JUNIOR CLERKSHIP GUIDELINES

I.                   Objectives

A.    General Objective:

To provide the third year medical students adequate clinical exposure in the Department of Ophthalmology  in preparation for Senior Clerkship

B.     Specific Objectives:

1.      To reinforce the basic training of Junior Clerks on the essentials of history making, doing a complete physical examination, formulation and plans of management.

2.      To teach Junior Clerks how to make daily progress notes.

3.      To familiarize and enable Junior Clerks to perform common ward/OPD procedures as deemed necessary by the department.

4.      To expose Junior Clerks with the duties and responsibilities of going on duty within the hospital.

II.                Duties and Responsibilities

1.      A group of Junior clerks shall be assigned to a resident and intern buddies.

2.       The junior clerks shall be present in the OPD every Monday to Friday at the following schedules:

Monday and Wednesday        4:00-7:00 pm

Tuesday and Thursday            2:00-5:00 pm

Friday                                      5:00-7:00 pm

3.      Leave of absence must be obtained from the Dean of the College.

4.      There will be a time that a junior clerk shall accomplish history taking, physical examination, and daily progress notes of the patient assigned to him. These shall all be personally handwritten.

5.      He shall observe, assist, and in certain instances, may be required to do different ward/OPD procedures with supervision.

6.      He must be familiar with the common laboratory tests and their interpretation.

7.      He is required to join ward rounds, conferences, endorsements, and other related department activities when applicable.

8.      He is required to attend the joint monthly junior clerkship conference, which as much as possible, is multi-disciplinary in nature. This is scheduled every last Tuesday of the month from 3:30-5:00 pm. Before the conference, he is required at 2:00-3:30 pm to go to OPD. If the schedule of the conference falls on a holiday, it shall be re-scheduled on the next clerkship day. The conference is presented by the different groups and the case will depend on the department where the group will be rotating. The schedule will be predetermined by the preceptor. The case to be presented will be assigned at least one week before the schedule of presentation. The presenting group shall prepare a protocol to be posted at the bulletin board for junior clerks at least a day prior to the schedule of the conference. A copy shall be provided to the resident and consultant preceptors of the presenting department.

9.      The junior clerk may be required to present a case/report during his/her rotation.

10.  The junior clerk shall go on duty in the hospital from 9pm to 7am, at least twice a month.

11.  The junior clerks may observe the operation of a patient assigned to him or seen in the OPD during their rotation.

12.  Patients are the first consideration of the junior clerk, and shall be treated with utmost dignity.

III.             Rules and Regulations

1.      The junior clerk should at all times observe proper professional decorum and ethics towards the patient.

2.      The junior clerk is not allowed to accept fees, gifts, or presents in any form from the patients or their relatives.

3.      He may be allowed to look at the charts of patients assigned to him. No portion of the chart should be photocopied.

4.      The junior clerk should wear the prescribed uniform with nameplate within hospital premises. A medical bag containing the necessary medical equipment is required. The prescribed scrub suit should be worn in the surgical services when necessary.

5.      Surgical gowns and scrub suits are allowed only in surgical services and should not be worn outside the operating room.

6.      The junior clerk has no jurisdiction over the nurses or paramedical personnel.

7.      Gambling and drinking of alcoholic beverages or other intoxicating substances are prohibited, and are punishable by expulsion from the College.

8.      The junior clerk should be familiar with the rules and regulations of the hospital. Ignorance of the rules should not be taken as an excuse.

IV.             Evaluation

1.      The performance of junior clerks shall be reviewed by the resident monitor based on criteria set forth by each department.

2.      The grade reports shall be completed by the resident monitor, and shall be submitted within ten days after completion of the shift.

V.                Penalties

A.    Offenses Affecting Attendance

1.      Absence Without Leave        -Repeat Service Rotation

(Reports for the day but subsequently disappears before the end of his tour of duty without permission)

2.      Out of Post (outside the hospital premises)    -14 days extension

3.      Unexcused absence               -2 days extension for every day of

absence

4.      Excused absence                    -make up for every day of absence

5.      Tardiness (reports after 15 minutes from the ideal time of reporting)

1^st offense                   -warning

2^nd offense                  -journal report

3^rd offense                   -2 days extension

4^th and subsequent offense      -1 day for each tardiness

NOTE: Whenever a junior clerk is absent, he and she should secure an excuse slip from the Dean’s Office and likewise submit an excuse letter addressed to the consultant preceptor.

B. Offenses affecting uniform and equipment

Considered as unexcused absence:

1.      Without uniform

2.      Incomplete uniform

3.      Without nameplate

4.      Incomplete equipment as per requirement of each department

5.      Without reference book (General Ophtha byVaughan)

C. Offenses affecting learning experience

D.Offenses affecting other hospital personnel

Unreasonable argument with and disrespect of paramedical personnel after proper investigation – Penalty t the discretion of the committee on clinical training program

E. Offenses affecting conduct of junior clerks

Expulsion or suspension from the college at the discretion of the committee on clinical training program

1.      Inebriation

2.      Gambling

3.      Smoking within hospital premises

4.      Gross discourtesy

5.      Use of profane language

6.      Unauthorize press release

7.      Forgery

8.      Cheating

F. Any situation/Offense not covered above shall be referred to the Committee on Clinical Training Program

IV. Implementation of Extension of Duties

1.      Completion of extension of duties of any junior clerk shall be made after the junior clerkship rotation program for each year

2.      Any junior clerk who has extension of duties shall report to the chief resident of each department or the preceptor in charge, in the absence of a chief resident, for duty assignment.

3.      One day extension is equivalent to at least 3 hours of duty.  Depending on the department policy, a student extendee might be required to attend morning endorsement of senior clerks.

4.      An extendee junior clerk shall comply with all the requirements of one department before he can work on to other departments where he has also some deficiencies

5.      He is not allowed to work 24 hours to compensate for the remaining deficiencies. He may however work on a Saturday, Sunday or holiday.

6.      A certificate of completion/fulfilment of extension of duties should be submitted to the consultant preceptor for final clearance.

7.      All junior clerks should be cleared of all deficiencies in all departments on or before March 31 of each school year provided the clerk has no extension of duties in any department that will require him/her to continue to serve beyond the said date.  In case of the latter, clearance will be given after completion of the extension of duties.  Failure to submit the clearance on the said date will mean an unsatisfactory rating.

SCHEDULE OF ACTIVITIES FOR JUNIOR CLERKS

Day  1-2          Orientation                      by: Resident Monitor

1^st week           Lectures:                         by: 1^st/2^nd yr Res

                                    VATEF

                                    Ancillary Exams

                                                Tonometry

                                                Visual Fields exams

                                                Slit Lamp Exam

                                                Indirect Ophthalmoscopy

                                                Tests for strabismus

                                                Exophthalmometry

                                                Test for lacrimal apparatus

2^nd week          Visual Presentation on ECCE and Phaco        by:  Chief Resident

                        Lecture                                  by: Ophtha PGI

                                    Ocular Emergencies

                                    Red Eye

3^rd week           Chief Resident’s Lecture

                        Patient assignment for clinic-pathologic conference

                        Preparation for CPC

4^th week           Reporting                                        by: Junior Clerks

                                    Anatomy of the Eye

                                    Physiology of the eye

                                    Pupillary light reflex

                                    Marcus Gunn Pupil

                                    Oculocardiac Reflex