PGY1 Pediatric Medicine

Educational Goals & Objectives

The Pediatric Medicine rotation will provide the PGY1 resident with an opportunity to become
skilled in the prevention, evaluation and management of acute and chronic medical conditions
commonly seen in pediatric medicine. Residents will rotate through the clinic, inpatient service,
and neonatal intensive care unit, caring for patients from infancy through adolescence. The
focus will be on the relationship with patients and their families, continuity of care, and the
effective delivery of primary care. Residents will gain exposure to a broad spectrum of medical
conditions, ranging from core pediatric medicine issues to conditions requiring knowledge of
allergy and immunology, child development, dermatology, genetic and metabolic disorders,
nutrition, ophthalmology, orthopedics, otolaryngology, and preventative medicine, as they
pertain to the psychiatric care of children in the community.

This rotation will serve to help prepare the resident for their rotations in Child & Adolescent
Psychiatry.

Faculty will facilitate learning in the 6 core competencies as follows:

Patient Care and Procedural Skills

1. All residents must be able to provide compassionate, culturally-sensitive care for children and their families.
2. All residents will demonstrate the ability to take an age-appropriate medical history and incorporate information from the electronic medical record.
   1. PGY1s should be able to:
      1. differentiate between stable and unstable symptoms
      2. elicit risk factors in the child’s environment that contribute to the development of chronic disease
      3. take a complete developmental history for infants and young children, including information on pregnancy and labor and the achievement of developmental milestones
      4. recognize the significance of input from teachers regarding performance at school and learning issues
3. Residents should be able to perform a physical exam appropriately focused on the patient’s presenting complaint.
   1. PGY1s should become competent in routine newborn and well child checks, sports physicals, and assessing sexual development and Tanner staging.
4. Residents will understand the indications, contraindications, complications, limitations, and interpretation of the following procedures:
   1. PGY1s: bladder catheter placement, cerumen removal, fluorescein and Wood’s light exam of eye, incision and drainage of skin abscesses, interosseous line placement, lumbar puncture, nail removal, pelvic examination and PAP smear, PALS, punch biopsy, splinting and casting, suturing and suture removal, vascular access.

Medical Knowledge

1. PGY1s will learn the approach to acute medical issues in the newborn, including:
   1. Anemia
   2. Apnea
   3. Cyanosis
   4. Hip dysplasia
   5. Hypoglycemia
   6. Jaundice
   7. Maternal infections (HIV, Hepatitis)
   8. Meconium-stained amniotic fluid
   9. Neonatal abstinence syndrome
   10. Perinatal asphyxia
   11. Polycythemia
   12. Premature and post-date gestations
   13. Respiratory distress
   14. Rh factor and blood type incompatibility
   15. Seizures
   16. Sepsis
   17. Shoulder dystocia
2. Residents will become comfortable with social and ethical issues affecting families, including adoption; divorce, separation and death; guidelines for effective parenting; nontraditional families, and withdrawal of life support.
3. PGY1s will develop an approach to the following presenting conditions, including an understanding of the pathophysiology, differential diagnosis, focused diagnostic evaluation, and therapy:
   1. Abdominal pain
   2. Cough
   3. Depression
   4. Diarrhea
   5. Fever
   6. Headache
   7. Heart murmur
   8. Hematuria
   9. Limp or extremity pain
   10. Lymphadenopathy
   11. Obesity
   12. Otalgia
   13. Petechiae/purpura
   14. Proteinuria
   15. Rash
   16. Red eye or wandering eye
   17. Rhinorrhea
   18. School failure
   19. Seizures
   20. Sore throat
   21. Undescended testes
   22. Vomiting
   23. Wheezing
4. Through the Pediatric and Child and Adolescent Psychiatry rotations, the resident will be introduced to or directed to learn more through self-directed study of common childhood illnesses, including:
   1. ADHD
   2. Allergic rhinitis
   3. Anorexia and bulimia
   4. Appendicitis
   5. Asthma
   6. Bronchiolitis and/or pneumonia
   7. Celiac disease
   8. Cellulitis
   9. Conjunctivitis
   10. Croup
   11. Dermatitis: atopic, contact, seborrheic
   12. Diabetes mellitus
   13. Fracture
   14. Gastroenteritis
   15. Glomerulonephritis
   16. Group A streptococcal pharyngitis
   17. Henoch Schoenlein purpura
   18. Hip dysplasia
   19. HIV
   20. Impetigo
   21. Intussusception
   22. Juvenile Rheumatoid Arthritis and reactive arthritis
   23. Kawasaki disease
   24. Legg-Calve-Perthes disease
   25. Lice and scabies
   26. Meningitis
   27. Mononucleosis
   28. Nursemaid elbow
   29. Osgood Schlatter disease
   30. Osteomyelitis
   31. Otitis media and otitis externa
   32. Pelvic inflammatory disease
   33. Postnasal drip
   34. Rheumatic fever
   35. Sexually transmitted infections
   36. Sickle cell crisis
   37. Sinusitis
   38. Slipped capital femoral epiphysis
   39. Transient synovitis
   40. Tuberculosis: active and latent
   41. Unintended pregnancy
   42. Urinary tract infection and pyelonephritis
   43. Urticaria
   44. Vasculitis syndromes
   45. Viral exanthem
   46. Viral upper respiratory infection
5. Residents will understand the effective use and interpretation of the following tools:
   1. AMA Guidelines for Adolescent Preventative Services (GAPS)
   2. APGAR score
   3. Ballard score
   4. Bioelectrical Impedance Assay of body fat (BIA)
   5. Connors and Vanderbilt questionnaires
   6. CRAFFT behavioral health screening tool
   7. Developmental screening tests
   8. HEADSSS questionnaire (Home, Education, Activities, Drugs, Sex, Suicide/Depression, Safety)
6. Residents will become familiar with frequently used complementary and alternative medicine treatments for common pediatric problems.
7. Residents will be aware of American Academy of Pediatrics guidelines for health maintenance and be able to counsel patients and their families on the following matters pertaining to growth, development, and health care maintenance:
   1. Alcohol and drug screening and counseling for adolescents and children in upper elementary grades
   2. Caloric requirements and nutrition
   3. Contraception, safe sex, healthy relationships, and consent
   4. Exercise and promotion of healthy lifestyles for both children and their families
   5. Gender identification and sexual orientation
   6. Injury prevention (burns, child abuse, car seats and seat belts, choking, drowning, falls, firearms, fire safety, helmets, poisoning, sunscreen)
   7. Screening for anemia, lead exposure, fluoride, hearing and vision, hypertension, hyperlipidemia, obesity, and TB
   8. Vaccination
8. Residents will understand indications for ordering and interpretation of results from diagnostic, laboratory and imaging studies relevant to the diagnosis and treatment of the above conditions.

Practice-Based Learning and Improvement

1. All residents should be able to access current clinical practice guidelines to apply evidence-based strategies to patient care.
2. All residents should learn to function as part of a team, including the pediatrician, nurse, pharmacist, dietitian and social worker to optimize patient care.
3. All residents should respond with positive changes to feedback from members of the health care team.

Interpersonal and Communication Skills

1. PGY1s must demonstrate organized and articulate written (electronic) and verbal communication skills that build rapport with patients and their families, convey information to other health care professionals, and provide timely documentation in the chart.

Professionalism

1. All residents must demonstrate strong commitment to carrying out professional responsibilities as reflected in their conduct, ethical behavior, attire, interactions with colleagues and community, and devotion to patient care.
2. All residents should be able to educate patients and their families in a manner respectful of gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation on choices regarding their care.

Systems-Based Practice

1. PGY1s must have a basic understanding that their diagnostic and treatment decisions

involve cost and risk and affect quality of care.

Teaching Methods

1. Supervised patient care in the clinic and hospital
   1. Residents will initially be directly observed with patients, to facilitate the acquisition of excellent history taking, physical exam, and procedural skills.
   2. As residents become more proficient, they will interact independently with patients and present cases to faculty.
      1. For PGY1s, initial emphasis will be on diagnosis and basic management.
2. Conferences
   1. Specialty-specific didactics
3. Independent study
   1. Journal and textbook reading TBD by Attending physician
   2. Online educational resources
      1. American Academy of Pediatrics
         1. Professional resources -> Clinical Support
      2. American Academy of Pediatrics Statement: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents
   3. The American College of Obstetricians and Gynecologists Committee Opinion: Adolescents and Long-Acting Reversible Contraception
   4. Trans and gender diverse resources:
      1. https://transcare.ucsf.edu/guidelines
      2. http://transhealth.ucsf.edu/trans?page=guidelines-terminology
   5. Up To Date
   6. Clinical Key

Evaluation

1. Case and procedure logs
2. Mini-CEX bedside evaluation tool
3. 360 Evaluation
4. Mid-rotation verbal feedback

Rotation Structure

1. Residents should contact Dr. Shuman the day prior to confirm start time and location.
2. Residents should spend their time in the clinic or hospital, dividing their time as appropriate to achieve the above educational goals.
   1. Residents are the primary care providers for these patients. Residents will be involved in discussion of patient presentation, generation of a differential diagnosis, development of a treatment plan, and patient follow up. In addition, residents will be involved in surgical procedures as is appropriate.
   2. Case-based learning is most effective. Nightly reading/study should be based on patients seen during the day.
   3. When doing pediatric consults, the resident should understand the question asked and provide a concise answer.
3. Residents may be asked to do focused literature searches or presentations during the course of the rotation.
4. Call and weekend responsibilities to be determined by Dr. Shuman.
   1. Hours worked must be consistent with ACGME requirements and are subject to approval by the Program Director.
5. V. Residents have didactics and should be excused in a timely fashion to attend.