibited in the ward, OPD, delivery and operating rooms. Newspapers, reading materials other than medically oriented notes or text, radios and televisions are not allowed. 3.4. Foods and drinks are prohibited inside the sterile areas. 3.5. Patients feelings must be respected. Unnecessary comments or discussion

1.7.7. To recognize and manage common surgical complications with direct supervision of the resident/consultant.. 1.7.8 To develop awareness in the moral aspect of medical practice.

2. General Rules and regulations 2.1. Daily attendance is checked at 7:30 am except for incoming clerks on 24-hour duty who should report at 7:00 am. No clerks should leave their post unless the reliever has arrived and proper endorsements were made. Only those going on 24-hour duty should report on Sundays. Official time-out for those not on 24-hour duty is 5:00 PM except on Saturday which is 12:00 noon. 2.2. Medical clerks should wear the prescribed uniform, nameplate, and black shoes. White pants are allowed for female medical clerks on 24-hour duty only after office hours, ie., 5:00 PM to 7:00 AM. During Community Medicine rotation, medical clerks should wear the prescribed shirt. They should have clean, short and unpolished nails. Hairs should be kept short for boys and kept tidy for girls. No beards, moustache, earrings for boys. No dangling earrings and heavy make-up for girls. 2.3. All are required to attend the scheduled activities within the department. From duty and those on 24-hour duty should also attend unless there are serious patients being monitored or attended. In case they cannot attend,

that may affect adversely the physical and mental conditions of the patient should be avoided. 3.6. Due respect must be accorded whenever any university or hospital authorities and or any member of the department enter the ward.