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Diagnostic & Complex Care Clinic (Peds 465)

Pediatric Diagnostic and Complex Care Clinic Rotation

Contact: Maria Ferris, MD, MPH, PhD cell and pager number 919-260-5013

Welcome Note


We are delighted you have chosen to rotate in our clinic. The patients we serve come referred from around the state with clinical questions that have not been resolved by general practitioners. We are the team with a little bit more time to think about the patient and family issues and the opportunity to provide families their “last stop”. Our goal is to understand what these puzzling or medically complex patients (and families) need. While most of your rotation will be in the Chapel Hill location, our clinics are located at: 1) Ground floor Children’s Hospital Specialty Clinics, ask nurses for Diagnostic and Complex Care Clinic Phone 984-974-1401; 2) Raleigh Specialty Clinic at Rex Hospital, and 3) UNC Park Scholar Children’s Clinic, 4414 Lake Boone Trail, Suite on 5th Floor.

First Day Information

Please look at the Diagnostic Clinic call schedule and contact the physician on call for the day when you start your rotation. PLEASE READ THE MEDICAL RECORDS of the patients to be seen on the days you will be in clinic, as this will help you maximize learning opportunities. BEFORE THE FIRST DAY of your rotation, you will need to know where to go as our clinic rotates sites. The Attending’s schedule is located on WebXchange or call 844-UNC-PEDS.

Goals and Objectives

OVERALL EDUCATIONAL GOALS:

To achieve competency in the care of patients with complex medical conditions. The Trainee completing the elective in the Diagnostic Clinic should be able to

  1. Suspect, accurately document, and initiate a diagnostic evaluation of frequently encountered symptoms, signs or laboratory abnormalities which may be manifestations of their primary conditions or a new condition altogether
  2. Develop a treatment plan for acute complaints or changes in their chronic conditions
  3. Manage the approach to patients with multi-system medical complexity
  4. Coordinate consultations and communicate with referring primary care providers the outcome of our services and interactions with other interdisciplinary team members

OBJECTIVES:

On completion of the elective, the Trainee should be able to:

  1. Perform a history and physical examination adequately to detect abnormalities in new conditions or acute on chronic conditions
  2. Demonstrate proficiency in interpreting laboratory studies
  3. Detect, evaluate and manage states of abnormal body homeostasis
  4. Recognize, evaluate and manage health conditions such as: Headaches, weight changes, constipation, complex organic and non-organic conditions

Evaluation

Rotation or Elective: Trainee performance and evaluation is based on the quality of (1) their patient assessments and treatment plans (2) judicious use of ancillary studies and consultations (3) the evaluations they propose in case presentations.

At the conclusion of the elective, the attending will complete an evaluation form indicating their estimation of the degree to which the Trainee has successfully achieved each of the objectives of the elective. The Trainee will also evaluate (1) the effectiveness of the experience in providing adequate information and instruction to facilitate achieving each objective, and (2) the performance of each Attending as a teacher.

Rotation Learning Activities

Patient assessments: Under the direct supervision of an Attending, Trainees evaluate children seen at the diagnostic clinics. These evaluations include taking a history, performing a physician examination, ordering and interpreting studies and consultations necessary to formulate a differential diagnosis and treatment.

Case-Presentations: Trainees meet with an Attending each week to discuss simulated case presentations directed to achieving each objective. Trainees are expected to (1) review reading material provided in the syllabus, (2) read the simulated case presentation(s), and (3) answer questions stimulated by the case(s) and intended to facilitate the Trainee’s self-evaluation of his/her understanding. The format of the seminar is to address specific questions, initiated by the Trainee, which insure an understanding of concepts essential to achieve the objective.

Conferences: Trainees attend formal conferences devoted to issues in chronic conditions and when possible, please attend morning report at 7:45 AM and noon conference at the Curnen Denny Conference room (Women’s hospital conference room 3). Pediatric grand rounds at 8:00 AM are located in the main auditorium, 4th floor, old clinic building.

Readings and Resources

Headache

  1. Lecture/handout
  2. Slide presentations: http://slideplayer.com/slide/4744711/
  3. Review papers

a) Evidence base: https:www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=177&seg_id=3682

b) Headache in the ER: http://pediatrics.aappublications.org/content/124/1/e12

c) Headaches in infants and children: https://clinicalgate.com/headaches-in-infants-and-children

4. Patient/family education material: USE EPIC NEUROLOGY HANDOUTS