Pediatric General Wards
I. Rationale
The specialty of family practice is vitally interested in all aspects of pediatric health and disease. This
curriculum addresses the care of hospitalized children. Pediatric health maintenance will be addressed in
the FPC curriculum, and Ambulatory Pediatrics curriculum. Care of the healthy newborn will be
addressed in the FPC curriculum, Nursery curriculum, and OB continuity curriculum. Care of the acutely
ill child in continuity setting is addressed in the FPC and Ambulatory Peds curriculum. The immediate
care of childhood emergencies is addressed in the Pediatric Emergency curriculum, PALS and neonatal
resuscitation courses.
As a family physician, Graduates must be comfortable and able to deal with a wide variety of pediatric
conditions, be able to diagnose and treat in inpatient and outpatient setting. Graduates must be able to
recognize situations which require immediate support, require hospitalization, and/or EMS
support/transportation, or require referral.
II. Goals
The purpose of the Pediatric Wards rotation for Emory Family Medicine residents is to build experience in
the inpatient care of children of all ages, and supporting parents and/or caretakers during the process of
their child’s hospitalization. The residents should become familiar with appropriate, relative and absolute
indications for hospital admission, as well as parameters for safe and appropriate discharge from hospital
care.
Patient care/Medical knowledge
A. Acquire the knowledge base and skills to provide inpatient care to infants, children and
adolescents.
B. Learn appropriate incorporation of health promotion and disease prevention into pediatric
inpatient care.
C. Understand the importance of educating the patient, parent and public about environmental
factors that can adversely affect the physical and mental health, and normal development of
children.
Interpersonal Skills/Communication Skills
A. Demonstrate the ability to communicate effectively with the patient, as well as the patient’s
family and caregivers, to ensure that the diagnosis and the treatment plan are clearly
understood. Develop skills in communicating findings, educating both patients and their
families, discussing sensitive issues and negotiating a plan of action.
B. Develop a therapeutic relationship with both the patient and parent/guardian.
Practice-Based Learning and Improvement
A. The encounter with the patient and the parents will trigger the graduates’ lifelong interest in
maintaining and updating skills and knowledge as essential for delivering safe and high
quality patient care. Residents must be able to investigate and evaluate their patient care
practices, appraise and assimilate scientific evidence, and improve their patient care
practices. Residents must be proactive in obtaining the skills and knowledge needed to
effectively treat childhood conditions.
Last updated March 7, 2013
Systems Based Practice
A. Recognize personal practice limitations and understand the role of other health care
providers and resources in providing optimal care to the pediatric patient. Understand the
role of various health care providers and disciplines in the transition of care from ambulatory
to inpatient care and vice versa.
B. An awareness of the unique vulnerabilities of infants and children that may require special
attention, consultation, referral and/or reporting to child protective services.
Professionalism, Bioethical Decision Making, Attitudes
The resident should demonstrate attitudes that encompass:
A. Empathic concern for the health of the child in the context of the family.
B. A commitment to carrying out professional duties, in a responsible manner, and adhering to
ethical principles in order to deliver optimal patient care at all times.
III. Objectives
Medical Knowledge/Patient Care
A. Demonstrate the ability to take an age-appropriate history and perform a physical exam.
B. Synthesize an appropriate diagnosis and treatment plan for common pediatric conditions.
C. In the appropriate setting, by the end of the rotation and at time of graduation, the resident
should be able to demonstrate the ability to apply the knowledge of:
1. Routine, normal, neonatal issues, and management
2. Normal growth and development
3. Developmental disorders
4. Fluid and electrolyte disorders
5. Common neonatal problems, such as feeding, nutrition, hyperbilirubinemia and neonatal
jaundice, hypoglycemia, neonatal sepsis, ALTE, recognition of the high risk neonate, and
common neonatal rashes
6. Abnormal or unhealthy family situations
7. Other common infectious diseases, such as pneumonia, meningitis, sepsis, UTI'S, strep
throat/tonsillitis/pharyngitis, mononucleosis
8. Other disease of the respiratory system including croup, reactive airway disease, asthma,
obstruction, foreign body aspiration, bronchiolitis, tuberculosis
9. Diseases of the cardiovascular system, including the evaluation of heart murmurs,
rheumatic fever, congenital heart disease, essential hypertension, SBE prophylaxis, and
Kawasaki's Disease.
10. Diseases of the hematologic system, including iron deficiency anemia, hemolytic anemia
and hemolytic disease of the newborn, hemophilia, sickle cell anemia, lymphadenopathy
evaluation, and myeloproliferative disorders.
11. Diseases of the neurologic system including, febrile and idiopathic seizures,
hydrocephalus, headache, head injuries, meningitis, attention deficit disorder, cerebral
palsy, congenital neurologic disorders
12. Common orthopedic problems including, arthritis and joint pains, hip pain evaluation,
and osteomyelitis management.
13. Common dermatologic problems including viral exanthems, manifestations of systemic
conditions, skin infections and complications
14. Common diseases of the genito-urinary system including hematuria, cystitis,
pyelonephritis, congenital urinary deformities, sexual development and Tanner stages,
hernia diagnosis, glomerulonephritis, and sexually transmitted diseases.
15. Common gastrointestinal system problems including issues of feeding and nutrition -breast, formula, and solid food, approach to abdominal pain, colic, pyloric stenosis,
Last updated March 7, 2013
16.
17.
18.
19.
20.
21.
hepatitis, gastroenteritis, constipation, diarrhea, encopresis, parasitic disorders, Meckel's
diverticulum, volvulus, and intussusception
Common metabolic and endocrine disorders including diabetes mellitus, normal and
abnormal growth, hyper/hypothyroidism, inborn errors of metabolism, and abnormal
vaginal bleeding
Common ophthalmologic problems including periorbital cellulitis and retinal hemorrhages
Common pediatric psychiatric and behavioral issues, including normal age- specific
behavioral development, childhood depression, teenage suicide, substance abuse,
adolescent adjustment reactions, school problems
Surgical pediatric problems, such as appendicitis, pyloric stenosis, testicular torsion,
intussusceptions
Pediatric emergencies, such as child abuse, poisoning, trauma, near drowning,
anaphylaxis, burns, acute abdomen, airway obstruction, epiglottitis, cardiac arrhythmias,
and respiratory and cardiac arrest
Pediatric pharmacology. Age specific drug dosing, warnings, cautions, contraindications.
D. The resident shall perform and gain competence in the procedures associated with the
diagnosis and treatment of the above-mentioned conditions, including:
1. Indication for and interpretation of xrays - chest, extremities, abdomen, skull, sinus,
lateral neck, head CT and MRI
2. Lumbar puncture and analysis of CSF
3. Nasogastric tube placement
4. Placement of CVP lines
5. Endotracheal intubation
6. Arterial puncture
7. Analysis of ABG's
8. Bladder catheterization
9. Suprapubic catheterization
10. Peripheral blood smear interpretation
11. Preparation and administration of nebulization treatments for asthma
12. Management of fluid resuscitation
13. Appropriate ordering and interpretation of CBC, serum electrolytes and blood chemistries
14. EKG interpretation
15. Transillumination of the sinuses
16. Transillumination of the scrotum
17. Neonatal Resuscitation
18. NPR, PBLS and PALS training and certification
19. Basic life support
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty
Conference
X
Morning Report
Didactics
X
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
Last updated March 7, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Program Director
X
In-Training Exam
Review
360 ᵒ evaluation
Videotape Review
1) NPR, PBLS, PALS exam
2) Upper level resident evaluation
X
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal Skills/Communication Skills
A. Demonstrate the ability to communicate effectively with the patient, as well as the patient’s
family and caregivers, to ensure that the diagnosis and the treatment plan are clearly
understood.
B. Develop skills in communicating findings, educating both patients and their families,
discussing sensitive issues and negotiating a plan of action.
C. Develop a therapeutic relationship with both the patient and parent/guardian.
D. Develop positive and functional relationships with colleagues as well as with other disciplines
and support staff
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
X
Morning Report
Didactics
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
Review
360 ᵒ evaluation
Videotape Review
1) Upper level resident evaluation
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
X
Reading
X
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Practice-Based Learning and Improvement
A. Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents must be
proactive in obtaining the skills and knowledge needed to effectively treat childhood
conditions.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty
Conference
Last updated March 7, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Morning Report
Didactics
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
X
X
X
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
X
Review
360 ᵒ evaluation
Videotape Review
1) NPR, PBLS, PALS exam
2) Upper level resident evaluation
X
Reading
X
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Systems Based Practice
A. Recognize personal practice limitations and seek consultation with other health care providers
and resources when necessary to provide optimal patient care. Understand the role of
various health care providers and disciplines in the chain of care.
B. Develop an awareness of social, cultural and environmental factors that impact the health
and well-being of infants and children, and understand preventable and unpreventable
factors which may contribute to childhood health problems.
C. Develop and show understanding of the importance of continuity and access to care for
prevention of illness. Facilitate smooth transition of care at time of patient discharge from
hospital.
D. Develop and show understanding of state laws, which affect the delivery of health care to
minors.
E. Communicate verbally and document within the patient’s record clearly and completely both
to facilitate care and meet the documentation billing requirements of both Medicaid and
private health insurance.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty
Conference
Morning Report
Didactics
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
Review
360 ᵒ evaluation
Videotape Review
1) Upper level resident evaluation
Last updated March 7, 2013
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
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:
A. 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.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the ward in time, in order to be able to perform and complete assigned duties
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
G. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
H. Appear professionally dressed and well groomed.
I. Complete notes, referrals and other forms of communication and documentation in a timely
fashion.
J. Attend required didactics, conferences.
K. Respond to pages and clinic messages in a timely fashion.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
Didactics
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
Review
360 ᵒ evaluation
Videotape Review
1) Upper level resident evaluation
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
IV. Instructional strategies (see above)
A. Resident will perform daily rounds on a panel of inpatients assigned to the resident. Resident will
develop and document an assessment and plan for each of their patients.
B. Daily rounding with pediatric ward attending. Residents will present their patients to the
attending.
C. Attendance of conferences, as scheduled by the rotation
D. Readings as assigned by pediatric Ward attending
E. Daily reading to deepen understanding of medical conditions of cases in resident’s patient panel.
F. Monograph #369: Heart Conditions in Children; #333 Childhood Infectious Disease Update
Last updated March 7, 2013
G. Reference resource: The Harriet Lane Handbook, the AAP’s Red Book
V. Evaluation strategies (see templates above)
A.
B.
C.
D.
E.
F.
G.
H.
Observation by Pediatric Ward Attending and upper level resident
Chart review
Mid-rotation evaluation by Pediatric Ward Attending
End of rotation evaluation by Pediatric Ward Attending
Resident evaluation of rotation and faculty
Topic presentation during the last week of the rotation
ITE profiles
Completion of readings and >90% score on open book Monograph quizzes
VI. Suggested Reading List
E-books at the Emory Library,
http://health.library.emory.edu/collections/etextbooks
search titles as below, and search “pediatric” for additional resources
Nelson Textbook of Pediatrics
http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1
The Harriet Lane Handbook.
http://health.library.emory.edu/search/apachesolr_search/harriet%20lane?filters=tid%3A3&retainfilters=1
Red Book
http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1
AAFP monographs
#333 Childhood Infectious Disease Update (2007)
#362 GI conditions in children (2009)
#369: Heart Conditions in Children (2010)
#393 Respiratory issues in infants and children (2012)
VII. Implementation Methods
Location:
Contact:
Susie Buchter, MD
Department of Pediatrics
Grady Memorial Hospital
69 Jesse Hill Jr. Drive
Atlanta, GA 30303
(404) 778-1440 Residency Program
(404) 778-1450 Neonatology Business
Family Practice Center: Half day per week.
Call/Vacation: Call will be with the PedsWard Clinic. Vacation is not permitted on this rotation.
Supervision: Residents will be supervised by Dr. . Residents should document all patient care and
procedures in New Innovations.
Last updated March 7, 2013
Conferences: The resident is expected to attend Pediatric grand rounds.
Addendum (provided by rotation):
Mandatory training for the EPIC Electronic Medical Record system at CHOA is now in effect as below:
Welcome New Medical Students, Residents and Fellows at Children's
Healthcare of Atlanta!
Children’s Healthcare of Atlanta has adopted Epic, an electronic medical record system, which
includes most inpatient nursing and physician documentation. While the software usability is
state of the art, there is compelling evidence that high-quality training on the electronic record is
necessary for clinicians to provide safe and efficient care.
The training below is required of medical students, residents and fellows who provide inpatient
care at Children’s:
Course Length Method of Training Pre-requisites?
Inpatient MD/AHP
Epic Chart Review 101
Online Training
45 min self-paced online
module
No
Inpatient MD/AHP
Epic Documentation 101
Online Training
20 min self-paced online
module
Yes, Inpatient MD/AHP
Epic Chart Review 101
Online Training
In order to take these classes, you will need to log into Aspen, the learning management system
for Children’s.
To Log into Aspen
Use the following Web address: https://aspen.choa.org
Enter your user name and password.
User Name: your user name is your first and last initials + last 4 of your social
Password: your password is your first and last initials + last 4 of your social
Note: you will be asked to change your password to something unique
To Register for the Online Training Modules
On the Aspen home page look for the heading Physician Training
To find the Inpatient MD/AHP Epic.Chart Review 101 Online Training, click the Epic Chart
Review link
To find the Inpatient MD/AHP Epic.Documentation 101 Online Training, click the Epic
Documentation Link
Last updated March 7, 2013
*** Important Notes for taking the online training modules***
The online training modules contain audio. Please make sure your sound volume is
turned on.
Ensure that pop-up blockers are turned off.
Please complete your training at least 2 business days before your rotation at
Children’s to allow for processing.
Minimum computer requirements:
Intel Pentium III 600MHz processor or equivalent
Microsoft Windows 2000, XP, or Vista
256MB of RAM (512 MB recommended)
Screen Resolution of 1024 x 768 or above
Broadband Internet connection (dialup is not recommended)
Microsoft Internet Explorer 5 or above
Adobe Flash Player 9
Sound Card and Speakers
All Popup Blockers Must be disabled. This includes those built into IE7, Yahoo, and
Google toolbars among others.
Upon Completion of the Online Training Modules
You will receive an email from the Epic Security team informing you of your Epic username
and password within one business day of completing the training with a passing grade of 80% of
above.
If you receive a grade of 79% or below you will be required to re-take the online training
module.
The first time you log into Epic it will require you to change your password to something
unique.
HIPAA & Password Management
You will receive a variety of passwords to Children’s Healthcare of Atlanta operating systems
and applications, such as Windows and Epic. Please keep your password confidential. Do not
share your password with family members or co-workers. Any violation of this policy could result
in suspension of activities at Children’s Healthcare of Atlanta.
If You Need Assistance
If you cannot login to Aspen, please call Renita Murray at (404) 785-6418 to verify that you
have been entered into the Children’s system.
If you have difficulty completing the online training modules, please call the Solution Center at
(404) 785-6767.
Last updated March 7, 2013