Monday Tuesday Wednesday Thursday Friday Saturday Sunday. Youth Protection Clinic. Developmental Clinic. Clinic. Grand Rounds 12:30-13:30

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McGill University Pediatric Residency Program

Community Pediatric Rotation for PGY-II, PGY-III

Rotation Site: C.H.V.O. – Hôpital de Gatineau

Rotation Supervisor: Giuseppe Ficara

Rotation Template:

Week 1

Monday Tuesday Wednesday Thursday Friday Saturday Sunday AM Consultation

Clinic Consultation Clinic Youth Protection Clinic Developmental Clinic Asthma Clinic

Journal Club 12:30-13:30 Grand Rounds 8:00-9:00 Rencontre Post-clinique 12:30-13:30 Ambulatory Rounds 12:30-13:30 PM ER (clinic) visits CF or Diabetes Clinic

ER (clinic) visits Diabetes Clinic ER (clinic) visits

Week 2

AM NICU NICU NICU NICU NICU

Rencontre Post-clinique 12:30-13:30 Grand Rounds 8:00-9:00 Rencontre Post-clinique 12:30-13:30 Ambulatory Rounds 12:30-13:30

PM NICU NICU NICU NICU NICU

Week 3

AM Consultation

Clinic Consultation Clinic Youth Protection Clinic Developmental Clinic Ward* On-Call On-Call

ER (clinic) visits Diabetes Clinic Ward* On-Call

Week 4

AM Ward* Ward* Ward* Ward* Post-call

PM Ward* Ward* Ward* Ward* Post-call

The above schedule represents a typical month for a pediatric resident. It can be modified to meet specific educational objectives.

If the resident sees patients that require follow-up within the month, then they can be scheduled during the afternoon slots dedicated to clinic patient’s emergency visits. If the resident has a two month rotation, then specific follow-up clinics can be scheduled during the second month.

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* = pediatric resident will be on-call (home-call) from Friday to following Thursday, with supervision from attending physician. They will take first line calls on Friday, Sunday, Tuesday, and Thursday, while remaining available for all emergencies or unique learning opportunities on other nights. They will round on their in-patients both Saturday and Sunday morning.

Description of the rotation

The community pediatric rotation in Gatineau will expose residents to secondary and tertiary care pediatrics in the community setting. They will work in various general and specialized pediatric clinics where patients are referred from community physicians, or where patients with complex problem lists are followed. Furthermore, residents will do one week of in-patient service where they will be responsible for their patients, as well as ER and in-patient consults from general practitioners. Their last week will be spent in the advanced level-II NICU, where they will be responsible for their patients, in-patient consults from general practitioners covering the nursery, and consults for high-risk deliveries/case-room management of neonatal distress.

The supervisor for this rotation is Dr. Giuseppe Ficara, CHVO-Hôpital de Gatineau, 4th

floor Pediatric Clinic, (819)-561-8565. Dr. Ficara will meet with the resident at the

mid-point of their rotation for formal feedback, and once again at the end of the rotation (the feedback will be a consensus of all supervisors involved). This is of course in addition to all formative feedback offered throughout the rotation by clinical supervisors. Dr. Ficara will oversee the supervision process, which will consist of one clinical mentor during the ward-service week, one clinical mentor during the NICU service week, and various mentors during the clinic weeks. The resident will be expected to present one case (along with discussion) at one of the two journal clubs during the month.

Learning Objectives (based on CAMEDS competencies) Medical Expert:

• Assume primary responsibility in the diagnosis and management of pediatric problems encountered as a community consultant, under direct supervision from mentor (pediatrician)

• Develop additional exposure to specific problems through specialized clinics (Asthma, Diabetes, Development, Youth Protection, Cystic Fibrosis)

• Acquire an appreciation for pediatric practice outside the tertiary university-hospital setting

• Develop decision-making abilities and skills which are necessary in the absence of subspecialists immediately available

• Learn how to communicate effectively with subspecialists over the telephone to transmit accurate information, and develop skills to determine which patients can be co-managed with telephone support & which patients must be transferred

• Develop skills necessary to make appropriate decisions about patient transport to another centre (most appropriate mode of transport, personnel for transport, and medical issues related to condition of the patient)

• Learn about practice management and administration in the community setting

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• Interaction with parents and children in the clinical setting

• Interaction with other members of pediatric team (pediatricians, nurses, respiratory therapists, physiotherapists, occupational therapists, dieticians, psychologists, social workers, secretarial staff)

• Interaction with physicians and professionals requesting consultations and expert advice

• Interaction with consultants (pediatric subspecialists) over the telephone

Scholar:

• Capacity for independent learning around cases

• Interactive & effective lecturing during presentation

Collaborator:

• Functions well and respectfully within the pediatric team

Professional:

• Honesty, integrity, ethics

• Responsibility & self-discipline

Advocate:

• Understanding of the need for pediatricians to advocate on behalf of children and their specific needs in the community that they care for

Manager:

• Observation of pediatrician’s role within multidisciplinary team

• Observation of pediatrician’s role as a consultant rather than primary care provider

Giuseppe Ficara, May 2003

This document complements the report submitted by Dr. Saleem Razack to the CMQ (“Rapport d’étapes des milieux de formation”) subsequent to his Gatineau site visit on December 19th_{, 2002,}

as well as the document given to residents at the beginning of their Gatineau rotation entitled “Pediatric Resident Rotation… CHVO-Gatineau”.

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Updated May 5th_{, 2003}

Pediatric Resident Rotation

McGill University – Faculty of Medicine

Centre Hospitalier des Vallées de l’Outaouais

Pavillon de Gatineau

Please refer to document entitled “McGill University Pediatric Residency Program

Community Pediatric Rotation for PGY-II, PGY-III; Rotation Site: C.H.V.O. – Hôpital de Gatineau” which complements this one.

This document will refer to specific information related to the resident rotation at the CHVO site. Residents will spend 4 weeks rotating through the Pediatric Dept. at the CHVO.

The 4 weeks will be divided as follows:

Week

1 Monday Tuesday Wednesday Thursday Friday Saturday Sunday AM Consultation

Clinic Consultation Clinic Youth Protection Clinic Developmental Clinic Asthma Clinic

ER (clinic) visits Diabetes Clinic ER (clinic) visits

Week 2

AM NICU NICU NICU NICU NICU

PM NICU NICU NICU NICU NICU

Week 3

AM Consultation

Clinic Consultation Clinic Youth Protection Clinic Developmental Clinic Ward* On-Call On-Call

ER (clinic) visits Diabetes Clinic Ward* On-Call

Week 4

AM Ward* Ward* Ward* Ward* Post-call

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The above schedule represents a typical month for a pediatric resident. It can be modified to meet specific educational objectives.

If the resident sees patients that require follow-up within the month, then they can be scheduled during the afternoon slots dedicated to clinic patient’s emergency visits. If the resident has a two month rotation, then specific follow-up clinics can be scheduled during the second month.

* = pediatric resident will be on-call (home-call) from Friday to following Thursday, with supervision from attending physician. They will take first line calls on Friday, Sunday, Tuesday, and Thursday, while remaining available for all emergencies or unique learning opportunities on other nights. They will round on their in-patients both Saturday and Sunday morning.

Pediatric Ward Service

Residents will be responsible for ward admissions, ER & in-patient consults, and fielding selected telephone consults from community physicians.

Each patient should have a complete admission note or consultation, and daily progress note documented in the chart.

All orders and medical prescriptions MUST be counter-signed by staff physician.

Each resident will discuss with their mentor how their days will be organized, but a typical day may be as follows:

8AM – resident rounds on patients. 9AM – resident and staff sit-down rounds. 10AM – resident and staff bedside rounds.

11AM – resident completes the day’s work to be done for patients (discharges, organizing tests & consultations, and so on), and writes progress note for the day.

12PM – Break for lunch + topic discussion

1PM – Follow-up on morning’s work, including lab results & radiology. Residents are responsible for putting together all of the day’s labs and putting films aside in Radiology to be viewed with staff that same day. Some of the more acutely active patients will also need to be examined several times per day.

2PM – Admissions & new consults (which may be interspersed during the day, depending on the urgency). When a resident is paged for a new consult or admission, the staff must be advised immediately of the new patient, so that they can be triaged appropriately.

3:30PM – Sign-out rounds + topic discussion.

4PM – Clerkship lectures (Teleconferenced from CHEO for medical students, and residents are welcome to attend.)

Residents will also be responsible for student supervision on the ward, appropriate to their level of training.

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NICU

Residents will be responsible for NICU admissions & consults, as well as attending high-risk deliveries.

Each patient must have an admission note or consultation in the chart, as well as daily progress notes.

Again, all orders and medical prescriptions MUST be countersigned by staff, and staff physicians should be advised immediately of all consultations or requests to attend births.

Each resident will discuss with their mentor how their days will be organized, but a typical day may be as follows:

8AM – resident rounds on patients. 9AM – resident and staff sit-down rounds. 10AM – resident and staff bedside rounds.

11AM – resident completes the day’s work to be done for patients (discharges, organizing tests & consultations, and so on), and writes progress note for the day.

12PM – Break for lunch + topic discussion

1PM – Follow-up on morning’s work, including lab results & radiology. Residents are responsible for putting together all of the day’s labs and gathering X-rays to be reviewed with staff that same day. Some of the more acutely active patients will also need to be examined several times per day.

2PM – Admissions & new consults (which may be interspersed during the day, depending on the urgency).

3:30PM – Sign-out rounds + topic discussion.

4PM – Clerkship lectures (Teleconferenced from CHEO for medical students, and residents are welcome to attend.)

Residents will also be responsible for student supervision in the unit, appropriate to their level of training.

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Out-patient clinics

Residents will attend of variety of general and subspecialized pediatric clinics over two weeks. Residents will discuss with their mentor how each clinic will be organized. For most clinics, the resident will see the patient first, and then review with the staff. For some of the subspecialized clinics (eg Youth Protection), the resident will benefit from clinical exposure, however it may be more appropriate for them to observe the encounter.

Residents will be responsible for documenting the clinic visit in the chart, organizing follow-up and lab tests, and writing a letter to the referring physician as the case may be. As with their in-patient experience, all documents must be counter-signed by the staff physician.

On-Call

Residents will take call during their week of ward service. While on-call, residents will be responsible for the pediatric ward and NICU, ER consults, and deliveries.

They will take home call, and must discuss ALL decisions with the staff physician. Call will work in the following manner:

Friday: first-line call (will receive sign-out from NICU physician @ 5PM) Saturday: round with staff in AM, then sign-out to NICU physician

Second-line call (ie only for emergencies)

Sunday: round with staff in AM, then receive sign-out from NICU physician First-line call

Monday: second-line call Tuesday: first-line call Wednesday: second-line call Thursday: first-line call

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Procedures

Residents will be exposed to a variety of procedures throughout their clinical experience. If they have not already had the chance to do so, they will be given the opportunity to learn:

Under supervision from MD or RN, will learn: -venipuncture

-nasogastric tube insertion

-throat swab + nasopharyngeal aspirate -PPD (from clinic RN)

Under supervision from MD, will learn: -lumbar puncture

-airway skills

-principles of neonatal resuscitation

Under supervision from lab technician, may gain exposure to: -interpretation of urinalysis

-interpretation of blood smear

Residents with special interests may request exposure to other clinical skills. Resource People

Rotation supervisor: Dr. Giuseppe Ficara (pager: 719-0557) Faculty: Dr. Henriette Fortin Dr. Josée Bernatchez Dr. Marie-Hélène Landreville Dr. Eve-Marie Bélanger Dr. Chantal Gagné Dr. Jean Lemonde Dr. Mariette Boisvert Dr. Sonia Bédard Dr. Dominic Héon Dr. Julie Nault Dr. Dionne King Dr. Giuseppe Ficara Clinic Nurses: Suzanne Marsolais Ginette Renaud Clinic Secretaries: Sylvie Wolfe Sylvie Guérette

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Librarian:

Michel Turpin 561-8106

Complete list of pediatric reference texts, common pediatric journals, and computer/Internet access. Important numbers: Hospital: 561-8100 Pediatric Ward: 561-8384 NICU: 561-8393 ER: 561-8222 Clinic: 561-8565 Clinic Fax: 561-8103 Hematology: 561-8251 Biochemistry: 561-8252 Microbiology: 561-8253 Filmothèque: 561-8187 Administration: Suzanne Lessard

All residents are provided with a pager, parking pass, ID card, and locker. As well, all visiting trainees are provided with an apartment during their rotation (accommodations within walking distance of the hospital).

Expectations

Residents will be expected to meet the objectives listed above, as well as conform to all McGill University guidelines.

Residents will be required to prepare one case presentation and discussion, to be presented at a journal club during their rotation (see below).

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Teaching Sessions

There will be a journal club every second Tuesday between 12:30-1:30PM.

Case presentations and clinical discussions within the Pediatric Group are held every Thursday from 12:30-1:30PM, and on every second Tuesday between 12:30-1:30PM (alternate with journal club).

Grand Rounds are videoconferenced from the Montreal Children’s Hospital every Wednesday morning from 8-9AM.

Ambulatory Rounds are videoconferenced from the Montreal Children’s Hospital every Friday afternoon from 12:30-1:30PM.

Twice each month, the residents will be invited to formal teaching offered by pediatricians to family medicine residents.

As well, there will be daily informal teaching sessions + bedside teaching between resident and mentor.

As mentioned above, lectures will be teleconferenced daily from CHEO between 4PM & 6PM for medical students (except Fridays). Residents are free to attend these lectures if they wish. Evaluations

Evaluations will respect the standards set forth by the McGill University.

Each resident will receive feedback halfway through the rotation, and once again at the end of the rotation.