March 2012

St. Elizabeth Family Medicine Residency Program

Curriculum for:

PEDIATRICS
Introduction
The Pediatric rotation is an essential part of the three years of family medicine residency training.
Effective preventive health care holds the promise of a lifetime of wellness. Family Physicians have
the unique opportunity to treat the entire family, and therefore are able to better assess the effect of
the individual family members on the childs health. As every patient encounter presents an
opportunity to learn, the residents are encouraged to fully utilize every opportunity to better
understand the special nature and needs of children.
Goals
The overall goals of the Pediatrics Curriculum are that, at the conclusion of their rotation, they will:
A. Demonstrate an overall understanding of childhood medical and mental health and social
issues, as well as their management;
B. Demonstrate a level of professionalism, manifested through a commitment to carrying out their
given responsibilities, adherence to ethical principles and sensitivity to a culturally and
economically diverse patient population.
Objectives
Upon completion of their rotation, the first, second and third year Resident will:
A. Display an attitude and skill that encompasses, and is not limited to:
1.
2.
3.
4.
5.

Concern of the health of children in the context of the family

Compassion for the special needs of children and the need to be the advocate for their care
Awareness of the importance of health care access and continuity of care to prevent illness
Passion for the promotion of healthy lifestyles in children and their families
Awareness of the unique vulnerability of children that may require special attention,
consultation and referral to community organizations
6. Knowledge of the impact of social, cultural and environmental factors on childrens lives
and preventative medicine
7. Skill in obtaining information regarding school performance and possible detection of
learning disabilities
B. Meet each of the following expectation:
1. 100% attendance and no tardiness
2. Good communication with the patients family, adhering to the principles of cultural
competence
3. Daily case presentations with complete history and examination
4. Daily readings from recommended texts, including self-study questions
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5. Maintenance of a professional attitude and appearance at all times

PGY 1
Upon completion of their rotation, the first year Resident will:
A. Be able to discuss the following areas in the fetal and neonatal period, with the Pediatric
attending:
1.
2.
3.
4.

Gestational age assessment and risk factors

Effect of labor and delivery on the infant
Adaptations of extra uterine life
Diagnosis and appropriate management of:
a. Meconium aspiration
b. Perinatal asphyxia
c. Respiratory distress
d. Cyanosis
e. Apnea
f. Seizure
g. Hypoglycemia
h. Sepsis
i. Developmental dysplasia of the hip
j. Birth related injuries
k. Anemia
l. Rh and blood type incompatibility
m. Polycythemia
n. Jaundice
o. Prematurity and post-dates
p. Maternal infections
q. Sudden Infant Death Syndrome
r. Neonatal Resuscitation

B. Be able to perform the following tasks in a well newborn and child care:
1. Recommending schedule and content for examinations from birth to adolescence
2. Providing age-appropriate anticipatory guidance
3. Assessing growth and development
4. Advising effective parenting and discipline
5. Preparing parents for school readiness
6. Advising nutrition, feeding and dental care
7. Advising appropriate preventive medicine and screening tests
8. Discussing prevention of accidents and injuries
9. Assessing and educating parents about child abuse
10. Recommending age-appropriate immunizations
11. Performing newborn screening, including:
a. Anemia
b. Lead
c. Fluoride
d. Obesity
e. Hypertension
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12. Assessing Pediatric psychological and behavioral problems, including but not limited to:
a. Recognition of families with mental health risk
13. Diagnosing and treating the following disorders:
a. Attention Deficit Hyperactivity Disorder and its differential diagnosis
b. Feeding and elimination problems
c. Eating disorders
d. Somatic and sleep disorders
e. Mood disorders
C. Be able to perform the following tasks:
1.
2.
3.
4.
5.
6.

Assign APGAR score accurately

Certify in Neonatal Resuscitation and demonstrate competence
Obtain and write a comprehensive pediatric history and examination
Show the use of growth charts including calculation of BMI
Administer and interpret developmental screening tests
Perform history and examination of child abuse cases and communicate with appropriate
social agencies
7. Interpret behavior questionnaires for parent/teacher assessment of attention deficit
hyperactivity disorder (ADHD)
8. Interpret hearing and vision screening tests
9. Perform pneumatic otoscopy and interpret Tympanogram
10. Perform bladder cauterization and suprapubic aspiration
11. Perform throat culture and interpret rapid streptococcal screening tests
PGY 2
Upon completion of their rotation, the second year Resident will:
A. Be able to demonstrate the understanding and advising in the following areas:
1.
2.
3.
4.
5.
6.

Social and ethical issues

Adoption and foster care
Divorce, separation and death
Impact of family violence and drug and alcohol abuse
Child abuse
Values and challenges of non-traditional families

B. Be able to discuss genetics and developmental disabilities, including but not limited to the
following topics:
1.
2.
3.
4.

Genetic screening
Chromosomal disorders
Developmental delays
Learning disabilities

C. Be able to demonstrate the understanding of the following medical problems of children and
adolescents:
1. Allergic disorders, including:
a. Asthma
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2.
3.

4.

5.

6.

7.

b. Atopy
c. Allergic Rhinitis
Inflammatory disorders, including:
a. Juvenile Rheumatic Arthritis
b. Vascular Syndromes
Renal disorders, including:
a. Glomerulonephritis
b. Hematuria / proteinuria
c. Urinary tract infection / pyelonephritis
d. Vesicluo urethral reflux
e. Hypospadius
f. Enuresis
g. Cryptorchidism
Endocrine / metabolic disorders, including:
a. Diabetes mellitus
b. Metabolic syndrome and obesity
c. Thyroid problems
d. Failure to thrive
e. Growth problems
Neurological disorders, including:
a. Seizures
b. Headache
c. Syncope
d. Cerebral Palsy
Dermatological disorders, including:
a. Atopic dermatitis
b. Rashes
c. Cellulitis
d. Acne
e. Burns
Musculoskeletal disorders, including:
a. Club foot
b. Fractures
c. Gait problems
d. Scoliosis
e. Back ache
f. Limping

D. Be able to demonstrate proficiency in the following tasks:

1. Perform vascular access
2. Perform lumbar puncture
3. Perform gynecological examination
4. Calculate fluid and electrolyte requirements
5. Interpret various common blood test reports in children, including arterial blood gas
6. Insert nasogastric tube placement
7. Perform emergency endotracheal intubation
8. Perform phototherapy
9. Removal of impacted cerumen
10. Perform nasal washing
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PGY 3
Upon completion of their rotation, the third year Resident will:
A. Demonstrate the knowledge of the following medical disorders:
1. Gastrointestinal disorders, including:
a. Gastroenteritis
b. Constipation
c. Encopresis
d. Abdominal pain
e. Common infections
f. Malabsorption
g. Food poisoning
h. Gastro esophageal reflux
i. Colic
j. Obstructive conditions
k. Hernia
2. Cardiovascular disorders, including:
a. Heart murmurs
b. Congenital heart disease
c. Chest pain
d. Hypertension
e. Syncope
3. Pulmonary disorders, including:
a. Bronchitis
b. Croup
c. Pneumonia
d. Tonsillitis
e. Sinusitis
f. Asthma
g. Epistaxis
4. Otological disorders, including:
a. Otitis media
b. Externa
c. Hearing loss
d. Foreign body
5. Ophthalmological disorders, including:
a. Conjunctivitis
b. Blocked naso-lacrimal duct
c. Red eye
d. Decreases visual acuity
6. Other infections, including:
a. Sepsis
b. Meningitis
c. Osteomyelitis
d. AIDS
7. Neoplastic disorders such as leukemia and common tumors
8. Adolescent health
9. Tanner staging
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10. Behavioral disorders, including:

a. Sexuality
b. Peer pressure
c. Anorexia nervosa
d. Bulimia
e. Adolescent risk taking behavior
f. Substance abuse
g. Adolescent preventative health care
h. Precocious puberty
i. Depression and suicide
j. Sexually transmitted diseases
k. Menstrual problems
l. Violence
m. Medico legal issues of adolescence
B. Be able to demonstrate proficiency in performing the following tasks:
6. Basic Pediatric Radiological diagnosis
7. Management of warts with cryotherapy
8. Removal of common skin lesions
9. Suture placement and removal
10. Management of Nursemaid elbow
11. Excision of an ingrowing toe nail
12. Dietary evaluation and counseling
13. Corneal staining
14. Removal of foreign body from nose and ear
15. Coordination of patient care, hospital admissions and specialty consultation and
community service referral
C. Osteopathic physicians will integrate principles of Osteopathic Medicine in all aspects of
patient care.
Implementation
The Pediatric Rotation consists of a one-month block and one 2 wk block in PGY 1 and a one month
block in PGY 2 and 3. Aside from this, the resident has the option of doing an additional elective
pediatric rotation. The locations of the pediatric rotation include the East Utica Medical Center,
Childrens Health Center, Faxton-St. Lukes Memorial Hospitals Nursery and Pediatric Units,
Pediatric Clinic at the Family Medicine Center, and the St. Elizabeth Medical Centers Ortho-Peds
Unit. Other elective Pediatric Rotations are arranged individually. Residents also develop continuous
and longitudinal experience, with their own pediatric patients during their regular clinic hours at the
Family Medicine Center at Hobart Street, and also in the Emergency Department at St. Elizabeth
Medical Center. In addition, residents also attend School Health visits with the attending. There will be
a week overlap period between the Pediatric and the Behavioral Medicine rotation to help Residents
to gain an understanding of developmental disabilities and the role of Community agencies.
Attending Objectives
The Pediatric attending is expected to fulfill the following responsibilities:
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A. Daily supervision of the clinical care of the resident (physical exam, assessment, and
treatment plan);
B. Development of a continuity of care perspective;
C. Assigning topics for review and presentation;
D. Attending bimonthly Pediatric Morning Report and Journal Club topics to discuss cases and
new research;
E. Monthly Pediatric lecture for Interns and Medical students; and
F. Organizing Neonatal Resuscitation Program for certification of new interns as well as new third
year residents needing to recertify.
Evaluation
The resident will be evaluated on the basis of his/her competency in the following six areas:
A. Provide Patient Care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health; objective A.
B. Demonstrate Medical Knowledge about established and evolving biomedical, clinical, and
cognate, for example epidemiological and social-behavioral, sciences and the application of
this knowledge to patient care; objectives B-I.
C. Apply Practice-Based Learning and Improvement that involves investigation and evaluation
of their own patient care, appraisal and assimilation of scientific evidence, and improvements
in patient care; objective J4
D. Demonstrate Interpersonal and Communication Skills that result in effective information
exchange and teaming with patients, their families, and other health professionals; objectives
J1-J5
E. Exhibit Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population;
objectives J 1-5
F. Apply Systems-Based Practice, as manifested by actions that demonstrate an awareness of
and responsiveness to the larger context and system of health care and the ability to
effectively call on system resources to provide care that is of optimal value; objective I 10
G. Osteopathic physicians will utilize Osteopathic Philosophy and Osteopathic Manipulative
Medicine as appropriate; objective L
Methods of Evaluation

The competence of the resident and the input of the attending will be evaluated using multiple
methods of assessment:
A. Formative Evaluation
1.

The pediatric attending will provide on-going and regular feedback throughout the
rotation to advise the resident of his / her performance, and suggestions for improvement
where and when necessary. This will be assessed using oral response, patient encounter
observation, a checklist, and chart review.
2.
The resident will keep a log of all patient encounters throughout the rotation. The log
will be sent to the residency office at the end of the rotation. This will be assessed using
portfolio evaluation.
B. Summative Evaluation
A formal evaluation will be completed by the teaching attending at the end of the rotation. The
evaluation is an outcome-based measure, and will be assessed using a global rating.
C. Evaluation of the Attending
Each resident will evaluate the teaching / supervising attending at the end of the rotation, as
well as evaluate the curriculum of the rotation itself. The attending evaluations are done
anonymously. This will be measured by a global rating.
Materials Utilized
The Harriet Lane handbook : a manual for pediatric house officers / 2012
Tschudy, Megan M.
WS 29 H297 2012 19th ed.
Johns Hopkins: The Harriet Lane Handbook, 19th ed. 2011 (MD Consult)
Rudolph's pediatrics / 2011
Rudolph, Colin David,
WS 200 R917 2011 22nd ed.
Nelson textbook of pediatrics. / 2011
Kliegman, Robert.
WS 100 N432 2011 19th ed. /
Kliegman: Nelson Textbook of Pediatrics, 19th ed. 2011 (MD Consult)
American Academy of Pediatrics textbook of adolescent health care / 2011
Fisher, Martin M.
WS 460 A3162 2011
Atlas of pediatric physical diagnosis / 2007
Zitelli, Basil J.
WS 17 A881 2007 5th ed.
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Pediatric Annal (2006--) (Basch)

Pediatrics (1997--) (Basch)
Current Problems in Pediatric and Adolescent Health Care (2008--) (MD Consult)
Journal of Pediatrics (1996--) (MD Consult)
Pediatric Clinics of North America (1996--) (MD Consult)