Pediatric Outpatient PGYII

Description of Rotation or Educational Experience

Each resident will spend a dedicated one month on the “Outpatient Pediatrics” block rotation.  During this block each resident will work directly with and be supervised by board certified pediatricians in his/her respective outpatient clinic setting.  This outpatient rotation will be accomplished in the office of The Children’s Clinic at Willow Creek in Johnson, AR.

The resident will see patients in the FMC for three ½ days per week.

The specific goals and objectives for this educational experience are described below.

Patient Care

Goal

Provide outpatient care for newborns, children, and adolescents that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Competencies

The resident will become familiar with the following:

·         Management of well child care.

·         Diagnostic screening for developmental delay.

·         Tympanometry and hearing loss evaluation.

·         Spirometry:  office diagnostics/follow-up and home monitoring.

·         Development of asthma action plan.

·         Effective pediatric examination techniques.

·         Scoliosis screening techniques, recognition and appropriate management.

·         Development of plan of evaluation and therapy for ADD/ADHD.

·         Strabismus evaluation and management.

·         Parent and patient counseling.

Objectives

The resident will be able to:

• Perform an initial evaluation of the pediatric patient and present each case to the preceptor.
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and patient/family preference, up to date scientific evidence and clinical judgments.  

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. 

Competencies

The resident will become familiar with the following:

• Immunizations and primary prevention
• Diagnosis of abuse and neglect
• Child development and nutrition
• Psychosocial issues:  internal (e.g. drugs/sexuality/risky lifestyle/substance abuse)
• Psychosocial issues:  external (e.g. siblings/divorce/blended families/environmental stress/abuse/neglect/alcoholism)
• Asthma: pathophysiology, diagnosis and management
• Fever, diarrhea and vomiting. 
• Learning disorders/ADD/ADHD syndromes
• URI’s:  acute, recurrent, and chronic; including otitis media
• UTI/pyelonephritis
• Abdominal pain
• Childhood illnesses:  impetigo, varicella, pinworms
• Cardiac murmurs:  diagnosis and management, family counseling
• Common rashes:  recognition, evaluation and management
• Viral exanthema:  recognition and management
• Amblyopia

Objectives

The resident will develop skill in: 

• Performing pediatric history and physical examination in various age groups.
• Performing tympanometry and audiology exams.
• Interpreting lab and x-ray reports pertinent to pediatric practice.
• Interpreting developmental screens.        

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. 

Competencies

• The resident will identify strengths, deficiencies and limits in ones knowledge and expertise.

Objectives

The resident will:

• Obtain and use information from the population of patients seen
• Use information technology to access medical information and support their education
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
• Gain an understanding of the limitations of the family physician’s ability to provide certain types of pediatric care and the need for consultation.

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. 

Competencies

The resident will:

• Advocate for quality patient care.
• Practice cost effective health care and resource utilization that does not compromise the quality of care.

Objectives

The resident will

·         Understand the systems of health care available for the pediatric patient and how to access such care.

Professionalism

Goal

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

Competencies

The resident will:

• Be cognizant of the need to maintain a professional demeanor at all times in dealing with a diverse patient population base.

Objectives

The resident will:

• Carry out the medical encounter in a professional manner regardless of the patient’s socioeconomic status or diversity in gender, age, culture, race, religion, disability or sexual orientation.

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. 

Competencies

The resident will:

• Communicate effectively with other physicians, health professionals, patients and their families/guardian.

Objectives

The resident will:

• Communicate with patients and families/guardian tailored to their knowledge and understanding of disease processes.
• Communicate with other physicians and healthcare workers in an effective and professional manner.

Teaching Methods

Direct preceptor-resident interaction in the outpatient setting, didactic lectures, role modeling, and case-based learning.

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., Pretince-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