PEDU-4024 - Acting Internship - Pediatric Chronic Care Rehabilitation

PEDU-4024 - Acting Internship - Pediatric Chronic Care Rehabilitation

Elective Title: Acting Internship - Pediatric Chronic Care Rehabilitation
Course Number: PEDU-4024
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Pediatric Clerkship
Responsible Faculty Director: Christine Murphy, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Other Faculty: Sally Robinson, MD
Location to Report on First Day:
An email will be sent with instructions.

1. The student will be able to describe the psychological, social, and financial impact of chronic illness in childhood on the child, the family, professional care-givers and society. 2. The student will define the role of the pediatrician in working with the family and with health and educational professionals to provide and/or coordinate care of the child with chronic illness. 3. The student will develop skills and values appropriate to care for children with a chronic condition.

1. Students will understand the basic medical problems of the most frequent chronic conditions, i.e. spina bifida, cerebral palsy, mental retardation and traumatic brain injury. 2. Students will be able to describe the function of the allied health professionals in a rehab setting. Objectives on family: 1. Students will be able to describe the make-up of a traditional and not so traditional family. 2. They will be able to elicit the information about support systems. 3. They will be able to describe the differences in cultural family values. 4. They will be able to discuss the impact of the chronically ill child on families (functional/dysfunctional). 5. Students will be able to describe the impact of chronic illness on the siblings of the chronically ill child. 6. They will be able to elicit and chart family information. Objectives on bioethical and social issues: 1. The students will be able to describe the difference between cure and improved function. 2. The students will be able to discuss the ethical dilemmas associated with high tech medicine and low-tech social policy. 3. The students will be able to discuss the importance of leisure time and spirituality in functional living. 4. The students will be able to describe financial issues: cost of care, impact of that cost on families, ethical decisions related to cost.

Description of course activities
1. Perform history and physical exam on all assigned patients. 2. Write histories and physicals in acceptable manner. 3. Participate on inpatient rounds in the role as an intern. 4. Attend Special Services Clinic 5. Read appropriate materials pertaining to assigned patients and present relevant information on rounds. 6. Attend all team conferences and family meetings.
Students will have about 35 hours a week of faculty time and about 8 hours a week for self-directed study

Type of students who would benefit from the course
Anyone interested in pediatrics, physical medicine, psychiatry, family medicine, neurology, or any subspecialty that has individuals with chronic illness.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 am - noon 1 pm - 5:30 pm
Tuesday 8:00 am - noon 1 pm - 5:30 pm
Wednesday 8:00 am - noon 1 pm - 5:30 pm
Thursday 8:00 am - noon 1 pm - 5:30 pm
Friday 8 am - noon 1 pm - 5:30 pm
Saturday none none
Sunday none none

 Average number of patients seen per week: 10-15
 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?
  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?
    Faculty in Childrens Inpatient Unit and Special Services Clinic.
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Usual teaching format as house staff.
  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)?
    Clinic notes, generally 1-2 per day
  B. Format - What guidelines are set for the student's written work?
    Appropriate medical record documentation.
  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?
  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)?
    Thoughtful questions and discussion in conferences, current literature review in topic areas pertinent to patients.

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.
    A narrative summary and grade card that will be discussed with the student and filed at the Office of the Registrar. Design-a-case module and Blackboard Pediatric-to-Adult-Care Transitions module. Completion of self-selected project.

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.
    Students will be given real-time feedback after evaluation of patients and presentations.

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.
    Students will practice complex history taking and physical exam. They will have the opportunity to research and interpret complicated diagnostic tests.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Students may have the opportunity to assist with gastrostomy and tracheostomy tube changes and fitting with assistive devices.

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)?
    Acting interns will assume similar responsibilities including medical record documentation and teaching.

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?
    The course will help broaden the perspective of the student such that they may be a much more holistic, discerning clinician.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Midpoint feedback will be provided verbally. Deficiencies will be remediated in real time with conversation and tasks aimed at deficiencies.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Provided verbally in context of weekly presentation time, usually with Dr. Murphy. Students will be given opportunity to focus on areas of weakness/deficiencies the following weeks until successfully improved.

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.
    Students will encounter 2 faculty members who will primary in their experiences and will be able to supervise and evaluate for a letter of recommendation. Students may also receive some degree of supervision from the clinic nurse practitioner. Supervision for clinic is provided primarily by these faculty members, although on occasion, a resident may be present.