Ambulatory Pediatrics

  1. Rationale

The care of children is an integral part of the scope of practice of the family physician. The family physician is uniquely suited to care for children within the framework of the entire family. This curriculum is designed to prepare the resident to care for the newborn through the age of adolescence. This curriculum has two components: the focused rotation in ambulatory pediatrics and the longitudinal experience provided in the Family Practice Center which occurs throughout the three years of residency training.

  1. Goals

Residents will be evaluated on the following six competencies, eventually achieving the expected level of a board certified family physician. Achievement of satisfactory performance levels for all six competencies will be necessary for successful completion of the rotation.

III.Objectives

Medical Knowledge/Patient Care

  1. Understand normal neonatal physiology and the transition into the infant period.
  2. Understand expected developmental milestones, changes in feeding, patterns of sleep, patterns of behavior in the neonatal, infant, toddler, preschool, and grade school child.
  3. Understand the importance of preventive services for the pediatric population.
  4. Be able to identify a child in an abnormal or unhealthy family situation.
  5. Diagnose and manage common neonatal issues such as: nutrition, hyperbilirubinemia, hypoglycemia, neonatal fever, routine newborn care, and recognition of the high-risk newborn.
  6. Be familiar with common infant/toddler issues such as: schedule for well baby examination, immunization recommendations, timing of developmental milestones.
  7. Diagnose and manage common infectious diseases: URI, otitis media, otitis media with effusion, otitis externa, sinusitis, pneumonia, meningitis, sepsis, UTI’s, tonsillitis, and mononucleosis.
  8. Diagnose and manage diseases of the respiratory system such as: reactive airway disease, croup, epiglottitis, foreign body aspiration, and tuberculosis.
  9. Diagnose and manage diseases of the cardiovascular system: evaluation of heart murmurs, rheumatic fever, Kawasaki’s disease, congenital heart disease, essential hypertension, and SBE prophylaxis.
  10. Diagnose and manage diseases of the hematologic system such as: iron deficiency anemia, hemolytic disease of the newborn, sickle cell anemia, hemophilia, evaluation of lymphadenopathy, and myeloproliferative disorders.
  11. Diagnose and manage diseases of the neurologic system such as: febrile and idiopathic seizures, hydrocephalus, headache, head injury, cerebral palsy, and congenital neurological disorders.
  12. Diagnose and manage common orthopedic problems such as: in-toeing, out-toeing, genu varus, genu valgus, the child with a limp, “growing pains”, common fractures and dislocations, and the sports physical.
  13. Diagnose and manage diseases of the dermatologic system such as: atopic dermatitis, contact dermatitis, acne, impetigo, viral exanthems, pediculosis, scabies, dermatophyte infections, and pigmented lesions.
  14. Diagnose and manage diseases of the genito-urinary system such as: UTI, hematuria, proteinuria, pyelonephritis, enuresis, toilet training, congenital GU deformities, hydrocele, cryptochordism, and hernia.
  15. Diagnose and manage disease of the gastrointestinal system such as: issues of good nutrition, colic, pyloric stenosis, abdominal pain, constipation, encopresis, malabsorption, gastroenteritis, parasitic infestations, Meckel’sdiverticulum, volvulus, and intussusception.
  16. Diagnose and manage disease of the endocrine system such as: abnormal growth patterns, precocious puberty, diabetes mellitus, hyper/hypothyroidism, and inborn errors of metabolism.
  17. Diagnose and manage ophthalmologic issues including: conjunctivitis, strabismus, amblyopia, periorbital cellulitis, myopia, foreign bodies, and nasolacrimal duct obstruction.
  18. Diagnose and manage allergic conditions such as: rhinitis, food intolerance, insect bites, skin testing, anaphylaxis and desensitization.
  19. Diagnose and manage psychiatric and behavioral issues such as: strategies for discipline, corporal punishment, ADD, depression, conduct disorder, adjustment disorders associated with major life events (divorce, death, terrorism, war).

20. Residents will strive to perform and gain competence in the following:

  1. Venipuncture and peripheral blood smear interpretation, arterial blood gas sampling and interpretation, and IV placement
  2. Throat culture
  3. Indication for and interpretation of chest, sinus, lateral neck, skull, abdominal, and sinus x-rays
  4. Preparation and administration of nebulization solution for reactive airways disease
  5. Basic ECG interpretation and auscultation of heart murmurs
  6. Urethral catheterization and microscopic examination of the urine with interpretation
  7. Lumbar puncture
  8. Transillumination of the sinuses
  9. Transillumination of the scrotum
  10. Wet prep examination of vaginal secretions
  11. Guaiac of stool specimens
  12. Nasogastric tube placement
  13. Foreign body removal from the eye, nose and ears
  14. Circumcision

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other

Interpersonal/Communication Skills

  1. Learn to effectively communicate with parents of pediatric patients.
  2. Learn to adopt nonthreatening body language when communicating and examining a pediatric patient.
  3. Learn how to provide appropriate counseling with regard to immunizations; their risks, benefits, and how to deal with parents who decline them.
  4. Learn how to provide age appropriate anticipatory guidance.
  5. Gain self-awareness of one's own attitudes toward potentially controversial issues such as breast feeding, feeding practices, corporal punishment, and toilet training and be able to provide unbiased, non-judgmental guidance.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

  1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.
  2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  3. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
  4. Arrive at the clinic in a timely fashion to see patients and attend morning report.
  5. Work effectively as a member of a team.
  6. Respect patient privacy by guarding medical records and discussion of personalinformation about patients.
  7. Assist patients and their families in planning for future care needs and care decisionsbased on prognosis for the disease.
  8. Support the patient in their healthcare decisions.
  9. Demonstrate professional, respectful demeanor when addressing team members, patients,ancillary staff, and consultants.
  10. Appear professionally dressed and well groomed.
  1. Completes clinic notes, referrals in a timely fashion.
  2. Attends required didactics, conferences.
  3. Responds to pages and clinic messages in a timely fashion.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other

Practice-based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

  1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.
  2. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
  3. Obtain and use information about their own population of patients and the larger population from which their patients are drawn.
  4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
  5. Use information technology to manage information, access on-line medical information; and support theirown education.

6. Learn to incorporate health promotion and disease prevention into patient care.

7. Use evidence-based medicine, evaluation of available evidence, and use of best-available

evidence at morning report meetings and during routine clinical care.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

Systems-based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

  1. Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
  2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
  3. Practice cost-effective health care and resource allocation that does not compromise quality of care.
  4. Advocate for quality patient care and assist patients in dealing with system complexities.
  5. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.
  6. Understand and be able to code effectively for health maintenance visits.
  7. Be able to implement a charting system that documents developmental milestones, anticipatory guidance, immunizations, and screenings.
  8. Understand the medico-legal aspects of reporting suspected child abuse.

9. Acknowledge the impact of one’s own beliefs and experiences with child rearing upon

one’scurrent practices.

10. Become familiar with the available resources in the community for children and families

withspecial needs.

11. Be able to formulate an appropriate consult to the resources available.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

IV. Instructional Strategies (see above)

  1. Direct patient care 3.0 days per week in Ambulatory Pediatrics site and 1.5 days per week in the Family Medicine Clinic at Dunwoody and 0.5 day in didactics.
  2. Completing a thorough H&P, assessment, differential diagnosis, and plan to be presented to the faculty member and pediatric attending as appropriate to the particular setting.
  3. Weekly didactics, before clinic conferences, and Pediatrics conferences
  4. Associated rotations for additional ambulatory pediatrics experience: Family Medicine Clinic, Pediatric Wards, Emergency Medicine
  5. Required readings of the following Monographs:

338 Children’s Office Emergencies (2007)

300 Update in Children’s Health (2004)

312Well Child ages 2 months to 2 years (2005)

313Well Child ages 2 to 18 years (2005)

V. Evaluation Strategies (see above)

  1. Observation by Pediatric and Family Medicine attending
  2. Review of resident’s clinic notes and discussion of the assessment and plan
  3. Procedure documentation by the resident
  4. End of rotation evaluation
  5. Family Medicine and Pediatrics Conference attendance
  6. In-training exam profiles
  7. Resident evaluation of rotation and faculty

H. Completion of required readings and scoring >90% on open book Monograph quizzes

VI. Implementation Methods

This curriculum is reinforced in two ways. There is a focused four-week rotation that takes place at the Grady Neighborhood Health Clinics. During the rotation the resident will actively participate in the management of pediatric patients under the direct supervision of the attending physician. The resident will also experience a longitudinal exposure to ambulatory pediatrics in the family medicine continuity clinic. The resident will spend six ½ days per week at the rotation site, three ½ days per week in continuity clinic, and one ½ day in didactics. Readings can be obtained from section IV and should also be solicited from the Residency Support Staff.

Contact Information

Mamie Phillips, MD, Peds

Betti Jo Steele, MD, Peds

Asa G. Yancey Health Center

1247 Donald Lee Hollowell Pkwy

Atlanta, GA 30318

404-616-2265 ofc

404-616-2825 fax

Practice Manager: Steven Juhase, 404-616-9922 ofc

Dawn Swaby-Ellis, MD, Peds

Elaine Poirier-Elliott, RNP, MPH, Peds

North Dekalb Health Center

3806 Clairmont Road, NE

Chamblee, GA 30341

404-616-0700 ofc

404-616-3078 fax-

Practice Manager – Michelle Skipper

VII. Rotation Schedule

FMC = Family Medicine Clinic: 3 half days/week

Peds = Ambulatory Pediatric Clinic: 6 half days/week

Didactics = 1 half day on Thursday AM/week

*Nursing Home Visit = 1 half day/month

Last Updated April 19, 2013