University of Babylon



Welcome to Pediatrics! . .

Abdulmahdi A. Hasan*

*Ph,D, pediatric & Mental Health Nursing ,College of Nursing, Babylon University

Before we get started . . .

What goals do you hope to accomplish during your pediatric clerkship?

What are some things that scare you

about pediatrics?

Orientation Overview

Clerkship Essential Information

Rationale

Expectations

Break!

Evaluation

Learning Activities

Break!

Clinical Topics

Development

Formulas

Writing Rx

IV Fluids

Community Sites

MCG Schedule and Tour

Meet with Chiefs

Why Pediatrics?

You have to!

You will use this knowledge and skill.

All physicians will take care of children at some time in their career!

This may be the only chance you have to learn pediatric medicine

It’s Different!

Growth & Development

Physical

Psychosocial

Prevention & Health Maintenance

Family & Community

Child Advocacy

Goals of Pediatric Clerkship

Acquisition of a basic knowledge of growth and development (physical, physiologic and

psychosocial) and of its clinical application from birth through adolescence.

Acquisition of the knowledge necessary for the diagnosis and initial management of

common acute and chronic illnesses.

An understanding of the approach of pediatricians to the health care of children and

adolescents.

An understanding of the influence of family, community and society on the child in

health and disease.

Goals of Pediatric Clerkship

Development of communication skills that will facilitate the clinical interaction with

children, adolescents and their families, ensuring that complete, accurate data is obtained.

Development of competency in the physical examination of infants, children, and

adolescents.

Development of clinical problem-solving skills

Development of strategies for health promotion as well as disease and injury prevention.

Development of the attitudes and professional behaviors appropriate for clinical practice.

What’s Expected of Me?

Attitudes

Empathy

Compassion

Understanding

What’s Expected of Me?

Attitudes

Empathy

Compassion

Understanding

Skills

Patients

Observation & Experience

What’s Expected of Me?

Attitudes

Empathy

Compassion

Understanding

Skills

Patients

Observation & Experience

Knowledge

Specific Objectives:

Other

What’s Expected of Me?

Reading

Curriculum

Patient-inspired reading

What’s Expected of Me?

Reading

Curriculum

Patient-inspired reading

Conferences

Conferences

All Augusta Students

Weekdays @ 12:15 (Usually Dugas, but check schedule!)

Grand Rounds - Friday @ 8:00

Morning Report: Mon – Thurs @ 8:00

Schedule: Ped5000 Web Page

What makes rounds “Grand”?

“Grand Rounds” is different than “Rounds”

Weekly conference attended by faculty, residents, students, and sometimes ancillary staff

Often a topic is presented by a specialist or a visiting professor

A continuing medical education opportunity

What is “Morning Report”?

Gathering of faculty, residents, and students on Mon.-Thurs. mornings

An intern or senior student presents a case

The chairman or faculty moderates discussion about differential diagnosis and brings out

teaching points

Students, residents, and faculty are expected to participate

Conferences

All Augusta Students

Weekdays @ 12:15 (Usually Dugas, but check schedule!)

Grand Rounds - Friday @ 8:00

Morning Report: Mon – Thurs @ 8:00

Schedule: Ped5000 Web Page

MCG Inpatient Rotation:

General Attending Rounds: Thurs. @ 2pm with General Attending on 4C

Chief Jeopardy: 2nd Mon. @ 3pm with Chief Resident

Off-Campus Sites:

CD’s of Lectures at sites

Lectures also on-line through Vista

(not compatible with Mac, so check out a laptop)

Grand Rounds available by Podcast



What’s Expected of Me?

Reading

Curriculum

Patient-inspired reading

Conferences

Rounds

What is a “Team”?

Group of medical staff all responsible for patient care

Often a hierarchy of responsibility:

Attending physician – in charge and ultimately responsible for decisions and outcomes,

teaches, mentors

Resident – usually 2nd or 3rd year – supervises, oversees other members of team, leads,

organizes, teaches

Intern – 1st year of training, responsible for direct patient care, may oversee the students

Senior Medical Students – acting interns; responsible for direct patient care

Junior Medical Students – direct patient care, knows details on their patients

Ancillary Staff – may include nurse practitioners, physician’s assistants, pharmacists,

nurses, respiratory therapists, dieticians, child life

What are “Rounds”?

Many patient care decisions are made during “rounds”.

A gathering of the “team” to discuss all patients under their care

“Sit Down Rounds” – located in a small conference room with formal teaching

“Walk Rounds” (“Bedside Rounds”) – walking from room to room with point of care

teaching

More about “Rounds”

JMS is expected to present their patients including assessment and plan

Intern may add additional information

Resident may elaborate on plan and teach

Attending has final say about assessment and plan, assesses knowledge, and teaches

What’s Expected of Me?

Reading

Curriculum

Patient-inspired reading

Conferences

Rounds

Internet

What’s Expected of Me?

Reading

Curriculum

Patient-inspired reading

Conferences

Rounds

Internet

“Entitlement”

Phase III - A Paradigm Shift

Phase III - A Paradigm Shift

The Ideal Pediatric Site

Ideal:

Inpatient Pediatrics

Newborn Nursery

Ambulatory Pediatrics

Desirable:

Subspecialty

Labor and Delivery

Overnight Call

Office Management

Where Am I Supposed to Be?

Six Week Community Sites

Able to provide all three ideal components

Albany, Columbus MC, Rome, Savannah, Tifton(2)

Two Week Inpatient Sites

General Pediatrics – Gen1, Gen2 (2 teams includes Endo, Rheum, ID, GI, AI)

Hospitalist -- Gen3 (complex Gen Peds, Surgical, Pulmonology)

Subspecialty- SS (Hem-Onc/Nephrology/Cardiology)

Four Week Ambulatory Sites

Where Am I Supposed to Be?

Four Week Community Sites

MCG

One week Nursery AM/Adolescent PM

Three weeks Clinic including some subspecialty

Community Sites

Longitudinal – nursery in early AM, then clinic

Aiken, Athens, Brunswick (2), Calhoun, Dalton, Fayetteville, Ft. Benning, Ft. Stewart,

Jasper, Kennesaw, Marietta (2), Nesbit, Phenix City, Toccoa, Valdosta (2), West Cobb,

Wrens

Augusta Pediatric Associates (APA)

Two weeks at MCG (NBN, Cardiology)

Two weeks APA for general clinic

What’s Expected of Me?

Attitudes

Enthusiastic

Inquisitive

Teachable

Challenge those who teach you

Performance

Clinical Performance Guidelines (Internet)





Oral Presentations . . . . .

Outpatient Case Presentations

Starting the Presentation: identifying information and chief complaint.

History of Present Illness: Should take no more than half of total time

Organized: logically and chronologically:

Positive and negative symptoms associated with the illness.

Provide any treatment measures used by the family (including non-prescription

treatments)

Other information:

Briefly summarize any other major ongoing medical problems

Briefly summarize medications and allergies.

Outpatient Case Presentations (cont)

Physical examination:

A brief “word picture” of the patient’s appearance is extremely helpful

Include pertinent positive findings and relevant negative findings.

Vital signs should be mentioned if they are pertinent.

Growth parameters (expressed as percentiles on the growth curve) are important in

infants and children presenting for check-ups.

Let your preceptor know if there is a part of the physical exam that you would like help

with.

Finishing the presentation:

Your assessment of the patient (what do you think is going on?)

Your plan (what you would like to do).

Be prepared to support your assessment and plan.

Length of Presentation: 2 minutes or less!

Documentation

Medical Record is a legal document

Document accurately and carefully

Appropriate vs. Not appropriate

Discuss assessment and plan before documenting OR change note after discussion!

SOAP Note

Subjective (history)

Objective (physical exam)

Assessment (diagnosis)

Plan (consults, IV fluids, medications, d/c, etc.)

Stretch Break!

How Will I be Evaluated?

Objective (Exams): 40%

Subjective (Clinical): 55%

Professionalism: 5%

Departmental Exam (15%)

Format:

32 MCQs (2 points each = 64 points)

2 Essays (10 points each = 20 points)

Rx/medication order (5 points)

IV Fluid Order (5 points)

Growth Chart (6 points)

Time:

Fourth Friday 9:30AM

1 hour and 45 minutes

Location: Done by computer

Vista

Administered at clinical sites, not in Augusta (except for Augusta/Aiken students

Departmental Exam grades will be posted on Vista

Clinical Teaching Cases

20 Clinical cases at the end of the curriculum

Common scenarios

Keyed to clerkship goals & objectives

Two of these cases will be part of the Departmental Examination, counting for 20% of

the test score

NBME Pediatric Shelf Exam (25%)

Sixth Friday at 8:30 AM

Scoring based upon NBME percentile ranks by quarter

Minimum passing is 5th percentile

Must pass the Shelf to pass the clerkship!

Minimum score for an A is 70th percentile

See Web Page for specifics

How Will I be Evaluated?

Objective: 40%

Departmental Examination (15%)

NBME Pediatric Specialty Exam (25%)

Subjective: 55%

Based upon performance evaluations throughout the rotation

Must achieve an average score of 70% or higher from combination of these evaluations to

pass the rotation.

Meeting Expectations should be 85%

Pediatrics has high expectations

Tips for Performing Well Clinically

DO:

Make life easier for your team – be helpful

Show enthusiasm

Make yourself available

Demonstrate your knowledge

Ask for and respond to feedback

Pick up new patients

DON’T:

Disappear

Say negative things about other physicians

Avoid picking up patients

Pretend you know an answer when you don’t

Study so much that patient care suffers

MCG Feedback Cards

The Problem:

Many students

Many preceptors

Many different clinics

The Solution:

Feedback Cards

MCG Feedback Cards

The Problem:

Many students

Many preceptors

Many different clinics

The Solution:

Feedback Cards

Procedure:

Student gives a card to the preceptor (staff or resident) who precepted him/her the most

for that particular clinic session

Preceptor fills out the card and places it in box

Additional cards are available if an unselected preceptor feels it is needed

Clinic evaluation is based on the cumulative weight of all the evaluation cards

Clinical Performance Grading Scale:

Clinical Performance – 55%

MCG Inpatient (20%):

All evals count equally including resident

MCG Nursery/Ambulatory (35%):

5% Nursery

30% Clinic (Feedback Cards)

Four Week Community Sites (35%):

All evaluations count equally

Augusta Pediatric Associates – APA (35%):

5% MCG Nursery/Adolescent

5% Cardiology

25% APA Evaluation

Clinical Performance – 55%

Six Week Community Sites:

All evaluations count equally

Some sites have a Head Evaluator who gets input from all the others

If you work primarily with 1-2 attendings, it is helpful to let me know

How Will I be Evaluated?

Objective: 40%

Departmental Examination (15%)

NBME Pediatric Specialty Exam (25%)

Subjective: 55%

Professionalism: 5%

Professionalism – 5%

25 points – Complete all Assigned CLIPP Cases

2 points each + 1 point if all done

Vista

CLIPP

Computer-Assisted Learning in Pediatrics Project

31 Interactive clinical cases covering the core content of the Ped5000 Curriculum

Web-Based

Requires each student to register (using Groupwise email address) to get login &

password

Helps ensure all students will have similar exposure to case content selected by the

clerkship director

CLIPP Registration Menu

CLIPP Cases: Menu (partial view)

Example of a CLIPP Case

CLIPP

Student usage of CLIPP will be available to Dr. Leggio for each individual student (such

as which cases each student performed and how long he/she spent on each case). You

will not get credit for doing only a few minutes or a few cards. Needs to be clear that you

did the case!

You are assigned 12 Cases. Recommend doing 3 per week. Assignments on PED 5000

website under Study Aids.

The Multiple Choice Questions on the Departmental Exam will come from standardized,

validated CLIPP Final Exam Questions based on the assigned cases

CLIPP Case Assignments

How Will I be Evaluated?

25 points – Complete all Assigned CLIPP Cases

2 points each + 1 point if all done

30 points – Mid-Rotation Feedback Form

Mid-Rotation Feedback

The student is responsible for :

Printing the form

Giving it to their attending physician

Completing and reviewing it together

Returning it to the clerkship coordinator (fax ATTN: Janis Richardson 706-721-3295)

Must be completed by:

Six Week Sites: end of 4th week

MCG: end of first week of inpatient

Mid-Rotation Feedback Form

Mid-Rotation Feedback Form

How Will I be Evaluated?

25 points – Complete all Assigned CLIPP Cases

2 points each + 1 point if all done

30 points – Mid-Rotation Feedback Form

30 points – SPEL

15 points mid-rotation; 15 points end (minimum 30 patients)

Student Patient Encounter Log

LCME requires MCG to track each student’s clinical experiences

MCG Solution: One45

Web-Based system

Patient encounters should include basic demographic information, 1 or 2 major

diagnoses, and any procedures performed

Maximum of 10 patients per day

Passport: Very Important for tracking procedures & competencies

Patient Tracking Log & Passport

Way for you to track your cases

YOU MUST ENTER DATA INTO ONE45 IN ORDER FOR IT TO COUNT!!!

Students are expected to log patients at least weekly. Less than 30 patients in 6 weeks

will be considered not meeting the requirement unless notified early in rotation about

inadequate numbers of patients.

Clerkship Director will be reviewing logs mid-rotation and making recommendations.

SPEL Required Diagnoses for PED 5000

SPEL Required Diagnoses for PED 5000

SPEL Required Diagnoses for PED 5000

SPEL Required Diagnoses for PED 5000

14 Domains of Patient Types or Core Conditions

20 different patients must be seen:

Health Maintenance (5)

Growth (1)

Nutrition (1) Development (1)

Behavior (1) Upper Resp Tract (2)

Lower Resp Tract (2) GI/GU (1)

Derm/Heme (1)

CNS (1)

Emergent condition (1)

Chronic condition (1)

Fever (1)

Jaundice (1)

One45 Webeval

This is the login screen on One45 to access your personal eDossier.

You can access via emails from evaluation services and at:

webeval/georgia/public/

How Will I be Evaluated?

25 points – Complete all Assigned CLIPP Cases

2 points each + 1 point if all done

30 points – Mid-Rotation Feedback Form

30 points – SPEL

15 points mid-rotation; 15 points end (minimum 30 patients)

5 points – Timeliness

Points deducted for >5 minutes late for exams, or chronic tardiness to conferences,

rounds, etc.

How Will I be Evaluated?

25 points – Complete all Assigned CLIPP Cases

2 points each + 1 point if all done

30 points – Mid-Rotation Feedback Form

30 points – SPEL

15 points mid-rotation; 15 points end (minimum 30 patients)

5 points – Timeliness

Points deducted for >5 minutes late for exams, or chronic tardiness to conferences,

rounds, etc.

10 points – Communication

E-mails from community sites, e-mails when absent, etc.

How Will I be Evaluated?

Objective: 40%

Departmental Examination (15%)

NBME Pediatric Specialty Exam (25%)

5th percentile nationally to pass

70th percentile nationally for an A

Subjective: 55%

Based upon performance evaluations throughout the rotation

Must achieve an average score of 70% or higher from combination of these evaluations to

pass the rotation.

Professionalism: 5%

Must have score of 70% or higher to pass the rotation.

How Will I be Evaluated?

Grading Policy:

Policy & Evaluation Forms – Posted on the

Students who average ................
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