Ambulatory Pediatrics
I.
Rationale
The care of children is an integral part of the scope of practice of the family physician. The
family physician is uniquely suited to care for children within the framework of the entire family.
This curriculum is designed to prepare the resident to care for the newborn through the age of
adolescence. This curriculum has two components: the focused rotation in ambulatory
pediatrics and the longitudinal experience provided in the Family Practice Center which occurs
throughout the three years of residency training.
II.
Goals
Residents will be evaluated on the following six competencies, eventually achieving the expected
level of a board certified family physician. Achievement of satisfactory performance levels for all
six competencies will be necessary for successful completion of the rotation.
III.
Objectives
Medical Knowledge/Patient Care
1. Understand normal neonatal physiology and the transition into the infant period.
2. Understand expected developmental milestones, changes in feeding, patterns of sleep,
patterns of behavior in the neonatal, infant, toddler, preschool, and grade school child.
3. Understand the importance of preventive services for the pediatric population.
4. Be able to identify a child in an abnormal or unhealthy family situation.
5. Diagnose and manage common neonatal issues such as: nutrition, hyperbilirubinemia,
hypoglycemia, neonatal fever, routine newborn care, and recognition of the high-risk
newborn.
6. Be familiar with common infant/toddler issues such as: schedule for well baby
examination, immunization recommendations, timing of developmental milestones.
7. Diagnose and manage common infectious diseases: URI, otitis media, otitis media with
effusion, otitis externa, sinusitis, pneumonia, meningitis, sepsis, UTI’s, tonsillitis, and
mononucleosis.
8. Diagnose and manage diseases of the respiratory system such as: reactive airway
disease, croup, epiglottitis, foreign body aspiration, and tuberculosis.
9. Diagnose and manage diseases of the cardiovascular system: evaluation of heart
murmurs, rheumatic fever, Kawasaki’s disease, congenital heart disease, essential
hypertension, and SBE prophylaxis.
10. Diagnose and manage diseases of the hematologic system such as: iron deficiency
anemia, hemolytic disease of the newborn, sickle cell anemia, hemophilia, evaluation of
lymphadenopathy, and myeloproliferative disorders.
11. Diagnose and manage diseases of the neurologic system such as: febrile and idiopathic
seizures, hydrocephalus, headache, head injury, cerebral palsy, and congenital
neurological disorders.
12. Diagnose and manage common orthopedic problems such as: in-toeing, out-toeing,
genu varus, genu valgus, the child with a limp, “growing pains”, common fractures and
dislocations, and the sports physical.
13. Diagnose and manage diseases of the dermatologic system such as: atopic dermatitis,
contact dermatitis, acne, impetigo, viral exanthems, pediculosis, scabies, dermatophyte
infections, and pigmented lesions.
Last Updated April 19, 2013
14. Diagnose and manage diseases of the genito-urinary system such as: UTI, hematuria,
proteinuria, pyelonephritis, enuresis, toilet training, congenital GU deformities, hydrocele,
cryptochordism, and hernia.
15. Diagnose and manage disease of the gastrointestinal system such as: issues of good
nutrition, colic, pyloric stenosis, abdominal pain, constipation, encopresis, malabsorption,
gastroenteritis,
parasitic
infestations,
Meckel’s
diverticulum,
volvulus,
and
intussusception.
16. Diagnose and manage disease of the endocrine system such as: abnormal growth
patterns, precocious puberty, diabetes mellitus, hyper/hypothyroidism, and inborn errors
of metabolism.
17. Diagnose and manage ophthalmologic issues including: conjunctivitis, strabismus,
amblyopia, periorbital cellulitis, myopia, foreign bodies, and nasolacrimal duct
obstruction.
18. Diagnose and manage allergic conditions such as: rhinitis, food intolerance, insect bites,
skin testing, anaphylaxis and desensitization.
19. Diagnose and manage psychiatric and behavioral issues such as: strategies for
discipline, corporal punishment, ADD, depression, conduct disorder, adjustment disorders
associated with major life events (divorce, death, terrorism, war).
20. Residents will strive to perform and gain competence in the following:
a. Venipuncture and peripheral blood smear interpretation, arterial blood gas sampling
and interpretation, and IV placement
b. Throat culture
c. Indication for and interpretation of chest, sinus, lateral neck, skull, abdominal, and
sinus x-rays
d. Preparation and administration of nebulization solution for reactive airways disease
e. Basic ECG interpretation and auscultation of heart murmurs
f. Urethral catheterization and microscopic examination of the urine with interpretation
g. Lumbar puncture
h. Transillumination of the sinuses
i. Transillumination of the scrotum
j. Wet prep examination of vaginal secretions
k. Guaiac of stool specimens
l. Nasogastric tube placement
m. Foreign body removal from the eye, nose and ears
n. Circumcision
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
Morning Report
X
X
Faculty Supervision
and Feedback
Quarterly Review
Evaluation Methods
X
Attending Evaluation
X
X
X
Directly Supervised
Procedures
In-Training Exam
X
Videotape Review
X
Program Director
Review
360 ᵒ evaluation
Other
Last Updated April 19, 2013
Interpersonal/Communication Skills
1. Learn to effectively communicate with parents of pediatric patients.
2. Learn to adopt nonthreatening body language when communicating and examining a
pediatric patient.
3. Learn how to provide appropriate counseling with regard to immunizations; their risks,
benefits, and how to deal with parents who decline them.
4. Learn how to provide age appropriate anticipatory guidance.
5. Gain self-awareness of one's own attitudes toward potentially controversial issues such
as breast feeding, feeding practices, corporal punishment, and toilet training and be able
to provide unbiased, non-judgmental guidance.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
X
X
Program Director
Review
360 ᵒ evaluation
Other
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
X
Directly Supervised
Procedures
In-Training Exam
X
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents are
expected to:
1. 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 on-going professional development.
2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business
practices.
3. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and
disabilities.
4. Arrive at the clinic in a timely fashion to see patients and attend morning report.
5. Work effectively as a member of a team.
6. Respect patient privacy by guarding medical records and discussion of personal
information about patients.
7. Assist patients and their families in planning for future care needs and care decisions
based on prognosis for the disease.
8. Support the patient in their healthcare decisions.
9. Demonstrate professional, respectful demeanor when addressing team members,
patients, ancillary staff, and consultants.
10. Appear professionally dressed and well groomed.
Last Updated April 19, 2013
11. Completes clinic notes, referrals in a timely fashion.
12. Attends required didactics, conferences.
13. Responds to pages and clinic messages in a timely fashion.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
X
Program Director
Review
360 ᵒ evaluation
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised
Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents are expected
to:
1. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology.
2. Locate, appraise, and assimilate evidence from scientific studies related to their patients'
health problems.
3. Obtain and use information about their own population of patients and the larger
population from which their patients are drawn.
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
5. Use information technology to manage information, access on-line medical information;
and support their own education.
6. Learn to incorporate health promotion and disease prevention into patient care.
7. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Last Updated April 19, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Evaluation Methods
X
Attending Evaluation
X
X
Program Director
Review
360 ᵒ evaluation
Other
Directly Supervised
Procedures
In-Training Exam
Morning Report
X
Videotape Review
X
Faculty Supervision
and Feedback
Quarterly Review
Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide care that is
of optimal value. Residents are expected to:
1. Understand how their patient care and other professional practices affect other health
care professionals, the health care organization, and the larger society and how these
elements of the system affect their own practice.
2. Know how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources.
3. Practice cost-effective health care and resource allocation that does not compromise
quality of care.
4. Advocate for quality patient care and assist patients in dealing with system complexities.
5. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
6. Understand and be able to code effectively for health maintenance visits.
7. Be able to implement a charting system that documents developmental milestones,
anticipatory guidance, immunizations, and screenings.
8. Understand the medico-legal aspects of reporting suspected child abuse.
9. Acknowledge the impact of one’s own beliefs and experiences with child rearing upon
one’s current practices.
10. Become familiar with the available resources in the community for children and families
with special needs.
11. Be able to formulate an appropriate consult to the resources available.
Learning Activities
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
X
X
Program Dir
Review
360 ᵒ evaluation
Other
Last Updated April 19, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised
Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
IV.
Instructional Strategies (see above)
A. Direct patient care 3.0 days per week in Ambulatory Pediatrics site and 1.5 days per week in
the Family Medicine Clinic at Dunwoody and 0.5 day in didactics.
B. Completing a thorough H&P, assessment, differential diagnosis, and plan to be presented to
the faculty member and pediatric attending as appropriate to the particular setting.
C. Weekly didactics, before clinic conferences, and Pediatrics conferences
D. Associated rotations for additional ambulatory pediatrics experience: Family Medicine Clinic,
Pediatric Wards, Emergency Medicine
E. Required readings of the following Monographs:
338 Children’s Office Emergencies (2007)
300 Update in Children’s Health (2004)
312 Well Child ages 2 months to 2 years (2005)
313 Well Child ages 2 to 18 years (2005)
V.
Evaluation Strategies (see above)
A.
B.
C.
D.
E.
F.
G.
H.
VI.
Observation by Pediatric and Family Medicine attending
Review of resident’s clinic notes and discussion of the assessment and plan
Procedure documentation by the resident
End of rotation evaluation
Family Medicine and Pediatrics Conference attendance
In-training exam profiles
Resident evaluation of rotation and faculty
Completion of required readings and scoring >90% on open book Monograph quizzes
Implementation Methods
This curriculum is reinforced in two ways. There is a focused four-week rotation that takes place at the
Grady Neighborhood Health Clinics. During the rotation the resident will actively participate in the
management of pediatric patients under the direct supervision of the attending physician. The resident
will also experience a longitudinal exposure to ambulatory pediatrics in the family medicine continuity
clinic. The resident will spend six ½ days per week at the rotation site, three ½ days per week in
continuity clinic, and one ½ day in didactics. Readings can be obtained from section IV and should also
be solicited from the Residency Support Staff.
Contact Information
Mamie Phillips, MD, Peds
Betti Jo Steele, MD, Peds
Asa G. Yancey Health Center
1247 Donald Lee Hollowell Pkwy
Atlanta, GA 30318
404-616-2265 ofc
404-616-2825 fax
Practice Manager: Steven Juhase, 404-616-9922 ofc
Dawn Swaby-Ellis, MD, Peds
Elaine Poirier-Elliott, RNP, MPH, Peds
North Dekalb Health Center
3806 Clairmont Road, NE
Chamblee, GA 30341
Last Updated April 19, 2013
404-616-0700 ofc
404-616-3078 faxPractice Manager – Michelle Skipper
VII.
Rotation Schedule
FMC = Family Medicine Clinic: 3 half days/week
Peds = Ambulatory Pediatric Clinic: 6 half days/week
Didactics = 1 half day on Thursday AM/week
*Nursing Home Visit = 1 half day/month
Last Updated April 19, 2013