Pediatrics 251

Integrated Clinical Clerkship II in Pediatrics

Course Description
Participatory care to enhance integration of basic
pediatric knowledge and acquisition of
fundamental skills related to promotion of
health, diagnosis, and treatment of commonly
encountered pediatric disorders in an in-patient
setting with community orientation.
CREDIT: 4 weeks

Course Coordinators

Head Consultant/Coordinator:
Dr. Marissa Lukban (09228858384)
Rotation Period: Oct 26 Nov 22
LU6 Faculty Coordinator: Dr. Marissa Lukban
(09228858384)
Resident Monitors: Dr. Marianne Naria
(09322764772), Dr. Kris Alonzo (09228796122)

Faculty Preceptors for the month:

Dr. Jun Anacleto (09053626895)
Dr. Marissa Lukban (09228858384)
Dr. Casis-Hao (09178950617)
Dr Tanega-Aliling (09175008464)

Preceptorship Schedule/Ward Assignments

Oct 26-Nov
Faculty
Nov 2-Nov 8
1
Group A / Group A /
Dr. Anacleto
Ward
Ward
Group B / Group B /
Dr. Lukban
Ward
Ward
Dr. Casis- Group C / Group C /
Hao
Nursery
PER
Dr. Tanega- Group D / Group D /
Aliling
PER
Nursery

Nov 9-Nov Nov 16-Nov

15
22
Group B / Group B /
PER
Nursery
Group A / Group A /
Nursery
PER
Group D / Group D /
Ward
Ward
Group C / Group C /
Ward
Ward

Schedule of Ward, PER, Nursery Rotation

Ward 9 or
11 (Gen
Ped or
Subspec)
NXI
PER

Week 1
A
B

Week 2
A
B

Week 3
C
D

Week 4
C
D

C
D

D
C

A
B

B
A

Introduction
Clinical clerks will rotate in Pediatrics for a total of four
weeks as blocks of 16 students.
The rotation will be divided into a two-week stay in the
general pediatric service/ subspecialty service (Wards 9
and 11), and one-week stay each in the nursery and
pediatric emergency room.
The clerks will be distributed to the 4 general pediatric
services and 2 subspecialty services in wards 9 and 11.
There will be four clerks assigned per area.

Objectives
At the end of the 4-week rotation, the student is expected
to:
1. Show proficiency in history taking and physical
examination of pediatric patients.
2. Diagnose common childhood illnesses and discuss the
pathophysiology of the disease.
3. List appropriate diagnostic tools and interpret the
results.

Objectives
4. Know the principles of medical management of common
childhood illnesses and preventive care.
5. Acquire skills in performing common pediatric
procedures.
6. Exhibit the proper attitude and dedication to serve
others, as well as develop confidence and patience in
handling pediatric patients.

ROTATIONS

WARDS
Each clerk will have a two-week rotation in the general
pediatric service or subspecialty service.
Each ward service is composed of a consultant-in-charge,
one senior resident, two junior residents, one to two
interns and one to two clinical clerks. There will be equal
patient decking among clerks and interns.
Each clinical clerk is expected to play an active role in
the diagnosis and management of patients assigned to
each service.

WARDS
He/ she is also expected to participate in other activities
of the service like journal reports, service rounds, audits,
case management reports, and activities/conferences
scheduled by the department.
Each student will be responsible for the patients
assigned to them and the residents of the service will be
directly in charge of supervising the students.

WARDS
The students are required to make clinical notes* on their
patients, facilitate the labs and interdepartmental
referrals ordered, clinical assessment / monitoring, and
endorsing his/ her patients.
Emphasis will be given in enhancing skills in history
taking, complete physical examination, assessment and
differential diagnosis, ordering basic laboratory
examinations and how to interpret them, and basic
principles of medical management.
*incoming and outgoing notes, clinical abstract and discharge summary

WARDS
Each group will be divided into three subgroups and each
subgroup will go on duty every three days.
The duty team is tasked to receive endorsements from
the post and pre-duty teams, monitor all the patients
admitted in the assigned ward and document properly
all the findings, carry out orders made during the tour of
duty, and stabilize newly admitted patients.
Duty starts at 4:30pm until 7:30am on regular days and
12 noon until 8am on holidays and weekends.

WARDS
There shall be a TIC (temporary in charge) student for
every admission after office hours. He/She is expected to
retrieve pertinent laboratory results and radiographs
before the duty ends.
The TIC is expected to obtain a good clinical history and
do a complete physical examination of the patient
decked to him. He/ she will then present the patient
during student endorsement conferences.

NURSERY
Pre-duty clerks
Each clerk is required to make DRI rounds, chart three
patients, and facilitate latching on of well babies from
7:30 to 9am except on days when they have to attend
department conferences from 8-9am.
From 9am to 4:30pm, he/she is expected to study and
present a case of a neonate admitted in NICU 2 or 3, to
the NICU fellow

NURSERY
Duty clerks
Duty clerks are expected to stay in the catchers area
from 7:30 am to 7:30 am the next day
They are expected to assist in catching and resuscitation
of newborns; assess and do thorough physical
examination of the newborns; accomplish paper works;
help in the admission of newborns in the ICU if needed

NURSERY
Post-duty clerks
Each clerk is required to make DRI rounds, chart three
patients, and facilitate latching on of well babies who
he/she resuscitated at OBAS during her duty from 7:30
to 9am except on days when they have to attend
department conferences from 8-9am. He/she is relieved
from duty after 9am.

PEDIA ER
Pre-duty clerks are expected to do blood extractions and IV
insertions to old patients, and monitor patients at the PER
from 7:30am to 7:30 pm.
Duty clerks are decked to newly admitted patients; and are
expected to get the history, do physical examination, help in
the resuscitation/management, and to facilitate laboratory
examinations at the PER from 7:30am to 7:30pm or 7:30pm
to 7:30 am the next day.
Post-duty clerks are relieved from their posts at
7:30am/7:30pm after endorsing to the incoming duty team.

PRECEPTORIALS

Preceptorials
Each group of four students will meet with a consultant
preceptor once weekly throughout the entire rotation;
each group will thus have to complete FOUR preceptorial
sessions.
Students are expected to present a patient (preferably
with a condition included in the list of must-know topics)
and discuss relevant aspects of diagnosis, differential
diagnosis, management and the BIOETHICS aspects of
the case and will be graded individually based on the
parameters listed in the evaluation sheet.

Preceptorials
The students may be pulled out of their respective
place of rotation and excused from ward work
during the scheduled hour of preceptorials.
Each group will be assigned to 2 consultants for
the duration of the rotation and each consultant
will evaluate them for two preceptorials.

ATTENDANCE

Attendance
The university rule on absences and tardiness will be
followed. A student is required to be present at least 80% of
the entire rotation. If a student accumulates more than 20%
of absences, he/she is automatically dropped from the
rotation.
All clerks are required to sign on the attendance
sheet/logbook located in the Ward 11 Residents Callroom
Official Time in/Time out hours:
Weekdays: 7:30 am/ 4:30 pm
Weekends: 8:00 am/12:00 nn

CONFERENCES

Endorsement Conferences
These are conducted every Tuesday (7:30 - 9am)
and Saturday (8 - 9:30am). The ward post duty
team is tasked to report on a case admitted
during 7:30 am 12 midnight. The clerk-incharge is expected to know the history and PE of
their patients, assessment, differential diagnosis,
labs and interpretation, and basic principles in
managing the case.

Special Lectures

These will be conducted by resident monitor of the block

during the 1st 2 weeks of each rotation preferably from
1-2 pm to supplement the learning of the students.

Topics:
1.
2.
3.
4.
5.
6.
7.

Pediatric history and PE

Growth and Development
Fluid and electrolyte management
ABG interpretation
ECG reading
CBC and Blood transfusion
PALS

Major Conferences
Clerks are required to attend staff conferences,
monthly audits, special lectures, etc. The schedule
of conferences will be posted at the bulletin board
outside the Pedia Office.

CLINICAL WORK DOCUMENTS

1. Incoming Notes - should be submitted within 24 hours

after shifting in.
2. Clinical Abstract - should be inserted in the chart within
12 hours for non- toxic patients and within 6 hours for
toxic patients.
3. Clinical History - should be made for all new
admissions. This includes a complete clinical history
and physical examination, short course at the PER, as
well as the assessment and plan. This should be on a
problem-based format. For non-toxic patients, this
should be incorporated in the patients chart within 24
hours of admission and for toxic patients, within 12
hours.

4. Progress Notes - should contain the length of hospital

stay, patients current weight and vital signs, pertinent
PE, present working impression, and present problems.
This should also be in problem-based format. This
should be inserted in the chart every 5 days for nontoxic patients. Frequency of progress noted for toxic
patients will be at the discretion of the senior resident
of the service.

5. Endorsement Sheet - should be placed at bedside (or

endorsed to the duty team), containing the name,
age/sex, service, weight, ET size and depth (if
applicable), complete assessment, endorsements and
list of medications.
6. Interdepartmental Referrals - should be accomplished
accordingly in compliance to other departments
requirements for referrals.
7. Outgoing Notes- should contain the course during the
patients hospital stay, plan of management and
special endorsements.

Sample Problem List

Torres, Janea
2/F
7.8kg
4th hospital day, 3rd ward day
Present Working Impression:
PCAP D
Acute gastroenteritis with severe dehydration

1. PCAP D
S> 3 day history of cough productive of yellowish
sputum, fever Tmax 38.7C, difficulty of breathing
Course in the Wards:
Intubated ET4.5 L12, present MV settings:
100%, 18/5, 30, 0.5
Started on Cefuroxime (100mkday) 250mg IV q8
D2+2
Salbutamol nebulization q6

1. PCAP D
O> HR 138, RR 46, alar flaring, subcostal
retractions, (+) crackles on both lower lung fields
Latest CBC:
118/0.389/19.2/0.88/0.10/0.01/0.01/368
CXR:

1. PCAP D
O> Latest ABG
7.43

23.3

37.6

1.2

238.7

99.2

Normal acid base balance with

overcorrected hypoxemia

1. PCAP D
P>
Diagnostics:
Do serial ABGs
Monitor CBC trend
Therapeutics:
Cefuroxime (100) to complete 2 weeks
Referral: Pulmonology

2. AGE with severe dehydration

S> 2 day history of loose watery stools, vomiting,
abdominal pain
O> HR 138, sunken eyeballs, dry oral mucosa, skin
pinch slow to return, CRT 3 seconds, cool hands and
feet

2. AGE with severe dehydration

A> AGE with severe dehydration
P> Continue hydration using WHO protocol for
severe dehydration
Monitor urine output (latest 2.8cc/kg/hr for the
past 8 hours)
NPO for now, monitor Hgt q8,
last Hgt taken 12:00nn, 80mg/dl
Follow up fecalysis, blood cultures

MERITS AND INFRACTIONS

Merits and Rewards

Outstanding endorsement
As recommended by the residents of the service where
the students rotated
Other merits/demerits may be given by the residents-incharge on a case to case basis but these are subject to
approval by the LU6 committee.

Infractions, Penalties and Make-up Duties

1 tardiness (15 minutes late)

4 hrs
1 excused absence (day)
12 hrs (make-up)
1 unexcused absence (day)
24 hrs
1 excused absence (duty)
24 hrs (make up)
1 unexcused absence (duty)
48 hrs
Out of post
36 hrs
Negligence in monitoring
48 hrs
Incoming/outgoing notes/History/Abstract
12 hrs/day delayed
Progress notes/ endorsement sheet
6 hrs/day delayed

WRITTEN EXAMINATION

Quizzes
Clerks are required to take the quizzes after each
lecture which will be credited as part of their endof-rotation exam grades.

End-of-Rotation Exam
This will cover questions on normal growth and
development, as well as common pediatric illnesses
commonly encountered in the emergency room, nursery
and the wards.
It will also include questions on the special lectures,
pediatric diagnostic examinations, clinical practice
guidelines (e.g. fluids and electrolytes ,x-ray reading,
ABG and ECG interpretation, management of diarrhea,
sepsis, pneumonia, meningitis, etc). Please review your
LU5 lectures in pediatrics.

Final Examination
This will be given at the end of the rotation, and will
cover topics included in the list of must-know topics.

Comprehensive Exam
This will be given at the end of the school year as
scheduled by the college.

EVALUATION

Assessment Tools

Preceptorials/ Case
Presentations
Comprehensive
Examinations

% Distribution

Rating scale

25%

Objective written exam

10%

End-of-rotation exam
Final examination in
Pediatrics

Objective written exam

15%

Objective written exam

15%

Supervisor evaluation
Peer evaluation

Rating scale
Rating scale

25%
5%

Attendance
TOTAL

Attendance card/Logbook

5%
100%

MUST-KNOW TOPICS (see list of topics)

GUIDE TO DAILY SCHEDULE OF ACTIVITIES (see tables)
List of References:
Required: Nelsons Textbook of Pediatrics, 19th edition
Suggested: Fundamentals of Pediatrics: Competency-Based

Must Know Topics

General Pediatrics
1. Growth and development
2. Dehydration, fluids and electrolytes
3. Preventive Pediatrics
4. Pediatric procedures
5. Pediatric Resuscitation
Allergy and Immunological Diseases
1. Acute urticaria
2. Allergic rhinitis
3. Anaphylaxis
4. Bronchial Asthma
5. SLE
Cardiology
1. Congenital heart disease
2. Rheumatic fever & RHD
3. Rhythm disturbance

4. Pediatric ECG interpretation

Endocrinology
1. Adrenal gland disorders
2. Diabetes mellitus
3. Thyroid gland disorders
Gastrointestinal Diseases
1. Acute and chronic diarrhea
2. Protein Energy Malnutrition
3. Hepatitis and Jaundice
Hematology-Oncology
1. Acute/chronic leukemia
2. Anemia
3. Hemophilia
4. Lymphoma
5. Solid abdominal masses

Must Know Topics

Infectious Diseases
1. Dengue fever
2. Enteric fever
3. Tuberculosis
4. Viral exanthema
Neonatology
1. Newborn care
2. Hyaline membrane disease
2. Jaundice in neonates
3. Neonatal sepsis
4. Persistent pulmonary HPN in newborn

Neurology

1. Coma & increase intracranial pressure

2. Congenital Brain & Spine malformations
3. CNS infections & complications
4. Seizures & status epilepticus
Pulmonology
1. Pneumonia & respiratory tract infections
2. ABG interpretation
Renal Disorders
1. Nephrotic/Nephritic syndrome
2. Urinary tract infection

REQUIREMENTS to be SUBMITTED

1. 4 SGD Grades (Case Management Evaluation Form)

2. 4 Unified Teacher Evaluation Tools for Small Group Sessions
3. 2 Ward Grades (PCEX for Students Form) Junior
Resident/Resident-in-Charge, Service Consultant/Service
Senior Resident
4. 2 PER Grades (PCEX for Students Form) Junior Resident, PER
Consultant/Senior Resident
5. 2 Nursery Grades (PCEX for Students Form) NICU Resident,
NICU Consultant/Fellow
6. Peer Evaluation Form
7. Feedback Form
8. Index Card of Procedures / Clinical Skills

IDC 205
Non-clinical Career Options

Panel Discussion
(Pediatrics or Family Medicine)

Requirements:
Attendance
Reflection Paper

Welcome to
PEDIA!!!