150-55TH Street
Brooklyn, NY 11220
Pediatric Clerkship
Medical Student
Guide
Manzur Sheikh, MD, FAAP
Clerkship Director
(718) 630-7724
Pager 7054
MSheikh@lmcmc.com
Contents
Cover Page .......................................................................................................................... 1
Contents .............................................................................................................................. 2
Contacts............................................................................................................................... 3
Department of Pediatrics................................................................................................. 3
Clinic Contacts and Locations ........................................................................................ 4
SITE .................................................................................................................................... 4
How to Page .................................................................................................................... 4
Emailing an lmcmc.com email ....................................................................................... 4
Introduction ......................................................................................................................... 5
Expectations and Responsibilities................................................................................... 6
Professionalism and Dress .............................................................................................. 6
Orientation ...................................................................................................................... 6
Rotations ............................................................................................................................. 7
Out Patient Services- Clinic and Private Offices- Three weeks ..................................... 8
Emergency Department- One week ...............................Error! Bookmark not defined.
Labor and Delivery/Nursery and Pediatrics- One week each ......................................... 8
On Call Scheduled *See attached calendar ............................................................ 8
Clinical Write-Ups (Case Presentations) &Topic Discussions ........................................... 9
Clinical Write-Ups / Case Presentations ......................................................................... 9
Topic Discussions ........................................................................................................... 9
Teaching Rounds, Conferences, Lectures and Grand Rounds Schedule .......................... 10
Exams and Presentations * See attached Calendar ........................................................... 11
Mid Core Evaluations ................................................................................................... 11
Oral Final Exam ............................................................................................................ 11
Final Exam .................................................................................................................... 11
Logs and Modules ............................................................................................................. 14
Encounter Log ............................................................................................................... 14
Log of Manual Skills and Procedures ........................................................................... 14
Modules (SGU) ............................................................................................................. 14
Recommended Reading .................................................................................................... 16
Included In This Package .................................................................................................. 16
2
Contacts
Department of Pediatrics
Manzur Sheikh, MD FAAP
Executive Director of Pediatrics
(718) 630-7724
Pager Number 7054
Location: Station 2-03
MSheikh@lmcmc.com
Stephanie Bryant, MD FAAP
Associate Program Director
(718) 630-7545 or 7530
Pager Number 3822
Location: Nursery or Pediatrics
SBryant@lmcmc.com
Norma Villanueva
Network Chief Children and Adolescents
(718) 630-6794
Location: 5602-2nd Ave
NVillanueva@lmcmc.com
Alison Cruz
Medical Education
Administrative Assistant
(347) 377-4397
Location: Station 3-04 Rm. 3524
Acruz2@lmcmc.com
Theary Oum
Pediatric Administrative Associate
(718) 630-6375
Location: Station 3-03 3526
Soum@lmcmc.com
3
Clinic Contacts and Locations
SITE
HOURS
SITE DIRECTOR
MEDICAL and DENTAL
DIRECTORS
Brooklyn Chinese FHC
5008 7th Avenue
Brooklyn, NY 11220-3209
Front Desk/Reception 4800
P 718-210-1030
F 718-871-0969
Mon. - Thurs
9:00am-5:30pm
Fri – 9:00am-5:00 pm
Sat & Sun
10:00am-6:00pm
Christina Tsai, MBA
Site Director
P 718 210-1031
F 718 871-0969
Pgr: 4824
Qiuqu Zhao, MD
Medical Director
P 718-210-1032
F 718-871-0969
Cell 646-427-0520
Pgr 3412
Caribbean American FHC
3414 Church Avenue
Brooklyn, NY 11203-2714
P 718-630-2197
F 718-940-2914
Mon-Fri 8:00am-8:00pm
Sat 8:00am-4:00pm
Claudya C. Verdiner
Site Director
P 718-630-2197 Ext 4043
F 718-940-2914
Pgr: 4652 / 917-269-0601
Anita Beecham-Robinson, MD
Medical Director
P 718-630-2197 Ext 4045
F 718-940-2914
Pgr 2370 / 917-269-3733
Park Ridge FHC
6317 4th Avenue
Brooklyn, NY 11220-4922
P 718-907-8100
F 718-492-8614
Mon-Wed 8:15am-8:00pm
Thurs 9:45am-8:00pm
Fri 8:15am-5:00pm
Sat 8:30am-3:30pm
Ivan Cortes
Site Director
P 718-630-6837
F 718-492-8614
Pager # 3466
John McAdam, MD
Medical Director
P 718-907-8198 Ext 2123
F 718-492-8614
Park Slope FHC
220 13th Street
Brooklyn, NY 11215-4802
P 718-832-9677
F 718-832-5991
Mon, Fri 8:30am-5:00pm
Tue-Thu 8:30am-8:00pm
Sat 8:00am-4:30pm
Charles Paturno
Site Director
P 718-832-5980 ext. 1920
F 718-832-5991
Pgr 917-269-0530 / 2055
Nonkulie DlaDla
Medical Director
P 718-832-5980 ext. 1922
F 718-832-5991
Sunset Park FHC
Ambulatory Pediatrics
5610 Second Avenue
Nurses Stn 7499
Information/Security Ext
8520
Mon-Thurs 8:30-9:00pm
Fri: 8:30am-7:00pm
Sat & Sun (Urgent Care)
9:00am-5:00pm
Claudette Richardson
Site Director
P 718-630-6042
F 718-630-6878
Pgr #
Sharon Jospeh-Giss, MD
Medical Director
P 718 630-8672
F 718 630-6877
Pgr #
How to Page
From inside the hospital: Dial *621 or 8700 – wait for prompt – input pager number – wait for
prompt – input extension
From outside hospital: Dial (718) 630-8700 – wait for prompt – input pager number – wait for
prompt – input telephone number
Emailing an lmcmc.com email
When sending an email to an lmcmc.com email, put “LMC” in subject line to ensure delivery.
WiFi
Login: lhsguest
Password: lhs2009
4
Introduction
The Pediatrics Clerkship provides a clinical learning experience that prepares
you to communicate effectively with patients and families and learn to evaluate
and manage children from newborn through adolescence. The clerkship
integrates a foundation of medical knowledge with clinical and communication
skills to enable you to identify and provide quality pediatric care. The
Department of Pediatrics places special emphasis on professional behavior, as
well as, knowledge, interviewing skills, clinical problem solving and the ability to
communicate information.
This six-week core clerkship allows you to gain clinical experience in evaluating
newborns, infants, children and adolescents, both sick and well, through clinical
history taking, physical examination and the evaluation of laboratory data.
Special emphasis is placed on: growth and development, nutrition, disorders of
fluid and electrolytes, common infections, social issues, and preventative care
including: immunizations, screening procedures, anticipatory guidance. The
student will develop the necessary communication skills to inform, guide and
educate patients and families.
Pediatric ambulatory and in-patient services provide an opportunity to observe
and enter into the care of pediatric medical and surgical disorders. You will
learn how to approach the patient and family and communicate effectively as
they take admission histories and perform physical examinations. You will then
provide the patient and parents with the necessary information and guidance to
understand and support the child through the time of illness. You will learn age
specific skills regarding interviewing pediatric patients and relating to their
parents, and will develop the skills necessary to examine children from newborn
through adolescence utilizing age appropriate techniques. The adequacy and
accuracy of your knowledge, communication skills, manual skills and
professional behavior will be measured and evaluated by their supervising
physicians, residents and preceptors. There will be formative evaluations and
discussion of your progress throughout the rotation with emphasis on a formal
mid-core and end-core assessment.
5
Expectations and Responsibilities
It is expected that there be full and active participation in the multiple learning
opportunities: didactic learning, clinical seminars, self-directed learning modules,
patient rounds and conferences.
Preceptor sessions are mandatory and take precedence over all other clinical
activities. You should excuse themselves from their other assignments and
attend their preceptor session, unless excused by their preceptor. All of these
components are designed to expand your concept of how to provide quality care
for pediatric patients.
Professionalism and Dress
ID cards should be worn at all times above the waist and visible. All Pediatric
Students must dress in business attire. Students are never permitted to wear
sneakers. Anyone who is required to wear sneakers for medical purposes must
provide a doctor’s note with Dx, start and end dates. All males must wear a shirt,
tie and dress slacks. All females must wear dresses, skirts or dress slacks and
(business) tops. No jeans Leggings, tank tops or t-shirts will be permitted. If you
are required to wear scrubs, they must be put on in the locker room and removed
before leaving the building at any time. While wearing scrubs you should have a
white lab coat on at all times. If you wear a shirt under scrubs, sleeves must be
shorter than scrubs.
Students are required to act courteous and professionally at all times. You must
protect patient confidentiality. At no time should there be any discussions of
patients in common areas, elevators, in the cafeteria and outside the hospital.
You should be familiar with HIPPA laws.
Orientation
You will start the rotation by reporting to Diana Calderon, the Medical Student
Coordinator. She is located on the third floor in the Executive Offices 3-04.
Once you are processed, and (s) he is issued an ID card, Dr. Sheikh will
welcome and orient you. After this orientation, Alison will give each student
his/her schedule.
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Rotations
You will be involved in all patient care activities in the out-patient facility and
inpatient unit. You will observe, and given immediate feedback, as they take a
history and perform a physical examination on a newborn and a child. As an
absolute minimum, you should examine five term newborns. This includes
reviewing the maternal medical record, performing a physical examination on the
infant, and talking with the parent about basic care of the newborn and
anticipatory guidance.
As an absolute minimum, you should be involved in the care of a child with:
a. a gastrointestinal illness, such as dehydration
b. a child with a neurological or neurodevelopmental problem
c. a child with a respiratory and/or cardiac problem (chronic illness is preferable)
d. a child with fever
e. a child suspected as being the victim of child abuse/neglect or where the
differential diagnosis includes child abuse/neglect. There should be a discussion
of the recognition and reporting requirement and the child protection response
and services.
Involvement in these cases should include taking a history, performing a physical
examination, discussing the differential diagnosis, formulating a plan for
laboratory/radiologic studies and deciding on a treatment plan. These cases may
be from the inpatient units, the nursery, the Emergency Room, or the out-patient
setting.
Depending on circumstances, in cases of child abuse, participation may be
limited to participation as an observer, especially in cases of sexual abuse.
As an absolute minimum, you will participate in the care of two adolescents. This
includes taking a history and performing a physical examination as well as
reviewing the immunization record and assessing the adolescent’s health,
behavior, educational and environmental issues. It is preferable that one of the
two adolescents described will have a chronic illness.
You will give, at a minimum, one major presentation during the rotation. The
presentation will be evaluated by the preceptor.
Thursdays are Non-Clinical Days, report to Lutheran Medical Center
Conference Room for Pediatric Grand Rounds, then follow Teaching
Rounds, Conferences, Lectures and Grand Rounds Scheduled
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Emergency Department- One week
Emergency department and urgent care experiences permit the student to be the
first to evaluate infants and children with acute illnesses. Emphasis is placed on
the evaluation of febrile illnesses, and common emergencies of childhood (e.g.
poisonings, injuries). If you are on evening shift, you do not have to report to to
topic discussions. Please see calendar for ED Rotation Schedule.
Out Patient Services- Clinic and Private Offices- Three weeks
In the out-patient services, the student learns the milestones of growth and
development, infant feeding, child nutrition, preventative care (including
immunization, screening procedures, anticipatory guidance), the common
ailments of childhood and diagnosis of rare and unusual illnesses. In the
pediatric sub-specialty clinics, the student will observe the progression and
participate in the management of a wide variety of serious and chronic pediatric
illnesses.
Labor and Delivery/Nursery and Pediatrics- One week each
The initial management of the newborn is learned in the delivery room. Students
then practice the examination of the newborn and learn about the initiation of
feeding, neonatal physiological changes, and common newborn conditions. In
the newborn intensive care unit, the student is an observer of the management of
the premature and term infant with serious illness. Emphasis is placed on
observing and understanding the role of the pediatrician in the multidisciplinary
team approach to critical care.
During these rotations you will be assigned a pager. These will be distributed to
you on Monday and you must return on Friday. Please see attached beeper
assignment.
On Call Scheduled *See attached calendar
Call occurs during Pediatric and Regular Nursery Rotations.
Call begins at 7am and ends at 7pm.
If you are on-call for Saturday or Sunday, the call starts at 8:00am, with Morning
report.
No one is on-call the last week of your rotation.
8
Clinical Write-Ups (Case Presentations)
&Topic Discussions
Clinical Write-Ups / Case Presentations
A minimum of four complete clinical write-ups (case presentations) is required
per student. These write-ups will be critiqued by the preceptor and returned to
the student. It is preferable that the patients selected for these write-ups be
examples of the case mix from you rotations. The write-ups will be handed in at
intervals during the rotation and returned promptly so that the student can
improve their written expression.
Topic Discussions
You must present two topic discussions, one each while in your Pediatric Floor
and Newborn Nursery rotations. The topic discussion will be presented in Power
Point format. If you are on that date alone, make the presentation about 20
slides in a 35 to 45 minute presentation. If two persons are to present, cut the
presentation to about 10 to 15 slides and keep presentation to 20 to 25 minutes.
Included in this discussion should be the definition of the condition, background,
clinical assessment and etiological discussion, diagnostic workup, treatment and
prognosis.
Email these presentations to Dr. Sheikh before-hand at MSheikh@lmcmc.com
9
Teaching Rounds, Conferences, Lectures and
Grand Rounds Schedule
Thursdays are Non-Clinical Days, report to Lutheran Medical Center
Conference Room for Pediatric Grand Rounds and follow the schedule
below.
Type of Rounds
Bedside Rounds
Attending Rounds
Frequency
Daily
Daily
Time
7:00am to 8:00am
8:30am to 9:30am
Topic Discussions*
Monday, Tuesday,
Wednesday,
Friday
1st, 2nd, 4th & 5th
Thursdays
3rd Thursday
12:00pm to
1:00pm
Grand Rounds
Perinatology
Conference
Please refer to Grand
Rounds Scheduled, Subject
to change.
Preceptor
Sessions**/ Case
Presentations
Radiology Rounds
Thursdays
Review of Shelf
Exams
Thursdays
(excluding last week)
Thursdays
8:30am to 9:30am
9:00am to 10:00
am
Location
Pediatric unit
Pediatric Unit
Playroom
Room 6128
Executive Board
Room
Auditorium
10:00am to
12:00pm
Room 6128
12:00pm to
1:00pm
2:00pm to 4:00pm
Dr. Gudy’s Office
Room 6128
*All students in Pediatrics Nursery and or ED should report to Case
Presentations & Topic Discussions Monday, Tuesday, Wednesday and
Thursday.
**You must attend the Preceptor Sessions. The Preceptor Sessions
will include clinical discussions that focus on problem solving, decision
making and adherence to bioethical principals. You should come
prepared with your Case Presentations to these sessions. These
preceptor sessions are conducted on Thursdays from 10am to 12pm.
10
Exams and Presentations * See attached Calendar
Mid Core Evaluations
Each student will have a formative mid-core evaluation. You will bring a print out
of their Patient Encounter Log to the session. The Log will be reviewed for
completeness, quality of notes and mix of cases. The student’s professional
behavior will be addressed, as well as progress in attaining the knowledge and
skills required to evaluate a patient. There will be appropriate comments and
suggestions given to the student to guide them toward improvement. The
preceptor will submit a written assessment of the Mid-Core evaluation. These
evaluations occur on the Fourth week of rotation. Please refer to Calendar for
dates and times.
Oral Final Exam
An oral examination, lasting 15 minutes or longer, will be given during the last
week of your rotation by Dr. Sheikh. Please refer to Calendar for date and times.
Final Exam- SGU ONLY
The final written examination will be the National Board of Medical Examiners
Clinical Subject Examination. This exam will be given the last Thursday or Friday
of your rotation. Bring your printed logs with you.
Core Topics
General
a. Pediatric history
b. Pediatric physical exam
c. Patient write-up (problem oriented approach)
d. Begin to formulate a differential diagnosis that relates to the
Presenting complaint, symptoms and findings on history and
physical examination.
e.
Formulate a plan for further evaluation (ie.laboratory, radiology),
treatment and management.
Well Child Care
a. Immunizations
b. Routine screening tests
c. Anticipatory guidance
d. Nutrition
Growth and Development
a. Developmental milestones (when and how to evaluate)
b. Failure to thrive
c. Short stature
Neonatology
a. The normal newborn
b. Neonatal problems (jaundice, respiratory distress, sepsis, feeding
issues)
c. Newborn screening
d. APGAR scoring/Ballard scoring.
e. Fetal Alcohol Syndrome
f. Sudden Infant Death Syndrome
Common Childhood Illnesses and Their Treatments
1. Ear Nose and Throat (ENT) and pulmonary disorders
11
a. Upper Respiratory Infection (URI)
g. Bronchiolitis
b. Pharyngitis
h. Asthma
c. Otitis media
i. Foreign body
d. Sinusitis
j. Pneumonia
e.
Cervical adenitis
k. Cystic fibrosis
f.
Croup/epiglottitis
l. Tuberculosis
2. Eyes
a. Conjunctivitis
c. Amblyopia
b. Ocular trauma
d. Strabismus
3. Cardiac
a. Fetal circulation.
b. Congenital anomalies: Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Tetralogy of Fallot,
transposition of the great vessels, coarctation of the aorta, patent ductus arteriosus (PDA), pulmonic stenosis (PS).
The significance of these defects as isolated findings and as they relate to genetic syndromes.
c. Acquired heart disease: Rheumatic Fever (RF),
d. myocarditis
e. Hypertension
4. Gastrointestinal Disorders (G.I.)
a.
Gastroenteritis
b.
Constipation/Hirschsprung’s disease
c.
Acute abdomen (appendicitis, intussusception, volvulus)
d.
Inflammatory bowel disease
e.
Gastroesophageal reflux disease (GERD)
5. Endocrine
a.
Diabetes, Diabetic Ketoacidosis (DKA)
b.
Thyroid disease
c.
Adrenal disease
d.
Congenital Adrenal Hyperplasia (CAH)
e.
Failure to Thrive
f.
Obesity
g.
Metabolic Syndrome
6. Neurology
a.
Seizures
b.
Meninigitis
c.
Head trauma
d.
Cerebral palsy
e.
Tumors
7. Hematology/Oncology
a.
Anemias/hemoglobinopathies
b.
Pediatric malignancies (Acute Lymphatic Leukemia, lymphomas, neuroblastoma, Wilm’s tumor)
c.
Immune thrombocytopenic purpura (ITP)
8. Renal and Genitourinary (G.U.)
a.
Urinary tract infections (UTI’s)
b.
Nephritis/nephrosis
c.
Fluid and electrolyte balance
d.
Congenital anomalies
9. Dermatology
a.
Seborrheic dermatitis
b.
Atopic dermatitis
c.
Impetigo
d.
Fungal Infections
e.
Exanthems
f. Neurocutaneous stigmata (neurofibromatosis, etc.)
10. Ingestions and Toxidromes
a. Lead poisoning
b. Salicylate, acetaminophen
c. Iron
11. Common Pediatric Orthopedic Problems
a. Developmental dysplasia of the hip
b. Osgood Schlatter
c. Slipped Capital Femoral Epiphysis
d. Torsions
e. Legg-Calve-Perthes disease
f.
Dislocated radial head,(Nursemaid’s elbow)
g.
fractures
12. Musculoskeletal System
a.
Osteomyelitis/septic arthritis
b.
Muscular dystrophies
13. Adolescence
a. Tanner staging
12
b. Precocious/delayed puberty
c. Stages of adolescent development
d. Sexually transmitted infections
e. Pregnancy/menstrual irregularities
f.
Vaginal discharge
14. Child Maltreatment Syndrome
a.
Physical abuse
b.
Sexual abuse
c.
Emotional abuse
d.
Neglect
15. Genetics
a.
Down Syndrome, # 21 trisomy
b.
#13 trisomy
c.
#18 trisomy
d.
Turner Syndrome
e.
Klinefelter Syndrome
16. Collagen Vascular
a.
Juvenile Rheumatoid Arthritis
b.
Systemic Lupus Erythematosus
c.
Henoch Schonlein purpura
d.
Kawasaki disease
e.
Hemolytic Uremic Syndrome
17. Behavioral Issues
a. Temper tantrums
b. Discipline issues
c. Sleep disorders
d. Attention Deficit Disorders
e. Hyperactivity issues
f. Learning disabilities
g. Oppositional defiant disorders
18. Miscellaneous
a.
Fever without focus
b.
Human Immunodeficiency Virus infection (HIV)
c.
Acquired Immunodeficiency Syndrome (AIDS)
19.Bioethical Principals.
a. Respect for persons( privacy, confidentiality, informed consent,
Inclusion of patient/parent in decision making, provision for identity and culture, disclosure).
b. Medical beneficence (concern for the patient’s best interest).
c. Non-maleficence (not harming).
d. Utility (balancing potential benefit to potential harm).
13
Logs and Modules
Encounter Log
The student will keep a Patient Encounter Log. The log will list all of the patients
that the student has had direct contact with. The log should reflect a commitment
to accurate record keeping. The note should be concise and reflect knowledge
of the case.
Log of Manual Skills and Procedures
The student will maintain a log of Manual Skills and Procedures that lists the
procedures performed or witnessed.
The following procedures are recommended to be performed or witnessed during
the pediatric rotation:
a) vision and hearing screening
b) otoscopy
c) administration of inhalation therapy
(Metered Dose Inhaler/MDI/Spacer/Nebulizer).
d) throat culture
e) immunizations: intramuscular injection, subcutaneous injection.
f) Mantoux testing: PPD
g) nasopharyngeal swab
h) peak flow measurement
Modules (SGU)
The students are responsible for completing the introductory modules of the
Communication Skills course prior to the start of the 3 rd year core rotations. This
self-directed learning computerized course can be accessed through the SGU
website at My SGU (click Communication Skills course, upper left corner).
In addition, the modules required for the pediatric rotation are:
#21 Communication and Relationships with Children and Parents
#22 The Adolescent Interview
The student will participate in the self-directed web-based learning course,
CLIPP (Computer-Assisted Learning in Pediatric Programs).
The 25 assigned will be completed during the 3rd and 4th years.
Third Year Cases
Nursery: 1, 7, 8.
Ambulatory Care: 2,3,4,5
Inpatient: 10,13,19,25,30
Other: 21,26,27,28,31
Fourth Year Cases
Week 1: 11, 12
Week 2: 16,17
Week 3: 20,23
Week 4: 24, 32
14
The course is accessed through Sakai on the SGU website under the heading
“Lessons”. The student will be directed to the Med-U website for case content
and will complete all of the questions in the module. The student will then go
back to the SGU website to answer 5 questions. The student must get 80% of
the questions correct to receive credit for the module.
Completion of the cases will be monitored through the Office of Distributive
Education.
The preceptors are able to monitor the students’ progress.
Completion of this course is required and will be monitored through the 3 rd and
4th year.
There are an additional 7 cases in the CLIPP program that are not on the
required list. You may do these on your own or as directed by your preceptor.
You may do the 4th year cases during your 3rd year or any case directed by your
preceptor.
Pediatrics : Expected Patient Encounter List
Complaints
Well Child Visit (Birth -1yr) ( #1)
Well Child Visit (1 - 12yr) ( #1)
Well Child Visit (13 - 19 yr) Adolescent ( #1)
Newborn Evaluation ( #1)
Abdominal pain, infant or child ( #1)
Pediatric Fever ( #1)
Rash ( #1)
Diagnoses
Anemias (specify type in notes) ( #1)
Gastrointestinal illness ( #1)
Growth and Development Issue ( #1)
Heart Murmur ( #1)
Neurologic or Neurodevelopmental disorder
( #1)
Respiratory illness, Lower ( #1)
Respiratory illness, Upper ( #1)
15
Recommended Reading
1. Pediatrics for Medical Students by, D. Bernstein and S. Shelov
2. Nelson Text for Pediatrics
3. USMLE text
Included In This Package
- Rotation Schedule
- Calendar- On Call Schedule, Mid-Core Evaluations, Oral Exams and ED
Rotation
- Pediatric Topic Discussions
- Meeting Calendar
- Pediatric Conference Schedule
16