Pediatric General Wards I. Rationale
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Pediatric General WardsI. RationaleThe specialty of family practice is vitally interested in all aspects of pediatric health and disease. This curriculum addresses the care of hospitalized children. Pediatric health maintenance will be addressed in the FPC curriculum, and Ambulatory Pediatrics curriculum. Care of the healthy newborn will be addressed in the FPC curriculum, Nursery curriculum, and OB continuity curriculum. Care of the acutely ill child in continuity setting is addressed in the FPC and Ambulatory Peds curriculum. The immediate care of childhood emergencies is addressed in the Pediatric Emergency curriculum, PALS and neonatal resuscitation courses. As a family physician, Graduates must be comfortable and able to deal with a wide variety of pediatric conditions, be able to diagnose and treat in inpatient and outpatient setting. Graduates must be able to recognize situations which require immediate support, require hospitalization, and/or EMS support/transportation, or require referral. II. Goals The purpose of the Pediatric Wards rotation for Emory Family Medicine residents is to build experience in the inpatient care of children of all ages, and supporting parents and/or caretakers during the process of their child’s hospitalization. The residents should become familiar with appropriate, relative and absolute indications for hospital admission, as well as parameters for safe and appropriate discharge from hospital care. Patient care/Medical knowledge Acquire the knowledge base and skills to provide inpatient care to infants, children and adolescents. Learn appropriate incorporation of health promotion and disease prevention into pediatric inpatient care. Understand the importance of educating the patient, parent and public about environmental factors that can adversely affect the physical and mental health, and normal development of children. Interpersonal Skills/Communication Skills Demonstrate the ability to communicate effectively with the patient, as well as the patient’s family and caregivers, to ensure that the diagnosis and the treatment plan are clearly understood. Develop skills in communicating findings, educating both patients and their families, discussing sensitive issues and negotiating a plan of action. Develop a therapeutic relationship with both the patient and parent/guardian. Practice-Based Learning and Improvement The encounter with the patient and the parents will trigger the graduates’ lifelong interest in maintaining and updating skills and knowledge as essential for delivering safe and high quality patient care. Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents must be proactive in obtaining the skills and knowledge needed to effectively treat childhood conditions. Systems Based Practice Recognize personal practice limitations and understand the role of other health care providers and resources in providing optimal care to the pediatric patient. Understand the role of various health care providers and disciplines in the transition of care from ambulatory to inpatient care and vice versa. An awareness of the unique vulnerabilities of infants and children that may require special attention, consultation, referral and/or reporting to child protective services. Professionalism, Bioethical Decision Making, Attitudes The resident should demonstrate attitudes that encompass: Empathic concern for the health of the child in the context of the family. A commitment to carrying out professional duties, in a responsible manner, and adhering to ethical principles in order to deliver optimal patient care at all times. III. Objectives Medical Knowledge/Patient Care Demonstrate the ability to take an age-appropriate history and perform a physical exam. Synthesize an appropriate diagnosis and treatment plan for common pediatric conditions. C. In the appropriate setting, by the end of the rotation and at time of graduation, the resident should be able to demonstrate the ability to apply the knowledge of: Routine, normal, neonatal issues, and management Normal growth and development Developmental disorders Fluid and electrolyte disorders Common neonatal problems, such as feeding, nutrition, hyperbilirubinemia and neonatal jaundice, hypoglycemia, neonatal sepsis, ALTE, recognition of the high risk neonate, and common neonatal rashes Abnormal or unhealthy family situations Other common infectious diseases, such as pneumonia, meningitis, sepsis, UTI'S, strep throat/tonsillitis/pharyngitis, mononucleosis Other disease of the respiratory system including croup, reactive airway disease, asthma, obstruction, foreign body aspiration, bronchiolitis, tuberculosis Diseases of the cardiovascular system, including the evaluation of heart murmurs, rheumatic fever, congenital heart disease, essential hypertension, SBE prophylaxis, and Kawasaki's Disease. Diseases of the hematologic system, including iron deficiency anemia, hemolytic anemia and hemolytic disease of the newborn, hemophilia, sickle cell anemia, lymphadenopathy evaluation, and myeloproliferative disorders. Diseases of the neurologic system including, febrile and idiopathic seizures, hydrocephalus, headache, head injuries, meningitis, attention deficit disorder, cerebral palsy, congenital neurologic disorders Common orthopedic problems including, arthritis and joint pains, hip pain evaluation, and osteomyelitis management. Common dermatologic problems including viral exanthems, manifestations of systemic conditions, skin infections and complications Common diseases of the genito-urinary system including hematuria, cystitis, pyelonephritis, congenital urinary deformities, sexual development and Tanner stages, hernia diagnosis, glomerulonephritis, and sexually transmitted diseases. Common gastrointestinal system problems including issues of feeding and nutrition -- breast, formula, and solid food, approach to abdominal pain, colic, pyloric stenosis, hepatitis, gastroenteritis, constipation, diarrhea, encopresis, parasitic disorders, Meckel's diverticulum, volvulus, and intussusception Common metabolic and endocrine disorders including diabetes mellitus, normal and abnormal growth, hyper/hypothyroidism, inborn errors of metabolism, and abnormal vaginal bleeding Common ophthalmologic problems including periorbital cellulitis and retinal hemorrhages Common pediatric psychiatric and behavioral issues, including normal age- specific behavioral development, childhood depression, teenage suicide, substance abuse, adolescent adjustment reactions, school problems Surgical pediatric problems, such as appendicitis, pyloric stenosis, testicular torsion, intussusceptions Pediatric emergencies, such as child abuse, poisoning, trauma, near drowning, anaphylaxis, burns, acute abdomen, airway obstruction, epiglottitis, cardiac arrhythmias, and respiratory and cardiac arrest Pediatric pharmacology. Age specific drug dosing, warnings, cautions, contraindications. D. The resident shall perform and gain competence in the procedures associated with the diagnosis and treatment of the above-mentioned conditions, including: Indication for and interpretation of xrays - chest, extremities, abdomen, skull, sinus, lateral neck, head CT and MRI Lumbar puncture and analysis of CSF Nasogastric tube placement Placement of CVP lines Endotracheal intubation Arterial puncture Analysis of ABG's Bladder catheterization Suprapubic catheterization Peripheral blood smear interpretation Preparation and administration of nebulization treatments for asthma Management of fluid resuscitation Appropriate ordering and interpretation of CBC, serum electrolytes and blood chemistries EKG interpretation Transillumination of the sinuses Transillumination of the scrotum Neonatal Resuscitation NPR, PBLS and PALS training and certification Basic life support
Interpersonal Skills/Communication Skills Demonstrate the ability to communicate effectively with the patient, as well as the patient’s family and caregivers, to ensure that the diagnosis and the treatment plan are clearly understood. Develop skills in communicating findings, educating both patients and their families, discussing sensitive issues and negotiating a plan of action. Develop a therapeutic relationship with both the patient and parent/guardian. Develop positive and functional relationships with colleagues as well as with other disciplines and support staff
Practice-Based Learning and Improvement A. Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents must be proactive in obtaining the skills and knowledge needed to effectively treat childhood conditions.
Systems Based Practice Recognize personal practice limitations and seek consultation with other health care providers and resources when necessary to provide optimal patient care. Understand the role of various health care providers and disciplines in the chain of care. Develop an awareness of social, cultural and environmental factors that impact the health and well-being of infants and children, and understand preventable and unpreventable factors which may contribute to childhood health problems. Develop and show understanding of the importance of continuity and access to care for prevention of illness. Facilitate smooth transition of care at time of patient discharge from hospital. Develop and show understanding of state laws, which affect the delivery of health care to minors. Communicate verbally and document within the patient’s record clearly and completely both to facilitate care and meet the documentation billing requirements of both Medicaid and private health insurance.
Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to: Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities. Arrive at the ward in time, in order to be able to perform and complete assigned duties Work effectively as a member of a team. Respect patient privacy by guarding medical records and discussion of personal information about patients. Demonstrate professional, respectful demeanor when addressing team members, patients, ancillary staff, and consultants. Appear professionally dressed and well groomed. Complete notes, referrals and other forms of communication and documentation in a timely fashion. Attend required didactics, conferences. Respond to pages and clinic messages in a timely fashion.
IV. Instructional strategies (see above)Resident will perform daily rounds on a panel of inpatients assigned to the resident. Resident will develop and document an assessment and plan for each of their patients. Daily rounding with pediatric ward attending. Residents will present their patients to the attending. Attendance of conferences, as scheduled by the rotation Readings as assigned by pediatric Ward attending Daily reading to deepen understanding of medical conditions of cases in resident’s patient panel. Monograph #369: Heart Conditions in Children; #333 Childhood Infectious Disease Update Reference resource: The Harriet Lane Handbook, the AAP’s Red Book V. Evaluation strategies (see templates above) Observation by Pediatric Ward Attending and upper level resident Chart review Mid-rotation evaluation by Pediatric Ward Attending End of rotation evaluation by Pediatric Ward Attending Resident evaluation of rotation and faculty Topic presentation during the last week of the rotation ITE profiles Completion of readings and >90% score on open book Monograph quizzes VI. Suggested Reading List E-books at the Emory Library, http://health.library.emory.edu/collections/etextbooks search titles as below, and search “pediatric” for additional resources
http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1 The Harriet Lane Handbook. http://health.library.emory.edu/search/apachesolr_search/harriet%20lane?filters=tid%3A3&retain-filters=1 Red Book http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1 AAFP monographs #333 Childhood Infectious Disease Update (2007) #362 GI conditions in children (2009) #369: Heart Conditions in Children (2010) #393 Respiratory issues in infants and children (2012)
Department of Pediatrics Grady Memorial Hospital 69 Jesse Hill Jr. Drive Atlanta, GA 30303 (404) 778-1440 Residency Program (404) 778-1450 Neonatology Business
Inpatient MD/AHP Epic Chart Review 101 Online Training 45 min self-paced online module
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To Log into Aspen Use the following Web address: https://aspen.choa.org Enter your user name and password. User Name: your user name is your first and last initials + last 4 of your social Password: your password is your first and last initials + last 4 of your social Note: you will be asked to change your password to something unique To Register for the Online Training Modules On the Aspen home page look for the heading Physician Training To find the Inpatient MD/AHP Epic.Chart Review 101 Online Training, click the Epic Chart Review link To find the Inpatient MD/AHP Epic.Documentation 101 Online Training, click the Epic Documentation Link *** Important Notes for taking the online training modules*** The online training modules contain audio. Please make sure your sound volume is turned on. Ensure that pop-up blockers are turned off. Please complete your training at least 2 business days before your rotation at Children’s to allow for processing. Minimum computer requirements: Intel Pentium III 600MHz processor or equivalent Microsoft Windows 2000, XP, or Vista 256MB of RAM (512 MB recommended) Screen Resolution of 1024 x 768 or above Broadband Internet connection (dialup is not recommended) Microsoft Internet Explorer 5 or above Adobe Flash Player 9 Sound Card and Speakers All Popup Blockers Must be disabled. This includes those built into IE7, Yahoo, and Google toolbars among others.
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If you cannot login to Aspen, please call Renita Murray at (404) 785-6418 to verify that you have been entered into the Children’s system. If you have difficulty completing the online training modules, please call the Solution Center at (404) 785-6767. Last updated March 7, 2013 Directory: documents documents -> Concept stage documents -> Concept stage documents -> The great global switch-off documents -> Nonprofit grant application documents -> The Truth about the Rwandan Genocide documents -> Annual InStructional unit plan documents -> Chaos equipment included Download 124.27 Kb. Share with your friends:
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