ROTATION SUMMARY
GREEN TEAM & GREEN/RED NIGHT FLOAT
Rotation Contacts and Scheduling Details
Rotation Director:
John Kerner, M.D.
750 Welch Road, Suite 116
pager: 1-3078
e-mail: jkerner@stanfordmed.org
Administrator:
Carmen Kimberling
Carmenk@stanford.edu
(6500 723-5070
Introduction
The pediatric gastroenterology core rotation provides an opportunity for the resident to develop an understanding of
the pathophysiology, clinical manifestations, and management of complex common and unusual disorders of the
gastrointestinal tract, liver, and pancreas. Emphasis will be placed on the performance of a detailed and focused
history and physical examination and the interpretation of laboratory, imaging studies, and G-I procedures (e.g.,
upper endoscopy, colonoscopy). Following completion of the rotation, residents will be able to initiate initial
evaluation and management of these complex patients.
Weekly Schedule - Inpatient
Time
Monday
Pre-round
0700-0800
Morning Report
0800-0830
or
8 -9 GI/Liver
Mtg 750 Welch,
Ste 116
0830
ROUNDS
900
Tuesday
Pre-round
Morning Report
Wednesday
Pre-round
Morning Report
Thursday
Pre-round
Morning Report
ROUNDS
ROUNDS
ROUNDS
Friday
Pre-round
Grand Rounds
(8:00-9:00)
ROUNDS
11-1200
Patient Care
Patient Care
Patient Care
1200-1300
1300-1800
1700
Conference
Patient Care
Sign-out
Conference
Patient Care
Sign-out
Conference
Patient Care
Sign-out
Weekly Schedule – Outpatient
Monday
Tuesday
8:00-9:00 am
8:00-8:30 am
G-I/Liver
Morning Report
Meeting
750 Welch Rd.
Suite 116
Wednesday
7:30 am – 8:30 am
1st Weds. each
month
Multidisciplinary
Conference with
Radiology and Peds
Surgery
………………….
Patient Care
Chairman’s Rds
Conference
Patient Care
Sign-out
Patient Care
Conference
Patient Care
Sign-out
Thursday
8:00-8:30 am
Morning Report
Friday
8:00-9:00 am
Grand Rounds
9 am – noon
G-I Clinic
9 am – 12 noon
Consults/
Directed Reading
8:00-8:30 am
Morning Report
9:00 am – 12:00
pm
G-I Clinic
Inpatient
Consults/Directed
Reading
Inpatient Consults/
Directed Reading
……………………
10 am - 12 noon+
Nutrition Support
Last updated 6/10
Rounds
Admin Conference
room (basement
LPCH)
Noon Conference
Noon Conference
Noon Conference
Noon Conference
12:00 pm – 1 pm
G-I Teaching
Seminar/
Path Conference
once a month
1:00 pm – 5:00
pm
G-I Clinic
1:00 pm – 5:00 pm
G-I Clinic
G-I Clinic
(SCVMC)*
1:00 pm – 5:00 pm
G-I Clinic
……………………
1:00 pm – 5:00
pm
G-I Clinic
1st and 3rd Thursday
of each month:
1:30 pm – 5:30 pm
G-I Clinic
(PAMF)**
*Attending:
Dr. Manuel Garcia/Dr. Missy Hurwitz. The GI clinic at SCVMC can accommodate one additional
physician (Fellow or Resident) per session. When the Fellow is scheduled to be at VMC, residents should attend GI
Urgent Clinic. Residents are responsible for asking the Fellow his/her schedule for VMC at the start of the rotation.
**Attending:
Dr. Dorsey Bass
+ 11-1 on the 2nd Wednesday of each month
Rotation Specifics
Orientation
Residents should receive sign-out before beginning the rotation so they are well versed with the patients on the first
day. Interns are expected to arrive at the hospital with enough time to pre-round on their patients before Morning
Report. Your supervisors will arrive by 7am on Intern Switch Day to help orient you to the service. The Senior
Resident on the Team should hold a brief session on the first day of the rotation to discuss how Rounds will be
conducted and expectations for presentations, pre-rounding, notes and interaction with medical students and
attendings.
Rounds
The Green team is comprised of the Gastroenterology and Liver service and each team typically has their own
Fellow and Attending; rounds are conducted independently. The Green team is composed of an intern, supervising
junior resident and physician assistant. The Senior Resident leads rounds. During the weekdays, the team is
expected to walk round to see patients and discuss the plan with the family and the nursing staff.
Patient distribution is as follows:
The Transplant PAs primary responsibility is to the surgical services and surgical patients. If 2 PAs are on
service and available they should be able to cover both the transplant surgical and medical patients up to 16
(dependent on surgical acuity).
-Exceptions to above: If both PAs are required in the operating room or if the combined transplant
surgical/medical service >8pts with one PA sick/PTO/conference/in OR the residents or fellows will cover
the post transplant medical patients.
When combined GI/pre transplant census is high (>10pts) the intern will cap at 10, the junior resident will
take on 2 additional patients, and patients above that will go to PAs(pre txp) and/or fellows(GI). The PAs
should be responsible for any of those patients they take on for the entire day or longer if necessary until
the census decreases. They will primarily take on pre transplant patients who have completed the
evaluation process and remain hospitalized or those that are readmitted post evaluation. When the team
census is > 12 and the PA’s are unable to take on the remainder of patients (due to their patient load or if
large volume of GI patients), the GI fellows and attendings will assist the residents in completing those
Last updated 6/10
work assignments that involve large time commitments with low learning potential (ie discharge
preparation and paper-work, etc).
-In times of low census for the combined GI/Liver team, to maximize the learning experience the intern
will have a minimum of 5 patients to include the post transplant readmits (especially if surgical census is
high).
Patient placement is as follows:
 PRE TRANSPLANT ADMISSIONS:
o Please admit them to the LIVER TXP service, not GI. Please activate the Liver or Small Bowel
transplant evaluation plan which will help you with the labs needed for work up. You do not need
to repeat labs that have already been obtained at an outside facility EXCEPT HIV and blood
type(2 are required but only 1 must be done here if already performed at outside hospital). ALL
patients need echos regardless of presence of murmur unless one has been obtained at outside
facility. Only obtain consults from services as needed based on patient’s PMH.
The PA will serve as the liaison between the Green Team and the surgical Transplant team. They
will ensure all the required tests and studies are ordered for transplant evaluation. If an incoming
evaluation is known ahead of time they will initiate the order set for the Green team.

POST TRANSPLANT READMISSIONS:
o The PA will admit and activate the order set for any post transplant patient that arrives to the floor
prior to 1600. If staffing/timing allows, the PA will perform the H&P on ER or clinic patients
prior to admission, but if not, will initiate order set and the PM resident will verify meds/diet and
activate the order set.
Please admit under the LIVER TXP service. Activating the post txp readmit plans (liver in place,
SB to follow soon) will save you time since most of the medications and standard labs are part of
the plan.
The Green team is not responsible for surgical patients and should defer all calls to the transplant
fellow/attending if they are contacted regarding these patients when the transplant PA is not available.
Clinic
GI clinic is held Monday and Thursday mornings and every afternoon. Interns will be exposed to a balanced variety
of outpatient management issues by the completion of the rotation. The GI Clinic operates like other traditional
clinics. The resident will take the initial History and Physical then present that patient to the Attending. The
Attending and resident will then see the patient together and the resident will be responsible for dictating the
management plan. Residents are encouraged to keep track of the patients they see in clinic and follow-up on the
outstanding laboratory results. Also, residents should “sign-out” all patients seen in Urgent Clinic to the Fellows as
they will follow-up lab studies on these patients. Residents are expected to see patients with all types of diagnoses
and in various stages of treatment. It is not practical nor beneficial from an educational perspective to seek out only
new diagnoses.
Pagers
The Green Team will have a team text pager and phone to facilitate communication.
Sign-out, Call Schedule & Evening Communication Expectations
The PA will sign out to the dayshift junior/intern(Junior’s preference) at 1600. The PA will update the sign out in
Cerner each day. This will include any major changes to the care plan, any major problems that occur during the
day and any labs/studies or issues that needs to be closely followed overnight. The PA will also be available for
signout or concerns from the night team.
M-F AM Sign Out: If there are significant events that require extensive communication, to save time in the am the
NF intern can email the covering PA (mmerrill@lpch.org, lkjelson@lpch.org). The PA will call or be available to
be called before 0615 or after 0645 for verbal sign out.
Weekend/Holiday Sign Out: The PA will provide a detailed sign out via email to the junior/intern on medical
patients to the weekend team on Friday evening and leave updated sign-out in Cerner system. The covering
interns/residents from the weekend will maintain a signout that will be emailed to the PA at the end of the weekend.
Last updated 6/10
The weekend covering PA is responsible for both adult and pediatric surgical patients on the weekends and is not
available to follow medical patients on the weekend.
Weekend Rounds
Patients will be divided into two teams for weekend call: General Pediatrics/Cards-Pulm (Blue/Yellow) and RenalRheum/GI (Red/Green). On Saturday, each team will round with two interns or residents and one supervisor.
Members of the team who are post-call (varies by call schedule – it may be an intern or supervisor) leave after
rounds are completed. The on-call team will always include one team member from a regular daytime weekday
team. The supervisor who oversees both teams will be one of the supervisors of the daytime weekday teams (Blue,
Yellow, Red, and Green) plus the Resident Reserve who regularly fills in for Continuity Clinic absences.
Night Team
The Night Team usually consists of two interns and a senior supervising resident. The interns often will cover
night call responsibilities of the Ward team they were on in the previous block to maintain continuity. The Night
Team arrives at 5 pm for interns and 6 pm for supervisors and receives sign-out from the daytime teams. As time
progresses, Night Teams will know the service better. Therefore, sign-out should be relatively quick and concise—
focusing on new admissions and new developments for existing patients.
On the Wards and Oncology, the Night Team or Night Float will work all day on Sunday and 14-hour shifts Monday
until Thursday. On Sundays, it is expected that the Night Team interns will pre-round and write notes on their
patients (with the help of the Saturday on-call intern) and then round with the attendings, starting at 8:30. The
Night Team should use this Sunday call to better acquaint themselves with the attendings and the patients on their
teams. During their weekday calls, the Night Team is only responsible for pre-rounding on and writing notes for
the new patients who they admitted during the previous night.
At 7:00 each morning (Monday through Friday) supervisors from each team will meet with the Night Team
supervisor to sign out new patients and important overnight events. Interns should provide written sign-out
to the daytime teams and give verbal sign out to the daytime interns about new admissions and overnight events.
As part of our educational curriculum, we hold Evening Report each night at 10 pm in the Housestaff Lounge.
These reports, led by overnight pediatric hospitalists, will focus on acute ‘on call’ issues. The sessions will be very
flexible and will include bedside teaching, practical skills, and physical exam rounds.
Resident Roles and Responsibilities
The PL-1 and PL-2 assigned to G-I/Liver Transplant will be responsible for the day-to-day management of all
medical patients followed by either the G-I service or the Liver Transplant Service (except those followed in the
PICU and except for any liver or liver/small bowel transplant patients followed by the Pediatric Liver Physician’s
Assistant).
Intern:
 Primary physician for all medical patients on the G-I or Liver Transplant Service except as stated above.
 Responsibilities:
 Write up and dictate history, physical, and treatment plan on all service admissions in consultation
with the PL-2 and G-I or Liver Transplant Attending (it is unnecessary to leave the written note in the
chart as long as you print out your dictation and place it in the chart prior to leaving the hospital)
 Write all of the orders on G-I and Liver Transplant medical patients.
 Arranging for all special diagnostic tests.
 Maintenance of charts, including daily progress notes, growth charts, and lab results on all patients. In
general, progress notes should be written at the earliest after morning rounds, but preferably later in the
day when results of laboratory tests, cultures, radiologic studies, etc. are available. If a significant
change in the patient’s status, requiring a change in management occurs after the daily progress note is
written, an addendum must be written.
 Keeping parents and patients apprised of progress, lab results, new developments, etc.
 Discharge summaries must be dictated on all patients within 48 hours of discharge. Face sheets must
be completed at the time of discharge.
 As the primary physician, the intern is responsible for knowing each of his/her patients in detail
including past medical history and relevant psychosocial history.
 Rounds:
Last updated 6/10




Interns will be responsible for presenting their patients in detail at Work Rounds in the morning and
briefly presenting a review of the status and treatment plan of the intern’s patients to the on-call
residents on Evening Sign-Out Rounds.
Interns will be expected to have rounded on their inpatients prior to morning work rounds so they will
be able to present an up-to-date clinical summary and appropriate latest labwork. Presentation should
be succinct: reviewing each patient in appropriate detail by active problems with a presentation of
assessment and plan for each problem. New patient admissions will be presented formally and in
detail.
Additional teaching rounds will be arranged between the Attending, Fellow, and Housestaff.
Outpatient Clinic:

The inpatient residents are not expected to attend outpatient clinic.
 The intern on the outpatient portion of the rotation is expected to function according to the outpatient
GI selective (see other portion of manual)
Supervising Resident:
 Direct supervision of the PL-1 for all medical inpatients on the G-I or liver transplant service (except as stated
before)
 An admission history and physical is to be dictated on each medical patient on the services above by a resident
(If a sub-I dictates a note, a resident is required to write a complete H&P for the chart).
 Supervising proper maintenance of the patients’ charts on the above services.
 The PL-2 will lead morning Work Rounds, focusing on all active problems for each patient.
 The PL-2 will perform G-I consultations as requested by the G-I Attending only if the service is extremely light.
PA Roles and Responsibilities
In an effort to improve communication between the residents and PAs, the PA will be available to meet with the
intern and junior resident at the beginning of their rotation if they have any questions. They can go over the PA role
and also orient them to the established order sets for transplant evaluations/readmissions. They can be reached at
any time via pager or cellphone (Melanie 799-8591; Lynn 644-7059). If at any time the night float has questions
about sign out or concerns about the patients they can call the covering PA-there is someone always available unless
in the OR.
Primarily, the residents are not responsible for the post transplant patients Monday-Friday 0700-1600. The PA
reports to the fellow or attending physician regarding these patients. For the patients on the Liver team that the PA
follows, the PA will be allowed the same autonomy as that of a supervisory resident. It is understood that the
supervisory residents will play a large role in caring for these children during nights, weekends, and during the day
in cases of emergencies; however it is not necessary for supervisory residents to confirm physical exams or labs of
these patients prior to rounds.
The PA will identify themselves to the nurse taking care of the patient each morning that they are to be the primary
contact for any issues. Please defer any questions from the nurses or consulting services (aside from matters that
require emergent response) to the responsible PA.
FACULTY PRECEPTORS
John Kerner, M.D.
Manuel Garcia, M.D.
Dorsey Bass, M.D.
Eric Sibley, M.D.
Ken Cox, M.D.
William Berquist, M.D.
Ricardo Castillo, M.D.
Missy Hurwitz, M.D.
Clare Wilson, M.D.
James Lue, M.D.
Brandy Lu, M.D.
For the inpatient service, one of the above attendings will be responsible for GI inpatients and all consults; Liver
Transplant patients, Small Bowel Transplant patients, or combined Liver-Small Bowel Transplant patients will be
covered by a separate attending. There will be 1-2 fellows on inpatient service, depending on the schedule (if there
are 2, they will parallel the patient load of each attending).
Evaluation and Feedback
The methods of evaluation for the Green Team Ward Rotation will consist:
 Global Rating Scales –MedHub Resident Evaluations, Faculty Evaluations, Rotation Evaluations
These evaluation tools will be included in each resident’s portfolio.
Last updated 6/10
Resident performance (including knowledge base, diagnostic skills, and ability to formulate a plan of management)
is evaluated during the inpatient experience and by a written examination modeled after the ABP certifying
examination.
Feedback should be provided by the supervisor to intern on a regular basis, but at least weekly. The focus of
feedback will be on competency-based goals and objectives. The senior resident should request feedback from the
attending on a weekly basis. At the end of the rotation an end-of-rotation feedback session will be conducted by the
supervising resident and attending.
Each Junior resident will give an oral presentation either on an “AAP Top Ten List” topic or a journal article of
particular relevance or a relevant case presentation with discussion. Faculty evaluation of the presentation will be
added to the resident’s portfolio.
Each resident will keep a journal recording a running list of the diagnoses of all inpatients and outpatients seen so
the faculty can help assure there is a broad exposure to Pediatric G-I cases over the course of the rotation.
References
Each resident will receive a folder including:
1. A CD with current articles on all aspects of pediatric G-I, liver, nutrition, and transplantation.
2. Listing of all faculty and ancillary staff, including phone and pager numbers.
3. A review article on Failure to Thrive and on Parenteral Nutrition.
4. A Pediatric Formula Guide and supplementary information on nutrition assessment..
Last updated 6/10
Competency-based Goals and Objectives
Goal 1. Be able to recognize the physical signs of underlying acute or chronic liver disease.
Resident Objectives:
Describe the clinical findings (signs and
symptoms of liver disease)
Instructional Strategies
Abdominal exams comparing
liver and spleen exams with
Attending exam
Assessment of Competency
 Medhub
 Direct observation
ACGME Competency Goals
MK
Appreciate petechiae,
jaundice, encephalopathy
Describe the laboratory findings in liver
disease.
Clinical rounds
 Medhub
 Direct observation
MK
Name the 5 main etiologies for liver
disease.
Clinical rounds
Read Chronic Viral Hepatitis,
Hochman (Peds in Review
Article).
Clinical rounds
Patient care
Read Managing Liver Failure
(DA Kelley)
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
Patient Care
NeoReviews 2001: Nutritional
Management of Neonatal and
Infant Liver Disease
Prep 2009 Q#49&97
Patient care
Discussions with supervising
resident
Transplant Slide Show
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
PC
SBP
SBP
MK
Describe the pathophysiology of liver
failure and appropriate management
strategies for the complications thereof
including ascites, coagulopathy and
encephalopathy.
Explain the unique nutritional needs of
patients with liver failure and apply
strategies to meet those needs.
List indications for transfer to an intensive
care setting.
Describe the process by which a child
gets listed for liver transplant and factors
that effect their placement on the list.
 PA verbal feedback
Attend transplant discussion
conference
Goal 2. Understand the work-up and management for failure to thrive from a gastroenterologist viewpoint.
Resident Objectives:
Define failure to thrive.
Last updated 6/10
Instructional Strategies
Review article: Failure to
Thrive from a
Gastroenterologist Perspective
Assessment of Competency
 Medhub
 Direct observation
ACGME Competency Goals
MK
Obtain detailed nutritional histories.
Define the initial GI work-up for a child
with failure to thrive including the
screening labs for Celiac Disease, IBD
and Cystic Fibrosis.
Analyze malabsorption patterns from
serum and stool.
Explain indications for admission.
Brainstorm key insightful
questions you may add to the
history taking.
Reflect on questions
Attendings inquire about on
History.
Article
Read Childhood Malabsorption
Article (Peds in Review, M.
Pietzak)
Review Dr. Kerner’s
Malabsorption powerpoint
Patient care
Discussion with Attendings
 Medhub
 Direct observation
ICS
PC
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
SBP
PC
Goal 3. Know the major causes of chronic diarrhea and the steps in diagnosis and management.
Resident Objectives:
Define acute versus chronic diarrhea.
Instructional Strategies
Review MMWR Managing
Acute Gastroenteritis.
Generate a differential diagnosis for the
major causes of chronic diarrhea
(Infectious, IBD, Malabsorption).
Prep 2009 Q#193
Read AGE in Industrialized
Countries
Read Inflammatory Bowel
Disease (J. Hayms)
Sabery article
Name the screening labs and studies for
the major differential diagnoses.
Define the initial pharmacologic
management of patients with
inflammatory bowel disease.
Bass/Mian
Assessment of Competency
 Medhub
 Direct observation
ACGME Competency Goals
MK
 Medhub
 Direct observation
MK




MK
Medhub
Direct observation
Medhub
Direct observation
MK
Goal 4. Understand the differences in conjugated and unconjugated hyperbilirubinemia, the corresponding etiologies and management.
Resident Objectives:
Define conjugated and unconjugated
hyperbilirubinemia.
Instructional Strategies
Review Sahar Rooholamani’s
neonatal cholestasis
powerpoint.
Read Neonatal Cholestasis
(Peds in Review, F. Suchy’s)
Patient care
Last updated 6/10
Assessment of Competency
 Medhub
 Direct observation
ACGME Competency Goals
MK
Differentiate breast feeding and breast
milk jaundice, onset, and management.
Explain the rationale for the expedient
work-up of direct hyperbilirubinemia and
indications for initiating a work-up.
Define the initial work-up of conjugated
hyperbilirubinemia incuding the
ndications for and interpretation of results
of lab tests, ultrasound, HIDA scan, and
biopsy.
Define steps to optimize nutritional
management in patients with
hyperbilirubinemia.
Review Sahar Rooholamani’s
neonatal cholestasis
presentation.
Read Guidelines for Infantile
Cholestasis (J Ped Gastro)
 Medhub
 Direct observation
MK
Berquist case
Review Sahar Rooholamani’s
presentation.
 Medhub
 Direct observation
MK
PC
Review Sahar Rooholamani’s
presentation.
 Medhub
 Direct observation
MK
Medhub
Direct observation
MK
PC
Patient care

Goal 5. Learn the approach to diagnosis and management of acute GI Bleeds.
Resident Objectives:
Define upper versus lower GI bleed and
explain how to differentiate these.
Generate a differential diagnosis by age
for acute GI bleed. Specify at least three
major etiologies and explain how to
differentiate among the conditions.
Instructional Strategies
Patient care
Observe gastric lavage on
patient
Read Lower GI Bleeding in
Children. (Pediatric
Emergency Care, A. Leung)
Assessment of Competency
 Medhub
 Direct observation
ACGME Competency Goals
MK
PC
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
PC
Read Gastroesophageal
Variceal Hemorrhage (Medical
Progress, Sharara)
Patient care
Prep 2009 Q#29
Specify the management of an acute GI
Bleed. Take into account IV access,
indicated laboratory studies and
frequency of repeat labs, dietary status,
assessment of resources, vital sign
monitoring and medications (see below).
Last updated 6/10
Patient care
List indications for Protonix and
Octreotide in the setting of acute GI
bleed.
Read Octreotide Therapy for
Acute GI Bleed (J Pedatr
Gastro)
 Medhub
 Direct observation
MK
Goal 6. Understand basic nutritional requirements by age. Recognize the varying nutritional needs of patients with chronic illness and gastrointestinal pathology
and recommend appropriate dietary modifications.
Resident Objectives:
Initiate optimal TPN for neonate.
Instructional Strategies
Review NICU guide on
parenteral nutrition.
 Review TPN orders with supervising
Initiate optimal TPN for child.
Review Drs. Hurwitz and
Kerner’s TPN chapter.
 Medhub
 Direct observation
MK
PC
Describe the recommended monitoring
while advancing TPN. Explain the
considerations in advancement of
dextrose, amino acids, and intralipids
Describe the complications of long term
parenteral nutrition and strategies to
prevent these complications.
Review LINKS TPN pathway
Nutritional Support Team
discussion
 Medhub
 Direct observation
MK
PC
Review Drs. Hurwitz and
Kerner’s TPN chapter.
Patient care
Prep 2009 Q#17
Attend nutritional support team
meeting
 Medhub
 Direct observation
MK
PC
 Medhub
 Direct observation
SBP
Utilize the multidisciplinary nutritional
resources available to LPCH patients
including nutritionist, nutritional support
team and pharmacist.
State the caloric requirements by age.
Define allergic colitis and describe your
management approach to including
formula choice.
Name a standard infant and pediatric
formula. Recognize the major
components and differences in infant
Last updated 6/10
 Nutritional support team
 Patient care
 Check calories provided in





patients on TPN and
observe child’s growth
pattern.
Prep 2009 Q#1&94
Review Dr. Kerner’s
Pediatric Formula Guide
Article on Allergic colitis?
Patient care
Read Enteral Nutrition
Article (Serrano)
Assessment of Competency
resident/Attending
ACGME Competency Goals
MK
PC
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
versus pediatric formulas including
calorie and osmotic load differences.
Describe the basic composition of
specialized pediatric formulas, Viovenex
and Peptamen.
Explain how to address the unique
nutritional challenges in patients with
short bowel syndrome. Describe the
importance of the length of bowel and
functional anatomy in design of
nutritional strategy and prognosis.
 Review Dr. Kerner’s
Pediatric Formula Guide
 Review Dr. Kerner’s
Pediatric Formula Guide
 Patient care
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
 Medhub
 Direct observation
MK
 Medhub
 Direct observation
MK
PC