Overview
The pediatrics curriculum of Memorial Hospital’s Family Medicine Residency consists of six months of structured experience in general inpatient pediatrics and pediatric intensive care unit at Beacon Children’s Hospital. 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 effectively involves specialists in the care of patients. (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 hands-on training sessions during intern orientation. 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 and fellowship trained pediatric intensivists. It is the responsibility of these physicians to attend rounds, teach resident physicians and provide supervision of resident care as the attending for patients admitted to Beacon Children’s Hospital. The community pediatricians with inpatient privileges retain the same responsibility as described above.
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 are many opportunities for procedures for residents to perform. Procedures typically performed by residents on this rotation include (PC): lumbar puncture, intubation. Circumcisions are routinely performed on the postpartum floor during the resident’s obstetrics rotation.
Resident Responsibilities:
At the beginning of every block, the new team of pediatric 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 when 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 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 actively engage with specialists involved in their patients’ care.
Resources:
- “Up-to-Date”
- Memorial Hospital Online Medical Library
Methods of Evaluation:
Staff attendings complete a form at the end of every block evaluating resident’s performance during that rotation. Residents will specifically be evaluated on the following ACGME Milestones:
PC-1: Cares for acutely ill or injured patients in urgent/emergent situations and in all settings.
MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
MK-2: Applies critical thinking skills in patient care.
PROF-1: Completes a process of professionalization.
PROF-2: Demonstrates professional conduct and accountability.
SBP-1: Provides cost-conscious medical care.
SBP-4: Coordinates team-based care.
C-2: Communicates effectively with patients, families, and the public.
C-3: Develops relationships and effectively communicates with physicians, other health professionals, and health care teams.
C-4: Utilizes technology to optimize communication.
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.
