Pediatrics

Course #: 810J

Title:  School Age Child in Developmental/Behavioral Pediatrics

Selective Director(s):  Angela LaRosa, M.D. & Jane Charles, M.D.

Maximum Number of students per block: 1

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Identify developmental, behavioral and psychosocial problems using the medical history and exam of the school age child.
2. Describe the typical presentation of common developmental and behavioral problems in the school age child such as Attention Deficit/Hyperactivity Disorder (ADHD), sleep problems, enuresis and encoporesis.
3. Recognize academic underachievement and conditions that may be responsible such as learning disorders, ADHD and anxiety.
4. Understand the impact of biological, social and psychological aspects of the family that may lead to behavior problems (i.e., family history of mental illness, alcoholism, poverty, domestic violence).
5. Distinguish between age-appropriate behavior and abnormal behaviors that may suggest a neurodevelopmental/behavioral disorder.
6. Describe the interventions and community services available to children with behavioral problems.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Taking a complete and relevant history and performing a pertinent physical exam on patients presenting with a potential developmental/behavioral problem.
2. Administering and interpreting age appropriate screening tools to identify clinically significant behavioral concerns.
3. Reading and discussing current literature on topics outlined in the objectives as well as topics pertaining to specific patient encounters.
4. Observing behavior management counseling to families (i.e., time-out, token economics, positive and negative reinforcements to extinguish behaviors).

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 3 patients with ADHD
2. 1 patient with parent-child conflict
3. 1 patient with enuresis
4. 1 patient with encoporesis
5. 2 patients with sleep problems
6. 1 patient with a learning disability
7. 2 patient with developmental delay/disorder
8. 2 patients with oppositional defiant disorder (ODD)
9. 1 patient with autism and mental disability

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Assessment of the student’s proficiency in obtaining a relevant behavioral and developmental history by attending faculty.
2. Evaluation of the student’s skill in presenting an appropriate differential diagnosis after patient encounter and evaluation by attending faculty.
3. Assessment of the student’s ability to formulate an appropriate treatment plan after patient encounter by attending faculty.

Please outline when and how the learners will receive feedback on their performance:
Students will receive informal feedback by attending faculty during clinic after patient encounters in order to gradually improve their assessment and diagnostic skills. In addition, more formal feedback will be provided by the attending faculty midway through the selective discussing student’s strengths, areas needed for improvement and any concerns they may have and again at the end of the selective.

Course #: 811J

Title:  Adolescent Medicine

Selective Director(s):  Janice Key , M.D.

Maximum Number of students per block: 2

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Conduct a history and physical examination for a health maintenance visit or an acute visit with an adolescent.
2. Assign a sexual maturity rating (Tanner Stage), cognitive maturity estimate, and growth assessment (plot and interpret the height, weight and body mass index) for a patient.
3. Discuss the risks and strengths of a particular adolescent patient and possible approaches to preventative interventions for that patient.
4. Provide individual preventative counseling for an adolescent patient.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Attend Adolescent Medicine Clinics and participate in supervised patient care activities.
2. Attend School Based Clinics and participate in supervised clinical activities.
3. Attend didactic seminars with all Adolescent Medicine faculty. These seminars will be conducted specifically by the faculty for the residents and students on the Adolescent Medicine rotation and will include topics from the course syllabus.
4. Attend rural outreach clinic and participate in supervised patient care activities.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 2 adolescents with possible Attention Deficit Disorder (ADD) or Attention Deficit/Hyperactivity Disorder (AD/HD)
2. 2 adolescents with sexually transmitted disease(s)
3. 2 adolescents regarding family planning
4. 1 adolescent with depression
5. 1 adolescent with possible substance abuse

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Direct observation of patient care skills demonstrated in clinic and other patient care settings by the attending physicians.

Please outline when and how the learners will receive feedback on their performance:
One mid-session meeting to provide feedback will be set up with selective director and one final evaluation meeting with selective director on the last day of the session.

Course #: 812J

Title:  Pediatric Cardiology

Selective Director(s):  Varsha Bandisode, M.D.

Maximum Number of students per block: 6

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Discuss normal and complex cardiac anatomy and physiology in pediatric patients, the transitioning physiology of the neonate, and the complex cardiac physiology of congenital cardiac disease states.
2. Perform a basic pediatric cardiac examination and correlate cardiac exam findings to the cardiac physiology in the neonate and child.
3. Identify basic and complex congenital cardiac defects.
4. Perform basic electrocardiogram reading for pediatric patients.
5. Describe the management and treatment of cardiac arrhythmias in pediatric patients.
6. Describe the surgical treatment of congenital heart disease, and the management of congenital and acquired cardiac disease.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Participation as an integral member of the cardiac inpatient team. The student will be assigned patients to expose him/her to the daily management of the pediatric cardiac patient. The student will present the history, exam, and relevant studies of the assigned pediatric cardiac patient and formulate an assessment and plan for the patient’s continued management and care.
2. Participation in daily rounds and attendance at didactic teaching sessions. During daily rounds, the attending faculty will review his/her own history and physical exams of the patient with the student, particularly focusing on physical findings and important historical factors helpful in making the diagnosis.
3. Participation in the critical evaluation and assessment of the pediatric cardiac consult. Bedside teaching will be provided during the cardiac evaluation.
4. Observation of the evaluation and assessment of the pre-operative pediatric cardiac patient, surgical procedures, and follow-up of the patient in the early post-operative period focusing on the altered cardiac physiology.
5. Attendance at cardiology clinics during the rotation to improve pediatric cardiac exam skills and observe outpatient evaluation techniques.
6. Observation of specialized therapeutic modalities which aide in diagnosis and management of the complex pediatric cardiac patient. The student will be given opportunities to observe echocardiography and cardiac catheterization available for delineating complex anatomy and interventional techniques for therapy.
7. Completion of an assigned oral presentation based on the student’s pediatric cardiac patient exposure.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. Up to 4 pediatric cardiac patients, depending on the cardiac inpatient census.

Students will be exposed at a minimum to:
1. 1 patient with a common diagnosis (i.e.VSD, ASD, and PDA, and the AV Canal defect)
2. 1 complex cardiac patient, including patients with Single ventricular physiology in varying stages of repair.
3. 1 patient with acquired heart disease, including cardiomyopathy, myocarditis, and Kawasaki’s disease.
4. 1 critically ill premature and full-term neonate patient with secondary pulmonary hypertension in.
5. 1 (possible) cyanotic neonatal or pediatric patient.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Direct observation of history taking and physical exam skills as assessed by the attending faculty.
2. Completion of the assigned oral presentation based on the student’s cardiac patient exposure by the attending faculty.

Please outline when and how the learners will receive feedback on their performance:
Students will receive verbal feedback about their performance from attending faculty during the rotation.

Course #: 813J

Title:  Multi-Disciplinary Approach to Chronic Diseases in Pediatrics

Selective Director(s):  C. Michael Bowman, Ph.D., M.D.

Maximum Number of students per block: 2

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Describe the importance of chronic diseases in Pediatrics, including their occurrence, care, outcome, and impact on the child and family.
2. Demonstrate approaches to maximize patient and family functioning.
3. Recognize the necessity of multi-disciplinary teams to optimize care and family support for children with chronic diseases.
4. Describe the challenges chronically-ill children face in school and the resources schools have to assess and help care for such children.
5. Recognize and appreciate variations in care style among various caregiver teams and disciplines.
6. Describe approaches to maximize compliance with care (getting the family to “buy into” daily care for their child.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Participation in patient rounds and related clinic activities with attendings and residents.
2. Completion of readings from selected references to fill in fundamental understanding and clinical teaching when patient availability does not match learning objectives;
3. Attendance at case conferences as available and relevant and completion of CLIPP cases when relevant.
4. Completion of special focused learning modules to include pulmonary function testing, EEG lab, renal dialysis (both hemo- and peritoneal), diabetes education, allergy testing, bronchoscopy/GI endoscopy as available and relevant; pre- and post-natal genetic counseling sessions, newborn screening program discussion(s), IEP session.
5. Completion of special project report (case study) report at the end of the rotation discussing how principles learned during the rotation apply to a particular patient and family which the student followed throughout the three week rotation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 1 patient with sickle cell disease or other hematological issue
2. 1 patient with cystic fibrosis or asthma
3. 1 patient with allergies/immune response disorder
4. 1 patient with developmental delay
5. 1 patient with metabolic disease or condition
6. 1 patient with gastrointestinal disease or condition
7. 1 patient with neurological condition.
8. 1 patient with a genetic condition.
9. 1 patient with genitourinary disease or condition.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Direct observation of clinical and patient care skills, including knowledge based, by the attending physician and residents.
2. Completion of special project report reviewed by selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive verbal feedback about their performance during the rotation by attendings and residents.

Course #: 814J

Title:  Prematurity and Its Sequellae

Selective Director(s):  C. Michael Bowman, Ph.D., M.D. and Lakshmi Katkaneni, M.D.

Maximum Number of students per block: 1

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Identify common problems encountered following a premature birth and assist in its management and typical course.
2. Discuss the risks of premature birth and the importance of its prevention.
3. Describe the physiology of labor.
4. Describe the pathophysiology of apnea, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis etc.
5. Demonstrate maintenance of family involvement during the prolonged stay in the neonatal intensive care unit (NICU).
6. Maximize patient and family functioning after discharge, including the role of multidisciplinary evaluation, support and follow-up, and the provision of appropriate in-home services.
7. Describe growth and development to heal immaturity and injuries.
8. Describe how to avoid new complications following hospital discharge.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. Participation in neonatal intensive care unit rounds and related clinic activities with attendings and residents.
2. Completion of readings from selected references to fill in fundamental understanding and clinical teaching when patient availability does not match learning objectives.
3. Attend case conferences as available and relevant and complete CLIPP cases when relevant.
4. Completion special focused learning modules to include occupational therapy/physical therapy swallowing evaluation, hearing and retinal evaluations, participation in discharge teaching for an infant from the nursery, diuretic and oxygen therapy, apnea/bradycardia monitor usage.
5. Completion of a special project report (case study) at the end of the rotation discussing how principles learned during the rotation apply to a particular patient and family which the student followed throughout the three week rotation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 1 premature infant with feeding/swallowing issues
2. 1 premature infant with respiratory distress syndrome
3. 1 premature infant with intraventricular hemorrhage or hydrocephalus or cerebral palsy or seizures
4. 1 premature infant with congenital heart disease or 1 premature infant evaluated for congenital heart disease
5. 1 infant or child with syndrome or chromosomal abnormality or other genetic disease
6. 1 premature infant with anemia or other blood dyscrasia
7. 1 premature infant with nasogastric or nasoduodenal or gastic or jejunal feeding tube or total parenteral nutrition

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Direct observation of clinical and patient care skills, including knowledge based, by the attending physician and residents.
2. Completion of special project report graded by selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive verbal feedback about their performance during the rotation by attendings and residents.