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Pediatric Junior Clerkship 2008-2009

ALL JUNIOR STUDENTS PARTICIPATING IN THE PEDIATRIC JUNIOR CLERKSHIP ARE RESPONSIBLE FOR READING AND UNDERSTANDING ALL INFORMATION ON THIS WEBSITE!!

The Junior Pediatric Clerkship is an 8 week experience consisting of the following:

2 weeks of Ambulatory Pediatrics

2 weeks of newborn nursery/subspecialty clinics

4 weeks of inpatient wards

This course must be completed in 8 contiguous weeks that correspond with the Medical School's calendar for the junior class.

Students are divided into two groups: one group does the inpatient (ward) portion of the clerkship, while the other group works in a general pediatrics ambulatory care clinic, subspecialty clinics and newborn nursery for 4 weeks. At the end of 4 weeks, groups switch assignments.

During your rotation on Ambulatory Pediatrics/Nursery, you will be subdivided into 2 groups.  For two weeks, one group will be assigned to the General Pediatric Clinic Service and the other group to the Nursery/Subspecialty Service.  After two weeks, the two groups will switch assignments.

The Pediatric Clerkship will provide experience to the student in a unique, complex, and challenging field of medicine. It will focus on issues unique to the newborns, infants, children, and adolescents in the inpatient and ambulatory settings. The clerkship will expose the student to numerous disease entities in the pediatric and adolescent patient and subsequently to their treatment options.

CORE CURRICULUM*

* Adapted from the curriculum developed by the national organization, Council on Medical Student Education in Pediatrics (COMSEP).

The clerkship will emphasize the importance of several basic core skills or principles such as growth and development, the principles of health supervision, the recognition of common health problems, and the role of the pediatrician in preventive care. It will stress the importance of collaboration between the pediatrician and other health professionals.

The clerkship will emphasize those aspects of general pediatrics important for all medical students and will provide a basic foundation for those students who elect to further study the health care of infants, children, and adolescents.

During the clerkship, students will have the opportunity to participate in the clinical activities of both the general and certain subspecialty pediatric services. The emphasis, however, in all services is placed on basic issues and common illnesses. The subspecialists will have the opportunity to emphasize aspects of their particular area of expertise that are important for the education of the general physician.

As one of the core clerkships of medical school, the Department of Pediatrics shares the common responsibility to teach the knowledge, skills, and attitudes basic to the development of a competent general physician.

GOALS

  1. Provide a suitable environment for students to learn about the care of infants, children, and adolescents.

  2. Enable students the opportunity to interview, examine, and communicate with patients and their caregivers on a daily basis.

  3. Provide the students with the basic core knowledge and skills necessary to treat common pediatric illnesses.

  4. Allow students the opportunity to observe and understand the role of the pediatrician in the coordination of medical and psychosocial care of patients.

  5. Foster camaraderie with other health care professionals and approach the care of children as a team effort.

  6. Provide students with effective role models to attain the professional attitude and conduct appropriate for all physicians.

OBJECTIVES

At the completion of the Junior Pediatric Clerkship, all students should be able to:

  1. Perform a comprehensive history and age-appropriate physical examination on an infant, child, and adolescent patient.

  2. Recognize and document pertinent positive and negative historical and physical exam findings accurately and concisely in the written medical record.

  3. Organize and communicate orally a patient’s medical history in a concise and logical manner.

  4. Accurately interpret laboratory, diagnostic, and imaging studies.

  5. Develop a differential diagnosis and formulate a management plan for common childhood illnesses.

  6. Recognize a seriously ill infant, child, or adolescent.

  7. Communicate diagnosis, procedures, and treatment plan for a given patient.

  8. Recognize the special psychosocial needs of patients and their caregivers.

  9. Recognize the signs and symptoms of child abuse.

  10. Assess normal growth and development from infancy to adolescence.

  11. Describe the indications and performance of common pediatric procedures.

  12. Utilize educational resources such as textbooks, journal articles, and computer web sites to further increase your fundamental pediatric knowledge and to find updated information.

  13. Exhibit professional attitudes and behavior.

 

BASIC CORE KNOWLEDGE FOR THE PEDIATRIC CLERKSHIP

  Core lecture series or self-study exercises:

A.  Ambulatory

*1.  Approach to the Pediatric Patient (Dr. Barajaz)

2.  Asthma/Pediatric respiratory diseases

3.  Child abuse issues

*4.  Immunization Update (Dr. Cedotal) 

5.  Interviewing Skills         

6.  Otitis media

*7.  Safety Prevention and Anticipatory guidance (Dr. Horton)          

 B.  Adolescent

*1.  The adolescent interview/issues (Dr. Davis)

  C.   Cardiology

*1.  ECG interpretations (Dr. Kiel or Dr. Wu)

*2.  Harvey - Ward Team Only! (Dr. Kiel or Dr. Wu)

D.  Endocrinology

*1.  Fluid and Electrolytes (Dr. Broussard)

2.  Diabetes

E.   Allergy and Immunology

*1.  Development of Allergy in Infants (Dr. Bahna) 

F.   Infectious Disease

1. Community-acquired pneumonias

2.  Pharyngitis / sinusitis / croup

*3.  Exanthems (Dr. Bocchini)

G.   Hematology/Oncologv

*1.  Anemia (Dr. Jeroudi)

H.   Growth / Development

*1.  Nutrition (Wendi Miller)

*2.  Development Examination (Ms. Julian)

I.   Pharmacology

*1.  Pediatric Medications ( Dr. Barajaz)

J.  Newborn

*1.  Breastfeeding (Dr. D. Bienvenu)

 

*These lectures will be held in Room 5-333.  The rest of the topics will be covered in Case Files cases, supplemental reading assignments or clinical experiences.


Proficiency in Core Knowledge

Students will be expected to achieve proficiency in the following core knowledge areas.

 A.  Otitis Media:  Differentiate between the following:

1.  Normal ear

2.  Acute otitis media

3.  Otitis media with effusion

B.  Adolescent’s HEEADSSS interview

C.  Immunizations

1.  Schedule         

2.  Counseling of patients and/or caregivers

 

Evaluation of Core Knowledge

1.  Assess core knowledge, at end of 8 week rotation, with the National Board of Medical Examiners subject examination in Pediatrics.

2.  Direct patient contact with direct preceptor instruction, supervision, evaluation, and feedback of students on a case-by-case basis.

3.  Randomly and frequently evaluate the progress of each student’s performance using My Evaluations.

4.  SCAG evaluation of each medical student by the adolescent patient who participated in the HEEADSSS exam.  (SCAG = structured communication adolescent guide)

5.  Direct observation of students performing a newborn exam in the Nursery, direct observation in the ambulatory care clinic (PACC/ACCESS), and direct observation on the Pediatric ward.

6.  Supervision, instruction, and evaluation by upper level residents.

 

BASIC CORE SKILLS FOR THE PEDIATRIC CLERKSHIP

Numerous skills are taught during the pediatric clerkship. However, there are certain basic core skills that the Department of Pediatric considers to be fundamental. Aspects of these skills that are unique to pediatrics are identified in the curriculum. All students will be expected to develop a specific level of competence in these skills at completion of the clerkship. The development of competent clinical skills requires both practice and supervision with feedback.

Skills

All students will be expected to achieve proficiency at completion of the clerkship in the following core skills:

1.  Interview and communication skills

a.  Demonstrate effective interviewing skills with patients and/or parents and other caregivers in the ambulatory care clinic, the ER, the Pediatric ward and the newborn nursery.

b.  Demonstrate effective oral communication with patients and/or parents and other caregivers in the ambulatory care clinic, the ER, the Pediatric ward and the newborn nursery.

c.  Demonstrate effective oral communication with other health professionals.

d.  Demonstrate proficiency in the written documentation of medical information.

2.  Age- Appropriate Physical Examination in any setting

a.  Perform an age-appropriate physical examination on an infant, child, and/or adolescent.

b.  Perform a complete HEENT examination on an infant, child, and/or adolescent with specific emphasis on the ear exam using pneumatic otoscopy. All students should be able to identify a normal ear, otitis media with effusion and acute suppurative otitis media.

c.  Perform a complete cardiac and respiratory examination.

·  Demonstrate the correct method of measurement of respiratory rate (RR), heart rate (HR), and blood pressure (BP) on an infant, child, and/or adolescent.

·  Recognize that RR, HR, and BP measurements are age-related.

3.  Clinical Problem Solving

a.  Develop a differential diagnosis and plan of management for common childhood illnesses.

b.  Interpret the results of commonly ordered laboratory tests, such as the CBC, urinalysis, serum electrolytes, and recognize that the normal values of some tests may vary with the age of the patients.

c.  Use the pediatric literature to research the diagnosis and management of clinical problems.

4.  Newborn Examination

a.  Perform a complete newborn examination to include examination of the eyes for the red reflex, hip exam, and neurological exam to include the eliciting of primitive reflexes.

5.  Growth Parameters and Developmental Assessment

a.  Understand how to accurately measure the height, weight, and head circumference on an infant, child, and/or adolescent.

b.  Plot out accurately the growth parameters on the appropriate growth curve.

c.  Calculate the BMI on all patients > 2 yrs of age

d.  Perform a screening developmental assessment on an infant, child, and adolescent.

6.  Common Pediatric Illnesses

a.  Manage appropriately all patients that are seen by the student.

b.  Manage a child with an abnormal ear exam.  Demonstrate the ability to diagnose and treat:

      ·Acute suppurative otitis media

      ·Otitis media with effusion

7.  Procedures

a.  Demonstrate an understanding for the indications and the basics of performing pediatric procedures such as lumbar puncture, suprapubic aspiration, venipuncture, IV placement, throat culture, and urethral catheterization.

8.  Preventive Care

a.  Demonstrate an understanding of the importance of preventive care, anticipatory guidance, and especially the importance of immunization practices in infancy, childhood, and adolescence.

b.  Counsel parents regarding preventive care (childhood immunization, childhood safety, and poisoning, etc.)

c.  Counsel adolescents on preventive issues concerning pregnancy, sexually transmitted diseases, and immunizations.

9.  Perform a HEEADSSS exam on an adolescent patient.

10.  Prescriptions

a.  Write a prescription and calculate the dosage by weight in mg/kg in the infant and child.

b.  Explain to patient, parents, and/or caregiver the correct method to administer the medication.

11.  Professionalism

a.  Demonstrate the attitudes, conduct, and professionalism befitting a physician.

 

Evaluation of Core Skills

 See each rotation's web page for specifics.