Pediatric Inpatient PGYI

Description of Rotation or Educational Experience

To train and educate resident physicians in in-patient pediatrics and neonatology by providing opportunities in which they may acquire knowledge and skills in this area appropriate to the practice of Family Medicine.  To provide exposure to all ages of children in the pediatric unit, and nursery. During this 1 month (4 week) rotation, each PGY-1 will work directly with and be supervised by board-certified pediatricians who serve as Supervising Pediatrician within the Washington Regional Medical Center.

Goal I: To achieve competence in diagnosing and managing common medical conditions of children and infants as appropriate for the Family Physician.

Goal II: To achieve competence in recognizing and referring complex medical disorders of children, adolescents and infants.

Goal III: To adequately recognize, treat adolescents and children in an emergent situation (critical).

This rotation will be accomplished primarily on the inpatient pediatric service at Washington Regional Medical Center (WRMC). Additionally, those residents completing a block rotation in Maternity Care at Willow Creek Women’s  Hospital (WCWH) will also be supervised in the newborn and neonatal care that is provided for each of those babies who are the product of the delivery of residency continuity maternity patients.

The Resident is expected to:

·         Attend one pm half day FMC clinic each week.

·         Perform rounding and writing appropriate notes on all pediatric patients assigned to him/her, prior to the arrival of the pediatrics attending physician.

·         Begin rounding and writing notes on nursery patient not earlier than 7:30 am so as to allow the nursery nurses to complete their daily early morning shift-changing activities.

·         Begin daily rounds with the supervising pediatrician in the nursery at 8:00 am, M-F.

·         Accompany and assist the supervising pediatrician in his/her daily activities including but not limited to attending complicated deliveries and C-sections, tending to emergency department patients and to deteriorating nursery patients.

Patient Care

Goal

Provide inpatient care for newborns, children, and adolescents.

Competencies

·         The resident will recognize and treat common pediatric behavioral, medical, and surgical diseases and disorders in the inpatient settings, keeping the role of the family physician clearly in focus.

Objectives

The resident will:

·         Use the problem-oriented approach to Pediatrics in the in-patient setting with emphasis on the establishment of an appropriate and comprehensive data base and treatment plan utilizing indicated resources and consultations.

·         Become familiar with neonatal resuscitation, stabilization, and preparation for transport of the distressed neonate.

• Demonstrate empathic concern for the health of the child in the context of the family.
• Facilitate discharge planning.
• Understand the unique vulnerabilities of infants and children that may require special attention, consultation and/or referral.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Be able to understand perinatal complications. Become familiar with the following. 

Objectives

• The residents over three years will become competent to diagnose and treat the above medical conditions.
• The resident will learn limitations and, when consultation is necessary, how to obtain a consult.

The resident should become familiar with the following skills:

·         Utilization of PALS

·         IV Access

·         Lumbar puncture

·         Management and calculation of IV fluids and electrolytes

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify and perform appropriate learning activities.

Objectives

The resident will begin with orientation (PGY I), continue with increasing responsibility with both

in and out patient care in the FMC and hospital.  The structural pediatric rotations will continue

the process. 

Competencies

• Use information technology to optimize learning.

Objectives

• The resident becomes competent in the use of UpToDate, DynaMed, and journal searches.  The resident will learn to utilize a variety of knowledge sources.
• The resident will become competent in the use of EMR technology to track patients, recover lab data and medical reports.  The resident will become competent to use the PDA with Epocrates and 5-Minute Clinical Consult.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

Work in inter-professional teams to enhance patient safety and improve patient care quality.

Objectives

• The resident will learn the different healthcare settings and how to move their patients easily to the best setting for the patient.
• Be cognizant  of the financial cost, risks and benefits of various conditions and procedures:

1.       Bladder catheterization

2.       MRI

3.       Lumbar puncture

4.       Vascular access

·         Advocate for quality patient care and assist patients and families dealing with system complexities.

·         Work to control health care costs and allocate resources to provide high quality care.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others.

Objectives

The resident will:

·         Gain an understanding of compassion, integrity, and respect in care of the child with acute and chronic problems.

·         Demonstrate a commitment to carrying out his/her professional responsibilities.

·         Demonstrate respect, compassion and integrity and a responsiveness to the needs of children and families.

·         Demonstrate adherence to ethical principles.

·         Show sensitivity and respect to diverse patient populations.

·         Know when to seek consultation from other appropriate specialists to either manage or co-manage a patient for optimal care.

·         Respond to pages and other consultations in a timely manner.

·        Dictate comprehensive history and physical exams in a timely manner.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with physicians and other health professionals.

Objectives

The resident will:

• Learn appropriate consultation, timely transfers, and other options of care for acute and chronic problems.  This will be monitored at daily report and on rounds.
• Recognize the impact of social, cultural and environmental factors that will affect the health and well-being of infants and children.
• Understand the importance of educating the public about environmental factors that can adversely affect children and about development of community programs that promote the health of children.
• Demonstrate an awareness of the importance of physician, health care professionals, and families working as partners to promote optimal health for children.
• Demonstrate interpersonal and communication skills that result in effective information exchange with patients, families and colleagues.
• Work effectively with others as a member of a healthcare team. 

Teaching Methods

Discussion of cases, evaluation of x-rays and lab results, and preceptor rounds.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Behrman RE, et al. Nelson Textbook of Pediatrics.  16^th ed., Philadelphia, WB Saunders, 2000.

Rudolph AM.  Rudolph Pediatrics.  20^th ed., Appleton & Lange, 1996.

Gomella TL, Neonatology:  management, procedures, on call problems, diseases and drugs.  4^th ed., Prentice-Hall, 1999.

Pfenninger JL, Fowler GC.  Procedures for Primary Care Physicians.  St. Louis, MO, Mosby, 1994.

Merenstein GB.  Handbook of Pediatrics.  18^th ed, Appleton & Lange, 1997.

Siberry GK.  The Harriet Lane Handbook:  A manual for pediatric house officers.  15^th ed., Mosby, 2000.

Hay WW.  Current Pediatric Diagnosis and Treatment.  15^th ed., Appleton & Lange, 2000.

On Line Resources:

UpToDate and DynaMed