My brother plans to stay in QC while he reviews for his board exams. And me, I don't know yet.
Clerkship is rather exhausting daw. My friends advise me to stay near UST, in cases of "emergency" and "emergency calls(?)" and plus its really exhausting daw (have to say it two times? haha).
There are 3 duty divisions:
[Day 1] Pre-duty: OPD, 7am to 5pm (10hours)
[Day 2] Duty: 7am to 7am (24hours)
[Day 3] From duty: 7am to 12noon (30hours duty to "from")
Conferences are held usually at 7-9am, but in surgery rotation, conferences are held at 10am or at 1pm.
No, I am not that excited. I just need a place to stay, I need to reserve as early as possible because otherwise, all the "nice places" will be occupied.
I have 31 weeks left. 31 weekends with YOU, actually less than 31, I'm going home during the semester and Christmas breaks.
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WHY EXHAUSTING? BROWSE THROUGH below!!! haha...
UST – FMS Clerkship
Overview:
* 1 year duration
* Rotations
- o Medicine (2 months)
- o Pediatrics (2 months)
- o Obstetrics (4 weeks)
- o Gynecology (2 weeks)
- o OB-Fabella (2 weeks)
- o Surgery (2 months)
- o Community Medicine (Sapang Palay)(1 month)
- o Neurology-Psychiatr y (2 weeks)
- o Dermatology (2 weeks)
- o Ophthalmology (1 week)
- o ENT – HNS (1 week)
- o Legal Medicine (1 week)
- o San Lazaro Hospital (1 week)
- o Electives (1 month), to choose from:
- + Anesthesiology (2 weeks)
- + Cardiology (2 weeks)
- + Pulmonology (2 weeks)
- + Surgery
- + Psychiatry (at least 1 week, max 2 weeks)
- + Family Medicine (at least 1 week, max 2 weeks)
- + Rehabilitation Medicine (at least 1 week, max 2 weeks)
- + Ophthalmology (at least 1 week, max 2 weeks)
* Research Paper is required prior to graduation
* Written Revalida is given during the 1st or 2nd Saturday of December
* Oral Revalida will start on the first week of March
* Get a copy of the latest Handbook of Medical and Surgical emergencies and borrow the older one. Read the topics ahead. Focus on the topics of your current rotation.
* There are mini-revalidas and teachings in almost all rotations to prepare you for revalida
Hospital Work
* Do’s:
- o Be kind to everyone (esp. to nurses)
- o Get complete history and correct physical exam
- o Know your patient’s case by heart
- o Always bring at least vital signs monitoring equipment
- o It’s better if you have your own laptop, typewriter, a group printer, bond paper and, other office supplies
- o Bringing gloves, masks, syringes, IV canula (Venflon, Neoflon, Vasofix), and micropore tape will not just sometimes help the patient but will save you time as well
- o Shop for your patients at the Pay Hospital (shop = asking for supplies left by Pay patients, from sterile gauze, to Blood Transfusion set, to a vial of Insulin), avoid paying for their expenses
- o If your patient is financially challenged, refer them to Sagip Foundation for medications (max of 500.00/week) and St. Cosmas and Damian Fund for expensive ancillary tests/procedures
- o Attend AdCons and the monthly CPC/CMC
- o Donate blood for patients if you are qualified
* Don’t’s
- o Leave unfinished paper works, errands, etc.
- o Giving incomplete endorsements
- o Being rude to people
- o Lying to your residents
- o Not checking your patient’s chart
- o Being tardy
- o Giving too much information to relatives
- o Not monitoring your patient on time
- o QT monitoring (Q tingin)
* Ward duties:
- o X-ray or any radiologic exam request should have a duplicate copy for all in-patients. Have it signed first by a Radiology resident (1st or 2nd year) before giving the request to the Radiology lab and proceeding to the cashier. Always ask for an initial reading of every imaging procedure.
- o Laboratory requests should be accomplished by medical clerks (except on Neurology where the nurses do the job, and sometimes, the same thing is done by the nurses at the Female Surgery Ward, so ask them first before doing it)
- o Patient’s companion will be the one who should bring the request except on special circumstances
- o Always transport a patient using a wheel chair or a stretcher whichever is needed
- o Accomplish Official Consultation Report (referral) form in 2 copies
- + Always inform the resident and or intern about the referral (be ready to be asked revalida-type questions)
- + For Medicine (CV Med, Pulmo, etc) - always log the referral on the log book inside the Medicine Staff Room
- + DM center referral – get a form first at DM Center (3 copies ata dapat)
- + Nutrition referral – write the patient’s height and weight and compute the BMI
- + CV Med referral – photocopy the ECG tracing (1 for the resident and 1 for the chart), and write the initial/official reading of the chest x-ray, 2D-echo, or other studies
- + Infectious diseases – give a copy of the blue notes/white notes (whichever is available), a copy of lab/ancillaries worksheet
- + No need to submit a new consultation form for the follow-up of previously referred in-patients, just inform the intern/resident that you are just referring back your patient
- + St. Cosmas and Damian Indigent Fund forms should be accomplished in triplicate and signed by the Chief Resident or senior resident
- + Get ready to make a clinical abstract (most of them will ask for one)
- o Get a CUR card so you can borrow floor lamps, suction apparatus, etc, but don’t lose it because you will not be cleared for graduation
* Admitting a patient
- o Follow a systematic way of decking
- o Patients should have an admitting history (c/o Intern on-duty) and Record for hospital admission (c/o Clerk-in-Charge)
- o Surgery patients sometimes have their Record for Hospital Admission already accomplished at the OPD so admitting history na lang and POS ang kailangan
- o Always check first if there is an available bed
- o There should be a Physician Order Sheet (POS) signed by the admitting resident before you ask the resident(s) from another service if the patient will just squat in their ward
- o The CIC will accompany the patient/companion to the Social Service to have the admission paper stamped as “service bed” and then proceed at the Admission Office. In case the patient will be admitted beyond office hours, no need to pass by the Social Service.
- o Tips: admitted patients will save money on labs and other ancillaries (if a procedure can be done later, don’t request it when the patient is still at the ER)
- o Carry out all requests as soon as possible
- o Finish the database and other paper works on time
* Discharging a patient
- o Before a patient is discharged, all the referrals must sign on the POS that they don’t have any objection for discharge or they will order take home medications or OPD follow-up instructions for the patient
- o Prepare 2 brown envelopes and the write the following details at the back:
- + Name of patient, age. Sex
- + Date of admission
- + Date of discharge
- + Admitting diagnosis
- + Final diagnosis
- + Consultant in-charge
- + Resident(s) in-charge
- + Clerk in-charge
- o Discharge summary
- + Don’t forget the ICD-10 code of the final diagnosis(es)
- + At the back, type/print the PE on admission, course in the ward, PE on discharge
- o Medicine/Pedia: Discharge summary and Initial Summary (OR Tech and Follow-up record if applicable)
- o Surgery/Gynecology: Discharge summary, Initial Summary and OR Tech + Follow-up record if applicable
OPD
- * Starts at 8:00 am (but you should come at 7:00 am because there are other activities prior to 8:00 am like quiz in Dermatology, Lectures in Pedia and Ophtha, etc)
- * New patients of each clinic will have a new form
- * Check if they really have a valid yellow-card (OPD Card)
- * Number of patients in the morning is 50 (max) and in the afternoon, 30
- * There are different forms for each clinic but a uniform Follow-up form (except in Pedia)
- * Present your patients to the residents and you will accomplish the prescription, lab/radio requests, referral form, and follow-up slip
- * Dismissal time: wait until all patients were seen and examined by the resident/consultant
MEDICINE
- * There is an exam after the orientation (enumeration, identification type)
- * There are quizzes during the rotations
- * Know your alternates and their patients
- * Refer your patients before 4pm
- * Get a basic knowledge of ECG interpretation
- * Review pharmacology of antihypertensives, antibiotics, antilipidemics, diuretics, antidiabetics, antithyroid, antacids, NSAIDS, and steroids
- * Read/research about your patient’s case (you can receive Merits)
- * Additional papers needed per medicine patient together with the database:
- o Blue notes
- o Master Problem List
- o Therapeutic Drug Index
- * Attend to Code Blue of all adult patients at the CD
- * S.O.P.:
- o call your groupmates
- o inform the residents, nurses
- o get a cardiac board
- o call the ECG technician at the Heart Station at 2nd Floor CD (or use the paging system if you can’t find her)
- o call the priest only if the patient is Catholic (namura na kami ng pari nung tinawagan namin sya tapos non-catholic yung patient)
- * Your patient will be under your care until his or her discharge
- * The Discharge Summaries are checked by the residents (esp the Clinical Summary)
- * At OPD, some residents will come inside your cubicle and make you hurry (some will give a mini-revalida, but don’t be afraid)
- * As courtesy, wait for your residents to finish attending to all patients before you leave. You can buy a drink but return back asap.
PEDIATRICS
- * 1 month Ward
- + There is a unique Pedia database, handwritten only
- + Make White Notes asap
- + There are weekly Grandrounds
- + There are conferences (hema, cardio, gastro/nutri, nephro, infectious disease; and Saturday AdCons)
- + There are lectures by consultants
- + It is important to have a Pedia Cuff.
- + Monitor patients’ VS accurately. RR, HR should be taken one full minute.
- o 5 days acute infectious 1
- o 5 days acute infectious 2
- o 5 days Chronic ward (leukemias, seizures, rheuma patients)
- o 5 days Malnutrition Ward (compute for 24-hour food recall)
- o 5 days NICU/Nursery CD
- + Be ready to catch babies! Always check the OB-DR if the patient is ready to deliver. Learn to iron and fold sheets of white cloth.
- + Consultants will drop by to make rounds and ask you questions)
- o 5 days Fabella
- + You will master Ballard’s scoring after this rotation
- + Wear a scrub suit inside the DR
- + If you’re assigned in the ward, you will also make progress notes of all babies in the CS and NSD ward with these questions: nakaihi na ba, nakadumi na, malakas dumede/sumuso, malakas umiyak, nanilaw, may lagnat)
- + Warning: Charts can be dirty. Some patients are slow.
- + You will be scolded if the residents will see you leave wearing your scrub suit
- * 1 month OPD (including 5 days of ER)
- o Sick-baby (there are lectures at 7am by consultants)
- o Well-baby (immunizations, there’s a lecture at 7am)
- o Nephro clinic
- o Pulmo/Asthma/ Allergology clinic
- o Developmental
- o Neurology
- o After ER duty, you will proceed to PICU (3rd floor, Pay Division), and make a report on an assigned topic. After that, go back to OPD to help your classmates.
OBSTETRICS
- * Everyday you will meet consultants because there are many rounds/cons
- * OB- UST (4 weeks)
- * Alphabetically arranged grouping (1st 10 or 11)
- * Pre-duty – OPD
- * Duty – ward (white scrub suit inside the DR)
- * From (ward) – do discharge papers and there’s a radio lecture at 11 – 12
- * From (pay) – go to OPD at 8:00 am
- * You will be exempted from attending a conference if your patient is about to deliver
- * Monday and Friday are OPD High-risk patients day
- * Wednesday – OB-Gyn Grand rounds (brace yourselves)
- * Saturday – High-risk con (prepare yourselves for torture)
- * Every 3rd duty, 2 of your groupmates will rotate at DR-Pay together with 2 from Gyne)
- * At DR, NSD patients will be monitored q15 minutes! Back pain!
- GYNECOLOGY
- * Half of the group (15 or 16 clerks) will rotate at a time
- * Alphabetical system of grouping
- * There are more conferences with consultants
- * From (pay) – go to OPD at 8:00 am
- * There is a teaching. A clerk is assigned to a consultant for a Gyne case graded teaching. Give a courtesy call first before asking for a teaching schedule.
- * There is a “speech power” the night prior to your Pre-Op rounds
- * The pre-duty will “sterilize” the specula
- * Always provide examination gloves at the IE room
- * You can group according to friends
- * There are 5 posts (now only 4)
- o Pre-duty (labor room)
- + Insert IV cannula
- + Extract blood at the same time (Lav top for CBC, clin chem Red top)
- + Be the runner of lab requests/food
- + Push Magnesium Sulfate
- + Assist on CS
- o Duty (24 hours)
- + Handle all primigravids (handle all patients if there are no nursing/midwifery students)
- + Bring your ID so you can borrow a primi set (warning: watch closely your set as some might be lost and they will ask you to replace it). Wash the set before returning
- + You might want to bring your own gloves kasi recycled ang gloves doon!
- + You will asked to buy food for your resident so one must be the Runner after the pre-duty people leave
- + Assist on CS after the pre-duty people leave
- o From duty (progress notes lang then leave)
- o OPD (most benign, you can have your lunch break and leave before 5 pm)
- o Ward (run errands, follow-up labs)
- * There are requirements
- o 10 NSDs
- o 5 CS assists (you will sometimes be the 1st assist!)
- o There is a final exam
- o Photocopy your grading sheets then have it stamped and submit in their office
- * 2 groups of clerks at a time (around 60 clerks)
- * You will rotate in 6 divisions (10 days each)
- o GS 135 (soft tissue, breast, thyroid, chole, trauma)
- o GS 24 (esophagus, stomach, intestines, rectum, liver)
- o TCVS/Ortho
- o Pedia Surg/Urology
- o Neuro/Plastic
- o OPD/ER
- * You can group according to friends (duty group). So 20 will be on-duty per day that will be divided into 6 subspecialties
- * Update the diagnosis and CIC of index cards of patients placed on their beds
- * White scrub suit
- * In most ORs, a floater and a runner is needed
- o A floater is usually needed to take pictures and relay info to the runner (always bring a digital camera in case of emergency ORs)
- o A runner will get blood from the blood bank, talk to patient’s relatives, etc
- * Post-op monitoring: q15 min for the first 2 hrs, q 30 for the next 2 hrs, then…
- * Don’t lose surgical specimens! Accomplish the histopath form and don’t lose the tracer
- * There are conferences in the afternoon
- * Every Friday, there is a skills lab with consultants (suturing, knot-typing, bandaging and splinting, cyst excision or any minor OR procedures)
- * There is a mini-revalida with your designated consultant (it can be an OPD case, ward or theoretical)
- * There’s an online final exam
- * There’s an evaluation form that includes the following:
- o OPD patients (new patients only or old patient with new complaint)
- o List of procedures done at the OPD/ER
- o List of patients with OR
NEUROPSYCH
- * Perhaps the most toxic rotation (neuro part)
- * 1 week psych and 1 week neuro
- * Most neuro patients are monitored Q1
- * There is Neuro Adcon on Mondays and Psych Adcon on Tuesdays
- * Psych Team Con during Thursdays
- * Grandrounds on Friday morning
- * All pre-duty people should be at OPD
- * If you will admit a psych patient, prepare yourself for a long interview
- * Community Center is the name of Psych ward
- * Psych patients should have a daily MMSE and other psych tests as ordered
- * Psych patients are private patients
- * Sunday mornings are special for psych patients. The group assigned should prepare for a mass and group activity (most of the time videoke and charades)
DERMATOLOGY
- * OPD only so half day during Saturdays and Sundays off
- * There’s a quiz at 7 am, followed by a mini-lecture on the topics for the day
- * Grandrounds every Wednesday morning
- * 2 pm ang pasok sa hapon but 1 pm if there’s a lecture
- * 3 teachings are required. 1 must be from Dra. Toralba, avoid steroids when you present to her.
- * Dove White unscented for extrasensitive skin, Petroleum jelly (Lander or Vaseline only) are frequently prescribed
- * Be careful in touching skin lesions!
- * There’s a final exam, 100 points.
OPHTHALMOLOGY
- * OPD only
- * 7 am call time
- * There are skills lab or lectures at 7 am
- * Dr. Say wants a clerk to observe in his surgeries at the Eye Center (“duty” people should bring white scrub suits)
- * There are teachings required. Lecture attendance should be signed by the consultant in-charge
ENT
- * Sunday is admission day
- * Otoscope and Head mirror are must-haves in OPD
- * Pre and From duty should be in OPD
- * Duty people should stay in the ward
- * There’s a lecture (prepared by clerks) at 1 pm
- * All lectures/adcons should be compiled in a CD at the end of rotation
- * ORs here can last for 12 hours or more (i.e, laryngectomy)
- * Good thing, the residents are the ones who prepare the OR tech
- * Walk-in patients at the ward should be logged in the Record book.
LEGAL MEDICINE
- * Pre-duty people should be at Camp Crame. It’s a benign post. Just log patients on the respective log books. There are a lot of rape cases.
- * Duty – UST Legal med office. Always bring a ruler to measure the wounds, etc. Be warned that sometimes the nurses will call the office even the residents are not referring to Legal Med. Those calls can ruin your peaceful sleep ☺
- * All patients seen at UST should have a Medico-Legal form in 3 copies. Prepare a draft to be signed by the resident in-charge then make the 3 copies later.
- * From status – it’s for you to know…
SAN LAZARO
- * A lot better than Fabella
- * The place is relatively clean
- * Always wear masks. N95 is needed in the TB ward (Pavilion 10)
- * There are 6 rotations (ER, OPD – dog bites, TB ward, Pedia, Adolescent, Adult)
- * Do IV insertions even on infants. VS monitoring sometimes
- * An evaluation sheet is given to be signed by the resident and consultant in-charge
- * Don’t lose that sheet, you will get a demerit
- * 8am – 4pm during weekdays
- * 9 am – 1 pm during weekends and holidays
- * From Status: off at 1 pm during weekdays (unless there’s a lecture) and 11 am on weekends and holidays
- * Complete 5 charts per ward before you can be graded
- * Bring one 1x1 ID pic
- * There are only 2 duty days (1 weekend and 1 weekday). Guys are expected to be assigned at TB ward.
- * You must not leave the hospital premises when you’re on duty
- * Don’t use scrub suits, you’ll get a demerit
Things to have in Clerkship:
- * Med bag with complete equipment as much as possible
- * Otoscope in ENT and Ophthalmoscope in Ophtha ☺
- * Bringing your own gloves, syringes, KY jelly, micropore, IV cannula (pang-IV line like Venflon, Vasofix, Neoflon for pedia), sometimes tongue depressors, will save you time.
- * Ruler/measuring tape (useful esp in OB, Derma, and Legal Med)
- * White light for Derma
- * Andrew’s for Derma
- * Amsler grid, occluder, Jaeger chart for Ophtha
- * A notebook to write your own patients and for lectures as well
- * Liquid paper/ correction tape
- * Bond-paper
- * Carbon paper (but you can get one from the Admissions office)
- * Brown envelopes if you are kind to your patients
- * Felt-tipped pens/ whiteboard markers
- * Digicam
- * Again, a laptop and a typewriter
Helpful books:
- * Oc-oc notes
- * Pedia Blue Book from 3rd year
- * Washington Manual of Medical Therapeutics
- * First Aid for Medicine Clerkship
- * Surgery Recall
- * Harriet-Lane (Pedia Handbook)
- * MIMS/PPD
