Course Orientation - Preventive Medicine 4 - AY 2021-2022 - Signed

University of Santo Tomas
Faculty of Medicine and Surgery

Department of Preventive, Family and Community Medicine
Course Orientation AY 2021-2022

PREVENTIVE MEDICINE IV
COMMUNITY MEDICINE CLERKSHIP PROGRAM
COURSE ORIENTATION
AY: 2021-2022
DEPARTMENT OF PREVENTIVE, FAMILY AND COMMUNITY MEDICINE
Submitted by:
MA. TERESA TRICIA G. BAUTISTA, MD

Chair, Department of Preventive, Family and Community Medicine
Reviewed by:
MARIA ROSARIO F. CABANSAG, MD, MHPEd

Head, Curriculum Committee
ROBERT UY, MD
Library Coordinator
Approved by:
MA. LOURDES D. MAGLINAO, MD

Dean, Faculty of Medicine & Surgery
Modified from : 1
University of Santo Tomas –The Graduate school
Marcela J Leus, EdD


COURSE INFORMATION
1. Course title : PREVENTIVE MEDICINE IV

2. Course abbreviation: PREVMED IV
3. Credit units: 44 hours per week
4. Course pre-/co-requisites: Preventive Medicine 1, 2, 3
5. Course description
The blended curriculum is constructively aligned to the learning outcomes set by CHED where
practical application of the know-hows taught in the undergraduate preventive medicine
course equips the student to perform the six (6) roles of a primary care physician in the era of
Universal Health Care (UHC) and public health crisis. Such roles include being a health care
provider, educator, coordinator, navigator, manager/leader and researcher. There will be six
(6) modules integrating telemedicine, case simulations and studies with reflective processing.
At the end of the course, the senior medical student should be able to demonstrate the
abovementioned roles across the full spectrum of primary care from health promotion,
preventive, curative, rehabilitative and palliative care, consistent with UHC.
6. Course hours per week: 44 hours per week per group; one month rotation
7. Course placement: Monday to Friday 8:00-5:00 pm ; Saturday 8:00-12:00 nn via the Blackboard
8. School year: 2021-2022
9. Semester: All year round monthly rotation
10. Course Supervisor: Dr. Lynard Anthony D. Ignacio
Contact Information: Email add: ldignacio@ust.edu.ph ; Cell No. 09322302141
Department Chair: Dr. Ma. Teresa Tricia G. Bautista
Contact Information: Email add: mgbautista@ust.edu.ph; Cell No. 09178332514
11. Course facilitator/s:
Ma. Victoria P. Cruz, MD. Alejandro V. Pineda, Jr., MD.
Eva Irene Y. Maglonzo, MD. MHPEd Iluminada M. Lerma, MD.
Ma. Teresa Tricia G. Bautista, MD. Wilhelmina A. Mercado, MD
Ma. Victoria A. Rondaris, MD.MPH Philipp U. Po, MD
Venjilyn S. Villaver, MD Mary Agnes A. Regal, MD
Caroline Anne A. Castro, MD
12. Consultation schedule: During class hours and after class hours through Section
Viber group
Prepared by:
Lynard Anthony D. Ignacio, MD

Course Supervisor
Modified from : 2
Marcela J Leus, EdD


COURSE GOALS AND OBJECTIVES

Intended Learning Outcomes (ILOs)
M Institutional (IILOs) Program (PILOs) Course (CILOs)
I
S When you successfully complete
S UST-FMS Graduate Attributes When you successfully complete an Preventive, Family & Community
I A UST-FMS Graduate is expected to be a: M.D. degree, you will: Medicine 4 (Community Medicine),
O you will:
N
1. Competent Professional with Ethical Demonstrate competence in Formulate comprehensive patient-
Practice diagnosis, management and centered, family-focused and
who, inspired by the ideals of St. Cosmas presentation of clinical conditions community-oriented health care
and St. Damian, promotes excellence in Æ in various settings, to all types of Æ plans using the systems-based
C
the production, advancement and audiences, while adhering to code approach for the most common
O
transmission of specialized knowledge of conducts and legal standards. medical conditions in the primary
M
and skills in the field of medicine. CHED1,2,8 care setting ( 1D , 2D, 8D )
P
2. Scholarly Researcher and Critical
E
Thinker
T Demonstrate research skills in given
who, kindled by St, Thomas Aquinas’
E a scenario and specific health
ardor for truth aspires to become Analyze the public health situation
N problem, design a plan for
forerunners of intellectual creativity and, of a target population, including
C Æ conducting surveillance of decision Æ
in his quest for quality research, is the vulnerable
E making as a practitioner and
proficient and critical in assessing and ( 4D )
researcher to improve the quality
communicating information in the field of
of healthcare. CHED4
medicine that impact the profession, the
nation, and the global community.
3. Professional Christian Leader Evaluate a health care project/
who, touched by St. Dominic de Demonstrate leadership to initiate program that will impact total
Guzman’s apostolic fire, and warmed by planning, organizing, family and community well-being,
Mary’s motherly care, articulates ethics, implementation and evaluation of especially the underserved /
C truth and the highest level of maturity in healthcare programs, providing vulnerable
Æ Æ
O resolving issues and promoting inspiration and motivation to the
M healthcare team in promoting the Mobilize effectively the resources
innovations for the betterment of the in the family and community,
P community, especially the poor. well-being of the community.
A CHED3,5 including training of health allies
S and workers ( 3D, 5D, 6D )
S 4. Globally Engaged Citizen
Engage in advocacy activities in
I who, with ardent advocacy for life,
Demonstrate dedication to service partnership with individuals,
O promotes global readiness and
in implementing and promoting families, and communities to
N competitiveness in the medical
Æ healthcare innovations, with love Æ improve the health system for
profession through relational and
for one’s heritage, and respect for better health outcomes of the
interpersonal connectedness, with a
other cultures. CHED9 population
thorough understanding of cultural
( 9D)
diversities.
5. Committed Scholar Collaborate with stakeholders in
Demonstrate the use of a system-
who, nurtured by the dogmas of the various primary care settings (i.e.,
based approach in delivery of care
Christian faith and values, is dedicated to community, hospital, home,
through networking with relevant
C the pursuit of truth, through medical workplace, school, etc.) and across
Æ partners, while adhering to Æ
O informatics literacy and health economics all levels of care to address
principles of relevance, equity,
M proficiency. effectively the recognized health
quality and cost effectiveness.
M needs and social determinants of
CHED6,10
I health ( 10D )
T 6. Lifelong Learner
M who, empowered by St. Cosmas and St. Demonstrate personal and
Utilize self-directed learning in the
E Damian’s zeal for learning, is committed professional growth through
various activities such as group
N to the advancement of a higher culture medical researches and review of
Æ Æ report, case analysis and
T through a continuous search of medical literatures to ensure
workshops
intellectual inquiries and new knowledge, quality healthcare and patient
( 7D )
as well as faithfulness to Catholic safety. CHED7
intellectual traditions.
Modified from : 3
Marcela J Leus, EdD


COURSE FRAMEWORK
Curricular Domains from 6 Roles of the

First Year to Fourth Year Primary Care Physician
AREA OF FOCUS
Modified from : 4
Marcela J Leus, EdD


MICROCURRICULUM
INSTRUCTIONAL DESIGN
Intended Learning Outcomes Course Contents Learning Activities Assessment
(ILO) Tasks
Module on Health Care Provider
Demonstrate clinical competence Telehealth and Virtual Health Stations: Summative
• Formulate cost-effective and Telemedicine Teleconsultation – Rubrics for PFC
evidence-based patient-center, individual, groups case
family-focused and community- Health Support groups (Synchronous) presentations
oriented health care (PFC) plans
from preventive, promotive, Common conditions in Recorded Lecture on PFC Formative
curative, rehabilitative and palliative Primary care for (Asynchronous) Case discussions
aspects for most common medical individual and community during
conditions in the primary care health Case Simulations for PFC Telemedicine
setting approach including consultation
• Identify cases requiring prompt contact tracing
referral (Asynchronous, Formative
• Apply principles of community- synchronous) Critique and
oriented primary care to develop Feedback on
health promotion, wellness and Scholarly Debates Palliative care
disease prevention programs (Synchronous) case analysis and
relevant to the needs of the family scholarly debates
and population served. Coaching
(Synchronous)

(ILO) Tasks
Modules on Communicator/Counselor and Educator
Communicate effectively Individual primary care Demo and Return Demo Summative
• Demonstrate interpersonal skills by counseling of Health education • Rubrics for
effective use of active listening, Motivational counseling strategies (Synchronous) Health
communication skills and feedback Smoking cessation Education
• Utilize appropriate technology in counseling Demo lecture video on Activity
education, and standard protocols Grief counseling health education • Rubrics for Self-
• Develop appropriate methods for Family Meetings (Asynchronous) instructional
health information dissemination, materials for
risk reduction and disease Health Education Produce health BHWs
notification Strategies information materials • Performance
appropriate for a target Rating for
Adult learning principles population counseling skills
(Asynchronous)
Crisis Debriefing Formative
Psychological First Aid Demo and Return • Critique on
Demonstration: role-playing,
Risk communication and Individual counseling, OSCE
Public Health messaging Motivational counseling • Student
(Synchronous) reflection
Coaching (Synchronous)

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Marcela J Leus, EdD


MICROCURRICULUM

(ILO) Tasks
Modules on Health Manager, Advocate, Navigator and Coordinator
Lead and Manage health care teams Effective Leadership in Recorded lecture on Summative
• Demonstrate problem-solving skills Health Care , Conflict Advocacy and COPC • Rubrics on
and conflict management to resolution (Synchronous) Community /
negotiate overlapping and shared Advocacy
responsibilities for the benefit of Social and Resource Development of Project
patient / population-based care Mobilization Health Promotion or Terminal report
• Recommend community-level Advocacy project for • Rubric for
interventions to address the social Public Health community disaster
determinants of the health concerns Response/Disaster (Asynchronous) preparedness
of patients and families based on Preparedness presentation
the existing resources in the Incident Command System Case studies on
community Managing Health Formative
• Implement an action plan and Process of program Teams / UHC / • Student
project for an identified health management: Disaster preparedness reflection
problem in a community Planning, Organizing, (Asynchronous) • Assignments
Program implementation,
Monitoring and evaluation Coaching
Program Planning and (Synchronous)
implementation, Advocacy
development
Collaborate within inter-professional Universal Health Care Case Studies on Summative

teams System Navigation Models people with complex Rubric for
• Analyze health care delivery systems Multidisciplinary, needs requiring presentation of
as these affect healthcare Interprofessional and system navigation key informant
professionals, hospitals, outpatient Transprofessional (Asynchronous) interviews
clinics, home health facilities and collaboration
other community resources, Care coordination Coaching Formative
including transitions of care (Synchronous) Reflection Journal
Utilize system-based approach to Developing Patient- Actual or Case Summative

health care centered, Family-focused simulations to develop Rubrics for PFC
• Develop a Patient-centered, Family- and community-oriented Patient-centered, case
focused and Community-oriented care (PFC) Plan Family-focused and presentations
Care Plan (PFC) using the community-oriented
biopsychosocial approach Social and health care Plans Formative
determinants (Asynchronous and Reflection Journal
synchronous) Assignments
Practice the principles of social Program Evaluation Monitoring and Community /

accountability Social Responsibility in a Evaluation of Advocacy Project
• Implement and evaluate plans and Pandemic -Challenges, implemented activities Terminal report
programs that address health barriers, solutions (Asynchronous) (see above)
inequities

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Marcela J Leus, EdD


MICROCURRICULUM

(ILO) Tasks
Module on Researcher
4. Engage in research activities EBM Principles Critical appraisal of Summative
• Perform critical appraisal of EBM on Community-based journals on Public / Journal Appraisal
literature on community-based interventions / Public Health Community health Report
interventions interventions
• Apply quality improvement and (Synchronous and
evidence-based medicine principles asynchronous)
to improve quality care and health
care standards

(ILO) Tasks
Across all modules
Engage in continuing personal and Self-directed learning Critical reflections Formative
professional development (Asynchronous) Reflection Journal
• Actively seek continuing personal (portfolio)
and professional development Attendance in
courses and activities webinars
• Utilize up-to-date, practical, (Asynchronous)
relevant, and appropriate learning
on current events and social Reading assignments
determinants of health to improve (Asynchronous)
health outcomes
Adhere to ethical, professional and Volunteerism (Embedded / Formative
legal standards Public health crisis / Integrated in cases Reflection Journal
• Apply ethical principles and legal Pandemic response and all discussions) (portfolio)
standards at all times Ethical and legal standards
• Practice professionalism in all roles Critical reflections on
performed as physician at all times volunteerism, public
health emergencies
Coaching
(Synchronous)
Demonstrate nationalism, Advocacy (Embedded / Summative
internationalism, and dedication to Community organizing Integrated in cases Community
service Community engagement and all discussions) Project Terminal
• Respect expressions of faith, health Report (see
beliefs, and cultural practices of the Coaching above)
community, family and patient, (Synchronous)
including his/her Sexual Orientation Formative
Gender Identity and Expression Reflection Journal
*SOGIE (portfolio)
• Respond actively in community
development activities and
advocacies for emerging national,
regional and global issues
Modified from : 7
Marcela J Leus, EdD


COURSE RESOURCES
First and foremost, people from our partner communities is the key – from LGU officials, community
workers to the littlest member of the community. The community profile, set-up and its resources
(health indices etc.).
Secondly, the existing health care system – local health center, city hospital and other independent and
private health facilities nearby. Other key institutions and agencies in the neighborhood also play some
role. We will attempt to have a virtual community engagement.
Essentially, we will need electronic gadgets (tablets, cellphone, laptop, desktop), and internet
connectivity.
Other important resources are: Publications, IEC materials, books and journals, utilities, Support staff
Basic Reading
Latest local Clinical Practice Guidelines
Maglonzo, EI. The Filipino Physician Today. 2nd ed., UST Publishing House, 2010
DOH / WHO / CDC Primers on Health Programs
Latest local health indices
Health education materials
Extended Readings
Maglonzo, EI. Geriatric Medicine: Principles and Concepts. UST Publishing House, 2008
Gordis, L. Epidemiology 5th edition 2014, El Servier Saunders
Leopando, ZE (ed) et al. Textbook in Family Medicine Vol. 1 and 2. Manila: C and E Publishing, 2013.
Electronic and Web searches

Department of Health http://www.doh.gov.ph
PHILHEALTH http://www.philhealth.gov.ph
Philippine Health Agenda 2016-2022
National Objectives for Health: Philippines. (NOH 2017-2022 PDF)
Republic Act 11223 ‘UHC Law’
WHO Guide for Patient Safety
Modified from : 8
Marcela J Leus, EdD


COURSE ASSESSMENT
COURSE POLICIES (RULES & REGULATION)
Everyone is expected to abide by these policies and guidelines for an orderly and successful conduct of
the course. Amendments may be made only by a collective decision of the Community Medicine Faculty
Staff. Problems, comments and suggestions will be channeled to the Community Medicine Supervisor
and/or Chairman for consideration and to the Faculty Staff for appropriate action.
A. General guidelines and policies regarding mechanics of the course

1. Online activities will be a combination of synchronous and asynchronous activities.
2. Members of the Community Medicine Faculty Staff will supervise the activities of the students
according to their designated module.
3. Activities may be done on individual, pair or group basis according to the module requirement.
B. General guidelines and policies regarding conduct of the course

1. Students will have to work within the context of existing and future plans, programs and policies
of the Department/college/University.
3. Multi-disciplinary teamwork is encouraged whenever possible. Students should be able to
collaborate and work with allied health professionals and sectoral groups at different levels for
the health programs.
4. Students must report to their faculty adviser every week to report/ update on activities and
submit a progress report when required.
5. Students must implement only approved proposal/activities in the community/ school(s)/ health
facilities. When face-to-face classes resume, should there be a need to be excused from
reporting to the institution during the implementation period, he/she must inform the faculty
preceptor at least 3 days before.
6. For missed activities such as reports, workshop or group discussions, submit a valid
certification of absence to the faculty-in-charge within 72 hours. Do not wait until the end of
the semester to complete the missed activities.
C. Policies concerning Attendance

1. Attendance will be checked before and after synchronous activities.
2. Attendance will be checked randomly during asynchronous periods.
3. For online activities, non-attendance to any of the performance tasks may warrant make-up
work.
4. Non-attendance to more than 50% of the online hours may warrant repeat rotation.
5. Non-attendance to more than 20% of the face-to-face classes may warrant repeat rotation.
D. Policies concerning Proper Uniform

1. Students are expected to wear any official uniform top during online classes.
2. Students are expected to wear the official community medicine white t-shirt with logo, dark
jeans and closed shoes while in the community when face-to-face teaching is already allowed.
a. Students may report in their usual white UST-FMS uniform if they are on OPD-post.
b. Students MUST report in their usual white UST-FMS uniform, including footwear during
Saturday classes.
c. Students must wear their nameplates at all times.
d. Students are discouraged from wearing jewelries while in the community/field.
Modified from : 9
Marcela J Leus, EdD


E. Virtual Conferencing Guidelines
Before The Synchronous Activities

1. Set the conference date, start and end time, agenda, and conferencing software/application to
be used if different from Blackboard. Blackboard remains as the main platform. For files, the
alternative and back-up source is Google Classroom.
2. Facilitator of the day should send the meeting link to the students, to include meeting ID and
password if different from Blackboard. The alternative platform if Blackboard Collaborate is
unavailable is Google Meet.
3. Presenter/s should send the soft copy of their written reports to the consultants after the
presentation, as specified by the facilitator.
4. Participants should set-up and practice using the chosen software in advance. Determine if
online meeting app loading well. Test video, audio/microphone/headset, connection, and
sharing of presentation/slides. Setting-up a second screen may be helpful but not required.
5. Ensure reliable connectivity. Always have a back-up plan for internet connection - have your
mobile data internet ready in case your current connection weakens.
6. Choose appropriate location. Check what is seen using the camera – lighting, camera view, etc.
It will be best to choose a solid-colored background, or close the curtain if the window is seen.
Make sure that there are no distractions (video and audio) that may be seen or heard during the
presentation. Take advantage of virtual backgrounds too if your meeting app supports it to
instantly turn a messy space into a clean and professional one.
7. Choose appropriate clothing. It will be best to choose a solid-colored top than a
striped/checkered/printed top to avoid pixilation. Look professional and presentable.
Think of what you will wear if this was an in-office/department meeting. Stay in your
comfortable bottoms and slippers if you like.
During The Virtual Session

1. Be punctual and courteous. Greet your co-attendees. Turn off ringers and notifications of your
devices (phone, tablet, laptop, etc). If you're late to the meeting, let your team acknowledge
you.
2. If it is improper for a face-to-face meeting, then it doesn’t work for a teleconference either.
Don’t do anything annoying and distracting.
3. Attendees should mute their microphone during an on-going presentation to avoid distraction
to the presenter. Open your mic only when you have to say something
4. Give your full attention. Be present throughout the online activity. Try not to visit other websites
or chat with your other colleagues while the meeting is ongoing. Stay seated and give your full
focus on the agenda and to your colleagues moderating the meeting.
5. Let the presenter finish before asking questions. Use raise hand gesture/button, sign or chat
function to avoid overlapping of audio.
6. Avoid slowing of connection by closing unused applications and minimizing hand gestures and
body movements.
Modified from : 10
Marcela J Leus, EdD


Policies concerning Transportation (Face-to-Face)

1. Whenever feasible, all students will ride the school bus going to and from the community. All
standard and precautionary measures will be enforced.
2. If students cannot fit in the bus, additional private vehicles can be used by the students with
maximum of 3-4 riders per vehicle. An Informed Consent & Waiver of Claims For Non-UST Bus
Travel should be accomplished. Transportation fees will be divided among the riders.
3. UST will not be liable for students who will proceed directly to the community site.
4. Under special circumstances, certain transportation schemes may be allowed provided that the
faculty has given approval.
F. NOTICES AND ANNOUNCEMENTS

Unless otherwise directed by the Office of the Dean, the schedule for the school year will be as
promulgated and posted from the Dean’s Office.
National holidays and class suspensions in UST due to calamities means no travel to the
community and no classes altogether. Other suspensions including holidays in Navotas do not
necessarily cancel classes. Group leader is advised to coordinate with the class supervisor or
department chair.
All announcements of the Department (changes in schedule or activity) will be posted on the
bulletin board of the department outside room 329.
For online activities, announcements will be posted on Blackboard Community Clerkship course
site. Google classroom may also be used as instructed by the facilitator. Group leader will also
be notified separately through SMS or Viber.
G. DISCIPLINARY MEASURES
- Follow guidelines in student handbook
- Follow guidelines of OVRAA, Office of Student Affairs and Simbahayan Community
- Development Office in relation to conduct of community activities
- Non-compliance with any of the above-mentioned rules / instructions is suggestive
of insubordination
Modified from : 11
Marcela J Leus, EdD


Learning Modules
WEEK 1 WEEK 2 WEEK 3 WEEK 4

PRIMARY CARE CONSULTATIONS: OUTPATIENT CONSULTATION
TELEMEDICINE AND VIRTUAL HOME VISITS
COMMUNITY ENGAGEMENT: ADVOCACY & COMMUNITY-ORIENTED PROJECTS
Module 1 Universal Health Care: Debate on UHC Leading and Managing Presentation of Group
Manager Provider Network Health Care Teams in Written Report on
Coordinator Navigation Delivery Disaster Preparedness Disaster Preparedness
Navigator Models in Primary
Care for individual and
Population-based Workshop: Analysis of Presentation of group
services local disaster response work on Disaster
SGD: Case studies with Debate on UHC Preparedness
worksheets
Module 2 Telemedicine and Telemedicine and Disease Surveillance: Disease Surveillance:

Health Care Telehealth: Overview Telehealth: Contact Tracing: Presentation of
Provider and Ethico-legal Video Overview Recorded Key
aspects Tele Home Care for Informant Interview
COVID-19 cases or a Vaccination Team
Role Play / Processing Debate on Patient SGD: Case simulations, Member
Safety issues and concerns
Module 3 Health Education Adult Learning Virtual OSCE: Preventive Virtual OSCE:
Educator Strategies Principles in Training health counseling on Preventive health
Multidisciplinary Health common primary care counseling on
(No Care Teams (BHW) cases common primary care
telemedicine Role playing on health Creation of Self- cases
consults on education (patient, instructional materials
this day) family and mass with presentation/ Practice OSCE Practice OSCE
education) processing
Module 4 Effective Breast feeding Public Health: Role play on PFA:
Health Care Communication: Counseling Psychological First Aid Critiquing
Provider Primary care
Educator individual counseling
Demo-Return Demo Demo-Return Demo Demo-Return Demo Role playing and
Practice sessions Practice sessions Practice sessions feedback
Module 5 Advocacy Patient-centered, Public Health Concern: Presentation of
Manager Development and Family-focused and Palliative Care Advocacy and COPC
Health Care Social responsibility Community-oriented Projects
Provider Community-oriented Approach
Coordinator primary care cycle
Manager Project Proposal PFC Case Study Case Discussion
Presentation Processing
Module 6 EBM on Community EBM on Community EBM on Community EBM on Community
Researcher Interventions Interventions Interventions Interventions
(ex. School Health) (ex. Mental Health) (ex. Vaccines) (Vaccines)
Journal Appraisal Journal Appraisal Journal Appraisal Journal Appraisal
Data Management: Data Management: Data Management: Development of

Live Birth Medical Certification on Medical Certification on community level
Cause of Death: Cause of Death: Cases interventions
Overview
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Grading Scheme
The students' performance in the rotation shall be evaluated by the faculty preceptors. These
shall constitute the numerical evaluation rating for each of the six modules within the course. Emphasis
is placed on qualitative aspects of evaluation, i.e. what the students have achieved vis-a-vis course
objectives.
1. The student evaluation components are as follows:

COMPONENT INDIVIDUAL-BASED PERFORMANCE TASKS FACULTY
Module 1 5% Prompt and 15%
Module 2 complete submission of 15%
Module 3 e-Portfolio and 15% Designated Consultant/s
Module 4 requirements 15%
Module 5 15%
Module 6 5% Attitude & 15%
Attendance
Total 10% 90%
2. The student should receive a grade of at least 75.00 (transmuted) to pass the course.
Evaluation Tools
(Sample Rubrics, Customized depending on the task)
EVALUATION OF THE STUDENT’S PERFORMANCE BY THE FACULTY PRECEPTOR
PERFORMANCE-BASED CRITERIA FOR EACH MODULE POINTS

1. Participation Performed a reasonable amount of work with the corresponding 5
desired quality
Contributes ideas consistently
Demonstrated initiative
2. Over-all Completed or achieved projected deliverables (plans/programs/ 5
performance of activities) overcoming reasonable limitations and challenges
deliverables
3. Working relations Assumed expected role, demonstrated tact, professionalism 5
with consultants openness, cooperation and resourcefulness; Established good
and peers working relationship with peers
TOTAL (15% of the total grade) 15
INDIVIDUAL-BASED CRITERIA POINTS

Attitude Followed policies of the community/institution 5
Assumed accountability and fair share of assigned responsibility
and resources
Attendance Subtract 1.5 points for every day of absence 5
Subtract 0.5 point for every tardiness
TOTAL (10% of the total grade) 10
Modified from : 13
Marcela J Leus, EdD


SAMPLE RUBRIC FOR PLENARY / GROUP REPORTING
9-10 7-8 5-6 3-4 1-2

Exceptional Above average work, Fairly good job, Insufficient work, Scarce to nil work
work & quality, reasonable amount of some supervision lots errors and done, very careless,
almost no work with good and errors; needs supervision; major omissions,
supervision quality; little prompting; fair poor attitude unacceptable
needed; very supervision, few attitude attitude
good attitude errors, good attitude
EVALUATION FOR CASE STUDIES / SITUATIONAL ANALYSIS
DIMENSIONS 3 2 1
Define Demonstrates the ability Begins to demonstrates the Demonstrates a limited
problem to construct a clear and ability to construct a ability in identifying a
insightful problem problem statement with problem statement or
statement with evidence evidence of most relevant related contextual
of all relevant contextual contextual factors, but factors.
factors. problem statement is
superficial.
Identify Identifies multiple Identifies multiple Identifies only a single
strategies approaches for solving the approaches for solving the approach for solving
problem that apply within problem, only some of which the problem that does
a specific context. apply within a specific apply within a specific
context. context.
Propose Proposes one or more Proposes one solution that is Proposes a solution
solutions solutions that indicates “off the shelf ” rather than that is difficult to
comprehension of the individually designed to evaluate because it is
problem. Solutions are address the specific vague or only indirectly
sensitive to contextual contextual factors of the addresses the problem
factors as well as the one problem. statement.
of the following: ethical,
logical, or cultural
dimensions of the
problem.
Additional 1 point for clear, logical and grammatically correct written report
Total points= 10 (averaged with Reporting Grade, also 10 points)
ABSOLUTE COURSE REQUIREMENTS:
Performance Tasks per module

Submission of Terminal Report for the Advocacy and COPC Projects
Modified from : 14
Marcela J Leus, EdD


MEDICAL CLERK’S LEARNING e-PORTOLIO

Please accomplish. Thank you https://forms.gle/2yPSwH7VzW7teaj79
Student’s Name (Last, First, MI) ____________________________________________ Team:. _______
Date of Rotation _________________ First Loop: ___ Second Loop: ___ Leader □ Y □ N
STUDENT’S JOURNAL OF ACCOMPLISHMENTS
1. Briefly, what expectations in this rotation were met and not met?
___________________________________________________________________________________
2. What is your most insightful experience / realization in this course loop why?
___________________________________________________________________________________
Key messages learned in every module
Module 1 – Navigator and Coordinator Module 4 – Communicator, Counselor
Module 2 – Telemedicine Provider Module 5 – Health Manager, Advoate
Module 3 - Health Educator Module 6 – Public Health Researcher
Modified from : 15
Marcela J Leus, EdD


e-PORTFOLIO and COURSE EVALUATION

Students are given the opportunity to evaluate the conduct of the course in order to identify points for
future improvement. This is accomplished at the end of each course loop.
1st Loop Dates: __________________ 2nd Loop Dates: ____________________
Please assess and rate your learning experience

Strongly disagree / Disagree / Neither agree or disagree / Agree / Strongly agree
1. Overall quality of experience Rating: ________________________

I had unique opportunities to learn new things and develop my skills as a health professional
working with individuals, families and the community.
2. Breadth and scope of training Rating: ________________________

I had opportunities to perform or observe the multi-faceted roles of a primary care physician
as healer, counselor, health educator, manager, advocate, navigator and researcher.
3. Depth of training Rating: ________________________

I appreciated and understood the value of integrating biopsychosocial and other health
determinants with clinical medicine in the application of holistic health care.
4. Overall quality of supervision Rating: ________________________

I received sufficient amount and proper supervision during my rotation.
5. Professional atmosphere Rating: ________________________

This rotation broadened my perspectives as a physician and is helpful in my professional
advancement.
6. Personal growth Rating: ________________________

This rotation encouraged personal growth and contributed positively to my character.
7. Which learning activities / experiences did you find most beneficial and why?
8. Given the current limitations, what suggestions do you have to improve the community medicine
program? Other comments are most welcome.
Google Form
https://bit.ly/ComMedEval
Modified from : 16
Marcela J Leus, EdD


INFORMED CONSENT & WAIVER OF CLAIMS FOR NON-UST BUS TRAVEL
PLEASE READ CAREFULLY:   By signing this document you will waive certain legal rights, including the right to sue.
Name of Event: ☐ To-From community visit ☐ Others _________________________ Inclusive Date/s:

___________________
ASSUMPTION OF RISK
I am aware that taking the NON-UST BUS TRIP has inherent risks, including but not limited to:
1. lost or stolen property;
2. the possibility of being left without transportation if I choose not to show up at the appointed vehicle at the specified
time and location; and
3. bodily injury. 
I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property
damage or loss, resulting therefrom. I accept full responsibility for my actions.
I understand the rules for the said trip. I understand that the appointed vehicle will be leaving the venue at a time specified.
Should I choose not to show up at the time specified, it will leave the venue without me. Should I decide not to return with
the group, I must inform bus monitor / leader of this and I will be responsible for my own transportation and actions.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of approval to participate in the NON-UST BUS Trip, I agree as follows: 

1. TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the University of Santo Tomas, and its faculty
members, directors, officers, employees, students and representatives (all of whom are hereinafter collectively referred
to as "the Releasees");
2. TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer, or that my
next of kin may suffer as a result of my participation in the NON-UST BUS Trip due to any cause whatsoever INCLUDING
NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE. It is my responsibility to
abide by the laws of the country and to ensure adequate medical, personal health, dental and accident precautions, as
well as protection of my personal possessions. ____________ (initial)
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or
personal injury to, any third party, resulting from my participation in the NON-UST BUS Trip; and 
4. This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and
representatives in the event of my death or incapacity.
In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the
Releasees other than what is set forth in this Agreement.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING
CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE
AGAINST THE RELEASEES.
Printed Full Name Signature Date

1.
2.
3.

Modified from : 17
Marcela J Leus, EdD


SAFETY STRATEGIES IN THE COMMUNITY
Knowledge and Common Sense Are Keys to Safety.
Safety in the community requires common sense, preparation, and knowledge by faculty and
students. Faculty staff makes the community safe by:
• planning and implementing instructions that provide students the information they need to
conduct programs and activities safely.
• ensuring that all equipment is functioning safely.
• modeling compliance with safety rules and using the proper protective measures.
• supervising students to ensure that safety rules are obeyed.
Teaching students the proper way to handle materials / equipment in the community should
also help them learn correct handling on the job. Good safety instruction must be continuous
throughout the year. Emphasize safety practices on the first day and reinforce the concepts
whenever relevant. Students will not take safety rules seriously unless the teacher obeys and
strictly enforces these rules.
A. Safety Guidelines for the Faculty
1. Safety Rules
Faculty should develop a set of safety rules for students. Specific sanctions should be identified for
student violations of the rules. The rules and sanctions are spelled out in the rotation manual and
student’s handbook.
2. Safety Instructions
Faculty should include safety concerns and precautions specific to each task or activity.
Posters highlighting safety rules and techniques are effective reminders to students and all who
enter the facility.
3. Handling Substances/Reagents/Communicable Diseases
Faculty can reduce students’ exposure to possible harmful substances / exposure by selecting those
that pose a minimum risk. Faculty is responsible for training students in the proper handling of
substances/reagents/potentially infectious cases. Training should include the importance of:
• safe storage of substances/reagents and proper disposal of chemical/infectious waste.
• activating ventilation system for any scenario that may generate hazardous exposure.
4. Safety Protocols
a. Faculty should circulate among students to monitor students’ work and ensure that they
comply with safety instructions.
b. Faculty should stay in the community center at all times when students are working and not
let students work alone or unattended.
c. Faculty should make sure their students understand instructions before the students begin
work. Faculty should inform students about the special hazards and precautions associated
with specific tasks / activities.
d. Faculty should allow sufficient time for student performance. Rushing students often causes
accidents.
5. Knowledge of Materials, Equipment and Procedures
Faculty must be familiar with the chemicals, equipment, and procedures they are using. Faculty
should have a thorough understanding of the potential hazards of materials, equipment and
processes in the community facilities/area.
Modified from : 18
Marcela J Leus, EdD


6. Safety Practices
Faculty should follow current safety practices. The substitution of a less hazardous option can
improve safety. Faculty must be careful when using older books and references because certain
practices have changed in recent years. As needed, faculty should consult updated publications to
keep current on safety techniques.
7. Access to Sensitive/Valuable Equipment / Materials
The teacher must maintain strict control of access to certain sensitive and valuable
equipment/materials. Storage rooms and cabinets should be locked and access restricted to
prevent unauthorized use or theft.
8. Good Housekeeping and Safe Storage
Good housekeeping can make a significant contribution to safety. Faculty can promote good
housekeeping habits by:
• insisting on proper facility cleanup from the first day session.
• establishing a procedure for “checking” students at the end of an activity or class period.
Materials and equipment should also be checked.
• holding each student responsible for cleaning up his or her own area and materials. Faculty and
students should help each other with cleanup.
• assigning individuals or teams to take charge of common areas and by checking on the return of
items used in the activity.
• labeling shelves and trays so students can tell where to find/return materials.
• scanning the area, and not dismissing students until all is in order.
• making sure that fragile and bulky equipment is stored in a manner that minimizes the chances
of brushing or jarring it off the shelf. Shelves with raised edges are recommended for equipment
storage.
• making sure that cabinets and drawers are closed when not in use.
• arranging seats to allow safe and quick exiting in the event of an emergency. Aisles should be
unobstructed, and access to safety equipment such as fire extinguishers must not be blocked.
• making sure that wastes are deposited in appropriate receptacles.
9. Accidents
Be alert for the possibility of an accident. Know where all safety equipment is located and how
it works. Know the location of emergency cutoff switches or valves for water supply and
electricity. Check all physical facilities and equipment to ensure maximum safety conditions.
Take prompt action to report and correct unsafe conditions.
B. Safety Rules for Students

• Know the location of safety and first aid equipment, including fire extinguisher.
• Do not engage in horseplay or other acts of carelessness.
• Dispose of wastes properly. Do not put matches in the sink. Sharps and broken glassware should
be discarded in proper containers.
• Notify the teacher when you observe hazardous conditions in the area/s.
• Examine equipment for malfunction, cracks, or other defects before beginning.
• Report all accidents, no matter how minor, to your teacher immediately.
• Know the possible hazards for each activity/ procedure before conducting it.
• Perform only authorized and approved tasks/procedures/activities.
• Follow instructions explicitly.
• If at any time you do not understand an activity, ask your teacher to explain the procedure.
• Always prepare for an activity by reading the directions before you come.
• Set up equipment away from table edges to avoid dropping it on the floor.
• Wash hands after all spills and at the end of each patient encounter.
Modified from : 19
Marcela J Leus, EdD


• Read all labels twice before using any substance/medication.

• Never return excess reagents/substances to the stock bottle; discard any excess according to
approved procedures.
• Never mix substances / medications together unless the teacher instructs you to do so.
• Never taste unlabeled substances/ chemicals/medications.
C. Responses to Injuries
General Procedures
Emergency procedures should be established at the beginning of the school year and
conspicuously posted.
1. In the event of a student injury, the established emergency procedure should direct the student
to notify the faculty on duty
2. In the event of a student injury, the established emergency procedure should direct faculty to:
• contact any staff trained in emergency medical treatment, and the Department Chairman or
Secretary or Course Supervisor. Dept. of Preventive Medicine Office 406-1611 Loc 8310
• call ambulance as needed for additional medical assistance.
• notify the school administration: 406-1611
• keep the injured student calm and comfortable while awaiting the arrival of medical
assistance.
• notify the injured student’s parents or guardians immediately according to school system
procedures.
3. Faculty should strongly encourage parents or guardians of injured student to seek follow-up care
for the student from medical specialists.
4. Faculty should never have students go for medical assistance by themselves. In circumstances
where it is appropriate for students to seek medical assistance, always have another student
accompany the injured student.
5. Safety equipment should be located in a prominent place and clearly identified with signs.
C. Responses to Threats/Crimes/Non-physical Accidents
General Procedures
Suspicious activities should be reported immediately to the faculty on duty.
1. Faculty or student/s should

• contact the Department Chairman, Secretary or Course supervisor (see above).
• call the Barangay and/or local government officials or their representatives.
• call the police / bureau of fire depending on the situation.
• notify the school administration.
• notify other relevant personnel in the community (parish priest, principals, health center
staff, security guards etc.)
2. Faculty or student/s should
• Never settle out of the standard and usual protocol
• Never tolerate bribery and other non-Christian compromises
• Perform proper documentation of any case scenario
• Consult school administration before engaging in any definitive action
Modified from : 20
Marcela J Leus, EdD


COURSE CALENDAR
SAMPLE DAILY SCHEDULE
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Module 1 Module 2 Module 3 Module 4 Module 5 Module 6
8:00-11:00 Telemed Telemed Telemed Telemed
Recorded or
Recorded Live lecture and
Recorded or Recorded Recorded
11:00-12:00 Lectures* workshop Live session
Live Lecture* lecture lecture
12:00-1:00 L U N C H B R E A K
1:00-3:00 Group Work Group Work Group work Group work Group work
Group Group Group Group Group
4:00-5:00
presentation presentation presentation presentation presentation
First Day of Rotation: Give 15-20 minutes for the Orientation
Note:
*All asynchronous activities are open to live consultation with facilitators after the recorded lectures
When there are no ongoing telemedicine consultations, facilitators may already interject related modular
topics/activities
Student Groupings
Group Rotations Group Rotations

9 July 16 - Aug 15 4 Jan 16 – Feb 14
10 Aug 16 – Sept 15 3 Feb 15 – Mar 15
12 Sept 16 – Oct 15 5 Mar 16 – Apr 15
11 Oct 16 – Nov 15 6 Apr 16 – May 15
1 Nov 16 – Dec 15 8 May 16 – Jun 15
2 Dec 16 – Jan 15 7 Jun 16 – July 15
Modified from : 21
Marcela J Leus, EdD


PROCESS FLOW FOR TELEMEDICINE
NEW PATIENTS
1. Use Department FB Page: UST Community Medicine
- To receive messages from the health center/s that patients are already in queue
- Consultants are admin of the page
- Group leader/s may also be given admin privilege during the rotation
2. A Zoom Meeting Link will be set recurring daily 8am to 11am. All faculty and group leader’s
email address will be added as alternate hosts. Meeting details will be the same each day.
3. Faculty of each day or the group leader will start / launch / host the meeting.
4. Medical clerks to join the meeting. Separate guidelines on proper decorum will be made.
a. Medical clerks are grouped and assigned decking order.
b. Assigned groups start preparing for possible consults.
5. Health Center staff to identify patients for teleconsultation. HC Staff to obtain signed informed
consent from the patient in order to proceed with the teleconsultation. Signed informed
consent forms (or signed logbook) will be kept in the HC.
6. HC Staff will send notification message to Department’s FB Page messenger if patient/s are
ready to consult. Once notified, HC staff will assist the patient in joining the zoom meeting.
7. Medical Clerks will admit the patient to the meeting room and start the medical interview and
PE. HC Staff may be requested to assist in obtaining vital signs and relevant physical
examination findings. Breakout room/s may be used.
8. Faculty to observe the process and reserve comments later for processing. Faculty to supervise
/ oversee the clinical encounter and give the appropriate medical management.
9. Charting will be done by the assigned clerk on the Dept’s / HC’s patient record template. Soft
copy will be saved in a Google drive folder, which will be shared to the HC for reference (as
viewer). Charts will be labeled <K or SR><Last name, First Name> (K for Kaunlaran, SR for San
Roque)
10. A census log using Google sheets will also be accomplished by the assigned clerk/s. The Google
sheet will also we shared (as viewer) with the HC. Census will include date of consultation, last
name, first name, middle name, birthdate, age (autocompute), diagnosis, management.
11. Prescription using Dept’s template will be prepared and handwritten by the medical clerks and
will be sent to the faculty via online platform for signature (word or pdf). Faculty will send back
the prescription to the medical clerk in pdf format.
12. Work-up requests using Dept’s template will be prepared, handwritten and signed by the
medical clerks.
13. If patient needs a hard copy, the prescription and requests will be sent to the Health Center via
Viber or Messenger in pdf format. HC staff will transfer the prescription and/or requests to
official form.
14. If patient does not need a hard copy, the prescription and requests will be sent to the patient
via Viber or Messenger in pdf format.
15. Other instructions to the patient or to the HC Staff may be communicated using phone call /
viber / messenger or zoom.
16. Follow-up consultation may have to be scheduled.
17. During the pilot period (January to February), a maximum of five (5) patients per Health Center
will be accommodated.
How to Attend to Follow-Up Patients

-Same process as a new patient but at the start, HC to give advance notice via FB Page messenger
regarding patient’s details to give time for the electronic chart to be retrieved for review.
Modified from : 22
Marcela J Leus, EdD


UST FACULTY OF MEDICINE AND SURGERY

DEPARTMENT OF PREVENTIVE, FAMILY AND COMMUNITY MEDICINE
TELECONSULTATION INFORMED CONSENT
Sinasang-ayunan ko ang pagkonsulta sa UST Department of Preventive, Family and Community

Medicine (DPFCM) sa pamamagitan ng pagtawag o online konsultasyon. Naiintindihan ko at tinatanggap
na hindi ito katulad ng harap-harapan na pagkonsulta. Pag natapos na ang krisis sa COVID-19, ako ay
pupunta sa Health Center o sa Outpatient Department para magpakonsulta.
Kasama sa pagsang-ayon ko sa online konsultasyon ang pagpapadala ng larawan o video ng apektadong

parte ng aking katawan, kung kinakailangan. Naiintindihan ko na ang mga larawang / video aking
ipapadala ay kumpidensyal at gagamitin lamang sa aking pagpapagamot.
Mga kaugnay na panganib sa paggamit ng Telehealth (kung naangkop):
1. May pagkakataon na ang impormasyon na ibinahagi ay kulang upang

makapagbigay ng karampatang patong medical (ex. hindi malinaw na litrato atbp.)
2. Posibleng magkaroon ng pagkaantala sa pag-eksamin o sa paggamot dahil sa

mahinang signal o kabiguan ng mga electronic equipment.
3. Sa ilang mga pagkakataon, ang kakulangan ng pagkuha sa lahat ng iyong

medical history ay maaaring magresulta sa mga masamang reaksyon ng gamot o
mga allergic reaction o iba pang mga error sa paghuhusga;
4. Bagaman ang mga electronic systems na ginagamit namin ay may security network
and protocol para sa privacy at seguridad ng impormasyong pangkalusugan, sa
ilang mga pagkakataon, ang mga protocol sa seguridad ay maaaring mabigo at
magdulot ng paglabag sa privacy act / o impormasyon sa personal na kalusugan
Kasabay ng aking pagsang-ayon ay ang mga sumusunod:

1. Nauunawaan ko na ang aking pagkonsulta online ay maaaring hindi magresulta base sa aking
inaasahan.
2. Naiintindihan ko na ang UST-FMS DPFCM ay may protocol sa pagprotekta ng aking mga personal
na impormasyon ayon sa batas, ako ay nagpapasakop dito.
3. Ang bawat pagsagot ko sa text message ay may kaukulang bayad sa aking load, kung naangkop.
4. Nauunawaan ko na ang doktor ay maaaring hindi masagot ang lahat ng aking katanungan lalo sa
mga karamdaman na mas kailangan ang personal na konsultasyon.
Modified from : 23
Marcela J Leus, EdD


FACULTY CONTACT INFORMATION
Name of Faculty Module Email address Cellphone Number

Dr. Ma. Teresa Tricia Bautista 5 mgbautista@ust.edu.ph 09178332514
Dr. Maria Victoria Cruz 2 mpcruz@ust.edu.ph 0917-5178388
Dr. Lynard Anthony D. Ignacio 3, 6 ldignacio@ust.edu.ph 0932-2302141
Dr. Iluminada M. Lerma 2, 5 lmlerma@ust.edu.ph 09228787239
Dr. Eva Irene Y. Maglonzo 3, 5 eymaglonzo@ust.edu.ph 09178400062
Dr. Wilhelmina A. Mercado 1, 4, 6 wamercado@ust.edu.ph 0917-8149292
Dr. Alejandro V. Pineda, Jr. 1, 6 avpineda@ust.edu.ph 0917-8821008
Dr. Philipp U. Po 1, 4 pupo@ust.edu.ph 0922-8668747
Dr. Mary Agnes S. Regal 1, 2, 6 msregal@ust.edu.ph 0998-5543987
Dr. Ma. Victoria Rondaris 2 marondaris@ust.edu.ph 0917-8804009
Dr. Venjilyn Villaver 3 vsvillaver@ust.edu.ph 0920-8959823
--- END ---
Modified from : 24
Marcela J Leus, EdD

Course Orientation - Preventive Medicine 4 - AY 2021-2022 - Signed

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University of Santo Tomas

Faculty of Medicine and Surgery

MA. TERESA TRICIA G. BAUTISTA, MD

MARIA ROSARIO F. CABANSAG, MD, MHPEd

MA. LOURDES D. MAGLINAO, MD

1. Course title : PREVENTIVE MEDICINE IV

Lynard Anthony D. Ignacio, MD

COURSE GOALS AND OBJECTIVES

Curricular Domains from 6 Roles of the

Collaborate within inter-professional Universal Health Care Case Studies on Summative

Utilize system-based approach to Developing Patient- Actual or Case Summative

Practice the principles of social Program Evaluation Monitoring and Community /

Electronic and Web searches

COURSE POLICIES (RULES & REGULATION)

A. General guidelines and policies regarding mechanics of the course

B. General guidelines and policies regarding conduct of the course

C. Policies concerning Attendance

D. Policies concerning Proper Uniform

E. Virtual Conferencing Guidelines

Before The Synchronous Activities

During The Virtual Session

Policies concerning Transportation (Face-to-Face)

F. NOTICES AND ANNOUNCEMENTS

WEEK 1 WEEK 2 WEEK 3 WEEK 4

Module 2 Telemedicine and Telemedicine and Disease Surveillance: Disease Surveillance:

Data Management: Data Management: Data Management: Development of

1. The student evaluation components are as follows:

EVALUATION OF THE STUDENT’S PERFORMANCE BY THE FACULTY PRECEPTOR

PERFORMANCE-BASED CRITERIA FOR EACH MODULE POINTS

INDIVIDUAL-BASED CRITERIA POINTS

SAMPLE RUBRIC FOR PLENARY / GROUP REPORTING

9-10 7-8 5-6 3-4 1-2

EVALUATION FOR CASE STUDIES / SITUATIONAL ANALYSIS

ABSOLUTE COURSE REQUIREMENTS:

Performance Tasks per module

MEDICAL CLERK’S LEARNING e-PORTOLIO

Student’s Name (Last, First, MI) ____________________________________________ Team:. _______

STUDENT’S JOURNAL OF ACCOMPLISHMENTS

Key messages learned in every module

Module 1 – Navigator and Coordinator Module 4 – Communicator, Counselor

Module 2 – Telemedicine Provider Module 5 – Health Manager, Advoate

Module 3 - Health Educator Module 6 – Public Health Researcher

e-PORTFOLIO and COURSE EVALUATION

1st Loop Dates: __________________ 2nd Loop Dates: ____________________

Please assess and rate your learning experience

1. Overall quality of experience Rating: ________________________

2. Breadth and scope of training Rating: ________________________

3. Depth of training Rating: ________________________

4. Overall quality of supervision Rating: ________________________

5. Professional atmosphere Rating: ________________________

6. Personal growth Rating: ________________________

INFORMED CONSENT & WAIVER OF CLAIMS FOR NON-UST BUS TRAVEL

Name of Event: ☐ To-From community visit ☐ Others _________________________ Inclusive Date/s:

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of approval to participate in the NON-UST BUS Trip, I agree as follows:

Printed Full Name Signature Date

SAFETY STRATEGIES IN THE COMMUNITY

Knowledge and Common Sense Are Keys to Safety.

A. Safety Guidelines for the Faculty

Student’s Name (Last, First, MI) ______________________________________ Team:. _

1st Loop Dates: 2nd Loop Dates: __

Name of Event: ☐ To-From community visit ☐ Others _________________________ Inclusive Date/s:

In consideration of approval to participate in the NON-UST BUS Trip, I agree as follows: 