Pediatrics (Inpatient)

Overview:

The pediatrics curriculum of Memorial Hospital's Family Medicine Residency consists of at least four months of structured experience in general inpatient pediatrics including care of infants, children, and adolescents in the intensive care unit. Other components of the overall pediatrics experience include care of newborns in the general nursery and in the intensive care nursery, care of well-infants and children in the ambulatory setting, and care of adolescents in the ambulatory setting and in high school training rooms and during athletic competitions. (Separate curriculum guides are available for the NICU, Outpatient Pediatrics, and Sports Medicine rotations.) Three or four residents are assigned to the inpatient pediatrics rotation at all times.

 

Goal:

The inpatient pediatrics experience shall provide the family medicine resident with the clinical skills and knowledge to care for pediatric patients in the hospital setting.

 

Objectives:

While caring for patients in the hospital, the resident:

 

PGY-1

• is able to perform a complete and accurate history and physical exam. (PC)
• can present an appropriate and broad differential diagnosis for patients admitted to the hospital. (MK)
• demonstrates effective communication with patients and families. (ICS)

PGY-2

• is able to efficiently perform a focused history and physical exam on a patient with a specific complaint. (PC)
• is able to recognize and manage less frequently encountered pediatric problems (MK)
• demonstrates an effective therapeutic relationship with patients. (ICS)
• analyzes current pediatric literature related to patient care and is able to convey this information to peers and attendings. (PBLI)

 

PGY-3

• is able to analyze current medical literature as it relates to a specific patient and present this information to less experienced residents in a manner that is relevant to patient care. (PBLI)
• manages the flow of information between patients, families, and other medical team members in a manner that optimizes patient care. (ICS)
• recognizes the necessity of appropriate consultation and involves specialists in the care of patients effectively. (SBP)
• is able to demonstrate proficiency in the care of pediatric patients at the level of an independent practitioner. (PC)

Implementation:

 

  Educational Methods:

   PALS Course -Pediatric Advanced Life Support-all PGY-1 residents

•  Didactic sessions, interactive sessions, and hand-on training sessions. Approximately 14 hours in length. PALS provider card upon successful completion of written/skills examination.

Patient Care

•  The Pediatrics rotation is staffed by board certified family physicians and board certified pediatricians. It is the responsibility of these physicians to attend rounds, teach resident physicians, and to provide supervision of resident care as the attending for patients admitted to Memorial Hospital who do not have a private physician with privileges at Memorial and for non-critical patients transferred to Memorial Hospital from an outside hospital. The resident physicians also assist in the care of patients of private attendings who are usually pediatric hospitalists, general pediatricians or family physicians who have privileges at Memorial Hospital. The private attendings provide supervision for resident care of these patients . Residents care for patients in the pediatric intensive care unit under the supervision of these attending physicians and pediatric intensivists.

Pediatrics Case Conferences

•  Residents are required to present pediatric cases at the regularly scheduled pediatric case conference. See noon conference curriculum for details.

 

Procedures

•  There are no specific procedural requirements for this rotation. However, there is a separate Procedures Curriculum and residents may gain experience meeting these requirements during this rotation. Procedures typically performed by residents on this rotation include (PC): lumbar puncture, circumcision.

 

Resident Responsibilities:

 At the beginning of every block, the new team of pediatrics residents assumes care of any patients cared for by the previous team. While the resident is on-call, he/she will interview and examine any new patients admitted by the emergency department, directly admitted from a physician's office, or transferred from another institution. The interview may include talking with the patient, the patient's caregivers, or any other source, such as EMTs, with knowledge of the patient's situation. The resident then performs a complete physical examination with special emphasis on the organ systems most involved in the patient's pathology. The resident then discusses the case with the appropriate attending and determines what orders need to be written, including intravenous access, laboratory requests, radiologic or other testing, the calling of consultant assistance, and in cases where needed, the involvement of child protective services. The resident will present each patient's case at rounds the next morning and further ideas on the care of the patient will be offered by members of the team including the staff attendings who may, or may not, be the attending physician for that particular patient. Direct supervision of patient care is provided by the attending physician for each patient admitted. The resident is responsible for writing a progress note on each patient under the resident's care every day. As the patient's condition improves, the resident will prepare for disposition, which is usually to return home with parents, but in some cases may require the transfer for tertiary care at another institution or the discharge to a foster home. The resident is responsible for dictating or writing a discharge summary that accurately and succinctly describes the patient's presentation, hospital course, diagnoses, and disposition. Residents are expected to search the literature as they care for patients and prepare for their noon conference presentations. They are also expected to read the notebook provided that contains articles on the most common inpatient pediatric conditions.

 

Resources: 

Notebook of articles on most common inpatient pediatric conditions

“Up-to-Date”

Memorial Hospital Medical Library

 

Methods of Evaluation:

•  Staff attendings complete a form at the end of every block evaluating resident's performance during that rotation including level of training specific questions.

•  The knowledge base of each resident will be reviewed on the basis of the resident's performance on the annual family medicine in-training examination.

•  Each case presentation is evaluated for clarity, appropriateness of history and physical, differential diagnosis, literature review, ethical issues, and patient outcome.

 

Attachments:

• Rotation Evaluation Form

PGY1 Pediatric Evaluation Questions

  

Is the resident able to perform a complete and accurate general history and physical exam?

YES     NO

 

Can the resident present an appropriate and broad differential diagnosis for patients admitted to the hospital?

YES     NO

 

Does the resident accurately share medical information with patients and families and assess the patient's comprehension of the information? 

YES     NO 

 

PGY-2 Pediatric Evaluation

 

Does the resident demonstrate appropriate medical judgment to prioritize and efficiently perform a relevant and focused history and physical exam on a patient with a specific complaint?

YES     NO

 

Is the resident able to recognize and manage frequently encountered pediatric problems with minimal supervision?
YES     NO

 

Does the resident incorporate diverse sources of information into effective communication and relationship building with patients?

YES     NO

 

Can the resident analyze current medical literature related to patient care and convey this information to peers and attendings?

YES     NO

  

PGY 3 Evaluation questions

 

Is the resident able to analyze current medical literature as it relates to a specific patient and present this information to less experienced residents in a manner that is relevant to patient care?

YES     NO

  

Is the resident able to manage the flow of information between patients, families, and other medical team members in a manner that optimizes patient care?

YES     NO

 

Does the resident recognize the necessity of appropriate consultation and involve specialists in the care of patients effectively?

YES     NO

 

Does the resident demonstrate proficiency in the care of pediatric patients at the level of an independent practitioner?

YES     NO