Ambulatory Pediatric Subspecialties

Overview

The ambulatory pediatric subspecialties rotation is a preceptorial rotation lasting one block. The rotation occurs in the offices of pediatric subspecialists practicing at Beacon Children’s Hospital and includes: cardiology, hematology/oncology, developmental pediatrics, gastroenterology, neurology, pulmonology and infectious disease. The teaching of ambulatory pediatric subspecialties in the program includes this rotation as well as experiences in the Family Medicine Center, the noon conference series and on other rotations (see other curricula).

Goals

1. At the completion of this rotation, the resident will have an understanding of the practice of outpatient pediatrics by subspecialists in a community setting, which will facilitate appropriate care of patients and referral practices in the future.
2. At the completion of this rotation, the resident will have gained knowledge and skills in the care of children in the outpatient setting pertinent to the practice of family medicine.

Objectives

At the completion of this rotation, the resident will have demonstrated to the satisfaction of the preceptors:

• • medical knowledge in the care of children in the outpatient setting pertinent to the practice of family medicine, including the appropriate evaluation and treatment of (MK): heart murmurs, sickle cell disease, failure to thrive, inflammatory bowel disease, seizure disorders, asthma and infection management in chronically ill patients
  • the ability to perform an appropriate history and physical examination on children in the outpatient setting and to present these findings to another physician in an appropriate manner (PC)

• the ability to interpret appropriate data related to children in the outpatient setting and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits and risks of diagnostic and therapeutic options and co-managing patients appropriately with pediatric subspecialists (PC)
• the ability to make appropriate decisions in the care of children in the outpatient setting to assure high-quality care in a cost-effective manner (SBP)
• communication and interpersonal skills, which facilitate positive and therapeutic relationships (ICS)
• the ability to work cooperatively with other health professionals as part of a health care team (PC)
• compassion, respect and integrity; responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; a commitment to excellence and ongoing professional development (P)
• a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices (P)
• sensitivity and responsiveness to a patient’s and family’s culture, age, gender and disabilities (P)

There are no specific procedural requirements for this rotation. However, residents are encouraged to participate in procedures as they present and with supervision of the preceptor

Implementation

This is a preceptorial rotation, so the resident is assigned to several subspecialty pediatricians or pediatrics groups. The resident will accompany the pediatricians during their professional activities in Beacon Children’s Hospital, in the pediatrician’s office and in other locations involved in the preceptor’s usual practice. In the course of seeing patients, the pediatrician will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in the care of children.

The resident is responsible for contacting the pediatricians prior to the start of the rotation to arrange a schedule for the rotation. The resident must continue to meet usual residency obligations to his/her Family Medicine Center population, including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital and rounding in the nursing home. The resident is expected to attend noon conferences and abide by duty-hour restrictions in keeping with usual program policies. Upon completion of the rotation, the resident must complete the electronic evaluation form provided by the program.

Evaluation

The outpatient pediatrics preceptor will complete an evaluation form at the end of the rotation. Residents will specifically be evaluated on the following ACGME Milestones:

• MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
• PBLI-2: Demonstrates self-directed learning.
• PROF-2: Demonstrates professional conduct and accountability.
• PROF-3: Demonstrates humanism and cultural proficiency.
• C-2: Communicates effectively with patients, families, and the public.
• C-3: Develops relationships and effectively communicates with physicians, other health professionals, and healthcare teams.