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Care of Children

Overview

The main objective of this rotation is to become proficient at managing pediatric patients both in the inpatient and outpatient setting.  During this rotation the pediatric residents look after all the pediatric cases in both the nursery and the pediatric floor.  The residents enjoy working with all the local community pediatricians.  We are fortunate to have a pediatrician who is allergy, asthma and immunology Board certified, Dr. Jeffrey Rosch.  In addition to this there are several pediatric groups that the residents work with.  Pediatrics is one of the topics covered by our noon conference series and frequent lectures and/or case presentations are given by Dr. Younes, and Dr. Sponsler.  We are very fortunate at AFP to have the most experienced pediatrician in the community on our faculty. Dr. Rodney Sponsler is available for one-on-one teaching to discuss hospital cases and see patients in the office and pass on his many clinical pearls. During the pediatric rotation the residents also work with visiting pediatric cardiologists from Hershey Medical Center and Geisinger Hospital. 

First Year Pediatrics

Typical day

The first year on pediatrics begins the day by rounding on the pediatrics patients on the pediatrics floor.  The day then continues in an outpatient setting, usually with one of the local pediatricians working in the AFP office with Dr. Rodney Sponsler focusing on pediatric cases.  

Second and Third Year

Overview

Second and third year residents start the day by making rounds in the newborn nursery with the pediatrician.  They then follow the pediatrician to the pediatric floor to complete rounds with first year resident before either going to spend time with Dr. Sponsler or work with continuity patients or spending the day with one of our local six pediatrician private practice groups.  As much time as possible is spend in hands on pediatric care. 

Pediatric Electives

Overview

These are available both locally with one of the private pediatrician groups or further field locations such as the children's hospital in Pittsburgh or Philadelphia.  Residents work with their faculty advisor to tailor their electives to suit their needs.  

Other Teaching Resources

All the residents with Altoona Family Physicians become certified in Neonatal Resuscitation and Pediatric Advanced Life Support.  There is a well-equipped library at Altoona Hospital in addition to a library at the AFP office containing a wide range of pediatric textbooks.  The pediatric curriculum is also supported by pediatric topics covered in the noon conference series and by one-on-one time spent in tutorial and working with AFP pediatric cases with Dr. Rodney Sponsler. 

Night Float

The night float resident start at 6:00 at night and care for patients and do admissions (including pediatric admissions) until morning report the next day.  They do this Sunday night to Thursday night.  On Friday they see patients and have the weekend off.

Altoona Family Physicians 

Pediatric Rotation Goals and Objectives

Resident Year:                       PGY-1, PGY-2 and PGY-3

AFP Faculty Contact:           Fiona M^cLellan, MD

Rotation Description:

Inpatient Component:

            Two months in the first year and one month in each of the second and third year is spent on the Pediatrics rotation.  Residents on this rotation admit and manage pediatric patients under the supervision of attending pediatricians, attending family physicians, and family practice faculty.  Residents may be involved in the care of specialists' pediatric patients as well.  Primary patient care of all patients on the pediatric floor is provided by the first-year residents under the supervision of a second or third-year resident.  The residents write progress notes and orders after discussing the patients care plan with the attending physicians.  The second and third year resident also rounds on nursery patients under the supervision of the pediatric attending before meeting the first year resident on the pediatric floor to complete pediatric rounds.

Ambulatory Component:

            Residents see pediatric age patients in the FMC one half day per week (in addition to the usual 1/2 day per week continuity of care patients) under supervision of FMC faculty and Dr Sponsler while on Pediatrics.  The PGY-1 resident also spend one half day per week with Dr Rosch and Blair Medical Associates Pediatricians in their private offices.  In the second and third year the pediatrics resident spends 4 half days per week seeing patients in the offices of Pediatricians Drs D'Cruz, Moussa, Aswathappa, Younes and Youssef.  Residents also manage pediatric patients in their own panel of continuity patients. 

Goal:

 The overall goal of the Pediatrics curriculum is to train family medicine residents to provide comprehensive care including emergency care to children of all ages.  The specific ACGME competency-based goals and objectives for this curriculum are outlined below, noting that there is significant overlap between competency areas.

 Patient Care:

Goal:

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

 Competencies:

 Objectives:

 PGY-1 residents are expected to:

PGY-2 and PGY-3 residents are expected to:

Medical Knowledge:

Goal:

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies:

Objectives:

PGY-1 residents are expected to:

PGY-2 and PGY-3 residents are expected to:

Practice- Based Learning and Improvement

Goal:

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies:

Objectives:

All residents are expected to: 

PGY-2 and PGY-3 residents are expected to:

Systems Based Practice:

 Goal:

 Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

 Competencies:

Objectives:

All residents are expected to:

Professionalism:

Goal:

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies:

Objectives:

All residents are expected to demonstrate:

Interpersonal and Communication Skills:

Goal: 

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies:

 Objectives: 

All residents are expected to:

 Teaching Methods:

The pediatrics curriculum is taught during the Pediatrics rotation and longitudinally as described below:

Assessment Method (residents):

Each resident on the Pediatrics rotation is evaluated using a competency-based evaluation tool at the end of the rotation.  These evaluations are reviewed by the family medicine faculty quarterly and reviewed with the resident at the resident’s quarterly evaluation.  Specific resident evaluations include:

·         Evaluation by resident peers (senior resident is evaluated by the intern; the intern is evaluated by the senior resident).

·         Evaluation by the Pediatric attending physicians. 

·         Evaluation by nursing staff.

Assessment Method (Program Evaluation):

·         Each resident (intern and senior resident) is expected to complete a written evaluation of the Pediatrics rotation and of the Pediatric attending physicians each month that they are on pediatrics.  These evaluations are reviewed by the faculty member that coordinates the pediatrics curriculum.

·         The pediatrics curriculum is reassessed annually as part of the Altoona Family Physicians annual curricular review.

Level of Supervision:

Educational Resources:

Behrman RE, Kliegman RM, Jensen AB, eds. Nelson Textbook of Pediatrics. 18th ed.

Philadelphia, Pa.: Saunders, 2007.

Levetown M, American Academy of Pediatrics Committee on Bioethics. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics 2008 May;121(5):e1441-60. [256 references] available online www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=13404

 AAFP FP Essentials Monographs:

Hagan JF Jr., Shaw JS, Duncan PM. Bright futures: guidelines for health supervision of

infants, children and adolescents. 3rd ed. Elk Grove Village, Il: American Academy of

Pediatrics, 2008.

Hagan JF, Shaw JS, Duncan PM. Bright futures: guidelines for health supervision of

infants, children and adolescents: pocket guide. 3rd rev. Elk Grove, Il: American

Academy of Pediatrics, 2008.

AAP Red Book 2006, new edition available 6/09

www.aap.org

www.cdc.gov

www.cispimmunize.org for current immunization schedules

www.pediatriceducation.org for case presentations with pertinent teaching points highlighted

Sample Schedule:

PGY-1:

Each day starts with rounds on the Pediatric floor.  At the end of the day sign-out is given to the night float resident.

 BMAP = Blair Medical Associates Pediatrics

 PGY-2 or PGY-3:

 Each day begins with rounds in the Nursery.

PHCA = Pediatric Health Care Associates