PAEDIATRIC CLERKSHIP
CORE DOCUMENT CLASS OF 2014
MDCN 508
WELCOME TO PAEDIATRICS! ............................................................................................................................................................. 2 CONTACT INFORMATION .................................................................................................................................................................... 4 PAEDIATRIC UNDERGRADUATE MEDICAL EDUCATION SECTION LEADS AND ADMINISTRATIVE ASSISTANTS ....................................5 WHERE TO GO ON THE FIRST DAY OF ROTATIONS ............................................................................................................................................. 6 CALL ........................................................................................................................................................................................................ 8 DRESS CODE.............................................................................................................................................................................................. 8 COURSE 8 INFORMATION: ............................................................................................................................................................................ 8 ASSESSMENT ..................................................................................................................................................................................... 9 FOR SUCCESSFUL COMPLETION OF THE PAEDIATRIC CLINICAL CLERKSHIP, A STUDENT MUST HAVE: .............................................................................. 9 FORMATIVE OSCE...................................................................................................................................................................................... 9 FORMATIVE MCQ ...................................................................................................................................................................................... 9 LOGBOOKS ................................................................................................................................................................................................ 9 STUDENT PASSPORTS .................................................................................................................................................................................. 9 GUIDELINES FOR CLERK ABSENCES DURING THE PAEDIATRIC CLERKSHIP ........................................................................................ 10 ILLNESS (UME POLICY) ............................................................................................................................................................................. 11 MONITORING ACADEMIC AND CLINICAL WORK HOURS ................................................................................................................................... 11 CANADIAN UNDERGRADUATE CURRICULUM FOR PAEDIATRICS (CANUC PAEDS)............................................................................ 12 MEDICAL EXPERT ..................................................................................................................................................................................... 12 PROFESSIONAL ......................................................................................................................................................................................... 13 COMMUNICATOR ..................................................................................................................................................................................... 14 COLLABORATOR ....................................................................................................................................................................................... 14 MANAGER .............................................................................................................................................................................................. 14 HEALTH ADVOCATE .................................................................................................................................................................................. 15 SCHOLAR ................................................................................................................................................................................................ 15 CLINICAL PRESENTATIONS AND KEY CONDITIONS (CANUC PAEDS) ................................................................................................. 16 PAEDIATRIC CLERKSHIP TEACHING (CLASS OF 2014) MASTER SCHEDULE ........................................................................................ 21 RECOMMENDED READING .............................................................................................................................................................. 22 USEFUL INTERNET LINKS.................................................................................................................................................................. 23 HAND WASHING ............................................................................................................................................................................. 23 THE CLIPP (COMPUTER-ASSISTED LEARNING IN PAEDIATRICS PROGRAM) CASES ........................................................................... 24 CROSS-REFERENCE TO U OF C PAEDIATRIC CLERKSHIP CLINICAL PRESENTATIONS .................................................................................................. 24 DRUG CALCULATIONS FOR PAEDIATRICS ......................................................................................................................................... 25 BASIC CONCEPTS ...................................................................................................................................................................................... 25 EXAMPLE ................................................................................................................................................................................................ 25 PAEDIATRIC FLUID CALCULATIONS .................................................................................................................................................. 26 PAEDIATRIC CLERKING .................................................................................................................................................................... 27 HISTORY ................................................................................................................................................................................................. 27
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
PHYSICAL EXAMINATION ..................................................................................................................................................................... 28 IMPRESSION ........................................................................................................................................................................................ 29 PROBLEM LIST...................................................................................................................................................................................... 29 PLAN .................................................................................................................................................................................................... 29 ADMISSION CHECKLIST ........................................................................................................................................................................ 29 IN-PATIENT ROTATIONS (SURVIVAL GUIDE) .................................................................................................................................... 31 ROTATION EXPECTATIONS .......................................................................................................................................................................... 31 ALBERTA CHILDREN’S HOSPITAL CTU ROTATION ............................................................................................................................................ 35 PETER LOUGHEED CENTRE CTU ROTATION ................................................................................................................................................... 39 ACH PAEDIATRIC EMERGENCY DEPARTMENT (PED) ROTATION....................................................................................................... 41 “PAEDIATRIC HUMAN PATIENT SIMULATION SESSIONS” .................................................................................................................................. 42 Clerks Rotating through Paediatric Emergency Medicine ............................................................................................................... 42 Clerks Not Rotating through Paediatric Emergency Medicine ........................................................................................................ 42 WHAT TO DO WHEN YOU SHOW UP AT THE ACH PAEDIATRIC EMERGENCY DEPARTMENT ....................................................................................... 43 PAEDIATRIC CLERKSHIP EMERGENCY DEPARTMENT EVALUATIONS (SEE GENERAL COMMENTS) ................................................................................. 43 NEONATOLOGY ROTATION ............................................................................................................................................................. 44 LEARNING OBJECTIVES: ....................................................................................................................................................................... 44 WELCOME TO THE NICU ........................................................................................................................................................................... 46 Call (see general comments as well) ............................................................................................................................................... 48 Resuscitation ................................................................................................................................................................................... 48 INFECTION PREVENTION............................................................................................................................................................................. 48 EDUCATIONAL SESSIONS ............................................................................................................................................................................ 48 EVALUATION ........................................................................................................................................................................................... 49 General Information ........................................................................................................................................................................ 49 NEONATOLOGY ROTATION AT THE FOOTHILLS HOSPITAL................................................................................................................................... 49 Educational Resources .................................................................................................................................................................... 49 NEONATOLOGY ROTATION AT THE PETER LOUGHEED CENTRE ........................................................................................................................... 49 Educational Resources .................................................................................................................................................................... 50 NEONATOLOGY AT THE ROCKYVIEW GENERAL HOSPITAL .................................................................................................................................. 50 Educational Resources .................................................................................................................................................................... 50 COMMON ABBREVIATIONS USED IN THE NICU ............................................................................................................................................... 51 ALBERTA CHILDREN’S HOSPITAL SUB-SPECIALTY ROTATIONS ......................................................................................................... 52 WHERE TO GO ......................................................................................................................................................................................... 52 INTERIM ASSESSMENT PAEDIATRIC CLERKSHIP ROTATIONS ....................................................................................................... 53 SCAG – ADOLESCENT INTERVIEW FORM.......................................................................................................................................... 54
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
Welcome to Paediatrics! We hope you will enjoy your rotation with us and that you will use the new skills and knowledge you acquire in whatever area of medicine you plan to focus your career. Undoubtedly, you will also use some of the skills and knowledge in your personal life as you become involved in the lives of your own and others’ children. This core document describes the structure and expectations of the Paediatric block in your clerkship. It includes a detailed list of objectives, and information about the assessment (what your preceptors think of you), evaluation (what you think of this rotation), and examination processes. Also included is information to make life easier for you as you adjust to yet another clinical experience – lists of contact people and their phone numbers, tips on the paediatric history and physical examination, drug calculations, fluid management and recommended textbooks and websites. The faculty and house staff in Calgary, Red Deer, Lethbridge, and Medicine Hat are excited about helping you to have a challenging, stimulating, and worthwhile experience. We, along with our Administrative Coordinator, are available to you at all times. We are committed to providing you with an outstanding educational experience. Please contact us with any questions, concerns, or suggestions for improvement – we welcome your feedback! Enjoy your rotation!
Susan Bannister, MD, MEd, FRCPC Associate Professor Clerkship Director, Department of Paediatrics Julian Midgley, BM BCh, FRCPCH Associate Professor Deputy Clerkship Director, Department of Paediatrics Nicole Johnson, MD, FRCPC Clinical Assistant Professor Evaluation Coordinator, Department of Paediatrics
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Overview of the Rotation While students have somewhat different rotations the Clerkship Committee hopes that each rotation will provide a wellrounded paedatric education which will leave you with a solid foundation not only for the end of rotation examination but, more importantly, for working with children in your future medical careers. We make changes to the mandatory Paediatric clerkship each year based on the feedback we have received from past classes and we would be pleased to receive suggestions for improvement from the Class of 2014. The paediatric clerkship is six weeks in duration. Most students will complete a three week rotation in general paediatrics in one of the three settings: •
Outreach site of Lethbridge, Medicine Hat, or Red Deer (inpatients, outpatients, emergency department, neonatology)
•
Peter Lougheed Hospital (inpatients, outpatients, emergency department, neonatology)
•
Alberta Children’s Hospital (inpatients)
For these general paediatrics rotations you will be part of a team/group and will have the opportunity to interact with a small and focused group of preceptors. Your primary preceptor will be responsible for collating assessment information to fill out an ITER in the last week of your rotation. While this preceptor is your “go-to/contact” person and he/she will review your performance with you at the end of your three week block you should seek feedback from your other preceptors throughout your rotation. (see interim assessment form)
The other three weeks will be a combination of (usually) 2 of the following: •
Community Paediatrics
•
ACH Emergency Department
•
Neonatology
•
ACH subspecialties The ACH subspecialties available are •
Cardiology
•
Adolescent Medicine
•
Endocrinology
•
Gastroenterology
•
Infectious Disease
•
Nephrology
•
Neurology
•
Oncology
•
Respirology
•
Rheumatology
All clerks will get Simulation Sessions either during their Paediatric Emergency Rotation or during the three weeks of their non general paediatric rotation. See details about Simulation in the Emergency Department Section.
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Contact Information
Phone
Education Program Administrator, Department of Paediatrics Fax: (403) 955-3045 Mailing Address: C4-647-01, 4th Floor, Paediatrics, Alberta Children’s Hospital
Ms. Valerie Repper
403-955-2413
valerie.repper@albertahealthservices.ca
Clerkship Director
Dr. Susan Bannister
403-955-2413
susan.bannister@albertahealthservices.ca
Deputy Clerkship Director
Dr. Julian Midgley
403-955-7950
julian.midgley@albertahealthservices.ca
Evaluation Coordinator
Dr. Nicole Johnson
403-955-7771
nicole.johnson@albertahealthservices.ca
UME Program Coordinator
Matthew Sobczak
403-220-6846
peds@ucalgary.ca
ACH Emergency Department Physician Contact
Dr. Tanuja (T.J.) Kodeeswaran
drkodeeswaran@shaw.ca
ACH Emergency Department Administrator
Ms. Manjari (Manu) Shukla
403-955-2462
manjari.shukla@albertahealthservices.ca
PLC CTU Physician Contact
Dr. Kelleigh Klym
403-996-2670
kelleighfriesen873@gmail.com
PLC CTU Physician Contact
Dr. Kevin Levere
403-955-7211
kevin.levere@albertahealthservices.ca
Dr. Lori Walker (acting)
lori@talpt.com
Dr. Amonpreet Sandhu
amonpreet.sandhu@albertahealthservices.ca
Neonatology Physician Contact
Dr. Essa Al-Awad
essa.alawad@albertahealthservices.ca
North Hill Postpartum Clinic
Charge Nurse
403-660-7293
Outreach Lethbridge - Director
Dr. John Holland
403-320-7825
jhol1@telus.net
Outreach Lethbridge - Site Coordinator (rotation details)
Ms.Trudi Jersak
403-388-6552
trudi.jersak@albertahealthservices.ca
Outreach Medicine Hat - Director
Dr. Hendrik Hak
Outreach Medicine Hat Executive Assistant - VP Medical Services Palliser Health Region Regional Site Academic Support Assistant (rotation details)
Ms. Karen LaDuke
403-529-8124
karen.laduke@albertahealthservices.ca
Outreach Red Deer - Director
Dr. Kyle McKenzie
403-343-6404
kcm1@ualberta.net
Outreach Red Deer – Site Coordinator (rotation details)
Ms. Lorrie Cotter
403-309-5757
lorrie.cotter@albertahealthservices.ca
Accommodation Coordinator for Outreach
Ms. Kelly McSweeny
403-220-4257
kmcsween@ucalgary.ca
ACH CTU Physician Contact
hak6@shaw.ca
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Paediatric Undergraduate Medical Education Section Leads and Administrative Assistants Division/Group Contact
Clerk Education Contact
Admin. Assistant
Phone
Note: Please contact the Administrative Assistant first for each division listed below: Adolescent Medicine
Jorge Pinzon
jorge.pinzon@albertahealthservices.ca
Zoe Klintberg
955-2978
Cardiology
Robin Clegg
robin.clegg@albertahealthservices.ca
Jennifer Thurston
955-2625
Sarah Hall
sarah.hall@albertahealthservices.ca
Tammy Fournier
955-2251
Ted Prince
ted.prince@albertahealthservices.ca
Linda Beatty
955-7515
Emergency Medicine
Tanuja Kodeeswaran
drkodeeswaran@shaw.ca
Manjari Shukla
955-2462
Endocrinology
Josephine Ho
josephine.ho@albertahealthservices.ca
Bernie Guennette Rosie Binnette
955-7819
Gastroenterology
Leanna McKenzie
leanna.mckenzie@albertahealthservices.ca
Kim Cowell
955-7721
Genetics
Rebecca Sparkes
rebecca.sparkes@albertahealthservices.ca
Ashley Simpson
955-7613
Haematology/ Immunology
Doan Le
doan.le@albertahealthservices.ca
Ashley Simpson
955-7613
Hospital Paediatrics
Lori Walker (acting) Amonpreet Sandhu
lori@talpt.com amonpreet.sandhu@albertahealthservices.ca
Tammy Fournier
955-2251
Infectious Disease
Rupesh Chawla
rupesh.chawla@albertahealthservices.ca
Brenda Greig
955-7974
Neonatology
Essa Al-Awad
essa.al-awad@albertahealthservices.ca
Julie O’Keeffe (PLC/FMC/RGH)
943-4892
Nephrology
Julian Midgley
julian.midgley@albertahealthservices.ca
Dawn Bobbitt
955-7950
Neurology
Luis Bello-Espinosa
luis.bello-espinosa@albertahealthservices.ca
Anny Neisz
955-2481
Oncology
Greg Guilcher
greg.guilcher@albertahealthservices.ca
Greg Dinwoodie
955-7203
PLC
Kelleigh Klym
kelleigh.klym@albertahealthservices.ca
n/a
n/a
Palliative Care
Marli Robertson
marli.robertson@albertahealthservices.ca
Tara Roche
955-5465
Respiratory
Marielena Dibartolo
marielena.dibartolo@albertahealthservices.ca
Brenda Greig
955-7974
Rheumatology
Nicole Johnson
nicole.johnson@albertahealthservices.ca
Allison Hudders
955-7771
Community Paediatrics Developmental Paediatrics
955-7177
Program Administrator, Paediatric UME: Valerie Repper: valerie.repper@albertahealthservices.ca (Note: Please contact Valerie Repper first for all Paediatric Clerkship matters)
Phone (403) 955-2413
Director, Paediatric UME: Dr. Susan Bannister: susan.bannister@albertahealthservices.ca
Phone (403) 955-7049
Deputy Director, Paediatric UME: Dr. Julian Midgley: julian.midgley@albertahealthservices.ca
Phone (403) 955-7823
Evaluation Coordinator, Paediatric UME: Dr. Nicole Johnson: nicole.johnson@albertahealthservices.ca
Phone (403) 955 7823
Updated as of: April 1, 2013
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Where to Go on the First Day of Rotations ACH Inpatients
PLC Based Rotation
Please see CTU schedule (available on OSLER) and refer to ACH CTU clinical clerk survival guide section of CORE DOC for rotation details. All six clerks are to meet with Dr. Walker 07:30h on the first day of their rotation in ACH Unit 4 team room. Lockers will be provided, please provide your own lock. Please note that anyone doing a CTU rotation should watch the ACH PAEDIATRICS CTU SURVIVAL GUIDE Podcast (available on OSLER) prior to their rotation start date. For the clerks on the first week scheduled for night shifts while on Inpatient Teams: FAQ: Is the first shift on Monday night, or on Sunday night before you have the Monday morning orientation? Answer: Week 1 Clerks attend orientation on Monday morning and then start night shift on the Monday Night. Week 4 Clerks start night shift on the Sunday night then attend orientation on Monday morning. Contact: Dr. Lori Walker at lori@talpt.com. Assistant, Tammy Fournier 403-955-2251 or tammy.fournier@albertahealthservices.ca All clerks will meet on the first day of the rotation on Unit 31 at 07:45. They will first meet with nursing from 07:45 – 08:00. Teaching rounds begin at 0800 each day. The preceptor will spend time with orientation from 09:00 – 09:30. The ITERs (evaluations) should be completed by the final week's Paediatrician Preceptor. For the schedule please look on OSLER or contact Dr. Kelleigh Klym kelleigh.klym@albertahealthservices.ca or Dr. Lauren Redgate .
Outreach Lethbridge
Contact: Trudi Jersak trudi.Jersak@albertahealthservices.ca or 1-403-388-6552 for rotation details
Outreach Medicine Hat
Contact Karen LaDuke karen.laduke@albertahealthservices.ca or 1-403-528-8124 for rotation details
Outreach Red Deer
Contact Lorrie Cotter lorrie.cotter@albertahealthservices.ca or 1 -403-309-5757for rotation details
Community Paediatrics
*Contact clinic a minimum of 2 weeks before the start of the rotation to confirm time & location of clinic*
Children’s Health Clinic Manager.childrenshealth@gmail.com (Gaye Kingdon arranges Drs. T. Govender, H. Schroter, S. Wainer, all community placements H. Angeles, S. Rastogi Gaye.Kingdon@albertahe Main Floor, East Calgary Health Centre althservices.ca) 4715 - 8 Ave. SE Calgary, AB T2A 3N4 Tel: 403-955-1077 Fax: 403-253-3960 Associate Clinic - Dr. Kathleen Mitchell 340, 401-9 Ave SW Calgary, AB T2P 3C5 Tel: 403-221-4434 Fax: 403-221-4466 Dr. Roxanne Goldade Room 109–10333 Southport Road SW Calgary, AB T2W 3X6 Tel: 403-253-2352 Fax: 403-255-9322 Dr. Nathan Chan & Dr. Jane Cassie 4825 Dalhousie Drive NW Calgary, AB, T3A 6K7 Tel: 403-239-9333 Fax: 403-208-1648 Southport Pediatric Clinic Drs. B. Kelly, P Nieman, R Goldade Room 109–10333 Southport Rd. SW Calgary, AB T2W 3X6 Tel: 403-253-2352 Fax: 403-255-9322 Email:southportpeds@telus.net
SunnyHill Pediatric Clinic *contact Geraldine Villar (Geraldine@sunnyhillPediatricclinic.ca)* Drs. M. Wright, E. Shyleyko, C. Lever, T. Buors, S. Hall, S. Olliver, N. Cooper, L. Walker, D. Yow 200 – 1632 14 Ave NW Calgary, AB, T2N 1M7, North Hill Shopping Mall Tel: 403-284-0001 Fax: 403-284-1593 Dr Alex Leung #200, 233 – 16 Avenue NW, Calgary, AB T2M 0H5 Tel: 403-230-3300 Fax: 403-230-3322 Ladybug Pediatrics Clinic Drs. D. Nelson, T. Taylor, C Stanzeleit 120 – 1620 29 St. NW Calgary, AB T2N 4L7 Tel: 403-531-9757 Fax: 403-531-9752 Dr. Susan Aitken 137, 1829 Ranchlands Blvd. NW Calgary, AB T3G 2A7 TEL: 403-239-8888 Fax 403-241-1506 Okotoks Community Health Center Drs. F. Friesen, DR. K. Klym, Dr L Redgate 11 Cimmaron Common, Okotoks, AB T1S 2E9 TEL: 403-995-2670 Fax 403-995-2671
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Community Paediatrics (continued)
ACH Emergency Department
Neonatology
Cardiology Endocrinology Gastroenterology Infectious Disease
Nephrology Neurology
Oncology Respirology
Kaleidoscope Pediatrics Kiwi Pediatrics Drs L. Kardal, M. Kalny, J. MacPherson, D. Palmer, Dr A. Evans, Dr N. Forbes, Dr D. Ross 16662 McKenzie Lake Blvd SE, Calgary, AB T2Z 1N4 K. Culman, G. Chow, S. Cardwell, L. Racher #10, 8180 MacLeod Tr. SE, Calgary, AB T2H 2B8 Tel: 403-281-2500 Fax 403-256-2511 Tel: 403-252-6651 Fax: 403-640-0710 Email: kalpeds@telusplanet.net Please see ED schedule. On the first Monday please meet at 12:00 pm in the ED physician office. The assigned teaching preceptor will provide an orientation to the department prior to the teaching session. Please obtain your orientation binder at that time. Contact: Manjari Shukla: 403-955-2462 or manjari.shukla@albertahealthservices.ca Alternate Contact: Dr. Tanuja (T.J.) Kodeeswaran at drkodeeswaran@shaw.ca Please meet the Neonatologist on-service in the NICU at your designated location at 08:00 on the first day of your rotation. You will be expected to be on-call until 23:00 on Tuesdays and Thursdays. Please refer to the Core Document. Contact: Julie O’Keeffe at 403-943-4892 or Julie.O’Keeffe@albertahealthservices.ca Neonatology Physician Contact: Dr. Essa Al-Awad essa.alawad@albertahealthservices.ca Meet Dr. Robin Clegg in clinic on the 3rd floor of ACH for orientation/expectations at 08:00 Contact: Jennifer Thurston – 403-955-2625 or jennifer.thurston@albertahealthservices.ca ACH Diabetes/Endocrine Clinic, 3rd Floor at 08:30 – ask for Pam, who will provide information/ handouts and arrange tour of clinic with physician. Physician will provide scheduling, expectations, etc Contact: Pamela White: 403-955-7301 pamela.white@albertahealthservices.ca Clerks will be emailed reading material and an information letter before their elective with information re scheduling, expectations, etc. Contact: Pamela White: 403-955-7301 pamela.white@albertahealthservices.ca Please arrive at 08:15 at the Infectious Diseases clinic at the ACH. The ID Clinic is to the left of the main doors of the Children’s hospital. The ID nurse will meet you and introduce you to the ID staff. Students join our clinical service team (staff Paediatric ID specialist, fellow, +/- a resident). There are daily AM ambulatory clinics, consisting of APTP (Ambulatory Parenteral Therapy Clinic) patients (coming for assessment for IV Rx e.g., pyelonephritis , severe cellulitis, pneumonia) every day. There are general ID Clinics either two or three afternoons a week. The rest of the day is for seeing and rounding on inpatient consults. We have a large BMT unit and also see plenty of PICU patients and also complicated or unusual infections on the general wards. Students are expected to independently see and assess clinic and hospitalised patients, with an emphasis on seeing new patients. All cases are reviewed with the ID staff person. You would join the team for all clinics and rounds. The days are sometimes longish (typically 8 - 6) and you would be expected to do some reading around your cases. There are no on-call expectations. Contact: Brenda Greig: 403-955-7974 or brenda.greig@albertahealthservices.ca Meet at 08:30 on the first day for rounds in Nephrology Clinic Skills Lab 3rd floor ACH Orientation will take place the first Monday of the rotation, unless it is a stat day, in which it will take place the following day. The clerks would go to the Neurology clinic at 08:00 where they should identify themselves at the reception desk. Neurology normally sends each clerk an email about 2 weeks prior to their arrival with additional information that they might need. Contact: Anny Neisz at 403-955-2481 or anny.neisz@albertahealthservices.ca Go to ACH Unit 1 at 08:00 on the first day of your rotation and meet the Oncology team Contact: Carole Shepherd at 403-955-7396 or carole.wells@albertahealthservices.ca Clerks will be emailed division/clinic information before their elective. Contact: Brenda Greig: 403-955-7974 or brenda.greig@albertahealthservices.ca
Rheumatology
Contact: Allison Hudders at 403-955-7771 or allison.hudders@albertahealthservices.ca
Outreach Accommodation
Contact Kelly McSweeny, Coordinator, Rural/Regional Medicine, at kmcsween@ucalgary.ca or 1-403-220-4257. Travel claim forms and information can be found on the RPAP website at http://www.ucalgary.ca/ruralmedicine/expense
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Call In-house call is not required in certain rotations (e.g. ACH subspecialties, ACH Emergency Department, Community Paediatrics). If you are doing an inpatient rotation at ACH, you will do one week of nights, two weeks of days and one weekend – your schedule for this will be sent to you. Neonatology rotations have call until 11 pm. Office based/subspecialty based rotations may involve call from home. The Peter Lougheed Hospital and Foothills Hospital involve two evening calls per week (until 11:00pm). The Medicine Hat, Lethbridge and Red Deer rotations all involve call one evening per week and one - two weekends as per the participating paediatrician preceptors. Note that you may be on call on the last weekend of the paediatric clerkship after the final MCQ examination and so trips/vacations etc. should not be booked until your schedule is confirmed. Special requests to accommodate presentations at conferences or life important events should be made as soon as possible to avoid clashing will call schedules. As per Alberta Health Services protocol, clinical clerks leaving an AHS site are advised to call hospital security (403-944-7600 in Calgary) to request an escort to their vehicle or bus stop. No clerk is expected to be on call after 9pm on the evening prior to either the OSCE or the MCQ exam. See below regarding Course 8 and call.
Dress Code The families of the children we care for have placed their children into our hands with trust and confidence. It is imperative that we all demonstrate a trustworthy and professional approach to them at all times. Importantly, this includes ensuring our attire is appropriate, professional and sensitive to the multi-cultural milieu in which we work. Although you are still in training and may not yet see yourselves as young doctors, be assured that the children and their parents do. If your preceptor feels you are inappropriately dressed for work, you will be asked to leave and to return with more appropriate attire.
Course 8 Information: Course 8 is on the Friday afternoons (noon to 16:45) of weeks 1, 3 and 5 (of 6) of the paediatric clerkship Blocks. For the Class of 2014 half the Class will go to course 8 every four weeks. This means that, for each Block some clerks will attend Course 8 twice and some clerks only once. Students that are post call or on night shift may be excused from Course 8 but they must notify the UME Course 8 coordinator Marilyn Taylor Course8@ucalgary.ca by email beforehand with a copy to the Clerkship director susan.bannister@albertahealthservices.ca. For OUTREACH STUDENTS: Course 8 lectures will be available by podcast. Paediatric clerks at outreach sites are not required to come back to Calgary for Course 8 since they are all more than an hour’s drive from Calgary. If you wish to return for Course 8 you are required to have the consent of your preceptor.
MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Assessment The preceptor on service on the final week of each rotation is responsible for completing a final assessment form (ITER) for that rotation, with input from preceptors who were on service in the preceding weeks. For each two or three week rotation an interim assessment form should be provided by the student at the end of the first/each week, to the preceptor on service for that week, to provide interim feedback. This form should be faxed to Ms. Valerie Repper, Administrative coordinator for Undergraduate Education. For one week rotations the one45 system should be used. Assessments in the ACH Emergency Department are collated in a different manner because of the number of preceptors involved Electronic copies of the interim evaluation form can be accessed on OSLER under the courses tab and are also available in this core document. For successful completion of the Paediatric Clinical Clerkship, a student must have: 1. 2. 3. 4. 5. 6.
Taken the formative OSCE and the formative MCQ Attended the academic half-days (not required to attend if doing in-house call the night before) Completed the electronic patient logbook Completed and handed in the Student Passport Passed the final summative MCQ examination Been overall satisfactory on the clinical ITERS
Please note that you are excused from clinical activities for the duration of the formative OSCE and summative final MCQ examination but not for call or emergency department shifts in the evening.
Formative OSCE This takes place on the second Friday of the clerkship and gives clerks the opportunity to gauge their knowledge in various areas of paediatrics. Most stations are paper on pencil with tasks such as order writing, diagnosis/clinical observations from video/photographs etc. (see OSCE blueprint on OSLER). There are two clinical stations: a paediatric history and a paediatric clinical examination of real patients. Feedback will be by the preceptors at the clinical stations and at the review session immediately following the OSCE.
Formative MCQ A formative MCQ will be completed during the formative OSCE on the second Friday of the clerkship.
Logbooks On the second Friday, during the OSCE the “mid-rotation review� of logbooks will be completed as per UME Clinical Clerkship Policies and Procedures.
Student Passports The completed passports should be handed in to the UME office within 5 days after the end of the clerkship. Completed means that the observed items have been ticked off. Failure to hand in a completed passport will result in a performance deficiency. MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Guidelines for Clerk Absences during the Paediatric Clerkship During the paediatric clerkship illnesses, attendance at conferences and CaRMS interviews may all result in absences and missed opportunities for learning paediatric medicine. The purpose of these guidelines is to ensure that all clerks receive adequate clinical exposure to paediatrics and adequate feedback from preceptors. 1. All clerks are expected to notify the following people – at least 30 minutes before the start of the clinical experience – when absent: a. Clinical preceptor – (speak with this person). b. Ms. Valerie Repper – ACH (email is required) Valerie.repper@albertahealthservices.ca c. UME Paediatric Program Coordinator – UME (email is required) peds@ucalgary.ca 2. Days missed from any sub-rotation will be considered equal (eg. A day missed on a CTU is considered the same as a day missed on a sub-speciality rotation or a full day missed from the paediatric academic half day). 3. All absences are considered equal (sick, conferences, CaRMS interviews etc). 4. The Paediatric Clinical Clerkship Committee (PCCC) encourages students who miss call or ED shifts to rearrange their call or ED shifts with a colleague. 5. For absences due to an illness please refer to the UME Clerkship Policies and Procedures Handbook for information on requirements for a physician’s notes. 6. An absence that results in missing the formative OSCE will result in the deferral of the final examination until after the OSCE is completed. 7. Make-up time during the paediatric clerkship will depend upon the availability of preceptors and written approval by the Clerkship Director. 8. Make-up time will be arranged by the Paediatric Clerkship. 9. Make-up time may take place in any paediatric clinical sub-rotation, not necessarily the one in which the student missed time. 10. Less make-up time is required if make-up time is done during the rotation. 11. A minimum of 3 days of make-up time is required if make-up time is done at the end of the clerkship year. 12. Clerks will be assessed during their make-up time. 13. If the total days missed is greater than 3, then make-up time will be required as follows: a. If make-up time is completed during the Paediatric Clerkship, the days required is total days missed minus 3 (round up if necessary) b. If make-up time is completed outside of the Paediatric Clerkship, the days required is based on following table (round up if necessary) Total days missed 4 5 6 7 8 9 10
Make-up time required 3 4 4 5 5 6 7
Absenteeism may lead the PCCC to take any of the following steps: 1. Declare performance as incomplete, pending make-up time. If performance is deemed incomplete, then the student will not be allowed to write the final exam until all of the make-up time is completed at the end of the clerkship year. 2. Sign student off with a performance deficiency (this would likely reflect one-off professionalism concerns for clerks who choose not to follow policies and guidelines related to sick-leaves and absences) 3. Sign student off as unsatisfactory overall (this would likely reflect a pattern of professionalism concerns for clerks who choose not to follow policies and guidelines related to sick-leaves and absences). For more information please refer to the Clerkship Policies and Procedures Handbook.
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Illness (UME Policy) (Please refer to the Clerkship Policies and Procedures Manual) In the case of illness, the Associate Dean (UME) and the Departmental Clerkship Committee will judge whether a student’s absence from a rotation has significantly affected the satisfactory completion of that rotation. For illnesses of two days or more, the student must present a letter from his/her physician to the Associate Dean (UME) and the Departmental Clerkship Committee would then be responsible for making the necessary adjustments to the student’s program. Please note that individual clerkships may have separate policies on this matter. As such, the student is asked to refer to each clerkship core document regarding that clerkship’s specific policy.
Monitoring Academic and Clinical Work Hours Student’s hours should be set taking into account the effects of fatigue and sleep deprivation on learning, clinical activities, and student health and safety. For this reason, clerkships are asked to use, as a guideline, Article 14: OnCall from the Collective Agreement for the Professional Association of Resident Physicians of Alberta (http://www.para-ab.ca/agreement/collective-agreement/article14-on-call) when establishing clerks’ schedules for academic and clinical activities.
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Canadian Undergraduate Curriculum for Paediatrics (CANUC Paeds) Outcomes for the Graduating Medical Student Medical Expert The student is able to: Demonstrate proficiency in acquiring a complete and accurate paediatric history with consideration of the child’s age, development, and the family’s cultural, socioeconomic and educational background. Describe differences between the medical management of paediatric patients versus adult patients. Recognise an acutely ill child. Demonstrate an approach (the generation of a differential diagnoses, appropriate initial diagnostic investigations, and management plan) to the following core clinical paediatric presentations: Paediatric Health Supervision Newborn Neonatal Jaundice Fever Dehydration Respiratory Distress/Cough Developmental & Behavioural Problems Growth Problems Inadequately Explained Injury (child abuse) Abdominal Pain Vomiting Diarrhea Altered Level of Consciousness Seizure/Paroxysmal Event Headache Murmur Rash Bruising & Bleeding Pallor (anemia) Lymphadenopathy Limp/Extremity Pain Urinary Complaints (polyuria/frequency/dysuria/hematuria) Edema Sore Ear Sore Throat/Sore Mouth Sore Eye/Red Eye Please see list of conditions for each clinical presentation.
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Medical Expert continued Demonstrate physical examination skills that reflect consideration of the clinical presentation as well as the comfort, age, development, and cultural context of the infant, child, or adolescent. Demonstrate competence with the following paediatric physical examination skills in addition to general physical examination skills: Position and immobilise patient for certain physical exam skills Measure and interpret height, weight, head circumference (including plotting on growth curve and calculation of BMI) Measure and interpret vital signs Palpate for fontanelles and suture lines Perform red reflex and cover-uncover test Perform otoscopy Inspect for dysmorphic features Elicit primitive reflexes Perform infant hip examination Assess the lumbosacral spine for abnormalities Assess for scoliosis Palpate femoral pulses Examine external genitalia Assess for sexual maturity rating (Tanner staging)
Professional The student is able to: Demonstrate professional behaviours in practice including: honesty, integrity, commitment, compassion, respect and altruism. Demonstrate a commitment to perform to the highest standard of care through the acceptance and application of performance feedback. Recognise and respond to ethical issues encountered in clinical practice. Fulfil legal obligations as they pertain to paediatric practice (reporting child maltreatment). Recognise the principles and limits of patient confidentiality as it pertains to paediatrics (age of consent, emancipated minors, disclosure of suicidal/homicidal intent, and disclosure of abuse). Balance personal and professional responsibilities to ensure personal health, academic achievement, and the highest quality of patient care. Recognise factors such as fatigue, stress, and competing demands/roles that impact on personal and professional performance. Seek assistance when professional or personal performance is compromised.
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Communicator The student is able to: Demonstrate communication skills that convey respect, integrity, flexibility, sensitivity, empathy, and compassion. Communicate using open-ended inquiry, listening attentively and verifying for mutual understanding. Demonstrate a patient-centred and family-centred approach to communication which requires involving the family and patient in shared decision making, and involves gathering information about the patients’ and families’ beliefs, concerns, expectations and illness experience. Acquire and synthesise relevant information from relevant sources including: family, caregivers, and other health professionals. Demonstrate organised, complete, informative, legible, and accurate written/electronic information related to clinical encounters (such as: admission histories, progress notes, and discharge summaries). Demonstrate clear, legible, and accurate ‘doctors orders’ (such as investigations, medication orders and outpatient prescriptions). Demonstrate organised, complete, informative and accurate information in verbal patient presentations. Respect patient confidentiality, privacy and autonomy. Acknowledge/demonstrate the principals of dealing with challenging communication issues including: obtaining informed consent, delivering bad news, disclosing adverse medical events, and addressing anger, confusion, and misunderstanding.
Collaborator The student is able to: Work effectively, respectfully, and appropriately in an inter-professional healthcare team. Demonstrate understanding of roles and responsibilities in an inter-professional health care team; recognising his/her own responsibilities and limits. Effectively collaborate/consult/participate with members of the inter- and intra-professional team to optimise the health of the patient/family. Effectively work with other health professional to prevent, negotiate, and resolve inter- and intra-professional conflict.
Manager The student is able to: Demonstrate priority setting, and time management skills that balance patient care, academic responsibilities, and personal well being. Employ information technology to maximise patient care. Demonstrate a rationale approach to finite resource allocation in patient management; apply evidence in cost-effective care. Develop management plans that demonstrate due attention to discharge planning, and recognition of key community resources to support the family once out of hospital.
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Health Advocate The student is able to: Engage in advocacy, health promotion and disease prevention with patients and families including: mental health, child maltreatment, healthy active living, safety, and early literacy support. Identify emerging and ongoing issues for paediatric populations who are potentially vulnerable or marginalised including: First Nations People, new immigrants, disabled children, children with mental health issues, and populations living in poverty. Identify determinates of health for paediatric populations and the physician’s role and points of influence in these issues. Identify barriers that prevent children from accessing health care including: financial, cultural, and geographic.
Scholar The student is able to: Engage in self-directed lifelong learning strategies. Engage in self assessment through reflective practice. Apply the principals of critical appraisal of the literature to guide evidenced based patient care. Demonstrate integration of new learning into practice. Demonstrate effective teaching/learning strategies and content that facilitate the learning of others (peers, patients, families, allied health professionals).
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Clinical Presentations and Key Conditions (CANUC Paeds) Clinical Presentation Paediatric Health Supervision: newborn, infant, pre-school child, school-aged child, adolescent
Newborn
Neonatal Jaundice
Key Conditions * Nutrition Growth - HC, Ht, Wt, BMI Hypertension Health active living Mental health Normal development Immunisations Anticipatory guidance Injury prevention Vision and hearing Dental health Discipline / Parenting Sleep issues SIDS Crying / colic Sexual development / health Adolescent health surveillance (HEADDDS) Social-economic / cultural / home / environment Birth Trauma Depressed newborn Prematurity Respiratory distress Sepsis Hypothermia Hypoglycemia Dysmorphic features - Trisomy 21 - FAS / FASD Congenital infections Small for Gestational Age (SGA) Large for Gestational Age (LGA) Neonatal abstinence syndrome Abnormal newborn screen Abnormal physical findings - develop hip dysplasia - undescended testes - ambiguous genetalia - absent red reflex Vitamin K deficiency Hypotonia / floppy newborn Physiologic Breast feeding jaundice Breast milk jaundice Biliary atresia Hemolytic anemia Kernicterus
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Clinical Presentation Fever
Dehydration
Respiratory distress / Cough
Development & Behaviour problems
Growth problems
Inadequately explained injury (Child abuse)
Key Conditions * Urinary Tract Infection (UTI) Meningitis Viral Occult bacteremia / sepsis (<1mo, 1-3 mo, >3 mo) Kawasaki disease Mild/mod/severe dehydration Hypo/hypernatremia DKA Asthma Status asthmaticus Croup Bronchiolitis Pneumonia Pertussis Epiglottitis Tracheitis Cystic Fibrosis (CF) Congestive Heart Failure (CHF) Anaphylaxis Foreign body Global delay Delay in isolated domains - Speech / language - Gross motor Specific patterns - Autism Spectrum Disorder (ASD) - Attention Deficit Hyperactivity Disorder (ADHD) School failure / refusal Common behavioural issues - temper tantrums - sleep problems Height issues - short stature - tall stature Weight issues - Failure To Thrive (FTT) - anorexia - obesity Physical abuse Abusive head trauma Sexual abuse Neglect Domestic violence
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Clinical Presentation Abdominal pain
Vomiting
Diarrhea
Altered level of consciousness (LOC)
Seizure / Paroxysmal event
Headache
Murmur
Key Conditions * Constipation Functional Inflammatory Bowel Disease (IBD) Infection - gastroenteritis - Urinary Tract Infection (UTI) Intussusception Henoch Schonlein Purpura (HSP) Gynecologic / genito urinary GER / GERD Pyloric stenosis Malrotation / volvulus Intussusception Intestinal atresia Gastroenteritis Meningitis Pyelonephritis Space-occupying lesion Gastroenteritis Celiac Hemolytic Uremic Syndrome (HUS) Inflammatory Bowel Disease (IBD) Toddlerâ&#x20AC;&#x2122;s diarrhea Cystic Fibrosis (CF) Poisoning / intoxication Seizure Head Injury Meningo-Encephalitis Hypoglycemia Metabolic disease Febrile vs. non-febrile seizure General vs. focal seizure Status epilepticus Acute Life Threatening Event (ALTE) Syncope Breath-holding spell Migraine Brain tumour Increased ICP Concussion / trauma Innocent murmur Cyanotic heart disease Acyanotic heart disease - Ventricular Septal Defect (VSD) - Patent Ductus Arteriosus (PDA) - Coarctation of aorta
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Clinical Presentation Rash
Bruising / Bleeding
Pallor / Anemia
Lymphadenopathy
Limp/ Extremity pain
Urinary complaints (hematuria, dysuria, polyuria, frequency)
Edema
Key Conditions * Eczema Viral exanthemas Diaper rashes Seborrhea dermatitis Impetigo Cellulitis Scarlet fever Urticaria Drug eruption Scabies Acne Idiopathic Thrombocytopenic Purpura (ITP) Henoch Schonlein Purpura (HSP) Hemophilia Meningococcemia Iron deficiency Hemoglobinopathies Hemolysis Leukemia Reactive Benign Cervical adenitis Mononucleosis Leukemia Lymphoma Growing pains Trauma/ injury Osteomyelitis Septic arthritis Reactive arthritis - rheumatic fever - post infectious - transient synovitis Juvenile idiopathic arthritis Legg Calve Perthes Slipped Capital Femoral Epiphysis (SCFE) Osgood Schlatter Disease Malignancy - bone tumour - leukemia Urinary Tract Infection (UTI) / Vesicoureteric Reflux (VUR) Post-infectious Glomerulonephritis (PIGN) IgA nephropathy Diabetes mellitus Wilm tumour Enuresis Nephritic syndrome Nephrotic syndrome Cowâ&#x20AC;&#x2122;s milk protein allergy Renal failure
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Clinical Presentation Sore ear Sore throat / sore mouth
Sore / red eye
Key Conditions * Otitis media Otitis externa Pharyngitis Peritonsillar abscess Retropharyngeal cellulitis Stomatitis Dental disease Oral thrush Periorbital / orbital cellulitis Conjunctivitis
*â&#x20AC;&#x153;Key conditionsâ&#x20AC;? are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a scheme (approach to the clinical presentation). They highlight conditions that may be unique to paediatrics, that are essential, or that are common. See www.canuc-paeds.ca
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PAEDIATRIC CLERKSHIP TEACHING (CLASS OF 2014) MASTER SCHEDULE
Class Location: ACH – C2-143 (2nd Floor) Alberta Children’s Hospital Videoconference Locations: Lethbridge-Chinook Reg. Hospital-Pediatrics Room 5C132; Medicine Hat Regional Hospital - Pediatric Mobile Room 120: Red Deer Hospital - Mobile Unit 1 WEEK 1 Wednesday 12:30 PM – 13:30 PM Orientation: Dr. Susan Bannister/Valerie Repper 13:30 PM – 14:30 PM Nephrology: Fluids – A Practical Session Break 14:45 PM – 15:45 PM Endocrinology: Growth 15:45 PM – 16:45 PM Neurology: The Neuro Exam WEEK 2 Wednesday 12:30 PM – 13:30 PM Infectious Disease: Common Infections 13:30 PM – 14:30 PM Infectious Disease: Immunizations Break 14:45 PM – 15:45 PM Pulmonary: 15:45 PM – 16:45 PM Cardiology: Cyanosis & CHF Friday 12:00 NOON – 17:00 PM OSCE Location : Medical Skills Centre (OSCE/Formative MCQ/Log Book Review) WEEK 3 Wednesday 12:30 PM – 13:30 PM NICU: Cases In Neonatology 13:30 PM – 14:30 PM NICU: Cases In Neonatology Break 14:45 PM – 15:45 PM Endocrinology: Endocrine Emergency Cases 15:45 PM – 16:45 PM Nephrology: Renal Disease WEEK 4 Wednesday 12:30 PM – 13:30 PM Developmental Paediatrics: 13:30 PM – 14:30 PM Developmental Paediatrics: Break 14:45 PM – 15:45 PM Developmental Paediatrics: 15:45 PM – 16:45 PM Surgery: Acute Abdomen/Scrotum WEEK 5 Wednesday 12:30 PM – 13:30 PM Adolescent: 13:30 PM – 14:30 PM Genetics: Approaches To Clinical Genetics Break 14:45 PM – 15:45 PM Oncology: Yes - This Child Has Cancer 15:45 PM – 16:45 PM Gastroenterology: WEEK 6 Wednesday 12:30 PM – 13:30 PM Clerkship Review: Dr. Susan Bannister/Valerie Repper 13:30 PM – 14:30 PM Hematology: Break 14:45 PM – 15:45 PM Ethics: 15:45 PM – 16:45 PM Child Abuse: Friday 12:00 NOON – 17:00 PM Final (Summative) MCQ Location: HSC MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Recommended Reading CLIPP cases/website:
http://app1.med-u.org/player/app/homepage.html
Pediatric Clinical Skills Richard B. Goldbloom 2011 Fourth Edition, Saunders Essentials of Pediatrics Richard E. Behrman and Robert M. Kliegman 2002 Fourth Edition, Saunders First Exposure Paediatrics Joseph Gigante 2006 First Edition, McGraw-Hill Berkowitz's Paediatrics: A Primary Care Approach Carol Berkowitz 2008 Third Edition, American Academy of Pediatrics The Five Minute Paediatric Consult Editor: M. William Schwartz 2008 Fifth Edition, Lippincott William and Wilkins Neonatology at a glance Tom Lissauer, Avroy A Fanaroff, Michael Weindling 2011 Second Edition, Wiley Blackwell The Newborn Child Peter Johnston 2003Ninth Edition, Churchill Livingstone
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Useful Internet links CANUC Paediatrics Curriculum
www.canuc-paeds.ca
Canadian Paediatric Society
www.cps.ca
American Academy of Paediatrics
www.aap.org
The American Academy of Pediatrics Journal
http://pediatrics.aappublications.org/content
Archives of Disease in Childhood
http://adc.bmj.com/
Council on Medical Student Education in Paediatrics
www.comsep.org
Health Canada
www.hc-sc.gc.ca
Alberta Acute Childhood Pathways Teaching Website
http://pert.ucalgary.ca/airways/
AHS Acute Childhood Asthma Pathway:
Evidence based recommendations
Community Paediatric Asthma Service
http://www.ucalgary.ca/icancontrolasthma/
Initial Empiric Antibiotic Therapy in Hospitalised Children 2012 (internal link) Paediatric Medication Guides (internal link) CLS Lab Test Directory Minimum Whole Blood Volumes for Micro-Collections National Advisory Committee on Immunisation (NACI)
http://www.phac-aspc.gc.ca/naci-ccni/
Centers for Disease Control and Prevention
http://www.cdc.gov/
Pediatrics in Review Journal
http://pedsinreview.aappublications.org/
Refer to the posted documents on OSLER and the University of Calgary Paediatric Handbook.
Hand washing Infection prevention/control is particularly crucial in paediatrics. Wash hands before and after every patient (for your own protection and the patientsâ&#x20AC;&#x2122;) using soap and water or alcohol cleanser. For patients under enteric isolation, soap and water must be used. (see specific guidelines for neonatology)
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The CLIPP (Computer-assisted Learning in Paediatrics Program) Cases There are 32 “CLIPP” (Computer-assisted Learning in Paediatrics Program) cases and each will occupy between 30-45 minutes of your time. CLIPP cases are designed to supplement your learning or logbook requirements; they are not a mandatory requirement of the course. The cases are listed at: http://www.med-u.org/virtual_patient_cases/clipp. In addition there are 7 extended CLIPP Scenarios (eCLIPPs), an extension of the CLIPP, designed to teach complex health issues in paediatrics http://www.eclipps.org/ To access the CLIPP and eCLIPPs you will need to login at http://app1.med-u.org/player/app/homepage.html. Click on the “First Time User?” link and register using your ucalgary email address. You will receive an email entitled “iInTIME New Account” with a link to complete your registration.
Cross-Reference to U of C Paediatric Clerkship Clinical Presentations Clinical presentations
CLIPP cases
Paediatric Health Supervision
1, 2, 3, 4, 5, 6, 29
Newborn
1, 7, 9
Neonatal Jaundice
8
Fever
10, 11, 23
Dehydration
15, 16, 23
Respiratory Distress/Cough
7, 12, 13
Developmental & Behavioural Problems
4, 28, 29
Growth Problems
4, 26
Inadequately Explained Injury (child abuse)
25
Abdominal Pain
16, 22, 27
Vomiting
15, 16, 20
Diarrhea
26, 27
Altered Level of Consciousness
24, 25
Seizure/Paroxysmal Event
6, 19
Headache
7, 20
Murmur
18
Rash
2, 11, 21, 32
Bruising & Bleeding
5, 21
Pallor (anemia)
3, 6, 30
Lymphadenopathy
11
Limp/Extremity Pain
17
Urinary Complaints (polyuria/frequency/dysuria/hematuria)
31
Edema
31
Sore Ear
14
Sore Throat/Sore Mouth Sore Eye/Red Eye
31
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DRUG CALCULATIONS FOR PAEDIATRICS Basic concepts - most drugs in paediatrics are dosed on body weight
- some drugs are based on body surface area
- some neonates' drugs are based on their birth weight until they surpass their birth weight - references (eg Lexicomp) may list dosages in mg/dose or mg/day
Example
Emily is admitted for query meningitis. She is 4 days old; her birth weight was 3.5 kg. She now weighs 3.2 kg. One of the drugs you decide to treat her with is ampicillin.
Lexicomp-on-line entry for ampicillin. Usual dose for neonates:
postnatal age < 1 wk and > 2000 g for meningitis is 150 mg/kg/day, divided q8h.
Drug dose is based on her birth weight of 3.5 kg. 150 mg/kg/day x 3.5 kg = 525 mg/day
Drug is given q8h (in three divided doses).
525 mg/day divided by 3 = 175 mg/dose
Order is written as:
Ampicillin 175 mg IV q8h (150 mg/kg/day)
It is important to include the dose you used to calculate the patient's drug in brackets as part of your order.
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Paediatric Fluid Calculations “Maintenance Fluids” (4-2-1 Rule) – this only maintains “usual intake” *Note there are many approaches for calculating fluid requirements in paediatrics, this is one approach. • Used to calculate approximate basic fluid requirements in otherwise healthy children and infants • Need to make adjustments for patients with fever, renal impairment, heart disease, SIADH or uncontrolled losses (e.g. post surgical, vomiting or diarrhea) and neonates • Gives per hour fluid requirement Give 4 mL/h for each kg of first 10 kg (or portion thereof) Give 2 mL/h for each kg of second 10 kg (or portion thereof) Give 1 mL/h for each remaining kg Examples: Calculate “Maintenance Fluids” for each of the following: a) 4.2 kg baby = 4 x 4.2 = 16.8 mL/hr b) 11 kg child = (4 x 10) + (2 x 1) = 42 mL/hr c) 36 kg child = (4 x 10) + (2 x 10) + (1 x 16) = 76 mL/hr Total Fluid Intake TFI for Neonates Neonatal Day 1
60 mL/kg/day
Neonatal Day 2
80 mL/kg/day
Neonatal Day 3
100 mL/kg/day
Neonatal Day 4
120 mL/kg/day
Neonatal Day 5
150 mL/kg/day
Range for normal neonates 100 - 200 mL/kg/day May need to restrict fluids for babies with Congenital Heart Disease/Acute Kidney Injury (specify maximum TFI in orders) Fluid in (as TFI) calculate as mL/kg/day
Urine Out express calculate as mL/kg/hour
Choice of Fluids • Use the gut whenever possible (e.g. po or ng) • By NG, fluids can be given continuously or bolused • IV: As a general rule, it is safe to use D5W-0.45%Saline for most infants & children. For very young babies you may consider D10W-0.45%Saline. There are other exceptions, including those with head injuries or meningitis when D5W-0.9%Saline is more appropriate • For patients with DKA refer to DKA protocol for fluid management • 20 mmol/L KCL is often added to IV’s (even TKVO) as long as the patient has normal kidney function & normal serum potassium • Bolus using 0.9% Saline or Ringers Lactate only (usually 10 - 20 mL/kg) – no KCL • Remember TKVO can be a lot of fluid for a small child Above calculations apply for usual fluid requirements, not nutritional requirements
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PAEDIATRIC CLERKING History Date/Time ID & CC: • Age (in years/months or months/weeks if very young) and sex • Hometown • May include a major underlying diagnosis if there is one (e.g. epilepsy, CP, Trisomy 21, multiple developmental problems) • One sentence describing the main concern(s) of the patient/family in general terms e.g. “Three-month old male ex-prem (corrected age 40w) with CLD presents with cough and increasingly “noisy breathing” over past 12h” History of the Presenting Illness (HPI): • Describe each complaint as cited by caretaker/child • Give details of onset, provoking/relieving factors, quality/intensity, radiation, associated signs and symptoms and timing, where relevant, for each complaint • Describe family management of problem (drugs, other therapies) Review of Systems: • Here or at end of history. • Use age-appropriate questions to screen all systems. Immunisations: • Details, regular versus elective (if none ask why) Medications: • Include dose/kg, how given, adherence • Include non-prescription meds/vitamins/complementary therapies Allergies: • Drugs, foods, latex and environmental – specify symptoms • If anaphylaxis (ask whether carries Epipen) Past Medical History: Perinatal: Pregnancy • Bleeding, infections, HTN, GDM, ETOH/smoking/illicit drugs, medications Delivery • Gestation, induced/spontaneous/vaginal/C-S/breech/forceps/vacuum, birth weight Neonatal course Other • Cried? resuscitation?, APGARS, neonatal problems, early feeds • Past illnesses, hospitalisations, surgeries • Other clinics/specialists who see family • Previous growth problems or other concerns by family doctor/paediatrician
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Development: • Milestones • Vision/hearing/ life skills (toileting, feeding), sleep • Gross motor/fine motor/social/speech and language Nutrition/Activity: • Current feeding pattern including breast/bottle/weaning/feeding habits • Sports, activity, TV time Family History: • Draw a family tree • Family structure including who lives at home • Parents ages, occupation and health, consanguinity • Siblings age, sex and any illness • Inherited illness, childhood illness, child deaths, miscarriages/stillbirths Social History: • Where and with whom does the child live? Who has custody? • Who cares for child – daycare, sitter, parents? Smokers who live at home? • School — grade and any special assistance? • Supports (at home/while in hospital) • Financial concerns/support services involved • Impact of illness on child/family/siblings ADOLESCENT HISTORY (HEADSSSSS): See the SCAG form. Routinely ask • Home • Education, Eating habits • Activities • Drugs, ETOH, smoking • Sex, Sexuality, Safety, Social, Suicide • Other: immunisation (tetanus, hepatitis B)
PHYSICAL EXAMINATION In addition to general (adult type) physical examination (depends on patient age): Have toys handy (for distraction/developmental assessment) Observe carefully during history Inspect for dysmorphic features Be flexible, sensitive yet confident Position and immobilise patient for certain physical examinations (e.g. otoscopy) Measure and interpret height, weight, head circumference (including plotting on growth curve and calculation of BMI) Measure and interpret vital signs (including BP) Palpate for fontanelles and suture lines Perform red reflex and cover-uncover test Perform otoscopy Elicit primitive reflexes Perform neonatal/infant hip examination Assess the lumbosacral spine for abnormalities MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Assess for scoliosis Palpate femoral pulses Examine external genitalia Assess for sexual maturity rating (Tanner staging)
IMPRESSION A brief summary of your overall assessment including age, gender and most important findings on Hx, PE and Investigation. Explain how they may relate (max 3 sentences) e.g. Three month old ex-prem with mild CLD (night-time home O2) presenting with 12 hour history of increased cough and poor feeding but no fever, in moderate respiratory distress responding well to increased O2 and very frequent suctioning. Bilateral crepitations, congestion and CXR consistent with viral bronchiolitis with no evidence of bacterial pneumonia.
PROBLEM LIST A prioritised point form list of active and chronic issues including a DDx for active, undiagnosed problems e.g. 1. 2. 3. 4. 5. 6. 7.
moderate respiratory distress — likely viral bronchiolitis (RSV most likely), no evidence of cardiac signs and symptoms, differential diagnosis also includes bacterial pneumonia (Strep pneumo, E coli, Staph aureus) O2, qhourly suctioning, expect may require 3 - 5 days of hospitalisation dehydration/nutrition — mild dehydration, poor feeding trial of frequent small feeds, if not achieving maintenance, consider NGT feeds. CLD — continue current aldactazide dose but consider increase if not improving ex-prem — recheck CBC for anemia since history of anemia as newborn vaccinations — missed 2 month immunisations so consider prior to discharge development — needs a more thorough assessment of tone once more stable continuity — need to contact Dr. X, regular paediatrician in am
PLAN Outline in detail your plan for each problem on your problem list (e.g. as above).
ADMISSION CHECKLIST ***All admissions must include all of the following: (check all are done before calling senior to review)
A thorough paediatric history A complete physical exam A growth chart plotted with current measurements, including BMI A review of relevant investigations A review of old charts (where applicable) Formulation of a problem list and differential diagnosis A management plan for each problem Complete orders
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ď ą
Completed notification of admission form for primary care physician
The admitting clerk/physician is responsible for ensuring that new orders and notes reach the inpatient units and for drawing them to the attention of the charge nurse for processing
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In-Patient Rotations (Survival Guide) Clinical Teaching Units formally exist at both the Alberta Children’s Hospital and the Peter Lougheed Centre. This section of the core document will also be useful for the inpatient part of the outreach rotations in Lethbridge, Medicine Hat and Red Deer.
Rotation Expectations The following skills are particularly emphasised for the care of inpatients 1. Paediatric admission 2. Paediatric discharge 3. Providing Daily Care for 3+ paediatric inpatients
A. On the Wards •
Isolation guidelines – are posted on patient doors – gowns, masks, gloves etc may be required.
•
Use discretion when waking sleeping babies/children. Ask parents, nurses first unless the patient requires assessment immediately.
•
All diapers are weighed. If you change diapers, leave them on the scale for measurement.
•
Babies (even newborns) can easily fall from cribs/beds. Return bedrails to position as you found them upon entering the room. Never leave a baby or infant unattended with the rails down for even a moment.
•
Ask for help. If you are concerned about the status of any patient don’t hesitate to ask for help immediately (i.e. if your patient appears distressed in the morning, don’t wait until rounds!
B. CTU Professional Conduct, Teamwork and Leadership C. All CTU staff are expected to: •
Wear hospital identification visibly at all times
•
Introduce yourself and your role to families, patients, nurses
•
Respect confidentiality within shared patient rooms, public areas and ensure patient notes, lists and discussions are secure.
•
Demonstrate an understanding of family-centred care including the ability to interact with families in a friendly and professional behaviour.
•
Be available and interested in responding to acute problems.
•
Provide reliable follow-up of issues identified at rounds (i.e. investigations, treatments, reassessments) and report daily to team leader before sign-out.
•
Dress professionally and respectfully in attire acceptable to patients and families.
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•
When confrontations with families or staff arise, ensure they are managed in an appropriate manner, time and place. Ask for help if needed.
•
Be punctual for sign over, teaching sessions, rounds and patient encounters.
•
Be a team player, interact in a supportive, respectful and friendly manner with other team members including attendings, house staff, RN’s and multidisciplinary team members. Assist team members when needed.
Professionalism will comprise a portion of the evaluation for all team members. D. Family- Centred Bedside Rounds •
Occur daily
•
Junior residents and clerks are expected to have reviewed overnight progress, labs, investigations, examined the sickest patients/potential discharges, reviewed histories +/- physical examinations of new patients and considered a plan for the day for patients
•
Sign over is at 08:00 but clerks/ residents may need to come in earlier than 08:00 to ensure they have seen all their patients and are prepared for rounds.
•
Where possible, discharges should be finalised prior to rounds
•
Refer to your laminated cards for instructions on how to present in rounds and how to write a progress note
E. Admissions •
Juniors and clerks will assist with admissions during the day, during evening & night shifts and as well when on call. There are three types: a)
Direct (i.e. from a clinic, doctor’s office, or another hospital)
b)
Emergency department admissions
c)
PICU transfers (see section below)
•
Please see and complete admissions as efficiently and thoroughly as possible. Refer to the Paediatric Admission Format on your laminated cards.
•
Each admission must be reviewed upon completion with the senior and/or hospital Paediatrician.
F. PICU Transfers •
Where possible, see the patient prior to transfer from the PICU
•
The clerk/resident is expected to review and document pertinent chart information highlighting progress to date
•
Complete and document a thorough physical exam (for reference prior to transfer and to ensure stability for transfer)
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•
Write a “transfer note”. This may be less detailed than a formal admission – describe clearly active and inactive issues/problems/plans including current management/work-up.
•
Each transfer should be reviewed with your senior or hospital Paediatrician
G. Discharges •
Discharge planning should be discussed daily for each patient.
•
Discharges anticipated to potentially occur over the weekend or when a resident may be post-all should be fully prepared in advance.
•
Discharges should be prepared (i.e. including scripts, follow-up appointments, discharge summaries mostly complete) at least one day prior to planned discharge. Discuss discharge plans with the family the day prior where possible.
•
Discharge summaries are the responsibility of the clerk/junior resident covering the patient. All summaries should also be signed by a senior or attending.
•
Patients admitted less than 72 hours can have a short stay summary filled out (unless their course has been complicated, seen by more than 1 sub-specialist, or included a PICU admission).
•
Dictated Discharge Summaries are required for stays longer than 72 hours or for complicated admissions.
For all discharge summaries (written and dictated): • List as many appropriate primary and secondary diagnoses as possible • Complete summaries promptly • Send a copy to the referring ED physician • Send a copy to the family doctor or community Paediatrician. Fax a copy yourself to the physician who will follow-up, if the patient is expected to follow-up within one week. • An attending or senior resident should also sign all discharge summaries. Health Records is located on the lower level (LL) and is open 24h. Alternatively, you can request the unit clerks to keep the chart on the cluster for up to 24h following discharge if you need to dictate. A description of the accepted format for dictations is on the laminated cards. Please refer to when doing dictations. Discharge Orders: • Follow Up with physicians (when, with whom) • Planned investigations (when, what, send patient with requisition) or booked tests • Discharge medications (even if same as admission) • Specific things to watch for and what to do if they occur. • **Students should personally review all plans with family prior to discharge
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H. Community Follow-Up •
Ensure continuity of care and good follow-up
•
On admission, a Notification of Admission form must be filled out and sent to the patient’s family physician and/or Paediatrician
•
Link with community Paediatricians early for “concurrent care” if patient is complicated or chronic
•
Notify community Paediatricians directly by phone of important investigation findings, diagnoses, or deterioration in condition (i.e. transfer to PICU) for their patients
•
Prior to discharge, contact the primary care physician/Paediatrician by phone to arrange follow-up and update them on progress.
•
Fax a copy of the Discharge Summary to community Paediatrician/family physician
•
Fax a consult referral request along with relevant labs and the discharge summary if requesting consultation by a community Paediatrician. Send a DDR if follow-up is requested by a sub-speciality clinic or physician.
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Alberta Children’s Hospital CTU Rotation A. Clinical Teaching Units ACH has inpatient beds on 4 floors to care for hospitalised infants, children and adolescents aged 0-18 years. •
Red Team primarily cares for patients on Unit 2 (Floor 2).
•
Green Team looks after patients on Unit 3 (Floor 3).
•
Blue Team and Gold Team looks after patients primarily on Unit 4 (Floor 4).
•
Purple team patients are primarily on Units 2 and 3.
•
Only Red Team and Green Team are teaching teams. Residents and clerks will each be assigned to a CTU team for their rotation. Both Red & Green Teams include a hospital Paediatrician (attending), senior resident, 2-3 junior residents and 2 medical students. Blue team, gold team and Purple team do not usually have students or residents.
•
Most teaching sessions and handover rounds occur in the CTU team rooms located within each CTU (on the right side of main hallway leading to the intake desk on each unit). There is a resident lounge area on floor 4 and call rooms for residents and clinical clerks located on floor 3.
B. CTU Daily Calendar/Schedule The general daily CTU schedule is as below. A more detailed CTU calendar indicating rounds and scheduled teaching sessions for each week will be provided each week in the CTU team rooms. TIME
EVENT
LOCATION
08:00 – 08:30
Handover
Team Rooms
08:30 – 09:30
Pre-round assessments
ward/unit
09:30 – 12:00
Bedside ward rounds
ward/unit
12:30 – 13:30
Lunch/Teaching sessions
TBA
13:30 – 16:30
Ward work
ward/unit
1630
Team update/List update
Team rooms/ward/unit
1700
Evening handover Green team
Team rooms
1715
Evening handover Red team
Team rooms
Formal Teaching Sessions, Rounds, Academic ½ Day: Radiology Rounds:
Mondays 13:30 – 14:30 DI conference room
Resident Organised Teaching Sessions: Tuesday & Friday 12:30 – 13:30 (conf room 2) Grand Rounds:
Wednesday 8:30 – 9:30 Auditorium on 4th Floor
Clinical Clerk Academic ½ Day:
Wednesday 12:30 – 16:45 (see teaching schedule)
Paediatric Resident Academic ½ Day:
Thursday 13:00 – 16:30
Resident Rounds:
Friday 07:30 – 08:00 conference room 8/9/10
Clinical Clerk Course 8:
Friday 12:00 – 16:45 at UME
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C. Call (see general comments regarding call) Overnight Call •
You will do one week of overnight calls and one weekend of 24 hour calls
•
The week of overnight calls will consist of 5 consecutive nights Sunday – Thursday from 2100-0830 (except for week 1 of the block when overnight calls start on the Monday). PLEASE NOTE: Night shift on Sundays start at 20:00
•
You will be working with the same JR & SR resident during these 5 nights which will allow for graded autonomy and better evaluations throughout the week.
•
You should meet the night team on UNIT 4 @ 2100. If you are having trouble finding your team, please page the SR resident on pager #5254.
•
You will be excused from academic ½ day on Wednesday afternoons and Course 8 on Friday afternoons. However, if you have had a quiet night please do make efforts to attend the Wednesday teaching sessions.
•
Your main role during the night shift will be to do admissions. There will also be opportunity to assess ward patients and follow-up on patients that have been previously admitted.
•
Please arrange to sit down with your Sr. resident on the Thursday of your night call week to get feedback about your night calls.
Weekend Call •
You will be scheduled for 24 hour call on Friday & Saturday nights. Please refer to on call schedule.
•
Please meet in Team Room Unit 4 at 0800h for Saturday and Sunday morning handover
Float Shift Call •
You will also do 2 FLOAT CALL shifts during your two weeks of daytime teams
•
Float call shifts are from 1700-2300h. Please page the Sr. (pg # 5254) at 2pm the day of your float shift so that afternoon admissions can be assigned to you as the float shift clerk. This allows for those who are scheduled to be done at 5pm to get home in a timely manner.
D. Evaluations (see general comments regarding assessments) Clerks will receive frequent feedback during CTU daytime blocks and during evening / night shifts. Feedback may be formal (i.e. sit-down) or informal (i.e. comments during review of admissions, rounds, observed bedside exam, etc.) from the attendings, senior residents and other staff. Clerks should request specific feedback for admissions, patient presentations and day-to-day patient care. Your final CTU evaluation will be comprised of feedback from your two weeks of daytime teams as well as your one week of night team call. (Please arrange to sit down with your Sr. resident on the Thursday of your night call week to get feedback about your night calls). During your CTU orientation you will be provided with a detailed EVALUATION TABLE that will have specific details about who will do your evaluation and when. These evaluation tables are also posted in all the CTU team rooms. During week 3 of your rotation please contact your one-45 evaluator and arrange for one-45 email to that evaluator as well as a time to meet and complete the final evaluation.
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E. Absences/ Time away/Call requests Please also refer to Guidelines for clerk absences on Paediatrics section of the Core Document You are an essential part of the functioning of the CTU team and your absence is always missed! a. If you have specific scheduling/call requests please contact the UME Paediatrics Program Coordinator at peds@ucalgary.ca , as much in advance as possible so that the rotation schedule can be prepared accordingly. Last minute requests once the schedule is finalised cannot be guaranteed.
b. If for any reason you are unexpectedly going to be away for any period of time during your CTU
rotation (i.e. sick, exam, appointment) it is your responsibility to contact your “Team leader” (i.e. senior resident, or attending) as soon as possible (or at 08:00 in case of illness). If text messaging is used, please provide a call-back number.
c. If you are unexpectedly sick/away on a day that you are scheduled for WEEKEND or FLOAT CALL
please try to find a fellow classmate to trade call days with you. IF you are not successful then please contact the Senior Resident pager @05254 ASAP so that a replacement can be scheduled for call.
d. If you are unexpectedly sick/away and are scheduled for NIGHT CALL please contact the Senior Resident pager@ 05254 ASAP during the day so that a replacement for call can be scheduled. Please do not wait until evening to do so as finding a replacement becomes that much more difficult.
F.
Day of Examinations (Formative OSCE & Summative MCQ) •
Clerks will be excused from call at 21:00 on the night before an examination. Please remind your senior or staff when it is the night before an exam (they can sometimes lose track!)
•
Clerks are expected to be present on teams the day of exams. That is, if the exam is in the afternoon then clerks are expected to be present on teams for the morning. If the exam is in the morning then clerks are expected to return to teams for the afternoon. Clerks are also expected to return to teams for call following the exam. There are no exceptions.
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o Paging and Important Numbers Access pagers using the paging system: In hospital dial: 671
Out of hospital dial: 403 212-8223
Text paging can be accessed through the internal web homepage. Useful Pager Numbers Senior OnCall/Admitting pager – 05254 Junior OnCall – 01233 Red Team Attending – 01651 Paediatrician OnCall/Green Team Attending – 01652 Purple Team Attending – 01653 Blue Team Attending – 03915 Gold Team Attending – 08762 CTU Clinical Educator Medical Students (Dr. Sandhu) – pg# 10559 Useful Phone Numbers ACH main switchboard: 403 955-7211
Radiology – 57987
Unit 2 – 57889
Resident Lounge – 75472
Unit 3 – 57897
Central Lab – 770-3602
Unit 4 – 57892
Provincial Lab – 41200 or 41212
Emergency – 57070
Pharmacy – 57935
PICU – 57074
PADIS (Poison Control) 403 944-1414
Community Paediatricians/ Family Physicians – see directories located in each team room.
o Computer User name: ~pedres
Resident/Clerk password: group21 (PLEASE remember to log off!!!)
PACS/SCM – each clerk/resident should have their own login and password Computers in the team rooms are priority usage for those on teams for team patient related issues. If you are using the computers for other purposes (CLIPP cases, research paper, etc) please give priority to those using the computers for above mentioned purposes. The computers in the library can be used for all other non-team related purposes. With your ID card you can access the library 24 hours/day. Photocopiers are also located in the library.
Who do I contact if there is a problem? •
Your senior resident
•
Your attending
•
Division of Hospital Paediatrics: Clinical Educator for Clinical Clerks: Dr. Preet Sandhu at amonpreet.sandhu@albertahealthservices.ca
•
Paediatric Clerkship (see contact list for emails/phone numbers): - Clerkship Director: Dr. Susan Bannister - Deputy Clerkship Director Dr. Julian Midgley - Evaluation Coordinator Dr. Nicole Johnson - Clerkship Administrator: Valerie Repper
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Peter Lougheed Centre CTU Rotation The Peter Lougheed Centre (PLC) component of your Paediatrics Clerkship rotation blends general Paediatric exposure, and normal newborn teaching with opportunities for outpatient experiences. •Unit 31 CTU (all three clerks should attend Unit 31 for daily teaching from 0800-0900) TIME
EVENT
LOCATION
07:30 – 08:00
Handover / assessments
Unit 31 3121
08:00 – 09:00
Teaching
Unit 31 3121
09:00 – 09:30
Patient assessments
Unit 31
09:30 – noon
Bedside rounds
Unit 31
Lunch
TBD
TBD
12:30 – 16:30
ward work / consults
Unit 31/ER/newborns
12:30 – 16:30***
Clinics
To be arranged
17:00
Evening handover
Unit 3121
On your first morning you will join the team on Unit 31 (Paediatrics) at PLC. The Paediatrician who is Preceptor for that week will orient you following the morning handover and teaching session, but before Walk Rounds at 09:30. Please introduce yourself to the preceptor as they change over on the Friday preceding the week rotation. The Preceptor for your final week is responsible for completing your evaluation and performance review – it is the student’s responsibility to remind that Preceptor when they are in their final week. The Program Coordinator will submit the web evaluations once all the feedback has been received. You work under the supervision of general Paediatricians and “Junior Consultants” (senior Paediatrics residents) and nurses. The other important student contingent is made up of junior residents, most of whom are from the Family Medicine Residency Program but also first year paediatric residents. The day begins by 07:30 with handover/transfer of care. From 08:00, a one hour seminar (based on a curriculum for the Family Medicine residents) is directed by the Preceptor of the week, Junior Consultant or Neonatologist. Walk Rounds for the team commence at 09:30, so patient review occurs before 08:00 and from 09:00 – 09:30. Typically work arising from rounds is completed by noon. Other formal but less frequent learning opportunities can be found on schedules on Unit 31, room 3121. Afternoons are more self-directed. Wednesdays are academic half-days and are protected time. Please advise preceptors when you have other mandatory educational activities. There will be one SIM lab for every four-week resident block. Drs. Amanda Evans and Nathan Chan coordinate these sessions. For the remaining afternoons, and for times on call, you will assist the rest of the house staff with coverage of the PLC Paediatric service. On weekdays, this includes carry-over work from the morning and new admissions to Unit 31, assessments and consults on the Normal Newborn ward (Unit 33), attending neonatal resuscitations on Labour and Delivery (Unit 35A- while on newborns), business arising in the Neonatal Intensive Care Unit (NICU, Unit 35B- while on newborns) and consults from the PLC Emergency. There is one 24-hour call on a Wednesday night and four other calls that include a Friday, Saturday and Sunday.
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Neonatology week (in alphabetical order clerks will rotate weekly on newborn service) 1. Each week Clerks receive teaching from staff/Junior Consultants on Unit 31 from 08: 00 â&#x20AC;&#x201C; 09:00 Introduce yourself to the Unit Manager for Units 33/34 and provide pager number. Introduce yourself to the Unit manager in NICU and advise of your availability for attending resuscitation. 2. New and follow-up newborns (in Units 33 and 34) will be rounded on by a clerk and often a paediatric resident and then reviewed with the Paediatric attending, there is different attending on-call each 24 hours for normal newborns. Charts that are labelled MCC or LMG are patients of the family practice group and are reviewed only upon request. 3. Attend neonatology grand rounds (Tuesday afternoons) 4.
Spend afternoons (1 - 2) during their one week as an observer in resuscitation (clerk pager has to be linked with switch board so they could be paged for resuscitation), attend one lactation consultant clinic and one public health well baby clinic.
Newborn Rotation as per alphabetical order Newborn nursery
Mon
Tues
Wed
Thurs
Week 1 clerk A
A
A
A
A
Week 2 clerk B
B
B
B
B
Week 3 clerk C
C
C
C
C
Mon
Tues
Wed
Thurs
Week 1
C
Week 2 Week 3
Fri
Sat
Sun
Fri
Sat
Sun
B(24)
B
A
B
A
C(24)
C
B
C
B
A(24)
A
C
A
Public Health Clinic
PLC Call (24 = 24 hour call) Call
As a secondary level Paediatric service with a high rate of patient turnover, we hope you will get the most out of your experience at PLC and the attendant ambulatory opportunities. PLC CTU Evaluation Process on One45: Each week a Weekly Sub ITER will appear in your ONE45 Inbox. Please distribute this ITER to your preceptor that week. The number of weeks that you are on a PLC CTU rotation equals the number of Sub ITERs you will need to distribute - a three week rotation will have three sub ITERs. Dr. Kelleigh Klym will then complete your Overall ITER on ONE45 with the sub ITERs once your weekly preceptors completed. PLC Coordinators: Dr. Kelleigh Klym Dr. Kevin Levere
403-995-2670 403-955-7211
kelleighfriesen873@gmail.com Kevin.Levere@albertahealthservices.ca
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ACH Paediatric Emergency Department (PED) Rotation During your rotation, you will be expected to focus your learning on 5 clinical presentations: • Respiratory distress/cough • Dehydration/Shock • Altered level of consciousness • Limb/Extremity Pain (Trauma) • Fever/Rash (Infectious diseases) Given the nature of emergency medicine and the short duration of the emergency rotation, it is expected that each of you will have a somewhat varied experience in the Paediatric emergency department (PED) owing to variations in season and the sporadic nature of certain clinical presentations. To ensure that each of you meet your core objectives, it will be essential that you supplement your clinical experiences with a structured self-study program. Aim to spend about 2 hours on each of the above 5 topics. As a clinical clerk, you will be assigned to the Paediatric emergency department for two weeks. During those weeks, each clerk will do the following mandatory sessions: •
6-8 teaching shifts (3 hours each – 1200-1500, Mon, Tues, Wed, Thurs) During these shifts, your group will have an assigned instructor. Preceptors may choose to do a combination of small group teaching, bedside teaching, and observed history and physicals. Patients will be selected by the preceptor in order to meet the learning objectives of the rotation. There will be daily feedback provided during these shifts. (Note- all clerks assigned to the paediatrics ED during a given week will attend the teaching shifts together.)
•
6-8 independent shifts (5 to7 hours each) During these shifts, you will be assigned to the staff preceptor on duty. You will see patients independently and review patients with either the PEM physician or fellow. Patients will be seen in order of illness severity. This preceptor will fill out a formal evaluation of your performance at the end of the shift.
Sample PED Schedule (for clerks A, B C and D):
0800-1200
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
A
D
HPS
B
A
B (8-15)
B (8-15)
1200-1500 (teaching shift) ABCD ABCD Academic ABCD Half Day 1500-2000 B A C
Course 8
A (14-21) A (14-21)
For example, on Monday, clerk A would do an independent shift from (0700 or 0800) -1200, then meet up with the other clerks for their teaching shift from 1200-1500. At 1500, everyone else finishes for the day, and clerk B stays on until 2000 for an independent shift. Clerk C & D would only need to come in for the 3 hour teaching shift in the middle of the day. NOTE: * Shift start varies with preceptor shifts Please make every effort to report to the PED doc’s office at 12:00 sharp for your teaching shifts. •
If you are unable to attend a teaching shift – you must notify Manjari Shukla prior to 09:00 that day – 9552462 or email Manjari.shukla@albertahealthservices.ca (This is particularly important if you are the only clerk on PEM that week, as your teaching shift instructor is coming in just to teach you!) The PEM Clerkship Director is Dr. Tanuja Kodeeswaran drkodeeswaran@shaw.ca
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“Paediatric Human Patient Simulation Sessions” Clerks Rotating through Paediatric Emergency Medicine Critical events in paediatrics are infrequent, yet patients are likely to have a good outcome if successfully managed. Although many practising physicians will at some point be required to manage acutely ill children, very few opportunities to learn and practice the necessary skills are encountered during residency training, especially in nonpaediatric training programs (family medicine, emergency medicine, surgical subspecialties, radiology, anaesthesia, etc.). As such, many of these skills are taught didactically, with no opportunity for hands-on practice. These missed opportunities have a dramatic influence on physician confidence in these situations, but also allow for an increased possibility of medical error or adverse outcome. Human patient simulation (HPS) is a new area of medical education that has been developed in part to fill these voids. It is now used extensively in some of areas of medicine to teach and evaluate new techniques and rare events. It has already proven to be of benefit in paediatric resuscitation skills, but may also hold great potential to teach and allow practice for clerks and residents from numerous disciplines in the management of acutely ill children. In an attempt to meet this educational goal, and to provide practical experience caring for acutely ill or injured children, the Department of Paediatrics at the University of Calgary and the Alberta Children’s Hospital (ACH) have developed the KIDSIMTM Program whereby human patient simulation experiences are provided for trainees during different rotations. One of the main goals of our Paediatric Emergency Medicine (PEM) rotation is to provide experience with dealing with acutely ill or injured children. As most of you know, the experience in this area is somewhat variable based on what types of patients present to the Emergency Department during your rotation. As such, we have planned sessions on the HPS for clerks during their PEM rotation. These sessions will occur on the Wednesday morning of your PEM week from 09:30 – 12:00 in the HPS lab, which is currently housed in the Paediatric Emergency Department (PEM). A schedule of the session you are assigned to attend will be noted on your Paediatric Emergency Department Rotation Schedule. These sessions are considered a mandatory part of your rotation. Please check this schedule carefully for the date and time of your session. We look forward to having you in the HPS lab. Please direct any questions or concerns to Dr. Vince Grant, Medical Director of KIDSIMTM, Human Patient Simulation Program at 403-955-7643.
Clerks Not Rotating through Paediatric Emergency Medicine New for the Class of 2014. For those clerks not rotating through Paediatric emergency medicine rotations Human Patient Simulation (HPS) sessions will occur during the three weeks of non-general paediatrics (eg during the 2 weeks of community paediatrics, neonatology, PLC or subspecialty rotations). These will be on Thursday mornings between 08:00 and 10:00 in the HPS lab, which is currently housed in the Paediatric Emergency Department (PEM), on weeks 3 or 5 of the Clerkship Block of 6 weeks. The sessions will be aimed to improve recognition and management of common paediatric emergency presentations (eg asthma, seizure, anaphylaxis and sepsis). There is also a focus on teamwork precepts such as leadership and communication.
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What to do when you show up at the ACH Paediatric Emergency Department For Teaching Shifts: Please come to the doctor’s office in the emergency department at 12:00 sharp and meet with your preceptor. For Independent and Weekend Shifts: 1. introduce yourself to the doctors, nurses, RT’s, and unit clerk on duty 2. sign in on REDIS – acc1 3. sign up for the next patient to be seen (i.e. the lowest red number with an RN next to it) 4. if the patient is a CTAS 2 – make sure you tell a staff physician that you’re going in the room 5. obtain a focused history 6. perform a physical exam 7. write the H & P and time of assessment on the chart – (leave room for the staff doc to do a little writing please!) 8. find a staff physician to review the case 9. if you suspect that a child is quite ill, find someone to come take a look at them right away – don’t wait to complete your exam and charting 10. do not order any investigations without checking with a staff physician first
Paediatric Clerkship Emergency Department Evaluations (see general comments) 1. End-of-Shift Evaluation Form (Blue Form)
Use for clinical shifts only. Clerk asks clinical preceptor to fill out at the end of the shift •
Leave evaluation in the “Completed Clerkship Evaluations” box in the Emergency Department (Doctor’s office).
•
For a 2 week rotation a minimum of 6-8 blue evaluations must be completed. (numbers will depend on Stat days, MCQs, OSCEs, etc.)
2. Emergency Department Teaching Shift Observations Form (Green Forms) Use for teaching shifts only. To be completed by Teaching preceptor at end of session. One form per week to be left in “Completed Clerkship Evaluations” box in the Emergency Department (Doctor’s office). The blue and green evaluation forms and attendance sheets are kept in the Emergency Department #B1-195/Office #1334 on the left-hand side in one of the slots. 3. Emergency Department Teaching Shift Topics Used to track teaching topics during rotation and to be placed in the “Completed Clerkship Evaluations” Lock Box at the end of the week. NOTE: The student is responsible for submitting all required evaluation forms at rotation end in order for their evaluation to be completed. The ITER for the Paediatric Clerkship Emergency Department rotation will be compiled from the blue and green forms: The Paediatric Clerkship Program Administrator will collate information onto paper ITER or within One45. Paper ITER or One45 will be checked and signed off by faculty (Paediatric Clerkship Committee Emergency Department representative, Evaluation Coordinator or Clerkship Director). Revised: Oct 12, 2011 by tjk MDCN 508 - University of Calgary Paediatric Clerkship Core Document (14 April 2013)
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Neonatology Rotation The two week neonatology rotations for the clinical clerks will be at the Foothillâ&#x20AC;&#x2122;s Hospital NICU and the one or two week rotations will be at the Peter Lougheed Hospital or Rocky View Hospital NICU The rotation will also include one weekend day in the North Hill Community Health Clinic where you will participate in consultation including community visit for jaundice, lactation consultation, routine newborn visits etc. You are expected to be at the clinic between 9.15 â&#x20AC;&#x201C; 9.30 AM when the nurses see the first patient.
LEARNING OBJECTIVES: By the end of the rotation, the student will have acquired skills required to examine newborn infants, specifically Perform an initial assessment of the newborn and determine APGAR score. Perform newborn physical examination, including the following: Measure weight, length, and head circumference to determine growth status Assess cardiovascular system: murmurs, pulses Newborn eye exam Newborn hip exam Assess neuro-motor status including tone and reflexes Determine gestational age (including use of Ballard/Dubowitz scoring system) Develop an approach to the diagnosis, investigation and management of neonates with the following problems by obtaining appropriate historical information, performing a complete physical examination and ordering and reviewing relevant laboratory/diagnostic imaging data: Jaundice Respiratory distress in newborn Cyanosis (differentiate Cyanotic CHD from pulmonary causes) Birth injury, including scalp injury Abnormal neurological findings; lethargy, poor feeding, jitteriness, etc Hypoglycemia Common rashes and birthmarks Be able to discuss: Rationale for maternal screening: Maternal factors which may place the neonate at risk. Medications routinely given to all newborns. Newborn screening (TSH, Metabolic). Weight changes after birth and normal growth. Signs of an unwell infant: Risk factors and management of neonatal sepsis. Common complications of prematurity. Definition of LGA, SGA, AGA; differential diagnosis, complications and management of growth aberrance.
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Prematurity 1.
Discuss the common complications of prematurity.
2.
Outline the nutritional requirements of a premature infant.
3.
List the most appropriate investigations and screening tests needed in the follow-up care of the premature infant.
Cyanosis in the Newborn 1.
List the differential diagnosis of cyanosis in the newborn.
2.
Elicit and interpret information from the history and physical examination to differentiate among the causes of cyanosis in the newborn.
3.
List and interpret basic investigations used to differentiate the various causes of cyanosis of the newborn.
4.
Outline the initial management of a cyanotic newborn.
Neonatal Jaundice Classify neonatal jaundice and list the differential diagnosis Differentiate unconjugated versus conjugated hyperbilirubinemia and physiologic vs. pathologic jaundice. Elicit/ interpret information from the history and PE to determine various causes of jaundice. List and interpret the appropriate investigations used in the diagnosis of jaundice in the newborn. Describe the management of jaundice in the newborn. Understand the mechanism and side effects of phototherapy Nutrition 1.
List the benefits of breast-feeding.
2.
List the disadvantages and contraindications for breast-feeding.
3.
Outline the management of common breast-feeding problems.
4.
State the indications for special formulas and dietary supplements.
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Welcome to the NICU We work as a team in the NICU; do not hesitate to ask questions, share your views and opinion. Members of our team include but, not limited to: The Neonatologist on service or call, Clinical Associate, Clinical Assistants, Residents/Fellows, Nurse Practitioner, Nurse Clinicians, Respiratory Therapists, Dietitian, Pharmacist and Lactation consultant. The unit clerks are a valuable resource. The bedside nurse and the parent/caregiver play a pivotal role. Talk to them. Pay attention to their concerns, ideas and wishes. TYPICAL DAY IN THE NICU: Sign-out by the on-call team is at 8 AM on all days except Tuesdays and Fridays (0745) to facilitate resident teaching session. Evening sign out to the on-call team is at 5 PM.
Morning rounds start between 9 â&#x20AC;&#x201C; 10 AM. Be prepared with details on your patient for the rounds. Read the nursing notes written overnight. Look at the bedside nursing sheet which has information on: Patient Age, Gestational age (at birth and Corrected) Weight (birth, current and weight change) Vital signs, Respiratory status/support Feeding (type of feed, volume, frequency, mode of administration i.e. bottle/ breast / gavage and aspirates) Bowel movement, urine output and Chemstrip in certain cases TFI and IV fluids. Strive to examine your patient prior to the morning rounds (Notes can be written after rounds). Prior to examining a baby, please inform the bedside nurse so you donâ&#x20AC;&#x2122;t examine the infant in an inopportune moment (shortly after a feed, soon after the infant is settled etc). The bedside nurse presents the patient details on morning rounds at the FMC and at PLC and RGH the bedside nurse may occasionally present patient details. This is followed by the clerk presenting the relevant details and management plans which can be system based or problem based.
Daily notes should include the following: i.
Date & Time, DOL, CGA, Current weight and weight change
ii.
Current Issues / Problems / Concerns
iii.
Events in the last 24 hours
iv.
Fluid and Nutrition
v.
Medications
vi.
Results of Investigations
vii.
Detailed record of clinical examination of systems
viii.
Assessment / Impression and Plans
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Admission notes should include: i.
Reason for admission/ Hours of life/ Day of life for patients admitted from postpartum unit or transferred from other hospitals.
ii.
Gestational age, Birth weight.
iii.
Maternal History: significant pre-pregnancy medical status, past pregnancy history, pre-natal history to include fetal U/S, pregnancy course, serology/GBS status etc.
iv.
Labour/ Delivery/Resuscitation to include history suggestive of chorioamnionitis, antibiotics, PROM/ROM (hours) fetal heart rate pattern, meconium, mode of delivery etc.
v.
Apgar Score and Cord blood gases and resuscitation
vi.
Course prior to NICU admission (for those babies who are not admitted from FMC labour ward).
vii.
Comprehensive assessment of all systems.
viii.
Problems/ Diagnoses and Plans.
ix.
Perform Ballard scoring and complete the centile (growth) chart.
Documentation: Is vital and should be legible and complete. On admission â&#x20AC;&#x201C; In addition to the History and Physical exam and documentation, orange and green sheets have to be filled. Update the problem sheet (orange colour) as new problems arise. Discharge: The blue discharge sheet and orange sheet should be completed. Please notify the family doctor or paediatrician on the day you discharge the patient. The unit clerk can help you with the phone numbers.
Criteria for admission to the NICU: - Infant less than 36 weeksâ&#x20AC;&#x2122; gestation. - Birth weight less than 2250 grams. - Infant with respiratory distress and/or requiring oxygen/ respiratory support. - Infant who needs intravenous access for hypoglycemia or hypovolemia. - Infant with major congenital/surgical problems. - Any infant needing close observation, intervention or diagnostics etc. which cannot be done in the normal nursery. - Any infant the Fellow/Clinical Associate/Senior NNP/ Charge nurse or RT feels requires assistance with care.
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Daily Schedule - Sign in rounds is at 8 AM except on Tuesdays (at 7.45AM) to facilitate educational activity. - Sign out rounds is at 5 PM except, on call days when you are expected to be in the NICU until 11 PM. - Bedside ward rounds start between 9 – 10 AM. You will be assigned patients in the NICU and are expected to examine these infants, write progress notes, review relevant laboratory and radiology reports and present to the attending Neonatologist on rounds and formulate care plans under his/her guidance. Talk to the parents and learn how to give advice to the parents/caregivers and how to allay their anxieties.
Call (see general comments as well)
The rotation includes four calls in the two week rotation – two nights per week (until 11 PM). Please inform the members of your team the days you will be on call. You are expected to attend clinical service after the night on call. Attendance on the weekend is at the discretion of the neonatologist on service. Resuscitation
Attend newborn deliveries whenever there is no conflict with teaching. This would facilitate acquiring “hands-on experience” in neonatal resuscitation. Please inform the Respiratory therapist to page you for all the resuscitations during the day and until 11 PM the nights you are on call. Read the first three chapters of the NRP manual (this is placed in the folder marked “Clerk Teaching” on the computer).
Infection Prevention 1. 2. 3. 4. 5. 6.
HANDWASHING IS CRUCIAL Exercise appropriate diligence in preventing cross-infection. Microsan is available at every bedside and should be used liberally to cleanse hands before and after you examine a patient. Please do not wear white coats or long sleeved attire into Nurseries or the NICU. You are expected to wear scrubs. Watch and jewelry should not be worn. Stethoscopes will be available at each bedside and is not to be shared between patients. No food or personal belongings are allowed by the bedside.
Educational Sessions 1.
Neonatology Grand Rounds:
Three Tuesdays/ month from 4 – 5 PM – Coomb’s theatre, FMC.
2.
Clinical Rounds:
First and Third Fridays (8 AM - 9.30 AM) – FMC 580D.
3.
Resident teaching:
Tuesdays (NICU) and 2nd & 4th Fridays (FMC 580D) (8 - 9 AM)
Grand rounds, clinical rounds and Friday resident teaching sessions are accessible by telehealth. 4. 5.
Clinical Clerk Academic ½ day: Clinical Clerk Course 8:
Wednesdays, 12:30 – 16:45 at ACH. Fridays 12:00 - 17:00 at HSC.
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Evaluation The neonatologist on service on the final week of the clerk’s rotation will be responsible for providing a collated evaluation for the two weeks, with neonatologist/s who were on service in the preceding weeks. General Information
1. Identification badges must be worn and clearly visible at all times. 2. Parking is reciprocal between sites if you have a CHR parking permit.
Feedback/ Query Please call Dr. Essa Al Awad or Ms. Evelyn Villar (403-943-4892) if you experience any problems or concerns related to your rotation. Comments on the quality and components of the rotation are welcome and will assist us in improving the rotation and will be treated confidentially.
NEONATOLOGY ROTATION AT THE FOOTHILLS HOSPITAL The newborn rotation for clinical clerks at the Foothills Hospital is based in the Neonatal Intensive Care unit (Unit 50 and 55). The NICU is located on the fifth floor. On the first day of your rotation at 0800 hours meet with the Neonatologist on service for the week in the NICU. There are two teams – Green and Red team and a clerk will be designated to one of the teams. The teams have a combination of senior and junior residents and Neonatal Nurse Practitioners. The neonatologist for the team will be the preceptor.
Educational Resources 1. Videos on normal newborn exam and neonatal resuscitation in the folder marked “Clinical Clerks”. 2. Folder marked “Clinical Clerks” is placed on the desktop on the computer in Pod B, in the NICU, where reference books are kept. 3. Other information and textbooks are available in the NICU. These must not be removed from the unit. Book loaned to you during the rotation should be returned to the unit clerk at the end of the rotation.
Neonatology Rotation at the Peter Lougheed Centre The newborn rotation for clinical clerks at the Peter Lougheed Hospital (PLC) is based in the NICU (Unit 35B). The NICU is located on the third floor of the east wing at the PLC where the delivery suite, postnatal and Paediatric wards and NICU are located. On the first day of your rotation at 0800 hours meet with the Clinical Assistant/ Neonatologist on service/ Ms. Wilma Dove (Nurse Clinician) that will orient you.
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Educational Resources
1. Videos on normal newborn exam and neonatal resuscitation – These can be obtained from the Assistant Patient Care manager (Ms. Terry Holden) whose pager number can be obtained from the unit clerk. Video players are available in the telehealth room in the Paediatric unit (U31). 2. Folder marked (Clerk Teaching) is placed on the desktop of the computer by the pillar of knowledge in the NICU. The Clinical assistants will assist you with this. 3. Other information and textbooks are available in the NICU. These must not be removed from the unit. 4. There is a “pillar of knowledge” by the desk with many of the unit routines posted.
Neonatology at the Rockyview General Hospital The newborn rotation for clinical clerks at the Rockyview General Hospital (RGH) is based in the Special Care Nursery (Unit 63). On the first day of your rotation at 08:00 hours meet with the Neonatologist on service for the week. The Resident/ Fellow/ Clinical Assistant/ Nurse practitioner will orient you regarding the location of the delivery rooms/ORs as well as reviewing the unit routine. Educational Resources
1. Videos on normal newborn exam and neonatal resuscitation in the folder marked “Clinical Clerks”. 2. Folder marked (Clerk Clerks) is placed on the desktop of the computer in the Education room in the NICU. This folder has video on normal newborn exam and other neonatology based topics of interest.
Other information and textbooks are available in the NICU. These must not be removed from the unit.
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Common abbreviations used in the NICU AGA AOP A&B BPD BM
Appropriate for gestational age Apnea of Prematurity Apnea and Bradycardia Bronchopulmonary dysplasia Bowel movement
MAP MAS NEC NG NO
Mean Airway pressure Meconium Aspiration Syndrome Necrotizing enterocolitis Nasogastric Nitric oxide
CDH CGA
Congenital Diaphragmatic hernia Corrected gestational age
NPO OG
CLD
Chronic Lung Disease
OFC
CMD CMV CPAP CS
Continuous milk drip Cytomegalovirus Continuous positive airway pressure Chemstrip
PDA PPHN PIE PPS
CUS
Cranial Ultrasound
PRBC
Nil per oral (Nothing by mouth) Orogastric Occipito-frontal circumference (Head circumference) Patent Ductus Arteriosus Persistent pulmonary hypertension Pulmonary interstitial emphysema Peripheral pulmonary stenosis Packed red blood cells (concentrated)
DOL DDH EBM
PIH PE PTL
Pregnancy induced hypertension Pre-eclampsia Preterm labour
PROM
Premature rupture of membranes
ELBW ETT FiO2
Day of life (Age) Developmental Dysplasia of the hip Expressed Breast Milk Extracorporeal membrane oxygenation Extremely low birth weight Endotracheal tube Fraction of inspired oxygen
PVL PIP PIV
GBS
Group B streptococcus
PICC
GIR HC HUS HFV HFOV
Glucose infusion rate (mg/kg/min) Head circumference Head ultrasound High frequency ventilation High frequency oscillatory ventilation
RDS ROP RSV SVD SGA
Periventricular leukomalacia Peak inspiratory pressure Peripheral intravenous line Peripherally inserted central catheter Respiratory Distress Syndrome Retinopathy of Prematurity Respiratory syncytial virus Spontaneous vaginal delivery Small for gestational age
HIE HMF HSV IDM IUGR IVH IWL I/O LBW LGA
Hypoxic ischemic encephalopathy Human milk fortifier Herpes Simplex virus Infant of Diabetic mother Intrauterine growth retardation Intraventricular Hemorrhage Insensible water loss Intake and output Low birth weight Large for gestational age
SBR TTN/TTNB TFI UAC UVC VLBW
Serum bilirubin Transient tachypnea of the newborn Total fluid intake Umbilical arterial catheter Umbilical venous catheter Very low birthweight
ECMO
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Alberta Children’s Hospital Sub-Specialty Rotations Most clerks have a one-week subspecialty rotation (occasionally a two or three week rotation). This rotation allows focus on the following aspects of paediatrics: 1.
Recognize the health care challenges of a child with a chronic disease.
2. Identify members of an interdisciplinary team and describe their roles. 3. Appraise the impact of a child’s disease on his or her family. 4. Give examples of additional history skills, physical examination skills and diagnostic tests that are used in a sub-specialty. 5. Summarize the consultative process and recognize the importance of communication with referring physicians.
Where to go Before the beginning of your sub-specialty rotation, refer to the section “Where to Go on the First Day of Rotations” or contact your preceptor/clinic contact to determine where you are expected to be for the week. You may be given readings specific to your sub-specialty. For instance, if you are doing a week in oncology, please read the following BEFORE your rotation: -
Bates' "Guide to physical examination and history taking" with a focus on lymph node, liver and spleen exam
-
Carol Berkowitz’s text "Paediatrics: A Primary Care Approach” – read the chapters about: - Lymphadenopathy - Cancer in Children - Talking to Parents - Talking to Children - Talking to Adolescents
Gastroenterology Sub-Specialty Rotation (ACH) ONE45 Evaluations We will expect the student to email the ONE45 to the attending GI physician on Monday. Then, on Thursday - it will be the expectation of the student to ask the attending to complete the ONE45 form in the student's presence so the student receives feedback and the form is done. The students MUST release the forms to the preceptor at the beginning of the week (after they know who their preceptor will be) and remind the preceptor to complete it.
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Interim Assessment Paediatric Clerkship Rotations STUDENT NAME:
PRECEPTOR NAME:
(Please Print)
(Please Print)
PAED. ROTATION:
BLOCK:
DATE:
Feedback and evaluation for our learners is an important aspect of any rotation. We require completion on this form at least once in a 1 or 2 week block or twice in a 3 week rotation. Fund of Knowledge
U
PD
G
O
Clinical Skills-history, Physical Exam
U
PD
G
O
Communication Skills
U
PD
G
O
Record Keeping
U
PD
G
O
Problem Solving, Patient Management
U
PD
G
O
Professionalism, Responsibility
U
PD
G
O
Motivation
U
PD
G
O
Relationships-patients, Team
U
PD
G
O
U
PD
G
O
U
PD
G
O
Technical Skills
NA
Overall Assessment of Student Performance Number of Days/ Sessions Attended
____ U PD G O NA
unsatisfactory performance deficiencies noted good outstanding not applicable
Comments: ________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ____________________________________________________________________________ Faculty Signature___________________________
Student Signature ____________________________
PRECEPTOR: If a student has one U or two PD, please email Dr. Nicole Johnson: Nicole.johnson@albertahealthservices.ca or pager 04369 and cc Valerie Repper: Valerie.repper@albertahealthservices.ca. Please retain a copy of this form if you have any concerns about the student - it should be given to the person completing the final assessment. CLERK: Please give this form to your preceptor to inform your final assessment on this sub-rotation. Please contact the Clerkship Evaluation Coordinator Dr. Nicole Johnson if performance deficiencies or unsatisfactory scores are identified. Updated as of July 18, 2011
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Clerk
SCAG – Adolescent Interview Form Name_________________________ INSTRUCTIONS FOR SCORING THE SCAG / FEEDBACK FORM (Structured Communication Adolescent Guide) A.
Rate your doctor using this form:
EXAMPLES: 0 = POOR, Did Not Dr. didn’t ask at all.
B.
1 = FAIR, DID Dr. asked in a judgmental fashion. Dr asked as if reading a list. Dr. asked as if embarrassed. I felt a bit uncomfortable .
2 = EXCELLENT Did Well Dr. established trusting relationship. Dr. comfortable with questions. Dr. did not judge. I felt very comfortable.
Each section A-D has a global (general) rating: (1 2 3 4 5 6 7 8 9 10). Do not add up the scores from each section, give a general impression.
1 = Poor
10 = Excellent
THE SCAG - FEED BACK FORM – (Structured Communication Adolescent Guide) Did Not
Did
Did Well
0
1
2
A) GETTING STARTED
Example: I liked that you talked about confidentiality right away.
Greeted teen.
0
1
2
Introduced self and role.
0
1
2
Discussed confidentiality at beginning of interview.
0
1
2
GENERAL RATING
1 2 3 4 5 6 7 8 9 10 Did Not
Did
Did Well
0
1
2
Good eye contact and body language.
0
1
2
Encouraged teen to speak by asking questions other than ones with a yes/no answer.
0
1
2
Encouraged parent to speak (leave out if no parent present).
0
1
2
Listened and responded in a nonjudgmental way.
0
1
2
Established trusting relationship with teen by appropriate choice of words.
0
1
2
B) GATHERING INFORMATION
GENERAL RATING
Comments: Please give examples of things that stood out in your interview.
1 2 3 4 5 6 7 8
Comments: Please give examples of things that stood out in your interview. Example: “You sat too close and invaded my space.” “ You related to me and wanted to hear my point of view.”
9 10
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Kblake@dal.ca
© Blake
Did Not
Did
Did Well
0
1
2
Separated teen & parent explained need to talk to teen alone.
0
1
2
Discussed confidentiality.
0
1
2
Recognized there may be other issues and reviewed previous questions with teen alone.
0
1
2
Reflected on teen’s feelings or concerns, (example: You seem..)
0
1
2
13 Home: Family
0
1
2
14 Education: School
0
1
2
15
Friends, activities
0
1
2
16 Alcohol: beer & hard liquor
0
1
2
17 Drugs: cigarettes
0
1
2
18
Marijuana
0
1
2
19
Street drugs
0
1
2
20 Diet: weight/diet/eating habits
0
1
2
21 Sex: Boy friend/girlfriend
0
1
2
22
Sexual activity
0
1
2
23
Safe sex/contraception
0
1
2
24 Self: body image self esteem
0
1
2
25
0
1
2
Did not
Did
Did Well
0
1
2
26 Summary, recapped issues
0
1
2
27 Kept the confidentiality
0
1
2
28 Asked if there were any questions 29 Talked about what to do next (plan & follow up)
0
1
2
0
1
2
C) TEEN ALONE
Comments: Some important point made by the doctor in their words. Example: “I was glad you talked about confidentiality, I need lots of reassurance that you won’t tell my mom.”
LIFESTYLES
Moods/depression/suicide
GENERAL RATING
1 2 3 4 5 6 7 8 9 10
D) WRAP UP
GENERAL RATING
Comments: please give examples of things that stood out in your interview Example: I liked it when you finished by saying “we” do.
1 2 3 4 5 6 7 8 9 10
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