Pediatric Specialty Clinics PGYIII

Description of Rotation or Educational Experience

The PGYIII rotation in pediatrics allows the resident to rotate through various specialty areas of pediatrics.  The duration of the rotation is eight weeks. The resident will see continuity clinic patients in the FMC approximately three ½ days per week.

This outpatient rotation will be accomplished in various locations: 

v      The Family Medical Center in Fayetteville.  This is the office of Dr. Linda McGhee, one of our residency physician faculty members, who is dually board certified in Family Medicine and Pediatrics.

v      The Schmieding Developmental Center/Schmieding KIDS FIRST/Arkansas Children’s Hospital Outreach Pediatrics located in Lowell. 

The residents participate in a Well Child Clinic and Problem Pediatrics Clinic with Dr. Linda McGhee at the Family Medical Center.  The Well Child Clinic is for children ages two months to eighteen years for well child EPSDT’s.  Patients are evaluated on development and growth, immunizations are updated and families/guardians are educated on normal growth and development.  Referrals may be made for abnormal screenings. The Problem Pediatrics Clinic involves the evaluation of special pediatric cases in a comprehensive session which includes a thorough examination by the resident and Dr. McGhee, family counseling, and possible referral.  This clinic sees pediatric patients with medical conditions, growth and development disorders, and psychosocial issues.

The Schmieding Developmental Center provides comprehensive developmental assessments of children from birth to 18 years of age.  The staff of psychologists, physicians, and speech and language pathologists serves the mission of the developmental center:  to provide exceptional, comprehensive evaluations that look at each aspect of a child’s development and generate detailed intervention and treatment recommendations as well as follow-up care as appropriate. 

Schmieding KIDS FIRST is a comprehensive early intervention program for infants and young children who have special health care needs. Services at Schmieding KIDS FIRST clinics are tailored to meet the individual needs of children and families. Health monitoring, preventative health care, therapeutic services, developmental intervention and family-centered care are the core of the Schmieding KIDS FIRST program.  Patients include infants through preschool age who are at risk for developmental delays and/or disabilities.  Examples include children who are:  born prematurely, diagnosed as failing to thrive, diagnosed with a chronic illness that places their normal development at risk, exposed to alcohol or drugs prior to birth, and those born sick and require an unusual level of medical intervention.

The Arkansas Children’s Hospital Outreach Pediatrics program provides a variety of pediatric subspecialty clinics allowing excellent medical care for pediatric patients in the Northwest Arkansas area.  Because of this outreach program, the patients and their families do not have to travel to Little Rock for quality care.  Subspecialty clinics include: pulmonary, asthma, cardiology, rheumatology, hematology, rehabilitation, endocrinology, neurology, and gastroenterology.

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:

·         Learn to work with and consult pediatric subspecialists.

·         Participate in performing pediatric history and physical exams with the preceptor.

Objectives

The resident will be able to:

• 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 gain knowledge regarding the following pediatric conditions:

• Autism Spectrum Disorder
• Asthma: pathophysiology, diagnosis and management
• ADD/ADHD syndromes
• Failure to thrive
• Obesity
• Family conflict
• School problems
• Congenital heart problems
• Juvenile Diabetes
• Developmental disorders
• Growth problems
• Hypothyroidism
• Prematurity
• Scoliosis
• Cerebral Palsy
• Spina bifida

Objectives

The resident will gain experience in the initial diagnosis, management and/or referral of: 

• Autism Spectrum Disorder
• Asthma: pathophysiology, diagnosis and management
• ADD/ADHD syndromes
• Failure to thrive
• Obesity
• Family conflict
• School problems
• Congenital heart problems
• Juvenile Diabetes
• Developmental disorders
• Growth problems
• Hypothyroidism
• Prematurity
• Scoliosis
• Cerebral Palsy
• Spina bifida

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:

• 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 options available for the pediatric patient and how to access care for the complicated pediatric patient.

Professionalism

Goal

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

Competencies

The resident will:

• Demonstrate sensitivity and responsiveness to a diverse patient population including but not limited to diversity in gender, age, culture, race, religion, disability and sexual orientation.

Objectives

The resident will:

• Treat each patient and family with the utmost respect regardless of their socioeconomic status or diversity status.

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 with the utmost respect.
• 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., 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.

Reference distributed to resident at time of rotation:

“Bright Futures:  Guidelines for Health Supervision of Infants, Children, and Adolecents”.  This is a compendium of recommended readings in pediatrics; a publication sponsored by the U.S. Department of Human Services.

On Line Resources:

UpToDate and DynaMed