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Pediatric Intensive Care Sub-internship - PEDS8027
Curriculum & Course Overview
The following information provides an overview for the Pediatric Intensive Care Sub-internship Course Curriculum. All course information can also be found on the CANVAS learning management system for this course, including learning materials and requirements. Pediatric Intensive Care Sub-Internship Faculty & Staff Contact Information Director Angela Czaja, MD MSc Phone: 303-724-2393; Email: [email protected] Co-Director Jennifer Soep, MD Phone: 720-777-5417; Email: [email protected] Course Staff Contact Joyce Carpenter Phone: 303-724-2393; Email: [email protected] Course Coordinator Michael Baca Phone: 720-777-4804; Email: [email protected] Training Site Children’s Hospital Colorado 13121 E. 16th Ave (Pediatric Intensive Care Unit – 3rd floor) Aurora, CO 80045
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Course Number: PEDS8027 Updated 05-02-2018 Disclaimer: This handbook/syllabus does not constitute a contract, either expressed or implied, with the University of Colorado School of Medicine. The University reserves the right at any time to change, delete or add to any of the provisions at its sole discretion. Furthermore, the provisions of this document are designed by the University to serve as guidelines rather than absolute rules, and exceptions may be made on the basis of particular circumstances.
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Table of Contents
Curriculum & Course OVERVIEW ................................................................... Error! Bookmark not defined.
Faculty & Staff Contact Information ............................................................. Error! Bookmark not defined.
Disclaimer: .................................................................................................................................................... 2
Welcome ....................................................................................................................................................... 4
Rationale, Goals & Objectives ....................................................................................................................... 4
Course Structure & Clinical Responsibilities ................................................................................................. 5
Additional Learning Opportunities ............................................................................................................... 5
Recommended Resources ............................................................................................................................ 6
Evaluations & Grading................................................................................................................................... 7
Attendance .................................................................................................................................................... 8
Security, Student Safety, and Disaster Preparedness ................................................................................... 9
Hazard Exposure & Needle Stick ................................................................................................................. 10
Professionalism ........................................................................................................................................... 10
Academic Honesty Statement..................................................................................................................... 11
Mistreatment .............................................................................................................................................. 11
Communication ........................................................................................................................................... 11
Attire ........................................................................................................................................................... 12
FAQs ............................................................................................................................................................ 12
General Information for Pediatrics & Children’s Hospital Colorado ............. Error! Bookmark not defined.
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Welcome
Welcome to the online portal for your Pediatric Intensive Care Sub-Internship course. This inpatient clinical rotation is designed for medical students who are planning a residency in Pediatrics and to prepare him/her for internship. There is one distinct clinical site for this Sub-Internship, the Pediatric Intensive Care Unit (PICU) within the Children's Hospital Colorado (CHCO).
If you have questions or concerns about the rotation, please feel free to contact Dr. Angela Czaja or Michael Baca (Sub-I Course Coordinator). Rationale, Goals and Objectives During the Pediatric Intensive Care Sub-internship, students are expected to advance their knowledge base and skills needed to provide medical care for critically ill infants and children within a quaternary care system. Furthermore, they will develop experience working with an inter-disciplinary team including advanced practice practitioners, nurses, respiratory therapists, pharmacists, dieticians, social workers and child life specialists. It is expected that students will function more independently during their sub-internship than they did during their Phase III training, moving beyond observation and participation into the role of the primary provider. As interns do not rotate through the PICU at the Children’s Hospital of Colorado, students will be work closely with the second and third-year pediatric residents, and pediatric critical care fellows, in the care of their patients. They will be supervised by the pediatric critical care attendings/faculty, who rotate one week at a time. Students will gain independence through the month, such that, by the completion of the rotation, they should be able function at or near the level of a starting intern with respect to the objectives of the rotation. Link to Learning objectives: General Pediatrics Sub-Internship Goals and Objectives Core Goals
• Provide patient care that is compassionate, appropriate and effective for the treatment of health problems.
• Recommend and interpret common diagnostic tests and vital signs.
• Provide complete, well‐organized documentation of a clinical encounter.
• Provide a complete, well‐organized oral presentation of a pediatric patient.
• Recognize a pediatric patient requiring urgent or emergent care and seek help appropriately.
• Communicate effectively with patients, families and all members of the health care team.
• Demonstrate professionalism by showing compassion, integrity and respect for others, responsiveness to patient needs and accountability to course requirements.
• Demonstrate the medical knowledge necessary to care for common pediatric conditions.
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• Provide high-quality care and advocate for patients within the context of the health care system.
• Use evidence based medicine and self-directed learning in the care of patients and education of others.
• Develop the attitudes and skills necessary for self-reflection that leads to improvement in practice.
Course Structure & Clinical Responsibilities
Four weeks in length, this course is designed for students interested in further training in pediatrics. Students function as an intern and are responsible for the admission, evaluation and continuing care of inpatients. Sub-internships are offered at Children’s Hospital Colorado and Denver Health. This sub-internship encompasses wide spectrum of inpatient care in pediatrics. You will function as though you are the primary provider for your patients. This includes daily examinations and progress notes. You are encouraged to develop a strong therapeutic alliance with patients and their families. The average patient load is two to four patients per student. You are expected to present your patients on rounds with an initial presentation the morning following admission. You may be asked to present your patients in other settings including attending rounds, professor’s rounds or radiology rounds. Ideally, these presentations should be practiced beforehand with the senior resident or intern.
Students at Children’s will be assigned a schedule that includes day (Monday - Friday 6 am to 5 pm and one Saturday) and night (Monday - Friday 5 pm to 6 am) shifts.
Students at Denver Health will work days: Monday - Friday 6 am to 6 pm with one call night per week until 10-11 pm. You will be expected to work the entire next day after your call night except if you are on call on Friday night, when you will come in to round on Saturday and leave after rounds. You will not be on call on Saturday or Sunday nights.
You should NOT to be scheduled for an overnight or call the night before your follow-up meeting for the High Value Care curriculum.
Additional Learning Opportunities at Children’s
Conferences: You are invited to attend a variety of conferences that occur at Children’s Hospital Colorado. These are excellent presentations and are highly recommended for those students on site or near CHCO.
Morning report: 7:30-8:00 AM, Aspen Conference Room. Senior residents will present hospitalized patients for clinical discussion with faculty.
Noon conference: 12:00-1:00 PM, Aspen Conference Room. Lunch is provided daily ($2 for students) and there are didactic presentations, patient discussions, and M&M conferences on Wednesdays and Thursdays.
Grand Rounds: First three Friday afternoons of each month from 12:30-1:30 PM, Oxford Auditorium, 2nd floor Conference Center. Lunch is subsidized by the Department ($2 for students).
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Silverman Rounds: Dr. Silverman, a distinguished Professor Emeritus of Pediatrics, conducts physical exam rounds once a week at CHCO. These are highly rated by students and are mandatory for students on the CHCO wards unless excused by Dr. Silverman.
Recommended Resources
• Children’s Hospital Colorado Clinical and Research Library
• University of Colorado School of Medicine Health Sciences Library
• Up-to-date (Online at My Children’s Colorado)
• PubMed (Online at My Children’s Colorado)
• Your Child’s Health: The Parents’ One-Stop Reference Guide to: Symptoms, Emergencies, Common
Illnesses, Behavior Problems, and Healthy Development by Barton Schmitt
• Current Diagnosis and Treatment in Pediatrics, 20th Edition by William Hay, Myron Levin, Robin
Deterding, and Judith Sondheimer
• Child Health Clinic Trainee Manual
Videos: Online Med has videos pertaining to pediatrics. Some of our pediatric residents report these videos as one method of study that they used when they were third year students. https://onlinemeded.org/pediatrics Online Resources The Bright Futures Pocket Guide is extremely useful for your outpatient experience. This booklet contains information about what is covered at the different well child visits. While a paper copy can be purchased, a free electronic version is available through the American Academy of Pediatrics! Search for “Bright Futures Pocket Guide” in your internet browser and download it on your phone or tablet. The Health Team Works website has fantastic guidelines for Pediatric Obesity and Pediatric Asthma. Look them up at: http://www.healthteamworks.org/guidelines/guidelines.html MedU Developmental Milestones Chart is an interactive chart that allows you to test yourself on the milestones by age/domain. If you click on a milestone, you can watch a video demonstrating that milestone. https://www.med-u.org/child_dev/index PedScripts is a great resource to improve clinical reasoning in pediatrics. Algorithms help you think through common complaints in pediatric and related illness scripts give additional information about specific conditions. http://pedscript.businesscatalyst.com/ Children’s Hospital Colorado offers numerous clinical care guidelines that are used in our hospitals and clinics. Go to www.childrenscolorado.org/health-professionals/referral-tools/referral-guidelines (or search Children’s Colorado referral guidelines in your internet browser) to read about asthma, bronchiolitis, croup, headache, and more. Applications for Smart Device
ChildrensMD (Android, iPhone, iPad) - free
While designed for parents, this is a great app for students and residents as they learn the spectrum of
severity of common pediatric complaints. It was written by Dr. Bart Schmitt in the Child Health Clinic.
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ChildrensMD is derived from the clinical protocols used by pediatricians and nurses in 10,000 practices and
400 nurse advice call centers in the US and Canada. These protocols have been tested for 15 years on more
than 150 million symptom calls.
Podcast: PedsCases
Covers many clinical topics that third year medical students in pediatrics are expected to know. You can subscribe to the podcast on your smart device and listen as you drive to and from work each day or while you exercise or cook dinner! The cases are also available on their website if you prefer to listen while sitting at your computer. http://www.pedscases.com/podcasts
Evaluations and Grading Completion of the course and faculty/resident evaluations is vital to the ongoing improvement of the sub-internship. We take your suggestions for improvement very seriously. Furthermore, faculty and residents truly value your input on how to improve their teaching skills. Please be constructive in your evaluations. Faculty and residents receive a composite report of their evaluations annually and only if they receive 3 or more evaluations to maintain anonymity of students. Note: all course evaluations must be completed within our online evaluation system, New Innovations, to receive your final grade for the Sub-Internship. All clinical evaluations are completed in New Innovations. Below are the instructions for access evaluations through this software.
• Here is the link to New Innovations: https://www.new-innov.com/login/ (Links to an external
site.) (Links to an external site.)Links to an external site.
• The “Institution Login” should be already filled in as “CUGME” (all caps).
• Enter your username and password, which are both the same, unless you have logged in before
and changed your password. It should be your first initial and last name (all lowercase). For
example, Nancy Drew would be “ndrew” in both fields.
• Once you log in you will have the option to change your user name and /or
• your password by clicking on the “CHANGE PASSWORD” link on the menu bar
Overview of Grading We follow the University of Colorado SOM Advanced Studies Elective Grading and Remediation Policy. Students are required to have at least 3 clinical evaluation forms completed, one of which must be completed by an attending physician. Students provide a list of evaluators to the Sub-Internship Coordinator who will create the evaluations in our electronic evaluation system, New Innovations. Sub-internship Withdrawal The following procedure applies to both UCD SOM students and externs. Please note an extern’s home school has the right to change the grade.
• A student may unilaterally withdraw from a sub-internship when not eligible to drop an elective
course by 5:00 PM on the seventh calendar day of the elective and receive a grade of Withdraw
(W).
• After 5:00 PM on the seventh calendar day and prior to 5:00 PM on the last calendar day of the
sub-internship, prior approval is required from the Director of the sub-internship before a student
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may withdraw. Approval or disapproval of the withdrawal is at the Sub-Internship Director’s
discretion; the Sub-Internship Director will confer with the Sub Internship Committee Chair prior to
issuing the final decision.
o The Sub-Internship Director may present the student with one or more of the following
grade options:
▪ Withdraw (W)
▪ Incomplete (IP)
▪ Another appropriate grade based on the student’s performance during the
completed portion of the sub-internship, including Fail (F)
o If there are extenuating circumstances, the Sub-Internship Director and Sub Internship
Committee Chair may decide to refer the issue to the Sub-Internship Committee; this
option will delay the final decision and affect the student. See section I.B.1 for grading
options
• A student who leaves a sub-internship after seven days and fails to contact the Sub Internship
Director will receive a grade of Fail (F).
• A student may not withdraw from a sub-internship after 5:00 PM on the last calendar day of the
sub-internship.
The final grade is determined by the average of the clinical evaluations. Students must also successfully complete all of the project work by the final day of the rotation to pass the course. Ultimately, the Sub-I Course Director reserves the right to assign the final grade (Honors, High Pass, Pass, or Fail) based on all the information available to him/her. There is no limitation on the number of honors assigned for the sub-internship.
Attendance The Infant, Child and Adolescent clerkship complies with the School of Medicine’s policies for attendance on clinical rotations as follows:
• Attendance on the clinical rotation is required. If students have an illness or other emergency, they
must contact their attending and/or resident, as well as the student coordinator, clerkship director,
and the Office of Student Life prior to missing any time.
• An “excused” absence is an absence for which permission has been granted. Excused absences are
considered to occur in voluntary or involuntary situations as defined below:
o “Voluntary” absence: an absence for an event or events such as family events,
conferences, review courses, and personal appointments. Every attempt must be made to
schedule these outside of required curricular elements. Presenting at conferences or
attending professional meetings needs to be approved by Student Affairs and is limited to
48 hours.
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o “Involuntary” absence: an absence for serious illness, jury duty, and academic difficulties.
• An “unexcused” absence is an absence for which permission has not been granted.
• The student is required to contact the Office of Student Life for all absences.
• If absences last for more than two days, the clerkship director and the Associate Dean of Student
Life will work with students and faculty regarding make-up time/work, issues of earning credit, etc.
• The rotation will end by 5 pm on the last Friday afternoon of the scheduled clerkship.
Reporting an Absence In the event of an unexpected absence, you are required to notify:
• Your preceptor / clinic AND
• The Student Coordinator (720-777-6867) AND
• Clerkship Directors AND
• The Office of Student Affairs ([email protected])
Please refer to your contact information sheet for phone numbers and emails if available. This contact information sheet is located in your I.C.A.C folder given to you the day of orientation. Please note: pediatric residents and most of our faculty use [email protected] as their primary email address – and do not check their ucdenver account regularly.
Security, Student Safety, and Disaster Preparedness
Institutional emergency and disaster preparedness policies and plan are outlined in the “Emergency-Preparedness Quick-Reference Guide” for the Anschutz Medical Campus. The link is published in the Clinical Block Syllabus, posted on Canvas http://ucdenver.instructure.com, and located next to emergency phones (e.g., ED1 and 2) as well as many of the student lounge areas, small group rooms, and lecture halls. Colorado Springs Branch students have similar policies and procedures provided by the branch. The Medical Student Policies and Procedures Manual “White Book” (http://www.ucdenver.edu/academics/colleges/medicalschool/education/studentaffairs/studentresources/Documents/StudentHandbook.pdf) publishes emergency information (section 4.1), “In an emergency, both the Office of Student Life (303-724-6407) and the Registrar’s Office (303-724-8053) will make reasonable efforts to contact a student or a student’s designated emergency contact.” Emergency information is also found on the Student Life web site: http://www.ucdenver.edu/academics/colleges/medicalschool/education/studentaffairs/emergencies/Pages/Emergencies.aspx Security, student safety, and disaster preparedness as well as relevant contact information for all core clinical sites will be provided to students at individual clerkship orientations and on the Canvas Phase III course location.
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Hazard Exposure/Needle stick
On the CUSOM website at: Needle-Stick & Bodily Fluid Exposures
Professionalism
The Office of Professional Excellence exists to provide faculty, residents, fellows and students a resource on campus to obtain a fair and equitable treatment for all matters. Under appropriate circumstances, the office can serve as an advocate for fair and equitable treatment for faculty, residents, fellows, and students and can facilitate safe reporting of mistreatment or abuse. The Office is available to help faculty, residents, fellows, and students with all issues and concerns and provides consultations, short-term coaching, counseling, referrals, alternative dispute resolution and facilitation. The Office can also assist faculty, students, and staff members in preparation for various meetings and conversations. The services of the Office of Professional Excellence are provided free of charge. Contact the office by emailing Jeff Druck, MD at [email protected], Abbey Lara, MD at [email protected] or Josette Harris, MD at [email protected]. For faster response, (no
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confidential information please) call 303-724-7854. Offsite and onsite visits are by appointment only. Building 500, 8th floor, room 8000C. Students are expected to:
• Contact the appropriate block faculty and student life for all voluntary and involuntary absences.
• Check email and Canvas regularly for communication about block activities and updates. Respond within 24 hours to all block emails requiring individual student response.
• Attend all block conferences and required events and arrive on time to these events.
• Complete all required coursework and evaluation.
• Use smart phones and electronic tables with discretion
• Wear professional dress.
Academic Honesty Statement
Students are expected to adhere to the Honor Code of the University of Colorado School of Medicine which states that students must not lie, cheat, steal, take unfair advantage of others, nor tolerate students who engage in these behaviors. Please check the website for information on the Medical Student Honor Code. http://www.ucdenver.edu/academics/colleges/medicalschool/education/studentaffairs/AcademicLife/HonorCouncil/Pages/default.aspx
Mistreatment
If a student feels that he or she has been subject to mistreatment in the learning or clinical environment, there are a variety of options for reporting. We recognize that students may differ in how they want to address this issue, and we seek to provide a wide array of reporting options. Please check the website for information and reporting in regards to mistreatment vs. suboptimal learning. http://www.ucdenver.edu/academics/colleges/medicalschool/facultyAffairs/Professionalism/Pages/DefinitionsExamples.aspx
Communication
Email: For general administrative questions (including scheduling, preceptor information, etc) contact the coordinator by email or telephone. For other questions or concerns, feel free to email the clerkship directors and copy the coordinator. If we email you, we will contact you at your CU email address. Canvas: Course documents can be found on Canvas, including this Syllabus, handouts for learning sessions, and supplemental resources. You will turn in required course assignments and paperwork through Canvas. Most students use the phone app “Tiny Scanner” to take pictures of paperwork to convert to a PDF and upload into Canvas. We do send out reminders and notifications through Canvas. If you are not checking Canvas every day, be sure to configure your Canvas account such that you receive daily emails.
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Attire
Students should wear business casual clothing and closed-toe shoes during the day in clinic and inpatient settings. Scrubs are only appropriate for the well-baby nursery (day or night) and night shifts on the inpatient wards. White coats are optional. Follow the dress code at your individual sites.
FAQs
For grades, how is my grade weighted based on the amount of time I spend with an evaluator? Each evaluation is weighted equally.
How are comments factored into my grade? The grading committee reads each comment and they are a major contributor to the clinical grade. We have provided extensive faculty development to our preceptors so they know that we want them to describe what they see you do in the clinical setting. To obtain honors, we are looking for comments such as “takes ownership of patients”, “manages patients”, “is able to develop a complete differential diagnosis and suggest a reasonable plan for patients.”
How does the course director account for hard graders or variations? We perform faculty development so preceptors understand how the evaluations factor into the grade. We emphasize the importance of reading the descriptions along the performance scales to help determine how to complete the evaluations and how to write useful comments that describe the specific behaviors they have observed. If there are discrepancies between the ratings on the scales and the comments or significant differences in how preceptors rate a student, we will contact individual preceptors to get clarification.
Are grades ever changed? If we make an error in the grade determination, then we will make any necessary changes immediately. We perform an end-of-year grade review when we re-review student files that were borderline between pass/high pass or high pass/honors and can increase to a total of 50% honors and high pass.
What happens if evaluations are submitted after my summary evaluation is submitted? If we receive evaluations after the final grade has been determined, we will send an updated copy of the Grade Summary Form with the new comments included. If the evaluation might change the grade, we will flag the file for review at the end-of-the-year.
How do my evaluators know how to score my performance in Oasis? As mentioned above, we perform faculty development sessions to help train preceptors on how to complete the student evaluations. We also provide similar sessions to residents. There are on-line modules available to all faculty and residents to instruct them on general principles of evaluation and grading and that covers specifics about the process at University of Colorado.
How is a student’s development over the course of the rotation incorporated into the evaluation? We do not have a formal process for tracking progress over the course of the clerkship. However, we are primarily focused on what students are able to master by the end of the rotation, recognizing that some skills will develop and/or improve over the course of the 6 weeks.
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General Information for Pediatrics Sub-Internship Rotations Liability Insurance The University of Colorado provides malpractice insurance for all students registered in approved courses. This insurance provides $250,000 coverage for a single incident with one person and $400,000 for a single incident with more than one person involved.
Clinical & Resource Library & Family Health Library The Clinical & Resource Library is located on the 1st floor of the Admin Pavilion Building. It is next door to Aspen Conference room.
• Hours: Monday-Thursday 7:30am-5:30pm and Friday 7:30am-4:00pm (24 hour access with CHCO
Badge)
• Phone: 720-777-6400
• Fax: 720-777-7152
The Family Library Located on the 1st floor of the main hospital by the gift shop. Hours:
• Monday and Friday 9am-4pm
• Tues, Wed and Thurs 9am-7pm
• Saturday 9am-12pm
• Phone: 720-777-6378
• Fax: 720-777-7121
Lockers The lockers are located on the 1st floor of the Administrative Pavilion just outside Aspen conference room (where morning report and noon conferences are held). There are also additional lockers in the 8th floor workrooms.
Badge and Computer Access Medical Students receive their computer access along with their EPIC training on their first day of their rotation. Their access remains active for the duration of their program, until they graduate or leave for other reasons.
Children’s Hospital Colorado
In addition to computers on the floors and in the library, we have 3 computers in the Medical Education Office lounge which students can access 24/7.
For questions about computer access, please contact Children’s Training Coordinator:
Andrea Reed at 720-777-8396 or email her at [email protected]