Faculty Chair:

Leandrita Ortega, MD

Contacts:

John MacFarlane, MD

Required Experiences:

Outpatient pediatric training takes place in the offices of general pediatricians in the community. Residents will spend four 1/2 days in the outpatient pediatric clinic and four 1/2 days in the Family Medicine Clinic.

Optional Experience:

None

Weekly Schedule PGY2:

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	OP Peds	Clinic	Clinic	OP Peds	Clinic
	OP Peds	Clinic	Didactics	OP Peds

Weekly Schedule PGY3:

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	OP Peds	Clinic	OP Peds	Clinic	OP Peds
	OP Peds	Clinic	Didactics	Clinic

Requirements:

AOA

Pediatrics and Adolescent Medicine

The program must provide at least sixteen weeks of training in pediatrics and adolescent medicine, including at least four weeks of training during the OGME-1 year.

At a minimum this shall include:

Care of the newborn.
Ambulatory pediatrics.
Well childcare.
Inpatient pediatrics.
Emergency care of children.

ACGME

Residents must have at least 200 hours (or two months) and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting. (Core)

This experience should include a minimum of 75 inpatient encounters with children. (Detail)

This experience should include a minimum of 75 emergency department patient encounters with children. (Detail)

Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting. (Core)

This care must include well-child care, acute care, and chronic care. (Detail)

Residents must have at least 40 newborn patient encounters, including well and ill newborns. (Core)

Description of Rotation or Educational Experience:

At the end of this rotation, residents will have developed a framework to evaluate general ambulatory pediatric patients, normal newborn examinations and basic newborn care. There will be additional exposure to common developmental difficulties (eg. ADHD, enuresis, encopresis, behavioral concerns, affective disorders, etc). Residents will have the opportunity to participate in a team approach with psychologists for evaluation and management of these issues.

Expectations:

Residents

Residents are expected to arrive to the outpatient pediatric clinic and continuity clinics on time and to dress and act in a professional manner. They are expected to contact the pediatrician’s office prior to their first day on the rotation in order arrange the initial meeting time and location on day one of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

All residents are expected to evaluate and manage common signs, symptoms, and conditions associated to the pediatric population in a timely, effective, and compassionate manner.

Faculty

Family medicine faculty will provide precepting of pediatric cases and procedures as seen in resident continuity clinics. The pediatricians in their practices will provide precepting during the focused pediatrics rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of common pediatric conditions and their treatments.

Call

There is no call specific to this rotation.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of the health of infants, children and adolescents. This should include gathering patient and family information, synthesis, and partnering with patients and families for quality patient care.

Objectives:

Residents are expected to:

Demonstrate the ability to gather information appropriate for the age in pediatric patients
Demonstrate the ability to perform a complete well-child examination for the newborn, toddler and school-age child
Demonstrate the ability to state the impact of social, cultural and environmental factors that affect the health and well-being of infants and children
Demonstrate the ability to perform neonatal circumcisions and know the different approaches to perform such procedure
Perform pneumatic otoscopy
Assessment of developmental progress and identification of developmental concerns using the Ages & Stages Questionnaires from the EMR in the Family Medicine Center (Longitudinal)
Calculate BMI-for-age and interpret risk for overweight
Assess vital signs based on gender, age and height percentile
Perform an appropriate assessment for ADHD using patient history, physical and assessment questionnaire (longitudinal)
Provide behavioral assessments and interventions using an integrated behavioral care model.

Neonatal period

Identify the health risks of premature and post-dates gestation

Assess a newborn for jaundice in their first visit

Identify the adequacy of newborn feeding and the success of breastfeeding.

Determine appropriate laboratory follow-up for neonatal problems such as jaundice and anemia as well as perinatally-acquired infections such as Hepatitis B, Hepatitis C and HIV

Well newborn and child care

Provide anticipatory guidance appropriate to age and developmental stage on topics including:

Immunization risks and benefits
Circumcision risks and benefits
Feeding options and variations
Breastfeeding
Temperament and behavior
Sleep hygiene
Dental care
Developmental stages and milestones
Developmental screening tests
Family and social relationships
Effective parenting
School readiness

Physical and growth

1. Recognize appropriate feeding recommendations and practices based on age and developmental stage

2. Recognize normal growth patterns and caloric requirements in both term and preterm infants

3. Recognize normal growth patterns in children and adolescents

4. Identify variations from normal growth patterns due to common genetic syndromes, organic disorders and feeding problems

5. Identify children who are overweight or at risk for overweight and be able to provide guidance and interventions for maintenance of healthy weight.

6. Provide anticipatory guidance for injury prevention in a manner appropriate to age and developmental stage, including choking, poisoning, falls, burns, drowning, and injuries related to both unmotorized and motorized vehicles.

Understand common methods of “childproofing” home environments and recommendations for safe sleep practices for prevention of SIDS.
Identify risk factors for physical and sexual abuse
- Understand regulations and procedures regarding reporting of abuse
- Demonstrate proper documentation of abuse history and findings of Child Abuse

7. Immunizations

Demonstrate familiarity with guidelines for type and timing of vaccinations
Demonstrate familiarity with resources for administering “catch-up” vaccinations
Demonstrate knowledge of precautions and contraindications to vaccinations

8. Screening

Demonstrate ability to identify risk factors for anemia, lead, fluoride, and other environmental hazards in the pediatric community

Medical Knowledge

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Objectives

Residents are expected to:

Demonstrate understanding of the diagnosis, treatment and prevention of common medical problems of infants and children, including:

1. Allergic and inflammatory

Asthma
Atopy
Allergic rhinitis
Juvenile idiopathic arthritis (JIA/JRA)

2. Renal/Urologic/Genital

Glomerulonephritis
Hematuria/Proteinuria
Urinary tract infections including pyelonephritis
Vesicoureteral reflux
Hypospadias
Enuresis
Inguinal hernia

3. Genital

Normal genital exam
Undescended testis
Fused labia
Nonspecific vaginitis

4. Endocrine/metabolic and nutritional problems

Obesity
Failure To Thrive
Thyroid disorders
Type I and Type II Diabetes Mellitus
Abnormal growth patterns

5. Neurologic problems

Seizure disorders
Febrile seizures
Headache
Syncope
Psychomotor delay/Cerebral palsy

6. Skin disorders

Atopic dermatitis
Viral exanthems and enanthems
Bites and stings
Bacterial and fungal infections
Lice and scabies
Diaper rash
Acne
Burns

7. Musculoskeletal

Club foot
Developmental dysplasia of the hip
Rotational problems/gait abnormalities
a. In-and out-toeing
b. Metatarsus adductus
c. Medial tibial torsion
d. Femoral anteversion
Scoliosis, idiopathic or acquired
Aseptic necrosis of the femoral head (Legg-Calve Perthes)
Slipped capital femoral epiphysis (SCFE)
Common sprains, dislocations and fractures
Limping

8. Gastrointestinal

Gastroenteritis, viral and bacterial
Constipation/encopresis
Hepatitis
Colic
Gastroesophageal reflux and GERD
Food intolerance and malabsorption
Pyloric stenosis
Intussusception
appendicitis/peritonitis
Recurrent/chronic abdominal pain
Hernias

9. Cardiovascular

Congenital heart disease
Evaluation of heart murmurs
Chest pain
Hypertension
Syncope
Arrythmias

10. Respiratory tract

Viral upper respiratory tract infections
Reactive airways disease/Asthma
Cystic fibrosis
Bronchiolitis
Foreign body aspiration
Chronic aspiration
Viral or bacterial pneumonia
Pertussis
Tonsillitis/pharyingitis/sinusitis
Epiglottitis vs. croup
Epistaxis
Foreign body in nose

11. Ear

Otitis media, acute
Otitis media with effusion
Otitis externa
Hearing loss
Wax and foreign body in ear canal

12. Eye

Amblyopia
Strabismus
Lacrimal duct stenosis
Decreased visual acuity
Congenital cataracts
Conjunctivitis, viral or bacterial
Conjunctivitis, allergic or other
Orbital Cellulitis

13. Other serious infections

Sepsis and sepsis syndromes
Meningitis, encephalitis
Invasive streptococcal and staphylococcal disease
Osteomyelitis
HIV

Practice Based Learning and Improvement

Goal

Residents are expected to:

Identify strengths, deficiencies and limits in one’s knowledge and expertise.

Set learning and improvement goals

Objectives

Recognizes his/her own strengths and limitations as measured by global assessment.

Asks questions as an engaged, critical learner as measured by global assessment.

Uses information technology to manage information, access on-line medical information, and support their own education as measured by global assessment.

Complete assigned readings:

For R1: Week 1-4 assigned readings

For R2: Week 5-8 assigned readings

For R3: Week 9-12 assigned readings

System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

Coordinate patient care within the health care system relevant to their clinical specialty

Work in inter-professional teams to enhance patient safety and improve patient care quality

Objectives

Demonstrate familiarity with organizations that provide services to children in the community such as Child Protection Services, Aprendamos, Child Care Services, Center based developmental programs

Using a clinical case, demonstrate through action and verbal description the appropriate means of care coordination and communication with specialty services when required as measured by the 360 evaluations (longitudinal).

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

Demonstrate strategies in managing patients and parents with different cultural backgrounds around sensitive and protected subjects as measured by the 360 evaluations (longitudinal)

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.

Residents are expected to:

Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
Communicate effectively with physicians, other health professionals, and health related agencies
Maintain comprehensive, timely, and legible medical records

Objectives

Demonstrate effective communication with parents and other health professionals regarding their child’s health status and health problems
Complete medical records before the end of day’s work in the OP clinics and within 48 hours in the Family Medicine Center.

Teaching Methods

Clinical Teaching

Case-based teaching

Role Modeling

Didactic conferences

Assessment Method (Residents)

Formative Feedback (IEP quarterly meetings with advisors)

Global Assessment Tool through New Innovations

360 evaluations

Assessment Method (Program Evaluation)

Formative Feedback from Residents in the rotation

Global Assessment Tool through New Innovations

Evaluation at the end of the rotation by the preceptor

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.