Pediatrics

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Skills

I. Conduct a Patient/Parent Interview

  • Obtain a history from a second party (parent), as well as directly from the patient
  • Use different styles of questioning - open ended, directed, follow-up and summary.
  • Communicate information to parents/patients.
    • Insure that both the child and the parent understand the diagnosis and treatment, and have an opportunity to ask questions.
    • Incorporate anticipatory guidance as a part of health supervision visits and discharge from the nursery.
    • Direct an interview and exam for an acute specific complaint, or for a specific purpose (e.g., evaluation of heart disease, preschool physical and pre-sport physical, etc...)
 

II. Perform a physical exam 

  • Adjust the approach to the exam using the patient's age.
    • Adjust the content, sequence and focus of exam based on the patient's age.
    • Assess the child's developmental level, modify the exam accordingly, and use strategies to improve rapport with the patient
  • Demonstrate age specific exam skills for the:
    • Newborn:
      • assess the stability of vital functions, e.g. respirations, heart rate, temperature, feeding and stooling.
      • assess and interpret APGAR scores.
      • assess infant maturity.
    • Toddler, pre-school child
      • use techniques for building rapport with children who have stranger anxiety.
      • assess motor, language, and social development
    • Adolescent:
      • assess and stage secondary sexual characteristic
  • Measurement/Recording:
    • Measure height, weight, and head circumference
    • Plot and interpret data on growth chart
  • Specify how specific parts of the physical exam change with the patient's age and differ from the adult, including:
    • Obtain vital signs i.e., heart rate, respiratory rate, blood pressure, and temperature. Specify how normal values change for different ages.
    • Elicit newborn reflexes and state when they disappear.
    • Examine the tympanic membranes of an infant and child and identify abnormal hearing.
    • Examine the eyes for strabismus and identify an abnormal light reflex and/or abnormal visual acuity
    • Palpate nodes and specify the area(s) they drain; identify nuchal rigidity.
    • Distinguish between inspiratory and expiratory obstruction.
    • Auscultate for murmurs and palpate femoral pulses.
    • Palpate the abdomen for:
      • the liver
      • the spleen
      • abdominal masses
      • assess for rebound tenderness
    • Perform a rectal exam when indicated
    • Examine hips in the newborn and the young infant. Identify arthritis and abnormal gait
    • Identify skin disorders:
      • jaundice
      • petechiae
      • urticaria
      • vesicles
      • morbilliform rashes

III. Written and verbal communication skills

  • Produce a written record of the history and physical examination.       

             The record must:

    • Identify the chief complaint
    • Chronologically organize the present illness.
    • Specify the past history with specific emphasis on areas which are unique to pediatrics, to include:
      • neonatal history (birth weight, approximate gestational age, complications of pregnancy in mother, exposure to drugs, alcohol, medications, infections and complications of the newborn period such as prematurity, respiratory distress, jaundice, infections).
      • immunizations
      • development (6-7 milestones to ask about - social smile, roll over, sit alone, transfer object, stand alone, walk, say first words)
      • diet (breast fed, formula)
    • Detail a review of systems
    • Document the physical exam to include patient's appearance, vital signs, height, weight, head circumference, and percentiles.
    • Complete a problem assessment:
    • Define and assess each problem.
    • Develop a plan to evaluate and treat each problem
    • Plan for work-up and treatment for each problem
  • Give an oral presentation that includes the essential elements of the patient's history in a chronological sequence and a summary of the pertinent physical exam findings.

IV. Problem solving skills

  • Identify the medical problems during the history and physical exam
  • Recognize patterns of illness sharing a unified etiology (e.g. fever, vomiting, irritability or fever and refusal to walk or pallor and petechiae...)
  • Develop a differential diagnosis for each problem or group of problems which seem to logically group together and describe how age affects the differential diagnosis
  • Describe the usefulness of laboratory tests which may help to confirm or disprove the clinical hypothesis for the illness under consideration.
    • State how normal values change with age
    • Discuss cost versus usefulness, limitations. and costs of various studies
  • Discuss the usefulness, limitations and costs of various studies
  • Interpret basic studies such as the chest X-ray
  • Discuss the role of consultants as adjuncts to patient management