ROTATION SUMMARY
PEDIATRIC INFECTIOUS DISEASES
Rotation Contacts and Scheduling Details
Rotation Director:
Hayley Gans, M.D.
hagans@stanford.edu
650-723-5682
Administrator:
Kelley Nelson
kelleyn@stanford.edu
G330
650-723-5682
Positions Available: The Infectious Diseases rotation can accommodate 2 residents per month. The rotation is
offered all blocks as a 4 week rotation. The rotation is open to all training levels.
Introduction
The Pediatric Infectious Disease Selective will focus on teaching residents to diagnose and manage children with
common and complicated infections. As part of the rotation, residents will spend time learning microbiology
including proper specimen collection and interpretation of microbiology laboratory results and become familiar
with laboratory procedures and personnel. Residents will also attend one infectious disease clinic a week to gain
exposure to issues related to ambulatory care of patients with a wide range of infectious diseases.
Weekly Schedule
Monday
Morning Report
8 – 8:30am
Daily Rounds*
Noon Conference
12:00-1:00pm
Tuesday
Morning Report
8 – 8:30am
Daily Rounds*
Redbook Rounds
11:30-12:00pm
G330-Pedds conf. room
ID inpatient conference
12:00-1:00pm
G330
Wednesday
Morning Report
8 – 8:30am
Daily Rounds*
ID outpatient clinic
9:00-12:00pm
730 Welch
Noon Conference
12:00-1:00pm
Thursday
Morning Report**
8 – 8:30am
Daily Rounds*
Laboratory Rounds
10:30-11:30am
Clinical Labs
Friday
Grand Rounds
8 – 9:00am
Daily Rounds*
ID outpatient rounds
11:00-12:00
G330 or H330
Noon Conference
12:00-1:00pm
Pediatric Didactic Lecture
12:00-1:00pm
G330
* Rounds vary day to day, please check with fellow. Prior to daily rounds please discuss plan with the fellow
**The first Thursday of the month is Integrated Program meeting which is optional, check with fellow
Rotation Specifics
Orientation
Contact Kelley Nelson, Rotation Administrator, prior to the start of the rotation to determine the name and contact
information of the Fellow on service. The resident should contact the Fellow on service the first morning of the
rotation to arrange where to meet them at 830am. Please also pick up a packet from Kelley on or before your first
day of service which contains many usual items that are needed for the rotation.
Inpatient Rounds
• Pediatric infectious disease rounds occur daily, at a time and place decided upon by the team.
• Residents rotating on the Pediatric Infectious Diseases service are expected to follow a subset of the
patients on service and take complete responsibility for their care related to infectious diseases. This
includes pre-rounding every day, excluding post-call and weekends, discussing patients with the fellow
prior to rounds if time permits, and then formally presenting the patients to the attending. Residents are
encouraged to develop care plans in advance of rounds and be prepared to discuss their decision making
process and support for their plan.
• Residents are expected to independently do new consults and then provide follow up continuity care for the
duration that their patient remains on the ID service.
• The ID service has not formally developed a family centered rounding protocol, but the family remains an
integral part of our decision making process and as such education of the patient and family is paramount to
Last updated 6/10
•
our role. However, it is requested that all residents discuss ID issues with the primary team before sharing
major diagnoses or treatment plans with the patient, respecting our role as a consulting service.
Once decisions are made on rounds the residents is expected to discuss these with the primary team, and
then the resident is encouraged to communicate these with the family if agreed upon by the primary team.
Pediatric Infectious Diseases clinic:
• Patients scheduled to be seen in the Infectious Diseases clinic will be discussed the week before in
preparation. Residents are encouraged to see patients that interest them, and the distribution will be
determined by the fellow and residents in advance. This will allow the resident to read any referral
information that is supplied for the patient in preparation of their visit. If additional information is required
for the visit, the resident should let Juliet Haataja know so that she can obtain any necessary data before the
visit.
• Residents are expected to assume the responsibility for all follow up for patients that are seen by them in
clinic. Patients will be discussed in weekly outpatient rounds and the resident is expected to have reviewed
or recommended tests and be prepared to discuss the case in detail. The resident is expected to sign over all
outstanding out-patient care issues to the fellow when they rotate off service. In addition, please let Juliet
Haataja know all care plans and necessary follow up.
• After the patient has been discussed with the fellow and attending the resident should contact the referring
physician to discuss the recommendations.
• Juliet Haataja is the clinic nurse manager and will assist with all patient care issues, including obtaining all
information before the patient’s visit, and for scheduling all follow up studies, as well as any calls to the
families and physicians. She is not expected to call the referring physician to discuss our
recommendations, but can request any information.
Documentation and Communication
• H&Ps: A written and dictated history and physical are required of all children at time of the initial ID
consultation, including all outpatient consults.
• Written daily notes are required on all patients that are being followed by the ID service. In general, notes
are required on patients when new information or recommendations need to be communicated. The
ultimate decision to leave a note should be discussed during rounds, but residents should be prepared to
write a note daily.
Pagers
The resident is expected to carry their pager Monday through Friday 8am until 5pm, except when post-call.
Call Schedule
The resident is not required to take evening or weekend call for the infectious disease service.
Resident Roles and Responsibilities
• Perform inpatient consultations under the supervision of the ID fellow and attending.
• See new patients in infectious disease clinic and be present for evaluation of established
• outpatients
• Attend laboratory rounds and learn proper procedures for specimen collection and processing.
• Prepare one short (10 minutes) presentation on an ID topic of their choice during the selective
and present to the team.
• Attend scheduled teaching conferences and be prepared to present their patients to those attending
• the conference.
• Assist the ID fellow with phone calls from referring physicians.
Evaluation and Feedback
The methods of evaluation for the Infectious Diseases Selective Rotation will consist of:
• Medhub evaluations filled out by fellows and faculty. 360 Evaluation written at the end of the rotation by
ID team (attending and fellow).
• 2 consultation notes, one inpatient and one outpatient, will be reviewed with the resident in detail. Please
choose 2 notes and make an appointment with the attending to discuss.
• Self assessment: all house officers are expected to reflect on their performance using the self-assessment
tool and discuss it with their attending physician, mentor and/or residency program director.
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•
•
Feedback will be given throughout the rotation and a final oral feedback session will occur at the end of the
rotation. House officers are encouraged to solicit feedback from their supervising senior resident, onservice fellow, and attending faculty at the mid-point of their rotation to discuss areas for improvement and
again at the end of the rotation to gain an overall evaluation.
In-training exam. House officers take the in-training examination of the American Board of Pediatrics on
an annual basis. Cumulative results pertaining to ID (of all house officers) are reviewed by the Infectious
Diseases Program director and deficits are noted and used to change areas of focus for didactics.
Faculty
Last Name First Name Phone #
Amieva Manuel
Arvin Ann
Chen Sharon
Dekker Corry
Dyner LauraLe
Gans Hayley
Gutierrez Kathleen
Hong David
Lewis David
Maldonado Bonnie
Pizzo Philip *contact admin. Mira 4-5688
Prober Charles
Mathew Roshni
56564
Shehab Kareem
56564
Haataja Juliet
36299
Nelson Kelley
35682
Pager
14399
13221
14216
23052
14910
13815
13748
14443
13867
13566
13270
14531
22571
15179
Title
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Faculty
Fellow
Fellow
Nurse Coordinator
Administration
References
1) Principles and Practice of Pediatric Infectious Disease, Second Edition. Long SS, Pickering LK and Prober CG,
editors, Churchill Livingstone Inc. 2003.
2) Infectious Diseases of the Fetus and Newborn Infant, Sixth Edition. Remington JS and Klein JO, editors, WB
Saunders Company, 2006
3) Report of the Committee on Infectious Diseases, 2009 Redbook, Committee on Infectious Diseases, American
Academy of Pediatrics.
4) The Sanford Guide to Antimicrobial Therapy, Gilbert GN, Moellering RC, Eliopoulos GM, Sande MA. 39th ed.
2009
5) Manual of Clinical Microbiology, Eight Edition. Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH
2003
6) LPCh antibiogram, revised annually, available at http://peds.stanford.edu/links/patient-care-tools.html
*These books are available in ID office. Residents should consider having their own Redbook and Sanford Guide as
they will always be useful.
Last updated 6/10
Competency-based Goals and Objectives
Goal 1. Understand the appropriate use of antibiotics in managing infections in children.
Resident Objectives:
When caring for pediatric patients with common infections, determine
when and whether drug therapy should be instituted.
For common infections, demonstrate the ability to select an appropriate
antibiotic, dose and route, based on antimicrobial mechanism of action,
spectrum of activity, adverse effects, drug interactions, drug
penetration and relative costs.
Correctly prescribe antimicrobials based upon knowledge of local
susceptibility/resistance patterns for common pathogens.
Instructional Strategies
Patient care
Antibiotic Overview (provided)
Antibiogram (LPCH intranet)
Red Book
Patient care
Antibiotic Overview (provided)
Antibiogram (LPCH intranet)
Red Book
Text book (list provided)
Patient care
Antibiogram (LPCH intranet)
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
MK
PC
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
MK
PC
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
MK
PC
Instructional Strategies
Patient care
Microbiology rounds
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
In-service exam
ACGME Competency Goals
MK
Patient care
Microbiology rounds
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
MK
PC
Patient care
Microbiology rounds
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
MK
PC
Patient care
MK
Review the role and thought process when dealing with patients who
Antibiotic Overview (provided)
PC
have complex or life threatening illnesses, such as the use of static vs.
Text
book
(list
provided)
bactericidal drugs, drug combinations and synergies, and monitoring
Relevant literature search
patients for toxicity and efficacy.
Patient care
Direct Observation
MK
Develop familiarity with several reliable resources for information on
Antibiotic Overview (provided)
Medhub Evaluation
PBLI
common antibiotics, resistance patterns and new treatments for
Antibiogram (LPCH intranet)
Discussion with faculty/fellow
infectious diseases, and consistently use current information when
prescribing antibiotics.
Goal 2. Understand the laboratory methods used in pediatrics relating to the diagnosis and management of infectious diseases in children
Resident Objectives:
Identify specific tests available for the diagnosis of various infectious
diseases. Know the importance of proper specimen collection and its
effect on results, explain the limitations of those tests (sensitivity,
specificity, predictive values, cost), and describe the difference
between colonization with normal flora, colonization with a potential
pathogen and infection.
Describe principles of clinical application of rapid diagnostic
techniques for common pathogens (e.g., particle agglutination, rapid
strep tests, monoclonal FA tests).
Discuss the principles and clinical application of the following:
- Serologic tests such as Western immunoblot and enzymelinked immunosorbent assay (ELISA)
-
Molecular biologic tests including: polymerase chain reaction
(PCR), Southern Blot, and in situ hybridization
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-
Susceptibility testing including: minimum inhibitory
concentration (MIC), minimum bactericidal concentration
(MBC), and synergy and antagonism
-
Antibiotic serum concentrations and serum bactericidal titers
-
Screening test results vs. diagnostic test results, and
differences in the use and interpretation of such tests
Goal 3. To recognize common infectious diseases and understand the appropriate treatment in children.
Resident Objectives:
Critically evaluate a child presenting with signs and symptoms
suggestive of an infectious disease using thorough history and physical
examination.
- Identify and understand infectious disease in the inpatient
setting.
- Identify and understand infectious disease in the ambulatory
setting.
Develop appropriate differential using current medical information and
scientific evidence to support diagnosis.
Develop a diagnostic plan to support and evaluate diagnosis.
Understand current treatment options and apply appropriate treatment
plan using current scientific evidence.
Instructional Strategies
Patient care
Text book (list provided)
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
MK
PC
Patient care
Text book (list provided)
Relevant literature search
Patient care
Text book (list provided)
Relevant literature search
Patient care
Text book (list provided)
Relevant literature search
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
MK
PC
PBLI
MK
PC
PBLI
MK
PC
PBLI
Instructional Strategies
Patient care
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
PC
Patient care
Text book (list provided)
Relevant literature search
Patient care
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
PC
MK
PBLI
PC
Goal 4. To evaluate and diagnose children with common infectious diseases
Resident Objectives:
Gather essential and accurate information about patients through
thorough history with specifics to exposure history using medical
interviewing, chart review and physical examination.
Create a diagnostic plan based on patient information, current scientific
evidence and sound clinical judgment
Develop and institute patient care management plans
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Adjust plan daily using new laboratory and radiology information and
physical exam findings
Patient care
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
PC
Instructional Strategies
Patient care
Care conferences
Observe and reflect on
effective communication
modeled by other providers
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
ICS
PC
Patient care
Care conferences
Observe and reflect on
effective communication
modeled by other providers
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ICS
PC
Instructional Strategies
Patient care
Text book (list provided)
Relevant literature search
Clinical cases
Clinical conferences
Patient care
Text book (list provided)
Relevant literature search
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
PBLI
PC
MK
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
PBLI
PC
MK
Patient care
Clinical cases
Clinical conferences
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
PBLI
Assessment of Competencies
ACGME Competency Goals
Goal 5. To develop an effective plan for the care of children with infectious diseases
Resident Objectives:
Communicate effectively with patients and families, explaining in
detail the care plan
- To update the family daily using new information
- To answer all the patient’s and families questions daily
- To engage family and patients in care plan
- To educate patient and family on issues pertaining to infectious
diseases
- To be involved with patient care conferences providing relevant
infectious diseases information
To communicate effectively with colleagues
- To verbally explain care plan to referring team in timely fashion
- To update referring team daily with new information
- To answer all questions regarding infectious diseases plan daily
from referring physicians
- To educate colleagues on issues pertaining to infectious diseases
- To appreciate the role of a consultant in the care of a patient with
infectious diseases
Goal 6. To accurately diagnose and treat children with infectious diseases
Resident Objectives:
To use medical knowledge, medical literature and information to
develop a broad differential diagnosis for children evaluated for signs
and symptoms of infectious diseases
To use medical knowledge, medical literature and information to guide
daily decisions regarding patient care plan
To ask questions regarding the diagnosis, diagnostic evaluation, care
plan and test results relating to patient care and infectious diseases
Goal 7. To work effectively with patients and colleagues to care for children with infectious diseases
Resident Objectives:
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Instructional Strategies
To accept responsibility for the care of patients being evaluated for
infectious diseases
Patient care
Clinicla cases
Recognize professional limitations and request assistance or
supervision appropriately
Patient care
Clinical conferences
Demonstrate empathy and compassion to all patients, and understand
the sensitivity of some infectious diseases diagnoses
Patient care
Clinical cases
To respect patients, families and colleagues during all interactions
Patient care
Clinical cases
To respect the role of a consultant in the care of children with
infectious diseases
Patient care
Clinical cases
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
P
P
P
P
P
Goal 8. To understand how the care of children with infectious diseases is impacted by the health care system.
Resident Objectives:
Communicate effectively with the primary team to ensure that issues
related to infectious diseases are handled effectively and in a timely
fashion
Communicate effectively with primary team and case managers to
ensure that patient care is coordinated upon discharge including the
management of antibiotics, intravascular access and drug level
monitoring
Coordinate proper follow up care for children with infectious diseases
requiring prolonged care
Instructional Strategies
Patient care
Clinical cases
Assessment of Competencies
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
ACGME Competency Goals
SBP
Patient care
Clinical cases
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
SBP
Patient care
Patient care conferences
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
Direct Observation
Medhub Evaluation
Discussion with faculty/fellow
SBP
Identify costs for common diagnostic or therapeutic tests pertaining to
the care of patients with infectious diseases
Patient care
Clinical cases
Integrate cost awareness and cost benefit analysis into clinical decision
making
Patient care
Clinical cases
PBLI = practice based learning and improvement
ICS = interpersonal and communication skills
P= professionalism
MK= medical knowledge
PC= patient care
SBP = systems based practice
Last updated 6/10
SBP
SBP