PAC Sr Supervisory Rotation
Page 1 of 4
PEDIATRIC AMBULATORY CLINIC
Senior Supervisory Rotation
OVERVIEW:
This is a senior level rotation which builds upon skills previously attained on junior / intermediate level
rotations in the PAC/Newborn Nursery; the resident will have the opportunity to supervise the care for a
variety of acute newborn and childhood illnesses and the complications thereof. During the rotation, the
resident is part of a team, consisting of the pediatric clinic attendings and clinic staff and 1-4 interns or
intermediate residents.
Residents supervise care and provide call coverage for ambulatory patients in the Pediatric Ambulatory
Center (PAC) at OSF Sisters Community Health Care Center (OSF Sisters Clinic), and may occasionally
provide care or call coverage for newborns admitted to the Newborn Hospital Service (NHS) in the normal
newborn and Level 2 nurseries at Children’s Hospital of Illinois.
Residents will have progressive responsibility and autonomy as they advance through their training; at all
levels, they are responsible for the care of their patients during the time of the newborn hospital stay or
outpatient visit and for following through on lab and test results, unless patient care has been officially
handed off to another resident or an attending when the resident is not on call. This includes, but is not
limited to:
 Communicating effectively with patients, families, and other members of the team
 Performing age- and developmentally-appropriate H & P’s and developing a problem list, differential
diagnosis, assessment, and diagnostic/therapeutic plan
 Monitoring the patient’s response to treatment
 Coordinating outpatient care and follow-up
 Completing medical records thoroughly and promptly
Categorical pediatric residents and combined medicine-pediatric residents each have one 1-month block
rotation at the supervisory level; an additional month may be done as an elective, if desired.
Core Supervising Attending Clinic Physicians:
Zohra Moeenuddin, MD (education director)
Gail Streater, MD, PhD (operations director)
Teresa Lynch, MD
Lisa Phillips, MD
John Woerner, MD
Jessi Hanks, MD
Brian Bostwick, MD
Mary Schultz, MD
Attendings are all available by
pager or cell phone via the
Physicians Access Line or
SmartWeb
Work Hours & Responsibilities:
Clinic: M-F, 8:30 AM – 5:00 PM* (*phones off @ 4:30 PM)
Nursery: 7:00 AM** – 5:00 PM daily (**attending rounds @ 8:30-9 AM daily, except Thurs.)
The ambulatory team leads 1-2 Morning Reports per month; the intern or intermediate resident may be
assigned to present the case, but the supervisory resident is expected supervise the intern/intermediate
resident in the case presentation, and to lead the discussion and education on the topic presented.
Although the phones “shut off” at 4:30, residents are expected to stay until all patients have been staffed,
unless they need to leave to report for on-call duty, or are otherwise excused by the clinic attending.
308868009; revised 6/10
PAC Sr Supervisory Rotation
Page 2 of 4
Work Hours & Responsibilities (cont’d):
Residents take call covering OSF Call Center (clinic patient phone calls) and Newborn Hospital Service
patients in the normal newborn nursery and Level 2 nursery; this is home call, not counting toward the 80hour limit. Occasionally, a patient’s condition may require coming in from home to evaluate the patient.
When this occurs, the resident must let his/her attendings know, as these hours spent in the hospital do
count toward total resident work hours.
We strictly adhere to the ACGME resident work hour rules; residents are given an average of 1 day off in
7, per ACGME guidelines; due to scheduling or resident work hour requirements, these days off may
occur during the week.
GENERAL GOALS (see Training Level Specific Learning Objectives, page 3):
 Competent supervision, coordination, and evaluation of care in the outpatient setting
 Competence in educating and mentoring junior residents
 Competence in diagnosis and management of common pediatric and newborn problems, including
focused H & P, differential diagnoses, plan of care, and documentation of same
 Familiarity with office management and administrative issues pertinent to general pediatric practice.
 Familiarity with the practical aspects of common pediatric immunizations
 Familiarity with the techniques of telephone medicine and telephone triage services
Common Pediatric Illnesses:
 Asthma
 URI
 Sinusitis
 Otitis Media
 Pharyngitis / tonsillitis
 Croup
 Pneumonia
 Bronchiolitis
 Acute abdominal pain
 Gastritis / gastroenteritis
 Diarrhea
 Dehydration
 Constipation
Common Newborn Nursery Problems / Illnesses:
 Prenatal growth / IUGR, SGA, & LGA
 Apgar scoring / Ballard-Dubowitz exam
 Infant nutrition & feeding dysfunction
 Parenteral fluids for newborns
 Lactation, including maternal medications
 Hyperbilirubinemia
 Hypoglycemia / Hypothermia
 Respiratory distress / TTN
 Lethargy
 Newborn sepsis
 Abdominal distension / NEC / GI obstruction
 GBS exposure & GBS treatment algorithm
 Circumcision
 Pain management in the newborn
 Newborn hearing & metabolic screening
 Discharge criteria for the newborn











Periorbital/orbital cellulitis
UTI / pyelonephritis
Vulvovaginitis
Failure to thrive
Hyperbilirubinemia
Febrile seizures
Fever without focus
Simple lacerations and abrasions
Skin infections & abscesses
Fungal infections of the skin, hair, and nails
Common pediatric exanthems & enanthems
(e.g., scarlet fever, varicella, hand-footmouth disease, herpangina)







TORCH infections
Apnea & bradycardia
Infant of the diabetic mother
Polycythemia / anemia
Developmental dysplasia of the hip
GU anomalies
Brachial plexus injury & other orthopedic
problems
Cyanosis / congenital heart disease
Congenital anomalies / syndromes
HIV exposure
Neonatal seizures
Maternal substance abuse & neonatal
abstinence syndrome
Postpartum depression






308868009; revised 6/10
PAC Sr Supervisory Rotation
Page 3 of 4
PAC Senior Supervisory Resident
Specific Learning Objectives
Obtain a complete data base; synthesize data in
problem oriented format so that clinical problems can
be efficiently managed
Establish appropriate assessments and differential
diagnoses for clinical problems.
Compare and contrast treatment alternatives;
determine appropriate treatment for clinical problems.
Document findings promptly, thoroughly, and
accurately
Diagnose and appropriately manage common
pediatric and newborn illnesses and problems (see
list, page 2)
Establish a continuum of care, linking inpatient and
outpatient providers
Appropriately utilize consultants in the diagnosis and
management of clinical problems
Lead discussion of indications for common pediatric
tests and procedures, including newborn metabolic &
hearing screening
Demonstrate/model appropriate utilization and
interpretation of clinical tests
Primary
Competency
Domain
Teaching
Method
Evaluation
Method
PC / PBL
clinical
encounters
H&P review,
direct observation
clinical
encounters
reading list,
clinical
encounters
clinical
encounters
reading list,
clinical
encounters
clinical
encounters
clinical
encounters
reading list,
clinical
encounters
reading list,
clinical
encounters
direct observation,
feedback
didactic
discussions, direct
observation
H&P review,
direct observation
didactic
discussions, direct
observation
PC / MK
MK / PBL
PC / ISC / SBP
PC / MK
SBP
PC / SBP
MK
PC / MK
direct observation
direct observation
didactic
discussions, direct
observation
didactic
discussions, direct
observation
Demonstrate/model effective communication skills
with patients, parents, nursing staff,
attendings/consultants, and peers
Evaluate junior residents' competence in provision of
care and communication with patients, parents, and
staff
Lead discussion of common pediatric vaccines,
including routine schedule, informed consent, and
contraindications.
ISC
clinical
encounters
direct observation,
feedback
ISC / PRO
clinical
encounters
direct observation,
feedback
Identify and lead discussions of concepts of pediatric
health maintenance
MK
Demonstrate/model independent use of educational
resources to explore clinical problems
PBL
reading list,
clinical
encounters
reading list,
clinical
encounters
reading list,
clinical
encounters
didactic
discussions, direct
observation
didactic
discussions, direct
observation
didactic
discussions, direct
observation
review
conference
direct observation,
feedback
clinical
encounters
clinical
encounters
clinical
encounters
clinical
encounters
direct observation,
feedback
direct observation,
feedback
direct observation,
feedback
direct observation,
feedback
Organize morning report conference presentation;
lead discussion of case, differential diagnoses, and
plan
Implement effective triage of patients (visits and/or
phone calls) of varying levels of acuity
Actively assume ownership of patient care & clinic
administrative responsibilities
Accept and act upon constructive criticism and advice
MK / PBL
MK / PBL /
PRO
PC / MK
PC / PRO
PRO / ISC
Lead the ambulatory team, including providing
ISC / PRO
constructive criticism & feedback to junior residents
Competency Domains:
PC = patient care
ISC = interpersonal skills & communication
MK = medical knowledge
PRO = professionalism
PBL = problem based learning & improvement
SBP = systems based practice
308868009; revised 6/10
PAC Sr Supervisory Rotation
Page 4 of 4
RESOURCES:
Textbooks & Journals:
2006 Red Book
Schmitt, B. Pediatric Telephone Advice
Hurwitz, S. Clinical Pediatric Dermatology
Dixon & Stein, Encounters with Children
Vaughn & McKay,
Nelson’s Textbook of Pediatrics
Pediatric Clinics of North America
Online:
CDC website: www.cdc.gov
AAP website: www.aap.org
Pediatrics in Review:
http://pedsinreview.aappublications.org/
UpToDate: available via the SFMC library
homepage
Handouts:
PAC Newborn Packet
Newborn Reading List
PAC Sr. Resident Orientation Checklist
Your attendings, clinic staff, & other residents:
Please ask us if you need additional references, or
have a specific question
EVALUATIONS:
Written evaluations, based on completion of the expectations listed above, are completed as a group (at
rotation’s end) by the clinic attendings for all residents on this rotation. Attendings and supervisory
residents are encouraged to provide feedback to residents on the team throughout the rotation. Residents
are encouraged to ask questions and actively participate in patient care discussions, not only to
demonstrate their abilities, but to engage in the learning process.
308868009; revised 6/10