Alfonso Vargas, MDVice-Chairman for Education and International Affairs

Department of PediatricsLouisiana State University Health Sciences Center, New Orleans

Louisiana State University Health Sciences Center -School of Medicine in New Orleans - LSUHSC-SOM

Association of Pediatric Program Directors - APPD South East Regional MeetingAll Children’s Hospital – Johns Hopkins MedicineSt. Petersburg, FL - Sat. Sept. 8th, 2012

Hurricane Katrina

Hurricane Katrina

LSUHSC DEPARTMENT OF PEDIATRICS

NEONATAL TRANSPORT

Neonatal Transport

Neonatal Transport

Medical Center of Louisiana – “Charity Hospital”

LSU Health Sciences Center

Hurricane Katrina Impact. Tiger Care Clinic

(Main LSU Pediatrics Resident Training site) All computers and

flash drives were lost, as well as most patient charts

Children’s HospitalTemporarily Closed

September 1, 2005All patients evacuated to various Children’s

Hospitals

Present Day Pediatrics in New Orleans,

Louisiana

RECOVERY AFTER KATRINA

2005-2012

October 10, 2005

Children’s Hospital

LSUHSC Pediatrics Administration and most clinics are now located at Children’s Hospital

Research and Education BuildingThe Research Institute for Children - RIC

New Orleans

LSUHSC - Department of Pediatrics 2012-13

Clinical Faculty - 72 Research Faculty - Ph.D.’s - 11 Non-clinical Research - 13 Administrative Staff - 7 Fellows - 23Pediatrics Chief Residents - 2 (PGY-4)Pediatrics Residents - 49 (PGY 1, 2, & 3)Med/Peds Chief Residents - 2 (PGY-4)Med/Peds Residents - 23 (PGY 1, 2, 3, & 4)Coordinators: 2 (1 - Peds; 1 - Med/Peds)Program Directors: Bonnie Desselle, MD -

Pediatrics Betty Lo-Blais, MD - Med/Peds

Associate Program Directors: Drs. George “Jay” Hescock, Suzanne LeFevre & Rachel Dawkins

Department Head: Ricardo Sorensen, MD

THE PEDIATRIC MILESTONE WORKING PROJECT - ACGME & ABP

Working Group Advisory Board Carol Caraccio (Chair) Bradley Benson Ann Burke Robert Englander Susan Guralnick Patricia Hicks Stephen Ludwig Daniel Schumacher (*)ACGME Lisa Johnson Jerry Varsilias Caroline Fischer

Carol Aschenberger Richard Behrman Timothy Brighman Stephen Clyman Eric Holmboe M. Douglas Jones, Jr. Gail McGuiness Victoria Norwood Robert Perelman William Raszka Theodore Sectish Susan Swing

ACGME & ABPThe Pediatric Milestone Working Project

Competency - Patient Care

1. Gather essential and accurate information about the patient

A. Background Development of Information Gathering Skills:

EARLY -INTERMEDIATE -ADVANCED

Primary Author: Daniel Schumacher, MD

DEVELOPMENTAL MILESTONES

Too little or exhaustive => Analytical reasoningLinkage of signs & symptoms => Deeper

analytical reasoning - Pertinent positives & negatives - Broad diagnostic categories

Creation of “Illness Scripts” => Specific diagnostic considerations - Early & real time development of a differential diagnosis

Well developed “Illness Scripts” => Precise diagnosis to be reached with ease and efficiency

Robust “Illness Scripts” => Unconscious gathering of essential and accurate information in a targeted and efficient manner

LSUHSC & Children’s Hospital of New OrleansPediatrics Chief Residents 2012 - 2013

Nicole McMahon, MD & Chelsey T. Sandlin, MD

Chief Morning Reports

Given daily by the two chief residents

Focuses on specific patients seen by our residents

Encourages audience participation The chief complaint is provided by the resident who

saw the patient. Residents must ask for further pertinent

information and develop their differential diagnosis. The physical exam is finally given before the

audience must decide which tests they want to order.

Chief Morning ReportsResidents must develop an appropriate

problem definition using specific qualifiersThe group then thinks of the top 3-4

differential diagnoses Residents are split into groups to develop an “Illness

Script” for their assigned diagnosis -Implemented this year based on the 2013 Milestone

guidelines -The interactive style helps to guide adult learning

The chief resident ultimately presents a robust “Illness Script” for the actual diagnosis as well a brief presentation that contains the ABP Content Specs for the chosen topic.

SymptomsAcute /subacute Chronic

Localized DiffuseSingle MultipleStatic Progressive

Constant IntermittentSingle Episode Recurrent

Abrupt GradualSevere MildPainful NonpainfulBilious Nonbilious

Sharp/Stabbing Dull/Vague

Problem Characteristics

Ill-appearing/Toxic

Well-appearing/Non-toxic

Localized problem

Systemic problem

Acquired Congenital

New problem Recurrence of old problem

Semantic Qualifiers

Encourage the residents/students to use these qualifiers

when developing their problem definitions!

Illness Scripts

Predisposing Conditions Age, gender, preceding

events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc)

Pathophysiological Insult What is physically happening

in the body, organisms involved, etc.

Clinical Manifestations Signs and symptoms Labs and imaging

Thanks!

LSU