OM 7070

Course No.: Credit Hours: Term - Dates:

Faculty Guidebook for Pediatric Core Rotation OM7070 Course Title: Pediatrics 4 weeks, 10 credit hours Chair: Lisa Warren, D.O. for each rotation Variable in OMS III Level: OMS III academic year

Educational Goal Introduction: The pediatric clerkship experience introduces the student to a unique, complex and challenging field of medicine. It emphasizes those aspects of general pediatrics important for all medical students and provides a foundation for those students who elect to further study the health care of infants, children, and adolescents. Description: The pediatric rotation addresses issues unique to childhood and adolescents by focusing on human developmental biology, and emphasizes the impact of family, community and society on child health and well being. Additionally, the clerkship focuses on the impact of disease and its treatment on the developing human, and emphasizes growth and development, principles of health supervision and recognition of common health problems. Goals: The goals of the rotation are to foster: 1. Acquisition of basic knowledge of growth and development (physical, physiologic and psychosocial) and of its clinical application from birth through adolescence. 2. Development of communication skills that will facilitate the clinical interaction with children, adolescents and their families and thus ensure that complete, accurate data are obtained. 3. Development of competency in the physical examination of infants, children, and adolescents. 4. Acquisition of knowledge necessary for the diagnosis and initial management of common acute and chronic illnesses. 5. Development of clinical problem-solving skills. 6. An understanding of the influence of family, community and society on the child in health and disease. 7. Development of strategies for health promotion as well as disease and injury prevention. 8. An understanding of the approach of pediatricians to the health care of children and adolescents. 1

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Rotation Faculty Lisa Warren, D.O., Chair, Pediatrics lwarren@westernu.edu OAA Administrative Support: Marisa Orser, B.S., Manager of Rotations Department (909) 469-5253 Desiree Croucher, Lead Rotations Coordinator Hina Ahmed, Rotations Coordinator Kassidy Conlee, Rotations Coordinator compsite@westernu.edu

Core Pediatric Clerkship Learning Objectives At the end of the rotation, the student should: 1. Evaluate patients from infancy through adolescence in a variety of clinical settings, establishing rapport with the patient and family in order to obtain a complete history and physical examination. 2. Recognize the important role of observations as a method of obtaining data in the assessment of a child. 3. Perform complete physical examinations on an infant, child, and adolescent, including the documentation of normal findings. 4. Use developmental assessment as part of the physical examination for all ages. 5. Identify the physical changes during puberty and be able to conduct Tanner staging. 6. Observe physical findings unique to the pediatric age group, and understand how findings have different clinical significance depending on the age of the child. 7. Prepare a complete written summary of the history and physical and orally present the case in a focused and chronological manner. 8. Develop a complete problem list and a differential diagnosis for each problem; combine problems where appropriate to develop a differential diagnosis for the patients unique combination of symptoms. 9. Formulate an initial diagnostic and therapeutic plan, considering the cost, risk, benefits, and limitations of laboratory tests, imaging studies, medications, consultations, hospitalization and more conservative measures such as observation. 10. Use the pediatric literature to research the diagnosis and management of clinical problems. 11. Interpret the results of commonly ordered laboratory tests, such as the CBC, urinalysis and serum electrolytes and recognize that the normal values of some test may vary with the age of the patient. 12. Effectively communicate information about the diagnosis and treatment to the patient and caregiver.

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Texts and Media Pediatric Required Text: First Exposure Pediatrics by Joseph Gigante, Mc Graw Hill Optional Texts: The following text and handbooks are highly recommended, especially if you have an interest in pediatric medicine. They are also excellent reference texts. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. The Harriet Lane Handbook, 17th edition, Mosby Behrman et al: Nelson Textbook of Pediatrics (16th edition); Oski et al: Principles and Practice of Pediatrics (2nd edition); Lippincott Rudolphs: Pediatrics (20th edition); Appleton and Lange Zitelli/Davis: Atlas of Pediatric Physical Diagnosis Mosby-Wolfe Volpe: Neurology of the Newborn (3rd edition); Saunders Schwartz et al: Pediatric Primary Care, A Problem Oriented Approach ( 3rd edition); Mosby Seidel: Primary Care of the Newborn ( 2nd edition); John Hopkins Center; Mosby Manuel of Pediatric Therapeutics (6th edition): A Little Brown Spiral Manual; Lippincott-Raven Levin et al: Essentials of Pediatric Intensive Care (2nd edition); Blumer: A Practical Guide to Pediatric Intensive Care (3rd edition); Mosby Hurwitz: Clinical Pediatric Dermatology (2nd edition); Saunders Feigin/Cherry: Textbook of Pediatric Infectious Disease (3rd Edition), Saunders Algranati, Paula: The Pediatric Patient

NOTE: Individual preceptors may include other resources. Rotation Format, Evaluation, Grading, and Student Feedback Refer to the Clinical Education Manual. Involvement/Duties: The preceptor or institution is responsible for determining the degree of student involvement during the rotation. This includes access to the facility and areas within the facility, clinical access to patients, access to and contribution to the medical record, and observation and participation in procedures. If a licensed physician is not on the physical premises, a student is not to conduct patient care of any kind. Suggested daily schedule for inpatient rotation: Early morning: Student pre-rounds on 3-4 patients Reviews overnight events Writes progress note Updates labs, imaging, microbiology Student reports to intern or resident if appropriate Rounds: Student presents patients he/she pre-rounded on Presentation should be logical, clear, and concise and include assessment and plan Student answers questions and demonstrates reading on relevant topics Student participates in discussion of all patients 3

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Post rounds: Call:

Student attends any scheduled didactics Student assists attending physician or resident physician with daily duties and patient follow up Student participates in new patient admissions Student independently studies on relevant topics of the day and prepares for prerounding Student participates in outpatient clinic if appropriate Student participates in all call duties including overnight or weekend call with attending physician or house staff. The student should not take call more than every 4th night.

Suggested daily schedule for Outpatient rotation: Student arrives before clinic and reviews the schedule for the day Student asks which patients are most appropriate to see Student sees patient number 1 Student writes note on patient number 1 while attending sees patient number 2-3. Student presents patient number 1 Preceptor provides 1 minute feedback on presentation, assessment and plan Preceptor and student see patient number 1 Repeat process for next group of patient After Clinic: Preceptor assigns topics for the student to review Student attends any scheduled didactics Student assists attending physician or resident physician with daily duties and patient follow up Student independently studies on relevant topics of the day and prepares brief presentations (3-5 minutes) on assigned readings

Expectations During the rotation, the student is expected to do the following: Care for patients in an ambulatory and inpatient setting. See patients daily and write progress or clinic notes. Attend all scheduled conferences, morning reports or lectures. Develop clinical problem solving skills. Perform a literature search and critical review of the literature. Demonstrate intellectual curiosity, initiative, responsibility, and reliability. Complete all online CLIPP cases as assigned. Grading The student may be evaluated on their performance in the following areas:

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Newborn Nursery Newborn Resuscitation Newborn Exam Inpatient Service Admission History and Physical Daily Progress Notes Discharge Plan Ambulatory Clinic Well infant and child exam Sick visit care Adolescent health physical Clinical Equipment: A pediatric head for their stethoscope Calculator An insufflator bulb (optional) Pediatric Clerkship Areas of Competency: The student on pediatric rotation should be familiar with all areas of pediatric medicine. It is the students responsibility to learn about all the following pediatric areas and complete the reading assignments. Following is an outline of clinical topics: Medical Record: Documentation of admission history and physical exam Progress Note Procedure Note Medical Knowledge: Development of differential diagnosis Procedural Skills: Complete adult physical exam Presentation of patient on rounds Clinically-Related Experiences: Presentation Each student should make a 30-minute presentation on any general pediatric subject. The subject material can be assigned by the attending or can be presented as a case study from a patient discussed in clinic or inpatient service. Health Supervision Anticipatory Guidance Normal Vital Signs for Age Injury Prevention 5

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Immunizations Screening Tests, i.e., Vision Hearing, etc. Safety Substance Abuse

Growth and Development Cerebral Palsy Denver Developmental Screening Developmental Milestones Growth Charts Macro and Microcephaly Mental Retardation Short Stature Behavior Attention Deficit Disorder Depression Eating Disorders Encopresis Enuresis Temper Tantrums Toilet Training Sleep Problems Nutrition Breast Feeding Constipation Dental Caries Failure to Thrive Formula Feeding Infant, Child, and Teen Dietary Requirements Nutritional Anemia Obesity Vitamin and Fluoride Supplementation Issues Unique to Adolescence Acne Breast Problems High Risk Behavior Menstrual Problems Sexually Transmitted Diseases Sports Medicine Suicide

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Issues Unique to Newborns APGAR Congenital Malformations/ Medical Genetics Colic Cyanosis Developmental Dysplasia of the Hip Diaper Rashes Dubowitz Evaluation Fetal Alcohol Syndrome Gastroesophageal Reflux Infections of the Newborn Inborn Errors of Metabolism Newborn Care and Exam Pyloric Stenosis Respiratory Distress in the Newborn Common Pediatric Illnesses Acute Gastroenteritis Asthma Bronchiolitis Cellulitis Conjunctivitis Croup Cystic Fibrosis Dermatitis Fever Glomerulonephritis Headache Henoch-Scholen Purpura Hematuria Hemolytic Uremic Syndrome Hepatitis Insulin Dependent Diabetes Mellitus Kawasaki Syndrome Lead Poisoning Limping Child Meningitis Nephrotic Syndrome Otitis Media and Externa Pneumonia Rheumatic Fever Seizures Sinusitis Strabismus Urinary Tract Infection 7

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Viral Exanthems

Fluid and Electrolyte Management Daily Fluid and Electrolyte Requirements Dehydration Fluid Replacement Sodium Abnormalities Pediatric Emergencies Acute Abdomen Airway Obstruction Apparent Life Threatening Event (ALTE) Bites Burns Diabetic Ketoacidosis Fractures Head Injury Near Drowning Poisonings/Ingestions Reye Syndrome Sudden Infant Death Syndrome (SIDS) Testicular Torsion Child Abuse and Neglect Child Advocacy Munchausen by Proxy Neglect Physical and Sexual Abuse Shaken Baby Syndrome