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Electives - Pediatrics


ACE - A. I. in Pediatrics

Elective Number: 2420

Rotation Supervisor: Dr. Lisa Hainstock

Coordinator: Rachel Moon

Duration: 4 weeks

Available: all Rotations

A pager is required for this rotation but is not supplied by the department

Report to: Dr. Hainstock

Time to Report: 7:00 am

Place to Report: UVA Hospital 7 West, Room 7802

Attendance: A student may not take time off during this rotation.

Typical day: 6:30 am - 5:00 - 8:00 pm - Will also participate in night shifts just as the PGY-1s do.

Number of students per rotation: 1

Course Description: The student will do activities normally performed by an intern on the general pediatric ward service. This individual is the primary physician for the patient with direct supervision by a senior pediatric resident and pediatric faculty member. This includes but is not limited to admitting patients, discharging patients, examining patients daily, entering all orders and notes for assigned patients, writing admission history and physicals, writing daily progress notes, talking with consultants, interpreting laboratory and radiology studies, presenting patients on rounds with appropriate summation, assessment and plan, and talking with patients and their parents.

Typical Day Shift:

0645 – 0745 Preround on patients on wards
0745 – 0830 Attend morning report
0830 – 1100 Attending rounds
1100 - 1200 Work on patient discharges
12 00 – 1300 Attend resident noon conference
13 00 – 1700 Admit patients, attend patient meetings, manage patients, discharge patients
1700 Sign over to senior resident with late night to 2000 every 3rd night

Typical Night Shift

1900 – 2000 Sign over from day team
2000 – 0645 Admit patients to all services
0645 – 0745 Preround on some ptients
0745 – 0830 Attend morning report

Learning Objectives:

  1. Patient Care
    1. Independently collect both focused and comprehensive, developmentally appropriate patient histories.
    2. Independently perform both focused and comprehensive, developmentally appropriate physical examinations
    3. Synthesize information to formulate a differential and primary diagnosis
    4. Develop a prioritized and inclusive problem list
    5. Identify the reason for the patient’s admission
    6. Summarize interval patient information and rationale for ongoing clinical management
    7. Recognize patients requiring immediate attention by supervising physician
    8. Suggest appropriate diagnostic tests for the patient’s chief complaint and other medical problems
    9. Modify the primary diagnosis based upon interpretation of diagnostic studies
    10. Demonstrate family-centered approach to patient care
    11. Develop a prioritized management plan with the health care team and describe a rationale for the clinical plan
    12. Identify patient discharge needs and include in daily plan
    13. Manage time effectively in completing patient care tasks
    14. Identify relevant clinical information necessary for hand-offs
    15. Reassess patients continuously
    16. Formulate appropriate orders
    17. Prepare prescriptions
    18. Practice appropriate infection control measures while caring for patients
    19. Recognize how clinical uncertainty affects patient care
  2. Medical Knowledge
    1. Describe the epidemiology, pathophysiology, and clinical findings of common pediatric conditions that require hospitalization
    2. Describe the diagnostic evaluation and management of hospitalized patients with the following conditions:
      * Abdominal pain or distention
      * Altered mental status (e.g., irritability, lethargy, seizure)
      * Fluid, electrolyte and acid-base disturbances
      * Fever (including in immunocompromised patients)
      * Musculoskeletal pain or swelling
      * Respiratory distress
    3. Describe how age and development influence clinical findings and epidemiology of
      common pediatric conditions
    4. Identify criteria for admission and discharge from the hospital
    5. Recognize variations in common laboratory findings and vital signs
    6. Describe the signs and symptoms that suggest deterioration (including signs of shock and respiratory failure) or improvement of a patient’s clinical condition
    7. Describe the impact of chronic illness on a patient’s clinical findings & management
    8. Describe principles of pain assessment and management
    9. List drugs of choice and rationale for their use in common pediatric illnesses
    10. Calculate doses of medication based on age, weight, BSA, & diagnosis
    11. Identify contraindications to therapeutic drug use in children of different ages &/or diagnoses
    12. Calculate fluid and electrolyte requirements for children based on weight, caloric
      expenditure, diagnosis, & fluid status
    13. Describe the elements of informed consent
    14. Describe the indications, contraindications, risks and benefits of the following
      * Arterial puncture
      * Intravenous catheter insertion
      * Lumbar puncture
      * Nasogastric tube insertion
      * Urethral catheterization
      * Venipuncture
    15. List the indications for emergency vascular access
    16. Recognize opportunities for preventive services in hospitalized patients
  3. Interpersonal and Communication Skills
    1. Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
    2. Demonstrate relationship building skills in each clinical encounter and inter-professional exchange
    3. Gather patient information using active verbal and non- verbal listening skills, clarifying & summarizing statements, and open-ended and closed-ended questions within a structured format
    4. Elicit and recognize the perspectives and needs of families and provide care for patients within their social and cultural context
    5. Share information with the patient and family in a way that facilitates their understanding
    6. Include the family in the decision-making process to the extent they desire
    7. Provide education and patient instructions to patients and families, using written or visual methods, taking into account their health literacy level
    8. Recognize the situations in which interpreter services are needed and demonstrate how to use these services effectively
    9. Identify one's own reactions to patients and families, recognize when these reactions interfere with effective communication, and manage these reactions properly
    10. Communicate patient information accurately and efficiently to all health care team
      members, including the primary care provider
    11. Deliver organized, appropriately focused, and accurate oral patient presentations
    12. Convey concise, pertinent information at the time of hand-offs
    13. Frame a question for a consultant and communicate the patient information and clinical question effectively
    14. Write organized, appropriately focused, and accurate patient notes, including admission, progress, cross-cover, and discharge notes and summaries in epic EMR
  4. Professionalism
    1. Demonstrate personal accountability to patients, colleagues and staff, in order to provide the best patient care
    2. Demonstrate integrity, compassion, respect, altruism, and empathy when interacting with all members of the health care team, patients and their families
    3. Demonstrate a humanistic, family-centered approach to the care of the patient
      a) Identify the perspectives of patients, families, self & other healthcare team members
      b) Analyze how perspectives may conflict and converge
      c) Demonstrate altruism in negotiating a plan of care
    4. Provide culturally effective care
      a) Identify the important role of culture in the care of each patient
      b) Demonstrate a patient-based approach to cultural competence
      c) Elicit the cultural factors that may influence care of the patient
      d) Recognize how one's own beliefs affect patient care
    5. Demonstrate punctuality and ability to complete patient care tasks efficiently
    6. Adhere to institutional guidelines, including those regarding attire, language,
      documentation, and confidentiality
    7. Maintain appropriate professional boundaries with patients, families, and staff.
    8. Recognize the impact of stress, fatigue, and illness on learning and performance
    9. Recognize and appropriately act on unprofessional behavior demonstrated by others
  5. Practice-Based Learning and Improvement
    1. Demonstrate self-directed learning in daily practice by:
      a) Identify strengths, deficiencies, and limits in one’s knowledge and clinical skills through self evaluation
      b) Acknowledge own uncertainty
      c) Develop a plan for improvement
      d) Perform appropriate learning activities
    2. Improve one’s own practice by soliciting and incorporating feedback
    3. Demonstrate evidence-based clinical practice by:
      a) Access appropriate resources to answer clinical questions
      b) Critically appraise relevant literature
      c) Incorporate evidence from the literature into patient care
    4. Use information technology to optimize learning
    5. Participate in the education of patients, families, and the health care team
  6. Systems-Based Practice
    1. Demonstrate the appropriate utilization of consultants, including social workers, school teachers, nutritionist, and physical therapists, during hospitalization
    2. Recognize, address, and work to prevent errors and near-misses
    3. Recognize the role of systems solutions in improving patient safety
    4. Coordinate transition from inpatient to home care
      a) Identify medical needs (e.g., medications, nutrition, activity, and equipment)
      b) Arrange follow-up care (e.g., medical home/primary care, special services, support networks,subspecialty care)
    5. Recognize the impact of health insurance status on patient care and availability of services
    6. Recognize the existence of health care disparities & their impact on patient care

Principles essential to providing patient care as a fourth-year medical student on the pediatric ward AI rotation:

  1. Taking on primary responsibility for the patient.
  2. Focusing histories, physicals, and oral and written communication appropriately.
  3. Sharing information effectively with a patient and family.
  4. Prioritizing and organizing work effectively.
  5. Anticipating what a patient will need during the course of hospitalization (i.e. when they need to be re-examined, when a lab needs to be repeated, when additional therapy is necessary, when additional history needs to be obtained, discharge criteria) and communicating this information effectively in hand-overs.
  6. Re-evaluating a patient when you take on their care (i.e. the assessment and plan, as well as the clinical status) and looking further when the clinical picture does not fit.
  7. Continuing to think about and re-assess the patient during the course of the day.
  8. Coping with uncertainty in patient care issues (i.e. knowing what you know and what you don’t know, accessing best resources, and knowing when and how to get help).
  9. Functioning as a "team player" with residents, attendings, nurses, ancillary staff and all others involved in the care of the patient.
  10. Coordinating the care of your patient during hospitalization and in planning for discharge.


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