Subspecialties

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Subspecialties

  1. 1. 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.
  2. 2. 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
  3. 3. 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].
  4. 4. 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)
  5. 5. 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
  6. 6. 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
  7. 7. 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.
  8. 8. 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.
  9. 9. 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
  10. 10. 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.
  11. 11. 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:
  12. 12. 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.
  13. 13. 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.
  14. 14. 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
  15. 15. 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.
  16. 16. 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.
  17. 17. 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.
  18. 18. 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.
  19. 19. 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.

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