Pediatric 3rd Year Clerkship Goals and Learning Outcomes

Goals

  • Provide an educational program that helps prepare students for any residency they may choose as part of the general professional education.
  • Prepare students to be exemplary house officers.
  • Acquisition of basic knowledge of growth and development (physical, physiologic, and psychosocial) and of its clinical application from birth through adolescence.
  • Development of communication skills that will facilitate the clinical interaction with children, adolescents, and their families and thus ensure that complete, accurate data are obtained.
  • Development of competency in the physical examination of infants, children, and adolescents.
  • Acquisition of the knowledge necessary for the diagnosis and initial management of common acute and chronic illnesses.
  • Development of clinical problem-solving skills.
  • An understanding of the influence of family, community, and society on the child in health and disease.
  • Development of strategies for health promotion as well as disease and injury prevention.
  • Development of the attitudes and professional behaviors appropriate for clinical practice.
  • An understanding of the approach of pediatricians to the health care of children and adolescents.
  • Create an educational plan for continuous learning throughout your medical career.

Learning Outcomes

The Department’s expectations of your performance are linked with the College of Medicine’s competency-based curriculum and institutional learning outcomes.

  • Professionalism (P)
  • Practice-based learning (PBL)
  • Patient care (PC)
  • Interpersonal Communication (IC)
  • Medical knowledge (MK)
  • System based practice SBP)

General

  • Discuss and apply ethical standards of practice (P.01).
  • Demonstrate respect of patient, parent and family differences in attitudes, behaviors and lifestyles paying particular attention to cultural, ethnic, and socioeconomic influences (P.02).
  • Demonstrate intellectual curiosity, initiative, responsibility, honesty, and reliability (P.03, P.06, PBLI.02)
  • Demonstrate solicitation, acceptance, and action on feedback (P.05, PBLI.02).
  • Demonstrate collegiality and respect for all members of the health care team (P.06, SBP.06).
  • Demonstrate the ability to perform an appropriate focused and comprehensive medical history and physical exam on pediatric patients (PC.01)
  • Prepare a complete written summary of the history and physical and orally present the case in a focused and chronological manner (ICS.04, ICS.05)
  • Identify clinical problems and outline an initial diagnostic and therapeutic plan (PC.02, PC.03)
  • Know when hospitalization and diagnostic tests are indicated (PC.02).
  • Select the diagnostic tests which are most likely to be useful and be aware of their costs and limitations (PC.02, SBP.04)
  • Effectively communicate information about the diagnosis and treatment to the patient and caregiver (ICS.02, ICS.03).
  • Effectively communicate information about the diagnosis and treatment of patients, including transition of care or handoffs, to the patient care team (ICS.04, ICS.05).
  • Obtain updated information relevant to the diagnosis and treatment of the patient, performing a literature search and critical review of the literature (PBLI.01).

Specific

Health Supervision (MK.01, MK.02, ICS.02, ICS.03, PC.01, PC.02, SBP.02)

  • Describe the content of a health supervision visit and the factors used to determine the frequency of such visits. Gather health supervision data from a focused history and physical examination.
  • Discuss the appropriate use and interpretation of the following screening tests: Neonatal screening, Developmental screening, Hearing and vision screening, Lead screening, Drug screening, Hemoglobin screening, Cholesterol screening, TB testing
  • Demonstrate the ability to provide anticipatory guidance: nutrition, behavior, injury prevention, immunizations, pubertal development, sexuality, and substance use and abuse.

Growth (MK.02, ICS.02, PC.01, PC.02, PC.04)

  • Accurately measure height, weight and head circumference and plot the data on an appropriate chart.
  • Include an assessment of growth in the patient work-up.
  • Identify abnormal growth patterns and explain the initial assessment.
  • Outline the initial evaluation of a child with failure to thrive.
  • Identify by history, growth pattern and physical findings, the child with failure to thrive, hypothyroidism and growth hormone deficiency.

Development (MK.01, ICS.02, PC.04, PBLI.03)

  • Perform appropriate developmental screening on all patients as part of the health maintenance visit or inpatient evaluation.
  • Utilize knowledge of the developmental stages in the interaction of the patient and physician in the clinical setting.
  • Summarize the main adolescent developmental changes that are important to discuss with parents and adolescents.
  • Explain how to perform and assign the sexual maturity rating (Tanner) as part of the examination for adolescent.

Behavior (MK.01, MK.02, ICS.02, PC.01, PC.03)

  • Take a complete and relevant history and perform a pertinent physical examination on a patient who presents with a behavioral problem.
  • Elicit age-appropriate behavioral concerns during the health supervision visit.
  • Distinguish between age-appropriate “normative” behavior and psychiatric illness.

Nutrition (MK.01, MK.02, ICS.01, ICS.02, PC.01, PC.02)

  • Discuss the nutritional advice to provide families regarding breast feeding vs. formula feeding, why and when solids are added to an infant’s diet, use of cow’s milk
  • Discuss how to advise families about the dietary prevention and treatment of common pediatric mineral (iron, fluoride, and calcium) and vitamin deficiencies.
  • Obtain a routine diet history on an infant that includes: the type of feeding (breast vs. formula) with amount and frequency, types and approximate amounts of solids, and diet supplements given (vitamins, fluoride, iron).
  • Determine whether a formula-fed infant is receiving adequate calories.
  • Recognize when nutritional assessment is necessary beyond infancy and demonstrate how to obtain a daily diet diary.

Prevention of Illness and Injury (MK.02, ICS.02, PBLI.03)

  • Assess the immunization status of an infant, child, or adolescent during a health care visit. Initiate a discussion about immunizations with the family of an infant, a toddler, a child about to enter school, 7th grade, and college.
  • Provide anticipatory guidance about injury prevention to the patient and family of an infant, a toddler, a preschool age child, school age child and adolescent.

Issues Unique to Adolescence (MK.01, MK.02, ICS.02, ICS.03, PC.01, PBLI.03, SBP.02, SBP.04)

  • Conduct a health maintenance visit on a healthy early, middle, and late adolescent incorporating a developmental assessment, risk behavior assessment, and preventive counseling.
  • Assign a sexual maturity rating (Tanner stage) during the evaluation of the adolescent in the clinical setting.
  • Describe pertinent features of the history, physical examination when evaluating a boy or girl with delayed pubertal development.
  • Describe one’s approach to counseling a teenager concerned about contraception and sexually transmitted diseases and AIDS, or a youth who engages in high-risk behavior

Issues Unique to Newborn (MK.01, ICS.02, PC.01, PC.02, PC.03)

  • Gather appropriate history from parents/guardian and chart; perform a physical exam on a well or ill newborn and describe routine issues for counseling parents.
  • Discuss routine admitting orders for the normal newborn.
  • Develop a reasonable differential diagnosis and evaluation scheme for newborns with clinical presentations. Diagnoses may include jitteriness or Seizures, Bilious Vomiting, Jaundice, Hypoglycemia, Lethargy or Poor Feeding, Sepsis, Respiratory Distress, Rashes, Cyanosis, Delayed Passage of Meconium, Heart Disease, Pulmonary Disorders.

Medical Genetics and Congenital Malformations (MK.01, PC.01, PC.02)

  • Gather basic data from history/physical exam.
  • Consider useful laboratory tests when evaluating a child with a possible common genetic disorder or a congenital malformation.

Chronic Illness (MK.01, MK.02, ICS.02, ICS.04, PC.01, PC.02, SBP.06)

  • Perform an initial history and physical examination on a new patient who presents with a chronic illness. Include assessment of growth and pubertal development.
  • Take an interval history and problem focused exam on a patient seen in follow-up for their chronic disease.
  • Interact effectively with other members of a multi-disciplinary team caring for the child with a chronic illness.
  • Outline the basic management for a child who presents with the following chronic diseases: allergic rhinitis, chronic urticaria, asthma, sickle cell disease, seizure disorder, insulin dependent diabetes mellitus, cystic fibrosis, hemophilia, childhood malignancies.
  • Provide anticipatory guidance to the family of a child with one of the above chronic diseases, alerting them to the clinical symptoms that would signal complication from the disease or its treatment.

Therapeutics (MK.01, MK.02, PBLI.03, SBP.04)

  • Demonstrate the ability to write a prescription.
  • Explain how a drug dose is calculated for infants and pre-pubertal children.
  • List the most common generic types of medications used for management of the following uncomplicated conditions: otitis media, asthma, conjunctivitis, allergic rhinitis, urinary tract infection, impetigo, eczema, fever, streptococcal pharyngitis, acne

Fluid and Electrolyte Management (MK.01, MK.02, ICS.02, PC.01, PBLI.03)

  • Write maintenance fluid orders.
  • Obtain historical information to assess state of hydration. Recognize the physical exam findings of dehydration.
  • Calculate and write IV orders for initial fluid replacement and maintenance fluids for a patient with dehydration from 1) gastroenteritis, or 2) diabetic ketoacidosis.
  • Explain the clinical consequences of electrolyte disturbances, including hypernatremia, hyponatremia, hyperkalemia, and hypokalemia, and discuss the effect of pH on the serum potassium level.
  • Explain to parents how to use oral rehydration therapy for mild /moderate dehydration.

Poisoning/Prevention and Treatment (MK.01, MK.02, ICS.02, ICS.04, ICS.05, SBP.01)

  • Provide anticipatory guidance regarding home safety and appropriate techniques to prevent accidental ingestions.
  • Demonstrate knowledge about the use of the poison control center and other information resources in the management of the patient with an ingestion.
  • Describe the general principles of poison management to include obtaining essential information on the telephone.

Pediatric Emergencies (MK.01, MK.02, PC.01, PC.02)

  • Recognize how the signs of shock in a child differ from those of an adult.
  • Provide presentation and initial diagnostic assessment/management for the following: Shock, Ataxia, Seizure, Mental status changes, Respiratory Distress, Apnea

Child Abuse (MK.01, MK.02, PC.01, SBP.04, SBP.09)

  • Know the types of questions to ask in assessment of a child for non-accidental injuries and child abuse.
  • Summarize the ethical responsibilities to identify and report child abuse and the obligation placed on reporters by community or state.

Child Advocacy (MK.01, ICS.03, SBP.02, SBP.05, SBP.09)

  • Describe behaviors preventing children from access to health care
  • Identify the ways that practicing physicians can advocate for children.
  • Describe the types of problems that benefit more from a community approach rather than an individual patient approach.

Common Pediatric Illnesses (MK.02, PC.01, PC.02, PC.03, SBP.04, SBP.08)

  • Develop a diagnostic approach to any of the following clinical problems: Cough, Diarrhea (+/-) Vomiting, Fever, Dermatitis/Rash, Respiratory Infection, Sore Throat, Lymphadenopathy, Wheezing/Stridor, Otitis/Ear Pain, Eye Trauma, Joint/Limb Problems, Erythema/Swelling, CNS Problems, Abdominal Pain, Muscle Weakness, Rectal bleeding
  • Discuss the characteristics of the patient and of the illness that must be considered when making the decision to manage the patient in the outpatient setting or to admit to hospital.
  • Explain how the physical manifestations and the evaluation and management of many pediatric illnesses vary with the age of the patient. Give specific examples.
  • Discuss in some detail the appropriate uses of these diagnostic tests: chest x-ray, lumbar puncture and CSF examination, EEG, radiologic imaging, echocardiogram.
  • Perform common pediatric procedures necessary in the care of common pediatric illnesses: lumbar puncture, Intramuscular injection, capillary (fingerstick) blood draws.
  • Develop a diagnostic approach to any of the clinical signs listed below: Heart Murmur, Lymphadenopathy, Splenomegaly, Hepatomegaly, Abdominal Mass, Impaired Vision, White Pupillary Reflex, Impaired Hearing, Pallor/Anemia, Bleeding (Superficial), Bleeding (deep tissue), Hematuria, Proteinuria