Dr. Bumsted is also valuable support for Child Health 1 students. If students are uncomfortable addressing issues with Trevor, they should feel free to contact Dr. Bumsted. She is a great resource in terms of grading and evaluation, faculty and resident issues and work environment concerns.
Tracy Bumsted, MD, MPH Course Director for Child Health 1 Course Director for Pediatric Ward Subinternship Department of Pediatrics Oregon Health & Science University MC: CDRCP 707 SW Gaines Street Portland, OR 97239
Pediatric Medical Student Coordinator: Trevor Monteith
Trevor is the "go to" person for all the housekeeping and logistical support. He can also help troubleshoot problems and offer advice on how to proceed when issues crop up. He is the first place to go when students need information, have issues, concerns or suggestions.
Trevor Monteith Medical Student Coordinator Department of Pediatrics Oregon Health & Science University MC: CDRCP 707 SW Gaines Street Portland, OR 97239
The Child Health I clerkship focuses on medical, social, and developmental issues unique to the infant, child, and adolescent. The clerkship emphasizes those aspects of Pediatrics which are important for all medical students regardless of their eventual career path and provides a foundation for those students who elect to pursue further the study of infants, children, and adolescents.
There are two clinical sites at which third year students may choose to rotate: Doernbecher Children’s Hospital and Emanuel Children’s Hospital. There are some differences in the types of patients on the different services, but all students will have the opportunity to follow both general and subspecialty patients.
Students will learn through participation in patient care, through formal and informal lectures and teaching from attendings, fellows, and residents, through reading of text material and on-line or multimedia materials, and from each other. It is expected that students will take an active part in their own learning and the learning of their colleagues.
Goals and Objectives - Skills
Development of competency in obtaining histories from parents and children, and in obtaining information from other sources as necessary.
Development of competency in the physical examination of infants, children, and adolescents.
Development of clinical skills necessary for the diagnosis and initial management of common acute and chronic illnesses.
Development of effective communication with student and physician colleagues, with other medical personnel, with patients, and with families. Effective communication includes verbal communications on rounds as well as informal patient care settings and written communication in the form of chart notes.
Goals and Objectives - Knowledge
Basic knowledge of growth and development and its clinical application from birth through adolescence. This includes understanding of physical, physiologic, and psychosocial development and its impact on health and disease processes.
Pathology, pathophysiology, anatomy, presentation and course of common acute and chronic illnesses.
Understanding of the influence of family, community, and society on the child in health and disease.
Understanding of the knowledge, clinical skills, procedures, and viewpoints of other professional disciplines which contribute to the care of children including: nursing, respiratory therapy, psychology, social work, speech pathology, occupational therapy, physical therapy, etc.
Expectations
Students will actively participate in the activities of their team including: rounds, lectures, and patient care.
Students will admit and follow 2-4 patients at a time. Because team census, patient acuity and complexity vary considerably, the student and senior resident should determine the precise number of patients each student should follow.
Notes: Students will write admission and daily notes on their patients. At least some of these will be reviewed by your attending, chief resident, or senior resident for comments and suggestions.
Night-Call Students will take overnight call every 5th night. When on call, students should be available to take admissions, participate in patient follow-up, and assist the on-call team with cross-cover issues.
National Board of Medical Examiners Pediatric Subject Exam: On the last Wednesday of the clerkship, students will take the Pediatric Subject “Shelf” Exam. This exam will count for 10% of your final grade and the exam scaled score will appear on your Dean’s Letter for residency program applications. At the final exam, students should turn in the text book.
CLIPP Cases: Computerized Learning in Pediatrics Project is a recently created national project that offers students 31 interactive, Internet-based patient simulations to augment their clinical medical education. Using your OHSU email address, students can log on at www.clippcases.org using any computer with Internet access to complete the cases. Students will be instructed on which cases are required by the Course Director at orientation on the first day of the rotation. All cases offer a standardized curriculum, model clinical reasoning and best practice, and provide links to further information about selected topics. The use of video and still images greatly enhances this exciting project. Students must complete the required cases in order to obtain credit for them. Additional cases completion will positively effect students learning as well as the final grade for the course. Please see details about grading for CLIPP cases in course materials distributed at orientation.
Grading Clinical evaluations from attendings and residents: 70% NBME Pediatric Subject Exam: 10% CLIPP Cases: 20%
Pediatric History Learning Objectives and Competencies
Recognize that different clinical settings require adaptation of the medical history: complete, focused, or interval. Sometimes a complete history will be taken in stages. The initial history will guide initial evaluation and management; further detail can be obtained later, if necessary. The order and timing of history, exam, and treatment will be dictated by the acuity of the presenting illness.
The complete history will include:
Chief complaint. History of present illness. Past medical history—neonatal including: birth weight, gestational age, maternal complication, exposures, and newborn problems; medical problems; surgeries; medications; immunizations; diet; and developmental milestones. Family history—number and ages of siblings, known genetic disorders, early childhood deaths, illnesses in family members with special attention to those in children, psychiatric illnesses. Social history—home environment (type of home, who lives in home), school functioning, peer relationships. Complete review of systems
Pediatric Physical Exam Learning Objectives and Competencies
Recognize that the age (chronological as well as developmental) and presenting features of the child influence the approach to the patient, the areas included in the exam, and the order of the examination.
Recognize the important role of observation as a method of obtaining data in the assessment of the child.
Demonstrate the appropriate use of the limited or focused exam, especially in follow up of hospitalized patients.
Use a developmental assessment including: motor, language, and social development in the examination of all patients.
Observe how physical exam findings have different clinical significance depending on the age of the patient.
Communication skills: Family and Patient Communication, Admission Notes, Daily Notes, and Oral Presentations Learning Objectives and Competencies
Establish rapport with the patient and family. Be comfortable in your role as student physician. Effectively communicate information about data, diagnosis, and treatment plan to patient in family, in conjunction with resident and attending staff
Admission note: Write a complete summary of the patient's history and physical examination, with a global assessment as well as an assessment and plan for each problem identified. Avoid jargon, use proper grammar.
Daily note: Write a complete, but concise, daily note that includes events and data obtained in the previous 24 hours, physical exam, and assessment, as well as plans for identified problems. Avoid jargon, use proper grammar.
Oral presentation: Present a complete, well-organized summary of the patient’s history, pertinent physical findings, assessment and plan, differentiating between work round presentations and teaching presentations. Be able to explain the thought process that led to the diagnostic and therapeutic plan.
Knowledge Areas Growth Learning Objectives
Use of growth charts in the longitudinal evaluation of length/height, weight and head circumference.
Abnormalities of growth which warrant further evaluation including: crossing lines on a growth chart; discrepancies between height, weight and head circumference; short stature; failure to thrive; obesity; and micro- and mac rocephaly.
Intrauterine factors which affect growth of the fetus.
Normal variants of growth.
Competencies
Accurately measure height, weight and head circumference and plot on appropriate chart.
Include assessment of growth in the patient work-up.
Identify abnormal growth patterns and formulate and initial assessment.
Outline the initial evaluation of a child with failure to thrive.
Development Learning Objectives — recognize how the following developmental issues are important in clinical care
Infant—changes in reflexes, tone, and posture, progression of milestones during the first year
Toddler/child—language development, separation and autonomy
Adolescent—sequence of physical maturation and sexual maturity rating (Tanner staging)
Recognize delays in development that are clinically significant.
Competencies
Perform appropriate developmental screening on all patients as part of initial and ongoing evaluation.
Utilize knowledge of the developmental stages in the interaction between physician and patient.
Newborn Learning Objectives
Know the historical information, physical exam findings, and laboratory data that will develop the differential diagnosis for a newborn with one of the following presentations:
Jaundice
Seizures
Lethargy or poor feeding
Respiratory distress
Cyanosis
Bilious vomiting
Non-bilious vomitin
Hypoglycemia
Recognize factors in the maternal and newborn history that might put the newborn at risk for medical problems.
Describe the newborn physical examination
Competencies
Describe a differential diagnosis and initial evaluation scheme for newborns with clinical presentations as described in the first learning objective above.
Be able to examine a newborn including: assessment of jaundice, cardiac, respiratory and eye exam, and neurological assessment of tone and reflexes.
Issues Unique to Adolescence Learning Objectives
Recognize unique features of the physician-patient relationship during adolescence including: confidentiality and consent.
Observe strategies for interviewing and counseling adolescents.
Understand the normal parameters of growth and development in the adolescent including: physiologic, emotional and cognitive, and sexual/reproductive changes.
Know major causes or mortality and morbidity in adolescents.
Competencies
Describe features of the physician-adolescent patient relationship.
Be able to describe an approach to counseling an adolescent about contraception, sexually transmitted disease, or smoking/drinking/drugs.
Common Pediatric Illnesses Learning Objectives
Recognize signs and symptoms of common pediatric illnesses
Identify differential diagnoses for common illnesses
Initial laboratory or radiographic studies
Plan for initial management
Competencies
Develop a diagnostic approach to common presenting signs and symptoms
Understand how physical manifestations and evaluation and management of may pediatric illnesses vary with the age of the patient
Understand in detail the appropriate uses of the following diagnostic tests: Chest X-ray, lumbar puncture and CSF studies, CT/MRI/ultrasound, bacterial and viral cultures
Understand the characteristics of the patient and the illness that are considered when determining whether or not to admit the patient to the hospital.
Identify the patient who requires immediate medical attention and intervention.
Understand the initial assessment and management of pediatric emergencies: airway obstruction, respiratory distress, shock, seizures, and head trauma.
Understand the differences between types of shock—hypovolemic, cardiogenic, distributive, and septic.
Competencies
Recognize how the signs of shock differ in a child compared with an adult.
Describe anatomic and physiologic differences between the pediatric and adult airway and respiratory system and the effects of these differences on presentation of disease.
Be able to describe the initial assessment and management of upper airway obstruction, respiratory failure, shock, seizures, and head trauma.
Therapeutics Learning Objectives
Understand maintenance fluid, electrolyte, and caloric requirements of different age groups.
Understand physiology of dehydration (hyper, iso, hyponatremic) and its correction.
Competencies
Be able to write maintenance fluid orders.
Be able to plan for rehydration therapy.
Be able to calculate drug doses for infants and children.
Injury, trauma, poisoning Learning Objectives
Know the physical findings commonly associated with child abuse.
Know the physical findings expected in an infant who has been shaken.
Competencies
Describe the physical findings commonly associated with child abuse.
Describe the types of questions to ask in assessment of a child for non-accidental injuries.
