Your Contact Information 3 Year Pediatric ClerkshipYear Pediatric Clerkship … · ·...

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3rd Year Pediatric Clerkship3rd Year Pediatric ClerkshipBlock I

2007-2008

Your Contact Information

• Please give your preferred phone # & emails so that we can get in touch with you when changes arise.

www.medschool.lsuhsc.edu/pediatrics/clerkship/

What’s in your packet…•Orientation materials•Schedules•All clinical assignments•Ambulatory Card•Hospital information/disclaimers•Resident schedule•Ethics chapters to read for Ethics modulep•Educational Prescription (EBM)

What’s not in your packet - that you need!•Observed H & P information / written form•Forums competencies / curriculum •Other Ethics readings

Your homework tonight• This is only an introduction…• After, you must

– Familiarize yourself with the website– Read everything on the website

Id tif ti / bl l– Identify questions/problems early– Make your own personal calendar

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Be Organized• Be sure you know where you are going• Make a calendar tonight• Read about upcoming rotations before• Be on timeBe on time

Home Important Information Clerkship Activities For Faculty Resources Feedback & EvaluationContact Us

Clerkship Aims

Clerkship Di '

AnnouncementsWelcome to 3rd Year! Please explore our Pediatrics Clerkship website.In the event of hurricanes, notification of delays

Director's Letter

Chairman's Letter

Chief's Letter

and/or closures will be sent via LSUHSC email from Chancellor Rock. Information can also be obtained by checking the LSUHSC website under "Events."Save the DateOrientationsBoard ReviewsShelf Exams

Home Important Information Clerkship Activities For Faculty Resources Feedback & Evaluation Contact Us

Important Contacts

Maps & DirectionsM t'Margaret's

PearlsOrientation

Policy & ProcedureSchedules

Senior Students

Visiting Students


LSU Pediatrics FacultyDepartment Heads Other Helpful NumbersResidentsMaps & Directions Children's Physician

Ricardo Sorensen, MDChairman of Pediatrics

[email protected]

Robin English, MDClerkship DirectorPhone 896 3924Children s Physician

DirectoryPrivate Physician's Contacts

Phone 896-3924 Pager 374-2930

[email protected]

Simone Fogarasi, MDAssistant Clerkship Director

Phone 896-3924Pager 480-1386

[email protected]

Margaret Fanning Clerkship Coordinator

Phone 896-2066 Fax 894-5374

Our Aims of this Clerkship• National curriculum used for didactics• Learn about common pediatric illnesses and

issues• Gain appreciation of the differences between

di t i d d lt di ipediatrics and adult medicine• Understand role of growth, development,

prevention, family dynamics, impact of disease on child health

• Foster professionalism• Learn clinical reasoning skills – how to “think like

a doctor”

You will learn about…• Issues unique to the newborn infant • Issues unique to the adolescent patient • Growth and development • Infant feeding and childhood nutrition • Immunizations and preventive pediatrics • Genetic factors in health and diseaseGenetic factors in health and disease • Common pediatric illnesses • Therapeutics • Fluid and electrolyte management • Poisonings • Pediatric emergencies • Child abuse (forensic medicine)• Evidence Based Medicine • Ethics, Professionalism, Cultural Competency

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Clerkship Activities

• Clinical Care– Wards, Nursery, Ambulatory

• Conferences– Morning Noon Grand Rounds ClerkshipMorning, Noon, Grand Rounds, Clerkship

Director• Forums• Educational Prescriptions (EBM)• Observed H&P• NBME Shelf Exam


Academic CalendarResident

Schedules

Ambulatory SchedulesBlock III, 1/8-1/21Block III, 1/22-2/4Block III, 2/5-2/18

Student Schedules

,Block III, 2/19-3/4Block III, 3/5-3/18Block III, 3/19-3/30Private Physician AssignmentsBlock Schedules Block Schedule (Single Page)Block Schedule w/ PhotosClerkship Director's Conference ScheduleForums Schedules H&P SchedulesTesting Schedules

LSU PEDIATRIC THIRD YEAR BLOCK I SCHEDULE BEGINS: July 9, 2007 ENDS: September 28, 2007

SECTION I SECTION II SECTION III

7/9-7/22 7/23-8/5 8/6-8/31 9/4-9/28

Cheema, Anjum Nursery-Children’s

Clinics Wards – Children’sPurple/H l O l

Family Medicine

Hematology-Oncology

Conger, Andrew Nursery-Children’s

Clinics Wards – Children’sPurple/Hematology-Oncology

Family Medicine

Crenshaw, Kimberly

Nursery-Children’s


Family Medicine

Daly, David Nursery-Children’s


Family Medicine

Degatur, Benjamin Nursery-E. Jeff

Clinics Wards – Children’sSilver/Gold

Family Medicine


Clinical CareA b l tAmbulatoryNurseryWardsConferencesClerkship Director's ConferenceGrand RoundsMorning ReportNoon ConferenceForumsObserved H&P


AmbulatoryNursery

Wards

Ambulatory Rotation During these 2 weeks, you will be seeing pediatric patients in a variety of ambulatory settings, including primary and subspecialty care clinics. You will spend one day on the office of a Pediatrician in p yprivate practice. At the end of clinic present your ambulatory card to the attending physician who will sign to verify your presence and assign a Pass/Fail grade. At the end of the rotation, the completed card must be returned to Ms. Fanning. There is no night call during this rotation.

Clinic InformationPrivate Practice InformationDocumentsAmbulatory Card (MS Word format) Clinic ScheduleBlock I, 10/2-10/15Block I, 10/16-10/29Block I, 10/30-11/12Block I, 11/12-11/21Block I, 11/27-12/10Block I, 12/11-12/22Private Physician Assignments

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LSU

PEDIATRICS

JUNIOR

LSU PEDIATRICS JUNIOR AMBULATORY ROTATION

4/2/2007 4/3/2007 4/4/2007 4/5/2007

Orientation Forensic Medicine Endocrinology

Cheema, Anjum Residency ACC 3rd Floor 9-12 ACC 1st Floor 9-12

Planning Day General Surgery Neurology Well Child Care Forum

ACC 1st Floor 1-4 ACC 3rd Floor 1-4Children's Board Room

A 2-4

R

AMBULATORY

ROTATION

Orientation Hematology-Oncology General Pediatrics

Conger, Andrew Residency ACC 1st Floor 9-12 ACC 1st Floor 9-12

Planning Day Orthopedics Cardiology Well Child Care Forum

ACC 1st Floor 1-4 ACC 3rd Floor 1-4Children's Board Room

A 2-4

Orientation Dermatology Hematology-Oncology

Crenshaw, Kimberly Residency ACC 1st Floor 9-12 ACC 1st Floor 9-12

Planning Day Rehab

Endocrinology -Chalew Well Child Care Forum

Children's Board Room

LSU PEDIATRICS Third Year Block Schedule Block IV: 3/27/06 – 6/16/06JUNIOR AMBULATORY ROTATION:

OFFICE VISITS - (MCLNO and Children's)8:00 A.M. - 5:00 P.M. Check with offices for exact times.

April 12:Rogers, Charles Doskey, Richard 9605 Jefferson Hwy, Ste. E, River Ridge 9:00am

738-1604

April 11:Stumpf, Michael Collins, Keith 2017 Metairie Road, Metairie 8:30am

832-8022April 12:Subramanian, A Fisher, Marc 12A Westbank Expressway, Gretna 1:00 PM

361-0234

LSU Pediatric Clerkship Ambulatory Card Week #1Student Name____________________________

Morning Monday Tuesday Wednesday Thursday Friday

Date

Clinic

Location

Grade Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail

Evaluator

Comments

Afternoon Monday Tuesday Wednesday Thursday Friday

Date

Clinic

Grade Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail

Evaluator

Comments

Bottom Line for Ambulatory

• No call• Fill out your ambulatory cards• NOLA: All clinics are at Children’s

Metairie Clinic Tiger Care or privateMetairie Clinic, Tiger Care, or private offices. Morning & noon conferences are ok, but not mandatory. Call Margaret or Carol Vega with problems.

• Look on private office schedule for when to call (1 or 2 days before)


AmbulatoryNursery

Wards

Children’s Nursery The Children's Hospital nursery is a referral nursery for sick infants with complex problems that cannot p pbe managed at the referring hospital. If you have been assigned to the Nursery at Children's Hospital, you should go to the nursery on the 5th floor at Children's Hospital at 7:00 a.m. on the first day of the rotation to meet your LSU resident. You will be part of a nursery care team consisting of an LSU neonatologist, a neonatology fellow, and LSU pediatric residents. Staff rounds are conducted daily on all patients in the intensive care nursery.


AmbulatoryNursery

Wards

East Jefferson Nursery If you have been assigned to the Nursery at EJ

for the nursery portion of your block, go to the nursery on the 4th floor. Go to one of the nurseries and ask for the resident on service at 8 AM on the first day of the rotation to meet your LSU resident. You will be part of a nursery care team consisting of an LSU neonatologist, a neonatology fellow, and LSU pediatric residents. Staff rounds are conducted daily on all patients in the intensive care nursery. Judy Vollenwider is the nursing supervisor for the units, and she will provide a brief orientation to the units.

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More EJ Nursery Information• Your call schedule will be made in conjunction with the nursery

students assigned to Children’s Hospital. You may design your own call schedule to be approved by the upper level resident.

• Each student takes call once until 9:00 PM during the 2 week period including weekends. Please locate the resident/NP on-call for that date to begin your on-call experiencedate to begin your on call experience.

• On weekends, students assigned to Children’s Hospital should attend their patient duties at Children’s prior to going to the East Jefferson nursery. Please take an active part in making the on-call experience an educational one.

• You are required to attend all Pediatric Forums activities during this rotation.

Nursery Briefs

• It’s OK to wear scrubs• Wash your hands & then some• NOLA: Students make call schedule• NOLA: Students make call schedule.

Each take 1 call at EJ until 9pm (4th floor of EJ). Make your schedule early. Newborn forums will be covered by NICU staff.

• lsuvirtualnicu.com

Ambulatory You have been assigned to Children’s Hospital for the


AmbulatoryNursery

Wards

You have been assigned to Children s Hospital for the wards portion of your Pediatrics rotation. You should report at 7:00 am at the beginning of the rotation. Morning report is held Monday through Friday (except Wednesdays) at Children’s Hospital at 8:00 AM in room 3302 in the Ambulatory Care Center located at the corner of Henry Clay Avenue and Tchoupitoulas Street. When changing ward teams after the first 2 weeks, you are expected to contact your new senior resident in advance to establish a time and place to meet for your first day on their service. If contact has not been made earlier, you are expected at Children’s at 7:00 AM and should page your new senior resident at that time.

Ambulatory Teams at Children’s Hospital are divided into colors:


AmbulatoryNursery

Wards

Teams at Children s Hospital are divided into colors:

Purple covers the general pediatric hospitalist patients, allergy/immunology, infectious disease, forensic medicine, rheumatology, cardiology and genetics.

Gold covers neurology, rehab, gastroenterology and private pediatricians’ patients.

Silver covers pulmonology, nephrology, endocrinology and private pediatricians’ patients.

In addition, there is a “colorless” hematology-oncology team.

Children’s Wards FYI

• Call until 9pm q4• Weekend schedule to be determined by

residents (normally at least 1 student each day)day)

• Go where your residents go• Ward Expectations

Clinical Activities in General…..

• Fill out forms for EJ and CH• Parking at Children’s• Lunch at Children’s• Lunch at Children s• Professionalism issues

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A word about scheduling……

• Try to keep outside appointments to a minimum – don’t schedule during daytime activities if possible

• No plane tickets until 2 3 hours after exam• No plane tickets until 2-3 hours after exam scheduled to end – we will not give the exam early

• All absences need to be relayed to your residents on the team


Clinical CareAmbulatoryNurseryyWardsConferencesClerkship Director's ConferenceGrand RoundsMorning ReportNoon ConferenceForumsObserved H&P

Clerkship Director’s Conference

• Designed to help with presentation & clinical reasoning skills

• Must attend 2, may attend more.P /F il• Pass/Fail

• Format– Individual case presentations (45min)

Need volunteer each week (1 pt to NBME score)– Group case discussions

Clerkship Director’s ConferenceNew Orleans

• Dr. English – Thursday, July 26 – 12:00 to 1:30 – Room 2031 • Anjum Cheema David Daly, Jr. Jason Au Cregan Laborde• Andrew Conger Benjamin Degatur Torijuan Dallas Jonathan Lee• Kimberly Crenshaw Michael Hall Melissa Hirsu Brandi Lyony y• David Karam Michael Labarbara•• Dr. English – Friday, July 27 – 12:00 to 1:30 – Room 2031• Veermani Kumar Huy Nguyen Ross McCarron Brendan Sumich• Kim Lavigne Justin Walker Thuha Pham Benjamin Wright• Ray Mayo, III Joshua Wilensky Charles Smith Michael Wright• Toria Obey


Clerkship Director's

Grand Rounds G d R d i 1 t 3 d thDirector s

ConferenceGrand Rounds

Morning ReportNoon

Conference

Grand Rounds is on 1st, 3rd, 5th

Wednesday mornings at 8am in the auditorium at Children’s Hospital. All pediatric medical students on their wards should attend with their residents. A variety of pediatric topics are discussed by our LSU faculty and visiting faculty from other medical centers.



Conference

Morning Report at Children’s Hospital Morning report begins at 8am in conference room 3304on the third floor of the ACC portion of Children’s

Grand RoundsMorning

ReportNoon

Conference

on the third floor of the ACC portion of Children s Hospital. A resident will present an interesting patient case, and the chief resident will facilitate the formation of a differential diagnosis. Diagnostic and therapeutic management will be discussed. Medical students and residents are encouraged to participate in these discussions. All medical students and residents on ward services are expected to attend. On some occasions, morning report will be replaced by journal club or board review questions.

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ConferenceGrand Rounds

Noon Conference at Children’s Hospital Noon conference is located in the same room as morning report, 3304. It starts atGrand Rounds

Morning ReportNoon

Conference

room as morning report, 3304. It starts at 12:15. Attendance is expected of all medical students and residents on the wards and ambulatory services. Your residents may want you to attend these also if you are in the nursery. These conferences are presented by faculty members. Each month there is a different focus for the topics.


Clinical CareAmbulatoryNNurseryWardsConferencesClerkship Director's ConferenceGrand RoundsMorning ReportNoon ConferenceEvidence Based MedicineForumsObserved H&P

What is evidence based medicine?

Evidence Based Medicine

“the conscientious use, explicit, and judicious use of current best evidence in j

making decisions about the care of individual patients.”

Sackett DL, et al. Evidence-based medicine: what it is and it isn’t. BMJ 1996;312:71-2.

Evidence Based Medicine

Patient Values Medical Decision

ClinicalExpertise

ResearchEvidence

Educat iona l Prescr ipt ion

From the desk of: _______________________, MD

Name___________________________________________________________________________

Date and Place of Presentation________________________________________________________

The Patient:

________________________________________________________________________________

________________________________________________________________________________

The Intervention (therapeutic, diagnostic, prognostic, causal):

________________________________________________________________________________

Alternatives:

________________________________________________________________________________

The Target Outcome/s (a change in the risk or likelihood of):

E

________________________________________________________________________________

1. HOW you found what you found, i.e. Search Strategies;

2. WHAT you found (the citation);

3. The VALIDITY and of what you found (critical appraisal);

4 The Importance of what you found:

5. The valid and important results - (the bottom line):

6. How what you found will ALTER your MANAGEMENT of such nts;

How do you think you did? Poor good excellent What is your level of training? MS3 MS4 Intern 2nd yr 3rd yr Attending Was this Useful to you? No Somewhat Yes

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Evidence Based Medicine• Identify a clinical problem• Ask a relevant, focused

question• Acquire the necessary

resources to answer the

ASKAPPLY

Patient

resources to answer the question

• Appraise the evidence obtained

• Apply to patient care APPRAISE ACQUIRE

AnswerableQuestion

Resources

Evidence

ASK

• Formulate your clinical question:– Patient or Population

• Be specific– Intervention– Intervention– Comparison Group

• i.e. standard therapy, “gold standard”– Outcome of Interest

• i.e. efficacy of therapy, mortality, specificity of diagnostic test

ACQUIRE

• Classify the Clinical Question into Domain– Therapy

• Randomized controlled trials or meta analyses– Diagnosis

• Sensitivity and specificity, predictive value, diagnostic errors

– Prognosis• Cohort studies, survival analysis

– Harm or Casualty• Case control studies, cohort studies

ACQUIRE

• Search the Medical Literature– Select initial search terms:

• Population• InterventionIntervention

– Narrow search further with:• Comparison• Outcome

– Use MeSH terms to start, then use limiters

ACQUIRE

• Scan the articles for:– Is it a clinical study?– Is the research current?– Is the journal well-regarded?– Are the research questions similar to my question

with regards to Population, Intervention, Comparison groups and Outcomes?

• Select an article for appraisal

APPRAISE

• Validity– Can I trust this information?

• Clinical ImportanceIf t ill th f thi i f ti k– If true, will the use of this information make an important difference?

• Applicability– Can I use the information in this instance?

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APPLY TO PATIENT CARE

Patient Values Medical Decision

ClinicalExpertise

ResearchEvidence


Clinical CareAmbulatoryAmbulatoryNurseryWardsConferencesClerkship Director's ConferenceGrand RoundsMorning ReportNoon ConferenceEvidence Based MedicineForumsObserved H&P

Forums

• Purpose– Help develop clinical reasoning skills– Foster self study skills

Provide opportunity to discuss difficult– Provide opportunity to discuss difficult concepts

Forums always takes precedence over any other activity.


Forums Overview

ForumsCompetencies

Forums

Pediatrics Forums OverviewThese modules will be set up in a Problem Based Learning format, with all of you learning from and teaching each other. YourForums

Schedules

Forums Evaluation Form

learning from and teaching each other. Your forum leader will be there for you as a facilitator only – he/she will not be there to give you answers to the questions that arise. You should bring textbooks or other materials with you to the sessions so that you and your team members may look things up as questions come up. You will identify learning issues to study at a later time.


Forums Overview Forums

C t i

Forums CompetenciesAdolescent (large group) (Forensics) (large group)

CompetenciesForums

Schedules

Forums Evaluation Form

Clinical Problem Solving I Clinical Problem Solving II Chronic Illness / GeneticsEthics / Professionalism / Cultural Competency Newborn (done in NICU) TherapeuticsWell Child

Examples of Competencies

• Adolescent– Describe the sequence of physical changes of

puberty for boys and girls using Sexual Maturity Rating staging.y g g g

– Know the components of an adolescent health supervision visit.

• Forensics– Know the risk factors for child abuse.– Know the responsibilities of the mandatory

report to identify and report suspected abuse.

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Examples of Competencies

• Well Child Care– Describe variants of normal growth in healthy

children, including familial short stature and constitutional delay.y

– Know the maternal and infant contraindications to breastfeeding.

• Clinical Problem Solving I– For each of the conditions in the chart, know

the etiology, history and physical findings, laboratory findings and treatment


Forums Overview

Forums Obj i

Forums SchedulesMaster Block Schedule Team 1 (Delahoussaye, Foley, Gulotta, Koshy,

Objectives & CasesForums

Schedules

Forums Evaluation

Form

Leblanc, Bulot)Team 2 (Morris, Quin, Soine, Tan, Toribio, Wilson)Team 3 (Babineaux, Bright, Cusick, Eilers, Grieshaber, Larson)Team 4 (Le, Michel, Mitcham, Ragbir, Woodson) Team 5 (Areaux, Cantelli, Daste, Fletcher, Gray, Heiman)Team 6 (Latiolais, Obih, Portier, Schreiner, Vu, Wiegand)

Block IV, 2006-2007Master Forums ScheduleDate Forum

Preceptor Time Location Room

April 2 Residency Planning DayApril 3 Teams 1-4 Orientation

Fogarasi 9:30-12 ACC 3302April 4April 5 Team 2 Well Child Care Hescock 2-4 CH Board Rm AApril 6 Spring HolidayApril 9 Spring Holiday

April 10April 11 Team 4 Well Child Care Fogarasi 1-3 ACC3050April 12 Team 3 Well Child Care Singleton 1-3 CH Board Rm AApril 13

FORUM LEADER / BEEPER #: Dr. Catherine Spiller________________Cell: 338-2796____

WEEK DAY and DATE

TIME MODULE ROOM LCD? Over Proj?

1 Thursday,January 11th

3:00-5:00 PM Forensic Medicine Children’s HospitalAmbulatory Care Center – Room 3302

N N

1, 2 N/A N/A Newborn NICU N N

3 Monday,January 22nd

3:00-5:00 PM Well Child Care Children’s HospitalAmbulatory Care

N YJanuary 22 Ambulatory Care

Center – Room 3102

3 Friday,January 26th

3:30-5:30 PM Adolescent Medicine Children’s HospitalAmbulatory Care Center – Room 3302

Simulation Laboratory Session:Tuesday, January 23, 2007

1:00 – 3:00 PM: Lien Kim Bui, Laura Danzy, Robyn Deranger3:00 – 5:00 PM: Ross Hogan, Brett Lewis, Emily Miller

Tuesday, January 30, 20071:00 – 3:00 PM: Ross Hogan, Brett Lewis, Emily Miller3:00 – 5:00 PM: Lien Kim Bui, Laura Danzy, Robyn Deranger

More about Forums

• Use any resources you want• Bring books to forums sessions• Modules include discussions of cases,

i d th ti itiquizzes, and other activities • Absences

– If excused, make up the module & get a grade from the make-up facilitator

– If unexcused, make up the module & get a 0.

Please evaluate the student on the following during the module:Participation in the discussionFacilitation of their peers’ learningUse of teamwork to work through exerciseEnthusiasm for learningRespect for colleagues’ viewsPreparation for each module

MODULE H HP

P F COMMENTS

Well Child Care

20 % of your grade

Ethics, Professionalism, Cultural Competency

Therapeutics

Clinical Problem Solving I

Clinical Problem Solving II

Care of the Chronically Ill Child

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Peer Evaluation


Clinical CareAmbulatoryAmbulatoryNurseryWardsConferencesClerkship Director's ConferenceGrand RoundsMorning ReportNoon ConferenceForumsObserved H&P

Observed H&P

• Great opportunity• Takes place during ward rotation• Students responsible for contacting

t lpreceptor early on• Pass/Fail

H&P

• Interview• Physical• Feedback• Write-up & Growth Chart• More Feedback• DON’T BE NERVOUS


Chief Complaint Observed H&P GuidelinesChecklists

Growth ChartsPreceptor

Assignments

Important Aspects of a Pediatric HistoryImportant Aspects of Pediatric Physical ExamTips on General Interviewing StyleH&P Write-up Form

H&P Write-Up Form

Chief Complaint:

History of Present Illness ***Any birth history, past medical history, medication, allergies, immunizations, diet history, family history, social history, and review of systems that is pertinent to the HPI should be included in the HPI.

Past Medical History (include birth history, illnesses, medical problems, hospitalizations, surgeries, accidents):

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Growth ChartsRecommended Texts

Sample NotesWeb Resources




Growth Charts Boys 0-36 Months•Head Circumference•Length•WeightWeight•Weight-for-LengthBoys 2-20 Years•BMI•Height•WeightGirls 0-36 Months•Head Circumference•Length•Weight•Weight-for-Length•Weight


Chief Complaint Observed H&P GuidelinesChecklists

Growth ChartsPreceptor

Assignments

Important Aspects of a Pediatric HistoryImportant Aspects of Pediatric Physical ExamTips on General Interviewing StyleH&P Write-up FormPhysical Exam Checklist

Observed H&P Assignment

Student Clinical Preceptor

Preceptor’s Office #

Preceptor’s Beeper #

Jason Au Robin English

896.3924 374.2930g

Torijuan Dallas

Jay Hescock 896.3924 480.0952

Melissa Hirsu

Simone Fogarasi

896.3924 480.1386

Michael Labarbera

Caroline Straatmann

896-9329 480-1365


Growth ChartsRecommended

TextsSample Notes

CORE PEDIATRIC MATERIALThe following textbooks are recommended to use as references during your pediatric clerkship. You are not required to purchase any textbooks. Please know that most of these books are p

Web Resources available in the library, on-line, or in the bookstore.

•Nelson Essentials of Pediatrics, 5th Edition

•Nelson, Textbook of Pediatrics, 17th Edition

•Pediatrics: A Primary Care Approach - 2nd Edition

•Harriet Lane Handbook - 17th Edition

•Appleton & Lange, Review of Pediatrics-6th Edition

•PreTest Pediatrics - 9th Edition - 2001

•Blueprints in Pediatrics – 3rd Edition - Blackwell Science, 2004

•Pediatrics: First Exposure, 1st Edition


Growth ChartsRecommended

TextsSample Notes

Web Resources

Links***Interactive Web Cases Sponsored by COMSEP. ***Definitely worth checking out. ***http://www.clippcases.org/Questions & Discussions from University of MinnesotaWeb Resources Q yhttp://www.med.umn.edu/peds/education/studentinfo/questions/home.htmlCongenital Heart Defects & Radiologyhttp://www.med.umn.edu/radiology/cvrad/chd/chd.htmlAmerican Academy of Pediatricshttp://aap.org/AAP Policy Statementshttp://aappolicy.aappublications.org/Morbidity & Mortality Weekly Report from the CDChttp://www.cdc.gov/mmwr/

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Grading Overview

Shelf Exam

FormsClinical Evaluation FormEBM Evaluation FormShelf Exam EBM Evaluation FormForums Evaluation FormH&P Interview FormH&P Write-up Form

Grading Overview

• Clinical 70% – Ward evaluations– Nursery evaluation

Forums evaluation– Forums evaluation– Ambulatory (Pass/Fail)– Observed H&P (Pass/Fail)

• National Board of Medical Examiners Shelf Exam 30%

The best way to fail Pediatrics is to display unprofessionalto display unprofessional

behavior ☺

*Attendance Policy• Unexcused absences from any clinical assignment

or a pediatric forums module will result in a reduction of your grade to the next lowest grade.

• For an absence during the rotation to be considered excused, Drs. English, Fogarasi or Ms. Fanning must be notified on or prior to the day of the absence.

• If absent more than 2 days, the student will present a doctor’s note and arrangements will be made to make up those missed days.

• On ward and nursery rotations, you must also notify your resident

*Attendance Policy

• If missing the day with the private pediatrician, you must also call that office

• If missing a pediatric forums module, you must notify your forums leader. y y

• The missed module must be made up by making arrangements to attend the module with another group.

• The leader of the make-up session will assign your grade for that module.

Who is an Honors Student?• Reads on patients, knows their

diseases & plans• Develops plans of care for their

patients based on their reading• Is readily available to team

bmembers• Shows enthusiasm for learning• Eagerly helps out team members• Becomes an active member of

the team• Is punctual & attends

conferences consistently

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Getting Feedback….

• Residents and faculty will give feedback at different opportunities –be receptive to these constructive

tcomments.• Feedback card




Sample Progress Note

Always record the time & date of your note. Be sure to label your note with the appropriate team you are working with, and identify the type of note (i.e. progress, procedure, admission, lab addendum).

6/21/05 7:25am

L3 Purple Progress Note

The “S” stands for Subjective. This portion of your note should reflect the last 24 hours of events. This may include changes in clinical status, relevant concerns, review of systems, and any parental concerns. Complete sentences are not

S:Mother reports patient is improving. The patient has stopped vomiting, but has begun with loose green, watery bowel movements x7. Patient’s appetite has improved, and is now tolerating clears. Activity has almost returned to baseline. Mom concerned that patient is going to pull IV out.

Complete sentences are not required.

This portion of your note is the Objective part, or all of your data. Always report your vital signs. Try and present the most recent vitals, and then include a range. Report your Ins & Outs, and when possible include the cc/kg/hr of urine output.If there are drains or other different sources of ins & outs you may want to break these down (i.e. 400cc PO, 600cc IVF)For your exam, be thorough and concise. Be sure to examine the entire patient.

O:Tm 38 Tc 37.2 HR 105 (92-135) BP 95/65 (95-126/58-76) R 22 (20-26) Today’s Wt 12.2kgI/O: 1280/1600 + BM x7UOP: 5.4cc/kg.hrGeneral: Awake in mother’s arms sipping on juiceHEENT: Normocephalic, PERRL, clear rhinnorrhea, moist membranes, oropharynx clearNeck supple, shotty cervical lymphadenopathy Respiratory: Breathing easily, clear to auscultation bilaterallyCV: Regular rate, rhythm, no murmurs. 2+ DP and radial pulses bilaterally. Brisk cap refillBelly: bowel sounds present, soft, non-tender, non-distended, no organomegaly.GU: Normal tanner I female genitaliaExtremities: No swelling, moving all joints well, no edemaSkin: No rashes or jaundiceNeuro: Alert, oriented. Cranial nerves in tact. Strength in upper and lower extremities 5/5. DTR’s brisk and symmetric. No deficits identified.

Include all new labs and radiology reports. Be sure to include all cultures that are being followed. It is alright to report that a lab is pending. You may write the medications that your patient is on down the margin of the page.

MedsD5 1/2 NS + 20meq KCL/L 45cc/hr

Labs/RadiologyBMP from this morning is pending.6/20 Stool culture no growth to date.Stool Rotavirus positive.Stool Adenovirus negative.

Your Assessment should include the patient’s age, problems/diagnoses, current issues, and hospital day. This should be concise and accurate.

A:18 month old female with Rotavirus acute gastroenteritis and resolving dehydration. Emesis improving, now with copious diarrhea. Hospital day #2.

In your Plan section, think about what YOU want to do with YOUR patient. Suggest your ideas along with your rationale. It’s okay to take a chance here. You may divide this up by systems or by

P: 1.Acute Gastroenteritis: Vomiting has resolved, now tolerating clears. Will advance to bland diet. Diarrhea has begun. Will begin lactobacillus to help shorten symptoms. Appears to be viral in nature, but will follow stool culture. Continue with contact precautions.2.Dehydration: Will keep an eye on hydration status and try to heplock IV. Follow

di BMP t h k l ti f ildl d d bi bthis up by systems or by problems. Some patients may be better suited for a plan based upon their problems. Either method is acceptable as long as it is complete, accurate, and concise.Or by systems..If you decide to go by systems, you can use this “alphabetical” way to remember:A/B:Airway/BreathingCV: CardiovascularD: “Da brain”FEN/GI: Fluids, electrolytes, nutrition, GastroenterologyHeme: HematologicID: Infectious OrthopaedicRenalSocialEtc…

pending BMP to check on resolution of mildly decreased serum bicarb.3.Will follow patient throughout the day and discuss disposition with team.Or by systems…•Airway/Breathing: Stable, no issues.•Cardiovascular: Stable. Tachycardia from dehydration resolved.•D (neuro): Stable, no issues.•FEN/GI: Emesis resolving and tolerating clears now. Will try and advance to bland diet. Given loose stools, will start lactobacillus to help shorten course of diarrhea. Will follow BMP drawn this morning. Would consider heplocking IV, and monitor ins & outs. Will require an additional night in the hospital if patient cannot keep up with oral hydration.•Heme: No issues.•ID: Rotavirus positive. Follow stool culture. Contact precautions. Discussed hand washing with family.•Social: No issues identified.•Will discuss disposition of patient with team.

Physical Exam Pointers• Be gentle• Be flexible• Be respectful

Pediatric Physical Exam Video

http://129.106.196.5/ms/pedi/PDPhysical.wmv

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Be Organized• Be sure you know where you are going• Make a calendar tonight• Read about upcoming rotations before• Be on timeBe on time

Requirements

• Attendance required:– Forums– Clerkship Director’s Conference– All clinical activities– Simulator lab

• Assignments required for turn in:– 2 Educational Prescriptions (to your Forums leader)– Observed H & P written form– Ambulatory card

Margaret’s Pearls… Do you know where to go?

• Learn as much pediatrics as you can

• Keep an open mindC ll ith ti• Call with any questions or problems

On your mark, get set, go!

Date post:	15-Apr-2018
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