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PEDIATRIC ROTATION

VIEWS: 22 PAGES: 5

									                           PEDIATRIC ROTATION
COURSE COORDINATOR: Deborah McLeish, M.D., M.S.

You will be working with Drs. McLeish and Ward and Kyle McLean, PNP, on pediatrics
and responsible for inpatient services, consults and clinics. Pediatric inpatients will be in
the Children’s Hospital though some adolescents and some adults (primarily adults with
childhood disabilities) will be followed on B4/4.

In-patient responsibilities as for the pediatric rehab rotation include: admission history
and physical exam following the template and staffing with the nurse practitioner or
attending physician. You are to round daily with the pediatric nurse practitioner or
attending, and reviewing progress notes and orders. Your primary responsibility is to
communicate regularly with pediatric residents, parents, and the nurse practitioner and
attending and the rehab on-call team. You are encouraged to get to know your patient
including observing them in therapy. You are responsible for dictating discharge notes
(not dictated by the PNP) by or before the day of discharge.

You are responsible for completing assigned consults on pediatric patients (this may
include adolescents in the TLC or Neuro IMC); doing a history and physical examination
and staffing with the pediatric nurse practitioner or attending physician. .

You will also participate in clinics with Drs. McLeish and Ward as scheduled. You will
be better prepared if you read on appropriate topics prior to clinic (e.g. cerebral palsy,
spasticity, spina bifida, muscle disease, spinal muscular atrophy. The Pediatric PMR text
book edited by G. Molnar is a good review, there is notebook of articles, and Drs.
McLeish and Ward will provide additional appropriate articles.

You will also be learning to do Botox and phenol injections, and will be involved in
intrathecal baclofen trials and pump management. You should plan to spend time with
the rehab clinic nurses to develop competency in pump refills. You are encouraged to
review learning materials and articles on these topics as well, and develop an
understanding of management of pumps including problems.

This schedule is set up as the first through 5th weeks of the month, and will have to be
“translated” for the particular month. Residents are not required to attend Dean East clinic with
McLeish although this is a good clinical experience, and offers another chance for procedures at
St. Mary’s Hospital in Pediatrics on the 3rd floor. Check with McLeish ahead about this schedule.
Please note that both McLeish and Ward add on clinic patients and procedures, and you may
participate with these.

When Spina Bifida or NMD clinic has not been scheduled on Wednesdays with McLeish,
residents are expected to go to clinic with Ward, and vice versa. There is usually time on
Wednesday late afternoons to spend time with inpatient pediatric therapists.




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                                                                                          Revised 6/18/07



       PEDIATRICS ROTATION
          MONDAY                    TUESDAY               WEDNESDAY              THURSDAY               FRIDAY
                                                          Rounds w//McLean
                                    Rounds w//McLean &
            Rounds w/McLean                                  & McLeish
                                           Ward                                  Rounds w//McLean            Didactics
  st
 1 AM     8:30 Peds PMR Clinic w/                          8:30 Spina Bifida
                                     CP Clinic w/Ward                             Open for required
                  McLeish                                 Clinic w/McLeish &
                                       @Waisman                                     experiences
                                                            McLean UWHC
                                                                  F4/4
                                                          Spina Bifida Clinic
             Peds PMR Clinic
                                    Procedures w/Ward @      w/McLeish &         Peds PM&R Clinic
 1st PM        w/McLeish                                                                                 Rounds w/Ward
                                         Middleton          McLean UWHC               w/ Ward
                                                                  F4/4
                                     Rounds w//McLean
                                                          Rounds w//McLean       Rounds w//McLean
            Rounds w//McLean             & Ward
                                                                                                             Didactics
 2nd AM                                                    8:00 Spasticity &     Blaise Nemeth, M.D.
          8:30 Peds PMR Clinic w/   CP Clinic w/Ward @
                                                           Dystonia Clinic @      Peds Ortho Clinic
                  McLeish                Waisman
                                                          Waisman w/McLeish           UW East*
                                                             Procedures @                                Rounds w/Ward
           1:30 NeuroOnc Clinic     Procedures w/Ward @
 2nd PM                                                       Middleton          Clubfoot Clinic H4/2   Gait Clinic Starting
            w/Ward @ UWHC                Middleton
                                                              w/McLeish               w/Nemeth                 11/07
                                     Rounds w//McLean      Rounds w/McLean
            Rounds w//McLean                                                      Rounds w/McLean
                                         & Ward
  rd                                                                                                         Didactics
 3 AM                                                        Neuromuscular
            Peds PM&R Clinic                                                      Open for required
                                    CP Clinic w/Ward @    Clinic w/ McLeish &
               w/McLeish                                                            experiences
                                         Waisman             McLean H6/4
                                                             Neuromuscular
            Peds PM&R Clinic        Procedures w/Ward @                          Peds PM&R Clinic        Rounds w/Ward
 3rd PM                                                   Clinic w/ McLeish &
                 McLeish                 Middleton                                    w/Ward
                                                             McLean H6/4
                                                          Rounds w//McLean
                                     Rounds w//McLean
            Rounds w/McLean                                                      Rounds w//McLean
                                         & Ward
  th                                                      Spina Bifida Clinic                                Didactics
 4 AM
          8:30 Peds PM&R Clinic                             w/McLean (or            Peds Sedation
                                    CP Clinic w/Ward @
                 McLeish                                      Spasticity             w/ McLeish
                                         Waisman
                                                             w/McLeish)
                                                           Spasticity Clinic
                                                            w/McLean (or
                                    Procedures w/Ward @                          Peds PM&R Clinic
                                                              Spasticity                                    Gait Clinic
  th      Peds Neuro-Onc w/Ward          Middleton                                    w/Ward
 4 PM                                                        w/McLeish)                                 w/McLeish & Ward
                   H6/4                                                                 or
                                                                                                          till November
                                                                                   Peds Sedation
                                                          Clinic w/ McLeish &
                                                             McLean H6/4
                                                          Rounds w//McLean
            Rounds w/McLean
                                     Rounds w//McLean                            Rounds w//McLean
                                         & Ward            Spina Bifida Clinic
           Peds PM&R Clinic w/                                                                               Didactics
 5th AM                                                      w/McLean &           Open for required
           McLeish (or open for
                                    CP Clinic w/Ward @    McLeish (or open for      experiences
            required experience)
                                         Waisman          required experience)

                                                          Spina Bifida Clinic                            Rounds w/Ward
                                    Procedures w/Ward @                          Peds PM&R Clinic
 5th PM                                                     w/McLean &
                                         Middleton                                    w/Ward
                                                               McLeish


* Email Dr. Nemeth in advance to check his schedule and location




                                                                                                              64
McLeish will schedule formal didactic times with the resident. The resident is expected to come
prepared by reviewing appropriate materials. The pre/post test will be used as an outline for
discussion.

1st, 3rd, and 5th THURS and other (****) times (and when clinics are canceled) may be used for
patient care and follow up (including keeping up to date with ESA and for reading), and for
scheduling the following required and optional activities. Write up a sentence or two to
document the date of the experience and your key observation and give to McLeish and a copy to
Wendy Christophersen for your portfolio.

Required Learning Experiences
   1. Observe pediatric therapists on the ward (PT-Marcella Andrews, OT-Kristin Kienitz,
       Speech/Swallow therapist- Laurie Matsdorf: all available on voice mail number 3-8078)
       Time with all three services.
   2. Observe outpatient therapy session at Middleton (names and numbers follow) or at the
       Waisman Center (try to observe during formal developmental evaluation) – contact
       therapy staff soon after starting rotation: PT 5-1695: Janine Bessemer, Seth Newman,
       Betsy Zahn; OT 3-8081 Anne DeMark-Thompson, Mary Ellen Schmidt, Genna Freeman;
       Speech/swallow: Carol Gillen, Jennifer Holmes 3-8418) Time with all three services.
   3. Observe a video fluoroscopic swallow study (this is required if you haven’t previously
       seen a video fluoroscopic swallow study); Arrange with Laurie Matsdorf 3-8078, or
       Carol Gillen or Jennifer Holmes at 3-8418.
   4. Make site visit to the Communication Aides and Systems Clinic (CASC) – main
       secretary Deanne @ 263 – 2522 or Julie Gamradt can be reached at 3-5527 or email at
       casc-cdp@waisman.wisc.edu.
   5. Spend time with Scott Amyx, pediatric orthotist at the Middleton Rehab clinic to include
       orthotic evaluation and preparation (265-0135). REQUIRED.
   6. Spend time with Rose Ebner of National Seating and Mobility doing wheelchair and
       equipment assessment. She may be contacted at voice mail 223-1927 #307. REQUIRED.
   7. Residents are expected to prepare a 30 minute didactic presentation to the pediatric
       residents, medical students and pediatric therapists on a topic pertinent to pediatric rehab.

    Optional Learning Experiences
    8. Make site visit to the TRACE Center – contact person is Mary Sesto, Ph.D., P.T. Mary is
        best reached via email at msesto@facstaff.wisc.edu. OPTIONAL
    9. Spend time at a school with a school therapist when school is in session and this can be
        arranged. OPTIONAL
    10. Observe urodynamics – contact Dr. Kryger, pediatric urologist to help arrange this so
        you can become familiar with CMG/EMG testing and interpretation. OPTIONAL
    11. Residents may spend time (even OR time if interested) with Dr. Iskandar or Dr. Albright,
        pediatric neurosurgeons, Dr. Kryger or Dr. Slaugenhoupt, pediatric urologists, Dr. Mann
        or Dr. Noonan, pediatric orthopedists, Dr Iyama, pediatric developmentalist, Drs. Sheth,
        Stafstrum or Hsu pediatric neurologist. OPTIONAL.


                     PEDIATRICS REHAB ROTATION OBJECTIVES

By the end of the Pediatric Rehabilitation Rotation, the resident will be able to: and will be
evaluated by:




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Patient Care:
    1. Take a developmental history, and list tests that may be used in developmental evaluation
        of a child. Clinical observation, Mini CEX, discussion.
    2. Take a functional history pertinent to the child (e.g. to include bath seat, car seat,
        mobility equipment). Clinical observation, Mini CEX
    3. Include the child (when appropriate) in getting the history. Clinical observation, Mini
        CEX
    4. Perform a physical exam of the child, in a way which maximizes the ease of the child and
        the parent. Clinical observation, Mini CEX
    5. Perform physical exam of the adult with DD in a respectable way. Examine the child or
        adult with DD for evidence of scoliosis, hip dislocation, contractures, increased or
        decreased tone, weakness, presence of primitive reflexes, head and trunk control, balance,
        and coordination. Clinical observation, Mini CEX

Medical Knowledge:
  1. Identify findings regarding developmental stages, and recognize when a child is
      developmentally delayed. Clinical observation, oral exam
  2. Identify issues in the transition to adulthood of children with DD. Clinical observation.
  3. Describe issues in the PM&R management of adults with DD. Clinical observation
  4. Provide appropriate recommendations for the medical management of children with
      cerebral palsy. Changing nutrition, GI and GU, management, and musculoskeletal
      issues. Clinical observation, discussion
  5. Identify when treatment of spasticity is recommended, and outline an approach to
      spasticity management. Clinical observation Mini CEX and/or discussion
  6. Provide appropriate recommendations for the medical management of children with spina
      bifida (includes neurogenic bowel and bladder, and pressure sores). Clinical observation,
      discussion
  7. Provide appropriate recommendations for the medical management of children with
      NMD (including constipation, osteoporosis and steroid dependent).
  8. Appropriately prescribe orthotics, gait aides and other equipment for children with
      cerebral palsy, spina bifida, and NM diseases. Clinical observation, Mini CEX and/or
      discussion.
  9. Develop a comprehensive problem list to address specific needs for traumatic brain injury
      rehab for children. Clinical observation, discussion
  10. Describe an approach to the evaluation and treatment of toe walking in children.
  11. Provide appropriate recommendations for the medical management of children with
      Torticollis in children.

Practice-Based Learning and Improvement:
   1. Identify one learning topic weekly and describe how that has impacted his or her practice.
       Oral discussion
   2. Demonstrate ability to identify ways that a specific patient encounter could have been
       enhanced. Oral discussion
   3. Teach the pediatric residents, medical students, and therapists on an ongoing basis about
       PMR topics, and provide a minimum of one 30 minute didactic presentation. Clinical
       observation




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Communication and Interpersonal Skills:
  1. Treat the parent/family member and child with respect. Clinical observation, Mini CEX
  2. Communicate treatment plans and changes with parents of children on the inpatient
     service. Clinical observation, Mini CEX
  3. Avoid use or explain medical jargon. Clinical observation
  4. Coordinate care daily with pediatric residents for patients on the inpatient service.
     Clinical observation
  5. Communicate effectively with the other rehabilitation team members. Clinical
     observation
  6. Lead the weekly PM&R team meetings, being respectful of other team members.
     Clinical observation

Professionalism:
   1. Follow hospital guidelines for patient privacy and confidentiality. Clinical observation
   2. Be on time for rounds, for meetings, and for clinic. Clinical observation
   3. Follow PM&R manual guidelines for timely and complete documentation of patient visits
        including admissions and discharge notes consult notes, and clinic notes. Clinical
        observation
   4. Be able to provide the information necessary for parents to understand procedures and be
        able to go through the process to obtain written consent for procedures. Clinical
        observation
   5. Accept feedback willingly. Clinical observation

Systems-Based Practice:
    1. Understand and explain child-specific services related to special education, the Katie
       Beckett / Medical assistance program and other unique benefits for children with chronic
       health care support needs. Discussion
    2. Make recommendations regarding health promotion (immunizations, child safety, and
       primary care). Clinical observation
    3. Identify “barriers” to discharge home and return to school for inpatients, and help guide
       the team and child’s family to address these barriers. Clinical observation, 360
       evaluation




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