La Rabida Inpatient Rotation PL2 Residents

Transcription

1 PL2 Residents Residents rotate through the inpatient service at La Rabida Children s Hospital and Research Center over 1-2 months during the second year of residency. The inpatient service is separated into 2 teams, each comprised of 2 residents, an attending physician, and 1 medical student. Residents take in-house call every fourth night. During this rotation, continuity clinic is maintained and prioritized. Residents are required to attend all scheduled meetings and conferences except when detained by a medical emergency on the wards. Residents will be exposed to children with chronic disease, disabilities, physical and/or sexual abuse, failure to thrive, and elimination disorders. They have extensive exposure to both acute and chronic conditions in these patient populations. They are expected to demonstrate sensitivity and a positive, supportive and hopeful attitude to the treatment and rehabilitation of these children. Residents are the primary givers for their patients and follow their over the course of their month of service. As such, the resident is expected to perform a complete history and physical examination, formulate a differential diagnosis and working diagnosis, and develop a treatment plan appropriate to the suspected diagnosis or condition. Any questions, concerns, or issues regarding the medical plan should be discussed with the attending physician. The rotation seeks to emphasize several principles essential to the practice of pediatrics: Patients should be evaluated thoroughly taking into consideration not only medical/organic aspects of disease, but also the psychological, social, and environmental considerations Although the members of the medical team are the primary givers, the residents and attending physicians should work in close collaboration with ancillary staff, such as nutritionists, social workers, nurses, respiratory therapists, rehabilitative services, pharmacists and hospital school teachers, among others Continuum of is essential in pediatric and discharge planning, follow-up, and communication with primary physicians, either in writing or by telephone, is stressed Care to the pediatric patient should be of the highest standard, and cost-containment, quality, and risk management should be continually assessed A. Patient Care: 1. Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures 2. Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference 3. Develop, negotiate and implement effective patient management plans and integration of patient 4. Construct an individualized treatment plan for these complex patients B. Medical Knowledge: 1. Examine the of hospitalized patients with chronic diseases, including children who are chronically ill and children with acute exacerbation of chronic diseases 2. Develop a practical approach to the long-term of children with disabilities using a problembased approach 3. Demonstrate utilization of the many services available for the of children with disabilities 4. Treat otherwise healthy children with acute illnesses, as well as children with chronic disease who Updated

2 PL2 Residents have acute exacerbations of their disease process 5. Develop competencies in caring for children with various medical devices, including tracheotomies, mechanical ventilators, central venous access, and gastrostomy tubes 6. Demonstrate an understanding of the following topics during their rotation through clinical experience, didactic sessions or reading which includes, but is not limited to: o Asthma and environmental allergies o Chronic lung disease o Burns o Cerebral palsy o Child maltreatment o Chromosomal abnormalities o Developmental abnormalities o Diabetes mellitus o Down Syndrome o Encopresis o Enuresis o Failure to thrive o Juvenile rheumatoid arthritis o Lead poisoning o Physical disability o Sickle cell disease o Systemic lupus erythematosis o Traumatic brain injury Procedures to be reviewed and learned o Tracheostomy tube change o Arterial or venous blood gas collection o Nasogastric tube placement C. Practice-Based Learning and Improvement: 1. Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of 2. Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice 3. Develop and maintain a willingness to recognize and learn from errors and consequently improve the system or processes of 4. Use information technology or other available methodologies to access and manage information, support patient decisions, and enhance both patient and physician education 5. Develop teaching programs for residents and students D. Interpersonal and Communication Skills: 1. Provide effective and professional consultation to other physicians and health professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues 2. Demonstrate effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families Updated

3 PL2 Residents 3. Interact with consultants in a respectful, timely, and appropriate manner 4. Maintain comprehensive, timely, and legible medical records 5. Complete evaluations of the attending physician, staff, medical students, and rotation 6. Give age-appropriate anticipatory guidance including discussions of health promotion and disease prevention and control 7. Give timely feedback to colleagues regarding knowledge, performance, teaching, and communication 8. Develop skills to provide an appropriate sign-out to ensure safe patient 9. Recognize the importance of transfer of information in the safe of the hospitalized child E. Professionalism: 1. Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues 2. Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues 3. Adhere to principles of confidentiality, scientific/academic integrity, and informed consent 4. Recognize and identify deficiencies in peer performance and deliver constructive evaluation and criticism F. Systems-Based Practice: 1. Assess the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize for the individual patient 2. Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management 3. Collaborate with other members of the health team to assist patients in dealing effectively with complex systems and to improve systematic processes of 4. Recognize the signs and symptoms that lead to the early identification of risky behaviors and to gain familiarity with the appropriate interventions including family and community resources 5. Consistently r the cost of medical and become judicious in the use of medical tests and hospitalization 6. Demonstrate an understanding of the impact insurance status has on acquisition of appropriate health as an inpatient and outpatient 7. Assess the family s response to childhood chronic disease and incorporate the family into the plan 8. Discover the impact chronic disease has on families 9. Participate in and develop the ability to lead the multidisciplinary teams required to provide for complicated, chronically ill patients. This includes physicians, nurses, physical therapists, occupational therapists, speech therapists, social workers, infant development specialists and clinical psychologists 10. Organize and lead the multidisciplinary effort for patient discharge and adequate continuity of Updated

4 PL3/4 Residents The inpatient service is separated into 2 teams, each comprised of 2 residents, an attending physician, and 1 medical student. Residents take in-house call every fourth night. During this rotation, continuity clinic is maintained and prioritized. Residents are required to attend all scheduled meetings and conferences except when detained by a medical emergency on the wards. Residents will be exposed to children with chronic disease, disabilities, physical and/or sexual abuse, failure to thrive, and elimination disorders. They have extensive exposure to both acute and chronic conditions in these patient populations. They are expected to demonstrate sensitivity and a positive, supportive and hopeful attitude to the treatment and rehabilitation of these children. Residents are the primary givers for their patients and follow their over the course of their month of service. As such, the resident is expected to perform a complete history and physical examination, formulate a differential diagnosis and working diagnosis, and develop a treatment plan appropriate to the suspected diagnosis or condition. Any questions, concerns, or issues regarding the medical plan should be discussed with the attending physician. The rotation seeks to emphasize several principles essential to the practice of pediatrics: Patients should be evaluated thoroughly taking into consideration not only medical/organic aspects of disease, but also the psychological, social, and environmental considerations Although the members of the medical team are the primary givers, the residents and attending physicians should work in close collaboration with ancillary staff, such as nutritionists, social workers, nurses, respiratory therapists, rehabilitative services, pharmacists and hospital school teachers, among others Continuum of is essential in pediatric and discharge planning, follow-up, and communication with primary physicians, either in writing or by telephone, is stressed Care to the pediatric patient should be of the highest standard, and cost-containment, quality, and risk management should be continually assessed A. Patient Care: 1. Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures 2. Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference 3. Develop, negotiate and implement effective patient management plans and integration of patient 4. Construct an individualized treatment plan for these complex patients B. Medical Knowledge: 1. Examine the of hospitalized patients with chronic diseases, including children who are chronically ill and children with acute exacerbation of chronic diseases 2. Develop a practical approach to the long-term of children with disabilities using a problembased approach 3. Demonstrate utilization of the many services available for the of children with disabilities 4. Treat otherwise healthy children with acute illnesses, as well as children with chronic disease who have acute exacerbations of their disease process 5. Develop competencies in caring for children with various medical devices, including tracheotomies, Updated

5 PL3/4 Residents mechanical ventilators, central venous access, and gastrostomy tubes 6. Demonstrate an understanding of the following topics during their rotation through clinical experience, didactic sessions or reading which includes, but is not limited to: o Asthma and environmental allergies o Chronic lung disease o Burns o Cerebral palsy o Child maltreatment o Chromosomal abnormalities o Developmental abnormalities o Diabetes mellitus o Down Syndrome o Encopresis o Enuresis o Failure to thrive o Juvenile rheumatoid arthritis o Lead poisoning o Physical disability o Sickle cell disease o Systemic lupus erythematosis o Traumatic brain injury Procedures to be reviewed and learned o Tracheostomy tube change o Arterial or venous blood gas collection o Nasogastric tube placement C. Practice-Based Learning and Improvement: 1. Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of 2. Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice 3. Develop and maintain a willingness to recognize and learn from errors and consequently improve the system or processes of 4. Use information technology or other available methodologies to access and manage information, support patient decisions, and enhance both patient and physician education 5. Develop teaching programs for residents and students D. Interpersonal and Communication Skills: 1. Provide effective and professional consultation to other physicians and health professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues 2. Demonstrate effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families 3. Interact with consultants in a respectful, timely, and appropriate manner 4. Maintain comprehensive, timely, and legible medical records Updated

6 PL3/4 Residents 5. Complete evaluations of the attending physician, staff, medical students, and rotation 6. Give age-appropriate anticipatory guidance including discussions of health promotion and disease prevention and control 7. Give timely feedback to colleagues regarding knowledge, performance, teaching, and communication 8. Develop skills to provide an appropriate sign-out to ensure safe patient 9. Recognize the importance of transfer of information in the safe of the hospitalized child E. Professionalism: 1. Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues 2. Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues 3. Adhere to principles of confidentiality, scientific/academic integrity, and informed consent 4. Recognize and identify deficiencies in peer performance and deliver constructive evaluation and criticism F. Systems-Based Practice: 1. Assess the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize for the individual patient 2. Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management 3. Collaborate with other members of the health team to assist patients in dealing effectively with complex systems and to improve systematic processes of 4. Recognize the signs and symptoms that lead to the early identification of risky behaviors and to gain familiarity with the appropriate interventions including family and community resources 5. Consistently r the cost of medical and become judicious in the use of medical tests and hospitalization 6. Demonstrate an understanding of the impact insurance status has on acquisition of appropriate health as an inpatient and outpatient 7. Assess the family s response to childhood chronic disease and incorporate the family into the plan 8. Discover the impact chronic disease has on families 9. Participate in and develop the ability to lead the multidisciplinary teams required to provide for complicated, chronically ill patients. This includes physicians, nurses, physical therapists, occupational therapists, speech therapists, social workers, infant development specialists and clinical psychologists 10. Organize and lead the multidisciplinary effort for patient discharge and adequate continuity of Updated