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[ ] Ambulatory Clinic.doc [ ] Ambulatory Clinic.doc Document Transcript

  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 1 CONTINUITY CLINICAMBULATORY PEDIATRIC OUTPATIENT ROTATION Residents are assigned to one of the following four fivecontinuit outpatient y clinic sites: The Kid’s Place at the Hermann University of Texas Professional Building (“HUTPB”), the LBJ Pediatric Clinic (“LBJ”), The University of Texas Parkview Pediatric Clinic (“Parkview”), and the Northwest Assistance Ministries Pediatric Clinic (“NAM”), and Children’s Protective Services (CPS). Continuity Clinic occurs every morning and afternoon five days a week (M-F) at HPB and five afternoons a week (M-F) at LBJ and Parkview. Continuity Clinic is held once a week on Wednesday afternoon at the NAM clinic.These outpatient clinics are open five days a week. Adherence to the 80-hour work week is mandated. Medicine-Pediatric residents are often assigned to the Good Neighbor Clinic (“GNC”) as both pediatric and adult patients attend this clinic. Continuity Clinic is held three mornings a week (M, T, and F) and four afternoons a week (M, T, W, F) at Good Neighbor. The Good Neighbor clinic is closed Wednesday mornings and Thursday is used for a teaching day of medical students only. Residents spend one half-day a week at their respective Continuity Clinic. Residents are only allowed to miss Continuity Clinic if the clinic is closed for a holiday, if the resident is on vacation, or if the resident is post-call. Faculty from The University of Texas Medical School at Houston Division of Community and General Pediatrics supervise the residents in clinic. Patients seen in these outpatient continuity clinics (Community Clinics) include patients without a previously documented faculty physician from clinics or the emergency room, patients referred to the clinics, managed care patients, and patients requiring follow-up exams from inpatient care at MHCH or LBJ. Legend for Learning Activities AR – Attending Rounds GR – Grand Rounds NC – Noon DPC – Direct Patient Care JC – Journal Club Conferences CAT – Critically Appraised Topics MR – Morning Report RC – Research EBM – Evidence-Based Medicine M&M – Morbidity and Mortality Conference Course Conference SS – Senior Seminar E/C – Ethics/Communication MDR – Multidisciplinary Rounds SL – Subspecialty Conferences Lectures Legend for Evaluation Methods for Residents AE – Attending Evaluations PDR – Program Director’s Review (twice DSP – Directly Supervised Procedures annually) MR – Morning Report IE – In-Training Exam PR – Peer Review FS – Faculty Supervision & Feedback CR – Chart Review CSR- Chart Stimulated Review
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 2 Principal Educational Goals and Objectives by Relevant Competency The principal educational goals for residents on this rotation are indicated for the relevant ACGME competencies. The tables below each goal list the corresponding educational objectives, the relevant learning activities and the evaluation methods for each objective. The educational goals and objectives are applicable to PGY-1, PGY-2 and PGY-3/4 residents and the expected competency levels demonstrated by the residents should reflect their respective level of experience. A. Patient Care GOAL: Manage continuum of care for children seen in the pediatric clinic setting and promote preventive health care for children. Principal Educational Objectives Learning Evaluation Activities Methods 1. Develop history and physical examination skills DPC, FS AE, FS, PDR including chart documentation and interviewing. 2. Review past medical history, family history, DPC, FS AE, FS, PDR immunizations and development. 3. Assure continuitycontinuity of care when patients are DPC, FS AE, FS, PDR admitted to the Inpatient Unit from the ContinuityCommunity Clinic. Communicate with hospitalists or specialists who provide care for patients admitted or provide care directly to patients admitted from the ContinuityCommunity Clinic. 4. Function as the primary provider by providing family DPC, FS AE, FS, PDR support and helping with the transitions to and from the inpatient setting. 5. Develop short-term and long-term plans for patient care DPC, FS AE, FS, PDR and integrate these into case management or continuing care treatment plans. Recognize when it is necessary to update these plans. 6. Discuss the following preventive health care topics with DPC, FS, NC AE, FS, PDR patients and their families: a. Developmental assessments including normal screening. b. Plot growth curve c. Discipline and other parenting issues d. Immunizations – schedule, exceptions, side effects and contraindications e. Normal and abnormal sexual development of different ages f. Nutrition – obesity, breast feeding, infant feeding, vitamins and fluoride g. Screening lab data – lead and anemia 7. Refer patients to appropriate specialists and manage DPC, FS AE, FS, PDR follow-up visits.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 3 GOAL: Diagnose and manage common signs and symptoms that present to the ContinuityCommunity Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Recognize and manage the following episodic DPC, MR, FS AE, FS, PDR disorders: chronic pain, chicken pox, colic, common intestinal parasites, conjunctivitis, dehydration, diarrhea, fever, influenza, lymphadenopathy, neonatal infections, respiratory tract infections, pharyngitis, thrush, vomiting and persistent cough. 2. Recognize the following common behavioral problems DPC, MR, FS AE, FS, PDR and counsel parents: abuse, attention deficit disorders, depression, encopresis, eating disorders, enuresis, feeding problems, psychosis, sleeping disturbances, and speech disorders. 3. Recognize and manage allergies including allergic DPC, MR, FS AE, FS, PDR rhinitis and asthma. 4. Recognize and manage common pediatric ear, nose DPC, MR, FS AE, FS, PDR and throat problems including antimicrobial prophylaxis, acute otitis media, chronic otitis, otitis externa, epistaxis (PGY-2), hearing screening (PGY-1), and sinusitis (PGY-2). 5. Recognize and manage common pediatric eye DPC, MR, FS AE, FS, PDR problems including amblyopia (PGY-2), strabismus (PGY-2/3), styes and chalazia (PGY-2), tearing (PGY-2), and vision screening (PGY-1). 6. Recognize and manage common pediatric DPC, MR, FS AE, FS, PDR gastrointestinal problems including chronic abdominal pain, constipation, gastroesophageal reflux, inguinal hernia and hydrocele, hepatomegaly, malabsorption syndrome and pyloric stenosis. 7. Recognize and manage common pediatric DPC, MR, FS AE, FS, PDR genitourinary problems including dysuria and frequency, urinary tract infections and undescended testes. 8. Recognize and manage common pediatric DPC, MR, FS AE, FS, PDR cardiovascular problems including cardiac disease, heart murmurs, hypertension referral and evaluation and SBE prophylaxis. 9. Recognize and manage common pediatric DPC, MR, FS AE, FS, PDR dermatological problems including atopic dermatitis, bacterial skin infections, contact dermatitis, diaper rash, epidermal tumors, hair and nail disorders, insect bites and infections, papulosquamous disorders, psoriasis, seborrheic dermatitis, superficial dermatophyte and yeast infections, vascular nevi, vesicular, bullous and pustular eruption, viral exanthems, and warts and molluscum contagiosum.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 4 10. Recognize and manage vulvovaginitis. DPC, MR, FS AE, FS, PDR 11. Recognize and manage common pediatric DPC, MR, FS AE, FS, PDR musculoskeletal problems including bow legs, knock knees, developmental dysplasia of the hip, flat feet, limping, scoliosis, toeing in and torsional deformities. 12. Recognize and manage common pediatric neurological DPC, MR, FS AE, FS, PDR disorders including craniosynostosis, epilepsy, floppy infant, headaches, microcephaly, macrocephaly 13. Recognize and manage common endocrine problems DPC, MR, FS AE, FS, PDR including diabetes, precocious/delayed puberty, short stature and thyroid disorders. GOAL: Evaluate and manage common signs and symptoms that present to the ContinuityCommunity Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Evaluate and manage the following common signs and DPC, MR, FS AE, FS, PDR symptoms: a. General: Health supervision visits, Failure to thrive, weight loss or gain, fatigue, fever, constitutional symptoms, acute life-threatening event (“ALTE”), excessive crying b. Cardiorespiratory: Hypertension, rhythm disturbance, syncope, heart murmur, shortness of breath, chest pain, cyanosis, dyspnea, tachypnea, wheezing, stridor, inadequate respiratory effort, cough, hemoptysis, respiratory failure c. Dermatologic: Rashes, pigmentary changes, paleness, petechiae, purpura, ecchymoses, urticaria, edema d. EENT: Conjunctival injection, acute visual changes, ear, throat, eye pain, edema, epistaxis, foreign body, nasal, ear or eye discharge, hoarseness, stridor e. Endocrine: Polydipsia, polyuria, heat/cold intolerance, growth disturbance, normal and abnormal timing of pubertal changes f. GI/Nutrition/Fluids: Abdominal pain, mass or distension, ascites, dehydration, constipation, diarrhea, dysphagia, encopresis, hematemesis, inadequate intake of calories or fluid, jaundice, melena, rectal bleeding regurgitation, vomiting g. Genitourinary/Renal: Change in urine color, dysuria, edema, enuresis, frequency, hematuria, obstructive uropathy, oliguria, pain referable to the urinary tract, scrotal mass or edema, trauma to urinary tract or external genitalia h. GYN: Abnormal vaginal bleeding, pelvic or genital pain, vaginal discharge or odor, vulvar trauma or
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 5 erythema i. Hematologic/Oncologic: Abnormal bleeding, bruising, lymphadenopathy, hepatosplenomegaly, masses, pallor j. Musculoskeletal: Arthritis/arthralgia, bone and soft tissue trauma, limp, limb or joint pain, variations in alignment (i.e., intoeing) k. Neurologic: Ataxia, change in sensorium, diplopia, headache, head trauma, hearing concerns, gait disturbance, hypotonia, lethargy, seizure, tremor, vertigo, visual disturbance, weakness l. Psychiatric/Psychosocial: Acute psychosis, anxiety, depression, behavioral concerns, conversion symptoms, child abuse or neglect, hyperactivity, suicide attempt GOAL: Diagnose and manage common childhood conditions that present to the ContinuityCommunity Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Gather essential and accurate information using DPC, MR, FS AE, FS, PDR problem-focused interview, exam and diagnostic studies. 2. Formulate differential diagnoses with appropriate DPC, MR, FS AE, FS, PDR epidemiologic considerations. 3. Discuss appropriate prioritization of patients and DPC, MR, FS AE, FS, PDR recognize patients with potentially serious problems that require further evaluation, referral or hospital admission. 4. Recognize and manage the following common DPC, MR, FS AE, FS, PDR childhood conditions: 4a. General: Health supervision visits, colic, failure to thrive, fever, overweight, well-child and well adolescent care. 4b. Allergy/Immunology: Allergic rhinitis, asthma, recurrent infections, angioedema, serum sickness, and urticaria 4c. Cardiovascular: Heart murmurs, palpitations, congenital heart disease, myocarditis, cardiomyopathy, congestive heart failure, Kawasaki disease, rheumatic fever, bacterial endocarditis 4d. Dermatology: Abscess, atopic dermatitis, cellulitis acne, superficial skin infections, impetigo, molluscum, tinea infections, viral exanthems, verruca vulgaris, and other common rashes of childhood and adolescence 4e. Endocrine/Metabolic: Hypothyroidism, hyperthyroidism, diabetes mellitus, diabetes insipidis, precocious or delayed puberty, gynecomastia
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 6 4f. GI/Nutritional: Constipation, encopresis, gastroenteritis, foreign body ingestion, gastroesophageal reflux, nutritional issues, hepatitis, appendicitis, pancreatitis, inflammatory bowel disease, and bleeding in stool 4g. GU/Renal: Electrolyte and acid-base disturbances (mild), enuresis, glomerulonephritis, hematuria, Henoch Schonlein purpura, nephrotic syndrome, UTI/pyelonephritis 4h. Gynecologic: Genital trauma, labial adhesions, pelvic inflammatory disease, vaginal discharge or foreign body, STD’s 4i. Hematology/Oncology: Anemia, hemoglobino- pathies, neutropenia, leukocytosis, thrombocytopenia, abdominal and mediastinal mass (initial work-up) 4j. Infectious Disease: Cellulitis, cervical adenitis, pneumonia (viral or bacterial), laryngotracheobronchitis, periorbital and orbital cellulitis, initial evaluation and follow-up of serious deep tissue infections, dental abscess with complications, otitis media, sinusitis, upper respiratory tract infections, viral illness 4k. Musculoskeletal: Apophysitides, fractures, femoral retro- and anteversion, growing pains, limp, metatarsus adductus, sprains, stained Olgood-Shlater, tibial torsion 4l. Pharmacology/Toxicology: Common drug poisoning and overdose, ingestion avoidance 4m. Neurology/Psychiatry: Seizures (evaluation and adjustment of medications), developmental delay, acute neurologic conditions, behavioral concerns 4n. Pulmonary: Asthma exacerbation, bronchiolitis, croup, epiglottitis, pneumonia, sinusitis, tracheitis, viral URI and LRI 4o. Surgery: Initial evaluation of patients requiring urgent referral, pre- and post-op evaluation of surgical patients GOAL: Develop a logical and appropriate clinical approach to the care of children in the
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 7 clinical setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Utilize principles of decision-making and problem DPC, FS AE, FS, PDR solving skills in the care of children in the clinical setting. 2. Identify and prioritize patients’ medical problems and DPC, FS AE, FS, PDR generate appropriate differential diagnoses. 3. Use appropriate timing for diagnostic and therapeutic DPC, FS AE, FS, PDR interventions. 4. Adjust pace to patient acuity and volume. DPC, FS AE, FS, PDR GOAL: Provide sensitive support to patients and their families in the clinical setting and arrange for on-going support and/or preventive services. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss issues such as growth and nutrition, DPC, FS AE, FS, PDR developmental stimulation and schooling with patients and their families. 2. Recognize problems and/or risk factors in the child or DPC, FS AE, FS, PDR family (e.g., immunizations, social risks, developmental delay) and appropriately intervene or refer. 3. Document drug allergies. DPC, FS AE, FS, PDR 4. Discuss outpatient management and parent education DPC, FS AE, FS, PDR regarding chronic asthma. 5. Recognize and respond appropriately to common DPC, FS AE, FS, PDR reactions of family members to recommendations for optimal health supervision and management of common illnesses in children. 6. Treat families in a non-judgmental, culturally sensitive DPC, FS AE, FS, PDR manner.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 8 B. Medical Knowledge GOAL: Develop a differential diagnosis and formulate an appropriate work-up with diagnostic tests to establish a diagnosis for common childhood conditions that present to the ContinuityCommunity Clinic. Develop appropriate treatment plan for the diagnosis. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the pathophysiological basis of the condition or DPC, MR, FS, AE, FS, PDR injury. NC 2. Discuss criteria for hospital admission from the DPC, MR, FS AE, FS, PDR outpatient setting. 3. Utilize patient information, current scientific evidence, DPC, MR, FS AE, FS, PDR and clinical problem-solving skills to make informed diagnostic and therapeutic decisions. GOAL: Demonstrate knowledge and appropriately use common diagnostic tests in the outpatient ContinuityCommunity Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss indications for and limitations of standard DPC, FS AE, FS, PDR laboratory tests and imaging studies including principles of sensitivity and specificity. 2. Demonstrate knowledge of the age-appropriate DPC, FS AE, FS, PDR normal readings of standard laboratory tests and imaging studies. 3. Interpret abnormalities in the context of specific DPC, FS AE, FS, PDR physiologic derangements. 4. Discuss therapeutic options for correction of DPC, FS AE, FS, PDR abnormalities when appropriate. Laboratory Tests a. CBC differential, platelet count, RBC indices b. Blood chemistries – electrolytes, glucose, calcium, magnesium, and 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. ESR, CRP g. Routine screening tests (e.g., neonatal screens, lead)
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 9 h. Wet preps and skin scrapings for microscopic examination, including scotch tape test for pinworms i. Thyroid function tests j. Culture for bacterial, viral and fungal pathogens, including stool culture k. Urinalysis l. Gram stain m. Developmental and behavioral screening tests (e.g., Connor’s Denver, depression inventory) Imaging/Radiographic Studies DPC, FS AE, FS, PDR a. Plain radiographs of the chest, extremities, abdomen, skull and sinuses b. Other techniques such as CT, MRI, angiography, ultrasound, nuclear scans (interpretation not expected) and contrast studies Other Testing DPC, FS AE, FS, PDR a. Appropriately order/use electrocardiogram and echocardiogram GOAL: Demonstrate understanding of how to utilize physiologic monitoring and special technology in the ContinuityCommunity Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss appropriate monitoring techniques for age and DPC, FS AE, FS, PDR clinical setting, describe the indications and limitations of and interpret the results and measurement of the following monitoring modalities: cardiac monitoring, pulse oximetry and repeated assessment of temperature, heart rate, and blood pressure as clinically indicated during an office visit. 2. Appropriately use the following treatments/techniques DPC, FS AE, FS, PDR in the ContinuityCommunity Clinic setting: universal precautions, hand washing between patients, isolation techniques, administration of nebulized medication, injury, wound or burn care, and oxygen delivery systems. 3. Discuss normal and abnormal findings at tracheostomy, DPC, FS AE, FS, PDR gastrostomy, or central venous catheter sites and demonstrate appropriate intervention or referral.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 10 4. Demonstrate the skills for assessing and managing DPC, FS AE, FS, PDR pain and conscious sedation. 5. Discuss indications for and use of behavioral DPC, FS AE, FS, PDR techniques and supportive care and other non- pharmacologic methods of pain control.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 11 C. Practice-Based Learning and Improvement GOAL: Utilize a logical and appropriate clinical approach to the care of children applying principles of evidence-based decision-making and problem solving skills. Principal Educational Objectives Learning Evaluation Activities Methods 1. Develop and apply decision-making and problem FS, CAT, EBM, AE, FS, PDR solving skills in the care of children. DPC 2. Demonstrate ability to prioritize care needs: identify FS, DPC AE, FS, PDR urgent issues that require immediate attention, use appropriate timing for diagnostic and therapeutic interventions and adjust pace to acuity and volume. 3. Assess quality control and quality improvement FS, EBM, DPC AE, FS, PDR processes and utilize results to improve patient care practices and patient management in the ContinuityCommunity Clinic setting. 4. Discuss how clinical pathways and practice FS, DPC AE, FS, PDR guidelines can be used to improve patient care for patients evaluated and treated in the ContinuityCommunity Clinic setting. 5. Integrate professional scholarship including FS, EBM, DPC, AE, FS, PDR electronic and print literature with emphasis on the CAT integration of basic science with clinical medicine into decision-making regarding patient care.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 12 D. Interpersonal Skills and Communication GOAL: Participate effectively with other health professionals, specialists and other providers who refer patients both as the primary provider and as the consulting physician. Principal Educational Objectives Learning Evaluation Activities Methods 1. Communicate well and work effectively with fellow FS, DPC AE, FS, PDR residents, attendings, consultants, nurses, ancillary staff and referring physicians. 2. Develop and demonstrate skills as a team participant FS, DPC AE, FS, PDR and leader in the care of pediatric patients. 3. Present information concisely and clearly both FS, DPC AE, FS, PDR verbally and in writing on patients to other members of the health care team. 4. Utilize consultants appropriately and communicate in FS, DPC AE, FS, PDR an effective manner. 5. Communicate effectively while performing the role of FS, DPC AE, FS, PDR pediatric consultant for hospitalized patients managed by other providers (i.e., family physicians, surgeons, etc.) 6. Function as the primary care provider in a managed FS, DPC AE, FS, PDR care model requiring PCP involvement in obtaining continuing services from consultants and acquisition of durable medical equipment for children with complex diagnoses or chronic medical conditions. GOAL: Develop effective communication relationships with patients and their families. Principal Educational Objectives Learning Evaluation Activities Methods 1. Communicate with families in a developmentally, FS, DPC, E/C AE, FS, PDR culturally-sensitive manner that provides families/patient with the information they need to understand the illness/injury, participate in the care, give informed consent, and prevent future injury or dysfunction. 2. Effectively listen to the concerns of patients and their FS, DPC, E/C AE, FS, PDR families and respond with appropriate information and support. 3. Communicate to a given family and child the impact of FS, DPC, E/C AE, FS, PDR each phase of care on the final health care outcome, the psychosocial impact of illness on the child and family, and the financial burden to the family and the
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 13 health care system. GOAL: Maintain accurate, timely, legible and legally appropriate medical records in the ContinuityCommunity Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Write notes that clearly document the patient’s FS, DPC AE, FS, progress, relevant investigations and treatment plan. PDR, CR, CSR 2. Review the patient’s past records for information FS, DPC AE, FS, relevant to current visit. PDR, CR, CSR E. Professionalism GOAL: Provide sensitive support to patients and families of children in the ContinuityCommunity Clinic setting. Principal Educational Objectives Learning Evaluation Activities Methods 1. Treat families in a non-judgmental, culturally sensitive FS, DPC, E/C AE, FS, PDR manner. 2. Respond constructively to the “difficult” child and FS, DPC, E/C AE, FS, PDR parent and utilize consultant resources as appropriate. 3. Accept professional responsibility as the primary care FS, DPC AE, FS, PDR physician for patients under his/her care. 4. Partner with parents to develop plans to facilitate FS, DPC AE, FS, PDR optimal health and development for the patient. 5. Describe the role and beliefs of fathers, mothers, FS, DPC, E/C AE, FS, PDR grandparents, other family members and non-family members in understanding physician instructions, making health decisions and implementing management plans. 6. Develop treatment plans that take into account family FS, DPC, E/C AE, FS, PDR religious views as they relate to health care choices. 7. Describe the problems of indigent families in seeking FS, DPC, E/C AE, FS, PDR acute and preventive medical care for their children including barriers affecting compliance with medical instructions.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 14 GOAL: Demonstrate commitment to following ethical and professional principles and to ongoing professional development. Principal Educational Objectives Learning Evaluation Activities Methods 1. Demonstrate knowledge of ethical concepts of FS, DPC, E/C AE, FS, PDR confidentiality, consent, autonomy and justice. 2. Demonstrate knowledge of professionalism concepts FS, DPC, E/C AE, FS, PDR such as integrity, altruism and conflict of interest. 3. Increase self-awareness to identify methods to FS, DPC, E/C AE, FS, PDR manage personal and professional sources of stress and burnout. 4. Increase knowledge and awareness of personal risks FS, DPC, E/C AE, FS, PDR concerning drug/alcohol abuse for self and colleagues, including referral, treatment and follow-up. 5. Demonstrate initiative in seeking out and participating FS, DPC, E/C AE, FS, PDR in continuing education and professional development programs. GOAL: Practice ethically and within medical-legal constraints in the care of children presenting to the outpatient ContinuityCommunity Clinic. Principal Educational Objectives Learning Evaluation Activities Methods 1. Describe the ethical issues involved with treating FS, DPC, E/C AE, FS, PDR pediatric patients including obtaining informed consent for procedures and the judicious use of diagnostic testing and therapeutic modalities. 2. Describe the potential ethical dilemmas that may FS, DPC, E/C AE, FS, PDR present in the outpatient ContinuityCommunity Clinic setting including the following: a. Respect for patient autonomy and confidentiality in the FS, DPC, E/C AE, FS, PDR evaluation and treatment of sensitive conditions (i.e., pregnancy, request for contraception and sexually transmitted diseases). b. Treatment of disabled infants, children and FS, DPC, E/C AE, FS, PDR adolescents. c. Recruiting, enrolling and completing research in FS, DPC, E/C AE, FS, PDR pediatric patients. d. Deciding to accept/decline gifts, meals and CME FS, DPC, E/C AE, FS, PDR support from pharmaceutical representatives.
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 15 e. Compliance with reporting requirements for infectious FS, DPC, E/C AE, FS, PDR diseases, potential child abuse and neglect, or sexual relationships between adolescents and adults. 3. Discuss how to handle situations where one’s own FS, DPC, E/C AE, FS, PDR management goals for a patient are in conflict with the family and/or attending physician and when transfer of care is appropriate. 4. Describe measures to be taken to reduce medical FS, DPC, E/C AE, FS, PDR malpractice and liability in the outpatient ContinuityCommunity Clinic setting. 5. Describe sources of legal information regarding the FS, DPC, E/C AE, FS, PDR following issues: Patient/parent’s right to refuse treatment and the legal options available when parents refuse therapy or leave the ContinuityCommunity Clinic against medical advice; Child and adult abuse/neglect reporting and the referral of abused parents to resources for their protection; and compliance with HIPAA regulations. F. Systems-Based Practice GOAL: Interact with other health professionals, specialists and other providers who refer patients to the ContinuityCommunity Clinic both as the primary provider and as the consulting pediatrician. Principal Educational Objectives Learning Evaluation Activities Methods 1. Discuss the role of the pediatric consultant and FS, DPC AE, FS, PDR provide pediatric consultation to primary care providers and specialists in the outpatient ContinuityCommunity Clinic setting. 2. Describe the role of outpatient and managed care FS, DPC AE, FS, PDR case managers. Work with these case managers to provide optimal health care (PGY-3/4 only). 3. Function as the primary care provider in a managed FS, DPC AE, FS, PDR care model requiring PCP involvement in obtaining continuing services from consultants and acquisition of durable medical equipment for children with complex diagnoses or chronic medical conditions. GOAL: Demonstrate knowledge of key aspects of outpatient health care systems including cost control, billing and reimbursement in the ContinuityCommunity Clinic. Principal Educational Objectives Learning Evaluation Activities Methods
  • Continuity ClinicAmbulatory Pediatric Outpatient Rotation Page 16 1. Utilize consultants and other resources appropriately. FS, DPC AE, FS, PDR 2. Demonstrate sensitivity to the financial status of FS, DPC AE, FS, PDR patients; utilize resources appropriately for patients/families needing financial assistance. 3. Describe the common mechanisms of outpatient FS, DPC AE, FS, PDR ContinuityCommunity Clinic cost control in managed care settings, including pre-authorization. 4. Discuss common billing codes and documentation FS, DPC AE, FS, PDR procedures for the outpatient ContinuityCommunity Clinic.