Monday Tuesday Wednesday Thursday Friday Saturday Sunday. Youth Protection Clinic. Developmental Clinic. Clinic. Grand Rounds 12:30-13:30

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1 McGill University Pediatric Residency Program Community Pediatric Rotation for PGY-II, PGY-III Rotation Site: C.H.V.O. Hôpital de Gatineau Rotation Supervisor: Giuseppe Ficara Rotation Template: 1 AM Monday Tuesday Wednesday Thursday Friday Saturday Sunday PM ER (clinic) 2 Journal Club CF or Diabetes Youth Protection Developmental Asthma Grand Ambulatory 8:00-9:00 ER (clinic) Diabetes ER (clinic) AM NICU NICU NICU NICU NICU Grand 8:00-9:00 Ambulatory PM NICU NICU NICU NICU NICU 3 AM PM ER (clinic) 4 Journal Club CF or Diabetes Youth Protection Developmental Ward* On-Call On-Call Grand Ambulatory 8:00-9:00 ER (clinic) Diabetes Ward* On-Call AM Ward* Ward* Ward* Ward* Post-call Grand 8:00-9:00 Ambulatory PM Ward* Ward* Ward* Ward* Post-call The above schedule represents a typical month for a pediatric resident. It can be modified to meet specific educational objectives. If the resident sees patients that require follow-up within the month, then they can be scheduled during the afternoon slots dedicated to clinic patient s emergency. If the resident has a two month rotation, then specific follow-up clinics can be scheduled during the second month.

2 * = pediatric resident will be on-call (home-call) from Friday to following Thursday, with supervision from attending physician. They will take first line calls on Friday, Sunday, Tuesday, and Thursday, while remaining available for all emergencies or unique learning opportunities on other nights. They will round on their in-patients both Saturday and Sunday morning. Description of the rotation The community pediatric rotation in Gatineau will expose residents to secondary and tertiary care pediatrics in the community setting. They will work in various general and specialized pediatric clinics where patients are referred from community physicians, or where patients with complex problem lists are followed. Furthermore, residents will do one week of in-patient service where they will be responsible for their patients, as well as ER and in-patient consults from general practitioners. Their last week will be spent in the advanced level-ii NICU, where they will be responsible for their patients, in-patient consults from general practitioners covering the nursery, and consults for high-risk deliveries/case-room management of neonatal distress. The supervisor for this rotation is Dr. Giuseppe Ficara, CHVO-Hôpital de Gatineau, 4 th floor Pediatric, (819) Dr. Ficara will meet with the resident at the midpoint of their rotation for formal feedback, and once again at the end of the rotation (the feedback will be a consensus of all supervisors involved). This is of course in addition to all formative feedback offered throughout the rotation by clinical supervisors. Dr. Ficara will oversee the supervision process, which will consist of one clinical mentor during the ward-service week, one clinical mentor during the NICU service week, and various mentors during the clinic weeks. The resident will be expected to present one case (along with discussion) at one of the two journal clubs during the month. Learning Objectives (based on CAMEDS competencies) Medical Expert: Assume primary responsibility in the diagnosis and management of pediatric problems encountered as a community consultant, under direct supervision from mentor (pediatrician) Develop additional exposure to specific problems through specialized clinics (Asthma, Diabetes, Development, Youth Protection, Cystic Fibrosis) Acquire an appreciation for pediatric practice outside the tertiary university-hospital setting Develop decision-making abilities and skills which are necessary in the absence of subspecialists immediately available Learn how to communicate effectively with subspecialists over the telephone to transmit accurate information, and develop skills to determine which patients can be co-managed with telephone support & which patients must be transferred Develop skills necessary to make appropriate decisions about patient transport to another centre (most appropriate mode of transport, personnel for transport, and medical issues related to condition of the patient) Learn about practice management and administration in the community setting Communicator:

3 Interaction with parents and children in the clinical setting Interaction with other members of pediatric team (pediatricians, nurses, respiratory therapists, physiotherapists, occupational therapists, dieticians, psychologists, social workers, secretarial staff) Interaction with physicians and professionals requesting consultations and expert advice Interaction with consultants (pediatric subspecialists) over the telephone Scholar: Capacity for independent learning around cases Interactive & effective lecturing during presentation Collaborator: Functions well and respectfully within the pediatric team Professional: Honesty, integrity, ethics Responsibility & self-discipline Advocate: Understanding of the need for pediatricians to advocate on behalf of children and their specific needs in the community that they care for Manager: Observation of pediatrician s role within multidisciplinary team Observation of pediatrician s role as a consultant rather than primary care provider Giuseppe Ficara, May 2003 This document complements the report submitted by Dr. Saleem Razack to the CMQ ( Rapport d étapes des milieux de formation ) subsequent to his Gatineau site visit on December 19 th, 2002, as well as the document given to residents at the beginning of their Gatineau rotation entitled Pediatric Resident Rotation CHVO-Gatineau.

4 Updated May 5 th, 2003 Pediatric Resident Rotation McGill University Faculty of Medicine Centre Hospitalier des Vallées de l Outaouais Pavillon de Gatineau Please refer to document entitled McGill University Pediatric Residency Program Community Pediatric Rotation for PGY-II, PGY-III; Rotation Site: C.H.V.O. Hôpital de Gatineau which complements this one. This document will refer to specific information related to the resident rotation at the CHVO site. Residents will spend 4 weeks rotating through the Pediatric Dept. at the CHVO. The 4 weeks will be divided as follows: 1 AM Monday Tuesday Wednesday Thursday Friday Saturday Sunday PM ER (clinic) 2 Journal Club CF or Diabetes Youth Protection Developmental Asthma Grand Ambulatory 8:00-9:00 ER (clinic) Diabetes ER (clinic) AM NICU NICU NICU NICU NICU Grand 8:00-9:00 Ambulatory PM NICU NICU NICU NICU NICU 3 AM PM ER (clinic) 4 Journal Club CF or Diabetes Youth Protection Developmental Ward* On-Call On-Call Grand Ambulatory 8:00-9:00 ER (clinic) Diabetes Ward* On-Call AM Ward* Ward* Ward* Ward* Post-call Grand 8:00-9:00 Ambulatory PM Ward* Ward* Ward* Ward* Post-call

5 The above schedule represents a typical month for a pediatric resident. It can be modified to meet specific educational objectives. If the resident sees patients that require follow-up within the month, then they can be scheduled during the afternoon slots dedicated to clinic patient s emergency. If the resident has a two month rotation, then specific follow-up clinics can be scheduled during the second month. * = pediatric resident will be on-call (home-call) from Friday to following Thursday, with supervision from attending physician. They will take first line calls on Friday, Sunday, Tuesday, and Thursday, while remaining available for all emergencies or unique learning opportunities on other nights. They will round on their in-patients both Saturday and Sunday morning. Pediatric Ward Service Residents will be responsible for ward admissions, ER & in-patient consults, and fielding selected telephone consults from community physicians. Each patient should have a complete admission note or consultation, and daily progress note documented in the chart. All orders and medical prescriptions MUST be counter-signed by staff physician. Each resident will discuss with their mentor how their days will be organized, but a typical day may be as follows: 8AM resident rounds on patients. 9AM resident and staff sit-down rounds. 10AM resident and staff bedside rounds. 11AM resident completes the day s work to be done for patients (discharges, organizing tests & consultations, and so on), and writes progress note for the day. 12PM Break for lunch + topic discussion 1PM Follow-up on morning s work, including lab results & radiology. Residents are responsible for putting together all of the day s labs and putting films aside in Radiology to be viewed with staff that same day. Some of the more acutely active patients will also need to be examined several times per day. 2PM Admissions & new consults (which may be interspersed during the day, depending on the urgency). When a resident is paged for a new consult or admission, the staff must be advised immediately of the new patient, so that they can be triaged appropriately. 3:30PM Sign-out rounds + topic discussion. 4PM Clerkship lectures (Teleconferenced from CHEO for medical students, and residents are welcome to attend.) Residents will also be responsible for student supervision on the ward, appropriate to their level of training.

6 NICU Residents will be responsible for NICU admissions & consults, as well as attending high-risk deliveries. Each patient must have an admission note or consultation in the chart, as well as daily progress notes. Again, all orders and medical prescriptions MUST be countersigned by staff, and staff physicians should be advised immediately of all consultations or requests to attend births. Each resident will discuss with their mentor how their days will be organized, but a typical day may be as follows: 8AM resident rounds on patients. 9AM resident and staff sit-down rounds. 10AM resident and staff bedside rounds. 11AM resident completes the day s work to be done for patients (discharges, organizing tests & consultations, and so on), and writes progress note for the day. 12PM Break for lunch + topic discussion 1PM Follow-up on morning s work, including lab results & radiology. Residents are responsible for putting together all of the day s labs and gathering X-rays to be reviewed with staff that same day. Some of the more acutely active patients will also need to be examined several times per day. 2PM Admissions & new consults (which may be interspersed during the day, depending on the urgency). 3:30PM Sign-out rounds + topic discussion. 4PM Clerkship lectures (Teleconferenced from CHEO for medical students, and residents are welcome to attend.) Residents will also be responsible for student supervision in the unit, appropriate to their level of training.

7 Out-patient clinics Residents will attend of variety of general and subspecialized pediatric clinics over two weeks. Residents will discuss with their mentor how each clinic will be organized. For most clinics, the resident will see the patient first, and then review with the staff. For some of the subspecialized clinics (eg Youth Protection), the resident will benefit from clinical exposure, however it may be more appropriate for them to observe the encounter. Residents will be responsible for documenting the clinic visit in the chart, organizing follow-up and lab tests, and writing a letter to the referring physician as the case may be. As with their inpatient experience, all documents must be counter-signed by the staff physician. On-Call Residents will take call during their week of ward service. While on-call, residents will be responsible for the pediatric ward and NICU, ER consults, and deliveries. They will take home call, and must discuss ALL decisions with the staff physician. Call will work in the following manner: Friday: first-line call (will receive sign-out from NICU 5PM) Saturday: round with staff in AM, then sign-out to NICU physician Second-line call (ie only for emergencies) Sunday: round with staff in AM, then receive sign-out from NICU physician First-line call Monday: second-line call Tuesday: first-line call Wednesday: second-line call Thursday: first-line call

8 Procedures Residents will be exposed to a variety of procedures throughout their clinical experience. If they have not already had the chance to do so, they will be given the opportunity to learn: Under supervision from MD or RN, will learn: -venipuncture -nasogastric tube insertion -throat swab + nasopharyngeal aspirate -PPD (from clinic RN) Under supervision from MD, will learn: -lumbar puncture -airway skills -principles of neonatal resuscitation Under supervision from lab technician, may gain exposure to: -interpretation of urinalysis -interpretation of blood smear Residents with special interests may request exposure to other clinical skills. Resource People Rotation supervisor: Dr. Giuseppe Ficara (pager: ) Faculty: Dr. Henriette Fortin Dr. Josée Bernatchez Dr. Marie-Hélène Landreville Dr. Eve-Marie Bélanger Dr. Chantal Gagné Dr. Jean Lemonde Dr. Mariette Boisvert Dr. Sonia Bédard Dr. Dominic Héon Dr. Julie Nault Dr. Dionne King Dr. Giuseppe Ficara Nurses: Suzanne Marsolais Ginette Renaud Secretaries: Sylvie Wolfe Sylvie Guérette

9 Librarian: Michel Turpin Complete list of pediatric reference texts, common pediatric journals, and computer/internet access. Important numbers: Hospital: Pediatric Ward: NICU: ER: : Fax: Hematology: Biochemistry: Microbiology: Filmothèque: Administration: Suzanne Lessard All residents are provided with a pager, parking pass, ID card, and locker. As well, all visiting trainees are provided with an apartment during their rotation (accommodations within walking distance of the hospital). Expectations Residents will be expected to meet the objectives listed above, as well as conform to all McGill University guidelines. Residents will be required to prepare one case presentation and discussion, to be presented at a journal club during their rotation (see below).

10 Teaching Sessions There will be a journal club every second Tuesday between 1:30PM. Case presentations and clinical discussions within the Pediatric Group are held every Thursday from 1:30PM, and on every second Tuesday between 1:30PM (alternate with journal club). Grand are videoconferenced from the Montreal Children s Hospital every Wednesday morning from 8-9AM. Ambulatory are videoconferenced from the Montreal Children s Hospital every Friday afternoon from 1:30PM. Twice each month, the residents will be invited to formal teaching offered by pediatricians to family medicine residents. As well, there will be daily informal teaching sessions + bedside teaching between resident and mentor. As mentioned above, lectures will be teleconferenced daily from CHEO between 4PM & 6PM for medical students (except Fridays). Residents are free to attend these lectures if they wish. Evaluations Evaluations will respect the standards set forth by the McGill University. Each resident will receive feedback halfway through the rotation, and once again at the end of the rotation.