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MERCY MEMORIAL HOSPITAL SYSTEM
FAMILY MEDICINE RESIDENCY
PEDIATRIC EMERGENCY MEDICINE CURRICULUM (PGY-2)
Description of Educational Experience
The Pediatric Emergency Medicine Curriculum provides the family medicine physician
with the opportunity to develop competence in managing pediatric patients with acute
illness and injury of varying degrees of severity, from very minor to life-threatening. It is
a four week block rotation conducted within the second year of residency training, at the
Mercy Memorial Hospital Emergency Department.
Specific learning experiences of this rotation include the development of skills for
resuscitation, stabilization and triage of patients after initial evaluation, and interaction
with other professionals involved in emergency care in the emergency department. This
may include the trauma team, neonatal or pediatric teams, and other specialists from
fields such as anesthesia, radiology, dentistry, orthopedics, or surgery. Residents will also
be interacting with emergency medical personnel while preparing patients for transport or
the receipt of patients who have been transported via the EMS system, as well as initial
contact with safety officials from the justice and child welfare systems in the event of
suspected child abuse and neglect.
The Pediatric Emergency Medicine rotation provides the family medicine resident with
needed exposure to a large number of patients ranging in age from infancy through young
adulthood, with diverse healthcare problems of varying complexity. This rotation offers
experiences such as pediatric trauma that are not available in the family medical center,
as well as a variety of medical, psychosocial, and environmental illnesses and injuries
that are commonly encountered in the primary care setting.
Educational Goals:
The purpose of the Pediatric Emergency Medicine rotation is to provide family medicine
residents the opportunity to gain experience and competence in both common and
unusual pediatric illnesses and injuries of varying complexity. The emergency/trauma
department setting provides residents with exposure to pediatric patients from diverse
cultures, of mixed age range, with wide variances in physical, emotional, and
developmental characteristics, and the challenge of quickly examining, diagnosing, and
treating pediatric patients with emergent or life-threatening conditions.
Unfortunately, critically ill children may not survive a major trauma or acute illness, or
the future prognosis for full recovery is poor. Collaborative, supportive care of the
parents or caregivers, including family presence during invasive procedures, resuscitation
efforts, or at the time of death is a learning objective for this rotation.
Families present to the emergency setting with varying degrees of literacy, financial
resources, and psychosocial support systems. Underinsured or uninsured patients
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frequently use the emergency department as their primary care providers, and this may be
the only contact the patient has with the healthcare system. The physician needs to be
aware of possible difficulties in complying with prescribed treatment regimes, including
obtaining medications and accessing follow-up care. Discharge instructions or
explanations of the plan of care need to be appropriate to the educational, developmental,
and cultural level of the caregivers and patient.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health.
Competencies
Residents are expected to:
 Gather essential and accurate information about their patients
 Develop and carry out patient management plans
Objectives
The PGY-2 will be able to:
 Provide family-centered patient care that is compassionate and effective for the
treatment of illness and injuries in the emergent care setting
 Gather essential and accurate information about the patient and the specifics of
the medical condition for which they are seeking emergency care under timelimiting conditions
 Perform complete and accurate initial physical examinations and re-evaluations of
the unstable patient
 Demonstrate progressive ability to rapidly evaluate, diagnose, stabilize and treat
acutely and critically ill pediatric patients
 Select and interpret appropriate diagnostic studies in the evaluation of patients
 Determine which patients require in-hospital care and why, including medical,
psychosocial, and environmental considerations, as well as the level of care
needed (general floor vs. ICU)
 Recognize psychosocial issues affecting children and utilize appropriate
community resources and other therapeutic interventions to effectively manage
these issues
 Appropriately and safely use current technological equipment for monitoring or
diagnostic testing in the clinical care setting. Specific to this rotation, residents
may observe or be supervised in the use of:
1. Ultrasonography
2. Braslow Tapes
3. Invasive and noninvasive monitoring devices including ECG monitors,
end tidal CO2 monitors, pulse oximetry, and hemodynamic monitoring
4. Lumbar puncture
5. Radiant heat warmers
6. Rapid infuser devices
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Demonstrate basic clinical skills which may include but are not limited to:
1. Suturing and wound care
2. Blood sampling – arterial and venous catheterization
3. Placement of intravenous lines
4. Placement of intraosseous lines
5. Endotracheal intubation and mechanical ventilation
6. Chest tube insertion and management
7. PALS
8. Procedural sedation
9. Reduction and splinting and casting of simple dislocations/fractures
10. Simple removal of foreign bodies
11. Incision and drainage of superficial abscesses
Interpret with the assistance of a consultant the following diagnostic studies:
1. Ultrasound studies
2. Pediatric ECG rhythms
3. Radiographic, CT and MRI studies
4. Laboratory studies
Provide counseling and psychosocial support to families about possible or actual
complications, medical, surgical, or pharmacological therapeutic regimes, less
than optimal outcomes, and impending or actual death of a child
Provide patients with options for treatment based on the individual patient
situation as well as clinical information
Medical Knowledge
Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this
knowledge to patient care.
Competencies
Residents are expected to:
 Demonstrate an investigatory and analytic thinking approach to clinical situations
 Know and apply the basic and clinically supportive sciences which are
appropriate to their discipline
Objectives
The PGY-2 will be able to:
 Develop knowledge and skills in the following areas:
1. Pediatric history and physical exam
2. Normal pediatric growth and development
3. Current immunization requirements for pediatrics
4. Etiologies, significance, and treatment of fever and infection in children
5. Fluid and electrolyte management in children, including the calculation of
fluid and electrolyte replacement for volume depleted children
6. Pain management in children
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7. Specific problems of pediatric trauma victims
8. Manifestations and treatment of pediatric cardiac abnormalities
9. Pathophysiology etiologies, and treatment of common system disorders in
children, including respiratory, neurological, cardiac, endocrine,
hematologic, gynecologic, urologic, orthopedic and soft tissue conditions
10. Learn common dermatologic diseases and dermatologic manifestations of
systemic diseases in children
11. State and institutional specific reporting mechanisms for suspected child
abuse and neglect
Develop knowledge and skills in common pediatric invasive procedures which
may include:
1. Airway management and intubation
2. Arterial, venous, and intraosseous cannulation
3. Chest tube insertion
4. Lumbar puncture
5. Suturing and wound care
6. Hemodynamic monitoring
Develop knowledge and skill in the dosage and use of medications specific to
pediatrics
Develop knowledge and interpersonal skills when caring for the family of a
critically ill child, or a child with impending or actual death
Practice-based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of patients,
to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation and lifelong learning.
Competencies
Residents are expected to:
 Identify strengths, deficiencies and limits in one’s knowledge and expertise
 Set learning and improvement goals
 Identify and perform appropriate learning activities
Objectives
The PGY-2 will be able to:
 Appropriately identify gaps in knowledge
 Utilize available resources during the rotation to support and improve his/her own
learning (PDA, On-line resources etc.)
 Understand the concept of sentinel events or “near miss” events and know how to
assemble/work with a team who can evaluate and identify clinical practice or
environmental causes of injury and illness
 Use computers for word processing, reference retrieval, statistical analysis,
graphic displays, database management, and communication
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Systems-based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as, the ability to call effectively on other resources in the
system to provide optimal health care.
Competencies
Residents are expected to:
 Work in interprofessional teams to enhance patient safety and improve patient
care quality
Objectives
The PGY-2 will be able to:
 Demonstrate ability to work with a team of health care professionals to improve
quality of care
 Develop an awareness of and responsiveness to the larger context and system of
health care, as well as, the ability to call effectively on other resources in the
system to provide optimal health care
 Identify cost issues and use of resources in emergency/trauma care
 Identify elements key to patient safety such as the National Patient Safety Goals
for accuracy of identification and infection control
 Demonstrate appropriate use of referrals/consultations, including access to social
programs for the underinsured/uninsured
 Accept personal responsibility for improving patient safety and quality of care
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
Competencies
Residents are expected to:
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Show compassion, integrity, and respect for others
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Show respect for patient privacy and autonomy
Objectives
The PGY-2 will be able to:
 Follow all HIPPA guidelines
 Address the individual social and cultural needs of the patient
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Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and teaming with patients, their families, and
professional associates.
Competencies
Residents are expected to:
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Communicate effectively with patients and families across a broad range of
socioeconomic and cultural backgrounds
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Communicate effectively with physicians, other health professionals, and health
related agencies
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Recognize situations where consultations and referrals to other specialists are
necessary to effectively manage the care of the patient
Objectives
The PGY-2 will be able to:
 Convey the most important pieces of information to other health care
professionals during patient presentations
 Provide a primary care perspective while on specialty rotations
Learning Opportunities (residents)
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Direct patient care
Informal discussions
Mentoring/modeling
Formal didactics / Emergency Department presentations
Assessment Method (residents)
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Attending evaluation of the resident on New Innovations
Procedure evaluations: Procedure Log review at the end of the rotation
Resident performance on the annual In Training Examination
Assessment Method (Program Evaluation)
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Resident evaluation of rotation and the attending physician
Evaluation of the In Training Examination performance by resident year and by
overall program
Annual program review and assessment by residents and faculty
Graduate performance on ABFM certification examination
Level of Supervision
The resident functions under the direct supervision of the attending emergency room
physician.
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Educational Resources
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Evidence at point of care: UpToDate, Epocrates
Family medicine residents may complete appropriate sections of the Core Content
Review at www.corecontent.com for Adolescent, Pediatric-Neonatal, and/or
Urgent-Emergency
Major textbooks of Internal Medicine (Harrisons’, Cecil’s, etc.) and Family
Medicine (Rakel’s)
Common medical journals, such as the New England Journal of Medicine,
American Family Physician, Annals of Internal Medicine, Journal of the
American Medical Association
American Academy of Pediatrics website. www.aap.org
Assigned articles and searches in the course of care
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