• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Subspecialties
 

Subspecialties

on

  • 1,103 views

 

Statistics

Views

Total Views
1,103
Views on SlideShare
1,103
Embed Views
0

Actions

Likes
0
Downloads
3
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft Word

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Subspecialties Subspecialties Document Transcript

    • UAMS INTERNAL MEDICINE-PEDIATRICS RESIDENCY HOUSESTAFF MANUAL PEDIATRIC REQUIRED SUBSPECIALTY ROTATIONS Includes: Adolescent Medicine Allergy-Immunology Pediatric Cardiology Pediatric Endocrinology Pediatric Gastroenterology Genetics Pediatric Hematology-Oncology Pediatric Infectious Diseases Pediatric Nephrology Pediatric Neurology Pediatric Pulmonology Pediatric Rheumatology Note: All UAMS Med-Peds residents must successfully complete educational experiences in a minimum of 4 of these rotations to complete their training and to be eligible to sit for the ABP examination. All residents will complete a month of Pediatric Cardiology or Pediatric Hematology- Oncology (the curricula for each of these rotations is included in this section) so 3 additional selective rotations must be completed. The UAMS Med-Peds program also specifically requires Adolescent Medicine; however, this curriculum is included in this section.
    • ADOLESCENT MEDICINE Introduction/Purpose The Adolescent Medicine rotation aims to train residents in Pediatrics, Medicine- Pediatrics, and Family Medicine programs in the comprehensive management of adolescent health issues. The Adolescent Medicine discipline recognizes that adolescents are distinct from children and adults and that the approach to their care must recognize these distinctions. Rotation Contacts Brian Hardin, MD Elton Cleveland, MD Maria Portilla, MD Darrell Nesmith, MD, MPH Jennifer Woods, MD, MS Office Contact: Debbie Chumley (364-5352) Description of clinics and locations 1• Adolescent Center, 1201 Bishop Street. The Adolescent Center is considered the “home base” of the Adolescent Medicine rotation. Primary care adolescent medicine clinics are held here Monday through Friday. Morning clinics begin at 0800, and afternoon clinics begin at 1245. 2• Eating Disorder Clinic, WLR Specialty Clinic. The Eating Disorder Clinic meets in the West Little Rock Specialty ACH Clinic on Hermitage Street in West Little Rock, in the Park West Building. 3• Job Corps Wellness Center. Job Corps is a federally funded vocational training program for young adults. We provide admission physical examinations and health appraisals on all participants in the Job Corps programs as well as sick visits for those already in the program. Residents will attend the Job Corps Wellness Clinic once during the Adolescent Medicine rotation. General Responsibilities and Expectations 11 Attend all scheduled clinics. 22 Participate in scheduled and impromptu clinic discussions. 33 Utilize access to core articles (stored on WebCT). 44 Participate in orienting junior students to the Adolescent Center. Instructional Resources 11 Key articles on adolescent medicine topics (WebCT) 22 Core noon conferences 33 Rotation Discussions with Adolescent Medicine faculty 44 Case-based discussions as patients present to the Adolescent Clinic Topics to be Covered During the Adolescent Medicine rotation, topics to be covered include, but are not limited to, the following: 11 Consent and confidentiality
    • 22 Health maintenance examination and anticipatory guidance 33 Evaluation and management of STD syndromes, including vaginitis, cervicitis, PID, urethritis, epididymitis, genital ulcer disease, genital warts 44 Selecting an oral contraceptive pill 55 Indications for routing screening, including Pap, vision, cholesterol, diabetes 66 Amenorrhea and other menstrual disorders 77 Obesity-related conditions including hypertension, diabetes mellitus, dyslipidemia, and obstructive sleep apnea 88 Polycystic ovary syndrome 99 Preparticipation examination of the potential athlete 101 Headache in the adolescent 111 Somatization 121 Depression and other mental health conditions 131 ADD and ADHD evaluation 141 Wet prep interpretation 151 Gynecologic exam 161 Male genital exam 171 Back pain 181 Knee pain 191 Ankle sprain EDUCATIONAL GOALS AND OBJECTIVES [including venue in which each is covered] PATIENT CARE – that is compassionate, appropriate, and effective care for adolescents and young adults. By the end of this rotation, the resident will be able to: 1I. Understand normal adolescent growth and development, utilize Tanner Staging, and recognize deviations from the norm [Resident Noon Conference, Rotation Discussion, practical application in clinic] 2II. Describe the appropriate use and implementation of the preparticipation examination for athletes, including evaluating an athlete’s readiness to participate and contraindications for participation. [Rotation Discussion, practical application in clinic] 3III. Demonstrate proficiency at understanding the needs for a pelvic exam and performing the exam with sensitivity [Rotation Discussion]. 4IV. Understand and deliver routine health maintenance/anticipatory guidance for adolescents including these specific areas 5[Resident Noon Conference, Rotation Discussions] 0 I. Nutrition/Eating Disorders 1 II. Tobacco and substance use/abuse 2 III. School failure 3 IV. Depression 4 V. Sexuality including sexual orientation, pregnancy prevention and sexually 5 transmitted disease screening 6 VI. Immunizations 6 7V. Apply standardized guidelines (e.g., STD Treatment Guidelines) for diagnosis and treatment of conditions common to adolescents [Adolescent Clinic experience].
    • 8VI. Understand the utility of a multidisciplinary team approach to the care of adolescents with complex medical problems [Adolescent Clinic experience, Eating Disorder Clinic] 9 MEDICAL KNOWLEDGE – about established and evolving biomedical and clinical understanding of diagnosis and treatment of conditions related to adolescents and young adulthood. By the end of this rotation, the resident will be able to summarize the assessment, differential diagnosis, initial management, and indications for referral of the following conditions [Noon Conferences, Rotation Discussion, clinic preceptorship]: 1I. Constitutional: delayed puberty 2II. Abdomen: chronic abdominal pain, pelvic pain 3III. Cardiovascular: essential hypertension, chest pain, syncope 4IV. Genitourinary: amenorrhea, dysmenorrhea, dysfunctional uterine bleeding, irregular menses, vaginitis, sexually transmitted diseases, urinary tract infections, urethritis, epididymitits, pregnancy diagnosis, and contraceptive management 5V. Musculoskeletal: scoliosis that is < 20°, Osgood-Schlatter disease, patellofemoral syndrome, uncomplicated sprains, back pain, and knee pain 6VI. Skin: acne 7VII. Neuropsychiartry: headaches, dizziness, school avoidance, ADHD/ADD fatigue and depressive symptoms 8VIII. Breast: fibroadenoma, breast cyst, fibrocystic breast changes, gynecomastia PRACTICE-BASED LEARNING AND IMPROVEMENT – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the resident will be able to: 1I. Utilize current literature to identify standardized guidelines (e.g., STD Treatment Guidelines) for diagnosis and treatment of conditions common to adolescents. 2II. Identify individual learning needs and plan for continuing acquisition of knowledge and skills related to adolescents. INTERPERSONAL AND COMMUNICATION SKILLS – effective exchange of information. By the end of this rotation, the resident will be able to: 1I. Discuss consent and confidentiality with patients and their parents and apply to the interviewing and delivery of care to adolescents 2II. Understand Arkansas laws regarding consent and confidentiality in caring for an adolescent 3III. Establish rapport necessary to form a therapeutic relationship with the adolescent and parent. PROFESSIONALISM – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the resident will be able to: Page 4 of 4 Adolescent Medicine 1I. Demonstrate personal accountability to the well being of patients (e.g., follow-up lab results, writing comprehensive notes)
    • 2II. Demonstrate a commitment to professional behavior in interactions with staff and professional colleagues 3III. Be sensitive to diversity and recognize one’s own biases that may affect one’s response to adolescents SYSTEM-BASED PRACTICE – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the resident will be able to: 1I. Identify key aspects of health care systems as they apply to the care of adolescents and their families (e.g., challenges to access and continuity of care; factors affecting billing and reimbursement) 2II. Recognize and advocate for adolescents who need assistance to deal with health care system complexities Methods of Evaluation and Feedback 1I. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. 2II. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted. ALLERGY AND IMMUNOLOGY
    • Introduction/Purpose: Develop a working knowledge of normal development, pathophysiology, and clinical findings related to allergy and immunology and be able to recognize deviations from the norm. Rotation Contacts Faculty Supervisor(s): Stacie Jones, M.D. Office Contact: Jackie Holland, phone 364-2843 Location (“home base”) Allergy and Immunology office Prerequisites 11 Must be an upper level pediatrics or 3rd/4th year med/peds resident 22 Vacation is allowed during rotation. It is the resident’s responsibility to make up work missed during the time off. General Responsibilities and Expectations Outpatient clinics 11 Allergy Clinic 22 Asthma Clinic Inpatient consults 11 The resident will attend consults with the attending on service while on the rotation. Weekly/monthly schedules 11 Available on the 1st day of the rotation. Night or weekend call 11 Night or weekend call is not required during this elective. Attendance on rounds, consults, and/or procedures 11 Dress professionally 22 Be on time Vacation 11 Time off must be submitted to faculty supervisor/contact person 1 week prior to the start of the rotation. 22 If the resident takes vacation during this rotation, it is the resident’s responsibility to read about topics covered during the time off since these topics will be covered on assessments. Educational Responsibilities and Expectations 11 Complete pre- & post-tests during specified time periods. 22 Obtain reading materials required for the rotation. 33 Read required material and be prepared to discuss during didactics or teaching rounds. 44 Complete and submit rotation experience and faculty evaluations at the end of the rotation. Clinical Resources Allergy Clinic Asthma Clinic
    • Instructional Resources List of core topics covered during rotation 11 Immune System: Normal vs. Abnormal 22 Common Allergic Conditions: Those Not Necessarily Requiring Referral 33 Conditions Generally Referred for Further Evaluation 44 Allergic Rhinitis and Conjunctivitis 55 Asthma 66 Immunodeficiency 77 Food Allergy 88 Drug Allergy and Reactions 99 Urticaria, Angioedema, and Anaphylaxis 101 Atopic Dermatitis 111 Insect Hypersensitivity 121 Prevention Educational Goals and Objectives Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric resident will be able to: 11 Counsel parents/patients about the importance of early identification of allergy symptoms in their child. 22 Recognize, diagnose, and manage allergic conditions which may not necessarily require referral. Medical Knowledge – about established and evolving biomedical, clinical, and rotation- specific. By the end of this rotation, the pediatric resident will be able to: 11 Reach objectives outlined in Appendix A. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric resident will be able to: 11 Utilize research methods to identify current literature for treatment of allergy conditions. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric resident will be able to: 11 Collaborate with laboratories and other health care personnel to attain satisfactory management of allergic conditions in patients. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the pediatric resident will be able to: 11 Respect and maintain patient confidentiality. System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric resident will be able to: 11 Refer conditions related to allergy and immunology which generally require referral for consultation.
    • Methods of Evaluation and Feedback 11. Objective assessment of the resident knowledge or skills, including multiple- choice or short answer posttest that will cover basic principles relevant to the elective. 22. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. 33. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Education Plan Appendix Supplemental Goals and Objectives: 1 21. Normal vs. Abnormal Goal: Develop a working knowledge of normal development, pathophysiology, and clinical findings related to allergy and immunology and be able to recognize deviations from the norm. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 1a. Describe in general terms the normal development and pathophysiology of the immune system including the cellular components (T lymphocytes, B lymphocytes, Phagocytes and NK Cells) and humoral components (antibodies and complement system). 2b. Describe findings on history (patient and family) and physical exam which suggest allergy or immunologic dysfunction. 3c. Understand clinical circumstances and laboratory tests used by general pediatricians to identify allergic and immunologic diseases (allergy skin testing, RAST, delayed hypersensitivity testing with PPD, mumps, and Tetanus, specific antibody serology, and pulmonary function tests). 3 42. Common Conditions That May Not Need Referral Goal: Understand how to diagnose and manage allergic conditions which may not necessarily require referral. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: Recognize, diagnose, describe the pathophysiology of, and manage appropriately these conditions: 1a. Allergic rhinitis 2b. Allergic Conjunctivitis 3c. Atopic dermatitis 4d. Asthma, mild to moderate 5e. Urticaria/angioedema 6f. Food allergies 7g. Common drug allergies 8h. Insect sting allergy 5 63. Conditions Where Referral is Generally Required Goal: Understand how to recognize, manage, and refer conditions related to allergy and immunology which generally require referral for consultation. Objective: After a rotation with the Allergy and Immunology specialists, the resident will: Explain the pathophysiology, identify and provide initial management, and refer appropriately the following: Page 2 of 5 Allergy/Immunology Elective Appendix 1a. Conditions listed above, if severe or if reasonable management is unsuccessful
    • 2b. Patients requiring skin testing for diagnosis and/or immunotherapy 3c. Hereditary or severe angioedema 4d. Anaphylaxis 5e. Difficult to diagnose or manage allergic conditions (e.g., Latex allergy, Medication allergy, etc.) 6f. Patients with documented immunodeficiency (congenital or acquired), or suspected immunodeficiency 7g. Serum sickness reactions, or other immune-mediated adverse reactions 2 34. Allergic Rhinitis and Conjunctivitis Goal: Understand the diagnosis and management of allergic rhinitis and conjunctivitis. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Describe the available tests (the indications, limitations, and clinical significance) for diagnosing allergic rhinitis, including: 2a. Nasal smear for eosinophils 3b. Total peripheral eosinophil count 4c. Prick and intradermal skin tests for acute hypersensitivity 5d. RAST analysis 6e. Quantitative IgE level 72. Treat allergic rhinitis appropriately using available medications (e.g. antihistamines, topical steroids, topical antihistamines, leukatriene receptor antagonists, etc.) and provide education about environmental control and allergen. 83. Identify indications for referral to an allergist. 94. Provide immunotherapy under the supervision of an allergist including care for untoward reactions and adjustments needed, based on patient responses. 105. Describe the approach to diagnosis and management of conjunctival infection versus allergic conjunctivitis. 116. Distinguish relationships between allergic rhinitis, otitis media, sinusitis, asthma, and atopic dermatitis. 4 55. Asthma Goal: Understand how to diagnose asthma and how to manage mild and moderate cases. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Understand the natural history of asthma and risk factors for its development. 22. Recognize the initial presentation, describe associated complications, and assess asthma severity using standard scoring systems. 3 3. Explain the differential diagnosis of wheezing. 14. Describe the various triggers for asthma exacerbation (environmental and other) and educate the patient in avoiding these when possible. 25. Understand the pharmacological approach to the management of acute and chronic asthma for both outpatient and inpatient (including metered dose inhalers and nebulizers). 3 46. Identify the side effects and limitations of medications used to treat asthma.
    • 57. Demonstrate the appropriate use of diagnostic tests including arterial blood gas measurement, pulse oximetry, peak flow meters, simple spirometric equipment, and the interpretation of pulmonary function testing in the management of asthma. 68. Demonstrate the ability to educate the patient and his/her family about asthma and its management including triggers, environmental control, peak flow, medication and delivery systems, sports and exercise, school, and relaxation techniques. 79. Describe the indications for referral of patients with asthma to an allergist. 810. Understand and list the criteria for, how to recognize, provide initial treatment, and refer the patient with impending respiratory failure due to asthma. 911. Understand the differential diagnosis, evaluation, and pharmacologic treatment of wheezing in infants and toddlers. 2 36. Immunodeficiency Goal: Understand the role of the general pediatrician in the assessment and management of immunodeficiency. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Define the various types of immunodeficiency diseases by pathophysiology (e.g., humoral and cellular immunity: antibodies, complement, lymphocytes and phagocytes) and by etiology (e.g., genetic, infectious-related, post chemotherapy). 22. List symptoms and signs compatible with immunodeficiency including AIDS/HIV. 33. List the routine screening test used to assess immune function (specific antibody analyses and lymphocyte enumeration and function) and describe their indications and limitations. 44. Discuss the approaches for management of children with immunodeficiency. 55. Demonstrate knowledge of immunization requirements for children with immunodeficiency and identify appropriate reference materials for keeping up-to- date in this area. 4 57. Food Allergy Goal: Understand the role of the general pediatrician in the assessment and management of food allergy. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Discuss typical presentations for food allergies. 22. Explain the differential diagnostic considerations between food allergies and non-allergic food intolerances (e.g., enzyme deficiencies). 33. Explain the use of skin testing and when to use RAST analysis. 44. Describe open food challenge. 15. Describe double blind placebo-controlled food challenge (DBPCFC) and its use. 2 38. Drug Allergy and Reactions Goal: Understand the principles, diagnosis, and management of drug allergy. Objectives:
    • After a rotation with the Allergy and Immunology specialists, the resident will: 11. Recognize the signs and symptoms of drug allergies including rash, joint swelling, nephritis, and anaphylaxis. 22. Differentiate significant drug rashes from other exanthemas. 33. Describe mechanisms of drug allergy and differential diagnosis. 44. Treat effectively significant drug reactions (e.g., urticaria, serum sickness, anaphylaxis, Stevens Johnson Syndrome). 55. Counsel parents and children on the avoidance of drugs which led to significant allergic reactions and on the importance of notification of medical personnel. 4 59. Urticaria, angioedema, and anaphylaxis Goal: Understand the role of the general pediatrician in the assessment and management of urticaria, angioedema, and anaphylaxis. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Demonstrate awareness of etiologies of anaphylaxis—food, drug, latex, physical stimuli, autoimmune, etc. 22. Describe the differential diagnosis and pathophysiology of urticaria, angioedema, and anaphylaxis. 33. Discuss the role of direct mast cell stimulators (e.g., Vancomycin, narcotics, tartrazine, salicylates, radio-contrast dyes) in creating symptoms that mimic allergic disease. 44. Discuss the role for autoimmune disease (e.g., post-streptococcal, anti- thyroid) in causing chronic urticaria. 55. Describe the pharmacological management strategies for these conditions. 66. Describe the non-pharmacologic management, including environmental control and trigger avoidance. 77. Describe the overall treatment for anaphylaxis including the home use of “Epi-pens”. 88. Explain the value and use of the Medi-Alert system. 6 710. Atopic Dermatitis Goal: Understand the role of the general pediatrician in the assessment and management of atopic dermatitis. Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. List the criteria required for the diagnosis of AD. 22. Explain the role of food allergy in AD. 3. Explain the role of chronic Staph infection of the skin in AD. 4. Explain the role of topical and oral agents (anti-histamines, steroids, hydrophilic agents, antibiotics, leukatriene receptor antagonists) and the principals of therapy. 11. Insect Hypersensitivity Goal: Understand the role of the general pediatrician in management of insect stings.
    • Objectives: After a rotation with the Allergy and Immunology specialists, the resident will: 11. Contrast the difference in the four forms of insect reactions—local, large local, systemic with and without anaphylaxis. 22. List and explain the major groups of stinging insects—hymenoptera and fire ants. 33. Recognize when skin testing and immunotherapy are indicated. 44. Discuss prevention and acute management strategies. 2 312. Prevention Goal: Understand the role of the pediatrician in prevention related to allergy and immunology. Objectives: During a rotation with the Allergy and Immunology specialists, the resident will: 1. Counsel parents/patients about the importance of: 1a. Breastfeeding and diet in the prevention of allergic disease. 2b. Smoking as it relates to exacerbation of allergic diseases. 3c. Allergen avoidance and environmental control. 4d. Role of lay organizations and support groups.
    • Children’s Hospital Little Rock Allergy and Immunology Rotation Curriculum Many clinical states caused by allergic and immunologic disorders are commonly encountered by the general internist. For these dis- • Patient Care orders, the general internist should be able to initiate diagnostic evaluation and therapy. The goal of this rotation is to provide the • Medical Knowledge resident with an understanding of basic allergic and immunologic disease processes and skill in the developing work-ups and treat- ment of those disorders. In addition to fostering competence in pa- • Practice-Based tient care and medical knowledge, the service fosters practice- Learning based learning by providing opportunities to assess and improve practice, and systems-based learning via exposure to the contexts • Systems-Based and systems of hospital care. Collaborating with the health care Practice team supports the development of interpersonal communication and professional skills. • Professionalism • Interpersonal and Communication Skills Children’s Hospital Little Rock Stacie M. Jones, MD Professor of Pediatrics Chief, Allergy and Immunology JonesStacieM@uams.edu 501-364-1060 UH ALL IM
    • l. TAXONOMY OF OBJECTIVES, TEACHING METHODS, & ASSESSMENTS PATIENT CARE Allergy and Immunology PGY 1 Patient Care: To provide PGY 2 Patient Care: To provide PGY 3 Patient Care: To provide compassionate, appropriate and compassionate, appropriate and compassionate and appropriate effective treatment for all patients effective treatment for patients admitted treatment for patients admitted to the admitted to the hospital. to the hospital. hospital. Assessments Assessments Assessments Objectives Objectives Objectives Teaching Teaching Teaching Methods Methods Methods a. Residents will demonstrate basic skill a.  Residents will demonstrate a. Residents will demonstrate in gathering information from medical competence in gathering information proficiency in gathering information from interviews, physical examinations, B D E A C E from medical interviews, physical B D E A C E medical interviews, physical BDE ACE medical records, and diagnostic examinations, medical records, and examinations, medical records, and procedures. diagnostic procedures. diagnostic procedures. b.   Residents will demonstrate basic    b. Residents will demonstrate skill in skill in the ability to make informed teaching and modeling the decisions about diagnostic and ABC b.  Residents will develop, negotiate and AE BE AE development, negotiation and BE AE therapeutic options, based on clinical DE implement patient management plans. implementation of patient management judgment, scientific evidence, and plans. patient preference. c.   Residents will perform safely, under    c. Residents will demonstrate c. Residents will demonstrate supervision, the diagnostic procedures competence in performing diagnostic proficiency in performing the diagnostic E A E A E A considered essential to the practice of procedures considered essential to the procedures considered essential to the internal medicine. practice of internal medicine. practice of internal medicine. d.   Residents will demonstrate an     d. Residents will demonstrate d. Residents will demonstrate understanding of the basic components ABC knowledge and sensitivity toward knowledge and sensitivity toward A AE A AE A of palliative care and pain management DE differing ethno-cultural viewpoints and differing ethno-cultural viewpoints and issues. religious beliefs. religious beliefs. e.   Residents will demonstrate the ability    to work with other health care e. Residents will demonstrate skill in e. Residents will demonstrate professionals, and openness in taking ABC ABC E AE participating in palliative care and pain A proficiency coordinating palliative care A instruction from and be supervised by DE DE management. and pain management. upper level residents and attending physicians. f. Residents will demonstrate f. Residents will demonstrate f.   Residents will demonstrate    competence in working with other proficiency in working with other health understanding of the laws regarding health care professionals, and CE A E A care professionals and openness in E A release of medical information and openness in taking instruction from and taking instruction from and being patient confidentiality. being supervised by attending supervised by attending physicians. physicians. g. Residents will demonstrate skill in g. Residents will demonstrate g. Residents will demonstrate counseling patients/parents about the competence in counseling proficiency in counseling A AD A AD A AD importance of early identification of patients/parents about the importance of patients/parents about the importance of allergy symptoms. early identification of allergy symptoms. early identification of allergy symptoms. h. Residents will demonstrate h. Residents will demonstrate h. Residents will demonstrate skill in the competence in the recognition, proficiency in the recognition, diagnosis recognition, diagnosis and management A AD diagnosis and management of allergic A AD and management of allergic conditions A AD of allergic conditions which may not conditions which may not necessarily which may not necessarily require necessarily require referral. require referral. referral. i. Residents will demonstrate i. Residents will demonstrate understanding of the laws regarding understanding of the laws regarding CE A CE A release of medical information and release of medical information and patient confidentiality. patient confidentiality. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E.
    • MEDICAL KNOWLEDGE Allergy and Immunology   PGY 1 Medical Knowledge: To PGY 2 Medical Knowledge: To    PGY 3 Medical Knowledge: To understand biomedical, clinical and understand biomedical, clinical and understand biomedical, clinical and socio-behavioral knowledge about socio-behavioral knowledge about socio-behavioral knowledge about patient care in a hospital setting. patient care in a hospital setting. patient care in a hospital setting. Assessments Assessments Assessments Objectives Objectives Objectives Teaching Teaching Teaching Methods Methods Methods a.  Residents will demonstrate the ability a. Residents will develop clinically a.  Residents will demonstrate the ability   to provide clinically appropriate articles applicable knowledge of basic and to assess the scientific merit and A B C A D E or other publications to the PGY-1 ABC AE ABC AE clinical science that make up internal generalizeabilty of published medical residents to improve their medical medicine. research. knowledge. b. Residents will apply this knowledge b.  Residents will develop advanced b.  Residents will develop in-depth and   (as above) in developing critical A C D clinically applicable knowledge of basic detailed knowledge of basic and B D BD ADE ABC ADE thinking, clinical problem solving and E and clinical science that makes up clinical science that makes up internal decision making skills. internal medicine. medicine. c.  Residents will be proficient in the   c. Residents will demonstrate the ability c.  Residents will apply this knowledge application of this knowledge (as to apply the methods of Evidence- (as above) in developing critical BD A BD A C D above) in developing critical thinking, BD ACD Based Medicine to the analysis of the thinking, clinical problem solving and clinical problem solving and decision medical literature. decision making skills. making skills. d. Residents will demonstrate the ability d.  Residents will demonstrate the d. Residents will demonstrate the ability to interpret Evidence-Based Medicine of proficiency in the interpretation of to conduct clinically appropriate E A E A E A the medical literature and apply this to Evidence-Based Medicine of the literature searches. aid in patient care. medical literature to aid in patient care. e. Residents will demonstrate the ability e.  Residents will demonstrate an   e. Residents will demonstrate a basic to find practice-relevant information on E A E A advanced knowledge of research A E A knowledge of research design. the Internet. design. f. Residents will demonstrate basic f. Residents will demonstrate f.   Residents will demonstrate    skills in applying scientific principles in B C D A C D competence in applying scientific B C D A C D proficiency in applying scientific BCD ACD clinical decision-making. principles in clinical decision-making. principles in clinical decision-making. g. Residents will demonstrate g. Residents will demonstrate in-depth g. Residents will demonstrate knowledge regarding common clinical knowledge regarding common clinical knowledge regarding common clinical presentations (such as anaphylaxis, presentations (such as anaphylaxis, presentations (such as anaphylaxis, ABD AD ABD AD ABD AD conjunctival inflammation, cough, conjunctival inflammation, cough, conjunctival inflammation, cough, wheezing, skin whealing, rashes and wheezing, skin whealing, rashes and wheezing, skin whealing, rashes and pruitus) pruitus) pruitus) h. Residents will display skill in the h. Residents will display comptency in h. Residents will display proficieny in the ordering, understanding and ABD AD the ordering, understanding and ABD AD ordering, understanding and ABD AD interpretation of tests. interpretation of tests. interpretation of tests. i. Residents will display knowledge i. Residents will display advanced i. Residents will display advanced regarding clinical conditions and knowledge regarding clinical conditions knowledge regarding clinical conditions principles of management and and principles of management and and principles of management and indications for referrral for disorders indications for referrral for disorders indications for referrral for disorders such as: allergic rhinitis/sinusitis, ABD AD such as: allergic rhinitis/sinusitis, ABD AD such as: allergic rhinitis/sinusitis, ABD AD anaphaylaxis, asthma, dermatitis, drug anaphaylaxis, asthma, dermatitis, drug anaphaylaxis, asthma, dermatitis, drug allergies, hypersensitivity pneumonia, allergies, hypersensitivity pneumonia, allergies, hypersensitivity pneumonia, vasculitis, primary immunodeficiency, vasculitis, primary immunodeficiency, vasculitis, primary immunodeficiency, and urticaria. and urticaria. and urticaria. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E.
    • PRACTICE-BASED LEARNING Allergy and Immunology PGY 1 Practice-Based Learning and PGY 2 Practice-Based Learning and PGY 3 Practice-Based Learning and Improvement: Systematically analyze Improvement: Systematically analyze Improvement: Systematically analyze resident inpatient practice using quality resident inpatient practice using quality resident inpatient practice using quality improvement methods, and implement improvement methods, and implement improvement methods, and implement changes with the goal of practice changes with the goal of practice changes with the goal of practice improvement. improvement. improvement. Assessments Assessments Assessments Teaching Methods Objectives Objectives Objectives Teaching Teaching Methods Methods a. Residents will demonstrate an a. Residents will demonstrate skill in a. Residents will demonstrate the ability understanding of the tools and incorporating novel PBLI tools and ACE A to apply PBLI tools and methods to their A C E A AE A methodology for assessing their own methodology in the practices of all the own practices. inpatient practices. members of the inpatient team. b. Residents will demonstrate skill in b. Residents will demonstrate b. Residents will demonstrate the utilization of the results of practice ongoing application of PBLI in order to proficiency in monitoring and improving BDE AE BDE AE DE AE analysis in improving the quality of their achieve continuous quality improvement the performance measures of the inpatient care. in their inpatient practice. inpatient team. c. Residents will demonstrate skill in c. Residents will demonstrate c. Residents will demonstrate using the information system at DE AE compence in using the information DE AE proficiency in using the information DE AE Children's Hospital. system at Children's Hospital. system at Children's Hospital. d. Residents will demonstrate d. Residents will demonstrate d. Residents will demonstrate knowledge of performance measures BE A C knowledge of performance measures BDE A C knowledge of performance measures AE A as they pertain to practice improvement. as they pertain to practice improvement. as they pertain to practice improvement. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E.
    • INTERPERSONAL AND COMMUNICATION SKILLS Allergy and Immunology PGY 1   Interpersonal and PGY 2 Interpersonal and PGY 3 Interpersonal and Communication Skills: To have Communication Skills: To have Communication Skills: To have communication with patients, families, communication with patients, families, communication with patients, families, and other health care professionals in and other health care professionals in and other health care professionals in the hospital. the hospital. the hospital. Assessments Assessments Assessments Objectives Objectives Objectives Teaching Teaching Teaching Methods Methods Methods a.   Residents will monitor and guide    a.   Residents will teach and model    a. Residents will sustain effective and effective and professional effective and professional relationships professional relationships with patients, BE ABE BE A B E communication for all members of the BE ABE with patients, families and colleagues, families and colleagues. house staff team, including listening including listening skills. skills. b.    Residents will demonstrate the b.   Residents will demonstrate    b.   Residents will demonstrate    ability to use effective listening, competency in the use effective proficiency in the use effective listening, nonverbal, questioning, and narrative BE AB listening, nonverbal, questioning, and BE A B nonverbal, questioning, and narrative BE AB skills to communicate with patients and narrative skills to communicate with skills to communicate with patients and families. patients and families. families. c.   Residents will demonstrate    c.    Residents will demonstrate the c.   Residents will demonstrate    proficiency in providing their health care ability to provide their patients and competence in providing their health team, patients and families with clear families with clear information about BE AB care team, patients and families with BE AB BE AB information about their treatment their treatment programs and accepted clear information about their treatment programs and accepted alternatives, alternatives. programs and accepted alternatives. and in guiding patients and families in making difficult decisions. d.   Residents will demonstrate the    d.   Residents will demonstrate    d.    Residents will demonstrate the ability to teach members of their team to proficiency in teaching members of their ability to convey bad news while BE A B C convey bad news while supporting the BE A B C team to convey bad news while BE ABC supporting the emotional needs of the emotional needs of the recipients and supporting the emotional needs of the recipients and their families. their families. recipients and their families. e.   Residents will demonstrate    e.   Residents will demonstrate    e.   Residents will demonstrate the competence in teaching their team proficiency in teaching their team ability to write clear medical notes, E A B E members to write clear medical notes, E A B E members to write clear medical notes, E ABE orders in the medical chart, and orders in the medical chart, and orders in the medical chart, and requests for consultation. requests for consultation. requests for consultation. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E.
    • PROFESSIONALISM Allergy and Immunology  PGY 1 Professionalism: To carry out PGY 2 Professionalism: To carry out PGY 3 Professionalism: To carry out responsibilities in a professional responsibilities in a professional responsibilities in a professional manner. manner. manner. Assessments Assessments Assessments Objectives Objectives Objectives Teaching Teaching Teaching Methods Methods Methods a.   Residents will demonstrate    a.   Residents will demonstrate the    a. Residents will demonstrate respect, proficiency in maintaining an ability to teach and model respect, compassion and integrity in ABC ABC atmosphere of respect, compassion ABC BCE compassion and integrity in BCE BCE relationships with patients, families, and E E and integrity in relationships with E relationships with patients, families, and colleagues. patients, families, and colleagues within colleagues. the house staff team. b.   Residents will adhere to principles    b.   Residents will adhere to principles    b. Residents will adhere to principles of of confidentiality, scientific and of confidentiality, scientific and confidentiality, scientific and academic BE ABE BE ABE BE ABE academic integrity, and informed academic integrity, and informed integrity, and informed consent. consent. consent. c.   Residents will demonstrate the     c. Residents will demonstrate sensitivity c.   Residents will demonstrate the    willingness to provide needed care with and responsiveness to patients and willingness to provide needed care with the same standards to all patients colleagues in consideration of sex, age, BE A B E the same standards to all patients BE ABE BE ABE regardless of race, sex, religious culture, religion, sexual preference, and regardless of race sex, religious beliefs, beliefs, type of reimbursement, or ability beliefs. type of reimbursement, or ability to pay. to pay. d.   Residents will demonstrate the    d.   Residents will demonstrate    d. Residents will demonstrate the ability ability to teach their team members proficiency in teaching their team to interact with other health care BE AB about appropriate and inappropriate BE AB members about appropriate and BE AB members and peers in a professional interactions with their patients and inappropriate interactions with their manner. patients' families. patient’s and patients' families. e. Residents will model professional e. Residents will demonstrate the ability e.    Residents will monitor and guide      behavior with other members of the to interact with patients and patients' BE AB BE AB the professional behavior of all BE AB health care team, their peers, patients families in a professional manner. members of the house staff team. and patients' families. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E.
    • SYSTEMS-BASED PRACTICE Allergy and Immunology PGY 3 Systems-Based Practice: PGY 1 Systems-Based Practice: PGY 2 Systems-Based Practice: Understand and access the systems Understand and access the systems Understand and access the systems based practice of UAMS/Children's based practice of UAMS/Children's based practice of UAMS/Children's Hospitals in order to provide optimal Hospitals to provide optimal care. Hospitals to provide optimal care. care. Assessments Assessments Assessments Objectives Objectives Objectives Teaching Teaching Teaching Methods Methods Methods a.      Residents will demonstrate an   understanding of the contexts and a. Residents will demonstrate skill in a. Residents will demonstrate systems in which health care is BCD advocating and facilitating patients' BCD proficiency in advocating and facilitating B C D E AE AE A E provided, and demonstrate the ability to E engagement with the health care system E patients' engagement with the health apply this knowledge to improve and in all of its dimensions. care system in all of its dimensions. optimize health care. b.  Residents will understand the    b.   Residents will demonstrate skill in    b.   Residents will demonstrate skill in    process for requesting and providing evaluating and implementing the E A selecting appropriate consulting E A E A appropriate consultations for their recommendations of differing services for specific clinical problems. patients. consultants. c.      Residents will demonstrate the   c.   Residents will demonstrate skill in    c.   Residents will demonstrate skill in    ability to apply evidence-based ABC BCD A utilizing health care resources efficiently A maximizing patient flow while BDE A strategies to prevention, diagnosis, and D E E and prudently. maintaining high quality care. disease management. d.      Residents will understand the   d.   Residents will demonstrate skill in    d.   Residents will demonstrate skill in    appropriate roles of all the members of E A coordinating the functions of the multi- BDE A identifying and resolving conflicts within E A the multi-disciplinary health care team. disciplinary team. the multidisciplinary process. e.    Residents will demonstrate skill in      e.   Residents will demonstrate skill in    e.    Residents will demonstrate skill in      monitoring and modeling best practices E performing daily discharge and BDE A facilitating and coordinating complex BE A A in patient discharge as it relates to predischarge duties. discharge functions. patient safety and continuity of care. f.   Residents will demonstrate skill in     f.      Residents will demonstrate ability to   f.       Residents will demonstrate skill in monitoring the quality and timeliness of E maintain timely and accurate medical DE A E modeling and teaching the appropriate BE AE A E medical records entered by those under records. maintenance of medical records. their supervision. g. Residents will demonstrate accuracy g.   Residents will demonstrate skill in      g.    Residents will demonstrate skill in and thoroughness in patient sign CDE A teaching and modeling appropriate sign C D E A monitoring and maintaining handoff E A outs/hand offs. out/hand off techniques. safety. h. Residents will demonstrate h. Residents will demonstrate knowledge of the sources of financing knowledge of the sources of financing E A for patients as appropriate to the E A for patients as appropriate to the medical context and will display skill in medical context. teaching members of their team about these issues. Teaching Method As . A. A.      Reading      Direc B.      Rounds     B. C.      Conferences      C. D.      Direct Patient Care   D. E.       Resident/Attending Mentoring   E. II. LEARNING AND TEACHING TOOLS
    • Teaching Methods Independent Reading: Each resident will read independently to answer questions about patient care that arise during the rotation. The resident may use primary literature or other resources suggested by preceptors. Rounds: Rounds are conducted in inpatient wards three times per week. Conferences: Conferences are a weekly Allergy/Immunology lecture and a weekly Allergy/Immunology conference. Direct Patient Care: Hands-on direct and ongoing contact with patients. Resident/Attending Mentoring: Resident/attending mentoring will provide an ongoing process of feedback regarding resident performance. Journal Club Assessment Tools: Direct and indirect observation by attending: Direct observation will include scheduled formal observations with feedback. Indirect observation will include informal, ongoing and daily casual observation. 360 Multi-rater Evaluation: The 360 Multi-rater evaluation measures Professionalism and Interpersonal and Social Skills. Evaluators include patients, other residents, nurses, nurse practitioners, and social workers. In-Training Exam (ITE): Developed by the American College of Physicians and co-sponsored by the Association of Program Directors in Internal Medicine and the Association of Professors of Medicine, the Internal Medicine In-service Training Examination is designed to give residents an opportunity for self- assessment, provide program directors the opportunity to evaluate their programs and identify areas in which residents need extra assistance. Mini CEX: Assesses the clinical skills of residents. In this exercise, the attending physician directly observes a discrete resident-patient interaction and provides immediate feedback. Rotation Evaluation: Rotation evaluation is a monthly assessment based on the specific goals and objectives of the rotation as organized by competency to be completed by the attending physician. Educational Resources UAMS library. Ill. ENCOUNTERS AND VENUES Patient Characteristics and Venues Patients are primarily pediatric and adolescent allergy patients and adult and pediatric patients with immune deficiencies of various types cared for at the Arkansas Children’s Hospital-based clinic. Occasional inpatient consultations and short stay patients may also be encountered and assessed. Residents also have the opportunity to rotate through two private clinics for additional pediatric and adult allergy experience. In these settings more adult allergy patients may be encountered.
    • Mix of Diseases A. Asthma diagnosis, pathophysiology and treatment B. Rhinitis, classification, diagnosis and treatment C. Atopic dermatitis D. Anaphylaxis, diagnosis and treatment E. Drug reactions, diagnosis and treatment F. Food reactions, diagnosis and treatment G. Uticaria, diagnosis and treatment H. Initial evaluation of immunodeficiency states I. Allergy skin testing J. Allergen immunotherapy K. Status asthmaticus, diagnosis and treatment L. Care of patient with asthma and allergic rhinitis during pregnancy M. Sinusitis N. Allergic contact dermatitis, diagnosis and treatment O. Atopic dermatitis, diagnosis and treatment P. Stinging insect reactions, diagnosis and treatment Q. Clinical immunology, including components of the immune system and immunological reactions in the more common immunodeficiency states lV. POLICIES Policies are available from http://www.uams.edu/dim/residency_program/ V. SCHOLARSHIP Understanding and participation in scholarship is an essential component of residency education in General Internal Medicine. Developing research competency including understanding of how research is conducted, evaluated, explained to patients and applied to patient care is supported throughout conferences, grand rounds and mentoring activities. All senior residents participate in presentation of research studies as part of the Friday Residents’ Conference. Residents also present posters, author journal articles and present original research at national and local conferences.  
    • CARDIOLOGY- PEDIATRICS Page 1 of 5 Pediatric Cardiology:  Housestaff Manual  Cardiology  Revised 6/05; 6/07  UAMS COM Department of Pediatrics Cardiology Service Education Plan Introduction/Purpose The intent of the Cardiology Rotation is to: 1a. Provide a balanced cardiology experience to include inpatient care and clinics. 2b. Provide a structured learning environment to include history and physical diagnosis, ECG interpretation, didactic lectures, and bedside teaching. 3c. Expose the residents to pediatric patients initially presenting with common heart problems that they are likely to encounter in practice. Rotation Contacts Faculty Supervisor: Ritu Sachdeva, M.D., phone 364-1479  Admin Assistant: Becky Hooks, phone 364-2220  Office Location: 3rd floor of the new ACH office building. Prerequisites 11Must be a 2nd- year pediatrics or med/peds resident  22Successfully completed APLS or similar specialized training  33Vacation is not allowed during rotation.  General Responsibilities and Expectations  Outpatient clinics 11The resident will see patients in clinic under the supervision of the attending physician. 22The resident will discuss the history, physical examination, and any lab data such as ECG, chest X-ray, and echo results with the attending physician and formulate a management plan. 33The number of clinic patients will be limited to allow adequate time for teaching. 44The resident will assist in teaching junior medical students in the clinic. Inpatient wards 11Two residents will work with the Cardiology attending and Cardiology specialty nurse to care for patients on the ward (CV East) as well as the cardiology patients in NICU. 22Management of common cardiac problems such as congestive heart failure, arrhythmias, endocarditis, and various congenital heart diseases will be emphasized. 33Residents will NOT be involved in the immediate postoperative care of surgical patients, but will take care of them once they are stable and transferred over to CV East from the CV ICU. Page 2 of 5 Pediatric Cardiology 4
    • 55Residents will obtain a written and verbal transfer note from the nurse practitioner/physician taking care of the patient in CV ICU for appropriate patient care. 66Residents’ involvement with the NICU patients will focus on the cardiology aspect of the patients problems. Weekly call schedules 11Residents will have an average of one day off per week per month consistent with the RRC guidelines. 22The resident doing inpatient rotation will be on call until 7.30 PM and will check out to the general pediatric senior resident after that. 33Call coverage will involve routine calls regarding patients on the cardiology ward and any admissions to the ward. Attending physician on call should be informed about any issues and new admissions. 11Emergencies or care of unstable medical patients will be limited to the time necessary for the attending physician to arrive. 22On weekends the residents will sign off to the ward team resident on call after taking care of ward patients. Night or weekend call 11Not required for this rotation Attendance requirements 11Morning report – 8:00 a.m., Monday, Wednesday – Friday 22Dept. Grand Rounds – 8:00 a.m., Tuesday 33Cardiac cath and surgery review conference – Monday a.m. 44Cardiology review conference – 3-4 p.m. Thursday 55Scheduled 1-hour didactic lectures during the month Educational Responsibilities and Expectations 11Complete pre- & post-tests on WebCT during specified time periods.  22Obtain reading materials required for the rotation. At the beginning of the rotation,  residents will receive the didactic lecture schedule along with a folder that includes selected  pertinent cardiology articles.  33Attend the 1-hour didactic sessions scheduled throughout the rotation.  44Complete and submit rotation experience evaluation on WebCT at the end of the rotation  55Complete faculty evaluations at the end of the rotation.  Clinical Resources  11CVICU 22Cardiology Outpatient Clinics Instructional Resources  List of core topics covered during rotation Page 3 of 5 Pediatric Cardiology 1
    • 22Recognize symptoms of congestive heart failure and recommend a management plan. 33Management of bacterial endocarditis, Kawasaki’s disease and rheumatic fever. 44Perform a physical examination and develop a management plan for: 0o Tetralogy of Fallot 1o coarctation of the aorta 2o Arterial Septal Defect (ASD) 3o Ventricular Septal Defect (VSD) 4o patent ductus arteriosis (PDA) 55Recognize and manage treatment for cardiomyopathies 66Provide follow-up treatment of patients post cardiovascular surgery Required Reading and Viewing 11Interpretation of ECG’s will be emphasized. Optional Reading and Viewing 11WebCT cardiology section has web-site for murmurs and abnormal heart sounds ECGs and other diagnostic tests 11Dedicated time is set aside for residents to learn to interpret ECGs and other diagnostic tests pertinent to diagnosing cardiovascular diseases. Didactic Sessions Residents will have scheduled one-hour lectures during the rotation that will include the following topics: 11. Left-to-right shunting lesions 22. Cyanotic congenital heart diseases 33. Obstructive lesions: Aortic stenosis, pulmonary stenosis, and coarctation 44. Acquired heart disease such as Rheumatic and Kawasaki disease 55. Cardiac murmurs 66. Arrhythmias 77. Cardiac emergencies 18. Cardiomyopathies 29. ECG reading 310. Cardiac intensive care Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric resident will be able to: Page 4 of 5 Pediatric Cardiology 1
    • 22Interview patients and families and obtain accurate history for the evaluation of a wide range of pediatric cardiovascular diseases such as congenital heart defects, congestive heart failure, arrhythmias, endocarditis, and rheumatic fever. 33Demonstrate physical examination skills pertinent to the evaluation of cardiovascular system. 44Describe the indications for diagnostic tests, including chest x-ray, EKG, echocardiography, Holter monitoring, event recording, cardiac MRI, and cardiac catheterization based on the clinical assessment. 55Integrate history, physical exam, and laboratory data to reach a definitive diagnosis of a specific disease entity. 66Develop and carry out management plans in consultation with the attending cardiologist. 77Counsel and educate patients and their families about a variety of congenital and acquired cardiac diseases in consultation with the attending physician. 88Provide cardiovascular health assessment and anticipatory guidance for patients and their families aimed at preventing cardiovascular diseases. Medical Knowledge – about established and evolving biomedical, clinical, and rotation-specific. By the end of this rotation, the pediatric resident will be able to: 11Read the textbook and other sources such as journal articles and lecture material provided during the rotation to establish a good knowledge base of congenital and acquired heart disease. 22Distinguish normal from abnormal cardiovascular signs and symptoms, including: 01. Mechanisms of production of heart sounds and murmurs, with application to differentiation between organic and innocent murmurs. 12. Age-related changes and normal ranges in heart rate and blood pressure, from birth through adolescence. 23. Physiologic and pathologic variations in cardiac rhythm 34. Normal perinatal circulation, changes at birth, and their influence on the development of signs and symptoms of congenital heart disease in the neonate. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric resident will be able to: 11Utilize evidence-based medicine and practice-based experience to formulate a systematic method for patient evaluation and treatment. 22Facilitate the learning of students and other health care professionals, under direct supervision of the attending physician. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric resident will be able to: Page 5 of 5 Pediatric Cardiology 1
    • 22Demonstrate interpersonal and communication skills that will allow them to function as part of the cardiovascular health care team to provide coordinated patient care. 33Use effective listening skills to relate to the patients, their families and other members of the cardiovascular health care team. 44Provide information to team members, patients, and families utilizing verbal and written information. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the pediatric resident will be able to: BDemonstrate ethical principles pertaining to provision of withholding of clinical care, confidentiality of patient information, and informed consent. 11Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, disabilities, and social situations. Systems-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric resident will be able to 11Assess home-health needs for patients with complex congenital heart disease and utilize various resources to provide optimal patient care. 2 Methods of Evaluation and Feedback  11. Objective assessment of the resident knowledge or skills, including multiple-choice answer pre- and post-test that will cover basic principles relevant to the elective. 22. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. 33. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 3: Pediatric Endocrinology Housestaff  Manual  Endocrine  Revised 11/2006; 5/2007  UAMS COM Department of Pediatrics Endocrinology Education Plan Introduction/Purpose: This   elective   will   provide   residents   the   opportunity   to   enhance   their   general  knowledge  and clinical  skills regarding  the diagnosis  and treatment  of endocrine  disorders,  as  well as  develop  a  more  mature  and  comprehensive  understanding  of  the  many  systems   involved  in endocrine  physiology   and   pathophysiology.   They   will   also   have   hands-on   experience   in   the   outpatient   clinical  environment  to develop  their knowledge  of the overall  process  by which one evaluates  and medically  manages children who have endocrine disease.  Contact Person / Faculty Supervisor: Alba Morales Pozzo, MD  Prerequisites Must be a 2nd or 3rd year resident.  Vacation or time off for interviews is allowed, although discouraged, during rotation. For  scheduling purposes, vacation or time off must be submitted the week prior to the 1st day  of the rotation.  Responsibilities and Expectations  1• Complete the Endocrine pre-test on WebCT within the first four days of the rotation. 2• In the event that you miss a meeting or rounding with the attending, you should review the topics in resources provided during the rotation. Since residents may take vacation during this rotation, it is your responsibility to read about topics, listed in the Medical Knowledge objectives, covered during the time that you are absent. 3• At the end of the month, take the post-test on WebCT within the last four days of the rotation. 4• At the end of the month, fill out the rotation experience evaluation on WebCT. Clinical Responsibilities  1• Outpatient clinics begin at 9am. Residents will attend all scheduled clinics during the week. A monthly clinic schedule is provided for the resident at the time of the rotation. 2• Clinics are held at the Outpatient Center - Clinic 4 - and at the West Little Rock Subspecialty clinic. Instructional Resources  Didactic Sessions: Residents on the rotation will meet with Dr. Alba Morales at least 2/week at a convenient time in order to discuss specific topics relating to Pediatric Endocrinology. Required Reading and Viewing: A packet of review articles and a handbook of Pediatric Endocrinology will be handed to each resident at the beginning of the rotation. Goals and Objectives  Patient Care Residents will provide patient care that is compassionate, appropriate, and effective for the evaluation and management of children and adolescents with endocrine or suspected endocrine disorders.
    • Page 2 of 3 Residents will: 1• Employ appropriate skills, such as age-specific physical exams, taking a medical history cognizant of normal growth milestones, and interpretation of medical testing as it relates to age-specific ranges, to assess and address the normal process of growth and pubertal development. 2• Develop and demonstrate an initial approach to the evaluation of children with endocrine disorders, such as short stature, delayed and early puberty, hypo- and hyper-thyroidism, hypo and hyperglycemia, adrenal diseases and calcium disorders. Medical Knowledge Residents will demonstrate knowledge about various endocrine disorders and will be able to apply this information to the clinical care of a patient. Residents will demonstrate knowledge on the following topics: 1. Normal and abnormal growth and development 2. Thyroid diseases in childhood 3. Sexual ambiguity 4. Diabetes mellitus 5. Adrenal disease 6. Bone disease Practice-based Learning and Improvement Residents will be able to appraise and assimilate scientific evidence and improve their patient care practices for patients with endocrine disease. Residents will: 1• Choose an endocrine case of interest to follow during the course of the rotation, review relevant literature for current information and treatment options, and present findings at one of the didactic conferences. 2• Identify resources for up-to-date information regarding endocrine disorders in children and adolescents. Interpersonal and Communication Skills Residents will demonstrate interpersonal and communication skills that result in effective information exchange and cooperation with patients, their patient’s families, and professional associates. Residents will: 1• Demonstrate the ability to communicate effectively with parents/families/medical team regarding diagnostic studies performed while on this rotation, appropriate interpretation of the diagnostics, and the significance of the studies as they relate to the patient at hand. Professionalism Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents will be able to: 1• Demonstrate sensitivity and responsiveness to families and patients. Page 3 of 3
    • System-based Practice Residents will demonstrate an understanding and ability to work effectively within the hospital and clinical setting for evaluation and management of children with endocrine disease. Residents will be able to: 1• Describe the overall system for management of children with simple and complex endocrine disorders. 2• Identify essential tools to diagnose and care for children and adolescents with endocrine disease. Methods of Evaluation and Feedback  11. Objective evaluation of the resident will be performed using a posttest, which will cover basic principles relevant to the elective. 22. Subjective evaluations of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard written evaluation will be used and discussed with the resident. 33. At the end of the rotation the resident will submit feedback of the rotation experience. Evaluation may be submitted using the standard form available in the Pediatric Housestaff office or on the Endocrine WebCT course. The rotation is not complete until the rotation evaluation is submitted.
    • Page 1 of 3 Genetics Elective Housestaff Manual  Genetics Elective  Revised 9/07  UAMS COM Department of Pediatrics Genetics Elective Education Plan Introduction The purpose of this rotation is to introduce the general pediatric physician to inheritance  patterns, common genetic syndromes, standard practices of testing, and interpretation of  reports.  Rotation Contacts Faculty Supervisor(s)/Preceptor(s): Stephen Kahler, M.D.  Admin Assistant or Office Contact: Genetics Office, 364-2966  Location Genetics office  Prerequisites PMust be a 2nd or 3rd year pediatrics resident or 3rd/4th year med/peds resident.  11Vacation or time off for interviews is allowed during this rotation.  General Responsibilities and Expectations  Outpatient clinics 11Actively participate in scheduled genetic clinics. Inpatient consults 11Attend genetics consults with the faculty on service. Weekly/monthly schedules 111 Attend scheduled genetic conferences, including journal club, case conference, and   genetics-radiology conference. 222 Attend scheduled pediatric conferences, such as Grand Rounds and morning report. Where   genetics cases are discussed, the resident will be expected to contribute information in areas related to genetics. 33Attend any scheduled ethics conferences, if appropriately related to genetics. Night or weekend call 11This is no night or weekend call associated with this elective Attendance on rounds, consults, and/or procedures 111 Dress professionally   22Be on time Vacation  11Time off must be submitted to faculty supervisor/contact person 1 week prior to the  start of the rotation.  Educational Responsibilities and Expectations 11Obtain reading materials required for the rotation.  22Select and complete “work product,” described below required for completion of  rotation.  33Read required material and be prepared to discuss during didactics or teaching rounds.  44Complete and submit rotation experience and faculty evaluations at the end of the  rotation. 
    • Page 2 of 3 Genetics Elective Clinical Resources Genetics Clinic Instructional Resources List of core topics covered during rotation 11Pedigree composition 222 Inheritance patterns   33Common genetic syndromes Didactic Sessions 111 Sessions will be scheduled to accommodate the resident’s continuity clinic and   2vacation. Required and Optional Reading and Viewing REducational materials are located in the Genetics office, as well as online through the ACH library, and are available to the resident during the rotation. Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric resident will be able to: 11Obtain appropriate genetic/medical information from the patient and family. 22Perform a genetic/physical examination to form a diagnosis/differential diagnosis 33Make appropriate recommendations based on test results, family history, and patient exams. Medical Knowledge –established and evolving biomedical, clinical, and rotation-specific. By the end of this rotation, the pediatric resident will be able to: 11Demonstrate an understanding of inheritance patterns through discussions with the faculty attending. 22Interpret cytogenetic and/or molecular genetic reports. 33Recognize common genetic syndromes. 444 Distinguish indications for specific metabolite testing and interpretation of   0metabolic laboratory reports. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric resident will be able to: 11Utilize information technology to identify current literature applicable to genetics-related problems seen during the time on the elective. 000 Apply new methods of diagnosis or treatment modalities encountered in the   1literature as they relate to genetic syndromes in infants and children. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric resident will be able to: 11Work effectively with the general ward teams who request consultations. 22Effectively communicate genetics-related issues to patients and/or their families. 33Work effectively with laboratory technicians in performing and interpreting test results.
    • Page 3 of 3 Genetics Elective Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the pediatric resident will be able to: 11Be on time for meetings, lectures, and rounds. 22Dress professionally each day. 33Read assignments in advance to be prepared for discussion. System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric resident will be able to: 11Function effectively with other members of the health care team for the benefit of the patient. 22Recognize and advocate for patients who need assistance to deal with the complexities of health care system. “Work Product”  The resident will produce the following: 11. Select a genetic topic of interest, develop a general outline, and present to the Genetics division. A list of the pertinent literature identified during the research on the topic should accompany the outline. 22. Keep a diary of daily activities or summary interesting cases during the month and submit a reflective summary of what resident learned and how this new knowledge and skills will improve resident’s patient care practices. Work Product Expectation: A copy of the work product written outline should be submitted to the Genetics office by the end of the rotation or no later than 15 days into the next month. The elective is considered incomplete until the work product is received. Methods of Evaluation and Feedback  11. Subjective assessment of resident performance will be undertaken by the faculty attending’s evaluations of written patient consults/evaluations, presentation, and the degree to which the electives goals and objectives were met. The standard evaluation form will be used and discussed with the resident at the end of the rotation. 22. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 5 Pediatric Hematology-Oncology [Wards] Housestaff Manual  Hematology-Oncology Inpatient Wards  Rev 8/07  UAMS COM Department of Pediatrics Hematology-Oncology Inpatient Education Plan Introduction The purpose of this rotation is to provide an inpatient opportunity for pediatric interns and  residents to develop an understanding of the initial presentation, evaluation, treatment, and  management of common hematologic and oncologic problems in children.  Rotation Contacts Faculty:  Amir Mian, M.D.  Suzanne Saccente, M.D.  Kimo Stine, M.D.  Contact: Office Manager, 364-1494  Location (“home base”) Hematology Section office, 5th floor main hospital  The Blood and Cancer Center is located on the 3rd floor or Arkansas Children’s Hospital  Hematology-Oncology Wards  Prerequisites 11None  General Responsibilities and Expectations  Inpatient Wards 11Each resident will be assigned patient care responsibilities for the inpatient hematology oncology service with the senior resident responsible for patient care assignments. 22Residents are expected to attend rounds daily with the attending on service, unless they have alternative clinic assignments. 33In addition, residents are expected to read independently regarding patients they are caring for while on the hematology – oncology service. Weekly/monthly schedules 11Patient care rounds with the hematology oncology attending take place from 9 a.m. until 10 a.m. each morning Monday through Friday. 22Attend tumor board, which meets at 4 p.m. in the Pathology conference room on the first and third Wednesday of each month. A list of the patients to be discussed will be provided prior to the conference. Night or weekend call 11The call schedule will be provided by the chief residents, as well as time off assignments. Attendance on rounds, consults, and/or procedures. Attendance on rounds, consults, and/or procedures 11Dress professionally. 22Be on time. Vacation  11Residents may not take vacation or time off during this rotation.  Educational Responsibilities and Expectations 11Attend morning patient care rounds with the hematology oncology attending from 9 a.m.  until 10 a.m. each morning Monday through Friday. 
    • Page 2 of 5 Pediatric Hematology-Oncology Wards 11At least once each week one of these sessions will be an expanded “teaching session”. Alternatively the attending may select another time for teaching after consideration of the residents and students other clinical responsibilities. 22Complete pre- & post-test on WebCT during specified time periods, when they become available.  33Read required material and be prepared to discuss during didactics or teaching rounds.  44Complete and submit rotation experience and faculty evaluations at the end of the rotation.  Clinical Resources  11General Hematology-Oncology Ward 22Hematology-Oncology Office Instructional Resources  List of core topics covered during rotation 11Common hematologic problems: anemia, hemoglobinopathies, thrombocytopenia, neutropenia, and common bleeding problems, 22Common oncologic problems: acute leukemias, brain tumors, Hodgkin’s and non-Hodgkin’s lymphomas, neuroblastoma, sarcomas, Wilms’ tumor, bone tumors, retinoblastoma and histiocytosis Didactic Sessions 11Topics will be covered during the teaching morning patient care rounds At least once each week one of the morning patient care rounds will be an expanded “teaching session.” Alternatively the attending may select another time for teaching after consideration of the residents and students other clinical responsibilities. Reading Resources 11The Children’s Hospital Oakland Hematology/Oncology Handbook – a Mosby handbook by Caroline Hastings, M.D. Mosby, 2002. 22Principles and Practice of Pediatric Oncology – 4th edition by Phillip Pizzo and David Poplack. Lippincott, Williams and Wilkins, 2002. 33Pediatric Hematology by Robert D. Collins and Steven Swerdlow. Churchill Livingston, 2001. 44Hematology of Infancy and Childhood – 5th edition. David Nathan and Stuart Orkin. W. B. Saunders, 1998. Slides 11Teaching slides for peripheral blood smears will be available for the residents to review common findings on peripheral blood smears. 22In addition, a slide tray of bone marrow samples will be available for additional review. Applicable Hospital Committees 11Infection Control Page 3 of 5 Pediatric Hematology-Oncology Wards
    • Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric intern will be able to: 11Gather accurate information from the patient’s history and conduct a physical examination. 22Assist in making decisions using the diagnostic strategies available and the risks and benefits of various therapeutic interventions based on the patient’s information and scientific evidence coupled with clinical judgment. 33With the guidance of team members, assist to develop, carry out, and follow up on patient management plans. By the end of this rotation, the upper level pediatric resident will be able to: 11Use information from the patient’s history and physical examination, to develop diagnostic and therapeutic strategies for infants and children with hematologic and oncologic diseases. 22Assist the health care team in making decisions using the diagnostic strategies available and the risks and benefits of various therapeutic interventions based on the patient’s information and scientific evidence coupled with clinical judgment. 33Develop, carry out, and follow up on patient management plans. Interns and upper level residents should demonstrate increased autonomy as they progress through the rotation, requiring less supervision from the attending physician. Medical Knowledge – to establish an understanding of the disease processes and treatment options as they relate to the hematologic and oncologic diseases of children. By the end of this rotation, the pediatric intern will be able to: 11Identify common hematologic problems including anemia, hemoglobinopathies, thrombocytopenia, neutropenia, and common bleeding problems. 22Demonstrate a basic understanding of the common oncologic problems, their initial presentation, evaluation, and treatment strategies in children including acute leukemias, brain tumors, Hodgkin’s and non-Hodgkin’s lymphomas, neuroblastoma, sarcomas, Wilms’ tumor, bone tumors, retinoblastoma and histiocytosis. 33Perform the initial evaluation, and develop an initial management plan for common complications of malignancy and chemotherapy, including fever and neutropenia, infectious complications, tumor lysis syndrome, severe anemia, and bleeding. 44List the acute and delayed side effects of commonly used chemotherapeutic agents upon completion of the rotation. 55Participate in a discussion on the late complications of cancer treatment in children who are long- term survivors. By the end of this rotation, the upper level pediatric resident will be able to: 11Evaluate and treat common hematologic problems including anemia, hemoglobinopathies, thrombocytopenia, neutropenia, and common bleeding problems. 22Demonstrate a broader understanding of the common oncologic problems, their initial presentation, evaluation, and treatment strategies in children including acute leukemias, brain tumors, Hodgkin’s and non-Hodgkin’s lymphomas, neuroblastoma, sarcomas, Wilms’ tumor, bone tumors, retinoblastoma and histiocytosis. 33Evaluate a peripheral blood smear and fully interpret a complete blood count, common coagulation tests. 44Use blood products including red cells, platelets, and coagulation factors appropriately and demonstrate awareness of the complications associated with their use.
    • Page 4 of 5 Pediatric Hematology-Oncology Wards 55Demonstrate understanding of the diagnosis, interpretation of newborn screening and management of hemoglobinopathies, including the complications of sickle cell disease including painful crisis, fever, stroke, splenic sequestration and aplastic crisis. 66Lead a discussion on the late complications of cancer treatment in children who are long-term survivors. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric intern will be able to: 11Apply new material learned from outside reading and consultation into the care of their patients. 22Facilitate the learning of the medical students participating in the Pediatric Hematology-Oncology clinic and inpatient ward. By the end of this rotation, the upper level resident will be able to: 11Apply new material learned from outside reading and consultation into the care of their patients. 22Facilitate the learning of the medical students and the pediatric interns participating in the Pediatric Hematology-Oncology clinic and inpatient ward. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric intern and upper level resident will be able to: 11Communicate information to the patient and family regarding the test results, plan of care, and education about the disease process in appropriate terms for the patients and families to understand. 11Communicate important patient care information to appropriate members of the health care team, including nursing staff, social workers, child life members, other residents, consulting physicians, and hematology-oncology attending staff. 22Serve as role models and teachers for the junior medical students involved in patient care in the Hematology inpatient ward and outpatient clinics. In addition, the pediatric upper level resident will be able to: 11Serve as role models and teachers for pediatric interns as well as the junior medical students involved in patient care in the Hematology inpatient ward and outpatient clinics. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the pediatric intern and upper level resident will: 11Be prompt and well groomed in a professional manner. 22Adhere to ethical principles, including respect for the confidentiality of patient information and the need for informed consent. 33Demonstrate respect despite differences in patient’s culture, age, gender, or disabilities. System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric intern will be able to: 11Describe their role on the multi-disciplinary team. 22Show respect for importance of other health care professionals to improvement of outcome for their patients. 33Advocate for their patient to achieve the highest quality medical care. 44Identify cost effective measures in providing high quality care without compromising quality of care. Page 5 of 5 Pediatric Hematology-Oncology Wards
    • By the end of this rotation, the pediatric upper level resident will be able to: 11Demonstrate their ability to lead a multi-disciplinary team. 22Show respect for importance of other health care professionals to improvement of outcome for their patients. 33Advocate for their patient to achieve the highest quality medical care. 44Use cost effective measures in providing high quality care without compromising quality of care. Methods of Evaluation and Feedback  11. Objective assessment of the resident’s knowledge will be determined on a multiple-choice pre- and post-test that will cover basic principles relevant to this rotation. 22. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, participation in didactics, and observations of the execution of skills relevant to the learning objectives of the rotation. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. 33. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 4 Pediatric Infectious Disease Elective Housestaff Manual  Infectious Disease Elective  Revised 6/07  UAMS COM Department of Pediatrics Infectious Disease Elective Education Plan Introduction/Purpose The Pediatric Infectious Disease rotation provides an opportunity for the resident/senior medical  student to enhance their understanding of prevention, diagnosis and therapeutic management of  infectious diseases of pediatric patients.  Rotation Contacts Physicians: Stephanie Stovall, M.D.  Nada Harik, M.D.  Gary Wheeler, M.D.  Richard Jacobs, M.D.  Office Manager: Tanya Hogan, phone 364-41416  Location (“home base”) Infectious Disease section office, 4th floor Sturgis Building Prerequisites 11Must be a 2nd or 3rd year pediatrics resident or 3rd/4th year med/peds resident eligible for  electives.  22Vacation is allowed during this elective.  General Responsibilities and Expectations Outpatient clinics 11Pediatric Infectious Disease Clinic is held each Tuesday morning. Residents are expected to 0participate in inpatient consults i The Pediatric Infectious Diseases service provides 24-hour per day, 7-day per week consultant services. Residents on the rotation will be asked to participate during regular hours of the rotation (Monday - Friday, 0800-1700). Within usual working hours, patients requiring consultation in the late afternoon hours will be assigned rotating between the medical students and residents on the rotation. 0 Residents will be expected to independently read journal articles, textbooks, or other 0 materials provided by the attending on patients on the consultant service and teaching cases. 1They will be expected to participate in active discussion of the patients during rounds. Weekly/monthly schedules 11Available on the first day of the elective. Night or weekend call 11There will be no night call or weekend call during the Infectious Disease elective. Attendance on rounds, consults, and/or procedures 11Dress professionally each day since consults may be received at any time. 22Be on time for didactics, meetings, consults, and rounding with an inpatient team.
    • Page 2 of 4 Pediatric Infectious Disease Elective  Vacation  V ime off must be submitted to faculty supervisor or ID office manager 1 week prior to the start  T of the rotation.  11If the resident takes vacation during this rotation, it is the resident’s responsibility to read  about topics covered during the time off since topics may be covered on assessments.  Educational Responsibilities and Expectations 11Complete pre- & post-test during the first and last 4 days of the month.  22Obtain reading materials required for the rotation.  33Select and complete “work product”, if required, for completion of rotation.  44Read required material and be prepared to discuss during didactics or teaching rounds.  55Complete and submit rotation experience and faculty evaluations at the end of the rotation.  Clinical Resources Infectious Disease Clinic each Tuesday morning 11The diversity of patients referred to this clinic includes pediatric HIV/AIDS, congenital intrauterine infections, follow-up patients from hospitalization with osteomyelitis, pyogenic arthritis, meningitis, endocarditis, congenital syphilis, and a variety of other patients seen on the consultation service. 22A large number of referral patients for immune deficiency evaluation, fever of unknown origin, or otherwise undiagnosed recurrent or prolonged fevers are referred to this clinic by practicing physicians in the State of Arkansas. 33ID Clinic is an extremely worthwhile and educational experience and is staffed by Infectious Disease attending physicians. Instructional Resources Core topics covered during rotation 11HIV/AIDS, skin and soft tissue infections, congenital infections, meningitis/encephalitis, device associated infections, bacteremia/sepsis, pneumonia, tick diseases, histoplasmosis/blastomycosis, recurrent/prolonged fever, Kawasaki disease, infections in immunocompromised patients Didactic Sessions 11Minimum of 4 sessions per week – these are scheduled on Monday, Wednesday, Thursday and Friday. Multiple sessions or topics are covered in each session as time allows. The sessions occur during morning or afternoon rounds. 22A combined clinical case conference held in conjunction with the Internal Medicine Infectious Disease Division at the University of Arkansas for Medical Sciences on Mondays at noon either at UAMS or ACH Terrace Room. 33Rounds in the Clinical Microbiology/Virology Laboratories on Wednesdays at 1pm in the ACH microbiology laboratory.
    • Page 3 of 4 Pediatric Infectious Disease Elective 4 55Optional Infectious Diseases Unknowns Lecture (part of curriculum for the Junior Medical Students on the Pediatrics rotation) on Thursday at 7:30am 4th floor office building. 66Teaching and consultation rounds held daily Monday through Friday to discuss official consultations and teaching cases. 77Residents will be required to participate in the didactic lecture series. Topics will be assigned at the beginning of the rotation and these discussions should be approximately 15-30 minutes in length with an additional 30 minutes reserved for discussion. Journal Club 11Infectious Disease Attending Journal Club, Wednesday, 7:30am at UAMS Required Reading and Viewing 11Available on the first day of the rotation. Optional Reading and Viewing 11Available on the first day of the rotation. Photographs, DVDs 11RedBook online and pictures on ID office computer Applicable Hospital Committees 11Residents/students meet with infection control weekly in the micro lab at 11 am on Thursdays, but do not routinely attend the committee. There residents may be appointed to the infection control committee, but not necessarily the ones that take the rotation. Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the upper level pediatric resident will be able to: 11Order and interpret the basic assays in the clinical microbiology, serology, and virology laboratories. 22Develop and carry out patient management plans. 33Utilize anti-infective agents such as antibiotics, antifungals, antivirals, and antiparasitic agents. 44Make informed decisions about the diagnostic and therapeutic interventions for the different infectious diseases of children based upon patient information, up-to-date scientific evidence, and clinical judgment. Medical Knowledge – begin to establish an understanding of the epidemiological sciences as they relate to the infectious diseases of children.. By the end of this rotation, the upper level pediatric resident will be able to: 11Demonstrate an understanding of the importance of the epidemiological sciences as they relate to the infectious diseases of infants and children. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence.
    • Page 4 of 4 Pediatric Infectious Disease Elective By the end of this rotation, the upper level pediatric resident will be able to: 11Apply new methods of diagnosis or treatment modalities encountered in the literature as  they relate to the infectious diseases of infants and children.  22Facilitate the learning of the medical students on the Pediatric Infectious Diseases rotation. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the upper level pediatric resident will be able to: 11Effectively communicate issues related to infectious diseases both to the senior medical students as well as their patients and/or families. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. By the end of this rotation, the pediatric upper level resident will be able to: 11Discuss with the family the anticipated course of therapy including home therapies and intervention System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the upper level pediatric resident will be able to: 11Interact effectively with the clinical microbiology and virology laboratories.  22Demonstrate an understanding about home therapy for infants and children with infectious diseases. Methods of Evaluation and Feedback  11. Objective assessment of the resident knowledge or skills will be obtained through multiple-choice pre- and post-tests on WebCT. Results of the tests will not be used to grade the resident but will be used to assess the increase of knowledge during the elective. 22. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of patient consults or progress notes, didactic participation, and observations of evidence of knowledge and execution of skills relevant to the learning objectives of the elective. The standard Department evaluation form will be used and discussed with the resident at mid- and end of the rotation. Residents not performing satisfactorily will be counseled during the rotation. The resident will have the opportunity to meet with the attending to discuss their performance. 33. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 5 Pediatric Nephrology Inpatient Wards Housestaff Manual  Nephrology Inpatient Wards  Revised 9/07  UAMS COM Department of Pediatrics Nephrology Inpatient Wards Education Plan Introduction The purpose of this elective is to provide the intern and upper level pediatric resident with a  basic understanding of the spectrum of renal diseases as they effect children of different ages and  to develop the knowledge, attitudes, and skills necessary to diagnose, manage, and appropriately  refer children who present to primary care settings with renal needs or complaints.  Rotation Contacts Faculty /Preceptor(s): Mohammad Ilyas, MD  Richard Blaszak, MD  Eileen Ellis, MD  Karen McNiece, MD  Contact: Office Manager, 364-1847  Location (“home base”) Nephrology Office, 4th-floor Sturgis Building Prerequisites 11Vacation/time off for interviews not is allowed during this rotation.  General Responsibilities and Expectations Inpatient Wards 11Each resident will be assigned a number of patients that is commensurate with their level of training. The resident will be responsible for reviewing the preceding day’s events before morning report, daily progress notes, and presentation on rounds. Residents will perform independent consultative evaluations prior to discussion with the attending nephrologist. Weekly/monthly schedules 11Attend 90% or more of the scheduled didactic, case conferences, and morning report. Night or weekend call, if applicable 11Call schedules will be determined at the beginning of the rotation. Attendance on rounds, consults, and/or procedures 11Dress professionally. 22Be on time. Educational Responsibilities and Expectations 11Obtain reading materials required for the rotation.  22Complete skills inventory checklist for completion of rotation.  33Read required material and be prepared to discuss during didactics or teaching rounds.  44Complete and submit rotation experience and faculty evaluations at the end of the rotation. 
    • Page 2 of 5 Nephrology Inpatient Wards  Clinical Resources Nephrology Wards Instructional Resources List of core topics covered during rotation 11Developmental aspects of renal function and abnormal renal development 22Acute renal failure and its associated emergencies 33Disorders of water and electrolytes 44Metabolic acidosis 55Proteinuria (evaluation and differential diagnosis) 66Hematuria (evaluation and differential diagnosis) 77Tubular disorders and renal tubular acidosis 88Hypertension 99Chronic renal failure and the kidney as an endocrine organ 101Urinary tract infection and voiding dysfunction 111Urolithiasis and hypercalciuria 121Dialysis and continuous renal replacement therapies 131Transplantation immunobiology 141Drugs in renal disease Didactic Sessions 11Attend 90% of scheduled didactic and case conferences Journal Club 11Residents are strongly encouraged to attend the monthly Nephrology Journal Club. Required and Optional Reading 11Available from the Nephrology Office. Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric intern will be able to: 11Choose an appropriately sized blood pressure cuff for a child and perform blood pressure measurements. 22Perform a microscopic examination on a freshly voided urine sample according to their handout. By the end of this rotation, the upper level pediatric resident will be able to: 11Construct a plan for monitoring blood pressures general pediatric patients at risk for hypertension as identified by history and physical examination. 22Supervise medical students and interns in performing blood pressure measurements.
    • Page 3 of 5 Nephrology Inpatient Wards Medical Knowledge – about established and evolving biomedical, clinical, and rotation-specific. By the end of this rotation, the pediatric intern will be able to: 11Identify cases involving hyper- hyponatremia, hyper- hypokalemia, and hyper- hypocalcemia. 22Identify cases involving hematuria, proteinuria, hypertension, metabolic acidosis, urinary tract infection, glomerulonephritis, calculus, and renal failure. By the end of this rotation, the upper level pediatric resident will be able to: 11Develop a treatment plan for patients with hyper- hyponatremia, hyper- hypokalemia, and hyper- hypocalcemia 11Develop a treatment plan for patients with hematuria, proteinuria, hypertension, metabolic acidosis, urinary tract infection, glomerulonephritis, calculus, and renal failure Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric intern will be able to: 11Investigate and identify new methods of diagnosis or treatment encountered in the literature as they relate to renal diseases of infants and children. By the end of this rotation, the upper level pediatric resident will be able to: 11Interpret and assimilate evidence found in current literature and apply new methods of diagnosis or treatment as they relate to renal diseases of infants and children. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric intern will be able to: 11Explore their attitudes and beliefs regarding the initiation of long term dialysis in children with multiple medical problems and discuss with the upper level how these might influence their management of such children. 22Discuss the results of laboratory data and issues regarding treatment plans with colleagues and other members of the health care team. By the end of this rotation, the upper level pediatric resident will be able to: 11Identify their attitudes and beliefs regarding the initiation of long term dialysis in children with multiple medical problems and discuss with the attending physician how these might influence their management of such children. 22Communicate in an appropriate, compassionate, and effective manner, the results of laboratory data and issues regarding treatment plans to colleagues, patients, and families. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. During this rotation, the pediatric interns and residents will: 11Be punctual. 22Be well groomed. 33Be sensitive to the needs and concerns of patients and their families with renal disease 44Adhere to ethical principles.
    • Page 4 of 5 Nephrology Inpatient Wards System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric intern will be able to: 11Interact effectively with the clinical laboratories.  22Demonstrate an understanding about the importance of home therapy for infants and children with renal diseases. 33Advocate for the best interest of the patients and their families, utilizing other healthcare professionals appropriately as needed (e.g., social worker, patient-family representatives, interpreters, etc.). By the end of this rotation, the upper level pediatric resident will be able to: 11Interact effectively with the clinical laboratories.  22Coordinate with discharge planning to secure home therapy for infants and children with renal diseases. 11Effectively coordinate other healthcare professionals as needed (e.g., social worker, patient- family representatives, interpreters, etc.) for the best interest of the child. Skills Inventory Checklist  During the course of this rotation, each intern is expected to: 11Discuss with preceptor or upper level resident at least one child with hematuria, proteinuria, hypertension, metabolic acidosis, urinary tract infection, glomerulonephritis, calculus, and renal failure. 22Discuss with preceptor or in a case conference with members of the nephrology section, at least one child with hyper- hyponatremia, hyper- hypokalemia, and hyper- hypocalcemia. 33Successfully perform at least one microscopic examination on a freshly voided urine sample according to their handout. 44Formulate a plan for monitoring blood pressures in one of his/her general pediatric patients at risk for hypertension as identified by history and physical examination. During the course of this rotation, each upper level resident is expected to: 11Discuss in a case conference with members of the nephrology section, at least one child with hematuria, proteinuria, hypertension, metabolic acidosis, urinary tract infection, glomerulonephritis, calculus, and renal failure. 22Discuss in a case conference with members of the nephrology section, at least one child with hyper- hyponatremia, hyper- hypokalemia, and hyper- hypocalcemia. 33Successfully perform at least one microscopic examination on a freshly voided urine sample according to their handout. 44Formulate a plan for monitoring blood pressures in two of his/her general pediatric patients at risk for hypertension as identified by history and physical examination.
    • Page 5 of 5 Nephrology Inpatient Wards Skills Inventory Expectation: Skills Inventory Checklist should be submitted to the Nephrology attending by the end of the rotation and no later than 15 days into the next month. Each activity must be signed by the supervising preceptor. The elective is considered incomplete until the work product is received. Methods of Evaluation and Feedback  11. The interns and upper level residents will submit a skills inventory checklist pertinent to the elective. 22. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentation, and observations of the execution of skills relevant to the learning objectives of the elective. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. Feedback will be provided immediately after the performance of all skills required for this elective. 33. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 3 Child Neurology Inpatient Wards Housestaff Manual  Neurology Wards  Revised 9/07  UAMS COM Department of Pediatrics Child Neurology Inpatient Wards Education Plan Introduction/Purpose To explain why this rotation is important to the education, training, and overall awareness of  general pediatric physicians.  Rotation Contacts Faculty Supervisor: Rolla Shbarou, MD, or faculty assigned to Child Neurology Section  Contact: Malinda Scott, Office Manager, 5281  Location (“home base”) Child Neurology Office Prerequisites 11None  22 General Responsibilities and Expectations  Weekly/monthly schedules 11Will be available at the beginning of the rotation Night or weekend call 11Call schedules will be determined at the beginning of the rotation. Attendance on rounds, consults, and/or procedures 11Dress professionally 22Be on time Vacation  11Vacation is not permitted during this rotation.  Educational Responsibilities and Expectations 11Attend didactics conferences.  Educational Goals and Objectives  Patient Care – that is compassionate, appropriate, and effective. By the end of this rotation, the pediatric resident will be able to: 11In addition to the regular components of a thorough history, stress the importance of other factors, including: 1a) Identify any risk factors in the pregnancy, labor, or delivery that could have impacted the neurologic outcome. 2b) Document detailed developmental history identifying strengths, weaknesses, and isolated abnormalities, especially primary language delay. 3c) Document detailed family history.
    • Page 2 of 3 Child Neurology Inpatient Wards 4d) Document thorough social history, including factors such as school performance, need for special education or tutorial assistance, and any factors that contribute to underlying anxiety, depression, etc. 22Demonstrate the basic neurological exam, including the following: 1a) Identify components of neurologic exam. 1b) Demonstrate knowledge of grading on neurologic exam, including muscle strength and reflex parameters. 2c) Explain the importance of measuring head circumference and the implications of abnormal head circumference and growth trends. 22Develop a differential diagnosis of the hypotonic infant. 1a) List important diagnostic clues implicating a central vs. peripheral etiology. 2b) Establish the need for further evaluation based on the presumed etiology, i.e., the need for chromosome, MRI, CPK, metabolic evaluation, or EMG. 33Develop a differential diagnosis of acute ataxia. 1a) Demonstrate knowledge of cerebellar signs. 2b) Demonstrate basic knowledge of conditions contributing to ataxia – acute cerebellitis, cerebral lesions, drug toxicity, and neurodegenerative conditions. 44Recognize altered states of consciousness 1a) Establish a differential diagnosis for the patient presenting with altered mental status (AMS). 2b) Treatment of increased intracranial pressure. 55Recognize Guillain-Barre syndrome and other causes of weakness. a) Establish a differential diagnosis for acute weakness. b) Explain the basic pathophysiology involved with Guillain-Barre. c) Describe the treatment of Group B Strep (GBS). Medical Knowledge – about established and evolving biomedical, clinical, and rotation-specific. By the end of this rotation, the pediatric resident will be able to: 11Identify risk factors during pregnancy 22Develop differential diagnosis for a spectrum of possible neurological disorders. 33Recognize altered states of consciousness. Practice-based Learning and Improvement – to investigate, evaluate, and improve own practices; and to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric resident will be able to: 11Utilize information technology to identify current treatments for common neurological conditions in children and adolescents. Interpersonal and Communication Skills – effective exchange of information. By the end of this rotation, the pediatric resident will be able to: 11Work effectively with the other health care professionals on the team. Professionalism – professional responsibilities, ethical principles, and sensitivity to patients. While on this rotation, the pediatric resident will: 11Maintain patient confidentiality
    • Page 3 of 3 Child Neurology Inpatient Wards System-based Practice – effectively partnering with the larger context of health care and resources for optimal patient care. By the end of this rotation, the pediatric resident will be able to: 11Evaluate, manage, and refer patients with seizures to an outpatient clinic. 0a) Classify and differentiate seizures (generalized vs. partial, simple vs. complex). 1b) Develop a management plan uncomplicated seizure disorders. 1c) Follow protocol for evaluation and management of statue epilepticus. 2d) Explain diagnosis, management, and prognosis of febrile seizures. 22Evaluate and manage headaches, as an outpatient in the Emergency Department or Outpatient Clinic. 1a) Discuss treatment/management of acute headache. 2b) Diagnose and develop a treatment plan for pseudo tumor cerebri. 3c) Differentiate between tension and migraine headache. 4d) Differentiate a benign headache from a “malignant” headache. 5e) Identify and explain indications for neuroimaging. 33Understand the indications for, limitations of, and relative costs for neurodiagnostic testing. 1a) List indications for neurodiagnostic testing, such as EEG, CT, MRI, LP, EMG, and nerve conduction studies. 2b) Describe purpose and limitations of each of test. 3c) Compare relative costs of the various neurodiagnostic tests available. 4d) Explain the usefulness of these diagnostic tests for a variety of neurologic presentations. Methods of Evaluation and Feedback  11. Subjective assessment of resident performance will be undertaken by preceptors’ evaluations of written patient consults/evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard evaluation form will be used and discussed with the resident at mid- and end of the rotation. 22. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.
    • Page 1 of 10 Pediatric Pulmonary Wards Housestaff Manual  Pulmonary Ward Team  Revised 5/07  Pediatric Pulmonology In Patient Rotation Education Plan Introduction/Purpose: The Inpatient Pulmonary Ward Service provides 24 hour per day, 7 day per week resident and attending  physician services to infants and children admitted to the pulmonary team for evaluation and management  of airway, pulmonary, and/or respiratory control disorders. Residents assigned to the pulmonary team are  responsible for the day-to-day care of these patients with appropriate oversight provided by the inpatient  pulmonary attending. Residents are expected to actively discuss patients with the pulmonary attending on  a routine basis and during pulmonary rounds and to independently read journal articles, textbooks, or  materials that may be provided by pulmonary, consultant, and/or teaching attending physicians.  The goal of the Pediatric Pulmonology Inpatient Rotation is to provide the pediatric resident with a broad,  practical   experience   in  managing  children   with   respiratory   illnesses   in   the   hospital   setting   under   the  supervision of board certified Pediatric Pulmonologists. The objective of the rotation is to prepare the  pediatric resident to competently and confidently manage children with pulmonary illnesses and to know  when to refer to the pediatric pulmonologist. It is neither the intent nor the expectation of this rotation that  the   resident   will   be   exposed  to  every   component   of   the   pulmonary   section   of   the   Pediatric   Content  Outline during a one month rotation. However, it is the expectation and intent that the resident will  acquire those skills necessary to manage children with respiratory illness.  Contact Person/ Faculty Supervisor: Martin L. Bauer, M.D. Phone 364-6206  Pager 395-5979  Clinical Resources or Rotation “home base”  Arkansas Children’s Hospital wards Pulmonary Office – 4th floor Sturgis Building, phone 364-1006 Prerequisites 1•   Must   be   a   pediatrics   resident,   med/peds   resident,   or   rotating   resident   approved   by   the   pediatric  residency program.  2• Vacation/time off for interviews not allowed during rotation  Responsibilities and Expectations  1• Residents are assigned to calendar month rotations by the Chief Residents of Pediatric Residency Program. 2• Night and weekend call are assigned by the upper level or the attending on service. 3• Pulmonary Ward Rounds are held Monday through Friday from 1000 – 1130 in the Pulmonary Function Laboratory Conference Room. 4• On weekends and holidays, rounds will be held daily at a time and place determined by the Pediatric Resident and the attending. Residents will participate in all Pulmonology Ward Rounds, except when in their Resident Continuity Clinic, or when required to leave the hospital because of Work Hours policies.
    • Page 2 of 10 Pulmonary Wards 1• Pediatric Residents will participate in: the oversight of interns and medical students, decisions regarding learning issues to address during the month, actively searching for and providing journal articles or other materials for interns and medical students, and providing patient care information about members of the team to the pulmonary attending in an appropriate and timely manner. 2• The Pediatric Resident has responsibility for the management of all patients on the Pulmonology Service. 3• Pediatric Interns are assigned patients on the Pulmonary Service. They must see each of their patients before rounds each day (when not required to be absent by Work Rules Policies). The Pediatric Intern is expected to know the details of his/her patients’ histories during the previous 24 hours, current examination findings, and results of all diagnostic and therapeutic interventions. With this information and the assistance of the Pediatric Resident, the Pediatric Intern will develop a management plan to be presented at pulmonary rounds. The Pediatric Intern will include the medical student in these activities and guide the student in gaining knowledge and understanding appropriate to a third year medical student. Educational Goals and Objectives  Patient Care 1• Goals: By the end of this rotation, the pediatric resident will be able to provide patient care that is compassionate, appropriate, and effective for the treatment of pulmonary health problems and the promotion of pulmonary health. 11Objectives: 2o The resident will communicate effectively and demonstrate caring and respectful behaviors when interacting with pulmonary patients and their families. 3• The Pediatric Intern will: 41. Interview patient and family daily, monitoring their concerns and perceptions of illness and management. 52.   Update   patients   and   their   families   on   a   regular   basis   concerning   inpatient  evaluation and management.  63. Keep information obtained about patients and their families confidential  7• The Pediatric Resident will:  81. Anticipate patient and family concerns.  9o The   resident   will   gather   essential   and   accurate   information   about   their   pulmonary  inpatients in a prompt and timely manner.  10• The Pediatric Intern will:  111. Obtain and record admission history, examination, and diagnostics.  122. Obtain and record daily interim history, examination, and diagnostics.  13• The Pediatric Resident will:  141. Focus on most relevant historical, examination, and diagnostic observations. 
    • Page 3 of 10 Pulmonary Wards 15o The   resident   will   make   informed   decisions   about   diagnostic   and   therapeutic  interventions based on patient information and preferences, up-to-date scientific evidence,  and clinical judgment.  16• The Pediatric Intern will:  171. Develop comprehensive differential diagnosis.  182. List diagnostics to narrow differential.  1• The Pediatric Resident will:  21. Develop targeted differential diagnosis based on H&P.  32. Develop logical sequential diagnostic evaluation.  43. Anticipate diagnostic results with plan based on potential outcomes.  5o The resident will develop and carry out patient management plans.  6• The Pediatric Intern will:  71. Develop a management plan based on established diagnosis.  8• The Pediatric Resident will:  91. Develop a management plan anticipating diagnosis.  102. Change management based on results of treatment and diagnostics.  11o The resident will counsel and educate patients and their families.  12• The Pediatric Intern will:  131. Inform the family of diagnostic and therapeutic progress.  142. Help the family understand the medical process.  15• The Pediatric Resident will:  161.   Provide   anticipatory   guidance   for   the   family   concerning   diagnostic   and  therapeutic interventions.  172. Anticipate family questions and concerns.  18o The   resident   will   use   information   technology   to   support   patient   care   decisions   and  patient education.  19• The Pediatric Intern will:  201.   Use   appropriate   medical   information   technology   to   facilitate   comprehensive  differential diagnosis, diagnostic management, and current scientific understanding  of pathophysiology.  21• The Pediatric Resident will:  221. Use medical information technology to focus differential diagnosis, diagnostic  and therapeutic management.  23o The resident will provide health care services aimed at preventing health problems or  maintaining health of hospitalized pulmonary patients.  24• The Pediatric Intern and Resident will: 
    • Page 4 of 10 Pulmonary Wards 251.   Utilize   appropriately   general   and   pulmonary-specific   (e.g.,   influenza  vaccination, RSV prophylaxis, etc.) immunizations.  262.   Utilize   written  patient   instruction   for   the   education   of   patients   with   chronic  pulmonary diseases and/or disorder and their families (i.g., asthma).  27o The   resident   will   work   with   healthcare   professionals,   including   those   from   other  disciplines, to provide patient-focused care.  28• The Pediatric Intern will:  291. Report daily progress to senior resident and attending.  302. Communicate and work closely with Pulmonary APNs.  313. Identify consultants that might facilitate care of a patient.  324. Utilize ancillary medical professionals to optimize patient care.  33• The Pediatric Resident will:  11. Keep attending updated on current progress of each patient.  22. Communicate frequently with Pulmonary APNs.  33.   Consult   appropriate   subspecialists,   providing   the   subspecialist   with   specific  questions or concerns.  44. Communicate frequently with ancillary medical professionals involved in  patient care.  Medical Knowledge 1• Goals: By the end of this rotation, the pediatric resident will demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to the care of pulmonary patients. 11Objectives: 2o The resident will demonstrate an investigatory and analytic thinking approach to clinical situations. 3• The Pediatric Intern will: 41. Demonstrate acquisition of knowledge concerning pathophysiology, evaluation, and management of cystic fibrosis. 52.   Demonstrate   acquisition   of   current   knowledge   concerning   pathophysiology,  evaluation and management of other acute and chronic lung diseases and/or disorders  (e.g., asthma, bronchopulmonary dysplasia, etc.).  63.   Demonstrate   acquisition   of   current   knowledge   concerning   pathophysiology,  evaluation and management of ventilator-dependent patients.  7• The Pediatric Resident will:  81.   Apply   knowledge   of   pathophysiology,   evaluation,   and   management   of   cystic  fibrosis to optimize management by avoiding unnecessary interventions. 
    • Page 5 of 10 Pulmonary Wards 92. Apply knowledge concerning pathophysiology, evaluation, and management of  other acute and chronic lung diseases and/or disorders 10(e.g.,   asthma,   bronchopulmonary   dysplasia,   etc.)   to   optimize   management   by  avoiding unnecessary interventions.  113. Apply knowledge of pathophysiology, evaluation and management of ventilator- dependent patients to optimize management by avoiding unnecessary interventions.  Practice-based Learning and Improvement 1• Goals: By the end of this rotation, the pediatric resident will be able to investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve patient care practices. 11Objectives: 2o The resident will analyze practice experience and perform practice-based improvement activities using a systematic methodology. 3• The Pediatric Intern will: 41. Obtain patient specific basic information regarding evaluation and management of pulmonary diseases and disorders by reading from current general pediatric textbooks. 52. Obtain patient specific review articles. 63. Participate in pulmonary rounds, supporting differential diagnosis and management plans with reading described above. 14. Facilitate learning of students by discussing evaluation and management issues on a regular basis and constructively reviewing students’ written documentation. 2• The Pediatric Resident will: 31. Obtain patient-specific information regarding therapeutic modalities, pathophysiology, areas of current research, etc., by reading from leading general pediatric and pediatric pulmonology journals. 42. Participate in pulmonary rounds, supporting management plans with current literature. 53. Facilitate learning of students and interns by discussing and evaluating management issues on a daily basis and constructively reviewing students’ and interns’ documentation. Interpersonal and Communication Skills 1• Goals: By the end of this rotation, the pediatric resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with pulmonary patients, their families and professional associates. 11Objectives: 2o The resident will create and sustain a therapeutic and ethically sound relationship with patients and families. Page 6 of 10 Pulmonary Wards 3• The Pediatric Intern will:
    • 41. Demonstrate courtesy and respect to patients and their families. 52. Seek assistance from the senior resident, pulmonary attending, or other healthcare professional when appropriate. 6• The Pediatric Resident will: 71. Demonstrate courtesy and respect to patients and their families. 82. Seek assistance from the pulmonary attending or other healthcare professional when appropriate. 9o The resident will use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. 10• The Pediatric Intern will: 111. Obtain and record complete history, including HPI, PMHx, SHx, FmHx, ROS. 122. Obtain and record complete daily interim history and results of diagnostics and therapy. 133. Write legibly and use only approved abbreviations. 14• The Pediatric Resident will: 151. Obtain focused history. 162. Obtain focused interim history and review of diagnostics and therapy. 17o The resident will work effectively with others as a member or leader of a healthcare team or other professional group. 18• The Pediatric Intern will: 191. Attend and participate in pulmonary ward rounds by presenting patients and discussing patient and disease-specific evaluation and management issues with the pulmonary attending and ward team. 1• The Pediatric Resident will: 21. Lead and participate in pulmonary ward rounds, supervise interns and medical students, routinely communicate with the pulmonary attending and notify pulmonary attending of significant changes in the conditions of pulmonary patients and their families. Professionalism 1• Goals: The pediatric resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. 11Objectives: 2o The resident will demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and ongoing professional development.
    • Page 7 of 10 Pulmonary Wards 3• The Pediatric Intern will: 41. Demonstrate courtesy, respect and compassion to patients and their families and all members of the pulmonary and healthcare team. 52. Stay up-to date on patient and family evaluation and management issues. 63. Read about specific patient and family issues on a routine basis from current general pediatric literature. 7• The Pediatric Resident will: 81. Demonstrate courtesy, respect and compassion to patients and their families and all members of the pulmonary and healthcare team. 92. Stay up-to date on patient and family evaluation and management issues. 103. Read about specific patient and family issues on a routine basis from current pediatric pulmonology literature. 11o The resident will demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices. 12• The Pediatric Intern will: 131. Keep information obtained about patients and their families confidential. 142. With the help of the senior resident, keep patients and their families informed concerning pertinent evaluation and management issues, allow for questions and discussion regarding alternatives, appropriateness, etc. 153. Participate in discussions regarding ethical issues in patient case conferences. 16• The Pediatric Resident will: 171. Keep information obtained about patients and their families confidential. 182. With the help of the senior resident, keep patients and their families informed concerning pertinent evaluation and management issues, allow for questions and discussion regarding alternatives, appropriateness, etc. 193. Lead discussions regarding ethical issues in patient case conferences. 20o The resident will demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities. 21• The Pediatric Intern will: 221. Remember patient modesty and utilize chaperons as appropriate. 12. Utilize interpreters, social workers and patient-family representatives as appropriate. 2• The Pediatric Resident will: 31. Remember patient modesty and utilize chaperons as appropriate. 42. Utilize interpreters, social workers and patient-family representatives as appropriate.
    • Page 8 of 10 Pulmonary Wards System-based Practice 1• Goals: By the end of this rotation, the pediatric resident will demonstrate an awareness of and responsiveness to the larger context and system of health care for pulmonary patients and the ability to effectively call on system resources to provide care that is of optimal value. 11Objectives: 2o Advocate for quality patient care and assist patients in dealing with system complexities. 3• The Pediatric Intern will: 42. Actively advocate for the best interest of the patients and their families, utilizing other healthcare professionals appropriately as needed (e.g., social worker, patient- family representatives, interpreters, etc.). 53. Participate in multi-disciplinary case conferences concerning patients and their families on the pulmonary team. 6• The Pediatric Resident will: 71. Actively advocate for the best interest of the patients and their families, utilizing other healthcare professionals appropriately as needed (e.g., social worker, patient- family representatives, interpreters, etc.). 82. Participate in multi-disciplinary case conferences concerning patients and their families on the pulmonary team. Instructional Resources  1• Didactic Sessions: Every effort will be made to present brief didactic lectures on patient focused topics during daily rounds. 2• Required Reading: Nelson Textbook of Pediatrics: Read all sections relating to respiratory disease: Part XIV “Allergic Disorders” Chapter 130 “Allergy and the Immunologic Basis of Atopic Disease” Chapter 131 “Diagnosis of Allergic Disease” Chapter 132 “Principles of Treatment of Allergic Disease” Chapter 133 “Allergic Rhinitis” Chapter 13r “Childhood Asthma” Part XVII “The Respiratory System” Section 1 “Development and Function” Chapter 355 “Development of the Respiratory System” Chapter 356 “Regulation of Respiration” Chapter 357 “Respiratory Pathophysiology” Chapter 358 “Defense Mechanisms and Metabolic Functions of the Lung” Chapter 359 “Diagnostic Approach to Respiratory Diseases” Chapter 360 “Sudden Infant Death Syndrome” Section 2 “Upper Respiratory Tract” Chapter 361 “Congenital Disorders of the Nose” Chapter 362 “Acquired Disorders of the Nose” Page 9 of 10 Pulmonary Wards
    • Chapter 363 “Nasal Polyps” Chapter 364 “The Common Cold” Chapter 365 “Sinusitis” Chapter 366 “Acute Sinusitis” Chapter 367 “Retropharyngeal Abscess, Lateral Pharyngeal (Parapharyngeal) Abscess, and Peritonsillar Cellulitis/Abscess” Chapter 368 “Tonsils and Adenoids” Chapter 369 “Obstructive Sleep Apnea and Hypoventilation: Section 3 “Disorders of the Lungs and Lower Airways” Chapter 370 “Chronic or Recurrent Respiratory Symptoms” Chapter 371 “Acute Inflammatory Upper Airway Obstruction” Chapter 372 “Congenital Anomalies of the Larynx” Chapter 373 “Foreign Bodies of the Airway” Chapter 374 “Laryngotracheal Stenosis, Subglottic Stenosis” Chapter 375 “Congenital Anomalies of the Trachea and Bronchi” Chapter 376 “Bronchomalacia and Tracheomalacia” Chapter 377 “Neoplasms of the Larynx, Trachea, and Bronchi” Chapter 378 “Inflammatory Disorders of the Small Airways” Chapter 379 “Wheezing in Infants” Chapter 380 “Emphysema and Overinflation” Chapter 381 “α1-Antitrypsin Deficiency and Emphysema” Chapter 382 “Other Distal Airway Diseases” Chapter 383 “Congenital Disorders of the Lung” Chapter 384 “Pulmonary Edema” Chapter 385 “Aspiration Syndromes” Chapter 386 “Chronic Recurrent Aspiration” Chapter 387 “Gastroesophageal Reflux and Respiratory Disorders” Chapter 388 “Parenchymal Disease with Prominent Hypersensitivity, Eosinophilic Infiltration, or Toxic-Mediated Injury” Chapter 389 “Pneumonia” Chapter 390 “Slowly Resolving Pneumonia” Chapter 391 “Bronchiectasis” Chapter 392 “Pulmonary Abscess” Chapter 393 “Cystic Fibrosis” Chapter 394 “Primary Ciliary Dyskinesia (Immotile Cilia Syndrome)” Chapter 395 “Interstitial Lung Disease” Chapter 396 “Pulmonary Alveolar Proteinosis” Chapter 397 “Inherited Disorders of Surfactant Protein Metabolism” Chapter 398 “Pulmonary Hemosiderosis” Chapter 399 “Pulmonary Hemorrhage, Embolism, and Infarction” Chapter 400 “Atelectasis” Chapter 401 “Pulmonary Tumors” Chapter 402 “Pleurisy” Chapter 403 “Pneumothorax” Chapter 404 “Pneumomediastinum” Chapter 405 “Hydrothorax”
    • Page 10 of 10 Pulmonary Wards Chapter 406 “Hemothorax” Chapter 407 “Chylothorax” Chapter 408 “Bronchopulmonary Dysplasia” Chapter 409 “Skeletal Diseases Influencing Pulmonary Function” Chapter 410 “Neuromuscular Diseases with Pulmonary Consequences” Chapter 411 “Extrapulmonary diseases with Pulmonary Manifestations” Chapter 412 “Chronic Severe Respiratory Insufficiency” • Optional Reading: Gibson RL, Burns JL, and Ramsey BW. Pathophysiology and Management of Pulmonary Infections in Cystic Fibrosis. Am J Respir Crit Care Med Vol 168. pp 918–951, 2003 Rowe SM, Miller S, Sorscher EJ. Cystic Fibrosis. N Engl J Med 2005;352:1992-2001. Bush A. Decisions facing the cystic fibrosis clinician at first isolation of Pseudomonas aeruginosa. Paedric Respiratory Reviews (2002) 3, 82-88. Li Z, Kosorok MR, Farrell PM, et.al. Longitudinal Development of Mucoid Pseudomonas aeruginosa Infection and Lung Disease Progression in Children with Cystic Fibrosis. JAMA. 2005;293: 581-588 Leigh MW. Diagnosis of CF despite normal or borderline sweat chloride. Paediatric Respiratory Reviews (2004) 5(Suppl A), S357–S359 Beauchamp M, Lands LC. Sweat-Testing: A Review of Current Technical Requirements. Pediatr Pulmonol (2005) 1-5. Olsen DG, Swigonski NL. Transition to Adulthood: The Important Role of the Pediatrician. Pediatrics 2004;113:e159–e162. URL: http://www.pediatrics.org/cgi/content/full/113/3/e159 Residents are highly encouraged to seek relevant current literature pertaining to patients and or questions discussed in rounds. Methods of Evaluation and Feedback  11. Objective evaluation of the resident will be performed using a posttest, which will cover basic principles relevant to the elective. 22. Comparison of pretest and posttest will be used to evaluate the course. 33. Subjective evaluations of resident performance will be undertaken by attendings’ evaluations of written patient evaluations or progress notes, didactic presentations, and observations of the execution of skills relevant to the learning objectives of the elective. The standard written evaluation will be used and discussed with the resident. 44. The resident will submit an evaluation of the rotation experience using the standard form used by the Pediatric Housestaff office.
    • Page 1 of 4 Pediatric Rheumatology Elective Housestaff Manual  Rheumatology Elective  Revised 8/07  UAMS COM Department of Pediatrics Rheumatology Elective Education Plan Introduction/Purpose The rheumatology service sees a wide variety of children with rheumatologic disorders such as  juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), and dermatomyositis  (JDMS). In addition children with a host of other inflammatory diseases are referred for  evaluation. Having experience with these types of disorders would contribute to the overall  knowledge of general pediatricians making them more comfortable planning an evaluation of  such patients and ultimately making the decision as to when referral is necessary. In addition, the  primary care physician remains an integral part of the team providing ongoing management of  children with chronic conditions in collaboration with the rheumatologist.  Rotation Contacts Faculty Supervisor: Paula Morris, MD  Jason Dare, MD  Office Manager: Edward Alvarado, phone 364-3686  Office Location (“home base”) The rheumatology office is located on 4th floor Sturgis Building. Prerequisites 1• Residents must be a 2nd or 3rd year pediatrics resident or 3rd/4th year med/peds resident.  General Responsibilities and Expectations Outpatient clinics 1• Time on the rotation is primarily spent in the outpatient clinic and day medicine areas. Inpatient consults 1• The pediatric rheumatology service provides 24-hour/day, 7 day/week consultation service. Residents on the rotation will see consults during regular working hours. (Monday through Friday, 0800-1700) and then present the patient to the attending at which time an evaluation and treatment plan will be devised.. 2• The rheumatology service admits patients to the hospital for acute care. The resident will round on these patients and present to the rheumatology attending. Night or weekend call 1• There will be no night call or weekend call during this rotation. Attendance on rounds, consults, and/or procedures 11Dress professionally 22Be on time Vacation  11Time off for interviews or vacation is allowed during this rotation, but must be submitted  to Rheumatology office 1 week prior to the start of the rotation. 
    • Page 2 of 4 Pediatric Rheumatology Elective Educational Responsibilities and Expectations EOn the 1st Monday of the month, obtain  reading materials required for the rotation.  11Read required material and be prepared to discuss during didactic discussions or teaching  rounds.  22Each week, prepare for and present a brief discussion of the rheumatological topic of the  resident’s choice. These discussions should be approximately 5-10 minutes in length with an  additional 15 minutes reserved for discussion.  33Attend teaching and consultation rounds daily Monday through Friday to discuss formal  consults and teaching cases. These will be coordinated with the clinic schedule.  44Keep a written journal of cases seen, lab results, etc. and review weekly with the  rheumatology attending.  55Submit rotation experience and faculty evaluations at the end of the rotation.  Clinical Resources  1• Rheumatology Clinic 2• Day medicine 3• Inpatient consults 4• Rheumatology inpatients Instructional Resources Review articles covering major disease processes seen on the rotation Rheumatology text book (provided by the rheumatology section) Didactic Sessions Optional Reading Photographs, DVDs, etc. available in the Rheumatology office Educational Goals and Objectives  Patient Care – Compassionate, appropriate, and effective care for infants and children with rheumatological/immunological diseases. By the end of this rotation, the pediatric resident will be able to: 11Gather essential and accurate information about patients with inflammatory diseases. 22Demonstrate a basic ability to make informed decisions about the diagnostic and therapeutic interventions for the different rheumatological diseases of children based upon patient information, up-to-date scientific evidence, and clinical judgment. 33Develop and carry out patient management plans. 44Understand the treatment approach of rheumatology patients with various anti-inflammatory and cytotoxic agents in the treatment of rheumatological diseases and understand the role of the PCP in helping manage these medications. 55Order and interpret the basic assays in the serology laboratory and demonstrate the ability to order and interpret surveillance laboratory data to follow patients with specific disorders and/or patients on specific medications.
    • Page 3 of 4 Pediatric Rheumatology Elective Medical Knowledge – Acquire a clinical understanding of immunology, genetics, and infectious diseases as they relate to the rheumatological diseases of children. By the end of this rotation, the pediatric resident will be able to: 11Discuss the importance of immunology, genetics, and infectious diseases as they relate to the rheumatological diseases of infants and children. Practice-based Learning and Improvement – Investigate, evaluate, and improve individual practice, and be able to appraise and assimilate scientific evidence. By the end of this rotation, the pediatric resident will be able to: 11Apply and understand new methods of diagnosis or treatment modalities encountered in the literature as they relate to the rheumatological diseases of infants and children Interpersonal and Communication Skills – Enhance the effective exchange of information regarding complex patients with multi-system disease with families and other professionals. By the end of this rotation, the pediatric resident will be able to: 11Effectively communicate issues related to rheumatological diseases to patients and/or families. 22Coordinate the patient care team with other involved health professionals. 33Facilitate the learning of the medical students and other residents on the general team which is involved in the care of inpatient rheumatology patients. Professionalism – Fortify the resident’s commitment to meet professional responsibilities, to be ruled by ethical principles, and to demonstrate sensitivity to patients. While on this rotation, the pediatric resident will: 11Be prompt to all meetings, rounds, and conferences. 22Be well groomed and dressed in a professional manner. 33Show utmost respect to patients, families and co-workers. System-based Practice – Learn to effectively partner with the larger context of health care and available resources to provide optimal patient care. While on this rotation, the pediatric resident will: 11Seek evidence based information to assist in assessing and formulating a treatment plan for patients. 22Learn to be judicious with the health care dollar.
    • Page 4 of 4 Pediatric Rheumatology Elective “Work Product”  11. During the course of this elective, the resident should maintain a written journal of patients seen on the Rheumatology service. Results of laboratory studies, radiographic studies, etc. should be documented by the student or resident in the journal. On a weekly basis, the journal will be reviewed with rheumatology staff. At that time, the resident will be instructed as to how the various studies supported (or ruled out) the items on the differential diagnosis and will participate in the use of the information for planning treatment and/or follow-up. 22. Those residents interested in scholarly aspects of training, such as preparing/presenting abstracts (on clinical topics or case reports) and manuscripts for publication, should speak with a pediatric rheumatology attending who will be glad to provide assistance and guidance with the project. Work Product Expectation: Work Product should be submitted to the Rheumatology office by the end of the rotation and no  later than 15 days into the next month. The elective is considered incomplete until the work product is received. If a case report or manuscript continues under development after the end of the elective, the resident may submit a final copy of supervisor-approved product to the Housestaff office when the project is completed. Methods of Evaluation and Feedback  11. The written evaluation of the resident is based upon the degree to which the goals and objectives of the rotation were achieved. Residents not performing satisfactorily will be counseled during the rotation and will have the opportunity to meet with the attending to discuss their performance. At the end of the rotation, written evaluation of the resident’s performance will be submitted to the Housestaff Office. The standard Competencies/Dreyfus evaluation form will be used and discussed with the resident at mid- and end of the rotation. 12. The resident will submit a rotation experience evaluation using the Pediatric Residency program standard form. The rotation is not considered satisfactorily completed until all assessments and evaluations are submitted.