Pediatrics

• Program Information

• R-1 Year

• R-2 Year

• R-3 Year

• Reading List

Program Information (back to top)

Faculty:     Michael Purdon, MD

                 Howard Uman, MD

Resident Chairperson (2002-2003):

The pediatric curriculum balances experience in outpatient and inpatient settings. The  three-month rotation at Children's Hospital and Regional Medical Center, a tertiary care referral center, introduces first year residents to a full spectrum of inpatient pediatric disease. Further, the Family Medicine Service provides continued experience in inpatient pediatric care throughout residency. In contrast, in each resident's outpatient clinic, residents learn general health maintenance exams, management of acute pediatric illness, and care of their obstetrical patients' newborns. Management of acute pediatric illness is solidified during an eight-week rotation in the Mary Bridge Children's Hospital Emergency Department and various shifts in the Swedish Emergency Department. Second year residents care for newborn care during a two-week rotation.  The care of adolescents is addressed during a two-week adolescent medicine rotation and through numerous shifts in a homeless teen clinic. Both family practitioners and general pediatricians cover topics in pediatrics during didactics and patient-centered precepting.

R-1 Year (back to top)

Children's Hospital Medical Center Rotation

Children's Hospital and Regional Medical Center is an independent, private, not-for-profit regional pediatric center located in Seattle, Washington. As both a community hospital for Greater Seattle and the pediatric referral center for the Northwest, Children's provides, directly or in partnership with others, excellent pediatric care, education and research programs. Children's Hospital and Regional Medical Center is an advocate on behalf of health care needs for children at local, state and national levels.  Children's provides health care appropriate for the special needs of children regardless of race, sex, creed, ethnicity or disability

• Know how to write a history and physical.
• Know how to write admitting orders for pediatric patients.
• Know how to dose medications for pediatric patients.
• Know vital signs that should trigger evaluation.
• Know how to manage IVF and nutrition for pediatric patients.
• Know how to diagnose and manage most general pediatric admissions (i.e. r/o sepsis, pyelonephritis, cellulitis, and seizures).
• Know how and when to make appropriate consults.
• Know how to organize and arrange an appropriate discharge.

Three four-week blocks through CHMC inpatient medicine are provided. During this time two R-1's share equal responsibilities with pediatric and other family medicine R-1s in the admission and care of pediatric inpatients. For the purposes of night call, two family medicine residents are assigned during the same rotations. They function as a single FTE and  split the night call. The exact details of the split are arranged between the two residents. The residents function as members of a medical team under the guidance of a pediatric R-2 or R-3. In addition, a pediatric faculty member rounds with the team and is available for consultation and educational sessions. Although the pediatric attending for each patient supervises patient care, primary responsibility and management is provided by the R-1 assigned to the case. This service provides an excellent experience in the areas of diagnosis and treatment, nutritional requirements, psychosocial problems, and the coordination of multiple specialty services, both inside and outside the hospital.

R-2 Year (back to top)

Mary Bridge/Madigan Rotation

During the second year, each resident will spend two 4-week rotations combining pediatric emergency care at Mary Bridge Hospital in Tacoma and orthopedics at Madigan Army Medical Center.

Goals and objectives:

• Know how to recognize and manage basic pediatric orthopedic problems (i.e. in-toeing, scoliosis, hip dysplasia, and fractures).
• Know how to evaluate and stabilize pediatric trauma cases.
• Know the appropriate in-patient and outpatient r/o sepsis workup.
• Increase experience with lumbar punctures.
• Increase experience with laceration management and stitching.
• Recognize the acutely ill child that requires immediate attention, work-up, and admission

Each week will consist of two twelve-hour ER shifts. There is no overnight ER duty, but a room will be provided for those days when it is more convenient to stay in Tacoma (potentially 2 nights per week). During these 2 months, residents will also spend 2 full days per week in scheduled ortho clinics. One of the clinics the residents rotate through addresses pediatric orthopedic problems specifically. An orientation packet for Marybridge ER should be provided prior to the rotation along with the ER resident schedule. The contact person for MBER is Jonathan Challett (email: cerumen@u.washington.edu).

Please refer to the Orthopedics section of the Surgery curriculum chapter for information regarding Madigan Army Medical Center (Michael Tuggy is currently the MAMC coordinator).

On completion, the resident will be comfortable with resuscitation of the newborn and diagnosis and management of common problems of the neonatal period. A full and detailed list of objectives is outlined in the housestaff manual.

• Attend 10-20 deliveries taking an active role in treatment.
• Know how to recognize and manage a newborn in distress
• Review the newborn exam, basic work-up, identify birth defects.
• Recognize apnea/bradycardia and know when to place/remove monitor.
• Know how to evaluate respiratory status with exam, oximetry, ABG’s, CXR
• Know how to recognize, diagnose and manage hypoglycemia
• Know how to manage temperature stabilization
• Identify which babies specifically need transport to a level III hospital unit
• Know how to recognize, diagnose and manage hyperbilirubinemia, polycythemia
• Manage fluids, electrolytes, and nutrition using feeding protocols and hyperalimentation when appropriate
• Evaluate infections disease knowing indications for septic work-up, viral work-up, perform septic work-ups, and review choice of antibiotic
• Know when discharge is indicated

The first two weeks will allow three full days and one half-day in the NICU and decrease clinic time from three half-days to two half-days. Ideally, in order to maintain continuity, the resident should present his/her patients at rounds then leave for clinic on Tuesday mornings with the goal of starting clinic at 9:30.

The neonatology resident will also do four overnight calls on each of the Thursdays occurring during the four-week neonatology and adolescent medicine rotation. This will increase access to resuscitation management, admissions, case-based teaching, and procedures. Residents will need to attend ten resuscitations to complete the rotation objectives. Dr. Sweeney will sign off after reviewing the residents log. Additional call is optional but encouraged.

A concise and relevant teaching file will be available in which key articles (teaching x-ray files, videotapes, etc.) will be maintained by Dr. Mike Purdon in order to provide increased structure. Please see Mike Prior to the beginning of the rotation to review the objectives and to sign out the teaching file. A required checklist will be part of this file in order to assure the resident a quality experience, which includes working with the nurse practitioner on normal newborn exams and early discharge criteria.

The resident will also be provided with a pager specific for neonatal resuscitations (pager #424) and will be paged by the operator for all resuscitations.

**Two to three of the four afternoons are FP Clinic

R-3 Year (back to top)

Third year residents concentrate on polishing their skills in outpatient well childcare and management of acute illness. They will supervise care on the Family Medicine Service and see acutely ill children in the Swedish ER. In addition, they will continue their own pediatric practice in the Family Medicine Clinic. Inpatient pediatric care skills will be maintained on the FP Service. For those who wish more exposure to outpatient pediatrics, electives are available.

Swedish Inpatient Family Medicine Team:

The Family Medicine team at Swedish Hospital will follow all pediatric inpatients admitted via three teaching clinics and a limited number admitted by other private attendings. In-house faculty backup will be provided by both pediatric and family practice attendings. There are pediatric hospitalists who are also readily available for consultations. The pediatric hospitalists can also admit patients to the FP service at their discretion.

While on the Family Medicine team the R-2 or R-3 will be responsible to carry the Pediatric Code Beeper. They will respond promptly to all Ped Codes and code drills. Residents will be responsible to run the Ped Code until a more senior physician is present (i.e., ICU or private attending), at which time the resident will remain and assist as needed (especially with IV/IO access). Others who will respond include ICU attending, PICU nurse, Ped pharmacologist, Ped respiratory therapist, and anesthesia (responsible for intubation, if needed).

Our pediatric faculty is Dr. Howard Uman, MD. He will be involved in providing didactics and will also be scheduled as a clinical preceptor for pediatric cases. In the near future, Dr. Uman will also be coordinating an ADHD clinic.

Our faculty and invited guests present pediatric didactics. These occur on Tuesday afternoons on a rotating basis. Some of didactic topics are:

Acne Allergies Anemia

Asthma Burns Chicken pox

Circumcision Colds Colic

Conjunctivitis Cough Diarrhea

Ear Infections Eczema Encopresis

Enuresis Fever FTT

Headache Hyperactivity Jaundice

Nightmares/Sleep Obesity Rashes

Sleep Problems Sore Throat UTI

Vomiting Warts

Well-Child Check: newborn exam, newborn screens, vision/hearing screens, development, behavior/discipline, immunizations, nutrition, safety/abuse.

Eating disorders Conduct disorders/violence Suicide and depression

Teen pregnancy Amenorrhea/DUB STD's/Contraception

Sports Physicals

physiology and the relationship of exercise to optimal functioning of many organ systems are important in the training of family practice residents.

a) Textbooks -- General

1. Freidman SB, Fisher M, Schonberg SK (editors). Comprehensive Adolescent Health Care. St. Louis, Quality Medical Publishing, Inc., 1992.

2. Hofmann AD, Greydanus DE. Adolescent Medicine, 2nd ed. East Norwalk, CT, Appleton & Lange, 1989.

3. McArney Er, Kreipe RE, Orr DP, Comerci G (editors). Textbook of Adolescent Medicine, Philadelphia, W.B. Saunders Co., 1992.

4. Neinstein LS. Adolescent Health Care. A Practical Approach, 2nd ed. Baltimore, Williams and Wilkins, 1990.

5. Strasburger VC, Brown RT. Adolescent Medicine. Boston, Little, Brown & Co., 1991.

6. Smith MS. Chronic Disorders in Adolescence. Boston, John Wright, Inc., 1983.

b) Textbooks -- Gynecology

1. Emans SJH, Goldstein DP. Pediatric and Adolescent Gynecology, 3rd ed. Boston, Little, Brown & Co., 1990.

2. Strasburger VC. Basic Adolescent Gynecology. An Office Guide. Baltimore, Urban & Schwartzberg, 1990.

c) Textbooks -- High Risk

1. Dryfoos JG. Adolescents at Risk. Prevalence and Prevention. New York, Oxford University Press, 1990.

2. Hechinger FM. Fateful Choices. Healthy Youth for the 21st Century. New York Carnegie Corportation, 1992.

d) Textbooks -- Sports Medicine

1. Mithcheli LJ. Pediatric and Adolescent Sports Medicine. Boston, Little Brown & Co., 1984.

2. Reider B. Sports Medicine. The School-age Athlete. Philadelphia, W.B. Saunders, 1991.

3. Mellion MB, Walsh WM, Shelton GL. The Team Physician. Philadelphia, Hanley & Belfus, 1990.

4. Larstrom HL. Sports Medicine: Injuries and Prevention.

5. Birrer RB. Sports Medicine for the Primary Care Physician. Norwalk, CT., Appleton-Century Crofts, 1984.

6. Artal R, Wiswell R. Exercise in Pregnancy. Baltimore, Williams & Wilkins, 1986.

e) Journals

1. Adolescent Medicine: Start of the Art Reviews. Hanley & Belfus, Inc.

2. Journal of Adolescent Health. Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010.

3. The Physician and Sports Medicine. McGraw Hill Publishers, 1221 Avenue of the Americas, New York, NY 10020.

4. American Journal of Sports Medicine. Williams and Wilkins Co. 428 East Preston St., Baltimore, MD. 21202.

f) Articles

Articles are located in notebooks on file in the resident libraries at Swedish Family Medicine, Downtown Family Medicine, and the 45th Street Clinic.

g) Resources: Approach to the Adolescent Patient

h) Additional Resources

        References: Consent and Confidentiality in Health Care of Minors