Specific objectives and criteria for evaluation of medical students and residents
I. Overall Educational Goal:
The medical student and/or resident is expected to participate in the clinical management of pediatric patients with pulmonary disease under the direct supervision of a pediatric pulmonary attending, and to gain evaluative skills necessary for general pediatric practice. The clinical settings include the inpatient ward service, pediatric intensive care unit, neonatal intensive care unit, the pediatric pulmonary outpatient clinics, pediatric pulmonary function testing and the pediatric bronchoscopy service.
II. Specific Objectives
- Develop and demonstrate competent skills in obtaining a history and performing a physical examination focused on the pulmonary system, including but not limited to evaluation of breath sounds, work of breathing, lung consolidation and pleural effusion.
- Develop and demonstrate ability to interpret chest radiographs, arterial blood gas, pulse oximetry, pulmonary function tests, and respiratory tract cultures in the context of the overall pulmonary evaluation.
- Understand the capabilities and limitations of specialized techniques (e.g., bronchoscopy, fluoroscopy, chest CT, chest MRI) to characterize airway, lung, pleural, and mediastinal disease.
- Develop and demonstrate an orderly approach to evaluate pediatric patients with pulmonary disorders such as stridor, wheezing, chronic cough, apnea, recurrent pneumonia, chest pain and hemoptysis.
- Understand the natural history and recognize exacerbations of chronic lung diseases such as cystic fibrosis, asthma, interstitial lung diseases and bronchopulmonary dysplasia.
- Understand the appropriate use, risks and benefits of commonly used therapeutic modalities such as supplemental oxygen, airway clearance techniques, bronchodilators, diuretics, systemic and inhaled corticosteroids, and antibiotics.
- Understand the indications for performing tracheostomies in children and the inpatient/outpatient management of these children.
- Recognize obstructive sleep apnea and understand the evaluation, management and adverse effects of this disorder.
III. Learning Activities of the Rotation:
The principal learning activity of residents and medical students during the Pediatric Pulmonary rotation involves assessment of inpatients and outpatients with prompt review by a pediatric pulmonologist. Immediate feedback on the resident’s assessment and treatment plan is provided. Experience in the bronchoscopy laboratory is primarily observational, to expose the student or resident to the structural correlates of respiratory symptoms.
Medical students and residents attend the biweekly Chest Conference, a multidisciplinary conference attended regularly by students, residents, and numerous subspecialists, including pediatric pulmonologists, pediatric infectious disease specialists, and pediatric radiologists, with occasional attendance by pediatric cardiologists, pediatric surgeons, cardiothoracic surgeons, and pathologists. The resident or medical student on the Pulmonary rotation is expected to prepare a short presentation for one Chest Conference, reviewing a topic that is mutually agreeable to the resident/student and the attending, and preferably relates to a current pulmonary patient.
Other conferences attended by residents/students on the Pulmonary rotation are a weekly pulmonary division clinical conference (pediatric pulmonary faculty and fellows discuss interesting patients, outpatients, and bronchoscopies), a weekly pediatric pulmonary division conference (faculty and fellows discuss pulmonary topics in depth), and a weekly Children's Airway Center conference (multidisciplinary review of patients with complex airway issues).
Residents are expected to review a syllabus of reading material that has been compiled for their use and is available on the website, as well as perform literature searches on topics pertaining to the patients they encounter in the inpatient and outpatient setting.