CLERKSHIP MANUAL

UNIVERSITY OF SANTO TOMAS FACULTY OF MEDIClNE AND SURGERY

CLINICAL CLERKSHIP MANUAL 2007—2008

UNIVERSITY OF SANTO TOMAS FACULTY OF MEDICINE AND SURGERY CLINICAL PROGRAMS OFFICE

CLINICAL CLERKSHIP MANUAL 2007-2008

UNIVERSITY OF SANTO TOMAS FACULTY OF MEDICINE AND SURGERY

ADMINISTRATION

MA. GRACIELA G. GONZAGA, M.D.  D e a n

REV. FR. WINSTON F. CABADING, O.P.  Acting Regent 

EMELITA ANG-GAN, M.D.  Assistant Dean

IMELDA A. DAKIS, M.D. Faculty Secretarg

ALFRED H. BELMONTE, M.D.  Director, Clinical Programs

CLINICAL CLERKSHIP MANUAL SCHOOL YEAR 2007-2008 The clerkship training program of the UST Faculty of Medicine and Surgery is designed to expose the medical clerk to patient service, teaching/learning activities and research in compliance with the mission statements of the medical school and hospital. During their final year of undergraduate medical education, they are expected to apply previously learned skills in history taking and physical examination in order to diagnose, work-up and manage patients entrusted to their care. In the same manner, they are expected to establish their role in the medical community and develop the appropriate interpersonal skills required in dealing with superiors, subor¬dinates, patients and their relatives. As the most junior members of the medical staff they are expected to develop their sense of  responsibility for the comprehensive care of their patients. It is during this year that the medical clerk is expected to graduate from being a medical student to a physician.

1.

GENERAL DESCRIPTION

1.1 Under Republic Act 5956, Clinical Clerkship is the fourth and final year of the course curriculum for the degree of Doctor of Medicine. 1.2 Clinical Clerkship at the UST Faculty of Medicine and Surgery covers a period of twelve (12) months utilizing the services of the University of Santo Tomas Hospital with rotations at Dr. Jose Fabella Memorial Hospital, St. Martin de Porres Community Center at Sapang Palay, Bulacan, San Lazaro Hospital and the PNP Crime Laboratory.

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1.3 Clerkship officially starts and ends on April 16 of each academic year. Medical clerks who are not enrolled by April 16 automatically become irregular students. They will not qualify to take the Oral Revalida and subsequently be ineligible for graduation. 1.4 All clinical clerkship activities are handled by the Office of Clinical Programs under the office of the Dean of the Faculty of Medicine and Surgery. The Director of Clinical Programs functions as ov er-all supervisor of clerkship. Each department has a clerkship supervisor and a specific group of faculty members assigned to implement its individual training programs. 1.5 All UST medical clerks, having chosen to enroll in a Catholic University, are required to attend the Annual Retreat as well as other official/spiritual functions arranged by the Office of the Father Regent and the Office of Clinical Programs.

2.

OBJECTIVES OF THE PROGRAM

In keeping with the vision of the UST Faculty of Medicine and Surgery, the general objectives of the Clinical Clerkship Program are: 2.1 To graduate a physician educated in the basic principles of medicine and surgery who is qualified to undergo postgraduate training in any specialty. To achieve this, the medical senior must, at the completion of clerkship, be able to: 2.1.1 correlate the knowledge acquired in the first three years of the medical curriculum with clinical practice guidelines applied to patients seen at the UST Hospital and affiliate institutions. 4.

2.1.3 develop one’s abilities at problem solving as a basis for sound clinical  judgment. 2.2 To develop the medical clerks’ interpersonal skills as a physician, teaching him how to d eal with situations involving superiors and subordinates as well as patients and their relatives. 2.3 The formation of a physician who is conscious of and responsive to the health needs of the community and the country. 2.4 The formation of a Thomasian physician who is aware of the spiritual implications — religious and moral — in the practice of medicine, and conscious of the obligations of the physician to the patient and the medical profession, in accordance with the teachings of the Catholic Church. 3.

REQUIREMENTS FOR CLINICAL CLERKSHIP

3.1 Satisfactory completion of the first three (3) years of the medical curriculum of the UST Faculty of Medicine & Surgery. The Faculty does not accept transferees applying for the 4th or senior year in medicine. 3.2 Enrollment as a year student of the Faculty of Medicine and Surgery with submission of quarterly class cards as follows: 1st quarter: must be submitted prior to start of clerkship 2nd quarter: July 31 3rd quarter: October 31 4th quarter: January 31

3.3 Certificate of physical/mental health from the University Health Service submitted prior to enrollment.

3.4

Uniform Requirements.

3.4.1 The prescribed uniform for medical clerks is illustrated on p. 24. Cleanliness of all parts of the uniform is each medical clerk’s responsibility. 3.4.2 Shoes: Male clerks are required to wear black leather shoes. Female clerks are required to wear white leather ‘shoes. Clerks are NOT allowed to wear open-back shoes (including sandals and step-ins), athletic/rubber and canvas shoes. Rubber-soled leather shoes are acceptable. 3.4.3 Hair-Cut: Male clerks are not allowed to sport long hair. Hair should not touch the collar of the uniform. The use of hairpins, hairnets, pony tails, etc. by male students is not allowed. 3.4.4 Jewelry: Wearing of jewelry aside from watches & wedding/class rings is highly discouraged. Individual departments may disallow any/certain item/s of   jewelry at their discretion. 3.4.5 Male medical clerks are not allowed to use make-up, earrings, and other accessories ordinarily used by females. 3.4.6 Scrub suits. All medical clerks must have their own scrub suits, including a surgical cap/mask and slippers for use in the Operating/Delivery! Recovery Rooms/Nursery/Intensive Care Units.

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3.5 All medical clerks must have a medical bag with a complete set of  diagnostic instruments including: Stethoscope Otoscope / OphthaLmoscope Sphygmomanometer Thermometer Reflex hammer Minor surgical set Penlight Tongue depressor Disposable gloves

4.

ROTATIONS 4.1 Mandatory Rotations Duration Medicine — 8 weeks Pediatrics — 8 weeks Surgery — 8 weeks Obstetrics and Gynecology (including Fabella) — 8 weeks Community Medicine — 4 weeks

4.2

Dermatology — 2 weeks Ophthalmology/Otorhinolaryngology — 2 weeks Neurology/Psychiatry — 2 weeks Infectious Diseases (San Lazaro) — 1 week  Legal Medicine — 1 week  Elective Rotations:

Medical clerks are allowed to choose an elective rotation for a period of four weeks. Students with plans of taking post graduate training abroad should ascertain the requirements of 

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the state boards/countries where they plan to take the said training. The elective rotations can be used to complete these requirements. These rotations may be done completely or in part at any of the following departments: Surgery Family Medicine Medicine Psychiatry Anesthesia Rehabilitation Medicine

If a medical clerk chooses a mandatory rotation department for an elective rotation, the grade for the elective rotation shall be distinct and separate from the mandatory rotation grade. The elective rotation cannot be utilized to make up for deficiencies in the mandatory rotation to the same department and vice versa.

5.

EVALUATION AND GRADING

5.1 All medical clerks will receive a grade from each service/department they rotate in. The guidelines for evaluation may be utilized or modified by each department as they see fit. See appendix A. 5.2

Grades will be reported in percentage points. The passing mark is 75%.

5.3

Grades below 75% are considered as “Failure” or Unsatisfactory”.

Note: A failing grade automatically means repetition of the rotation in the same service and matriculation for the said shift. Failure automatically disqualifies the clerk from graduation. The terms “Repeat Rotation” or “Repeat Service” are equivalent to failure in the said service. —8—

5.4 Grades must be submitted by the Supervisor of Clerkship of each service/rotation and endorsed by the Department Chairman/OIC to the Director of  Clinical Programs within 15 days after c completion of the shift.

5.5 Liaison officers will be given copies of the grades of the medical clerks in their group. All complaints regarding grades, deficiencies and punishments must be submitted in writing to the Director of Clinical Programs within 10 days after the grades are released. Complaints filed after this deadline will not be enter¬tained. 5.6 Incomplete grades must be completed within one (1) month after said grades are released. Failure to complete said g rades after one month gives the department the option to Fail the clerk concerned. 5.7 At the end of the academic year, absences in all clerk¬ship conferences (CPC, Clinico-Moral Conference, Luis Guerrero Memorial Lecture etc) will be tallied by the Office of Clinical Programs. Each missed conference is equivalent to a deficiency of three (3) days absence. All medical clerks are required to attend these confer¬ences except: 5.7.1

clerks on rotation outside UST

5.7.2 clerks on 24-hour duty. All group leaders must submit the names of  group members on duty, countersigned by the resident-in-charge, at the start of  the conference. 5.8 5.8.1

Absences will require make-up duties as follows: Unexcused absences: Regular duty (8 hours) — 3 days 24-hour duty — 7 days

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5.8.2

5.8.3

5.8.4

Excused absences: Regular duty — 1 day 24-hour duty - 3 days Tardiness (2 lates) — 1 day Recurrent tardiness (3 consecutive. days or 4 days/week) — 5 days

Absence in conferences or teaching rounds — 1 day

5.8.5 Absence in CPC and Clinico-Moral conference — 3 days 5.8.6 Total absences, excused and/or unexcused totaling 20% of the shift or more shall automatically be considered “Failure”. The clerk must repeat the service and pay tuition for the same. A repeat service means non-inclusion in the graduation ceremonies. 5.8.7 Absences incurred from April to February must be made up prior to the oral revalida.

5.9 Students who drop from clerkship without the approval of the Director of Clinical Programs will be marked Absent without Leave. They will lose credits earned in previous rotations. 5.10 If circumstances require prolonged absence/s (exceed¬ing the maximum number of days allotted per rotation), students must apply for leave of absence. A leave of absence must be approved by the Director of Clinical Programs. It allows the students to leave clerkship for a maximum of one (1) year without losing credits for previously completed rotations. — 10 —

A copy of the duly approved leave of absence must be submitted to the Treasurer’s Office to avoid forfeiture of paid tuition fees. A leave of absence will genera lly delay graduation since the student will be unable tc. complete the required rotation prior to graduation. Medical clerks who exceed one (1) year leave of absence will automatically forfeit previous clerkship credits and will need to repeat clerkship’. Those on leave of absence for two (2) years or more will be required to pass a qualifying/validating exam prior to accept¬ance into clerkship. Those who cannot pass such an exam may be required to take a Refresher Course designed by the Department of Medical Education. Forms/requests for leave of absence are available at the Clinical Programs Office. 5.11 Excused absences must be validated as such by the Office of Clinical Programs after submission of a letter indicating the date/s invoLved and the reason for the absence/s. Submission may be in anticipation of or as soon as possible after the absence incurred. In general, absences are considered excused when they are due to: illness [with attached medical certificate issued by the Student Health Service or UST Hospital Medical Staff] serious illness/death in immediate family. certified official appointments [embassy, court hearings, etc] official school functions [missions, contests, competitions] other reasons, such as attendance at social functions etc. are generally considered unexcused, Forms requesting for excused absence are available at the Clinical Programs Office. — 11 —

6.1 6.1.1

Uniform Violations Not wearing the prescribed uniform — 3 days 6.1.2 Incomplete uniform — 2 days 6.1.3 Unauthorized shoes — 1 day 6.1.4 Long hair, untidy appearance — 1 day

6.2 6.2.1

Duty VioLations Out of post during regular clerkship hours — 3 days 6.2.2 Out of post, 24 hours duty — 7 days 6.3 Chart/Plates/Specimen Violations 6.3.1 Lost Charts/X-ray plates — 7 days 6.3.2 Unauthorized removal of any portion of patient’s chart — 7 days 6.3.3 No history/PB/progress notes within 24 hours from admission — 2 days Failure to complete discharge papers within 24 hours after discharge Loss of surgical/histopath specimen — 15 days Failure to submit surgical/histopath specimen within 24 hours — 3 days 6.3.7 Failure to submit autopsy/death protocol within 24 hours — 3 days

6.3.4 6.3.5 6.3.6

6.4 Conduct Violations 6.4.1 Drunkenness/Drinking within campus or hospital premises — 15 days Possession of alcoholic beverages — 7 days 6.4.2 Gambling within hospital premises — 15 days 6.4.3 Using/possession of dangerous drugs or firearms and violation of  penal provisions of R.A. 6425 — 30 days

6.4.4 Insubordination — Refusal to obey rules and regulations or to carry out lawfuL orders of residents/consultants or higher hospital authorities — 7 days 6.4.5 Theft or willful destruction of division! hospital property. — 7 days 6.4.6 Unprofessional/unethical conduct such as stealing, cheating and other similar acts of dishonesty. Fighting, other acts of physical violence* Indecent or obscene behavior — 15 days 6.4.7 Falsification of documents i.e. teaching forms, any part of the patient’s chart, medical certificates etc. — 30 days *Fighting In the context of inter-fraternity violence is strictly forbidden. Verified participation of any medical clerk in such fights will merit automatic suspension. Suspension of a medical clerk for a period as short as one week may make him ineligible for graduation.

It is not possible for the Faculty to enumerate all possible offenses. The medical school reserves the right to evaluate each situation and apply fair judgment. If any of the penalties herein enumerated differ from the Students’ H andbook, the more severe penalty shall prevail. In addition to the above sanctions, suspension or outright dismissal may be imposed, depending on the circumstances relative to the violation. Legal prosecution by the University can be initiated when indicated. 7.

MAKE-UP

7.1 Make-up for deficiencies incurred due to punishments or absences must be done before graduation except those incurred during the clerks’ last rotation. — 13 —

7.2 All deficiencies during Clerkship training must be made-up at the UST Hospital Clinical, Division and affiLiated hospitals. 7.3 Certification of completed make-up is required. The dates and the number of hours made up for must be included in the certification. 7.3.1 — —

The certification must be signed by: Chief or Senior Resident Department Chairman or Officer-in-charge

8.

REQUIREMENTS FOR THE REVALIDA EXAMINATIONS

8.1 All medical clerks are required to take the Written Revalida Examination which is given on the second Saturday of December. 8.2 Any medical clerk who gets 75% or more in the Written Examinations is exempted from the 1s1 exercise of the Oral Revalida. 8.3 To qualify for the Oral Revalida, a medical clerk must have: 8.3.1 Completed ten (10) months of Clerkship with satisfactory grades for those who enrolled on or before April (Regular) and twelve (12) months for those who enrolled after April 16 (Irregular). 8.3.2 No incomplete grades 8.3.3 No deficiencies (April 16 — February 15) 8.3.4 No suspension 8.3.5 Clearance from the Treasurer’s Office 9.

REQUIREMENTS FOR GRADUATION

To graduate, a clerk MUST: 9.1 Complete 12 months of clinical clerkship as certified by the Director of  Clinical Programs to include:

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9.1.1 9.1.2 9.1.3

No failure in any service No deficiencies (No incomplete grade, No make-up duties) Passing the Oral Revalida

9.2

Settle all accounts with the University Treasurer’s Office

9.3

Submit/present a group Research Scientific Paper

9.5 Obtain clearance from the Central Supply Service, Laboratory, Dormitory, X-ray, Records Section and Accounting Department.

REQUIREMENTS OF THE UST MEDICAL SCHOOL FOR CLERKSHIP ROTATIONS ABROAD A medical clerk may take an elective rotation in a foreign Catholic medical hospital provided he/she has: 1. Satisfactorily completed the 1st 3-years of the Medicine Curriculum (no failure in any subject) 2. A general weighted average of at least 2.50 in the 3-year basic courses. 3. Duly matriculated in the UST Faculty of Medicine and Surgery (Clerkship tuition for the entire year). 4. Submitted letter of intent indicating the institution, time and dates concern. 5. Submitted a course description to the department concerned. The department must endorse the rotation to the Dean’s Office, indicating their acceptance of the outside rotation instead of the same rotation at USTH.

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6. Dean.

Approval by the Director of Clinical Programs and the Office of the

7. A letter of acceptance from the Medical Director/Dean of the Catholic teaching university hospital abroad. 8.

Health and Malpractice Insurance covering the time! place of rotation.

9. At the end of the rotation, evaluation reports on the service rotations must be submitted to the Clinical Programs’ Office. These will be forwarded to the Offices of the Dean and University Registrar for approval.

CLERKSHIP ROTATION AT THE UNIVERSITY Of SANTO TOMAS HOSPITAL 1. PARTICIPATION OF THE UNIVERSITY OF SANTO TOMAS HOSPITAL 1.1 Provides patients and learning facilities (ward/out-patient department/service unit) where the clinical training of the medical clerks is facilitated. 1.2

Provides physical space for clerks/conference rooms in each division.

1.3

Provides guidance through the residents and fellows.

1.4

Chief Residents are appointed to teaching assignments (Clerkship).

1.5 Administers disciplinary action on matters within the hospital’s  jurisdiction. Sanctions are imposed through the Office of Clinical Programs of the Faculty of Medicine and Surgery. 2.

GENERAL CODE OF CONDUCT

All medical clerks: — 16 —

2.1 must wear the prescribed uniform at all times during his/her tour of duty to include the nameplate and identification card. Operating gowns and scrub suits shall be worn only inside special areas. 2.2 are not allowed to drink alcoholic beverages, ingest or smoke prohibited drugs, engage in gambling activities nor smoke cigarettes within the hospital premises. 2.3 must conduct themselves with proper decorum at all times. They should not exhibit Lewd and/or violent behavior towards patients, colleagues, superiors and paramedical staff. 2.4 shall not engage in activities constituting violations of the Sexual Harassment Act of 1996. 2.5 should handle equipment/property belonging to the division and/or the hospital with care. They are expected to observe proper hygiene and housekeeping in their areas of responsibility.

2.6 are responsible to all the interns, residents, consultants, department Clerkship Supervisors, the Director of Clinical Programs and the Medical Director. They must obey all lawful orders/regulations/rules of the division and the hospital. Refusal to obey rules and regulations as well as refusal to carry out orders made by residents/consultants or higher hospital authorities shall constitute insubordination. 2.7 should be aware of all the rules and regulations of the hospital, including those prescribed by the Division and other units of the hospital. 2.8 must follow the general norms of conduct of a Catholic Physician as embodied in the core values of the USTH. — 17 ¬

3.

DUTIES OF MEDICAL CLERKS

3.1

Schedule of Duties

Regular duty days: Monday to Friday —

7:00 a.m. — 5:00 p.m.

Saturday — 7:00 a.m. — 12:00 noon Sunday / Holidays — 8:00 a.m. — 12:00 noon 24-hour duty days — 7:00 a.m. — 12:00 noon of the following day 3.1.1 The Division may require medical clerks to report earlier than 7:00 a.m. for endorsements and other duties. 3.1.2

Holidays/suspension of classes under similar circumstances:

a) All national, university and faculty holidays wherein classes are suspended for undergraduates are automatically half-day for medical clerks rotating at UST Hospital. b) Unscheduled suspension of classes due to typhoon/floods are considered half-day if the suspension is announced before 12 noon. c) If the suspension is announced after 12 noon, it is considered in effect upon announcement. 3.2 Twenty four hour duties start at 7:00 am. of the duty day up to 7:00 a.m. of the following day. No medical clerk may leave and go off-duty earlier than 12:00 noon of the following day unless allowed by the Division Head/Chief  Resident.

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3.3

Out-Patient Department duties:

— Unless ordered by their service department to report to other stations, clerks assigned at the OPD do not need to report when the department is closed. 3.4 All trips outside USTH during office/duty hours must be authorized by the clerkship supervisor or department chairman. Medical clerks must not be ordered to leave the hospital for any unofficial functions which are not cleared with the Office of Clinical Programs. This includes conventions, parties or similar social gatherings. Medical clerks who leave the hospital under such circumstances do so on their own responsibility. 3.5

The daily schedule of activities is prepared by the individual divisions,

3.6 The primary duty and responsibility of the medical clerk is the complete and satisfactory care of the patients entrusted to him/her. He/She is considered as the youngest member of the medical team composed of Interns, Residents, Fellows and Consultants. 3.7 All medical records are the responsibility of the medical clerk. He/She should see to it that at the required date, a hospital chart is complete. * Clerks assigned to a patient more than 24 hours before a shift or rotation are responsible for the patient’s completed chart. 3.8 The medical clerk must keep all medical information strictly confidential. 3.9 The medical clerk should participate in the work-up, diagnosis and therapy of all patients entrusted to him! h er as follows: — 19 —

3.9.1 Preparation and completion of the official case history under the supervision of the Intern and Resident-in-charge. 3.9.2

Examination of patients and writing of daily progress notes.

3.9.3 Detailed knowledge of the patients assigned to him/her and general knowledge of all the cases in the ward. 3.9.4

Securing laboratory reports from Laboratory personnel.

3.9.5 Obtaining x-ray plates, charts and instruments, etc. using prescribed borrower’s cards (obtained from the Office of the Administrative Director in the ClinicaL Division). Completion of discharge summaries with the supervision of  the intern. This incLudes preparation of official forms for those undergoing autopsies.

3.10 Completion of histories and work-ups: 3.10.1 Within one hour after admission, a short admitting history with the pertinent physical findings and the admitting diagnosis must be in the patient’s chart. 3.10.2 The complete history and physical examination must be in the patient’s chart within 24 hours after admission and the corrected typewritten official form within 24 hours after correction. 3.10.3 Suggestions on initial laboratory tests are presented to the Intern and Resident. When approved by the Resident, they are written — 20 —

on the doctor’s order sheet and carried out as soon as possible. 3.10.4 Discharge arrangements should be completed on time, prior to the patient’s discharge. Completed charts must be submitted to the Resident within 24 hours after discharge. 3.11 All medical clerks must attend Residents’ and service Consultants’ rounds except when attending to seriously ill patients. 3.12 Medical clerks are required to attend all teaching conferences, general staff scientific meetings, departmental conferences, Clinical-Pathologic conferences, ward rounds, journal club meetings and all activities listed on the house staff schedule or prescribed by the Director of Clinical Programs. The valid exceptions to attendance at these meetings are: 1) assisting in an operative procedure, 2) care of critically ill patients, and 3) 24-hour duty assignment. 3.13 Medical clerks should assist in the performance of diagnostic and therapeutic procedures. They may perform procedures assigned to them by residents under the latter’s direct supervision and responsibility. 3.14 Medical clerks are subject to additional policies, rules and regulations promulgated by the hospital/ faculty administration. 3.15 Each group of medical clerks is required to submit a research paper/project as a requirement for graduation. Deadlines for the same will be announced accordingly.