General Pediatrics- Malcolm Grow MedicalCenter

GENERAL: As a PL-3 you will spend one month rotating through the General Pediatrics Clinic at 79th MG, Andrews AFB honing the skills of a primary care pediatrician in a busy clinic setting.

LOCATIONS: Pediatric Clinic, Malcolm Grow MedicalCenter, Andrews Air Force Base

POC: Capt Melinda Batman, Rotation Coordinator, (240)857-8072 office, Pager # 163-5327,

SCHEDULE: This rotation is designed to be a call-free rotation. You will generally see patients every 30 minutes. The daily schedule is as follow:

  • 0730Lecture (M-Thurs), Gr Rnds Fri
  • 1200Noon Conference
  • 1300Clinic

LEAVE: Allowed during this rotation after prior arrangement with Dr. Batman.

ATTIRE: Class B, khakis, or BDUs.

DIRECTIONS: Allow for an approximate travel time of 45 to 60 minutes. Directions are as follows:

  • Take I-495 East
  • Take exit 9 toward MD-337 / Allentown Rd / Andrews AFB / Morningside
  • Turn right onto Forestville Rd
  • Turn slight right onto MD-337 S / Allentown Rd
  • Turn slight left onto Robert M Bond Dr / Command Dr (first light and entrance to Andrews)
  • Turn slight right once past gate onto W Perimeter Rd
  • Proceed straight for approximately 0.5 miles
  • MalcolmGrowMedicalCenter is on the right side of the road

OTHER:

  • About 4 weeks before starting, you should get in contact with Dr. Batman, the resident coordinator to confirm that you will be arriving, review your continuity clinic schedule, and make any additional scheduling requests. During your month rotation, you will have two full-day continuity clinics instead of four half-days which must be arranged with Dr. Batman prior to your arrival.
  • The MGMC “Welcome Letter” with rotation specific goals and objective is below and also posted on the website.
  • Evaluations are important so we may accurately assess your performance and so you may have input about the rotation. Be sure to give your supervisors evaluation forms prior to leaving and have them fax your evaluations to Ms. Kinard at 301-295-5657.


DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 79TH AIRLIFT WING (AMC)

MGMC Pediatric Rotation Orientation

Welcome to Pediatrics! We hope this rotation will be an enjoyable learning experience for you.

Clinic Information

  • Andrews currently has 5 pediatricians, 2 nurse practitioners and various pediatric subspecialists who utilize our clinic to see patients.
  • Clinic phone numbers are: 240 857-2723, 240 857-8072/8092
  • To dial local phone numbers dial 99, then area code and number.
  • To dial toll free numbers dial 99, then 1 and the 800/888 number.
  • To dial long distance numbers (patient related only!) dial 98, then area code and number, pause for verbal prompt, then long distance code 6411-1141 then you should be connected.
  • GME Coordinator: Captain Melinda Batman —pager 163-5327, cell 281-543-2742, home 703-717-9086
  • Element Leader: Captain Melinda Batman – numbers as above.
  • Appointments: Mix of Wells, Routine, and Acute appts.

Daily Schedule

0730Lecture (M-Thurs), Gr Rnds Fri

0830Clinic

1200Noon Conference

1300Clinic

All Residents/Students Responsibilities

  • Notify GME coordinator ASAP (by means listed above) if you are going to be late or miss clinic.
  • Lecture begins at 0730 in the preceptors office. The lecture series will cover a range of relevant topics throughout the month. Please be on time.
  • On Friday mornings (0800-0900 )there is Grand Rounds—Internal Medicine Grand Rounds is 3 out of the 4 weeks, Pediatric Grand Rounds is usually held the 2nd Friday of the month in the 4th floor multidisciplinary room, also at 0800-0900.
  • Clinic begins each day after the morning lecture (approximately 0830), and in the afternoons at 1300. You must be on time. Your promptness/punctuality is a professionalism evaluation item and will be reflected on your end of the rotation evaluation.
  • All students/residents are required to give two morning lecture on a pediatric clinic topic of your choice. One lecture should be a clinically relevant patient encounter and be at least 30 minutes long, AND it should be a NEW TALK. The second lecture should be an pediatric article review such as from Peds in Review or Pediatrics. Please let the GME Coordinator know what topic you have chosen prior to your lecture. (NCC 3rd year—see your section for further details)
  • Since there is no weekday call for this rotation, all interns and residents will be expected to be in clinic until the end of the day, or until released by the preceptor.
  • If you have clinic or other didactics in the afternoon, inform the preceptor at the beginning of the morning.
  • Please touch base with the GME coordinator, Melinda Batman, at the beginning of the rotation to ensure that she has all of your scheduling needs accurately recorded. Please inform her ASAP of any changes to your schedule that may come up during the month. While you are here, you have patients that rely on you to be in clinic. In order to prevent re-scheduling or provider changes we need to know your schedule at all times and in a timely matter.

In clinic:

  • Review the growth chart of all patients seen, whether for a Well Baby Check (WBC) or other visit. If they have not been plotted within the last six months, plot them. Although they are usually plotted by the techs, you should still review the chart to ensure that they were plotted correctly.
  • Ask immunization status at every visit. This will help you learn the immunization schedule, and also ensures that the patient is not behind in his/her immunizations.
  • Formulate your own assessment and plan on every patient. Even if it is wrong or different from what the attending decides to do, it is an opportunity to learn and gain confidence in your diagnostic skills.
  • Although the nurses generally do venipuncture, IV placements, and urine caths, you should seek out the opportunity to do them yourself (time permitting).

FP-2 Responsibilities

  • PGY-2 residents will be given their own templates under the ALHTA, your appts will be every 20 minutes. (Find out from the front desk or daily schedule which room you have been assigned to work in for each day.) You will see and manage patients as independently as you are able. You may precept any patients with the preceptor. As you are at a higher level of training (more experience, etc) than the interns, the preceptors will expect you to display this during your precepting. You should present succinctly and cut to your direct clinical question. Be upfront about what you need help with and what you don’t: “This is a child with what seems like a URI, but I think I hear some rales, will you listen to confirm?” Or “This is a child who has evidence of an undescended testicle, when should this child be referred or is there a study I should do before referring them?”
  • If you feel a child you are seeing is sick or in need of extensive labs or studies acutely, or even hospitalization, this patient definitely needs to be precepted and/or seen by the preceptor ASAP.
  • You will demonstrate your pediatric clinical knowledge by giving a morning lecture on a clinical pediatric topic of your choice. This talk can be of any sort, but should take on more than a basic review of diagnosis and management. Push yourself and dig in to a subject to discover more about a clinical topic you feel weak on! The talk will be reviewed by the GME coordinator or another peds provider and feedback will be discussed with you following the talk.
  • All charts will be reviewed by the preceptor for that day. Please send them your charts as you finish them, for co-sign or at least at the end of the AM, and PM. Preceptors will give you feedback on your charting and management.
  • Please ask for feedback at any point. We will also try to provide feedback in a timely fashion.
  • Because you have your own template of patients, changes to your schedule need to be remedied ASAP so that patients will not be affected. This is an ACGME professionalism item, so please be prompt and responsible in letting the GME coordinator know about any changes ASAP.
  • If you are having a slow day, check with the preceptor or other clinic providers to see if they have interesting patients for you to see or are running behind and need help getting patients seen.

NCC- 3rd Year Pediatric Resident Responsibilities

  • You will see patients on your own template under AHLTA, these appts will be every 20 minutes.
  • You have all of the same responsibilities as the FP-2 (see above) but we expect even more from you!
  • You will operate mostly independently as a “staff” provider with a preceptor available for any questions. When you precept, you should feel free to cut right to your clinical question and skip the presentation…the preceptor can ask for details they need in order to help to answer your question or to help you make a clinical judgment.
  • While you are with us, your program has asked that you do one talk/presentation per week. The last of these should be a formal 45-60 minute presentation which is well researched. The remaining talks can be more informal and of any sort: journal club, current medical event review, short case presentation, CPG guideline summary, etc. Be creative. Your audience is the peds staff, FP residents, PA students, and sometimes medical students. The shorter talks should be about 30 minutes. All talks will be reviewed, and you will receive feedback following the talk. You may also be asked to do one of your lectures for the FP residents. This talk will be 45-60 minutes in length, on powerpoint and be about a pediatric case or diagnosis. The residents love talks with interesting twists, good pictures, and prefer not just another lecture with History, PE, etiology, pathophysio, treatment, etc. Something like Jeopardy, etc is always appreciated!

GOALS AND OBJECTIVES-see evaluation form for specific goals and objectives for the rotation

  • Interviewing parents, children, and adolescents, and examining infants, children, and adolescents.
  • Normal growth and development, infant and childhood nutrition, developmental milestones.
  • Common ambulatory pediatric illnesses (illnesses prompting clinic evaluation)
  • Recognition of the presentation of a seriously ill child, initial resuscitation and referral.
  • The identification of common behavioral and developmental problems, how to intervene and counsel a family, and make how to make appropriate referrals.
  • The physical and emotional problems of the child with chronic disease, and the resources available for these children/families.
  • Commonly used medications, doses, uses, side effects, contraindications, and necessary monitoring (a.k.a. using the Harriet Lane Handbook).
  • Common procedures, such as venipuncture, IV insertion, bladder catheterization, lumbar puncture, intubations.

EVALUATIONS

We will give you feedback on things that come up during the month; additionally, you may illicit/ask for feedback if you have questions or desire specific feedback. Feedback is a two-way street. The GME coordinator will compile info from all preceptors and your talks and will complete your end of the month evaluation; she will discuss this with you prior to the end of the month whenever possible. Please give us feedback on ways we can improve as well.

Capt. Melinda Batman, Pediatric GME Coordinator