Your Pediatric Emergency Medicine Rotation: Making the Most of the Educational Opportunities

2 Welcome!  The Pediatric Emergency Center (PEC) & Pediatric Urgent Center (PUC or “Walk-In”) offers a unique opportunity to participate in the care of sick and injured children.  The spectrum of disease & variations in severity is unmatched in any other pediatric rotation.  You will be directly managing patient care under the supervision of a faculty member of the Division of Emergency Medicine in the Department of Pediatrics of Emory University School of Medicine.

3 Opportunities to Learn Pediatric Emergency Medicine covers a very diverse group of medical and surgical conditions. Your rotation will include both clinical and didactic opportunities to optimize your exposure:  Experience in evaluation & management of patients under faculty supervision  Supervised clinical procedures  Board-type review questions to identify strengths and weaknesses in your knowledge base  On-line resources for clinical information  Small group sessions (“Precepting Sessions”)

4 This Orientation  General Expectations  Learning Activities  FAQs NOTE: This orientation is an introductory overview. All learners must review the resources found on our website under “Teaching Portal”:

5 Expectations  What to expect of the faculty (attendings and fellows)  What the faculty expects of you

6 Expectations of Faculty Faculty will:  give you the opportunity to examine, assess and present patients.  assess your patients and provide feedback on areas of agreement and disagreement.  explain their recommendations and decisions.

7 Expectations of Faculty cont’d Faculty will:  teach and supervise procedures.  provide feedback to you on perceived strengths and weaknesses during the rotation.  provide end of rotation evaluation.

8 Expectations of the Learners  Before you begin the rotation  Learning Activities During the Rotation  End of rotation

9 Expectations of the learners: Before you Begin  Log onto the Teaching Portal: login/password to the Teaching Portal should be provided prior to the start of your rotation:   (404)  Make sure your name activated on the site  Complete the On-Line Pretest Found on Teaching Portal website Purposes:  Identify weaknesses in knowledge base  Measure improvement in knowledge base

10 Expectations of the Learners  Before you begin  Learning Activities  End of Rotation

11 Self Directed Learning The learner must take responsibility for identifying and addressing learning needs.  Where do I feel unsure?  How can I become more competent in this area?

12 Learning Activities: Requirements  Take Pretest  Complete Learning Modules  Complete Procedure Log

13 PROCEDURE LOGS Per ACGME requirements, residents MUST keep track of their procedures.  Emory Pediatrics: Please enter your procedures on the ACGME web site within a week of completing the rotation. Jackie Riley will be printing out the completed list and forwarding it to us.  All other Residents: Use the procedure log provided on our website. Fax the completed log to Donna Stringfellow ( ) within a week of completing the rotation. A copy is available for download from our website.  Education  Teaching Portal  Procedure Loghttp:// FAILURE TO HAND IN YOUR PROCEDURE LOG WILL RESULT IN AN INCOMPLETE GRADE FOR THE ROTATION.

14 Learning Activities: Requirements  Participate in Precepting Sessions Practice reading radiographs in radiology rounds Give 1 mini-lecture Participate in discussions/workshops Observed H&P Provide feedback on the sessions  Take Post-test  no later than 1 week after your last shift

15 Precepting Attending Sessions  When: (excluding holidays) 11am-2pm  Hughes-Spalding: Monday, Wednesday, Friday  Egleston: Tuesday, Thursday  Who:  Residents & students scheduled that day  Led by faculty member or fellow  Purpose: Provide interactive and structured education during PEM rotation

16 Precepting Attending Sessions: Preparation  Prior to session day:  Go to Teaching Portal to indicate any preferred didactic topics for attending’s mini-lecture  Sign up for day to give your “mini-lecture” (Radiology Teaching File Notebook near x-ray viewing area)  Before the session starts:  Wrap up clinical work  Charge (or most senior) resident of the day prepares list of ~3-5 imaging studies to review for Radiology Rounds (see Radiology Rounds notebook)

17 Precepting Attending Sessions: Activities  Radiology Rounds: (Reading Room)  11:30-12:00 HS on Mon & Wed  1:30-2:00 EG on Tu & Th Cases presented by charge/senior resident Cases read by residents  Other Activities  “Mini-lecture” by attending  “Mini-lecture” by resident or student on elective  Observed H&P (at least once during month)  other activities: mock codes; procedure work shops; rounds in ED, wards, lab

18 Precepting Attending Sessions: Mini-Lecture  Sign up for a day you can give your mini-lecture ASAP (you do not need to specify the topic when you choose the date)  Choose a topic relevant to pediatric emergency medicine: ideally a topic which you need more information/understanding  Plan a minute talk/discussion: just enough time for a very focused topic!

19 Precepting Attending Sessions: Observed H&Ps  Our goal is to have at least 1 observed H&P for each resident during the rotation  Attending will provide verbal & written feedback  The written feedback form is evidence that you were observed during an H&P  The observed H&P can be performed during any shift during your rotation: it does not have to be during a Precepting Session

20 Precepting Attending Sessions: FAQs  Am I expected to come to sessions when I’m not scheduled to work?  No. But you are welcome to join us any time  Am I expected to give a mini-lecture again if I did none during a previous rotation?  Yes. One mini lecture per rotation  Are all students/residents expected to give a mini- lecture?  Only those rotating on Pediatric Emergency Medicine for 2 weeks or more

21 Precepting Attending Sessions: FAQs  What if it’s busy in the department?  minutes before each session you should prepare by wrapping up your work, limit taking on new responsibilities. If the department is unusually busy the precepting and shift attendings will discuss which residents should stay in the department and which can participate in the Precepting Session. Often residents will switch out to allow each other to participate in at least some of the Teaching Session.  What if I’d rather stay in the department?  Up to you: whatever you feel is the best learning opportunity

22 Precepting Attending Sessions  After the session you should receive an with a link to give your feedback on the session. Please take this opportunity to share your comments and advice! Other Questions/Comments: Michael Greenwald, MD

23 Resources  Texts, Journals, Articles  PEM website: Resident Handbook Clinical Guidelines Learning Modules  Ask questions!  Ask for feedback  Question attendings on their decisions  faculty with your questions

24 Clinical Guidelines found on PEM website Acute Gastroenteritis Asthma & bronchiolitis respiratory score Asthma Algorithm Asthma Guidelines Bronchiolitis Guidelines Burn Algorithm Burn Guidelines Chest X-Ray and Asthma Closed Head Injury < 2 years old : AAP Guidelines Closed Head Injury > 2 years old : AAP Guidelines Diabetic Ketoacidosis : Evaluation & Management

25 Clinical Guidelines found on PEM website Fever Guidelines part 1, 0-28 days Fever Guidelines part 2, days Fever Guidelines part 3, 2-6 months Fever Guidelines part 4, 6-24 months Fever/Neutropenia Rev 7/2006 Hyperbilirubinemia : Emory Neonatology Rev 2001 Long Board Sexual Abuse Guideline Sickle Cell Disease and Acute Chest Syndrome Sickle Cell Disease and Fever : Inpatient Sickle Cell Disease and Fever : Outpatient Sickle Cell Disease and Pain : Outpatient Tumor Lysis Syndrome Fever Guidelines part 1, 0-28 days Fever Guidelines part 2, days Fever Guidelines part 3, 2-6 months Fever Guidelines part 4, 6-24 months Fever/Neutropenia Rev 7/2006 Hyperbilirubinemia : Emory Neonatology Rev 2001 Long Board Sexual Abuse Guideline Sickle Cell Disease and Acute Chest Syndrome Sickle Cell Disease and Fever : Inpatient Sickle Cell Disease and Fever : Outpatient Sickle Cell Disease and Pain : Outpatient Tumor Lysis Syndrome

26 End of Rotation  Complete Post Test  Complete Learning Modules  Submit Procedure Log  Complete evaluations on faculty/rotation

27 FAQs Why do we rotate between the emergency department and urgent care?  Each side of the Emergency Department offers unique aspects of pediatric acute and urgent care  Faculty are assigned to these areas based on their expertise

28 FAQs: How should present a case?  Summarize the case briefly (should be able to do in 1 breath!)  Present Differential Diagnosis with rationale  Most likely & Most serious conditions  Not a laundry list  Present your Plan with rationale NOTE: This is where the learning is at!

29 FAQs What should I say when presenting to the attending when I do not know what to make of my patient’s complaints?  Summarize the case for yourself  Think of reasonable explanations for the symptoms  Research the condition before and after presenting

30 FAQs What are the requirements to pass the rotation?  Complete Post Test  Complete Learning Modules  Complete and submit Procedure log  Complete rotation evaluation  Passing (Acceptable) summary attending evaluation

31 FAQs : Who evaluates me?  Feedback on students and residents may come from a number of sources including attendings, fellows, staff (e.g. nurses), parents of patients.  You can always solicit feedback from any of the above individuals: ask during or at the end of your shift!

32 FAQs : Who evaluates me?  We try hard to address any concerns with examples and in a timely manner.  Final evaluation is a summary of feedback prepared by either the PEM program coordinator or your program director.

33 FAQs Who is my PEM program coordinator?  Emory Pediatrics: Dr John Cheng  Emory Emergency Medicine: Dr David Goo  Morehouse Pediatrics: Dr Taryn Taylor  Morehouse Family Practice: Dr Tiffany McKinnie  Emory Transitional Residents: Dr Mike Ziegler  Emory Psychiatry: Dr Debbie Young  Emory Family Practice: Dr Debbie Young  Emory School of Medicine (MS4): Dr Mike Ziegler  Emory Nurse Practitioner Students: Dr Tracy Merrill  Emory Physician Assistant Students: Dr Mike Ziegler

34 FAQs Can I take this rotation again as an elective? YES!

35 We hope you learn a lot during your rotation in the Pediatric Emergency Department!