University of Illinois

LCME

Liaison Committee on Medical Education

Goals and Objectives

Core Clerkship Goals and Objectives
Pediatrics

COURSE NAME
       
        Pediatrics

GOALS/OBJECTIVES

Learning Objectives:

  1. The student is able to discuss current philosophies and theories regarding recommendations for pediatric health maintenance.
  2. The student is able to outline an appropriate program of health maintenance for a child as suggested by the American Academy of Pediatrics, including:
    1. Appropriate frequency and content of routine examinations
    2. Essential screening procedures
    3. Schedule of immunizations
    4. Appropriate anticipatory guidance and counseling
    5. The function and utilization of ancillary health care providers
  3. The student is able to compare and discuss the above recommendations with his/her perception of childcare as observed during the clerkship experience.
  4. The student is able to obtain a complete history of the infant, child, and adolescent patient, incorporating specifically those aspects which tend to be age associated, including such information as:
    1. Parent-child relationships
    2. Reliability of information
    3. Developmental capabilities
    4. Child's lifestyle
    5. Feeding patterns
    6. Behavioral development
  5. The student is able to perform a comprehensive physical examination on the infant, child, and adolescent, with particular attention to those aspects of the examination that tend to differ from adults.
  6. The student is able to develop an appropriate written record of data from patients on whom a history has been obtained and a physical examination has been performed.
  7. The student is aware of the need to provide appropriate patient education, and can identify effective methods of disseminating health care information.

Learning Activities:

  1. Seminar/Lecture
    • Interview Techniques/Social Services - N. Mings
    • Behavioral Pediatrics – Dr. Morton
    • Growth and Development – Dr. Tripathy
    • Parenting Skills – H. Mirrell
  2. Clinical Experiences
    • Physical Examination – Dr. Tripathy
    • Individual patient care experiences in physician offices, and night clinic
  3. Readings - Texts: Nelson, Rudolph, American Academy of Pediatrics, Bright Futures, 3rd Ed., 2007
    PCNA – February 1998 – Physical Assessment, Green – Pediatric Diagnosis – 6th ed. Saunders, 1998
    Unit A-2  Procedures in Pediatric Medicine

Learning Objectives:

  1. The student is able to accurately weigh and measure children and plot this information on a standard age and gender appropriate growth chart.
  2. The student is able to safely administer a subcutaneous and an intramuscular injection to an infant or young child, utilizing sterile techniques and identifying appropriate sites.
  3. The student is able to safely and appropriately restrain an infant or child for a procedure.
  4. The student can accurately measure blood pressure in an infant, child, or adolescent using the appropriately sized blood pressure cuff.  Students are aware of alternate blood pressure measuring devices such as Doppler.
  5. The student can correctly collect laboratory specimens, including urine, blood, stool, nasal secretions, sputum, and throat swabs.
  6. The student is able to identify and perform appropriate screening measures for vision and hearing in children of various ages.
  7. The student understands the fundamental principles of starting and maintaining intravenous fluid therapy.
  8. The student is familiar with techniques for obtaining a blood specimen and the indications for each method, including finger stick, heel stick, venipuncture, femoral or external jugular puncture.
  9. The student recognizes how to perform a lumbar puncture in an infant or child and observes the procedure at least once.
  10. The student understands and follows isolation procedures and universal precautions for blood and body products.
  11. The student is aware of the need to be informed regarding location and operation of emergency medical equipment (e.g. Oxygen, Suction, Resuscitation Supplies) in any area where student is working.

Learning Activities:

  1. Seminar/Lecture
    • Clinic Orientation – P. Wingler
    • Hospital Orientation
  2. Reading - Texts: Nelson, Rudolph, Goldbloom, Pediatric Clinical Skills, 1998, Pfenninger-Fowler, Procedures in Primary Care, 2nd Ed., Mosby, 2003

Unit A-3  Growth and Development
Learning Objectives:

  1. The student recognizes the differences from birth through adolescence with regard to:
    1. Size (height, weight, head circumference): Body proportion, Rate of organ or system growth, Evaluation of BME (Body Mass Index)
  2. The student is able to plot growth parameters on a standard growth curve, and explain the significance of deviations from this curve.
  3. The student knows the usual timing of the common developmental landmarks:
    1. Motor — Primitive reflexes (e.g., rooting, suck, moro)
      Voluntary control:  head control, sit, stand, walk, run, ride tricycle, sphincter control
    2. Adaptive — Responds to auditory and visual stimuli, palmar grasp thumb and forefinger grasp, scribble, copy a circle, draw a person, build a three-block tower
    3. Language — coo, say words, phrases, sentences, knows name, follows simple commands
    4. Social — Responds to person, social smile, fear of stranger, able to feed, able to dress
  4. The student initiates an appropriate evaluation of a child with failure to thrive.
  5. The student appreciates the process of a child's social, emotional, and moral development.

Learning Activities:

  1. Seminar/Lecture
    Behavioral Pediatrics – Dr. Morton
    Growth and Development – Dr. Tripathy
  2. Patient Care Experiences
  3. Reading - Texts: Nelson, Rudolph, AAP, Bright Futures, 3rd Ed., 2007, Batshaw and Brooks, Children with Disabilities, 5th Ed., 2002, Capute and Accardo, Developmental Disabilities in Infancy and Childhood, 1996
    Dixon and Stein, Encounters with Children, Pediatric Behavior and Development, 2000
                        

Unit A-4  Developmental Evaluation
Learning Objectives:

  1. The student is familiar with the usual developmental landmarks and recognizes significant deviation from normal.
  2. The student recognizes the types of psychological and intellectual testing appropriate for evaluation of specific developmental problems (e.g., Ages and Stages Questionnaire, Peabody Picture Vocabulary, Peabody Developmental Motor Scales, Wecshler Intelligence Scale for Children, 4th Ed.)
  3. The student understands the concept of the multidisciplinary approach to the evaluation of a child with suspected developmental problems.
  4. The student recognizes the need for cooperation between educational and medical facilities in the diagnosis and management of the school-age child with developmental dysfunction and/or learning disability.

Learning Activities:

  1. Seminar/Lecture
    • Growth and Development – Dr. Tripathy
  2. Clinic Experience – Dr. Morton
    • Low Birth Weight Clinic
    • Child Diagnosis Clinic
    • Cleft Palate Clinic
  3. Reading - Texts: Nelson, Rudolph, Capute and Accardo, "Developmental Disabilities in Infancy and childhood," 1996
               Batshaw, “Children with Disabilities” 2002

Unit A-5  Social Issues in Pediatrics
Learning Objectives:

  1. The student recognizes the significance of family relationships in the development of the child.
  2. The student understands the effects of separation and divorce on the child and recognizes the unique problems of the single parent household.
  3. The student is aware of the influence of Day Care/Nursery School in the life of the child, and will recognize the need for licensing and monitoring such centers, and will appreciate the problems of control of infectious disease at these centers.
  4. The student recognizes the effects of maternal employment on the mother-child relationship.
  5. The student understands the effects of differing patterns of parental authority on child development.
  6. The student is familiar with legal means of adoption, with the rights of adoptive parents, and with the issue of the "open adoption."
  7. The student is familiar with foster care and its influence on the life of the child.
  8. The student recognizes the importance of education in childhood, appreciates various types of educational approaches, and can evaluate the child's adjustment to the school environment, to educational material, to teachers, and to peers.
  9. The student is familiar with the significance of television viewing and Internet usage upon the youth and can identify beneficial and detrimental effects.
  10. The student recognizes the significance of physical activity and participation in sports (both spontaneous and organized) in the development of the child and can evaluate the readiness of the child for various physical activities and the appropriateness of the program for an individual child.

Learning Activities:

  1. Seminar/Lecture
    • Behavioral Pediatrics – Dr. Morton
    • Child Abuse/Family Violence - K. Buetow
    • Social Services - N. Mings
    • Death and Divorce - H. Mirrel
  2. Patient Care Experiences - physician offices, nursery, weekly patient care seminars
  3. Reading - Texts: Nelson, Rudolph, Dixon and Stein, "Encounters with Children," Year Book Medical Publishers, 2000

Unit A-6  Immunization
Learning Objectives:

  1. The student is able to define the following terms and understand their significance:
    1. Active immunization
    2. Passive immunization
    3. Booster immunization
    4. Toxoid
    5. Antitoxin
    6. Killed vaccine
    7. Live vaccine
    8. Attenuated vaccine
    9. Conjugated vaccine
  2. The student knows the indications for administration, appropriate dosage schedule, possible side effects, and contraindications for use of the following commonly used vaccines:
    1. Diphtheria vaccine
    2. Pertussis vaccine
    3. Tetanus toxoid
    4. Measles vaccine
    5. Rubella vaccine
    6. Mumps vaccine
    7. Polio vaccine (Salk and Sabin)
    8. Influenza
    9. Hemophilus influenza B vaccine
    10. Hepatitis A vaccine
    11. Hepatitis B vaccine
    12. Varicella vaccine
    13. Pneumococcal vaccine, conjugate
    14. Meningococcal vaccine
    15. HPV vaccine
  3. The student knows the indications for use of the less commonly used vaccines:
    1. Pneumococcal vaccine
    2. Rabies vaccine
    3. Typhoid vaccine
    4. Typhus vaccine
    5. Cholera vaccine
    6. Yellow Fever vaccine
    7. Gamma globulin
    8. Smallpox vaccine
    9. Zostavax
    10. BCG vaccine
  4. The student knows the recommended immunization schedule for unimmunized or partially immunized children.
  5. The student is aware of the purpose and effect of the school immunization law in Illinois.
  6. The student is aware of immunization recommendations for the immunocompromised patient.
  7. The student is aware of the National Childhood Vaccine Injury Act and its requirements.
  8. The student is aware of the risk to the nonimmune adult of acquiring a so‑called "childhood disease."
  9. The student can perform and interpret tuberculin-screening tests, appropriate to needs of the patient.

Learning Activities:

  1. Seminar/Lecture
    • Lecture on Immunization - K. Buetow
    • Lectures on Infectious Diseases - D. Beck, M. Hill
  2. Patient care experiences in outpatient pediatrics
  3. Reading - Texts: Plotkin and Orenstein, Vaccines, 3rd ed., Saunders, 1999, PCNA, April 2000, Immunizations
    Supplemental, AAP 2006 Red Book, "Report of the Committee on Infectious Diseases," (available on-line at Carle)

Unit A-7  Behavioral Pediatrics
Learning Objectives:

  1. The student will demonstrate an understanding of the major developmental theories (Piagett, Psychoanalytic Theory, Learning Theory).
  2. The student demonstrates an understanding of the complex effect of punishment in children.
  3. The student understands the process of behavioral modification, and knows how to apply these principles to specific situations.
  4. The student will recognize age-specific behavioral issues and be able to give parents appropriate anticipatory guidance (e.g., temper tantrums, aggression, sibling rivalry, shyness, lying, fears, school phobias).
  5. The student recognizes the effect of illness (especially chronic) on a child's behavior and on family dynamics.
  6. The student will be aware of the process of moral development in children and develop realistic expectations of the ability of children to be responsible for their behavior.
  7. The student is able to recognize depressive illness in the child and adolescent.
  8. The student can identify autistic-like symptoms.

Learning Activities:

  1. Seminar/Lecture
    • Developmental Pediatrics Overview – Dr. Morton
  2. Patient care experiences, CDC Clinic
  3. Reading - Texts: Nelson, Rudolph, Dixon & Stein, "Encounters with Children," Year Book Medical Pub., 2006DSM-IV Revised, American Psychiatric Association, Levine, Carey, Crocker, "Developmental Behavior," 3rd Ed.,1999, Saunders, PCNA – ADHD, October 1999, PCNA, Child and Adolescent Psycho Pharmacology, October 1998
    AAP, ADHD: A Complete and Authoritative Guide, 2004

Unit A-8  Accident Prevention
Learning Objectives:

  1. The student is familiar with the incidence of injuries in childhood morbidity and mortality and can discuss age-related epidemiologic and preventive measures for vehicular accidents, burns, drownings, and poisonings.
  2. The student is able to discuss with the parents the proper use of auto safety restraints for:
    1. Child under 20 pounds
    2. Child 20-40 pounds
    3. Older child
  3. The student is able to perform immediate first-aid procedures for:
    1. Choking
    2. Drowning
    3. Burns (1, 2, 3)
    4. Lacerations/abrasions
    5. Head injury
    6. Fractures
    7. Blunt, visceral trauma
  4. The student knows the appropriate treatment for common poisonings (aspirin, acetaminophen, iron, lead, lye, hydrocarbons, organophosphates, opiates, tranquilizers), and is familiar with the use of ipecac, gastric lavage, activated charcoal, and catharsis.
  5. The student is familiar with the function of the Poison Control Center and knows how to contact the nearest center.
  6. The student is aware of emergency management of the severely traumatized child.

Learning Activities:

  1. Seminar/Lecture
    • Accidents - K. Buetow
  2. Patient care experiences
  3. Reading - Texts: Nelson, Rudolph, "Handbook of Common Poisonings in Children," 2nd edition, American Academy of Pediatrics Haddad, et al., “Clinical Management of Poisoning and Drug Overdose,” 3rd ed.,1998 Barkin and Rosen, "Emergency Pediatrics” 5th ed., Mosby,1999, Christophel and Gallagher “Injury Prevention and Public Health, Aspen Publishers, 1999, PCNA “Emergency Medicine, Dec 1999

Unit A-9  Nutrition
Learning Objectives:

  1. The student understands and can obtain references citing the dietary requirements for adequate nutrition in the infant, toddler, child, and adolescent.
  2. The student knows nutritional value of breast milk, modified cow's milk formulas, and special formulas (Isomil, Nutramigen, and Pregestamil, Lactose free.)
  3. The student is aware of the "non-nutritive" components (antibodies and antibacterial proteins; growth factors) in human milk and the potential health advantages of breast-feeding versus formula feeding.
  4. The student is familiar with principles of infant feeding, including appropriate introduction of solids into the diet.
  5. The student can discuss common nutritional deficiencies or excesses (e.g., iron, vitamins, cholesterol, salt).
  6. The student can appropriately evaluate a child or adolescent with obesity or anorexia.
  7. The student can recognize and evaluate a patient with "failure to thrive."
  8. The student recognizes the relationship between nutrition and illness.
  9. The student understands nutritional intervention techniques commonly used in both health and illness.

Learning Activities:

  1. Seminar/Lecture
    • Nutrition - T. Hatch
    • GI Disease - T. Hatch
    • Infant Feeding - S. Donovon
  2. Patient care experiences in clinic and nursery
  3. Reading - Texts: Nelson, Rudolph, Pediatric Nutrition Handbook (American Academy of Pediatrics, 1998)
                PCNA – Feb and April 2001, “Breast Feeding”

Unit A-10  Adolescent Medicine
Learning Objectives:

  1. The student recognizes the characteristic changes that occur during adolescence in the area of:
    1. Physical development (including use of Tanner Scale)
    2. Psychosocial development
    3. Cognitive development
  2. The student is familiar with the major causes of morbidity and mortality in the adolescent.
  3. The student understands the development of sexuality in the life of the young, mid, and late adolescent, can relate this to the health needs of the adolescent, and is able to appropriately examine and counsel the adolescent in this area.
  4. The student is aware of the medical needs of the homosexual youth, and can counsel such youths appropriately.
  5.  The student knows the incidence and etiologies of sexually transmitted diseases in the adolescent and is aware of appropriate methods of prevention, diagnosis and treatment for these conditions.
  6. The student is aware of the incidence rate of teen-aged pregnancies, and the medical and social implications of these pregnancies for mother and child.
  7. The student is aware of the role of athletics in the life of the teen.  The student is able to perform an appropriate screening examination prior to athletic participation.  The student knows incidence, prevention, and/or treatment of common athletic injuries.
  8. The student knows the nutritional needs of the adolescent, and the appropriate dietary modifications for weight loss, weight gain, or sports training.
  9. The student knows the symptoms and emergency treatment for substance abuse in the adolescent and is able to propose ongoing treatment plans.
  10. The student is aware of the health concerns of the teen, the need for confidentiality, and implications of the "minor consent" laws.
  11. The student can evaluate the mental health status of an adolescent, can recognize depressed and suicidal adolescents, and can develop a treatment or plan for these patients.
    • The student is aware of prevalence and implication of adolescent smoking, alcohol and substance abuse, and knows about programs and resources for prevention, treatment, and rehabilitation.

Learning Activities:

  1. Seminar/Lecture:  Adolescence, K. Winston, RN
  2. Patient care experiences
  3. Reading - Texts: Nelson, Rudolph, Friedman, "Comprehensive Adolescent Health Care," 1998, Neinstein, “Adolescent Health Care,” 3rd ed., Williams and Wilkens, 1996, PCNA, “Adolescent Medicine,” December 1997
    PCNA, “Adolescent Gynecology”, Part I June 1999, Part II August, 1999, Greydamus, Patel and Pratt, Essential Adolscent Medicine, McGraww-Hill, 2006

Unit B-1   Fetus and Newborn
Learning Objectives:

  1. The student is competent in the examination of the newborn, including the assessment of gestational age (e.g., Dubowitz exam).
  2. The student can identify the high-risk infant throughout the perinatal period.
  3. The student knows the major causes of prematurity, the appropriate treatment of the premature newborn, the common sequelae of prematurity, and can identify the major areas of concern or dysfunction relating to prematurity.
  4. The student has an overview of newborn resuscitation as taught in the Neonatal Resuscitation Program, primarily by attending several deliveries with a pediatrician, neonatal nurse practitioner on neonatologist.
  5. The student can give a differential diagnosis based upon pathophysiology and know the appropriate treatment for the following problems:
    1. Neonatal jaundice
    2. Neonatal respiratory distress syndrome
    3. Neonatal infections
    4. Neonatal hypoglycemia
    5. Infantile apnea
  6. The student is familiar with the concept of bonding and observes the phenomenon in the delivery room, and on the maternity floor, and is aware of the effect of neonatal illness on the bonding process.  Student is aware of controversial views of "bonding concept".
  7. The student can discuss with parents appropriate information regarding infant feeding (breast and bottle).
  8. The student recognizes the common congenital malformations and genetic diseases, such as Down's Syndrome, Cleft Palate, and dislocated hips.
  9. The student demonstrates a knowledge of newborn social, perceptual, and cognitive capacities.
  10. The student develops skill in the care and management of the normal newborn.
  11. The student is aware of signs, symptoms, diagnostic studies and sequelae of prenatal substance abuse and other prenatal toxic exposures.  This includes the involvement of social agencies as appropriate.
  12. The student develops an appreciation for problems encountered in transition and understands how to stabilize and transfer a sick newborn.


Learning Activities:

  1. Seminar/Lecture
    • Infant Feeding - S. Donovan
  2. Clinical Experiences
    • Newborn nursery 
    • Neonatal Follow-up Clinic. (meets monthly)
  3. Reading - Texts: Nelson, Rudolph, Taeusch, Ballard, Avery, "Diseases of the Newborn," 8th edition, Saunders, 2005
    Pediatric Clinic of North America, “Neonatal Update,” June 1998, Thureen, Deacon, O’Neill, Hernandez, “Assessment and Care of the Well Newborn.”  Saunders, 1999

Unit B-2  Fluids and Electrolytes
Learning Objectives:

  1. The student understands the physiology of fluid and electrolyte balance for the normal infant or child.
  2. The student knows normal values for blood electrolytes and blood gases.
  3. The student should recognize the physical and laboratory indications of dehydration.
  4. The student knows how to institute appropriate therapy for:
    1. Isotonic dehydration
    2. Hypotonic dehydration
    3. Hypertonic dehydration
    4. Diabetic ketoacidosis
    5. Knows how to monitor the therapy that has been instituted
  5. The student recognizes the indications for use of oral rehydration therapy, the proper constitution of rehydration fluids, and the benefits and limitations of the therapy.

Learning Activities:

  1. Seminar/Lecture
    • Fluid and Electrolytes – Dr. Nadeem Ahmed
  2. Patient care experiences
  3. Reading
    Texts:
    Nelson
    Rudolph
    Supplemental:
    Finberg, "Fluid and Electrolytes, Treatment of Dehydration,” in Finberg – Manual of Pediatric Practice, p. 32-45, Saunders, 1998
                              

Unit B-3  Infectious Disease

  1. Learning Objectives:
    1. The student should know the incubation period, mode of transmission, pathogenesis, signs and symptoms, spectrum of illness, laboratory diagnostic tests, and methods of prevention and treatment for the following disease and pathogens:
      1. Common Viral infections
        1. Measles
        2. Mumps
        3. Rubella
        4. Roseola
        5. Parvovirus
        6. Herpes and Simplex I & II
        7. Cytomegalovirus
        8. Epstein-Barr virus
        9. Varicella
        10. Hepatitis A/B/C
        11. Influenza
        12. Parainfluenza
        13. Respiratory synctitial virus
        14. Rotavirus
        15. Poliomyelitis
      2. Systemic infections
        1. Otitis media
        2. Sinusitis
        3. Upper Respiratory Infections
        4. Pharyngitis – Group A Strep and Viral
        5. Epiglottitis – Croup (bacterial and viral)
        6. Bronchitis
        7. Pneumonia
        8. Gastroenteritis
        9. Hepatitis
        10. Urinary tract infection
        11. Meningitis
        12. Impetigo
        13. Rickettsial infection
        14. Tuberculosis
        15. Pertussis
        16. Septic joints/osteomyelitis
        17. Syphilis
    2. Gonorrhea
    3. Parasitic and Protozoal infections
      1. Toxoplasmosis
      2. Amebiasis
      3. Giardiasis
      4. Malaria
    4. Recently recognized infectious diseases
      1. Kawasaki disease
      2. Chlamydia
      3. Legionnaire's disease
      4. Acquired immunodeficiency syndrome (HIV/AIDS)
      5. Lyme disease
    5. Toxic Shock Syndrome
    6. Hepatitis C
  2. The student should understand the pathophysiology of fever in infectious disease and know how to advise parents in methods of recording temperatures and in fever control.
  3. The student should be able to outline an appropriate diagnostic evaluation for an infant or toddler with a significant temperature evaluation.
  4. The student should be able to give the rationale for selection of specific antimicrobial therapy.
  5. The student should be aware of incidence and management of zoonotic infections (e.g., cat scratch, rabies, rat bite, typhus)
  6. The student should recognize the role of infectious agents in the immunocompromised host.
  7. The student should recognize the role of day care facilities in spread of infection and be familiar with prophylactic therapy for day care contacts of certain types of infections.

Learning Activities:

  1. Seminar/Lecture
    • Infectious Diseases - D. Beck, M. Hill
  2. Patient care experiences
  3. Reading - Texts: Nelson, Rudolph, AAP Red Book, "Report of Committee on Infectious Disease," 2006 (available on-line at Carle), Feingen and Cherry, "Pediatric Infectious Disease," Vol. 3, Saunders, 1998
    Steele, “Pediatric Infectious Diseases,” Parthenon, 2000, PCNA, “AIDS/HIV,” Feb 2000

Unit B-4  Chronic and Handicapping Conditions
Learning Objectives:

  1. The student knows the major causes for chronic or handicapping conditions in childhood.
  2. The student should be able to describe the functions of:
    1. Division of Specialized Care for Crippled Children (DSCC)
    2. Special Education Services
    3. Division of Vocational Rehabilitation
    4. PL 99-457
    5. Developmental Services Center (DSC)
  3. The student can identify young children with hearing or visual problems and institute appropriate intervention.
  4. The student knows the classification of causes of mental retardation.(DSMIV)
  5. The student understands the concept of mainstreaming and its implication for a child with developmental problems.
  6. The student understands the concept of "attention deficit disorder" and its differential diagnosis and is able to diagnose and institute therapeutic measures for the problem.
  7. The student recognizes the roles of the educator, the psychologist, the social worker, and the pediatric developmental specialist in the evaluation of the child with a learning disability.
  8. The student recognizes the impact of a learning disability on the adjustment of the child and his relations to family and friends.
  9. The student is aware of the effect of serious physical disability on the child's school, peer, and family relationships.
  10. Student can define the autistic-spectrum disorders


Learning Activities:

  1. Seminar/Evaluation
    • Neurologic Disorders – D. Piccheitti, MD
    • Attention Deficit Disorders – G. Kennedy, MD
    • Social Services - N. Mings
    • Developmental Issues – C. Morton, MD
  2. Patient Care Experiences
    • Cranio-Facial Clinic
    • Neonatal Follow-up Clinic
    • Child Diagnosis Clinic
  3. Reading - Texts: Nelson, Rudolph, Capute and Accardo, “Developmental Disabilities in Infancy and Childhood,” Brooker Publishing, 1996, Jackson and Vessey – Primary Care of the Child with Chronic Condition, 2nd ed., Mosby 1996
    PCNA-ADHD, October 1999, Accardo and Whitman,Dictionary of Developmental Disabilities, 1996, Batshaw and Brooks, “Children with Disabilities,” 5th Ed., 2002

Unit B-5  Drug Therapy
Learning Objectives:

  1. The student is aware of special pharmacologic considerations in treating the young child, including such variables as age and size of child, absorption, metabolism, and excretion of drugs, potential toxic effects, and influence of drugs on growth and development.
  2. The student understands situations that may interfere with compliance in drug therapy.
  3. The student is familiar with appropriate monitoring to ascertain effective drug level, or to detect onset of toxicity of selected drugs (anticonvulsants, theophylline, salicylate, aminoglycosides).
  4. The student appreciates the significance of excretion of drugs into the breast milk.
  5. The student is aware of problems relating to use of antibiotics and the emergence of resistant organisms.
  6. Student is aware of appropriate pain management in the pediatric patient, particularly in the very young child.

Learning Activities:

  1. Seminar/Lecture
    • Asthma - J. Moore
  2. Patient care experiences
  3. Reading - Texts: Nelson, Rudolph, Gellis and Kagan, "Current Pediatric Therapy," 18th Ed., 2006, PCNA, “New Frontiers in Pediatric Drug Therapy,” February, 1997, PCNA, “Child and Adolescent Psychopharmacology,” October 1998, Ferrari, “Anesthesia and Pain Management for the Pediatrician”, 1999, PCNA, “Acute Pain in Children,” June, 2000

Unit B-6  Child Abuse and Neglect-Family Violence
Learning Objectives:

  1. The student is aware of the incidence and significance of child abuse and neglect in current society.
  2. The student is aware of the effect of family violence on the development of the child.
  3. The student recognizes those social and health factors that are significant predictors of child abuse and neglect.
  4. The student can recommend intervention techniques to help families at risk for abuse and neglect, and is aware of community resources useful in the management of potential and actual instances of abuse and neglect.
  5. The student knows characteristic signs of neglect or abuse (physical, sexual, or emotional) and is aware of the immediate procedures to protect a possible abused child.
  6. The student is able to evaluate a child with failure to thrive, identifying appropriate medical and social concerns.
  7. The student knows the legal requirements for reporting suspected abuse (Abused and Neglected Child Reporting Act), appropriate ways of documenting abuse, and how to present a case appropriately to legal authorities.

Learning Activities:

  1. Seminar/Lecture
    • Social Work - N. Mings
    • Child Abuse - K. Buetow
  2. Patient care experiences (will include participation in child protection team evaluations and attendance at court cases, if possible)
  3. Reading - Texts: Nelson, Rudolph, *Giardino, et al., “A Practical Guide to the Evaluation of Child Physical Abuse and Neglect,” Sage, 1997, *Monteleone, “Child Maltreatment,” GW Medical Pub. 1998, PCNA, “Violence Among Children and Adolescents,” April 1998, *Hegar, Emans and Muram, “Evaluation of the Sexually Abused Child,” 2nd ed. (with CD) Osford 2000, *Hobbs and Wynne, Physical Signs of Child Abuse, Saunders, 1996
    *Hobbs, Hanks, and Wynne, “Child Abuse and Neglect a Clinicians Handbook, 2nd ed., Churchill and Livingston, 1999
    *Reece, Treatment of Child Abuse, Johns Hopkins, 2000
    *Books available in Dr. Buetow’s office.

Unit B-7  Neoplasms
Learning Objectives:

  1. The student knows the presenting symptoms, physical findings, and pertinent diagnostic tests for the major neoplasms (leukemia, CNS tumors, lymphoma, neuroblastoma, Wilm's, bone tumors).
  2. The student knows the incidence rates of the major childhood neoplasms, and the significance of neoplasms in childhood mortality.
  3. The student is aware of the major therapeutic modalities for childhood neoplasms and the relative advantages and disadvantages of each (chemotherapy, surgery, irradiation, bone marrow transplants).
  4. The student is aware of sequelae of treatment and subsequent disease in those who apparently recover from neoplasia.
  5. The student is aware of the emotional aspects that involve the patient, family, and medical personnel in planning and carrying out the care of a child with malignancy.

Learning Activities:

  1. Seminar/Lecture
    • Death and Divorce - H. Mirrell
    • Oncology – Dr. Musselman
  2. Patient care experiences
  3. Reading
    Texts:
    Nelson
    Rudolph

Unit B-8  Genetic and Metabolic Disease
Learning Objectives:

  1. The student can define single gene (autosomal dominant, autosomal recessive, X‑linked dominant, and X-linked recessive) and multifactorial inheritance and chromosomal disorders.
  2. The student knows indications for ordering genetic studies, and the appropriate tests to recommend.
  3. The student can describe the clinical manifestations and the karyotypic features of the following diseases:
    1. Down's syndrome
    2. Turner syndrome
    3. Klinefelter syndrome
    4. Fragile X syndrome
  4. The student should understand the principles of genetic inheritance and be able to counsel families with common inherited disorders (sickle cell disease, Tay‑Sach's disease, cystic fibrosis, hemophilia).
  5. The student is familiar with neonatal screening programs to rule out certain metabolic diseases.
  6. The student can define the basic defect in the following inborn errors of metabolism, can recognize the clinical symptoms, and know the prognosis and/or therapy:
    1. Phenylketonuria
    2. Lactose intolerance
    3. Galactosemia
    4. Hurler's (mucopolysaccharidosis)
    5. Glycogen storage disease
    6. Hypothyroidism
    7. Congenital adrenal hyperplasia
  7. The student recognizes the clinical situations that would prompt investigation for existence of an inborn error of metabolism.
  8. Student is aware of newer developments in DNA analyses in identification of specific genetic disorders, and the development of gene therapy potential.

Learning Activities:

  1. Seminar/Lecture
    • Genetics – C. Weaver, MD
    • Endocrine Disease – N. Ahmed, MD
  2. Genetic Clinic – C. Weaver, MD
  3. Reading - Texts: Nelson, Rudolph, Smith, "Recognizable Patterns of Human Malformation," 6th Ed., Saunders, 1997
    Hagerman and Silverman, “Fragile X Syndrome: Diagnosis, Treatment, and Research,” Johns Hopkins, 1991,           Accardo and Whitman, “Dictionary of Developmental Disabilities, Terminology,” Brooks, 1996
    Barartser and Winter, “Color Atlas of Congenital Malformation Syndromes,” Mosby-Wolfe, 1996
    Spitz, “Genodermatoses,” Saunders, 1995, Nylan and Ozand, “Atlas of Metabolic Diseases,” Chapman and Hall, 1998

Unit B-9  Morbidity and Mortality
Learning Objectives:

  1. The student knows the conditions that most commonly cause serious illness or death in the newborn, the infant, the school-age child, and the teen.
  2. The student understands the concepts of:
    1. Age-specific mortality rates
    2. Neonatal, perinatal, and infant mortality
    3. Disease incidence rates
  3. The student can meaningfully evaluate local, state, national, and international morbidity and mortality data, and can use these data as a basis for setting health care priorities.
  4. The student understands the current knowledge about S.I.D.S. and is prepared to counsel a family suffering this tragedy.  The student can counsel regarding SIDS prevention – smoking, sleep position, sleep conditions.
  5. The student understands the significance of a fatal childhood disease, and is aware of supportive measures to assist child, family, and staff in coping with the diagnosis and prognosis or both in a daily and long-term basis.
  6. The student understands and appreciates the significance and impact of the death of a child upon the parents and other family members, and is aware of some preventive measures to take with families.
  7. The student knows the principles of critical care, including resuscitation, fluid management of the critically ill, management of shock, and acute neurologic and respiratory disorders.

Learning Activities:

  1. Seminar/Lecture
    • Accidents - K. Buetow
    • Childhood Loss - H. Mirell
  2. Patient care experiences
  3. Reading - Texts: Nelson, Rudolph, PCNA, “Pediatric Oncology,” August 1997


Unit C-1  Immunologic Disease
Learning Objectives:

  1. The student recognizes the major diseases due to a primary or acquired deficiency in the immune system, and can confirm the diagnosis with appropriate laboratory evaluation  (congenital agammaglobulinemia, combined immunodeficiency disease, acquired immunodeficiency syndrome).
  2. The student recognizes the common symptoms of allergic-rhinitis, and can discuss possible etiology, initiate appropriate laboratory studies, and propose a treatment plan.
  3. The student can evaluate and recommend appropriate treatment for a child with significant asthma in order to reduce the immediate symptoms and obtain long-term relief.
  4. The student is able to monitor severity of acute asthma, using such procedures as peak flow, pulmonary function tests, and arterial blood gases.
  5. The student is familiar with allergy skin-testing procedures and with principles of hyposensitization.
  6. The student can recognize common skin manifestations of allergy (atopic dermatitis, urticaria, drug rash).
  7. The student is prepared to manage an anaphylactic episode, and to make recommendations for further precaution in the case of severe reaction to insect sting.
  8. The student knows presenting symptoms of the major inflammatory connective diseases of childhood—rheumatic fever, juvenile rheumatoid arthritis, Stevens-Johnson syndrome, Schönlein-Henoch vasculitis, Kawasaki disease.

Learning Activities:

  1. Seminar/Lecture
    1. Asthma - J. Moore, MD
    2. Pulmonary Function - D. Davison, MD
    3. Rheumatology - F. Stevens, MD
  2. Subspecialty Clinic
    1. Asthma – J. Moore, MD
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