PEDU-4047 - Acting Internship-Ambulatory Pediatrics

PEDU-4047 - Acting Internship-Ambulatory Pediatrics

Elective Title: Acting Internship-Ambulatory Pediatrics
Course Number: PEDU-4047
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Successful completion of the Pedi Clerkship. NOTE: C form is required, send to Tiffany Swain ( & Supervisor approval prior to registration.
Responsible Faculty Director: Maria San Andres, MD Periods Offered: 2-7, 9, 12, 13 excluding holiday period 8 
Coordinator: Tiffany Swain Other Faculty: Division of General Academic Pediatrics
Location to Report on First Day:
Primary Care Pavilion-Pediatric Clinic, Suite 103

1. Gain experience in the providing compassionate and effective health care for Pediatric patients.
2. Independently collect both focused and comprehensive histories, perform physical examinations, formulate differential diagnoses, order appropriate laboratory and screening tests and develop a prioritized management plan for children and adolescents in an outpatient setting.
3. Recognize patients requiring immediate attention by supervising physician.
4. Formulate appropriate orders, write notes and prescriptions

1. Demonstrate competency in independently performing a well child check with required screening tests and follow-up across all ages
2. Identify developmentally normal and developmentally delayed children during well child visits.
3. Discuss anticipatory guidance and health maintenance topics (e.g., safety counseling) at each well child visit.
4. Demonstrate competency in diagnosis and management of common childhood/adolescent conditions (acute respiratory and GI infections, common infections, dermatological disorders, allergy/asthma, behavior problems and Attention Deficit Hyperactivity Disorder)
5. Gain knowledge of general clinic function, operations, and appointment systems in the ambulatory setting
6. Gain knowledge of the role of advocacy in the practice of medicine
7. Demonstrate competency in basic healthcare systems skills, especially writing prescriptions, calling pharmacies, communicating with parents by phone in reference to their child’s medical visit, general usage of Electronic Medical Record to the extent allowed by this institution, learning appropriate indications for referral to ancillary services and various community services to aid in the care of a child.

Description of course activities
The student will be present in the general pediatric/adolescent clinic 4 1/2 days per week. There will be an orientation in Week 1 on Monday at 8:00am. He/she will take histories, examine patients, formulate diagnoses, and develop treatment plans for children and adolescents who are seen in the general pediatrics clinic in the Primary Care Pavilion. There will be close faculty supervision and review of all cases. The general schedule will consist of 2 patients per half day assigned to AI during week one and then increased to 3-4 patients per half day. Clinic notes should be completed within 24 hours of seeing patients.

Type of students who would benefit from the course
Students interested in specializing in general pediatrics, combined medicine/pediatrics, or family medicine would particularly benefit from this course.

Half day off subject to change based on preceptor's schedules.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Wk 1 Orient-wk2-4 study- off Pediatric clinic
Tuesday Pediatric clinic Pediatric clinic
Wednesday Pediatric clinic Pediatric clinic
Thursday Pediatric clinic Pediatric clinic
Friday Pediatric clinic Pediatric clinic

 Average number of patients seen per week: 27
 Call Schedule: None

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Faculty preceptor examines each child after student presents findings; oral feedback on history, physical exam, assessment, and plan are given to student regarding each patient.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    To the Faculty Preceptor
  B. Frequency / Duration of Presentation(s)?
    The student will present each patient he/she examines to the faculty preceptor.
  C. Format - What guidelines are set for the student's presentation?
    SOAP format is used for acute care visits; EMR template or form is followed for well child visits.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    The student will write up a history, physical, assessment, and plan for each patient seen.
  B. Format - What guidelines are set for the student's written work?
    SOAP format is used for acute care visits; well-child-care template form is followed for well child visits.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    students are expected to use current resources including but not limited to the internet.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    There is no examination. The student should write a brief list of goals to be achieved during this rotation. The student will be expected to present to clinic by 8 am every morning and 1 pm every afternoon and stay until all patients are seen (usually 12:00pm and 5:30pm). The student will also be encouraged to attend Grand Rounds, and other didactic offerings as permitted by the patient load.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The student will work with various clinic faculty members over the course of the rotation. Those faculty members will communicate their assessments of the student to the course director, who will complete the end-of-course evaluation form.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    They will receive daily feedback as they are engaged with a one on one process with faculty

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    physical exam skill needed to evaluate and determine needs in all areas of physical exam and diagnosis

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    They will be expected to see a patient, take a history and diagnosis and formulate a treatment plan that is applicable to the patient. They will be given gradually increasing responsibility for increasing numbers of patients based on their demonstrated skills. They should take ownership of each patient following up labs by contacting parents. If patient is needing follow up, will be made on their schedule so they can have continuity (ex. Bili, ADHD, or sick)

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    After this course a student should be ready to function well in an ambulatory setting as a PGY-1. It will solidify skills and judgement as well as knowledge bases that are needed to begin the task as a PGY-1 in an ambulatory setting.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    Directly from the faculty. The student will work with up to 4 different faculty, but one will be the primary faculty who provides evaluation a mid-point feedback.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Pediatric ambulatory minor trauma Septic evaluation in newborns

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Directly from the faculty. The student will work with up to 4 different faculty but one will be the primary faculty who provides summative evaluation a mid-point feedback.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    They will encounter up to 4 faculty but will often find one faculty that is predominant. They will have 8-12 sessions with many of the faculty