Empi Q7: Internship Program in the “New PROGRAM VULNERABILITY

● Lack of flexibility with the teaching modes

Normal”
○ Not capable of alternative program in terms of
OUTLINE teaching instruction &a assessment
● Multiple stakeholders and roles of clinical educators
I. Internship in the New Normal ○ Splitting focus In research & service training

LECTURE | RECORDING | BOOK | IMPORTANT | MNEMONICS

Principles of Infection Control for COVID-19 at PGH

DOWN MEMORY LANE ● Limit unrecognized entry of COVID-19 to PGH

● Isolate all symptomatic patients ASAP
● In March 1, 2020, there was an increase in number of
● Protect all PGH personnel
COVID-19 cases
● Infection control was the main problem at that time
● Affiliate schools were sending inquiries on the status of
● We were fortunate to have proactive leaders and
our training program, and the students were gradually
trailblazers in our hospital infection unit who released
pulled out
these principles
● We responded at the time that we would be proceeding
● We were provided instructions and specific equipment to
with typical clinic operations with emphasis on healthcare
don in certain areas
workers, patient screening, use of adequate PPEs, strict
● Were also informed & guided on COVID-19 zones adn
handwashing and disinfection
were given recommendations on how to stop the spread
● We employed shorter clinic hours so that staff and
& prevention of getting the virus outside the hospital
students would be able to travel with less traffic during
● Because we were a COVID referral center during the
peak hours
time, caring for the people with COVID were the priority
● Placed infographics on COVID-19 sx to advocate
vigilance over this pandemic when it was declared by
WHO in 2011
● On March 12, president Duterte declared lockdown
primarily of the NCR and our section decided to cancel
the training program with the safety of the students as the
main consideration

PRE-PANDEMIC

PROGRAM STRENGTHS
● Setting
○ We are able to ___ (disciplinary) tertiary teaching
hospital and a good place for interprofessional
collaboration
● Patients/cases
○ We have a variety of patients who trust us and are
generous in accommodating our students training
● Clinical educators
○ Clinicians
○ Draw from their individual experiences and seek
training to be better at what they do
● Affiliate schools / students
○ Who share our values of excellence and integrity

PROGRAM FOCUS
● Clinical reasoning
● Evidence-based PT
● Psychomotor skills in PT assessment and treatment
 Association)
○ Also developed inpatient non-COVID face-to-face
policies
○ Also proud of the EHEPSISYO (electronic home
exercise program)
■ Since we have limited time with the patient, we
follow it up with a good & easy-to-follow HEP
● We further developed the recover program – non-training
rotation that caters to charity and patients with COVID-19
in designated areas of PGH
○ Called the Recover or the Rehabilitation of
COVID-19 Patients for Early Recovery Program
● For training, we further involved our staff in the staff
development program and provided training for our
licensed PTs which is the continuing professional
development program in 2020 rising amidst the pandemic

STRATEGY During Crisis

● Keep everyone safe
● Minimize exposure to patient
● Conserve PPEs
● Solicit PPEs
Right After Crisis
● Keep everyone safe
● Restart operation with modified
approach
● Introduce virtual care
● Conserve PPEs
The New Normal
● Keep everyone safe
OPPORTUNITIES (BROUGHT BY RONA) ● Increase promotion and utilization of
● Redesign service delivery models telereheab for OPD patients
● Maximize training opportunities ● Continue with face-to-face
● Explore collaboration for research
POSITION Where to go

Service Training Research PLAN What to do

● We are currently at the stage right after crisis and
PERSPECTIVE What we see
transitioning towards the new normal
● An iterative process PROJECT What we prioritize
● Pertinent in this table is the overemphasis on PPEs and
keeping everyone safe in all phases of the COVID-19 PREPAREDNESS How to get ready
response
○ This is to highlight our demand despite our lack of
SERVICE
available PPEs
● Also important to note in the new normal is our plan and ● Tele PT protocol
mandate to start a training program as a national ● Inpatient Non-COVID face-to-face policy
university hospital ● Home exercise programs
○ Because we are mandated to provide service, a ● Outpatient non-COVID face-to-face policy
safe way to do this during that time was telerehab ● Inpatient COVID face-to-face policy
○ We developed telerehab guidelines initiated by the
department TRAINING
○ We facilitated consultative meetings with the ● Staff development program
paramedical sections ● Licensed PT development program
○ Pilot run the telerehab and telecare sessions ● Basic (undergraduate) PT program
○ Finally developed a teletherapy protocol which is
monitored regularly RESEARCH
○ All in accordance with governing laws and policies
● Participated and conducted COVID-related researches
on data privacy while still providing the best care to
our patients (E.g. WHO, World Confederation of
Physical Therapy/World Physiotherapy, Center for
Disease Control, Australian Physiotherapy
 Preparing for Basic PT Remote Rotation PHYSICAL THERAPY
● Purpose / Vision
○ To empower people to be autonomous and leaders
● The next step was to prepare for the offering of a training
in improving health and wellbeing of the Filipinos
program – particularly our undergraduate training
● Institutional Mandate
program
○ To provide quality service, training, and research
● Below are some of our considerations during this period
● Professional Mandate
○ To improve human function and movement and
WHAT WERE WE THINKING?
maximize physical potential
● Limit unnecessary exposure of both staff & interns
● Limited PPEs
● Willingness to report for duty?
● What can we offer that only us can offer?

WHAT DID WE DO?

● Attend CHED consultative meetings
● Brainstorm program outcomes and search best practices
in remote learning
● Propose a telerehabilitation guideline including the Basic
PT program
● Facilitate training of PT staff through online courses on
use of technology and policy and protocol development
(Coursera, independent universities)
● Survey of our affiliate schools on internet access and
stability
● Create rubric for trainee assessment

BASES FOR PROGRAM CREATION AND RESTRUCTURING

1. CHED
2. DOH (IATF Guidelines)
3. PGH – vision and mission/mandate at PTs in PGH
4. World Physiotherapy; PPTA

CHED PROGRAM OUTCOMES

● Apply scientific knowledge to the practice of physical
therapy
● Demonstrate consistent competence in comprehensive
exam, eval, assessment
● Demonstrate consistent competence in planning and
implementing appropriate PT interventions
● Apply teaching-learning principles
● Practice beginning management and leadership skills ● Sample of the application of IATF guidelines for UP
● Demonstrate research related skills ● As alert level goes up, it limits the face-to-face of
● Work effectively in an interprofessional collaborative students
setting
● Maximize use of technology
PREPARING FOR BASIC PT REMOTE ROTATION
● FOUR online courses
PT ROLES
● THREE CHED meetings
● Educator ● TWO department level meetings
● Clinician ● MULTIPLE section level service and education committee
● Researcher meetings
● Manager / Leader ● Procurement of equipment and supplies
● Advocate ○ In preparation for the implementation of the basic
● Community-based Practitioner PT remote rotation
● As proposed by the Philippine qualifications framework
● We highlight research and leadership skills as these are
institution’s mandates and because of the resources and
reach we have
STRENGTHS AND FOCUS Assessment: Individual and Group

Face to Face Tele ● Students are encouraged to collaborate & work in teams
● Learning module: Clinical reasoning, conduct of Ax & Tx,
● Setting ● Clinical reasoning Docu
● Patients/cases ● Evidence based PT ● Telerehab: Clinical reasoning, conduct of Ax & Tx, Docu
● Clinical educators ● Advocacy
● Case Conference: Reporting and participation
● Affiliate schools/students ○ More advocacy projects
● Clinical reasoning ● Tele standardized ● Journal Presentation: Reporting and participation
● Evidence based PT outcome measures ● Case-based Exam
● Psychomotor skills in PT ● Use of technology ● Peer Eval
assessment and treatment ● Self Eval
● Organization and Administration
● When we surveyed our students in our affiliate schools, it
revealed that we have students in category 2, meaning Students
they have limited/intermittent capacity for internet ● Academic contract
connectivity ● Data privacy waiver
● Our conservative estimate of the PT staff is also category ● Telerehab informed consent form for the students and
2 patients
● We have developed a 4-week program with at least 20
hours of synchronous sessions (the rest is Teachers:
asynchronous) ● Engage students
● The rotation is to develop an efficient, competent, and ○ Center of open & distance learning
compassionate entry level PT by utilizing information and ● Facilitate higher order thinking skills
communication technologies and providing ● Be a role model and exhibit professionalism
evidence-based PT services in patient care, health policy ● Teacher:student → 1:2
and advocacy, organization and management, and
research Evaluation and Monitoring
● He/she should also exhibit commitment to the
advancement of the profession, integrity, and
● Debriefing and feedback from teacher and student
responsiveness to the needs of Filipino people
● Will be done monthly
● We will be using these platforms as recommended by our
● Duration depends on time to take to accomplish the task,
information and technology office and data privacy
internet connectivity & difficulties experienced
specialists, and because we have institutional
subscriptions on these:
○ Zoom EXAMPLE
○ Gmeet ● Example of an advocacy project of students
○ Whatsapp ● 4-week program
○ Onedrive ● Gradually developed in the first two weeks and will be for
○ G suite implementation for the last 2 weeks
● Main focus is online
TEACHING-LEARNING ACTIVITIES (BASED ON TELEREHAB) ● Released in the FB of PAMILY PTNESS
● Theme for the month is based on the major celebration of
● Observation and discussion of telePT session (written
that month
evals; written and oral feedback)
● 2021 project is: JUANA HAVE FUN
● Written outputs: PTIE (physical therapy initial evaluation),
○ “Juana” since month of March is Women’s Month
CAT (Criticially appraised topic) paper, guided reflection
○ Focuses on risk factors for aging women who might
paper (debriefing session)
have risks for falls d/t osteoporosis
● Pre-recorded lectures/synchronous lecture for the
○ Focuses on keeping women moving, how to reduce
webinar
falls, etc.
● Video case-conferencing, video team-conferencing (for
○ Has a ZOOMba session
interprofessional collaboration)
● Another project (no poster in the PPT): Women’s Pelvic
● Online journal reporting
Health
● Administrative tasks: policy/protocol development and
○ Sige Ikembot: Guide to Pelvic Health
research related activities
○ Students created infographics on a taboo topic in
● For these teaching-learning activities, it is emphasized on
the PH
the facilitation of higher order thinking skills so as to
○ Students created demographics on women who
promote analytical and clinical reasoning skills, and deter
might have pelvic floor dysfunction
cheating
■ Defined what it is & highlighted the role of PTs
for pts who might have risks for pelvic
 dysfunction ■ Athritis c low risk for falls
○ No medical comorbodities of concern
○ Not difficult to monitor
■ Safe to be managed online
● In the last semester in 2021, there was good feedback &
there were decreasing pts for remote learning
○ They tried to screen better and allowed neuro pts
● In 2022, they were able to allow stroke or developmental
pediatric conditions

Blended Learning Track

● We are expanding our competencies

Format Focus Patients

● 2 weeks FTF ● Clinical reasoning ● Inpatients

● 2 weeks remote ● Evidence based ● Outpatients
learning track PT ● Telepatients
● Psychomotor
skills in PT
assessment and
treatment
FEEDBACK ● Advocacy
● Feedback from the first year of implementation ● Tele standardized
outcome
measures
Asynchronous Synchronous Patient care ● Use of technology
Sessions Sessions sessions

Educators Too much Connectivity Limited clinical OUR INTERNS PREPARATIONS

workload on issues; natural reasoning ● We believe that we still need to train you holistically
checking notes calamities facilitation with ● Spiritual
simulated
● Mental
patient
● Emotional
Interns Too much Connectivity Requesting ● Physical
reading issues; natural direct patient
assignments calamities contact SAFETY: PERSONAL PROTECTIVE EQUIPMENT
and outputs
● Currently, we are at safety level 2.5 when managing pts
● Need to bring KN95 masks
Basic PT Training Program Milestones ○ Recommends use of N95 mask
● In the clinics, there are reusable N99 respirators
● Also needs face shield & reusable gown
● What happened after receiving feedback ● If you are not engaging in pt care, you are expected to
wear KN95 mask while in the hospital
2020 2021 2022 2023

Fully remote Remote Remote Proposed

learning learning learning blended
program with program with program with learning
simulated low risk tele tele patients program with
patients patients with neuro direct patient
conditions contact

● Patients are considered low risk if they have

○ Stable MSK conditions
■ Upper back pain
■ MPS
■ Cumulative trauma disorder
■ Uncomplicated back pain
 Q&A

● Interns in telerehab already manage pedia and neuro

patietns

SAFETY: LOCATION
● Eating areas
○ Good ventilation with HEPA filter
● Direct patient contact
○ Ensures to have adequate ventilation
○ Adequate space to reduce infection
● Rounds areas
○ During rounds, it is made sure that you will not be
passing areas where COVID pts are managed
● Lounge
○ Away from pts or from where humant traffic will be

168 – number of interns for remote learning track

Consider the Following in Creating a Training Program for the

New Normal
● Focus on strengths
● Allow flexibility
● Communicate with stakeholders
○ What do they need? Do they share the same
values as you?
● Prepare the stakeholders holistically
● Provide necessary training and adequate equipment
● Keep updated of governing policies

It is often said these days, that the COVID pandemic has

forced us to change. In this case, from a face-to-face training
program to a fully remote training program then to a blended
training program then back to creating a flexible program for
the new normal.