PGY-1 Pediatric Medicine - University of Chicago (elective)

The Inpatient pediatric experience has been designed to develop the needed competencies for an intern to manage patients with a wide array of conditions requiring hospitalization, from the perspective of a general pediatrician. As an intern, the general pediatrics inpatient experience comprises 1-2 months of service  at Comer Children’s Hospital at the University of Chicago.  This monthly rotation is organized with a team consisting of two day senior residents and 4 interns. The four interns are responsible for Q4 in-house 16-hour overnight call on their service, and are supervised overnight by two alternating night senior residents to maintain continuity of care.  Residents are required to attend all scheduled meetings and conferences except when detained by a medical emergency on the wards.

While on this rotation the intern is expected to act as primary physician for the designated patients. The intern is expected to perform a complete history and physical exam, formulate a differential diagnosis and working diagnosis, and develop a treatment plan appropriate to the suspected diagnosis or condition, all under the supervision of a senior resident with whom all aspects of care are discussed. Interns are then expected to follow their patients throughout the length of the rotation, being responsible for the day to day management, follow up, procedures, consultations and discharge planning under the close supervision of the supervising resident and attending physician.

The attending physician has ultimate responsibility for the patients admitted under his/her care. The attending carries out daily rounds with the team and discusses each patient, verifying history and physical findings, and guiding the residents through the discussion of the appropriate management from the perspective of a general pediatrician. Rounds and attending-resident interaction provide the opportunity for the discussion of differential diagnoses, criteria for hospitalization, evidence-based treatment plans, and cost-effective medical care.  Attending physicians are Board Certified in General Pediatrics and act as role models in the intervention and communication with patients. They actively participate in family conferences, the process of delivering difficult information for patients and families, the interpretation of diagnosis and management plans to patients, in obtaining DNR authorizations, and in discussions with consultants, among others. The attending physician is readily available for consultation 24 hours a day, 7 days a week.

The rotation seeks to emphasize several principles essential to the practice of general pediatrics:

  • Patients should be evaluated thoroughly taking into consideration not only medical/organic aspects of disease, but also the psychological, social, and environmental considerations.
  • Although the members of the medical team are the primary care givers, the residents and attending physicians should work in close collaboration with ancillary staff, such as nutritionists, social workers, nurses, respiratory therapists, rehabilitative services, pharmacists and hospital school teachers, among others.
  • Continuum of care is essential in pediatric care and discharge planning, follow-up, and communication with primary care physicians, either in writing or by telephone, is stressed.
  • Care to the pediatric patient should be of the highest standard, and cost-containment, quality, and risk management should be continually assessed.

COMPETENCY 1. Patient Care – Interns are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, and treatment of disease. To that end, interns will:

  • Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures
  • Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference
  • Develop, negotiate and implement effective patient management plans and integration of patient care
  • Learn to construct an individualized treatment plan for these complex patients

COMPETENCY 2. Medical Knowledge – Interns are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others. Interns are expected to apply an open-minded, analytical approach to acquiring new knowledge, access and critically evaluate current medical information and scientific evidence, and apply this knowledge to clinical problem solving, clinical decision making, and critical thinking. Specifically, interns will:

  • Demonstrate knowledge regarding the care of hospitalized patients with acute injury and disease
  • Demonstrate skill in the assessment of the hospitalized child using a problem-based approach in an evidenced-based format
  • Supervise medical students in the assessment of patients using a problem-based approach in an evidence-based format
  • Develop an evidenced-based medical and social plan of care
  • Demonstrate cost-effective strategies of narrowing a differential diagnosis utilizing medical tests and appropriate subspecialty consultation
  • Demonstrate competency in relaying the patient’s medical issues in a concise problem-based format
  • Proficiently execute a care plan for a wide variety of childhood illnesses that require hospitalization
  • Adequately interpret of a wide variety of medical tests useful in patient assessment, including, but not limited to, complete blood count, complete metabolic panel, blood gas measurement, inflammatory markers, urinalyses, cerebrospinal fluid studies, coagulation studies, plain radiographs, computed tomography scans, magnetic resonance imaging, and electrocardiography.
  • Demonstrate competence in the management of both routine and urgent clinical scenarios
  • Demonstrate competence in the identification and appropriate intervention for children with urgent or emergent issues and declining clinical status requiring transfer to an intensive care setting

COMPETENCY 3. Practice-Based Learning and Improvement – Interns are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices. To that end, interns will:

  • Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care
  • Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice
  • Develop and maintain a willingness to recognize and learn from errors and consequently improve the system or processes of care
  • Use information technology or other available methodologies to access and manage information, support patient care decisions, and enhance both patient and physician education
  • Develop teaching programs for students

COMPETENCY 4. Interpersonal and Communication Skills – Interns are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. To that end, interns will:

  • Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues
  • Demonstrate effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families
  • Interact with consultants in a respectful, timely, and appropriate manner
  • Maintain comprehensive, timely, and legible medical records
  • Complete evaluations of the senior residents, attending physician, medical students, staff and rotation
  • Give age-appropriate anticipatory guidance including discussions of health promotion and disease prevention and control
  • Give timely feedback to colleagues regarding knowledge, performance, teaching, and communication
  • Develop skills to provide an appropriate sign-out to ensure safe patient care
  • Recognize the importance of transfer of information in the safe care of the hospitalized child

COMPETENCY 5. Professionalism – Interns are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society. To that end, interns will:

  • Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues
  • Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues
  • Adhere to principles of confidentiality, scientific/academic integrity, and informed consent
  • Recognize and identify deficiencies in peer performance and deliver constructive evaluation and criticism

COMPETENCY 6. System-Based Practice – Interns are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care. To that end, interns will:

  • Review the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient
  • Apply evidence-based, cost-conscious strategies for prevention, diagnosis and disease management
  • Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care
  • Recognize the signs and symptoms that lead to the early identification of risky behaviors and to gain familiarity with the appropriate interventions including family and community resources
  • Consistently appreciate the cost of medical care and become judicious in the use of medical tests and hospitalization
  • Begin to understand the impact insurance status has on acquisition of appropriate health care as an inpatient and outpatient
  • Effective interaction with multidisciplinary teams required to provide care for patients, including physicians, nurses, case managers, physical therapists, occupational therapists, speech therapists, social workers, and child life specialists
  • Organize and lead the multidisciplinary effort for patient discharge and adequate continuity of care