CLERK’S ORIENTATION

2018
THE MEDICAL CITY
DEPARTMENT OF OPHTHALMOLOGY

Cristina Angelica A. Tan, MD– MBA

WELCOME TO

TMC OPHTHA!
 THE BIG BOSSES
DR.VICTOR CAPARAS DR. IVO DUALAN
THE CHAIRMAN THE TRAINING OFFICER
OPHTHA RESIDENTS 2018
 3rd YEARS
CORINNA SAMANIEGO
THE CHIEF

PIA CRISTINA
TECSION TAN
 2 nd YEARS

DR. CAPARAS
THE CHAIRMAN EMAN
KAYE ECHEVARRIA
LOCAYLOCAY
MARGOT
JAVIER
 1 ST YEARS
JONNAH DENISE
CORINNA TEOPE ABBEY DE GUIA GRANADA
“KUY” “ABBEY” “DENISE”
GOALS FOR THE ROTATION
 BE PROACTIVE!
o Maximize YOUR learning
o LOOK for cases
o READ up on things you encounter
o Should be familiar or adept with the following
✓ History and PE (VAGETS)
✓ Slit lamp
✓ Diagnosing and managing common eye diseases
✓ Common eye center procedures
✓ Observe or assist cataract surgeries
o Have fun!
HOUSE RULES
 ATTENDANCE
o One week rotation
o Duty every 3 days
o Attendance sheet
- Post in corkboard in Telemedicine area (Reading
Room)
TELEMEDICINE OR READING ROOM
WHITEBOARD
 TIME IN
o Write CORRECT time
– Regular days: 7AM
• Attendance of Intern’s Reporting is a MUST
– EXCEPTION: Advised by From Duty resident to help in the OR
– Sundays and Holidays: 8AM for DUTY clerk
 MAKE–UPS
o Please be on time
– Accumulated late >1 hour (whole rotation)
= number of hours late x 2
– Excused absence (with medical certificate)
= exact number of missed hours
– Unexcused absence = number of hours late x 2
o List of all those make–ups will be given at the
end of the year
 TIME OUT
o Pre-duty: 5PM (except for Saturdays,12NN)
o Post-duty: 5PM (except for Saturdays,12NN)
 BE PREPARED!
o ALWAYS bring the following
✓Scrubsuit
✓Penlight
✓Jaeger chart
✓Ophthalmoscope
(at least 1 per duty team)
 BAGS
o Clerks’ Quarters
o Eye Center
- Duty clerks
oMay bring bags and sleeping materials after office
hours (beyond 5PM)

o BE CAREFUL WITH YOUR BELONGINGS

- Keep with you at all times
- Do not leave your gadgets in the reception
area
 MEALS
o Decking system with your Interns
o ALWAYS advise your Resident on duty AND
your Interns when you will be going out for
lunch/dinner
POSTS
PRE–DUTY
DUTY
FROM–DUTY
 PRE–DUTY
o Post: OPD
- Start: 8AM
- Cut off for patients: 10AM
o Ask Interns/Residents if there are any charts or
materials to be brought down to the OPD
 PRE–DUTY
o New patients: Database
 PRE–DUTY
o Old patients: Follow-up form
S Last ff-up date and diagnosis, new/old complaints,
improvement from last complaint, recent eye
medications
O VA distance & near (age>40), gross exam, pupils, EOMS,
digital tonometry, fundoscopy
Amsler grid for suspected maculopathies
Confrontation test for suspected retina or optic nerve
problems
❖YOU MAY USE THE SLIT LAMP. Don’t be shy to ask
questions
A and P For residents
FOLLOW-UP SOAP NOTES
 PRE–DUTY
o Refer your case to resident
o Focus on history and PE
o May give diagnosis
o Countercheck with resident in charge the
information/physical exam
 PRE–DUTY
o Logging
- TMC Prime (online database)
- Excel file
o If OPD ends early and papers and TMC Prime
logging is finished, may enter OR to observe or
assist in surgeries
- ALWAYS ask permission from OPD resident
POSTS
PRE–DUTY

DUTY
FROM–DUTY
 DUTY
o Post: EYE CENTER and FLOORS
- First in line in interviewing ER/admission patients
(with Duty intern/resident)
- Stay at the eye center during tour of duties
- Duty clerks will NOT stay/sleep in the quarters
 DUTY
o EYE CENTER
- Answer ER Referrals
• Relay message of caller to your intern or resident first
before allowing conduction to Eye Center
• Do NOT conduct the following referrals
✓Trauma – laceration, fracture
✓Chemical injury – irrigation should be done at ER
• Ask for 1L PNSS, Kelly pad, MACROset
✓Unstable patients – high BP, non-ambulatory
 DUTY
o ER REFERRALS
– With Interns
• 2 COPIES of ER database:
✓ 1 for eye center and the other 1 for ER (use carbon paper)
• Complete all necessary data
• Indicate date, healthcard or if personal charge (whichever
is applicable) on upper right corner
• Check consultant for the day and write in the “Attending
Physician”
• Log ER patients in the logbook provided and on Excel file
WHITEBOARD
VA ROOM
VA AREA AND SLIT LAMP
ALCAINE AND DYECAINE
 DUTY
o ADMISSION
– With Interns
• 1 COPY of database
o FLOORS
- Clerk may go on rounds with resident on duty
- Choose 1 patient for SOAP notes for the week
• 1 sheet of paper only
- If few admissions or referrals, may use the same patient
- Refer to daily Census for patient list
- SOAP notes to be submitted at the end of rotation
May issue demerits if not completed
SOAP NOTES
 DUTY
o END OF DUTY ENDORSEMENTS
- Endorse 1 ER case to resident on duty
✓History, PE, Diagnosis, Management
- Depending on availability of resident
 DUTY
o EYE CENTER PROCEDURES
– Stay at the work room IF there are no pending calls/tasks
with the interns
• You may study or do your requirements
• ALWAYS ask resident or intern if there are pending
requirements first
– Eye Center technicians and staff will approach you if
there are any tasks needed
✓History and PE (VA)
✓Skin test for flourescein dye
✓IV insertion for flourescein angiography
WORKROOM
 DUTY
o EYE CENTER PROCEDURES
– Be familiar with the following procedures
✓Automated Refraction/Keratometry (“AR/Kera”)
✓Fluorescein Angiography
✓Perimetry
✓Biometry
✓A scan (done by resident)
✓Specular Microscopy
✓OCT
o Refer to Clerk’s guide for TMC Eye Center
procedures
THE ‘AQUARIUM’
 DUTY
o INTRAVITREAL INJECTION
– May observe Consultant perform procedure
– Check whiteboard for schedule
– Wear cap and mask inside (semi–sterile room)
– Consultants may ask about the procedure. Be
prepared
INTRAVIT ROOM
POSTS
PRE–DUTY
DUTY

FROM–DUTY
 FROM–DUTY
o Post: OR
– Observe/assist procedures
– If no ORs, help in OPD
– Observe OR decorum
ORs FOR THE DAY
 FROM–DUTY
o PARU (Patient’s holding area)
• PARU Information Sheet form
✓ On desk: Fill in Chief complaint, history and ROS
✓ Check if consent was signed by patient
• Check if patient is dilated for cataract and vitrectomy
procedures.
• Check if with surgical marking (arrow above eyebrow)
PARU: OR 3 and 4 Schedule
PARU: Patient Info Sheet
 FROM–DUTY
o OR 3 and 4
– Assist transferring patients from wheelchair to bed
– May assist in surgeries ☺
✓Dr. Alex Reyes and Dr. JM Cruz (cataract)
✓Dr. Mercado and Dr. Bengzon (oculoplastic/orbit
surgeries)
• ASK FOR PERMISSION TO SCRUB IN
• Dr. Bengzon: You may be asked to sing. Please prepare a
song number(s)
OR 3 and 4
 FROM–DUTY
o OR technique and Take Home Instructions
– Help interns make OR techs and THIs
✓2 OR techs for Personal charge, 3 for HMO
✓2 THIs
– Get patient info from PARU
✓Age/Gender
✓Birthday
✓Laterality
✓Consultant and Resident assist
- Computer at OR 4, Printer at Whiteboard station
PARU: Patient Info Sheet
 OR Technique
Take Home Instructions
POSTS
STRAMA
 STRAMA
o THURSDAYS 7AM to 2PM
o From–Duty
- Inform resident and interns during your duty
- May leave at 5AM
o Duty
- Report back for duty after STRAMA
SGDs and ADCON
 SGD: DR. TIMOTHY TAN
1. RED EYE
2. OCULAR MANIFESTATIONS OF SYSTEMIC
DISEASE
• Main Source: Vaughan and Asbury
• Supplementary: Kanski and Will’s Eye
• Group Leader to reserve TMC conference rooms
or CHI/Library
• Borrow projector for the reporting
– ASMPH, TMC library, or batch mates
 TMC ADCON: DR. JM CRUZ
o Usually on Wednesdays 4PM
o Pre duty clerks on MONDAY will look for 1 case
each from the OPD (ideally new patients)
o DUTY clerks on MONDAY may also look for
cases (admitted/floor patients or ER patients)
o If no cases on Monday, TUESDAY pre-duty
and/or duty clerks will be tasked to look for
cases
 TMC ADCON: DR. JM CRUZ
o To be checked by Clerk’s Monitor or Resident
in charge by TUESDAY AFTERNOON
o Prepare powerpoint slide of all cases
✓Dr. Cruz will choose from list
o Group Leader to reserve ASMPH room
o Borrow projector for the reporting
 GRAND ADCON: DR. JM CRUZ
o With QMMC group
o No need for grading sheet
o Group Leader to reserve ASMPH room
✓Good for 30 people
EXIT EXAM
 EXIT EXAM
o Saturday after ADCON
o 50 items total
o Feedback after exam
REQUIREMENTS
 REQUIREMENTS
o SATURDAY 12NN after ADCON
✓Professionalism Grading Sheet (2)
✓Skills Grading Sheet (2)
✓SGD Grading Sheet
✓ASMPH Peer Evaluation Sheet
✓Institution Feedback forms
✓ASMPH Checklist of Must see cases
✓Attendance sheet
– NOTE: Do NOT submit BLANK grading sheets
 REQUIREMENTS
o Arrange alphabetically and submit in brown
envelope by Group Leader
o The whole group will accumulate 2 hours of
makeup for every day that the group envelope
is incomplete
SCHEDULE FOR JAN. 1 TO 14, 2018

JANUARY ACTIVITIES
1 (MONDAY) SKELETAL
2 (TUESDAY) ORIENTATION AT 730AM EYE CENTER
3 (WEDNESDAY) SGD WITH DR. TIMOTHY TAN (7AM-11AM)
4 (THURSDAY)
5 (FRIDAY) LEC (7AM-5PM)
6 (SATURDAY) STRAMA (1PM-5PM)
7 (SUNDAY) LAST DAY
GOALS FOR THE ROTATION
 BE PROACTIVE!
o Maximize YOUR learning
o LOOK for cases
o READ up on things you encounter
o Should be familiar or adept with the following
✓ History and PE (VAGETS)
✓ Slit lamp
✓ Diagnosing and managing common eye diseases
✓ Common eye center procedures
✓ Observe or assist cataract surgeries
o Have fun!