جامعة بابل | 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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