Download Pediatrics Clerkship BCC 6141 2003 – 2004 Course Syllabus

Pediatrics Clerkship
BCC 6141
2003 – 2004 Course Syllabus
FACULTY
Education Director Pediatrics Harold Bland, M.D.
Work phone:
850-644-2346
Office Location:
FSUCOM Faculty Annex
Pensacola Co-Clerkship Director Michelle Grier
Work phone:
850-478-6060x6610
Office Location:
Pensacola
Pensacola Co-clerkship Director Bob Wilson
Work phone:
850-478-6060x6610
Office Location:
Pensacola
Orlando Clerkship Director Joan Meek, M.D.
Work phone:
407-835-4103
Office Location:
Orlando
Pediatrics Clerkship Competencies and Learning Objectives
Competencies are broad statements of educational goals that serve to help
define and organize the specific learning objectives (knowledge, attitudes, and/or
skills) that a student would need to master in order to achieve competency in a
particular domain. The competency “domains” (bold type) cut across the entire
curriculum from first year to graduation.
Learning objectives (aka behavioral objectives, learning outcomes, etc.) are specific
statements describing what the student is to accomplish as a result of participating
in the clerkship for a period of six weeks. Learning objectives are grouped under
each competency area.
Essential Clinical Knowledge and Skills
Competencies
The competent student:
•
•
•
•
elicits an accurate and efficient medical history and performs an accurate and
efficient physical examination, appropriate to the patient and setting;
correctly determines when to perform a comprehensive or focused history and
physical examinations;
selects, performs, and interprets appropriate diagnostic or treatment
procedures and makes appropriate referrals for diagnostic or treatment
procedures beyond the scope of his/her experience and expertise;
develops a differential diagnosis and chooses appropriate diagnostic and
•
•
•
•
•
•
management plan;
is able to access decision-support resources (e.g., clinical guidelines,
treatment algorithms, and other evidence-based guidelines and resources)
and employs principles of evidence-based medicine in the diagnosis and
treatment of acute and chronic illnesses;
is knowledgeable about the diagnosis and management of common acute
ailments;
is knowledgeable about the on-going management of chronic diseases;
integrates health promotion and disease prevention into his/her practice;
is a knowledgeable patient educator and employs behavior change
techniques;
assesses pain and enhances patient comfort.
Topic: Pediatric Physical Examination
Learning Objectives
Students will:
Physical Exam
1.
Establish rapport with children of various ages in order to perform the
physical examination.
2.
Recognize that the age of the child influences the areas included in the
exam, as well as the order of the examination, and the approach to the
patient.
3.
Recognize the important role of observation as a method of obtaining data
in the assessment of the child.
4.
Perform a complete physical examinations on an infant, child and
adolescent, including the observation and documentation of normal physical
findings.
5.
Demonstrate the appropriate use of the limited or focused examination,
particularly in the ambulatory setting.
6.
Use developmental assessment as part of the physical examination for all
ages.
7.
Observe how normal behaviors, such as stranger anxiety, affect the ability
of the examiner to perform the examination, and develop strategies for
improving rapport.
8.
Perform the Denver Developmental Screening Test, and know how it is
used to assess motor, language and social development.
9.
Identify the physical changes of puberty and be able to conduct Tanner
staging.
10. Observe and demonstrate physical exam findings unique to the pediatric age
group, and understand how findings have different clinical significance
depending on the age of the child. Some examples are:
Appearance
·
Recognize signs of acute illness in an infant, toddler and child by evaluating
skin color, respiration, hydration, mental status, cry and social interaction
·
Recognize the importance of observing the psychosocial condition of the
child, including behavior, development, body habitus (height, weight, body
fat), relationship to parent and examiner, and general condition.
Vital signs
·
Measure heart rate, respiratory rate, blood pressure and temperature in an
infant and child, demonstrating knowledge of the appropriate sized blood
pressure cuff, interval to count respirations, and normal variation in
temperature depending on the route of measurement (oral, rectal, axillary or
tympanic)
·
Understand that normal values of heart rate, respiratory rate and blood
pressure change with age
·
Recognize the importance of assessing vital signs in the evaluation of acute
illness.
Measurements
·
Accurately measure height, weight and head circumference
·
Plot the data on an appropriate growth chart
·
Understand the normal relationships between height, weight and head
circumference
·
Recognize the usefulness of longitudinal data
HEENT
·
Identify the anterior and posterior fontanels and assess them for fullness
or turgor
·
Recognize the need for careful observation of the head size and shape,
symmetry, facial features, ear size and hair whorls as part of the examination
for dysmorphic features
·
Recognize the red reflex and strabismus
·
Assess hydration of the mucous membranes
·
Examine the tympanic membranes using pneumatic otoscopy
Neck
·
Palpate lymph nodes, know what anatomic areas they drain
·
Know that lymph nodes are more prominent during childhood
·
Recognize and demonstrate maneuvers that test for nuchal rigidity
Chest
·
Recognize how the rate and pattern of respirations change with age, and
that abdominal respirations are normal in infants
·
Observe the rate and effort of breathing as a measure of respiratory
distress
·
Recognize stridor, wheezing and rales and be able to distinguish between
inspiratory and expiratory obstruction
·
Interpret less serious respiratory sounds such as transmitted upper airway
sounds
Cardiovascular
·
Palpate pulses in the upper and lower extremities
·
Auscultate the heart for rhythm, rate, quality of the heart sounds and
murmurs
Abdomen
·
Understand that the liver edge, spleen tip and kidneys may be palpable in
the normal newborn
·
Examine the umbilical cord for signs of infection
·
Examine the abdomen for distention, tenderness, rebound and mass
lesions in an infant or young child with lethargy, irritability or signs of acute
illness, noting the inability of the patient to communicate symptoms of
abdominal complaints
·
Be able to do a rectal examination and recognize when it is indicated
Genitalia
·
Recognize the appearance of normal male and female genitalia in the
newborn
·
Recognize abnormalities, including cryptorchidism, hypospadias, testicular
mass in the male
·
Be able to examine the external genitalia of a female patient
·
Recognize the need for privacy at all ages
Extremities
·
Examine the hips of a newborn for dysplasia
·
Recognize arthritis
·
Evaluate gait and limp
Back
·
Know how to test for scoliosis.
Neurologic examination
·
Elicit primitive reflexes
·
Assess tone, gait, strength and reflexes, recognizing the importance of
symmetry
·
Assess developmental milestones
·
Recognize that much of the neurologic examination of infants and children
is accomplished through observation alone
Skin
·
Recognize jaundice, petechiae, purpura, common birth marks (such as
nevus flammeus and Mongolian spots), vesicles, urticaria and common
rashes, such as erythema toxicum, impetigo, eczema, diaper dermatitis and
viral exanthems
·
Recognize common skin findings associated with child abuse
·
Assess skin turgor
Topic: Healthy/Well Child/ Health Supervision
Learning Objectives
Students will:
1.
2.
3.
4.
5.
6.
Accurately measure height, weight, and head circumference (when
appropriate) and plot the data on chart.
Provide routine post delivery newborn care and recognize unique features of
a newborn exam (such as APGARS, AGA, SGA, LGA, newborn screening,
assessment of hip dysplasia, Vitamin K, Hepatitis B, universal hearing
screening and ophthalmological prophylaxis).
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).
Screen for anemia, lead poisoning, elevated blood pressure,
hypercholesterolemia, TB, visual problems, hearing problems, and renal
disease in accordance with the AAP guidelines.
Gather health supervision data on immunizations, sexuality, and /or
substance abuse data from a focused history and physical examination.
Perform appropriate developmental screening (developmental questionnaire,
Denver Developmental Screening Test; Tanner staging) on all appropriate
patients as part of the health maintenance visit or inpatient evaluation. The
student must be able to recognize 2 appropriate actions or attributes for each
7.
8.
9.
age.
Elicit age appropriate behavioral concerns during the health supervision visit
(e.g., infant; sleep problems; toddler/preschool: temper tantrums, toilet
training, eating problems; elementary school age: enuresis, attention deficit
disorder; middle school/high school: conduct disorders, eating disorders, risk
taking behaviors).
Conduct a health maintenance visit on healthy adolescents incorporating
preventive counseling and identification of risk behavior in these key areas:
sexuality/sexual activity (contraception, sexual orientation, and sexually
transmitted diseases), substance abuse, and personal safety (firearms,
violence, motor vehicles).
Provide anticipatory guidance and prevention regarding home safety,
appropriate techniques to prevent accidental ingestions, use of the poison
control center, and immunization in every clinical encounter.
Topic: Growth and Development
Learning Objectives
Students will:
1. Interpret data plotted on an appropriate growth chart.
2. Identify abnormalities on a growth chart which warrant future evaluation, such as
crossing lines on a growth chart, discrepancies between height, weight, and
head circumference, short stature, failure to thrive, obesity, microcephaly,
and macrocephaly.
3. Determine whether a child is receiving adequate calories.
4. Develop a brief differential diagnosis and initial evaluation of failure to thrive that
includes psychosocial factors.
5. Develop a brief differential diagnosis of short stature.
6. Interpret the results of commonly ordered laboratory tests such as: complete
blood count, urinalysis, blood chemistries, thyroid functions, and
radiographs.
Topic: Nutrition
Learning Objectives
Students will:
1. State the calories/kg/day needed for normal growth in infants and small children.
2. Identify the major differences between human milk and commonly available
formulas.
3. Describe the advantages of breast feeding and recognize common difficulties
experienced by breast-feeding mothers.
4. Identify factors that contribute to the development of obesity or failure to thrive
in childhood. 5. Indicate which vitamins and minerals commonly require
supplementation in infants, children and adolescents.
6. Explain why chronically ill children may have special nutritional needs requiring
unique diets, supplements, or feeding methods.
7. Identify ways diet can be an essential aspect of treatment of these children.
8. Provide nutritional advice that is correct and understandable to families
regarding: -infant breast feeding vs. formula feeding
-when and how solids are added to an infant’s diet
-when to introduce cow’s milk (importance of fat content)
10. Provide advice to families about the dietary prevention and treatment of
common pediatric mineral (iron, fluoride, calcium) and vitamin deficiencies.
11. 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).
12. Explain the basis for the need for fluoride supplementation.
Topic: Behavior and Development
Learning Objectives
Students will:
1. Identify behavioral and psychosocial problems using the medical history and
physical examination.
2. Describe the typical presentation of common behavioral problems at various
developmental levels and ages (e.g. infant: sleep problems, colic;
toddler/preschool: temper tantrums, toilet training, eating problems;
elementary school age: enuresis, encopresis, school phobia, attention deficit/
hyperactivity disorder; middle school/high school: conduct disorders, eating
disorders, risk taking behaviors).
3. Discuss guidelines for effective discipline of children.
4. Give examples of how somatic complaints may have a psychosocial contribution
(e.g. chronic nonspecific abdominal pain, headache, fatigue, and neurological
complaints).
5. Explain how family pathology contributes to childhood behavior problems (e.g.
alcoholism, domestic violence, depression).
6. Describing how the following developmental issues are important in clinical care:
- Infant: Changes in reflexes, tone and posture; cephalocaudal
progression of motor milestones during the first year; stranger
anxiety.
- Toddler/Child: Separation and autonomy in two to three-year olds;
concept of school readiness.
- Adolescent: Sequence of physical maturation and sexual maturity
rating (Tanner); stages of emotional development.
7. Identify early signs of mental retardation, cerebral palsy, and school failure.
8. Describe the appropriate use of the Denver Developmental Screening Test
(DDST).
9. Perform appropriate developmental screening (e.g. DDST) on patients as part of
the health maintenance visit or inpatient evaluation.
10. Explain to parents and adolescents the main adolescent developmental changes
that are important for them to know.
11. Perform the sexual maturity rating (Tanner).
Topic: Prevention of Illness and Injury
PRIVATE Learning Objectives
Students will:
·
Summarize the basic types of illness and injury prevention
anticipatory guidance routinely provided at different ages.
·
Identify resources to determine the immunizations currently
recommended from birth through adolescence including
adverse side effects and contraindications of each.
·
Describe how risk of illness and injury changes during
growth and development and give examples of the age-and
development-related spectrum of illness and injury.
·
Outline the physician's role in the prevention of sports
injuries and describe how the risks of injury vary with pubertal
development.
·
State the rationale for universal newborn immunization for
hepatitis B.
·
Assess the immunization status of an infant, child, or
adolescent during a health care visit.
·
Conduct a discussion about immunizations with the family of
an infant, a toddler and a child about to enter school. Include
immunization side effects in the discussion.
·
Counsel an adolescent about hepatitis B prevention.
·
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.
Topic: Newborn Problems
Learning Objectives
Students will:
1.
Describe the important historical information, physical exam findings, and
laboratory data helpful in developing the differential diagnosis newborns with
the following presentations:
o
o
o
o
o
o
o
o
o
Jitteriness or Seizures
Jaundice
Lethargy or poor feeding
Sepsis
Cyanosis
Respiratory Distress
Hypoglycemia
Non-Bilious Vomiting
Bilious Vomiting
Topic: Common Acute Clinical Problems
Learning Objectives
Students will:
1. Describe the important historical information, physical exam findings, and
laboratory data helpful in developing the differential diagnosis for the
following list.
o
Cough
o
Fever
o
Sore throat
o
Ear Pain
o
Abdominal Pain
o
Vomiting
o
Diarrhea
o
Rash/Dermatitis
o
Joint/limb problems
o
CNS problems
o
Heart Murmur
o
Pallor/Anemia
o
Brusing/Petechiae
o
Hematuria
o
Proteinuria
2. Describe the signs and symptoms of the above (number 1) clinical presentations.
3. Develop a treatment plan (including a prescription, as appropriate) for the above
(number1) clinical presentations.
4. Obtain and interpret age appropriate vital signs (temperature, respiratory rate,
heart rate, and blood pressure).
5. Perform otoscopy and recognize normal landmarks in the ear, acute otitis and
serous otitis.
Topic: Chronic Illnesses
Learning Objectives
Students will:
1. Describe the important historical information, physical exam findings, and
laboratory data helpful in developing the differential diagnosis for the
following list:
o
Allergies
o
Asthma
o
HIV
o
Diabetes
o
Sickle Cell
2. Perform an initial history and physical examination on a new patient who presents
with a chronic illness. Include assessment of growth and pubertal development.
3. Take an interval history and problem focused exam on a patient seen in follow up
for their chronic disease.
4. Describe the impact a chronic illness such as cancer, sickle cell disease, asthma,
or cystic fibrosis has on growth and development.
5. Recognize common psychological complications of chronic illness. Identify the
factors that contribute to family stress and disruption within the family of a
chronically ill child. Explain how the impact of chronic illness for the patient and
family changes as the child matures through adolescence.
6. Discuss factors such as dosing schedule, frequency of follow up, etc. that affect
the compliance with treatment regimens.
7. Outline the basic management for a child who presents with the following chronic
disease: allergic rhinitis, chronic urticaria, asthma, sickle cell disease, seizure
disorder, insulin dependent diabetes mellitus, cystic fibrosis, hemophilia, childhood
malignancies.
8. Identify the clinical signs and symptoms of the common complications of the
listed chronic diseases.
9. Explain the rationale behind common anticipatory guidance issues relative to the
common chronic illnesses listed.
10. Explain the role of multi-disciplinary teams in the management of the medically
complex child or a child with a chronic illness. Identify the social support services
available
11. Describe the financial and social costs of managing a child with chronic illness.
12. Interact effectively with other members of a multi-disciplinary team caring for
the child with a chronic illness.
13. 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.
Topic: Fluid and Electrolytes
Learning Objectives
Students will:
1.
2.
3.
4.
5.
6.
Explain/Describe the following, relative to a pediatric patient requiring
maintenance fluids:
Pathophysiology of hypernatremic and hyponatremic dehydration.
Daily water and electrolyte requirements
Factors which increase daily fluid requirements.
Conditions in which fluid administration may need to be restricted
(Syndrome of inappropriate ADH secretion (SIADH), congestive heart
failure, renal failure)
Explain/Describe the following, relative to a pediatric patient requiring a fluid
deficit replaced:
Causes of excessive fluid loss leading to dehydration.
Clinical complications of electrolyte disturbances, including
hypernatremia, hyponatremia, hyperkalemia, and acidosis.
Effect of pH on serum potassium levels.
Electrolyte composition of standard oral and IV solutions.
Appropriate laboratory studies and their interpretation.
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.
7.
Topic: Child Abuse
Learning Objectives
Students will:
1.
Describe the physical and behavioral signs of physical abuse, sexual abuse
and neglect.
List the risk factors for domestic violence and child abuse.
Describe the specific types of patterns of injury that suggest physical abuse.
List which family, social and environmental history items are important when
considering possible abuse.
Summarize the physical findings expected in an infant who has been
subjected to abuse by shaking (e.g. shaken baby syndrome).
Ask appropriate questions during the 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.
2.
3.
4.
5.
6.
7.
Professional Attitudes, Values, and Behaviors
Competencies
The competent student:
•
•
•
•
•
demonstrates commitment to service, excellence, and personal integrity;
honors the duties, responsibilities, and privileges that are intrinsic to the role
of physician;
recognizes an obligation to serve patients and their families to very best of his
or her abilities;
recognizes an obligation to serve the community at large and to represent the
profession in an exemplary fashion;
demonstrates willingness to work collaboratively with other health
professionals in meeting the health care needs of individuals and
communities.
Learning Objectives:
Students will:
1. Display a commitment to service, excellence, and personal integrity by:
A. Being cognizant of clinical guidelines and following those guidelines
appropriately.
B. Recording information accurately on patient charts
2. Honor the duties, responsibilities, and privileges intrinsic to the role of the
physician by:
A. Being punctual for all clinical responsibilities.
B. Showing responsiveness to patient and/or family members’ requests for
information through giving honest and appropriate answers.
3. Display the recognition of the obligation to serve patients and their families to the
very best of their abilities by:
A. Expressing the willingness to treat patients regardless of pay status.
B. Volunteering to provide patient care in “free” clinics as available.
4. Display the following knowledge and behaviors that demonstrates a recognition of
the obligation to serve the community at large and to represent the
profession in an exemplary fashion:
A. Accompany preceptor and participate with him/her in community health
related projects.
5. Displays the following knowledge and behaviors to demonstrate the willingness to
work collaboratively in meeting the health care needs of individuals and
communities:
A. Describe the characteristics of an effective and collaborative health care
team.
B. Participates in patient care as a team member with the preceptor and
his/her health care staff.
C. Name health care professionals and organizations that can be a resource
in the care of specific patients.
Moral Reasoning and Ethical Judgment
Competencies
The competent student:
•
•
•
recognizes the moral and ethical dimensions of clinical practice;
strives to honor patient values and preferences while preserving his/her own
sense of ethical and moral integrity;
is aware of the fundamental differences between legal principles (i.e., what is
required and permissible under the law) and ethical principles (i.e., what is
the “right” or “wrong” thing to do in any given case);
Learning Objectives
Students will:
1. Demonstrate knowledge of the moral and ethical dimensions of clinical practice
by:
A.
B.
locating and explaining the laws pertaining to the identification and
reporting of child abuse.
locating and explaining the laws pertaining to the treatment of
C.
adolescents, including issues of confidentiality and parental consent.
Bringing to the preceptor’s attention any suspicion of child abuse.
2. Demonstrate the effort to honor patient values and preferences while preserving
his/her own sense of ethical and moral integrity by:
A.
B.
appropriately challenging the pediatric patient when his/her behavior is
contrary to the enhancement of good health and personal safety.
negotiating with the patient and family to provide care which is as
patient centered as possible.
3. Demonstrates awareness of fundamental differences between legal principles
(i.e., what is required and permissible under the law) and ethical principles
(i.e., what it “right” or “wrong” thing to do in any given case) by:
A.
B.
Giving an example in pediatrics of a pediatrician choosing to follow
ethical principles as opposed to legal principles.
Identifying the conflict between a legal principle and an ethical
principle in real and hypothetical situations (e.g. a case being
discussed in a small group).
Communicating with Patients, Families, and Colleagues
Competencies
The competent student:
•
•
•
•
demonstrates effective verbal, non-verbal, and written communication skills;
effectively elicits information from patients and their families and clearly
conveys information to patients and their families in ways that maximize
understanding, retention and recall;
employs verbal and non-verbal skills to build trusting, therapeutic
relationships
communicates effectively, clearly, and accurately with colleagues, other
health care professionals, health care organizations faculty, and staff in oral
and written communications in keeping with HIPA guidelines.
Learning Objectives
Students will:
1.
Demonstrate knowledge and skill in demonstrating effective verbal, nonverbal, and written communication skills by:
A. Describing the characteristics of effective vs. ineffective verbal and nonverbal communication skills with patients and patient families. Include
in the explanation factors such as:
communicating to both patient and family simultaneously
comparisons of care that is, “physician-centered” vs. “patient
centered” vs. “relationship-centered.”
B. Displaying
-
the following non-verbal behaviors with patients/families:
listening attentively without interrupting.
making appropriate eye contact
appropriate physical contact (therapeutic touch)
C. Displaying the following verbal behaviors with patients/families:
appropriately greeting patient/family
introducing him/her self as a medical student
making empathic statements
periodically summarizing what patient/family has said and
checking for correct interpretation
summarizing and asking for additional questions or closing
statement at the end of the interview.
3.
Effectively elicit information from patients and their families by displaying
the following behaviors/characteristics:
A.
condition
B.
5.
Obtaining a medical history from a second party (usually the parent).
C.
Observing rules of privacy and confidentiality in older children and
adolescents.
D.
Obtaining a relevant history that is unique to pediatrics including (1)
past history (e.g. neonatal history, immunizations, development, diet,
etc.), (2) family history (e.g. number and ages of siblings, known
genetic disorders, etc.), (3) social history (e.g. assessment of home
environment, peer relationships), and (4) review of systems.
E.
4.
Interviewing patients/families appropriately (e.g. complete history, vs.
focused history) in a variety of clinical settings including:
initial history for a hospital admission
initial history for a first ambulatory visit
health maintenance visit
acute care visit
interim visit for a child with an acute or chronic health
Modifying the medical history depending on the age of the child, with
particular attention given to the following age groups; neonate, infant,
toddler/preschool aged child, school age child, adolescence.
Effectively convey information to patients/families in a way that promotes
understanding by displaying the following behaviors/characteristics:
A. Using language and terminology understandable to patient/family.
B. Providing essential information and not providing non-essential
information that may cause confusion.
C. Providing written information about the disease/condition at the
appropriate reading level of the patient/family.
D. Asking the patient/family to verbalize their understanding of disease,
condition, directions for administering/taking medications
Employ verbal and non-verbal skills to build trusting, therapeutic
relationships by displaying the following behaviors/characteristics:
A. Greeting the patient/family in a warm and friendly manner.
B. Making appropriate eye contact with patient and family members.
C. Repeating and rephrasing patient responses to questions.
D. Maintaining appropriate confidentially.
E. “Listening” to the patient/family story without passing judgment.
F. Identifying the primary concerns of the patient/family
G. Obtaining patient and family input relative to therapeutic strategies.
Communicate effectively, clearly, and accurately with colleagues, other
health care professionals, health care organizations faculty, and staff in oral
and written communications in keeping with HIPPA guidelines by:
A. Write a complete summary of the history and physical examination in a
timely manner which is suitable to place in the patient’s chart.
B. Write prescriptions that meet the following criteria:
Legible
Proper format
Complete information
*Date prescribed
*Patient name (at least first and last) and address
*Drug name, strength, dosage form, and quantity to
dispense
*Clearly stated instructions for use (i.e., not “use as
directed”), including proper use of abbreviations
*Prescriber name and address
*Refill information
Fulfill legal requirements (included in the “Information”
section above, relating to date, patient information, and
prescriber information)
C. Present a complete, well organized summary of the findings of the
patient’s history and physical examination, modifying the presentation
to fit the situation.
D. Explain the thought process that led to the diagnostic and therapeutic
plan.
E. Precisely describing the physical findings and avoiding vague terms and
jargon, such as “clear” and “WNL.”
7.
Application of Basic Biomedical and Behavioral Sciences to Patient Care.
These competencies cover the basic biomedical, behavioral, and quantitative
sciences identified by the National Board of Medical Examiners (NBME) as being
necessary for the competent practice of medicine. The NBME web site has a
comprehensive list of knowledge objectives that are assessed by steps 1 and 2 of the
USMLE . (Please see www.usmle.org/step1 and www.usmle.org/step2 )
Competencies:
The competent student:
•
•
Applies knowledge of the various causes of disease (genetic, developmental,
metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative,
traumatic, environmental and psychosocial) to the diagnosis and
management of specific patient presentations;
Applies principles of biostatistics, probabilistic reasoning, and epidemiology to
•
an understanding of disease processes and diagnostic and treatment decisionmaking;
Demonstrates context sensitive application of behavioral and developmental
theories and principles in the diagnosis and management of specific patient
presentations.
Learning Objectives
Students will:
1. Demonstrate knowledge of the various causes of disease (genetic, development,
metabolic, toxic, microbiological, autoimmune, neoplastic, degenerative,
traumatic, environmental and psychosocial) to the diagnosis and
management of specific patient presentations by:
A. Incorporating the basic sciences in their explanations of the causes of
pediatric diseases and conditions.
B. Including basic science information in formal presentations about pediatric
diseases and conditions.
2. Demonstrate their understanding of principles of biostatistics, probabilistic
reasoning, and epidemiology to an understanding of disease processes and
diagnostic and treatment decision-making by:
A. Incorporating knowledge of biostatistics, probabilistic reasoning, and
epidemiology during the processes of:
- taking a history,
- creating a differential,
- making a diagnosis, and
- managing the pediatric problem.
B. Describing the basic types of illness and injury prevention routinely
provided to different ages.
C. Initiate a discussion about immunizations with the family of an infant, a
toddler and a child abut to enter school. Include immunization side
effects.
3. Demonstrates context sensitive application of behavioral and developmental
theories and principles in the diagnosis and management of specific patient
presentations by:
A. Using communication that is consistent with patient’s developmental age.
B. Developing a differential diagnosis that takes into consideration
developmental and psychosocial issues and their contribution to the
presenting symptoms.
C. Using information from a variety of relevant sources ( e.g. family, school)
in the assessment of patient.
D. Developing a management plan that takes into account the developmental
and cultural needs of the patient.
Problem Solving and Critical Thinking
Competencies
The competent student:
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is able to characterize the nature and parameters of a problem and to
distinguish the known from the unknown, and the relevant from the
irrelevant;
formulates strategies for approaching problems, acting on problems, and
critically evaluating problem solutions;
avoids premature closure and considers alternative problem formulations and
solutions;
integrates, synthesizes, and generalizes appropriately from existing
knowledge;
employes probabilistic thinking in diagnostic reasoning and clinical decisionmaking.
Learning Objectives
Students will:
A. Develop a complete problem list and a differential diagnosis for each
problem; combine problems where appropriate to develop a differential
diagnosis for the patient’s unique combination of symptoms.
B. Use knowledge of key signs and symptoms and the frequency and
prevalence of diseases at different ages when developing a differential
diagnosis.
C. Formulate an initial diagnostic and therapeutic plan, considering the cost,
risks, benefits and limitations of laboratory tests, imaging studies,
medications, consultations, hospitalization, and more conservative measures
such as “observation.”
D. Interpret the results of commonly ordered laboratory tests, such as the
CBC, urinalysis, and serum electrolytes, and recognize that the normal values
of some tests may vary with the age of the pediatric patient.
E. Develop critical thinking skills and the ability to use scientific evidence in
making clinical decisions.
Life Long Learning and Information Management
Competencies
The competent student:
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is proficient in identifying, accessing, and critically appraising information
available on the internet and in other forms of print and electronic information
and data bases;
is a critical consumer of information and able to critically evaluate knowledge
claims in the medical literature.
Learning Objectives
Knowledge:
Students will demonstrate knowledge of the information resources and tools
available to support life-long learning.
A. Describe a variety of sources of medical information (e.g. bibliographic
databases, textbooks and medical news), their strengths and weaknesses,
their structure and content, the information needs they can address, and
copyright and intellectual property issues of their use.
B. Describe a variety of methods of accessing new information (e,g, conferences,
drug company representatives, and networked computers), their strengths
and weaknesses, the information needs they can address, and the context in
which they are most appropriately used.
A. Describe uses and features of general software to support personal and
clinical communications and information management (e,g, web browsers and
databases), their strengths and weaknesses and the context in which they are
most appropriately used.
Skills:
Students will be able to
A. Use library resources efficiently and effectively: find printed reference
materials for a specific topic, and interface with library personnel to obtain
sources of information.
B. Use computer generated resources efficiently and effectively: use online
reference databases to find information appropriate to the task and select
informational resources for self-directed learning.
C. Evaluate the usefulness of new sources of information, (e.g. web-based
clinical practice guidelines) and through the application of evidence-based
medicine criteria, the relevance and accuracy of informational resources.
D. Demonstrate computer literacy and skills to facilitate lifelong learning to
include the use of a variety of relevant hardware (e.g. PDAs, digital cameras,
video conferencing equipment), and software (e.g. personal databases, web
browsers, e-mail).
Attitudes:
The medical student should develop attitudes that allow him or her to:
A. Appreciate the importance of the need to deal effectively with the growing
body of information.
B. Accept the increasing role of computer technology.
C. Commit to self-directed learning principles and practice.
D. Maintain an open attitude to new sources of learning and information.
E. Value access to current and relevant information.
F. Maintain a healthy skepticism about the quality and validity of all information.
Social, Cultural, and Community Context of Health, Illness, and Care
Competencies
The competent student:
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recognizes the importance of the social, cultural, and community context of
health, illness, and disease and actively seeks to elicit information that is
culturally meaningful and important to the patient;
is familiar with, and employs, community based resources in providing care
for his/her patients;
strives to understand his/her own culturally derived beliefs, attitudes and
values and how these may influence interactions with patients, families, and
communities.
Learning Objectives
Students will:
A. Demonstrate recognition of the importance of the social, cultural, and community
context of health, illness, and disease and actively seeks to elicit information
that is culturally meaningful and important to the patient by displaying the
following knowledge and skills:
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During patient interviews, elicits information that is culturally
meaningful and important to the patient in a manner that is respectful
and supportive.
Describe the health belief systems of each of the cultures represented
by the preceptor’s patient population.
Describe the child rearing practices of each of the cultures represented
by the preceptor’s patient population.
Become familiar with language/terminology that is unique to the
patient’s culture and has implications for understanding the patient’s
illness
B. Demonstrate familiarity with, and employ, community based resources in
providing care for his/her patients by:
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Locating resources that specify community health resources available
to patients of the various cultures in the preceptor’s practice.
Providing patients with information about community resources
available which are culture specific.
C. Demonstrates an effort to understand his/her own culturally derived beliefs,
attitudes and values and how these may influence interactions with patients,
families, and communities by:
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Describing how his/her own beliefs, attitudes, and values are different
from patients of other cultures and how these are influencing his/her
interactions with patients and families.
Discuss cultural issues openly and respond to culturally based cues.
Describe how their own professional values may conflict with needs of
patients of patients from cultures different from their own.
Personal Awareness
Competencies
The competent graduate:
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is mindful, reflective and self-aware;
strives to understand his/her own values, attitudes, and beliefs and how these
influence interactions with patients, families, colleagues, and co-workers;
identifies personal strengths, weaknesses, and limitations and is committed to
taking steps designed to promote personal growth and development;
Learning Objectives:
Students will:
1. Self-assess there knowledge and skills accurately and comprehensively at the
beginning, middle, and end of the clerkship.
2. Design a plan for the improvement of knowledge and skills based on a selfassessment and on feedback and evaluation information from the preceptor.
Organizations, Systems, and Quality Improvement
The competent graduate:
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understands major approaches to health care financing and the implications
of differing reimbursement systems for the delivery of care and potential
conflict of interest;
works effectively as a team member and employs team-based techniques to
improve health care delivery;
utilizes continuous quality improvement principles and practices;
accepts responsibility to participate in health care policy debates and in the
formulation of health care policies at micro and macro levels designed to
enhance access to high quality medical care.
Examinations and Grading for the Pediatrics Clerkship
Students will be provided with frequent feedback about their performance. Midclerkship formative feedback will be given to the students by their clerkship faculty
and local clerkship director.
As a performance based course, all students will be expected to achieve competency.
Students who do not meet this standard will be required to remediate deficiencies
before being advanced to the fourth year curriculum. Students will be provided
frequent opportunities to assess their performance in non-graded exercises to
identify areas of strength and weakness prior to graded examinations.
The following methods will be used to assess student progress:
• NBME subject exam to assess knowledge acquisition.
• Clinical evaluations will be performed by the clerkship faculty, residents and
clerkship director using a standardized FSU COM clerkship evaluation form. Clerkship
directors at each site will submit a summative evaluation which will than be
forwarded to the Education Director for review and final grading.
• Objective Structured Clinical Examinations (OSCE) to assess communication skills,
physical examination skills, and clinical reasoning will be run by the FSU COM two
times during the year but not be part of the clerkship grade.
Grades will be based on these components:
(1) NBME shelf exam in Pediatrics– given on the last morning of the rotation.
(2) Clinical evaluations by clerkship faculty, staff and patients and Clerkship
Directors, with a final summary given by the Director of the Psychiatry Curriculum.
Students must pass all components to pass the course. The final grade for each
student will be based upon the same Honors, Pass, and Fail scale shared by each of
the clerkships.
Pass Requirements:
1) A student must meet expectations on all subcategories of any clerkship evaluation
assessment form pertaining to “Professional Behavior and Ethical Standards”; AND
2) A student must be judged to “meet expectations” in at least 13 of the 15
remaining subcategories on the assessment form and has no more than 2
“marginally meets expectations” in the remaining 15 subcategories; AND
3) A student must achieve a score on the NBME specialty shelf examination that is
no more than 1.99 SD below the national average for clerkships of comparable
lengths.
4) A student must satisfactorily complete all required projects (e.g. completion of
assigned Med Cases)
A student is at risk for failure if:
1) He/she does not meet expectations in any subcategory of any clerkship
evaluation assessment form pertaining to “Professional Behavior and Ethical
Standards”; OR
2) He/she does not meet expectations in 2 or more of the remaining 15
subcategories on the rating form; OR
3) He/she marginally meets expectations in 3 or more of the remaining 15
subcategories; OR
4) He/she achieves a score 2.0 SD or more below the national average on the NBME
specialty subject examination*.
*Students who do not pass the NBME will be given an opportunity to re-take the
examination to achieve a passing score and a passing grade in the clerkship. Those
who do not pass on the re-take will be required to repeat the clerkship in their senior
year.
Honors Requirements:
1) A student must meet expectations on all subcategories of any clerkship evaluation
assessment form pertaining to “Professional Behavior and Ethical Standards”; AND
2) A student must be judged to “exceed expectations” in at least 10 of the 15
remaining subcategories on the assessment form; AND
3) A student must achieve a score on the NBME specialty shelf examination that is
1.0 standard deviation above the national average for clerkships of comparable
lengths.