Post Graduate Internship at Pablo O. Torre Memorial Medical Hospital Bacolod

Dr. Pablo O. Torre Memorial Hospital, more commonly known as Riverside, is a 300-bed private tertiary hospital located at the heart of Bacolod City. The hospital has continually produced exemplary doctors who have undergone 1 year intensive training under their postgraduate internship program. Currently, the institution is training their 44th batch of postgraduate interns.

The usual departments where PGI rotates are:

1. Pediatrics (2 months)

2. Surgery (2 months)

3. Community and Emergency Medicine (2 months)

4. Internal Medicine (2 months)

5. Obstetrics and Gynecology (2 months)

6. Pathology (2 weeks)

7. Radiology (2 weeks)

8. Anesthesia (2 weeks)

9. Otorhinolaryngology (2 weeks)

10. Orthopedics (2 weeks)

As prescribed by the APMC, we do not have 24 hour duties. For most departments, we only have 12 hour duties either 8AM-8PM or 8PM-8AM. NO NIGHT DUTIES for the minor rotations. But for IM, we have a straight 16 hour cinderella duty (8AM-12MN). From Duty and On Call statuses are only half day during weekends and holidays. On duty interns go on skeletal duty during these times. Usual duty pattern is: Duty AM, OC, Duty PM, FD, OC. This pattern is flexible and sometimes your group will have an extra on call or from duty if you have 6 members in a group. Duties are every 3 days for IM. From duty interns are untouchable (except for IM and OB because they need to see OPD patients) but still need to attend conferences and endorsements. Because of this schedule and due to the limited number of PGIs, we go on single duties in almost all rotation.

The patient bulk is a little heavy. We do not have too many patients compared with public hospitals but not too few compared with the other private hospitals. Caseload is very varied. You can see patients admitted for simple allergic rhinitis to toxic patients admitted because of hypovolemic shock secondary to ruptured abdominal aortic aneurysm. Since there are plenty of rich people in Negros, sometimes you will be shocked to know that your patients is actually the owner of one of the biggest enterprises in Negros. Nevertheless, charity cases, albeit limited, are also existent allowing interns to have a better chance to learn ideal management from these cases.

Rotating in every department is really rewarding. The On Duty PGIs are the first call to see patients whether in the OPD, Acute care unit or in ER. On call PGI usually see direct to room patients first. Generally for all the patients that we see, we are required to have our own assessments and plans which our residents will gladly approve or correct if needed. For bedside procedures, PGIs are allowed to perform IV insertion, foley catheter and NGT insertions, etc. Ward calls include IV to follow, wound dressing, bedside procedures, accompanying toxic patient to imaging services, hospital transfers, referrals, medical abstracts, etc. We do not do q4, q2 and qhrly monitoring as these are nurses’ jobs.

For ward calls, we assess the patient first and then try to troubleshoot the problem if we are able to do so. We refer directly to our residents if needed. Minor rotations such as ENT and Ortho have no residents, thus PGIs act like one and refer directly to consultant. In minor rotations, we admit patients ourselves, see and manage patients at the OPD ourselves, follow-up ward patients ourselves and directly refer to the consultants if needed.

In terms of surgical cases, we scrub in almost all surgeries. Since there are only few surgical residents, we get to be the first assist often. Cases are very varied. Common cases include appendectomies, chole, mastectomy, herniorrhaphy, cysto-TURP, etc. Thoracovascular surgery, reconstructive surgery and organ transplant are also performed in our hospital. This is another plus for you if you wish to go on surgical training later on.

In the OB department, you will definitely master the art of fetal monitoring since it will be your job to perform NST, CST and CTG monitoring. Nurses do the labor watching so another plus points to those who do not want to be placed in such a socially awkward situation with a prepartum patient. There are limited charity cases in OB but you are free to ask your resident to perform NSVD do episiotomy or episiorrhaphy to uncomplicated charity cases.

For the Department of Emergency Medicine (DEM) rotation, you get to see patients yourself independently. You are free to perform necessary work-up, laboratory or imaging and manage them accordingly by yourself. You are even free to refer them to other services if needed or to advise admission if deemed necessary. Since there are no DEM residents, you get to refer directly to consultant if your are not able to manage the case yourself. In the ER, PGIs are the first line compressors during CPR but nurses also help. Sometimes, you are also given the chance to intubate patients yourselves. Community Medicine is integrated with the DEM rotation. We see and manage patients ourselves in the community without the need to refer to our residents if the case is not so complicated.

We also have daily conferences, each day for a different department. Topics discussed in conferences are must knows for the board exams. Endorsements are also vital in major departments such as Pedia, Surgery, OB and IM. Questions during endorsements are mostly pearls for the board exam. A formal review for the boards is offered towards the later part of the year for all interns. In Riverside, you will definitely have a lot of free time, it’s just up to you whether you will choose to spend your free time in studying or in other matters.

Finally, the best part of having your PGIship in Riverside: FOOD and MONEY. Daily conferences means daily feeding program. Your weight will surely suffer once you have signified to join this institution. Furthermore, there will be a lot of RTDs, interhospital conference and events that will sure add another problem to your ever dilemma of loosing those extra pounds you have.

Bacolod in general is a PGI friendly place. All hospitals offer huge stipend (or meal allowance as we call it) to their interns. While Riverside may not be offering the biggest stipend of them all, I believe you will surely be happy to line up at the cashier during the first day of each month to receive the your Php6000 allowance. Furthermore, it has also been agreed that interns will be paid Php50 for each medical abstract (Php100 for extra copies). However funds will be pooled and be used as your common fund with the other interns. During Christmas, caroling to consultant’s houses is common allowing the batch to earn hundreds of thousands which will also be pooled in the intern’s funds. At the end of the year, it is your batch’s discretion on how to use or to divide this fund.

At the end of the year, deserving interns will be awarded as outstanding interns. Most department offer a sure residency spot to those who has gained the award. For the overall most outstanding intern, he or she will gain a sure spot to any residency program he chooses which being offered at Riverside. Apart from this, being part of the alumni association of this institution, all interns will get to have the perk of being able to network with the biggest names in the medical industry in the province.

The biggest downside however of having your internship at DPOTMH are the massive amount paperworks. We make clinical histories to all our admitted patients. In other institutions this is the job of the clerks. In our hospital, PGIs as well as the resident residents make their own histories since the institution believe that there is no better way to learn medicine than to go back to the basics of history and PE. We also accomplish medical abstracts of our patients (but with a fee). We also make referral notes, progress notes (in some departments), and sometimes going home instructions. The most daunting paperwork probably is accomplishing hundreds of discharge summaries per rotation. Personally I don’t see this as a con since I am able to review what has been done to my admitted patients which I believe not most of the interns are able to do so.

Currently, Riverside is on the process of upgrading their facility and adding more hospital beds. In the next few years, the title of being the premier hospital in Negros will not be limited to the island anymore. Lucky for the incoming new interns since new advancement are being made in the hospital. Local and international accreditations are also in the pipeline. In the next few years (or months), Riverside will be one of the the biggest and most technologically advance healthcare training institution in the country. To sum it up, If you want a hospital that would guide you step-by-step in attaining your goal to becoming a good physician, expose you to what is ideal and to train you with the best facilities while at the same time give you a great degree of independence in terms of patient care and developing you clinical acumen, then Riverside is definitely the best place for you to have your PGIship.

#check out my post on the requirements and what to expect in Post Graduate Internship

This article was written by Aljeirou Alcachupas, MD upon the request of his friend. 😊

Post Graduate Internship

So it's already that time of the year when clinical clerks get busy for post graduate internship application. So what are the things you need to know before clicking the submit button in your online form? How do you choose the hospital best for you? Keep reading as I share to you the important things to note.

Post graduate internship is one of the most exciting milestones in one's medical training. You start with a thrilled heart as that newly acquired MD starts to sink in and you end it with heebie-jeebies as the board exam schedule hits you. Some say that PGIship is a break after that gruelling year of clerkship and a time to recharge yourself in preparation for more years of training in residency but some believe it is the best time to gain new skills and improve your clinical eye, and to prepare for the most important exam in medicine - the physician licensure exam. Nevertheless, choosing the right hospital is vital to get you to whatever goal you have.

Here's the schedule for 2018 Application:

•November 1, 2017-January 31, 2018: Application for the 1st round of matching

•February 16-April 15, 2018: Application for the 2nd round of matching

•May 1-June 30, 2018: Walk-in application period

How to apply?

Last year, the Association of Philippine Medical Colleges (APMC) launched the online application for internship. This is way better from years ago when medical clerks had to fill up hardcopy of forms and submit them to their respective schools for final submission to APMC. This way, you are able to track the progress of your application in real time while schools get to have a more convenient way of organizing and submitting requirements to APMC.

1st step is to register an account in the National Internship Program System (e-NIPS) here. and fill out the necessary details. Just make sure that you choose "Medical Student/Intern" option  in the --Select User Role-- so your application will be valid.

Also, don't forget to prepare a softcopy of your passport size photo to be uploaded in your profile. Then, you have to wait until your school validates and approves your account before you can start applying for a hospital.

Once approved, you can already access the long list of different hospitals you can choose from. e-NIPS only displays the hospitals with available slots, so don't wonder if the hospital listed during the 1st round is gone in the 2nd round. Below are photos taken from APMC-SN page containing the list of hospitals (1, 2, 3, 4)  and their corresponding slots.

You can choose up to 3 and rank them according to your preference. Aside from deciding which hospital to choose, the rank is also very crucial in the application since it will determine which hospital will be matched to you if you happened to be accepted in all 3 hospitals. Processing of applications is simultaneously done by hospitals, in contrary to what others believe that processing depends on the order of your hospital preference (some think that the 1st hospital of choice will be processed first and once denied, the application moves on to the next hospital of choice). So it is really possible that you will be accepted in all 3 hospitals simultaneously but the one matched to you is the hospital with the highest preference. So be sure with your preference before submitting because once matched, the unmatching process is so much of a hassle that you don't want to go through it. Also for this year, e-NIPS might not show your results in your other choices and will only display the one matched to you, unlike what they did last year that the applicants can see if they are accepted or not in each choice and they have the option to accept or refuse the assigned hospital. Apparently, e-NIPS has removed that option. So this year, if you want to change your hospital, you have to be unmatched first with the assigned hospital (write a formal letter to them), then repeat the application process but you will be allowed during the walk-in period only.

So for those still confused with the terms, let me make it simple. Being "accepted" to a hospital doesn't necessarily mean that you are already matched to it. You can be accepted in a hospital but not matched yet. The final status will be given when all the hospitals of your choice have submitted their final evaluation and e-NIPS will automatically "match" you to the hospital of higher preference. So being matched is the goal and again, once matched you can't reapply in the next round until you have unmatched yourself.

It is also important to remember that there are hospitals that post results early but there are buzzer beaters too so don't fret if your classmates are already matched during the first month of application while you are still waiting anxiously for your results. How will you know if your result is already final? Once accepted in the hospital with the highest preference, your status will automatically become "matched to _________ hospital" but if you were accepted in your lower-ranked hospital and your higher-ranked hospital is yet to release results, you will be given "pending" status. However, if your status indicates that you are "matched" to your lower-ranked hospital, it means that your higher-ranked hospital has already released results and did not accept you.

What if you only have one hospital in mind, are you really required to choose 3? You have the prerogative to choose only one and be charged with cheaper fees because you process only one set of requirements (TOR, Certificate of Eligibility from the Dean's Office and class ranking) or maximize choosing 3 institutions and get higher chance of getting matched because "probability" but pay higher fees for additional set of requirements. By the way, I'll leave the fees part to your school because charges may vary.

What can you do if you were not matched during the first round? You can still reapply in the 2nd round without paying additional fees. To those not matched in both rounds, you have to directly apply in your preferred hospital as walk-in applicant during the indicated schedule and once accepted, you have to inform the APMC for recording in e-NIPS. What if you were not able to make an online account and failed to apply in the 1st round? You can still register an account but you will be allowed for walk-in application only.

How to choose a hospital?

There are different kinds of training hospitals, the ones that will give you unlimited errands, hone your skills and train you to accomplish 5 different tasks in a minute; those which will let you sit with training doctors, study with them and get the Einstein out of you; or those which will demand you to work tirelessly while simultaneously being bombarded with series of reportings, endorsements and a consultant ready to prey on the remaining soul in you. But hey, you already got that MD and there's no room for backing out because you are already a step away from that license. What's even better is that APMC has ordered training hospitals to give not more than 12 hours of duty hours for post graduate interns. However, there are still remaining hospitals that give 24hr duties to interns. That, you have to know in your prospect hospital because it would still matter depending on your priorities.

In choosing a hospital, you have to first identify your strengths and the things that you already know, those skills you can confidently perform in any situation and of course your weaknesses, what were not taught to you that you want to learn and the things you want to improve on. From there, you can lay down your goals. Knowing what you want to specialize later on is also a good starting point.

Location: There are many hospitals to choose from north to south, you have the freedom to apply in any of those. This will matter if you already have a preferred place to settle down in the near future. Being able to train in your future hometown will give you the advantage to introduce yourself as a doctor and eventually start building your network of patients. Language is also an important factor here because medical terms have to be relayed to patients in their vernacular version, so you will be trained to talk to the patients more comfortably. There are also those who aim to be able to communicate to a wide variety of patients so they choose to train in places with different language. For instance, a doctor who is fluent in bisaya and hiligaynon chooses to train in Manila for flexibility and become language-ready.

Stipend: Hospitals give stipends as high as 10 thousand pesos with additional compensation with every paperwork you do and as low as free meals only. This depends if the priority is to earn as early as PGIship (but application screening might be more competitive) or if other goals outweigh this factor. If you are contented with free meals only, then you have one less problem in choosing your hospital.

Specialization: Each hospital has its own flagship program and you might consider one depending on the specialization you want. With this, you get to be immersed in the culture of the department and get acquainted with your possible future colleagues (residents and consultants). It will also help you reassess your passion for that field and give you the advantage of being familiarized with the know abouts in the department. The number of cases a hospital receives is also important here. There are hospitals that have a good number and variety of IM cases whereas some hospitals are known to have good training in trauma care because of the influx of trauma patients.

Type of hospital:  Being able to manage or handle patients directly may depend if the hospital is government or private. Interns may be limited in doing procedures in private institutions compared to public ones. However, there are hospitals which cater to both pay and service/charity patients so interns can do procedures with the latter. There are also other hospitals that, despite their public status, offer limited procedures to interns because of having fellowship programs wherein fellows have to perform the procedure themselves (e.g thoracentesis). On the other hand, being exposed in private hospitals will give you the advantage to observe the ideal management because they are able to request the necessary labs and procedures to patients freely. You also get to be exposed in modern equipment and technology, which will be a plus for your residency training.

Schedule: I think this is one of the most important things to consider especially if you are coming from afar. Some start as early as 5am and as mentioned earlier, some still have 24hr duties. There are also hospitals that conduct weekly board exam review for interns and some have weekly off the floors status/ interns' hour for educational purposes. This also includes the length of every rotation because some hospitals allow interns to rotate every month per department while some rotate every 2 months. Some offer elective sched as long as 2 months while some are only given 2 weeks of free electives.