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Clerkship Essentials

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    MUST KNOWS FOR FEU-NRMF CLERKSHIP

    SCHEDULE:

    The usual schedule is duty every THREE days. However, some rotations have duties every four or

    five days, sometimes even every other day.

    Pre-Duty: The day before you go on duty. You go to the hospital for 8-10 hours. The tasks for pre duty

    status vary per rotation.

    Duty:The day you spend >24 hours* (24 hour duty is subject to change)

    in an institution. Example, in the base

    hospital (FEU) Duty starts at 7:00 am the present day, until 7:00 am the following day.

    From-Duty:The remaining hours of the day after your 24-hour tour of duty. From duty status can be

    once relieved (meaning once the duty people are in, you guys could leave),or sometimes until 12 noon,

    if youre lucky, usually until 4-5 in the afternoon, and sometimes, when you are really, brimming with

    luck, the latest is 6-8 in the evening.(Are you counting the hours already?)

    For those areas with duties every 4 or 5 days, there are statuses such as Pre(3) or Pre(2) Duty. Hours are

    basically the same as those on Pre-Duty.

    THINGS TO BRING:

    It depends on the rotation. If you can, always bring an extra uniform or scrub suit when you are on duty.

    You never know when you might need one.

    Whenever youre rotating OUTSIDE, please take care of your things, esp your cardio stethoscopes,

    Welch Allyn bp apps Thieves have an eye for the expensive things. Never leave your valuables

    unattended. Worst case scenario: whole bag gets stolen (This happened in JR). So avoid using your

    expensive bags as well when rotating outside.

    Its handy to have a belt bag or sling bag with you during outside rotations so you always have your

    valuables and other paraphernalia with you.

    TERMS TO FAMILIARIZE YOURSELF WITH:

    Statuswhether you are pre, duty, or from, as explained above

    Insidebase hospital, a.k.a. FEU

    Demerita penalty; number of hours you get for a certain offense

    Meritreward; number of hours you get for getting a job done; this can make-up for your lates and

    demerits

    Disclaimer:This document is shared to you for the intention of guiding you on your tasks as you rotate in each department.

    Changes regarding duty schedules are subject to change; and are under the discretion of each department.

    Expect that you will looked DOWN as the lowest formin the hospital. You might have misunderstandings with other medicalstaff, but its best to always extend your patience. More often, nurses would get in your nerves. While some of them are really

    nice, there are, unfortunately, a bunch who would boss you around to get you to do things for them. Always keep in mind that

    youre only going to be an expensive monitoring machine for a year, so just bear with it. Always try to be polite, but know when

    to stand up for yourself when you know that youre right. One year will pass by quickly, trust me.

    Good luck, and enjoy clerkship! Make the most out of each experience, learn as much as you can, and perform procedures to

    enhance your skills. Bring a little notebook with you, notes can come in handy anytime! If you are not sure of something, you

    can always ask your PGIs before consultingyour residents. Im sure my batch mates would gladly teach you what they know.

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    SHOSenior House Officer who checks the attendance whenever you are in duty. Whenever you are on

    DUTY inside, dont forget to sign the logbook located at the information counter in the hospital lobby.

    Attendance will be checked at night (be alert for the page, or have someone text you when they hear it),

    however sometimes they check attendance twice, or even thrice, so be careful not to get out-of-post!

    (NCH also has a SHO).

    Out of Postnot being at your post regardless of status (pre, duty) This is equivalent to 5 days or (40

    hours) make-up

    JIOD Junior Intern On Duty: The leader of the group. This only applies to the Inside departments of

    Pedia, Surgery and IM. Roles will be discussed later on.

    JIICJunior Intern In Charge of a certain service patient/s.

    Ka-back a.k.a. co-JIIC / Whenever youre rotation is Ward/Servce inside, you will always have a ka-

    back or partner for each duty day who will be responsible to take care of your service patients when

    you are not within the hospital premises anymore, and likewise, you are responsible for their patients as

    well

    Endorsementmorning discussions of what happened during the 24-hour tour of duty with residents

    and consultants; you are expected to know the cases that will be endorsed

    Bedsidewhen you have to monitor patients vital signs q15 (such as BT or Chemo)

    De-bulking converting toxic monitoring (q2 to q4, q1 to q2) with your residents permission (orsometimes your own judgment, just be 100% sure that your patient is stable)

    Make upThe number of hours you need to cover for your lates, absences, and demerits. They can be

    started once you are on your 6thmonth of clerkship. However there are departments that only allow

    three clerks at a time to do their make-up, so reserve your make-up slot early, on the day you plan to do

    your make-up.

    BASIC RULES:

    1.

    )

    1.

    DO NOT FALSIFY VITAL SIGNS MONITORING

    2.

    AVOID SIGNING ATTENDANCE FOR GROUPMATES/FRIENDS3.

    NEVER LEAVE YOUR POST WITHOUT ASKING FOR PERMISSION

    4.

    ALWAYS KNOW WHEN TO REFERwhen a patients vital signs seemto be deranged,

    double-check it, refer immediately to your resident!

    5.

    ATTEND THE REVIEW EVERY SATURDAY as much as you can (They usually tolerate up to

    two absences, but never more than that)

    THE GOLDEN RULE IN CLERKSHIP: Be fair to your prime mates

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    ELECTIVES(Psych, ENT-HNS, Ophthalmology)

    Psych Inside:

    >Things to bring: Stethoscope, BP app, laptop, ipad, whatever gadgets can get you through the night

    > Attendance: The attendance sheet is inside the IM office.

    > Duty Schedule: Every 3 days (not sure if they changed it to 4) for two weeks

    > Posts: Blood Bank, OPD (sometimes when the IM department gets really toxic, I heard that they used

    to pull-out Psych JIs.)

    >This is the most benign rotation, ever. You get to enjoy the lounge, get complete bed rest as well.

    Btw, its your duty to get the water containers used for drinking refilled (just split the expenses among

    your prime mates), and your duty to answer the phone inside the female JI lounge

    >From status: once relieved, except when theres reporting

    >Be prepared to do a complete psychiatric history and mental status exam whenever theres a service

    patient referral whos under the service of Dra. Yumul.

    Consultants youll meetin the OPD: Dr. Atanacio, Dr. Tan Chio-Chiong , Dra. De Castro

    Psych Outside: NCMH (National Center For Mental Health)

    >Things to bring: BP apparatus and stethoscope, thermometer, penlight (other PE essentials), carbon

    paper, lots of bond paper, clipboard, mosquito repellant lotion, alcohol

    > Environment: Its hot and humid in NCH especially in summer. Bring a portable fan if you can, and

    hydrate yourself! For car parking: Arrive at least before 7:30 and youd still have a good parking spot.

    They do charge a FIXED parking fee, I just cant remember how much.

    > Attendance: Time in: 8:00 am General attendance is in Pavilion 1, and your respective pavilions.

    > Duty schedule: Every four days (not sure if this is still the rule)for two weeks

    Pre duty: 8-5pm

    From status: 5pm> Posts: ER/ACIS, Pavilions

    > Other reminders: Keep track of the requirements youve passed. They usually hand out a clearance

    form, accomplish it, and make sure you take a picture of it before completing your rotation (just in case

    you have questionable deficiencies). You also have to take an exit exam.

    Ophthalmology

    >Things to bring: OPHTHALMOSCOPE! BP apparatus and stethoscope, thermometer, penlight, scrub suit,

    cap and masks (if on duty)

    > Attendance: 7-7:30 am attendance at the OPD

    > Duty schedule: Every four days (not sure if this is still the rule) for two weeks

    > Posts: OPD, ward if duty, OR, RR (So bring scrub suitsbut youll only get to observe)

    > Other reminders: Expect a lot of patients at the OPD! Assessing each patient can take a long timebecause you have to thoroughly perform visual acuity tests. Prepare for reporting. When a patient is

    scheduled for OR, be there at least 30mins-1hr before the procedure.

    ENT-HNS

    >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suits, cap and mask

    > Attendance: 7-7:30 am at the OPD

    WHAT YOU MUST KNOW FOR EACH ROTATIONLets get started!

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    > Duty schedule: Every four days (not sure if this is still the rule) for two weeks

    > Posts: OPD, ward, OR, RR

    > Other reminders: There would be a designated Washer at the OPD, whose task is to clean the

    tongue depressors, etc and other paraphernalia used in the OPD. Grab the chance to perform an aural

    toilette if allowed by your residents! Also prepare for reports. You would usually observe surgeries

    performed at the OR.

    *ENT-HNS residents are really, really nice and super cool! Just dont abuse them and dont be

    disrespectful. They are very considerate and they really get well along with JIs. Expect an ENT vs.

    OPHTHA showdown at the end of your rotation

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    PEDIATRICS

    Pedia Inside

    >Things to bring: BP apparatus and stethoscope (PEDIA CUFFS! For baby, toddlers, school age children),

    thermometer (AXILLARY), penlight, TAPE MEASURE, otoscope, ophthalmoscope, laptop, THERAPEUTIC

    INDEX, CALCULATOR, name STAMP

    > Attendance: STRICTLY 7:00 amat the conference room

    They are very strict about coming in early, so avoid getting late! And the departmentsclock is around

    FIFTEEN minutes earlier than the rest of the hospital so be early!

    > Duty schedule: Every three days

    > Posts: OPD (7 days)weekdays from 7-4pm

    SERVICE: (2 weeks)

    Pre-duty: 7-4pm

    From duty usually goes home in the afternoon, usually after reporting

    NICU (7days)

    Pre duty: 7-4pm

    From duty: Once relieved status

    > Other reminders:

    SERVICEAssign a JIOD for each duty. JIOD duty will only include studying the admissions, discharges

    during the 24 hour tour of duty. STUDY THE CASES! *Pedia endorsement is the MOST TOXIC and

    UNNERVING*. During endorsement, you are expected to know everything about the patient by

    HEART, starting from the history, even the laboratory results, etc. You are not allowed to have a

    copy of the history with you during endorsement. Memorize everything.Be prepared for the

    bed side endorsement. During De Vega rounds, the JIIC must be prepared for the endorsement

    as well. He can ask basically anything, even the discharges or admissions the previous days. So

    just know your patient. The department is very strict with their monitoring, so never miss a

    monitoring on a patient.

    Always do your SOAPing and update your paperworks.

    Prepare good reports for merits.NICU

    Coordinate with your OB co-JI when asking about the maternal history. You would need that for

    the endorsement. Assign a JIOD for each duty, who will also possibly endorse the next day.

    Whenever Dr. Becina is around, and he asks you to touch the baby, WASH YOUR HANDS first

    before anything else!

    OPD

    Bring complete paraphernalias for assessing patients. Examine your patients in the examining

    table. Be systematic with your PE, the department is strict with their OPD charts. Do not use

    abbreviations. Have someone assigned as your logger so he/she could start logging patients as

    early as 2pm, or even after lunch so you could avoid going home late.

    Pedia Outside

    JRRMMMC (Jose R. Reyes Memorial Medical Center)

    >Things to bring: BP apparatus with PEDIA CUFFS and stethoscope, thermometer, penlight, tape

    measure, scissors, tape (though you could get/hoard lots of micropore from the station or ER), mosquito

    repellant lotion, alcohol, SCRUB SUIT (green), MASKSalways wear them!

    > Environment: Its hot and humid too!

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    > Attendance: 7:00 am at the pedia office (If youre going to bring a car, go in early, before 7am so you

    could get a parking spot. There is no parking fee)

    > Duty schedule: Every three days for two weeks

    > Posts: WARD/ER for one week, OPD/NICU for one week

    > Other reminders:

    NICUBring your own caps and masks. Pre-duty tasks include monitoring, and running errands

    (esp when you need to go outside and you have to change back to your uniforms. Smock gowns are not

    allowed). Pre duty can also be assigned to the OPD. DUTYIn charge of all deliveries, and making sure

    the tackle box is always complete with the necessary paraphernalia. Your cue on an ongoing delivery is a

    buzzer. You also have to take the maternal history and relay it to your residents. The census is

    accomplished by your PGIs.From duties can go home after endorsement.

    ER/WARDExpect this rotation to be toxic and exhausting. ER post is usually from 8am-5pm.

    You can go to the ward once your PGI arrives, if there are no other pending tasks or if the ER is not toxic.

    Ask permission from your resident first. In the ward, you do EVERYTHING-- Monitoring, weighing all

    babies, history and PE, discharge summaries and clinical abstract, extractions, insertions, ambu-bagging,

    CPR, obtaining initial readings from the radio department, send specimens to the lab, etc. Do as much

    procedures as you can. Pre-duties are the ones usually assigned to do the paperwork and monitoring

    before they go home, so that the from-duties can rest. From duty can go home 12noon, as long as thereare no afternoon conferences.

    *Whenever youre in JR, go the DOH cafeteria. The food is good yet its cheap.

    NCH (National Childrens Hospital)

    > Things to bring: BP apparatus with PEDIA CUFFS and stethoscope, thermometer, penlight, tape

    measure, scissors, tape, mosquito repellant lotion, alcohol, SCRUB SUIT (any color), MASKS always

    wear them!

    > Environment: Its hot and humid in NCH especially in summer. Bring a portable fan if you can, and

    hydrate yourself!

    > Attendance: STRICTLY 8:00 am in the neuro wardPre-duty: Until 4-5pm

    From status: OPD in the afternoon (during nephro, cardio, hema award)

    > Duty schedule: Every three days for two weeks

    > Posts: WARD

    > Other reminders:

    Monitoring can be toxic and tiring. Always refer to your residents for any deranged values. Get the

    opportunity to do lumbar tap while in the neuro ward. Be prepared for codes. Attend lectures and

    conferences. Expect reporting, and always be with your residents during bedside rounds. Parking spots

    are limited in the area. Always report for sho, and you can change your into your scrub suits after SHO.

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    SURGERY

    Surgery Inside

    >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suit, cap and mask

    > Attendance: Time in: 7:00 am (STRICTLY)

    > Duty schedule: Every three days for one month

    > Posts: Pre-duty: OPD

    Duty: Ward, OR, RR, ICU

    > Other reminders:

    For OR patients, you are expected to be at the OR an hour before the scheduled procedure. The

    department is not too strict about the monitoring. Closely monitor patients for the first 24 hours after

    their OR. The from-duties may go home as long as there are no assigned reporting/lectures/conferences

    for the day. Be careful from being marked as out-of-post, so always ask permission from your

    residents if you are allowed to go home. Two JIs are required to scrub-in an OR for a service patient.

    Surgery Outside

    MMC POC JR

    Things to bring BP app, steth, smock

    gown, scrub suit any

    color), jacket, pillows,

    blanket, food

    BP app, steth, scrub suit

    (any color)

    BP app, steth, scrub suit

    (green), micropore,

    scissors

    Attendance 7:00 am at the

    residents office

    7:00 am at the ER

    complex

    7:00 am the ER complex

    Schedule DUTY-FROM for one

    week (From status til 12

    noon)

    DUTY FROM for one

    week (From status is

    once relieved)

    PREpaperworks and

    procedures in the ward;

    ambu-bagging in the

    SICU; scrubbing in the

    OR (which happens

    rarely)DUTYER complex only

    FROMdischarge

    summaries

    Posts OR, ER ER, (Ward only to insert

    NGTs, etc), ambulance

    conductions

    ER, WARD

    Other reminders -Dont forget to claim

    your meal stubs (Food

    from the caf are

    expensive but you can

    always buy outside)- From duties are

    expected to scrub in for

    ORs occurring until 12

    noon

    -NO MONITORING IN

    THIS HOSPITAL!!!! (This

    - Move quickly! Focus

    on the pertinent

    examination findings on

    your patient. Patients

    can pile up any timeand they may come in

    waves.

    - Focus on NOI, TOI,

    POI, DOI (Nature, Time,

    Place of Injury)

    - NO MONITORING!

    - This is one of the most

    toxic rotations. During

    duty, be prepared for all

    procedures

    extraction, insertion,abg, follow up of initial

    radiologic findings or

    laboratory results. Be

    prepared to deal with

    VA and burn patients in

    the ER, also brace

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    is relatively a benign

    post except for long

    hours at the OR)

    -Be sure to have your

    infamous rooftop

    photosand with the

    Lap God, Dr. KST.

    -Overnight parking in

    the open area near the

    hospital costs Php 100

    and above. The parking

    fee inside the hospital is

    EXTREMELY expensive!

    - You are expected to

    help (CPR, ambu bag)

    during CODES occurring

    within the ER complex.

    - Dont lock yourselvesin the lounge, go out

    from time to time and

    help your PGIs in the

    ER.

    - You dont have to

    worry about the food, it

    is always provided by

    the respective team on

    duty. JIs always eat

    together with residents

    - For ambucons: know

    the case of the patient

    - You can park our car if

    you arrive early,

    however, slots are

    limited, and there is a

    parking fee.

    yourself for drunk,

    demanding patients

    who come in for

    medico-legal purposes.

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    OBSTRETRICS AND GYNECOLOGY

    OB Inside

    >Things to bring: BP apparatus and stethoscope, thermometer, penlight, scrub suit (green), cap and

    mask, TAPE MEASURE, bond paper (lots), clipboard folder with margins (1 inch on all sidesas a guide

    for your histories), scrub suits, cap and mask

    > Attendance: Time in: 7:00 am (STRICTLY)

    > Duty schedule: Every three days for one month

    > Posts: Pre-duty: OPD

    Duty: Ward, OR, RR, BEDSIDE (BT, Chemo), (ICUon rare cases)

    > Other reminders:

    You will learn a lot from this rotation. Prepare yourself for tons of handwritten paperwork.Be

    patient with the labor watch, and closely monitor all patients endorsed. Never self de-bulk your patient

    monitoring. Do your paperwork immediately so they can be checked by the residents asap for quick

    revision. Be prepared for the reporting, oral and written revalida. Refer asap to your residents for any

    deranged vital signs. Attend lectures and endorsement, they would often check the attendance. If you

    are unsure about the fetal heart tones, refer to your resident immediately! Girlstie your hair during

    grand rounds!

    OB Outside

    RMC JRMMMC

    Things to bring BP apparatus and stethoscope,

    thermometer, penlight, scrub suit

    (any color), smock gown, cap and

    mask, TAPE MEASURE

    BP apparatus and stethoscope,

    thermometer, penlight, scrub suit

    (green), cap and mask, TAPE MEASURE

    Attendance 7:00 am at the ER 7:00 am at the DR

    Schedule DUTY FROM for two weeks

    FROM status12 noon

    PRE 7-5 at the OPD

    DUTY FROM for two weeks

    FROM status until 12 noon unless there

    are conferences in the afternoon, and besure to endorse to the duty residents

    before going home

    Posts DR/WARD/OR/ER OPD/ER/WARD/DR

    Other reminders -No sleeping allowed during duty

    hours, during wee hours in the

    morning. Keep yourself awake!

    -Expect mass deliveries: be quick

    and be ready to do successive

    insertions, extractions, catheter

    insertions, and deliveries. Avoid

    baby-out (babies delivered inthe bed/stretcher), this

    corresponds to a demerit. Update

    your vital signs monitoring and do

    your labor watch meticulously.

    -Be prepared for an exit exam

    -You may be called as a first assist

    OPD: designate a JI for vital signs taking,

    for abdominal girth measurement, etc.

    You are only allowed to leave at 5:00

    pm.

    WARD: monitoring, paperwork,

    extractions, ALL errands, scrub in to CS

    procedures and other OR procedures

    DR: deliveries, labor watchER: this post is toxic! History/PE of the

    patient, extraction, insertion

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    during emergency CS cases

    -Pre duty task: Monitoring,

    insertion in the ward, extractions,

    discharge summaries and clinical

    abstracts

    From: paper works (but the pre-

    duties would usually accomplish

    everything so the from duties can

    take their rest)

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    COMMUNITY AND FAMILY MEDICINE

    ER WARD COMMUNITY

    Things to bring BP app, steth,

    thermometer, penlight

    BP app, steth,

    thermometer

    BP app, steth,

    thermometer,

    ophthalmoscope, TD,umbrella

    Attendance 7:00 am CFM office, ER

    logbook

    7:00 am CFM office 7:00 am CFM office

    Schedule Every three days (20

    days)

    FROM: attend morning

    endorsements and

    lectures, then come

    back in the afternoon

    for lectures

    Every four or five days (20

    days)

    OFF on pre duty days that

    fall on a week end

    FROM: must attend

    lectures

    7:00-5:00 am weekdays

    only (20 days)

    Posts ER

    OPDPre-Duty

    CommunityVital

    Signs/Triage;

    Immunization; Extraction

    CommunityPatient

    history, assessment

    and management

    Other reminders Bring your own masks

    which you can use for

    ambu-bagging

    Your task is to do q15

    monitoring, ambu-

    bagging and CPR; it is

    notyour task to take

    the vital signs in the

    triage area

    Take note of your

    immunization/extractions.

    Prepare for endorsements

    with Dra. Samaniego

    Monitor patients (usually

    two or three only)

    Accompany Dr. Joves

    during rounds and youll

    learn a lot!

    Take note of all the

    patients you see in the

    community

    This is one of the benign rotations because you get to have weekends off, and youll experience

    the classroom setting again. However, it gets busy during the second month as you prepare you

    papers for the community and family presentation, so manage your time wisely. Always attend Dr.

    Joves lectures!You will learn a lot of basics in this rotation. Avoid loitering outside the classroom, if

    you get caught you will be given an out of post! Do not get left by the bus!

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    INTERNAL MEDICINE

    IM Inside

    Service

    >Things to bring: BP apparatus , Steth, penlight, thermometer (all PE essentials including neuro bag), > >

    Attendance: Time in: 7:00 am in the IM office

    > Duty schedule: Every three days for one month

    > Posts: Ward

    Pre-Duty: q4 monitoring of respective assigned station, history until 3:00 pm, discharge

    summaries and clinical abstract; prepare for possible endorsement the following day. Dont

    forget to get the history youve written before going to the morning endorsement

    From duty: can go home after conferences

    Be present during lectures, attendance is always checked.

    > Other reminders:

    JIOD: patient and chart rounds, in charge of keeping the nook clean (All demerits are group

    demerits, times three to the JIOD)

    Monitor your patients, relay all those vital signs that need to be relayed! Refer asap whenneeded.

    FLOATERS: BT, chemo, q15 and q30

    FOR SERVICE PATIENTS: Always know your patient and your co-JIIC s patient. Accomplish

    referrals on time. Always check your charts for any updates. Dont forget to do your patients

    and your co-JIIC patients SOAPing. Update your discharge summaries and clinical abstract daily.

    Good reports are given merits, as well as good endorsement.

    Tips: DO YOUR HISTORY and PE METICULOUSLY. They give demerits for crappy morning

    endorsements.

    ICU/CCU

    >Things to bring: BP apparatus, Steth, penlight, thermometer (all PE essentials including neuro bag),

    scrub suits ICU door codes: 1214# or 1213#

    > Attendance: Time in: 7:00 am in the ICU

    > Duty schedule: DUTY FROM for one week

    FROM status: Once relieved after endorsement

    > Other reminders: Bring a laptopfor paperwork needed for service patients

    Avoid Dra. Yumul during endorsement. Learn as much as you can from the residents Monitor patients

    q15 and relay any deranged values immediately. Prepare for morning endorsement if you have service

    patient admission

    OPD

    >Things to bring: BP app, Steth, penlight, thermometer (all PE essentials including neuro bag)

    > Attendance: Time in: 7:00 am in the IM office and OPD logbook

    > Duty schedule: 7-4pm everyday for one week

    > Other reminders: Prepare for reporting, learn as much as you can from your residents. If there are too

    many patients, start logging early

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    IM outside

    RMC EAMC

    Things to bring BP app, steth, mask, thermometer,

    penlight, extra uniform

    BP app, steth, mask, thermometer,

    penlight, extra uniform

    Attendance 7:00 am at the IM ward 7:00 am at the IM officeSchedule DUTY-FROM for one week (From status

    til 12 noon)

    PRE DUTY FROM for one week

    Posts ER, WARD WARD, ambulance conduction

    Other reminders You will do ward work (extractions,

    insertion, monitoring, mannitol drips,

    CTT bottle change)

    FROM status: 12 noon; in charge of

    discharge summaries and clinical

    abstracts

    ER: history, PE, prescribe medications,

    do ECGGrab the opportunity for intubation

    Parking: thirty pesos FIXED rate*

    WARD

    -

    Monitoring, extractions,

    discharge summaries,

    clinical abstract, carry out

    orders of your respective

    teams (prescribe

    medications, fill out

    laboratory request forms)-

    From status: usually 5-6pm.

    You can go home once your

    team is done with their

    rounds are you are finished

    carrying out their orders

    -

    PHILHEALTH/CF3 forms

    require a DAY by DAY

    course in the ward

    Parking Fee: 100 pesos for

    overnight parking

    Grab the opportunity for intubation

    and thoracentesis

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    Comprehensive Examinations

    -

    Most questions are lifted from the lectures so attend as much lectures as you can.

    -

    You would find it impossible, or at times hard to find time to study for the comprehensive exams

    while being on duty and having something else to study about. So dont feel bad when you fail

    the first exam. Chances are, youd still pass the removals exam. Just avoid taking post-promo

    removals.

    SOAPING FORMAT

    This is only a SAMPLE format

    S>Patient seen and examined on his/her ____ hospital day, (__day of illness), ___day afebrile, with the following subjective complaints:

    No or with fever, etc (other signs and symptoms)

    For pedia patients: ask about bowel movement, urine output, and activity

    O>

    General: conscious, coherent, afebrile, not in cardio respiratory distress with the

    following vital signs: BP CR RR Temp

    Pink palpebral conjunctiva, anicteric sclera, no nasoaural discharge, no

    tonsillopharyngeal congestion (Pedia version: *use what only applies*: normocephalic, anterior andposterior fontanel is open/closed and measures, pink palpebral conjunctiva, white sclera, ear canal is patent with

    whitish material partly occluding the canal, intact tympanic membrane, moist/dry lips, pink buccal mucosa, non-

    hyperemic pharyngeal walls)

    Neck is supple, no neck vein engorgement, no cervicolymphandenopathy

    Chest: symmetrical chest expansion, no retractions, no lagging, clear breath

    sounds (Pedia version:include air entry whether good, fair or poor; be specific about the location ofretractions, whether intercostals or subcostal)

    Heart: Adynamic precordium, normal rate, regular rhythm, no murmurs

    Abdomen: globular/flabby/flat, normoactive bowel sounds, soft, non-tender

    Extremities: no gross deformities, full and equal pulses, no cyanosis, no edema,

    CRT

    Working Diagnosis

    P> Diet, Diagnostics, Drugs, Disposition


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