Download Primary Goals for this Rotation - Stony Brook University School of

Stony Brook Pediatrics
Ward Rotation (Day Team)
Level-Based Goals and Objectives
Primary Goals for this Rotation
Competencies
GOAL I: Common Signs and Symptoms (Inpatient). Evaluate and manage
common signs and symptoms associated with acute illness and hospitalization.
1. Evaluate and manage, with consultation if indicated, patients with
signs and symptoms that commonly present to the Inpatient Unit
(examples below).
PL-1: Evaluate and manage routine cases
PL-2: Evaluate and manage moderately complex cases
PL-3: Evaluate and manage moderately complex and rare cases
a) General: acute life-threatening event (ALTE), constitutional
symptoms, hypothermia, excessive crying, failure to thrive,
fatigue, fever without localizing signs, hypothermia, weight
loss
b) Cardiorespiratory: apnea, chest pain, cough, cyanosis,
dyspnea, heart murmur, hemoptysis, hypertension,
hypotension, inadequate respiratory effort, rhythm disturbance,
shock, shortness of breath, stridor, syncope, tachypnea,
respiratory failure, wheezing
c) Dermatologic: ecchymoses, edema, petechiae, purpura, rashes,
urticaria
d) ENT: acute visual changes, conjunctival injection, edema,
epistaxis, hoarseness, nasal discharge, stridor, trauma
e) Endocrine: heat/cold intolerance, polydipsia, polyuria
f) GI/Nutrition/Fluids: abdominal masses or distention,
abdominal pain, ascites, dehydration, diarrhea, dysphagia,
hematemesis, inadequate intake, jaundice, melena, rectal
bleeding, regurgitation, vomiting
g) Genitourinary/Renal: change in urine color, dysuria, edema,
hematuria, oliguria, scrotal mass or edema
h) GYN: abnormal vaginal bleeding, pelvic pain, vaginal
discharge
i) Hematologic/Oncologic: abnormal bleeding, bruising,
hepatosplenomegaly, lymphadenopathy, masses, pallor
j) Musculoskeletal: arthritis/arthralgia, bone and soft tissue
trauma, limb pain, limp
k) Neurologic: ataxia, coma, delirium, diplopia, headache,
hypotonia, head trauma, lethargy, seizure, vertigo, weakness
K, PC, IPC,
SBP
l) Psychiatric/Psychosocial: acute psychosis, child abuse or
neglect, conversion symptoms, depression, suicide attempt
GOAL II: Common Conditions (Inpatient). Recognize and manage common
childhood conditions presenting to the Inpatient Unit.
2. Evaluate and manage, with consultation as indicated, patients with
conditions that commonly present to the Inpatient Unit (examples
below):
PL-1: Evaluate and manage routine cases
PL-2: Evaluate and manage moderately complex cases
PL-3: Evaluate and manage moderately complex and rare cases
e) General: failure to thrive, fever of unknown origin
f) Allergy/Immunology: acute drug allergies/reactions,
anaphylaxis, immunodeficiencies, including graft vs. host
disease, recurrent pneumonia, serum sickness, severe
angioedema
g) Cardiovascular: bacterial endocarditis, cardiomyopathy,
congenital heart disease, congestive heart failure, Kawasaki
disease, myocarditis, rheumatic fever
h) Endocrine: diabetes (including diabetic ketoacidosis),
electrolyte disturbances secondary to underlying endocrine
disease
i) GI/Nutrition: appendicitis, bleeding, cholangitis, complications
of inflammatory bowel disease, complications of liver
transplantation, cystic fibrosis, gastroenteritis (with/without
dehydration), gastroesophageal reflux, hepatic dysfunction
(including alpha-1-antitrypson disease), bowel obstruction,
pancreatitis, severe malnutrition
j) GU/Renal: electrolyte and acid-base disturbances,
glomerulonephritis, hemolytic-uremic syndrome, nephrotic
syndrome, urinary tract infection/pyelonephritis
k) Gynecologic: genital trauma, pelvic inflammatory disease,
sexual assault
l) Hematologic/Oncologic: abdominal and mediastinal mass,
common malignancies, fever and neutropenia,
thrombocytopenia, severe anemia, tumor lysis syndrome, vasoocclusive crises and other complications of sickle cell disease
m) Infectious Disease: cellulitis (including periorbital and orbital),
cervical adenitis, dental abscess with complications,
encephalitis, HIV, infections in immunocompromised hosts,
laryngotracheobronchitis, late presentation of congenital
infections (CMV, syphilis, tuberculosis, abscesses), line
infection, meningitis (bacterial or viral), osteomyelitis,
pneumonia (viral or bacterial), sepsis/bacteremia (including
newborns), septic arthritis, tuberculosis
n) Pharmacology/Toxicology: common drug poisoning or
overdose, dose adjustment for special conditions or serum drug
levels
o) Neurology: acute neurologic conditions (acute cerebellar
ataxia, Guillain Barre syndrome, movement disorders),
developmental delay with acute medical conditions, seizures,
shunt infections
p) Respiratory: airway obstruction, asthma exacerbation, bacterial
tracheitis, bronchiolitis, croup, cystic fibrosis, epiglottitis
q) Rheumatologic: Henoch Schonlein purpura (HSP), juvenile
rheumatoid arthritis (JRA), systemic lupus erythematosus
(SLE)
r) Surgery: pre- and post-op consultation and evaluation of
surgical patients (general, ENT, orthopedics, urology,
neurosurgical, etc.), special needs of technology-dependent
children (blocked trachea, gastric tube dysfunction)
GOAL III: Diagnostic and Screening Procedures (Inpatient). Utilize common
diagnostic tests and imaging studies appropriately in the inpatient setting.
1. Demonstrate an understanding of the common diagnostic
tests and imaging studies used in the inpatient setting, by being
able to:
PL-1: a – d;
PL-2 & PL-3: e - h
a) Explain the indications for and limitations of each
study.
K, PC
b) Know or be able to locate age-appropriate normal
ranges (lab studies).
K, PC
c) Discuss therapeutic options for correction of
abnormalities.
K, PC
d.) Recognize cost and utilization issues
e.) Recognize cost and utilization issues and apply to
patient care
f.) Interpret test results in the context of the specific
patient.
g.) Apply knowledge of diagnostic test properties, including
the use of sensitivity, specificity, positive predictive
value, negative predictive value, false-positive and
negative results, likelihood ratios, and receiver operating
characteristic curves, to assess the utility of tests in
various clinical settings.
h): Discuss and manage therapeutic options for basic and
complex laboratory abnormalities
3. Use common laboratory studies when indicated for patients in the
inpatient setting, such as:
PL-1: Understand indications for ordering basic laboratory studies
SBP
SBP
K, PC
K, PC, PBLI
SBP
K, PC
PL-2: Understand indications for ordering laboratory studies,
and indications for further work-up/follow-up;
PL-3: Understand how to differentiate between similar tests in
different contexts, and use evidence-based data to guide laboratory
evaluation.
a) CBC with differential, platelet count, RBC indices
b) Blood chemistries: electrolytes, glucose, calcium, magnesium,
phosphate
c) Renal function tests
d) Tests of hepatic function (PT, albumin) and damage (liver
enzymes, bilirubin)
e) Serologic tests for infection (e.g., hepatitis, HIV)
f) C-reactive protein, erythrocyte sedimentation rate
g) Therapeutic drug concentrations
h) Coagulation studies
i) Arterial, capillary, and venous blood gases
j) Detection of bacterial, viral, and fungal pathogens
k) Urinalysis
l) Cerebrospinal fluid analysis
m) Gram stain
n) Stool studies
o) Other fluid studies (e.g. pleural fluid, joint fluid)
p) Electrocardiogram
4. Use common imaging or radiographic studies when indicated for
patients on the inpatient unit.
PL-1: Understand indications for ordering basic radiographic studies
PL-2 & PL-3: Understand indications for ordering radiographic
studies, and indications for further work-up/follow-up; understand
how to differentiate between similar tests in different contexts.
a)Plain radiographs of the chest, extremities, abdomen, skull,
sinuses
K, PC
b)Other imaging techniques such as CT, MRI, angiography,
ultrasound, nuclear scans, contrast studies (interpretation not
expected)
c)Echocardiogram
GOAL IV: Monitoring and Therapeutic Modalities (Inpatient). Understand how
to use physiologic monitoring and special technology in the general inpatient
setting, including issues specific to care of the chronically ill child.
1. Demonstrate understanding of the monitoring techniques and
special treatments commonly used in the inpatient setting, by
being able to:
PL-1:
a) Discuss indications, contraindications and complications.
K, PC
b) Demonstrate proper use of technique for children of varying
ages.
c) Determine which patients need continuous monitoring or
special monitoring (e.g., neurological checks).
PL-2 & PL-3:
d) Interpret and respond appropriately to results of monitoring
based on method used, age and clinical situation.
2. PL-1: Understand the indications for appropriate monitoring
techniques in the inpatient setting such as:
PL-2 & PL-3: Understand, order and manage appropriate
monitoring techniques in the inpatient setting, such as:
a) Monitoring of temperature, blood pressure, heart rate,
respirations
b) Cardiac monitoring
c) Pulse oximetry
K,PC
3. Use appropriately the treatments and techniques used in the
inpatient setting, such as:
PL-1: Discuss indications, contraindications and complications
PL-2 & PL-3: Understand, order and manage appropriate
treatments and techniques in the inpatient setting, such as
a)
b)
c)
d)
e)
f)
g)
h)
Universal precautions
Nasogastric tube placement
Administration of nebulized medication
Injury, wound and burn care
Oxygen delivery systems
I.V. fluids
I.V. pharmacotherapy (antibiotics, antiepileptics, etc.)
Transfusion therapy
K, PC
4. PL-1: Describe key issues in the inpatient and home management
of the technology-dependent child with the following care needs:
PL-2, PL-3: Arrange follow-up and guidance re: home care needs
of the technology-dependent child:
a)
b)
c)
d)
e)
5.
Tracheostomy
Chronic mechanical ventilation
Chronic parenteral nutrition (HAL)
Gastrostomy tube for feedings
Permanent central venous catheter
K, PC, SBP
K, PC, IPC
PL-1: Recognize normal and abnormal findings at
tracheostomy, gastrostomy, or central venous catheter
sites, and
PL-2 & PL-3: demonstrate appropriate intervention or referral for
problems encountered.
6. Demonstrate the skills for assessing and managing pain.
PL-1:
a) Use age-appropriate pain scales in assessment.
b) Describe indications for use and side effects of common
narcotic and non-narcotic analgesics.
PL-2
c) Administer medications to control pain in appropriate
dose, frequency and route.
K, PC
PL-3:
d) Describe indications for and use of behavioral techniques and
supportive care, and other non-pharmacologic methods of pain
control.
GOAL V: Provide family-centered patient care that is developmentally
and age-appropriate, compassionate, and effective for the treatment of
health problems and the promotion of health.
PL-1: Use a logical and appropriate clinical
approach to the care of hospitalized patients,
including:
a) Careful data collection and synthesis
b) Appropriate orders for vital signs, I & Os,
medications, nutrition, activity
c) Well thought-out daily care plans
PL-2: Use a logical and appropriate clinical approach to the
care of hospitalized patients, applying principles of evidencebased decision-making and problem-solving, demonstrating:
d) Careful data collection and synthesis
e) Appropriate orders for vital signs, I & Os,
medications, nutrition, activity
f) Well thought-out daily care plans
g) Good clinical judgment and decision-making
h) Careful discharge plans (orders, patient
education, follow-up)
i) Prioritize care based on acuity
K, PC, IPC, P,
SBP
PL-3: In addition to the above, provide leadership to junior
residents in leading rounds and teaching regarding the care of
patients and their families in all aspects listed above.
PL-1, PL-2, Pl-3:
2. Provide sensitive support to patients with acute and
chronic illnesses and to their families, and arrange
for ongoing support and services at discharge.
IPC, P, SBP
GOAL VI: Understand the scope of established and evolving biomedical,
clinical, epidemiological and social-behavioral knowledge needed by a
pediatrician; demonstrate the ability to acquire, critically interpret and
apply this knowledge in patient care.
PL-1, PL-2, PL-3:
1. Demonstrate a commitment to acquiring the base of
knowledge needed to care for children in the
inpatient setting.
K, PBLI
2. Know and/or access medical information
efficiently, evaluate it critically, and apply it to
inpatient care appropriately.
K, PC, PBLI
PL-2:
PL-3:
3. Evaluate medical information
efficiently and critically, and apply such
knowledge in cases in which clinical
decision-making is ambiguous or
complicated.
K, PC, PBLI
GOAL VII: Demonstrate interpersonal and communication skills
that result in information exchange and partnering with patients,
their families and professional associates.
PL-1:
1. Provide effective patient education, including
reassurance, for condition(s) commonly seen on the
inpatient service.
2. Maintain accurate, legible, timely and legally appropriate
medical records.
3. Document changes in status or management plans for
patient with “event’ or “on call” notes.
4. Present focused questions (written and verbal) to consultants.
K, PC, IPC
IPC
K, PC, IPC
IPC
PL-2 & PL-3:
5. Participate and communicate effectively as part of an
interdisciplinary team, as both the primary provider and
IPC, P
the consulting pediatrician (e.g., patient presentations,
sign-out rounds, communication with consultants and
primary care physicians of hospitalized patients).
PL-2 & PL-3
6. Develop effective strategies for teaching students,
colleagues, other professionals and laypersons.
IPC
(applies to supervising residents)
7.
Demonstrate leadership skills:
a) Contribute to teaching on attending rounds.
IPC, P
b) Supervise interns and students
appropriately (assist with procedures,
confirm follow up on tasks…)
GOAL VIII: Demonstrate knowledge, skills and attitudes needed for
continuous self-assessment, using scientific methods and evidence to investigate,
evaluate and improve one's patient care practice.
PL-1: Be able to obtain appropriate information
PL-2 & PL-3: Be able to obtain and critically appraise
appropriate information
PBLI
0. Use scientific methods and evidence to investigate,
evaluate and improve one's patient care practice in the
inpatient setting.
1. Identify personal learning needs, systematically organize
relevant information resources for future reference, and
plan for continuing acquisition of knowledge and skills.
PBLI
GOAL IX: Demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to
diversity.
PL-1, PL-2, PL-3:
1. Demonstrate personal accountability to the well being of
patients (e.g., evaluating patients and reviewing charts
before work rounds, following-up on lab results, writing
comprehensive notes, and seeking answers to patient
care questions).
P
PL-1, PL-2, PL-3:
2. Demonstrate a commitment to professional behavior in
interactions with staff and professional colleagues.
P
PL-1, PL-2, PL-3:
3. Adhere to ethical and legal principles, and sensitivity to
diversity while providing care in the inpatient setting.
PL-2 P PL-1, PL-2, PL-3:
4. Demonstrate honesty and reliability
P
P
1, PL-2, PL-1, PL-2, PL-3:
Receptive and responsive to constructive criticism
P
GOAL X: Understand how to practice high-quality health care and
advocate for patients within the context of the health care system.
PL-1:
1. Be aware of and identify key aspects of health care systems,
cost control, billing and reimbursement in the hospital
inpatient setting.
SBP
PL-2, PL-3:
2. When providing care in the inpatient setting, consider
cost and resource allocation without compromising
quality of care.
SBP
PL-1:
3. Take steps to avoid medical errors by
recognizing the limits of one's
knowledge and expertise;
PL-2, PL-3:
SBP
4. Work with the health care team to
recognize and address systems errors.
Procedures
GOAL XI: Technical and therapeutic procedures.
PL-1: Describe the following procedures; how they work and when they should be
used;
PL-2: Describe the following procedures; how they work and when they should be
used; competently perform those commonly used by the pediatrician in practice.
PL-3 (optional): Describe the following procedures; how they work and when they
should be used, competently perform those occasionally or rarely used by the general
pediatrician in practice.
Pain management
K, PC
Arterial puncture
K, PC
Bladder: catherization
K, PC
Central line: use/care
K, PC
Chest physiotherapy
K, PC
Gastric tube placement (OG/NG)
K, PC
Intravenous line placement
K, PC
Lumbar puncture
K, PC
Medication delivery: IM/SC/ID
K, PC
Medication delivery: inhaled
K, PC
Medication delivery: IV
K, PC
Medication delivery: rectal
K, PC
PPD: placement
K, PC
Pulmonary function tests: peak flow meter
K, PC
Pulmonary function tests: spirometry
K, PC
Pulse oximeter: placement
K, PC
Rectal swab
K, PC
Sterile technique
K, PC
Suctioning: nares
K, PC
Suctioning: oral pharynx
K, PC
Suctioning: tracheostomy
K, PC
Venipuncture
K, PC
GOAL XII: Diagnostic and screening procedures.
PL-1: Describe the following procedures; how they work and when they should be
used;
PL-2: Describe the following procedures; how they work and when they should be
used; competently perform those commonly used by the general pediatrician in
practice.
PL-3 (optional): Describe the following procedures; how they work and when they
should be used, competently perform those occasionally or rarely used by the general
pediatrician in practice.
ECG: emergency interpretation
K, PC
ECG: perform
K, PC
Electroencephalogram (EEG)
K, PC
pH probe (Tuttle test)
K, PC
PPD: interpretation
K, PC
Monitoring interpretation: cardiac
K, PC
Monitoring interpretation: Holter
K, PC
Monitoring interpretation: pulse oximetry
K, PC
Monitoring interpretation: respiratory
K, PC
Pulmonary function tests: interpretation
K, PC
Radiologic interpretation: abdominal ultrasound
K, PC
Radiologic interpretation: abdominal X-ray
K, PC
Radiologic interpretation: chest X-ray
K, PC
Radiologic interpretation: CT of head
K, PC
Radiologic interpretation: extremity X-ray
K, PC
Radiologic interpretation: GI contrast study
K, PC
Radiologic interpretation: MRI of head
K, PC
Radiologic interpretation: nuclear medicine GI scanning
K, PC
Radiologic interpretation: renal ultrasound
K, PC
Radiologic interpretation: skeletal X-ray (incl. abuse)
K, PC
Radiologic interpretation: CT of the sinuses
K, PC
Radiologic interpretation: voiding cystourethrogram
K, PC
Core Competencies: K Medical Knowledge
PC - Patient Care
IPC - Interpersonal and Communication Skills
PProfessionalism
PBLI - Practice-Based Learning and Improvement
SBP - Systems-Based Practice
Performance Expectations by Level of Training
Beginning
Developing
Accomplished
Competent
Description of
identifiable
performance
characteristics
reflecting a
beginning level of
performance.
Description of identifiable
performance
characteristics reflecting
development and
movement toward
mastery of performance.
Description of
identifiable
performance
characteristics
reflecting near
mastery of
performance.
Description of identifiable
performance
characteristics reflecting
the highest level of
performance.
Medical
Knowledge
Patient Care
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1, PL2
PL2, PL3
PL3
Interpersonal and
Communication
Skills
Professionalism
Practice-Based
Learning and
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1
PL1, PL2
PL2, PL3
PL2, PL3
PL3
PL3
Improvement
Systems-Based
Practice
PL1
PL1, PL2
PL2, PL3
PL3