PEDU-4078 - Introduction to Caring for Children with Medical Complexities

PEDU-4078 - Introduction to Caring for Children with Medical Complexities

Elective Title: Introduction to Caring for Children with Medical Complexities
Course Number: PEDU-4078
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Interest in Pediatrics or Med/Ped residency
Responsible Faculty Director: Dr. Suzanne La Forte Periods Offered: 8  including holiday period 8 
Coordinator: Tiffany Swain Other Faculty: Sally Robinson, MD
Location to Report on First Day:
UTMB Pediatric Complex Care Clinic at Bay Colony

1. The student will begin to explore 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 begin to develop skills and values appropriate to care for children with a chronic condition through introduction to ethics topics related to this patient population.
4. The student will develop an introductory knowledge base of conditions resulting in medical complexity for pediatric patients.

Objectives for chronic conditions:
1. Students be introduced to the basic medical problems of the most frequent chronic conditions, i.e. spina bifida, cerebral palsy, intellectual disability, 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 and develop basic understanding of how families may access these in the community..
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 explore the difference between cure, improved function, and palliation.
2. The students will start to explore the ethical dilemmas associated with high tech medicine and low tech social policy.
3. The students will be start to explore the importance of leisure time and spirituality in functional living.
4. The students will be able to identify some financial issues: i.e. 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. Complete appropriate medical documentation acceptable for level of training.
3. Attend Complex Care Clinic and any other assigned supplemental activity (therapy sessions, diagnostic studies, etc.).
4. Complete pertinent materials pertaining to patient cases and discuss learning issues throughout the week.
6. Participate in patient developmental evaluations and other team member interactions.

Type of students who would benefit from the course
Students considering a career in pediatrics, Internal Medicine/Pediatrics, physical medicine/rehab, psychiatry, family medicine, or neurology.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00 5:30
Tuesday 8:00 5:30
Wednesday 8:00 5:30
Thursday 8:00 5:30
Friday 8:00 5:30

 Average number of patients seen per week: 20-30
 Call Schedule: N/A

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?
    Multidisciplinary complex care team, including faculty physician
  B. Frequency / Duration of Presentation(s)?
    1-2 day
  C. Format - What guidelines are set for the student's presentation?
  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 for assigned patients. Short essay for assigned online module(s).
  B. Format - What guidelines are set for the student's written work?
    Appropriate medical record documentation. Completion of assignment with appropriate depth and scope of response.
  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?
    References as needed. Student selected with faculty assistance/direction if needed.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    As related to patient case load and student selected.
  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)?
    1. Completion of pediatric to adult care transition online educational module. 2. Completion of Design-a-Case module for child with medical complexity.

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.

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.

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.