Pediatrics Syllabus

Chairs:

Virginia Campus: Breann Bailey, M.D. (bbailey@vcom.vt.edu)

Carolinas Campus: Hanna S. Sahhar, M.D., FAAP (hsahhar@carolinas.vcom.edu)

Rotation Credit Hours: 4

Goals

Demonstrate an ability to provide age-appropriate anticipatory guidance about nutrition, behavior, immunizations, injury prevention, pubertal development, sexuality and substance use and abuse.
Learn to measure and assess growth including height/length, weight, head circumference and body mass index using standard growth charts in the context of well child examination or a child with a known disorder.
Demonstrate ability to assess psychosocial, language, physical maturation, and motor development in pediatric patients.
Be able to provide nutrition advice to families with neonates, infants, toddlers, school age children and adolescents.
Interview and conduct a physical exam on an adolescent demonstrating respect for privacy, asking sensitive questions about lifestyle choices and giving appropriate counseling.
Perform a complete physical examination of the newborn infant.
Become familiar with both common genetic and non-genetic congenital disorders and genetic disorders presenting later in childhood.
Learn to consider the age, physical growth, developmental stage and family environment when assessing a pediatric patient with an acute illness and constructing a differential diagnosis and therapeutic plan for each problem identified.
Understand the long term medical needs, implications and complications of a pediatric patient with a chronic illness or disability.
Demonstrate skills necessary to calculate a drug dose, write a medication prescription, and calculate intravenous fluid requirements for a pediatric patient.

Rotation Description

During the third year geriatrics rotation, students expand their knowledge of Pediatric Medicine and gain the ability to apply this knowledge in the clinical setting. The curriculum is taught through VCOM TV on-line lectures, on-line case modules (CLIPP cases) and through one-on-one student-preceptor experience in caring for patients in the clinical setting. The Core Pediatric Medicine Competencies that are to be gained in the third year are found below.

Clinical Setting in Which Rotation Occurs
The practice of pediatric medicine occurs in the outpatient office setting, in the inpatient setting caring for both acute and chronic illnesses, in the delivery room and newborn nursery caring for neonates in the first days of life and in the emergency room. Students should review their specific site instructions for a more detailed description of their specific practice setting and be prepared to have a schedule that may include overnight call, early mornings, late evenings and some weekend responsibilities.

Requirements for Completion

Required Textbooks:

Blueprints in Pediatrics, 5th edition
Nelson, Kenneth Somatic Dysfunction in Osteopathic Family Medicine

Requirements for Successful Completion of the Pediatrics Rotation:

Attendance according to VCOM and preceptor requirements (see Student Handbook)
Completion of all Clinical Modules (CLIPP cases) in the Required Curriculum
www.clippcases.org - CLIPP: Computer-Assisted Learning in Pediatrics Projects. Requires registration*.
* The instructions for registering are on the Web site. Passwords will be created automatically for anyone with an e-mail address with "vcom.vt.edu" in it. The passwords and user names are e-mailed almost immediately after registering.
Patient Log - Pediatric Patient log
Your patient logs are to be submitted to your Site Coordinator at the end of your rotation and will be part of your evaluation for the clerkship
Rotation Evaluations:
- Mid-Rotation Evaluation
- Student Site Evaluation. Students must complete and submit at the end of rotation.
- Preceptor Evaluation form
  - It is the student's responsibility to ensure that all clinical evaluation forms are completed and submitted online or turned into the Site Coordinator or the Clinical Affairs Office at the completion of each rotation. Students should inform the Clinical Affairs Office of any difficulty in obtaining an evaluation by the preceptor at the end of that rotation
Successful completion of the end-of-rotation written exam.
The pediatric end-of-rotation exam questions will be derived directly from the specific objectives presented in each of the below modules.

RETURN TO TOP

Clinical Modules - Required for Completion

The pediatric curriculum is delivered through the 22 major topic titles which cover the core topics and clinical conditions most commonly practiced in pediatric medicine. Each of the following topics has specific learning objectives and is accompanied by an assigned reading in the text as well as an online case. Some topics may also have an accompanying VCOM TV lecture. The pediatric end-of-rotation exam questions will be derived directly from the specific objectives presented in each of the below modules. Thus success on the exam will require that students complete all module assignments, including reading, viewing of online videos and review of any accompanying cases or presentations.

1. Health Supervision [+]

Reading Assignment: Blueprints in Pediatrics, 5th edition, Chapter 4
Online Case: CLIPP cases 2, 3, 4, 5 and 6
Objectives

Describe the rationale for childhood immunizations and list the immunizations currently recommended from birth through adolescence
Describe the general indications and contraindications of immunizations
Discuss the rational for screening tests such as urinalysis, blood lead level, PPD, anemia screen, developmental screening, hearing and vision screening
Describe the components of a health supervision visit for newborns, infants, toddlers, school aged children and adolescents

2. Growth [+]

Reading Assignment: Blueprints in Pediatrics, 5th edition, Chapter 16
Online Case: CLIPP cases 2, 3, 4, 5 and 6
Objectives:

Describe variants of normal growth such as constitutional delay and familial short stature
Identify failure to thrive and overweight/obesity in a child or adolescent using BMI and standard growth curves
Know the differential diagnosis of an infant or child with failure to thrive
Be able to interpret a growth curve and recognize abnormal growth patterns

3. Development [+]

Reading Assignment: Blueprints in Pediatrics, 5th edition, Chapter 4
VCOM TV Video – Childhood development
Online Case: CLIPP cases 2, 3, 4, 5, 28
Objectives:

Describe the four developmental domains of childhood (gross motor, fine motor, language and social development)
Know critical developmental milestones in infants, toddlers and school age children and describe how these are evaluated in the office setting
Describe how abnormal findings on developmental screening tools would suggest a diagnosis of developmental delay, autism, pervasive developmental delay and mental retardation

4. Behavior [+]

Reading Assignment: Blueprints in Pediatrics, 5th edition, Chapter 4
Online Case: CLIPP cases 2, 3, 4, 5 and 6
Objectives:

Know normal patterns of behavior in the developing child

Newborns: development and evolution of social skills
Toddler: autonomy
School Age: independence
Adolescent: abstract thinking

Describe how somatic complaints may represent psychosocial problems (e.g. recurrent abdominal pain, headache, fatigue and neurologic complaints)
Know typical presentation of common behavioral problems in different age groups:

Newborns/Infants: colic, sleep problems
Toddler: temper tantrums, toilet training, feeding problems
School age: enuresis, attention deficit, encopresis
Adolescents: eating disorders, risk taking behaviors, conduct disorders

5. Nutrition [+]

Reading Assignment: Blueprints in Pediatrics, 5th edition, Chapter 16
Online Case: CLIPP cases 1
Objectives:

Describe the advantages of breastfeeding and describe common difficulties experienced by breastfeeding mothers.
Identify the known benefits of feeding human breast milk to infants
Know the signs and symptoms of common nutritional deficiencies in infants and children such as iron, vitamin D, fluoride.
Describe nutritional factors that contribute to the development of childhood obesity and failure to thrive
Discuss the endocrine, cardiovascular and orthopedic consequences of childhood obesity
Know the risk factors for the development of cardiovascular disease and diabetes in children

6. Adolescent Medicine [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 21
Online Case: CLIPP cases 22
Objectives:

Identify and describe the sequence of the physical changes of puberty in both males and females (Tanner Stages)
Describe the common risk taking behaviors of adolescents, such as alcohol and other drug use, sexual activity and violence and the consequences of these activities
Describe the common mental health problems in adolescence, including school failure, attention deficit, body image, eating disorders, depression and suicide
Know how to interview an adolescent using the HEADSS method
Know the components of the pre-participation sports exam

7. Newborn Exam [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 13
VCOM TV Video - Newborn Conditions and Pearls; Newborn exam
Online Case: CLIPP cases 1, 7, 8, 9
Objectives:

Understand the important elements of a prenatal history as they relate to the health of the unborn child, including the importance of maternal age
Recognize factors in the perinatal and newborn history that may put a neonate at risk for medical problems
Describe the transition from the intrauterine to the extrauterine environment, including temperature regulation, cardiovascular/respiratory adjustment, glucose regulation and initiation of feeding
Identify the key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score and Apgar score). Use weight and gestational age to categorize potential clinical problems
Be familiar with the newborn exam and the underlying pathology of certain exam findings (e.g. scalp swelling, absence of the red reflex, heart murmur, skin findings, positive ortolani/barlow)
List the complications and differential diagnosis for the following common problems that occur in the newborn
1. Jaundice
2. Respiratory distress
3. Poor feeding
4. Large and small for gestation infants
5. Sepsis
6. Hypoglycemia
7. Drug withdrawel/exposure
8. Prematurity
Demonstrate knowledge of the indication for newborn screening for TORCH infections, including HIV
Identify what medications are routinely given to all newborns (e.g., vitamin K, hepatitis B vaccine, eye prophylaxis).
Identify treatment options for hyperbilirubinemia and be aware of the American Academy of Pediatrics' practice guideline "Management of Hyperbilirubinemia in the Healthy Term Newborn."
Understand the clinical manifestations of congenital hypothyroidism
Be able to provide anticipatory guidance about breastfeeding, normal sleep patterns, appropriate car seat use, prevention of SIDS and the role of circumcision

8. Dysmorphology/Genetics [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 9
Online Case: CLIPP cases 28, 29
Objectives:

Describe the genetic basis and clinical manifestations of the following syndromes

Autosomal Trisomies (trisomy 21, trisomy 18, trisomy 13)
Turner Syndrome
Klinefelter syndrome
Fragile X
Chromosome 22Q11 deletion
Fetal alcohol syndrome

List the common medical and metabolic disorders (e.g. hearing loss, hypothyroidism, PCU, cystic fibrosis, hemoglobinopathis) detected through newborn screening programs
Describe the use of chromosomal studies in the diagnosis of genetic disorders

9. Common Acute Pediatric Illness [+]

Reading Assignment: Blueprints Pediatrics, 5th edition, Chapter 12
VCOM TV Video – Fever and Serious Bacterial Infections
Online Case: CLIPP cases 10, 12, 14, 15, 16, 17, 19, 20, 22, 23
Objectives:

List the age appropriate differential diagnosis for pediatric patients presenting with each of the following symptoms:

Abdominal pain
Cough/Wheeze
Diarrhea
Fever and rash
Fever without a source
Headache
Leathargy or irritability

Recognize common viral exanthems
Describe findings associated with a normal tympanic membrane, acute otitis media (AOM) and otitis media with effusion (OME) using proper techniques and skills.
List management options for uncomplicated AOM

10. Fluid and Electrolyte Management [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 7
VCOM TV Video - None
Online Case: CLIPP cases 16, 23
Objectives:

Estimate the percent dehydration based upon relevant physical exam findings.
Discuss 3 types of dehydration and appropriate rehydration method for each.
Calculate the bolus fluids, volume deficit and daily maintenance needs based on the child's weight.
Describe the impact and management of ongoing losses.
Understand the management of septic shock in the pediatric patient

11. Common Chronic Illness and Disability [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 20 (p 299-311); Chapter 6 (p 66-69);
Online Case: CLIPP cases 13, 26, 28
Objectives

Describe the clinical features of chronic medical conditions seen in children with the following:

Asthma
Atopic dermatitis
Cerebral palsy
Cystic fibrosis
Diabetes mellitus
Obesity
Seasonal allergies
HIV/AIDS
Sensory impairment

Describe how chronic illness can influence a child’s growth and development, educational achievement and psychosocial functioning

12. Congenital Heart Disease [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 3
Online Case: CLIPP cases 18
Objectives:

Evaluation of a heart murmur in infancy or childhood.
Recognition of congestive heart failure in an infant.
Understand the pathophysiology of ventricular septal defect and atrial septal defect
Know the management of CHF in an infant
Know the congenital cyanotic heart lesions
Understand the role of the ductus arteriosus and the clinical manifestations of a patent ductus arteriosus

13. Seizures and Epilepsy [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 15; pg 237-244
Online Case: CLIPP cases 19
Objectives

Understand the differential diagnosis of a first time seizure in a child
Be able to explain the evaluation, workup and treatment of a febrile seizure
Become comfortable with the key historical questions and physical exam in a child with seizures
Understand the classification of epileptic seizures and the characteristics of both neonatal and childhood epilepsy syndromes

14. Pediatric Dermatology [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 5
VCOM TV Video – Pediatric Rashes
Online Case: CLIPP cases 21, 32
Objectives

Outline the key history and physical findings associated with the following common pediatric dermatologic conditions: urticaria, seborrheic dermatitis, contact dermatitis, acne, superficial fungal infections, and scabies.
List a prioritized differential diagnoses for an urticarial rash.
Discuss the diagnosis and management of acne.
Discuss the general approach to choosing a topical steroid and the common side effects associated with their use.
List three at least three conditions in the differential diagnosis of diaper rash.
Formulate a differential diagnosis for petechiae and purpura in a school-aged child.
Summarize clinical features, lab findings, natural history, and complications of Henoch-Schönlein Purpura

15. Childhood Malignancies [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 17
Online Case: CLIPP cases 17, 20, 21
Objectives:

Formulate a differential diagnosis for petechiae and purpura in a school-aged child.
Differentiate normal and abnormal findings on examination of the lymph nodes, liver, and spleen
Know the differential diagnosis of an abdominal mass in a pediatric patient and the necessary workup for this finding (e.g. wilms tumor, neuroblastoma)
Know the location and manifestations of primary CNS tumors in the pediatric population
The principles of effectively breaking bad news to a patient and a patient's parents

16. Child Abuse [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 2 (pg 18-20)
Online Case: CLIPP cases 25
Objectives
1. List the characteristics of the history and physical examination that should trigger concern for possible physical, sexual and psychological abuse and neglect such as inconsistency in the history, unexplained delays in seeking care, injuries with specific patterns or distributions on the body
2. Describe physical signs and symptoms of shaken-baby syndrome.
3. Order appropriate laboratory and radiological studies for an infant with suspected physical abuse and shaken-baby syndrome.

17. Pediatric Emergencies [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapters 1 and 2
Objectives
1. Be able to identify the infant, child or adolescent with a medical emergency
2. Know the initial emergency management of shock, respiratory distress, lethargy, apnea and status epilepticus in pediatric patients
3. Describe the age appropriate differential diagnosis and key clinical findings for each of the emergent clinical problems:
  1. Airway Obstruction (croup, bronchilolitis, asthma, pneumonia, foreign body aspiration, anaphylaxis)
  2. Altered Mental Status (Head injury, increased ICP, substance abuse, infection, diabetic ketoacidosis, hypoglycemia, abuse, shcok and hypoxemia)
  3. Apnea (ALTE, seizures, respiratory infections, GERD, sepsi)
  4. Gastrointestinal bleeding (Meckels diverticulum, intussusception)
  5. Injuries and accidents (Animal bites, minor head injury, nursemaids elbow)
  6. Shock (sepsis, severe dehydration, DKA, congestive heart failure, electrolyte disturbances)
4. Describe the developmental vulnerability for poisoning and accidental ingestion in infants, toddlers, children and adolescents.

18. Pediatric Hematology [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 10
Online Case: CLIPP cases 3, 30
Objectives
1. Describe health maintenance and expected course for children with sickle cell disease.
2. Recognize the complications of sickle cell disease that may lead to additional morbidity and mortality.
3. Describe the management of acute chest syndrome
4. Discuss the common causes and work-up of anemia in an otherwise healthy child, as well as first-line therapy of iron-deficiency anemia
5. Understand the clinical manifestations and treatment for Idiopathic Thrombocytopenic Purpura

19. Gastrointestinal Disorders [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 8
VCOM TV Video – Abdominal Complaints
Online Case: CLIPP cases 22, 27
Objectives
1. Understand and demonstrate the approach to the physical exam in a patient with abdominal pain.
2. Understand the differential diagnosis for chronic abdominal pain.
3. Understand the differential diagnosis of intestinal blood loss.
4. Recognize critical findings ("red flags") that differentiate functional from pathological abdominal pain.
5. Understand the presentation and basis of therapy for inflammatory bowel disease.
6. Know the differential diagnosis of constipation and possible underlying etiologies associated with constipation in children.
7. List the differential diagnosis of diarrhea including the different causes of infectious diarrhea.
8. Review the presentation of and risk factors for pelvic inflammatory disease in an adolescent.
9. Know the differential diagnosis for both non-bilious vomiting (e.g. AGE, pyloric stenosis, GERD, metabolic derangements, increase ICP) and bilious vomiting (e.g. small bowel obstruction, volvulus) in the children of different ages.

20. Pediatric Musculoskeletal Disorders [+]

Reading Assignment: Pediatric Blueprints, 5th edition, Chapter 19
VCOM TV Video – Pediatric Extremity Injuries
Online Case: CLIPP cases 3, 30
Objectives
1. Be able to construct a differential diagnosis for limp in a pediatric patient (e.g. trauma, infectious, inflammatory, developmental, neoplastic, and metabolic)
2. Recognize the typical history, physical exam and treatment for nursemaid’s elbow

21. Pediatric OMM Objectives – Nelson Chapter 8 [+]

Compare and contrast the symptomatic manifestation and cause of somatic dysfunction in pediatrics vs. adults.
Compare and contrast choice of treatment modalities and approach to diagnosing and treating a child vs. an adult with OMM
Name risk factors for developing somatic dysfunction at a young age.
List the functional problems that can occur as a result of cranial dysfunction in an infant or young child.
Describe the underlying mechanical dysfunctions and etiology behind, Plagiocephaly, Torticollis, Sucking dysfunction, Infantile scoliosis, Pectus, Patellar disorders, Gastroesophageal reflux, colic, constipation, ENT and Psychomotor developmental dysfunctions.
Know the basic mechanics of midline and paired bones.
Be familiar with the therapeutic sequence recommended to initiate intervention in a pediatric patient.

RETURN TO TOP

Clinical Performance Objectives

While the end-of-rotation exam is derived from the didactic curriculum and objectives described above in the “Clinical Modules – Required Curriculum” section, the end-of-rotation evaluation completed by your geriatric preceptor is based on clinical core competencies. These core competencies reflect student performance in 6 key areas: communication, problem solving, clinical skills, medical knowledge, osteopathic medicine and professional and ethical considerations. Your end-of-rotation evaluation from your preceptor will be based directly on your performance in these 6 core competencies as described below.

Communication - the student should demonstrate the following clinical communication skills:
1. Effective listening to patient, family, peers, and healthcare team
2. Demonstrates compassion and respect in patient communications
3. Effective investigation of chief complaint, medical and psychosocial history specific to the rotation
4. Considers whole patient: social, spiritual & cultural concerns
5. Efficiently prioritizes essential from non-essential information
6. Assures patient understands instructions, consents & medications
7. Presents cases in an accurate, concise, well organized manner
Problem Solving – the student should demonstrate the following problem solving skills:
1. Identify important questions and separate data in organized fashion organizing positives & negatives
2. Discern major from minor patient problems
3. Formulate a differential while identifying the most common diagnoses
4. Identify indications for & appliy findings from the most common radiographic and diagnostic tests
5. Identify correct management plan considering contraindications & interaction
Clinical Skills - the student should demonstrate the following problem solving skills:
1. Assesses vital signs & triage patient according to degree of illness
2. Perform good auscultory, palpatory & visual skills
3. Perform a thorough physical exam pertinent to the rotation
Osteopathic Manipulative Medicine - the student should demonstrate the following skills in regards to osteopathic manipulative medicine
1. Apply osteopathic manipulative medicine successfully when appropriate
2. Perform and document a thorough musculoskeletal exam
3. Utilize palpatory skills to accurately discern physical changes that occur with various clinical disorders
4. Apply osteopathic manipulative treatments successfully
Medical Knowledge – the student should demonstrate the following in regards to medical knowledge
1. Identify & correlate anatomy, pathology and pathophysiology related to most disease processes
2. Demonstrate characteristics of a self-motivated learner including demonstrating interest and enthusiasm about patient cases and research of the literature
3. Are thorough & knowledgeable in researching evidence based literature
4. Actively seek feedback from preceptor on areas for improvement
5. Correlate symptoms & signs with most common disease
Professional and Ethical Behaviors - the student should demonstrate the following professional and ethical behaviors and skills:
1. Is dutiful, arrives on time & stays until all tasks are complete
2. Consistently follows through on patient care responsibilities
3. Accepts & readily responds to feedback, is not resistant to advice
4. Assures professionalism in relationships with patients, staff, & peers
5. Displays integrity & honesty in medical ability and documentation
6. Acknowledges errors, seeks to correct errors appropriately
7. Is well prepared for and seeks to provide high quality patient care
8. Identifies the importance to care for underserved populations in a non-judgmental & altruistic manner

RETURN TO TOP

For Students Pediatric Clerkship Requirements (3rd Year)
•	Pediatric Syllabus
•	Required Booklist
•	Evaluation Forms; Clinical encounter log, procedure logs

Pediatric Rotation Sites & Faculty
•	Meet the Pediatric Faculty
•	Pediatric Site-Specific Instructions

Pediatrics Fellowship and Career Information
•	Pediatric Fellowships and Careers
•	Pediatric Web Links and Resources

For Faculty
•	Faculty Development and CME Program
•	Useful Faculty Development Links (go to Quick Links)
•	Clinical Faculty Application
•	Preceptor Evaluation of Students

PEDIATRICS

For Students

For Faculty

Pediatrics Syllabus

Chairs:

Rotation Credit Hours: 4

Goals

Rotation Description

Requirements for Completion

Clinical Modules - Required for Completion

Clinical Performance Objectives