Ambulatory
Pediatrics
The University of Tennessee Health Science Center
&
Le Bonheur Children’s Hospital
2015‐2016
Department of Pediatrics
Ms. Jenn Wilson, Coordinator (
)
WELCOME TO AMBULATORY PEDIATRICS
This portion of your pediatric rotation has been designed to give you an excellent exposure to the world of out‐ patient pediatrics, which accounts for the bulk of pediatric care in this country. Very few children are ever admitted to the inpatient service of a hospital. Consequently, general pediatricians spend little or none of their time caring for inpatient children. The content of the shelf exam will reflect this reality.
The rotation is designed to provide you with a smorgasbord of pediatric experiences. You will have an opportunity to work with pediatricians in all backgrounds, from subspecialists to generalists, academicians to private
practitioners, to patients with acute and chronic illnesses.
To provide you with some continuity, you will attend some clinics more than once. This will allow you to delve deeper into the application of subspecialty pediatrics as well as help the clinicians to feel comfortable with allowing you more responsibility. You will also spend a day every week with a volunteer private practicing pediatrician.
The best way to get the most out of this part of the rotation is to be prepared.
Read about the disciplines of the clinics you’ll be attending the next day. This effort will allow you more participation in the care of the patients and allow the clinician to teach you on a higher level rather than simply reviewing the basics.
Ask questions; be assertive about requesting to be more active in the clinics and
to do more assessments. This shows the attending faculty that you are interested in the field they’ve chosen as a career.
Many of these clinics are very busy with complicated patients. Clinicians need to work quickly and effectively. If you simply stand behind them and shadow like you did in undergraduate, they will let you. You have to make it very clear that you want to participate in clinic rather than simply watch. Preparation prior to clinic will make them more agreeable to your active participation. Remember, be assertive, not aggressive.
You do not have to see every patient. Ask to see a patient on your own while the clinician sees several patients without you. Then, gather your thoughts quickly and present the patient to the clinician. Do not take more than two minutes to present.
Before they tell you the diagnosis, you commit to one out loud, then briefly explain why you think this way. The clinician will then enter the patient room, perform a brief exam and counsel the patient. They
shouldn’t give you a lecture on the topic but rather provide you with a single teaching pearl. Then, the process starts over again until the clinic ends and the last patient is seen.
Remain cognizant of the flow of the clinic. Do not impede the care of the patients. Save the more complex questions for the end of the day. The clinicians will be appreciative of your consideration for their time and their patients’ comfort.
That night at home, read about the conditions you witnessed during the day. This is the best way to solidify your learning.
IMPORTANT INFORMATION
Attendance
The LCME requires that your university provide proof of your clinical experience. Because you attend so many different clinics during this rotation, you will be responsible for providing documentation of your experience. You will receive index cards which you will use to provide that documentation. Compliance with this method of documentation is a professional attribute for which you will be graded. Failure to comply with documentation will result in a failing grade.
If you cannot attend a clinic for which you are scheduled:
Call 287‐6292 and speak with Ms. Wilson or Ms. Holloway regarding your absence and the reason for it. If the reason for the absence is accepted, an absentee slip will be generated and you will receive credit for that clinic.
If you miss two days of the rotation (need not be consecutive) you will need to provide us with a doctor’s excuse. If you miss three or more days, you will have to meet with the clerkship director to discuss making up the absence.
Please call after 8:00 a.m. Calling before 8:00 will direct you to the answering service. They will not give us the message and no absentee slip will be generated and you will not receive credit for the missed clinics.
You will be responsible for informing the clinic that you will be missing. Call the clinic and let them know not to expect you so that they won’t save patients for you.
Despite our best efforts, clinics are occasionally cancelled without our knowledge. If you show up at a clinic that has been cancelled, immediately call Ms. Wilson at 287‐6292. You will be given an alternative clinic to attend. Even if the attending tells you clinic is cancelled and you can go home, you must still call Ms. Wilson to either receive credit for the missing clinic or to arrange for an alternative experience.
Cards are not to be signed by attendings or residents until clinic is over. If you leave a clinic prematurely, even if you have a signature from the attending, you may not receive credit for that clinic experience.
At the end of the rotation, you should verify that you have a signed card documenting participation in all of the clinics on your clinic schedule.
Turn these cards into Ms. Wilson on the last Wednesday of the rotation.
There are 2 clinics scheduled every day AM & PM (morning and afternoon). If staying in the same clinic morning and afternoon, 2 signed cards are needed.
Clinic cards must be signed by the attending physician.
It is recommended that each student call their private doctor at some point between the orientation and their first scheduled day with the doctor to confirm the time and location of their meeting with their private doctor. A listing of PCP locations and phone numbers are located in this packet.
ST.
JUDE
We are very fortunate to be able to spend time in the world’s premier children’s research center, St. Jude. This opportunity is due in large part to the efforts of Dr. Joan Chesney. Consequently, every student will be able to spend a week at St. Jude rotating through the various outpatient clinics, leukemia, solid tumor, After Completion of
Therapy, just to name a few. It is an amazing place with amazing patients.
Clinic cards do not have to be signed during your St. Jude week. Students will still attend clinic with their private PCP during their St. Jude week and must attend the conferences on Wednesday and Friday afternoons at Le Bonheur.
6/23/2015
NEWBORN
CENTER
The shelf and Step II exams always contain a goodly number of questions regarding neonatology. Many of the survivors of this unit go on to require long term care and to utilize a higher proportion of the health care system. Their complex issues provide a wealth of clinical application of basic science, particularly physiology and
embryology.
Each student spends a week of mornings only in the Newborn Center with Dr. Talati or his designate.
You are excused from attending the morning of your private practice experience. Simply go to your PCP in the afternoon that week.
Clinic cards do not have to be signed at the Newborn Center.
It is imperative that students arrive to the NICU before 8:00 on the first morning and ask for the second year residents. The residents are trying to acquire essential information on these tiny, complex patients before rounds. If they have to wait on late students to orient them to the nursery, it can be detrimental to patient care and is therefore a serious dereliction in professionalism, not to mention, just plain rude. Be on time!
Students arrive before 8:00 every subsequent morning and are expected to stay until 12 pm (until 1.00 p.m. on Tuesdays). 2nd floor Rout Bldg.
Students are to follow 2‐3 patients with a resident for the week.
Attend rounds with the attending neonatologists on service; students will be divided in two groups to round with each team.
Follow Pediatric residents to the delivery room and observe management.
Medical students may not write orders or perform any procedures unless performed under strict supervision of the attending.
Goals
of
the
rotation:
Gather appropriate history from parents/guardians and Obstetricians; perform physical examination of a well or ill newborn
Acquire knowledge about illnesses of term and preterm infants including but not limited to seizures, jaundice, sepsis, hypoglycemia, feeding problems, cyanosis and respiratory disorders in a neonate and develop a differential diagnosis
Identify diseases detected by neonatal screening and understand the risk of maternal/fetal transmission of various infections including HIV
Identify key concepts used in clinical evaluation of gestational age (Dubowitz score) and physiologic stability (Apgar scores) at birth
Observe delivery room management of a neonate and identify routine medications and immunizations of a newborn
Appreciate the effects of pre‐ and intra‐partum events on the infant
Reading
Material
(available
in
the
NICU)
Manual of Neonatal Care
Resident’s Manual of Orientation
Allergy OPC Suite 400 9:00 AM 1:00 PM 287‐6224
Allergy Gtown 100 N. Humphreys Blvd, 2nd Floor 8:00 AM 747‐5300
Cardiology Lobby Level in New Hospital
Suite 400 8:30 AM
1:00 PM
Thursdays 12:00 PM 287‐5092 Boling Center for
Developmental Disabilities (CDD)
Boling Center on Jefferson, RM 135
across from Phi Chi House 8:30 AM 1:00 PM 448‐6511
Diabetes OPC Suite 240 8:00 AM 1:00 PM 287‐6959
Emergency Room Ground floor, New Hospital 8:00 AM 1:00 PM 287‐6112 or
287‐7700 ER Fellow Teaching
Ground floor, New Hospital
**ask for the fellow conducting the
teaching shift**
1:00 PM 287‐7700
Endocrinology OPC Suite 400 8:00 AM 1:00 PM 287‐6959
Endo Gtown 100 N. Humphreys Blvd, 2nd Floor 8:00 AM 1:00 PM 747‐5300
Gastroenterology OPC Suite 400 8:30 AM 1:00 PM 287‐4514
Gastro East Le Bonheur East
806 Estate Place 8:00 AM 12:00 PM 287‐4017
General Pediatrics OPC Suite 350 8:00 AM 1:00 PM 287‐5397
Genetics OPC Suite 400 8:00 AM 287‐4514
Genetics Gtown 100 N. Humphreys Blvd, 2nd Floor 8:00 AM 747‐5300
Newborn ICU Center Rout Building, 2nd floor
(Dr. Talati or his designee) 8:00 AM 545‐7366
Neurology Lobby Level in New Hospital
Suite 400 9:00 AM 1:00 PM 287‐5060
Pulmonology OPC Suite 400 8:00 AM 1:00 PM 287‐5222
Pulmonology Gtown 100 N. Humphreys Blvd, 2nd Floor 1:00 PM 747‐5300
Renal OPC Suite 400 8:00 AM
Tuesdays 9:30 AM 1:00 PM 287‐4514
Rheumatology OPC Suite 400 8:30 AM 12:45 PM 287‐6224
St. Jude
YOUTH VILLAGES DIRECTIONS:
6/23/2015
Meet at Youth Villages Monday, Tuesday, Thursday afternoons (1:30), Friday mornings (8:30). (See attached
map) Take either Summer Avenue or I‐40 East, and exit Germantown Parkway and go north to 7410
Memphis Arlington Rd. Then right into Youth Villages property. Take another quick right and follow drive
down to school (Paul Barret Jr. School on right). Turn left into parking lot, enter building and ask for
directions to the clinic (do NOT go to clinic for Intensive Res. Treatment). 252‐7771
CLINIC
LOCATIONS
Most clinics are located in the OPC (Outpatient Center), across Dunlap Street from the Research Tower. Clinics begin at
various times. See each clinic listing below for location and time. Refer to your individual schedule as to which clinics you
are assigned.
Some clinics are located in Germantown at 100 N. Humphreys Blvd (ULPS facilities). Pay close attention to your schedule.
*ALL WEDNESDAY MORNING CLINICS START AT 9:00* (EXCEPT ST. JUDE)
St. Jude Children's Research Hospital, ALL clinics start at 7:30am, including Wednesday morning clinic.
Orientation will be held in the Barry Building Conference Room on the 2nd Floor in Room# S2044A. If you
need assistance, please call Christine McManus at 901‐595‐7950. Orientation is generally at 7:15am unless
stated differently on your orientation sheet found in your packet given to you at general orientation. Maps
6/23/2015
END
OF
ROTATION
Items to bring Ms. Wilson on the last Wednesday of the rotation: Clinic cards (signed and all accounted for)
Signed Night Call card Signed Mastery Skills card
If
you
have
any
questions,
feel
free
to
contact
Dr.
Jameson
or
Ms.
Jenn
Wilson
at
287
‐
6292.
Directions to Youth Villages – Bartlett Campus (Old Boystown)
(DO NOT use your GPS. It takes you to the wrong location).
1. Head east on 1-40 toward Appling Rd.
56 ft
2.
Take
Appling
Rd
exit
North.
1.5
mi
3. Continue onto Brother Blvd. (Ignore Youth Villages Bldg
1.1 mi
on the turn. It’s administration only).
4. Turn left at Appling Rd. (thru
a
residential
area)
1.3
mi
5. Turn left at Memphis Arlington Rd.
0.3 mi
Youth Villages campus will be on the right.
7410 Memphis Arlington Road, Memphis, TN 38135-1908
OR
Take Summer Avenue east all the way to Memphis-Arlington Road and turn left.
Turn right into the first entrance and immediately turn right.
Once you’re on the YV campus
-
Turn right into the first entrance from Memphis-Arlington road and immediately turn right again
toward the school. (See Map)
Follow the road around to the Paul W. Barrett, Jr. School and park in the parking lot.
Walk around the school on the left and enter the entrance to the school (facing the lake.)
Walk through two sets of doors into the foyer. The clinic is directly ahead and slightly left.
If you get lost, call 252-7771 – Youth Villages Clinic
3\
Entrance Gate (1-5) P [ Patient Onl y Parkin g Kay Kat e Mail Roo m Dock (1-7) Danny Thomas/ALSA C Pavilio n Patient Car e Cente r Richard C. Shadya c ALSA C Towe r Danny Thomas Research Center Integrated Research Center Central Energ y Plan t Parking Garage 1 Incinerator/Hazardous Waste Chili's Care Center 545 Danny Thomas Place ALSAC Production Center 567 Danny Thomas Place 505 Building 305 Building Tamer-Rashid Building Parking Garage 2 Translational Trial s Uni t Longinotti Buildin g S) Barr y Buildin g T) Memphi s Grizzlie s Hous e U ) ALSA C Gif t Sho p V) Children' s GM P 448 North Second X) 16 0 Shadya c Avenu ePCP's
List
Physician ClinicName ClinicAddress ClinicPhone
Dr. Joshua Dillon Atoka Pediatrics 36 Capital Way, Suite E
Atoka, TN 38004 901‐837‐6801 Dr. William Fesmire Pediatrics East 120 Crescent Dr. Collierville,
TN 38017 901‐757‐3560
Dr. Jerri Giger Memphis Children's Clinic 6615 Kirby Center Cove
Memphis, TN 38115 901‐396‐0390 Dr. Tim Gillespie Memphis Children's Clinic 1129 Hale Rd. (Whitehaven)
Memphis, TN 38116 901‐396‐0390 Dr. Scott Kloek Memphis Children's Clinic 7705 Poplar Ave., Suite B230
Germantown, TN 38138 901‐396‐0390 Dr. Mike Lacy Memphis Children's Clinic 7672 Airways Blvd.
Southaven, MS 38671 901‐396‐0390 Dr. Manoj Narayanan Narayanan Pediatric Clinic 3964 Goodman Rd., Suite 133
Southaven, MS 38671 662‐895‐9498 Dr. Harry Phillips Memphis Children's Clinic 7672 Airways Blvd.
Southaven, MS 38671 901‐396‐0390 *Dr. Whitney Sanders* Memphis Children's Clinic 1129 Hale Rd. (Whitehaven)
Memphis, TN 38116
Ofc: 901‐396‐0390
Cell: 731‐694‐6092 Dr. Mel Senter Pediatrics East 2002 Exeter Drive
Germantown, TN 38138 901‐757‐3570 Dr. Van Snider Memphis Children's Clinic 7705 Poplar Ave., Suite B230
Germantown, TN 38138 901‐396‐0390 Dr. William Terrell Memphis Pediatric Group 1444 E. Shelby Dr., Suite 317
Memphis, TN 38116 901‐396‐8281 Dr. Lana Yanishevski Laurelwood Pediatrics 5050 Sanderlin
Memphis, TN 38117 901‐683‐9371
***Dr. Sanders would like for you to call the office number for checking on clinic cancellations,
clinic closings, or inclement weather. If you're running late or calling in due to illness,
please call her on her cell phone.
