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Pediatric Rotation

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  • 1. PEDIATRIC ROTATION COURSE COORDINATOR: Deborah McLeish, M.D., M.S. You will be working with Drs. McLeish and Ward and Kyle McLean, PNP, on pediatrics and responsible for inpatient services, consults and clinics. Pediatric inpatients will be in the Children’s Hospital though some adolescents and some adults (primarily adults with childhood disabilities) will be followed on B4/4. In-patient responsibilities as for the pediatric rehab rotation include: admission history and physical exam following the template and staffing with the nurse practitioner or attending physician. You are to round daily with the pediatric nurse practitioner or attending, and reviewing progress notes and orders. Your primary responsibility is to communicate regularly with pediatric residents, parents, and the nurse practitioner and attending and the rehab on-call team. You are encouraged to get to know your patient including observing them in therapy. You are responsible for dictating discharge notes (not dictated by the PNP) by or before the day of discharge. You are responsible for completing assigned consults on pediatric patients (this may include adolescents in the TLC or Neuro IMC); doing a history and physical examination and staffing with the pediatric nurse practitioner or attending physician. . You will also participate in clinics with Drs. McLeish and Ward as scheduled. You will be better prepared if you read on appropriate topics prior to clinic (e.g. cerebral palsy, spasticity, spina bifida, muscle disease, spinal muscular atrophy. The Pediatric PMR text book edited by G. Molnar is a good review, there is notebook of articles, and Drs. McLeish and Ward will provide additional appropriate articles. You will also be learning to do Botox and phenol injections, and will be involved in intrathecal baclofen trials and pump management. You should plan to spend time with the rehab clinic nurses to develop competency in pump refills. You are encouraged to review learning materials and articles on these topics as well, and develop an understanding of management of pumps including problems. This schedule is set up as the first through 5th weeks of the month, and will have to be “translated” for the particular month. Residents are not required to attend Dean East clinic with McLeish although this is a good clinical experience, and offers another chance for procedures at St. Mary’s Hospital in Pediatrics on the 3rd floor. Check with McLeish ahead about this schedule. Please note that both McLeish and Ward add on clinic patients and procedures, and you may participate with these. When Spina Bifida or NMD clinic has not been scheduled on Wednesdays with McLeish, residents are expected to go to clinic with Ward, and vice versa. There is usually time on Wednesday late afternoons to spend time with inpatient pediatric therapists. 63
  • 2. Revised 6/18/07 PEDIATRICS ROTATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Rounds w//McLean Rounds w//McLean & Rounds w/McLean & McLeish Ward Rounds w//McLean Didactics st 1 AM 8:30 Peds PMR Clinic w/ 8:30 Spina Bifida CP Clinic w/Ward Open for required McLeish Clinic w/McLeish & @Waisman experiences McLean UWHC F4/4 Spina Bifida Clinic Peds PMR Clinic Procedures w/Ward @ w/McLeish & Peds PM&R Clinic 1st PM w/McLeish Rounds w/Ward Middleton McLean UWHC w/ Ward F4/4 Rounds w//McLean Rounds w//McLean Rounds w//McLean Rounds w//McLean & Ward Didactics 2nd AM 8:00 Spasticity & Blaise Nemeth, M.D. 8:30 Peds PMR Clinic w/ CP Clinic w/Ward @ Dystonia Clinic @ Peds Ortho Clinic McLeish Waisman Waisman w/McLeish UW East* Procedures @ Rounds w/Ward 1:30 NeuroOnc Clinic w/ Procedures w/Ward @ 2nd PM Middleton Clubfoot Clinic H4/2 Gait Clinic Starting Ward @ UWHC Middleton w/McLeish w/Nemeth 11/07 Rounds w//McLean Rounds w/McLean Rounds w//McLean Rounds w/McLean & Ward rd Didactics 3 AM Neuromuscular Peds PM&R Clinic Open for required CP Clinic w/Ward @ Clinic w/ McLeish & w/McLeish experiences Waisman McLean H6/4 Neuromuscular Peds PM&R Clinic Procedures w/Ward @ Peds PM&R Clinic Rounds w/Ward 3rd PM Clinic w/ McLeish & McLeish Middleton w/Ward McLean H6/4 Rounds w//McLean Rounds w//McLean Rounds w/McLean Rounds w//McLean & Ward th Spina Bifida Clinic Didactics 4 AM 8:30 Peds PM&R Clinic w/McLean (or Peds Sedation CP Clinic w/Ward @ McLeish Spasticity w/ McLeish Waisman w/McLeish) Spasticity Clinic w/ McLean (or Procedures w/Ward @ Peds PM&R Clinic Spasticity Gait Clinic th Peds Neuro-Onc w/Ward Middleton w/Ward 4 PM w/McLeish) w/McLeish & Ward H6/4 or till November Peds Sedation Clinic w/ McLeish & McLean H6/4 Rounds w//McLean Rounds w/McLean Rounds w//McLean Rounds w//McLean & Ward Spina Bifida Clinic Peds PM&R Clinic w/ Didactics 5th AM w/McLean & Open for required McLeish (or open for CP Clinic w/Ward @ McLeish (or open for experiences required experience) Waisman required experience) Spina Bifida Clinic Rounds w/Ward Procedures w/Ward @ Peds PM&R Clinic 5th PM w/McLean & Middleton w/Ward McLeish * Email Dr. Nemeth in advance to check his schedule and location 64
  • 3. McLeish will schedule formal didactic times with the resident. The resident is expected to come prepared by reviewing appropriate materials. The pre/post test will be used as an outline for discussion. 1st, 3rd, and 5th THURS and other (****) times (and when clinics are canceled) may be used for patient care and follow up (including keeping up to date with ESA and for reading), and for scheduling the following required and optional activities. Write up a sentence or two to document the date of the experience and your key observation and give to McLeish and a copy to Wendy Christophersen for your portfolio. Required Learning Experiences 1. Observe pediatric therapists on the ward (PT-Marcella Andrews, OT-Kristin Kienitz, Speech/Swallow therapist- Laurie Matsdorf: all available on voice mail number 3-8078) Time with all three services. 2. Observe outpatient therapy session at Middleton (names and numbers follow) or at the Waisman Center (try to observe during formal developmental evaluation) – contact therapy staff soon after starting rotation: PT 5-1695: Janine Bessemer, Seth Newman, Betsy Zahn; OT 3-8081 Anne DeMark-Thompson, Mary Ellen Schmidt, Genna Freeman; Speech/swallow: Carol Gillen, Jennifer Holmes 3-8418) Time with all three services. 3. Observe a video fluoroscopic swallow study (this is required if you haven’t previously seen a video fluoroscopic swallow study); Arrange with Laurie Matsdorf 3-8078, or Carol Gillen or Jennifer Holmes at 3-8418. 4. Make site visit to the Communication Aides and Systems Clinic (CASC) – main secretary Deanne @ 263 – 2522 or Julie Gamradt can be reached at 3-5527 or email at casc-cdp@waisman.wisc.edu. 5. Spend time with Scott Amyx, pediatric orthotist at the Middleton Rehab clinic to include orthotic evaluation and preparation (265-0135). REQUIRED. 6. Spend time with Rose Ebner of National Seating and Mobility doing wheelchair and equipment assessment. She may be contacted at voice mail 223-1927 #307. REQUIRED. 7. Residents are expected to prepare a 30 minute didactic presentation to the pediatric residents, medical students and pediatric therapists on a topic pertinent to pediatric rehab. Optional Learning Experiences 8. Make site visit to the TRACE Center – contact person is Mary Sesto, Ph.D., P.T. Mary is best reached via email at msesto@facstaff.wisc.edu. OPTIONAL 9. Spend time at a school with a school therapist when school is in session and this can be arranged. OPTIONAL 10. Observe urodynamics – contact Dr. Kryger, pediatric urologist to help arrange this so you can become familiar with CMG/EMG testing and interpretation. OPTIONAL 11. Residents may spend time (even OR time if interested) with Dr. Iskandar or Dr. Albright, pediatric neurosurgeons, Dr. Kryger or Dr. Slaugenhoupt, pediatric urologists, Dr. Mann or Dr. Noonan, pediatric orthopedists, Dr Iyama, pediatric developmentalist, Drs. Sheth, Stafstrum or Hsu pediatric neurologist. OPTIONAL. PEDIATRICS REHAB ROTATION OBJECTIVES By the end of the Pediatric Rehabilitation Rotation, the resident will be able to: and will be evaluated by: 65
  • 4. Patient Care: 1. Take a developmental history, and list tests that may be used in developmental evaluation of a child. Clinical observation, Mini CEX, discussion. 2. Take a functional history pertinent to the child (e.g. to include bath seat, car seat, mobility equipment). Clinical observation, Mini CEX 3. Include the child (when appropriate) in getting the history. Clinical observation, Mini CEX 4. Perform a physical exam of the child, in a way which maximizes the ease of the child and the parent. Clinical observation, Mini CEX 5. Perform physical exam of the adult with DD in a respectable way. Examine the child or adult with DD for evidence of scoliosis, hip dislocation, contractures, increased or decreased tone, weakness, presence of primitive reflexes, head and trunk control, balance, and coordination. Clinical observation, Mini CEX Medical Knowledge: 1. Identify findings regarding developmental stages, and recognize when a child is developmentally delayed. Clinical observation, oral exam 2. Identify issues in the transition to adulthood of children with DD. Clinical observation. 3. Describe issues in the PM&R management of adults with DD. Clinical observation 4. Provide appropriate recommendations for the medical management of children with cerebral palsy. Changing nutrition, GI and GU, management, and musculoskeletal issues. Clinical observation, discussion 5. Identify when treatment of spasticity is recommended, and outline an approach to spasticity management. Clinical observation Mini CEX and/or discussion 6. Provide appropriate recommendations for the medical management of children with spina bifida (includes neurogenic bowel and bladder, and pressure sores). Clinical observation, discussion 7. Provide appropriate recommendations for the medical management of children with NMD (including constipation, osteoporosis and steroid dependent). 8. Appropriately prescribe orthotics, gait aides and other equipment for children with cerebral palsy, spina bifida, and NM diseases. Clinical observation, Mini CEX and/or discussion. 9. Develop a comprehensive problem list to address specific needs for traumatic brain injury rehab for children. Clinical observation, discussion 10. Describe an approach to the evaluation and treatment of toe walking in children. 11. Provide appropriate recommendations for the medical management of children with Torticollis in children. Practice-Based Learning and Improvement: 1. Identify one learning topic weekly and describe how that has impacted his or her practice. Oral discussion 2. Demonstrate ability to identify ways that a specific patient encounter could have been enhanced. Oral discussion 3. Teach the pediatric residents, medical students, and therapists on an ongoing basis about PMR topics, and provide a minimum of one 30 minute didactic presentation. Clinical observation 66
  • 5. Communication and Interpersonal Skills: 1. Treat the parent/family member and child with respect. Clinical observation, Mini CEX 2. Communicate treatment plans and changes with parents of children on the inpatient service. Clinical observation, Mini CEX 3. Avoid use or explain medical jargon. Clinical observation 4. Coordinate care daily with pediatric residents for patients on the inpatient service. Clinical observation 5. Communicate effectively with the other rehabilitation team members. Clinical observation 6. Lead the weekly PM&R team meetings, being respectful of other team members. Clinical observation Professionalism: 1. Follow hospital guidelines for patient privacy and confidentiality. Clinical observation 2. Be on time for rounds, for meetings, and for clinic. Clinical observation 3. Follow PM&R manual guidelines for timely and complete documentation of patient visits including admissions and discharge notes consult notes, and clinic notes. Clinical observation 4. Be able to provide the information necessary for parents to understand procedures and be able to go through the process to obtain written consent for procedures. Clinical observation 5. Accept feedback willingly. Clinical observation Systems-Based Practice: 1. Understand and explain child-specific services related to special education, the Katie Beckett / Medical assistance program and other unique benefits for children with chronic health care support needs. Discussion 2. Make recommendations regarding health promotion (immunizations, child safety, and primary care). Clinical observation 3. Identify “barriers” to discharge home and return to school for inpatients, and help guide the team and child’s family to address these barriers. Clinical observation, 360 evaluation 67