1. A MD residents must carry out the following clinical responsibilities in the Unit where they are posted :

a. Must know the working diagnosis of all in- patients.

b. Should write follow-up notes timely, completely, accurately directed towards the patient problem, properly, sequentially eliciting salient positive and negative points to support the diagnosis on the continuation sheet.

c. Should be able to present history, clinical examination findings when asked and justify logically by applying knowledge of disease and its pathophysiology in clear, organized, complete, accurate and polished manner. It should include psychosocial and preventive aspect also.

d. Should suggest investigations based on the working diagnosis with limitations incorporating considerations of costs, risks and benefits.

e. Should make available the investigations for the round.

f. Should guide juniors in history writing, examination and supervise them.

g. Should be responsible for the drugs written in the cardex.

h. Should write clear nursing instructions.

i. Should counsel parents in clear, appropriate, jargon-free and empathetic way.

j. Should be responsible for the planning of the nutrition needs for the child and instruct for its implementation to the dietician, nurses and counsel the parents on ways to fulfil it.

k. Should perform bedside procedures when needed.

l. Should perform the daily ward round being enthusiastic responsive, reliable, committed, cooperative and respectful way before the consultants round.

m. Should write the discharge summaries completely, with salient informations, write own full name and sign.

n. Should write referral notes as advised by the consultant and follow-up the referrals.

o. A third year MD residents will work as a second on call. They will carry out the following responsibilities:

- Review all cases admitted in the ward and observation room in the evening of the admission day.
- Be available to solve the problem if any as shown by the first on call.
- Inform the consultants about the problem and types of patients admitted.
- Review the treatment provided by the emergency or first on call doctor.
- Present the cases in the post admission morning round
- Be responsible for the presentation of the admitted cases in the seminar.

p. Take evening tutorial bedside clinical classes for the MBBS students.

2. They are responsible for the duties that are allotted to them.

3. They are responsible for the topic, journal club, cases, and a bedside clinical presentation of that is allotted to them and show the presentations outline three days ahead to the faculty member.

4. They should hand over the patients to each other during or after their duties.

5. They are responsible for the patient’s care in OPD.

6. They should carry out the functions that are allotted to them by their consultants.

7. They should teach juniors about the cases admitted in the ward.

8. Must inform the consultant if unable to attend the duties and should make alternative arrangements for their duties.

9. Should collect the evaluation form from the department and submit it to the respective unit heads for their own evaluation. Finally they should submit the evaluated form to the co-ordinator withi n one week after the end of respective posting.

10. They must maintain a log book as mentioned in the format and submit it duly signed by the unit head and to the co-ordinator within one week after the end of posting.

It is expected that the duty doctor should be aware of the following:

1. He/she should know about all the patients admitted in the Neonatal Unit. This includes – general condition of the patient; what drugs, feeds\fluids patient is on;
   any specific investigation or procedure that needs to be done on the patient and also what reports need to be traced or followed up.
   Tracing reports not only means getting them but also acting on them.
2. On duty doctors are also expected to know about any ‘problem’ babies in the maternity ward. This would include babies with feeding problems, those on antibiotics or other form of treatment and those with reports that need to be traced.
3. The doctor is expected to attend all high-risk deliveries in the labor room and also attend those deliveries for which he\she is called by the obstetricians or the nursing staff in the labor room.
4. All admissions to and discharges/referrals from the Neonatal Unit should be noted down in the register provided according to the format given.
5. For effective functioning and care of patients there should be a written hand-over during change of duty shifts, both in the evening (by the doctor stationed in the Neonatal Unit) and the next morning (by the first-on-call).
6. There should also be a note regarding the patient’s general condition and any change in treatment or procedure done on all patients admitted to the Neonatal Unit during duty hours.
7. The pediatric doctor is also occasionally called to attend to other sick children admitted in other departments of the hospital. Under such circumstances, the duty doctor is to respond appropriately.

On Saturdays, apart from the above-mentioned responsibilities the doctor is to do detailed rounds on neonates that are with their mothers in the maternity ward and other wards before sending them home.

While carrying out his/her responsibilities, if the duty doctor faces any problems he/she should contact the second-on-call.

A BRIEF ORIENTATION FOR RESIDENTS STARTING THEIR POSTING IN THE NEONATAL UNIT, TUTH.

The Neonatal Unit at TUTH provides Level II care to sick neonates and those needing supportive care. It is a small unit with a capacity for accommodating up to 10 neonates. Only babies who are delivered at TUTH are admitted to this unit. It is the hospital’s policy to ‘room-in’ newborn babies with their mothers soon after delivery and thus only those babies who cannot be kept at the bedside are admitted here.

The unit is equipped with incubators, warmers, phototherapy units, infusion pumps, syringe pumps, central supply of oxygen, suction apparatus, a refrigerator and drugs cabinet. The temperature in the unit is maintained at 25-260C by means of an air-conditioner or blower heaters during the winter months.

MD Pediatric residents are posted to this Neonatal Unit for a total period of 6 months during their residency. Apart from this they are also expected to do duties as First-on-call once a week and Saturdays by rotation at the Teaching Hospital.

The MD resident posted in the Neonatal Unit has the following responsibilities:

1. He/she looks after all babies admitted in the Neonatal Unit and those that are with their mothers in the maternity ward. This involves-
   • Each morning, at 9am, the resident should receive a formal handover of all the patients in the Neonatal Unit from the Doctor-on-call during the previous night.
   • From 9am till 4pm everyday, except Saturdays, the resident works in the Neonatal Unit and also stays on-call. This means he/she attends all the high-risk deliveries in the labor room including Cesearean sections.
   • At 4pm, the resident hands over patients admitted in the Neonatal Unit and those needing special attention in the Maternity ward to the doctor-on duty for that night.
   • Hand-over of patients should be done verbally as well as in written form in the register provided for the same.
   • The resident plans the treatment of each patient, sends relevant investigations and follows up on the reports.
   • The resident presents cases admitted in the unit to the Consultant during daily rounds
2. The resident is responsible for maintaining the registers on:
   a) Admission/Discharge of Neonates
   b) Congenital Anomalies
3. Every month, the resident presents statistics of the previous month during the
   Perinatal Mortality Meetings that are held on the second Wednesday of the
   month.
4. The resident may be asked to take some classes on Neonatology for the nurses and undergraduate medical students.