Rotation Contact

 Adam Gower, MD, MS – gower@email.unc.edu

Pulmonary Faculty


Stephanie Davis, MD


Elisabeth Dellon, MD


Charles Esther, MD


Jennifer Goralski, MD


James Hagood, MD


Mariana Henry, MD


Margaret Leigh, MD


Ceila Loughlin, MD


Marianne Muhlebach, MD


Terry Noah, MD


Tim Vece, MD

First Day Information

Rounds begin at 8:30am in the 5 Children’s Conference Room.

Rotation Information

Schedule for subsequent days:

Rounds 8:30-10:30am – family centered walk rounds are preferred M-F

Airway Center conference 7:30-8:30am on Tuesdays. Attendance is optional, but encouraged for discussion of inpatients with airway problems.

Chest conference 11:00am-12:00pm every other Monday. Attendance is expected.

Didactic teaching after rounds or at time to be negotiated by team. Topics of interest should be discussed on day 1 and with each change of attending/fellow

Intern and upper level resident are welcome to view bronchoscopies and to see patients in pulmonary clinic. Attendance at bronchoscopies on current inpatients is highly encouraged. These activities can be planned in advance or can be determined on short notice as per preference of residents and attending/fellow

How to Communicate Individual Needs?

Encourage discussion of expectations and individual needs and interests on day 1

Attendings and fellows can be approached at any time (in person, by pager, by email) to discuss concerns, to request additional learning opportunities, and/or to request feedback

What to be sure to write in clinical notes?

Differential diagnosis for problems that require investigation

Please include complete medication list and detailed test results (labs and radiology) rather than stating “refer to WebCIS”

Pulmonary function test results and interpretation should be included in daily progress notes when relevant. Please seek out attending/fellow to review PFTs and to assist with interpretation

Correct antibiotic doses are VITAL for children going home on IV antibiotics and must be included in discharge summaries

Discharge weight and oxygen flow/FIO2 when relevant

Do not state definite date of discharge for children with CF or others in hospital for prolonged therapies until actual day of discharge. Instead, include discharge criteria.

Timing of notes?

Inpatient progress notes should be completed as early as possible in the day, without disrupting patient care. Attendings must sign notes same day.

Admission notes should be completed and signed prior to rounds

Discharge summaries should be completed, signed and routed to correct attending within 48 hours of discharge

What to be sure to present on rounds?

24 hour events, new medical and social concerns, pertinent VS and physical exam findings, new results (labs including cultures, radiology, pulmonary function tests, bronchoscopy), summary of new recommendations from consultants, thoughts on the plan (therapeutic and diagnostic), discussion of disposition

Residents should enter all patients’ rooms with attending/fellow during rounds and should lead communication with patient/family.

Specifically call the attending/fellow for?

Worsening clinical status, rapid response/PICU transfer, new admissions

Help with challenging families

Discussion of new diagnoses, serious topics/difficult news

Evaluations/feedback if not offered. Recommend request for feedback from each fellow/attending if change weekly, at midpoint and end of rotation if fellow/attending duties extend beyond one week

Expectations for interactions with medical students on the rotation?

All are part of a team

Great opportunity for residents to do some teaching; if not re: pulmonary issues certainly for general pediatric and critical care issues

Students should present patients they are following and should be first to enter their patients’ rooms on team rounds

Expectations for interactions with others (clinical nurses, ancillary services, etc.)?

Typical interactions: working as a team, respectful to all,

Expected attendance at didactics or conferences?

Residents should plan to attend all of the residency program and department conferences

Specific Assignments:

Assignments typically are self-driven

“Bullet” presentations on specific topics are welcomed and appreciated

Other Expectations:

Residents should be independent with reading about medical problems they encounter; expect
literature search or seek us out for textbooks for reading

OVERALL EDUCATIONAL GOAL:
The purpose of the UNC Ward Service is to provide residents with those clinical experiences which are necessary for the development of proficiency in caring for infants and children in the hospital setting.

OBJECTIVES SPECIFIC FOR ALL LEVELS :
Demonstrate competence in working within the inpatient ward system to provide effective and efficient patient care including communicating with referring physicians and agencies; scheduling tests and procedures; managing transfers between units and other services; obtaining consults; and performing discharge planning. (PC, SBP)

Demonstrate competence in applying basic clinical skills (history, physical exam, differential diagnosis, and management plan) to the care of hospitalized children. (MK, PC)

Demonstrate competence in assessing clinical data and arriving at appropriate diagnoses. This includes collecting, recording, and presenting medical information in a concise and logical manner. (PBL, MK)

Demonstrate competence in establishing appropriate clinical priorities and in making decisions when managing several patients simultaneously. (PBL)

Demonstrate competence in developing and maintaining interpersonal relationships with patients, families, and other members of the health care team. (I&CS)

Demonstrate competence as the primary physician for assigned ward patients including managing common medical problems. (PBL, MK, I&CS)

Describe the pathogenesis of common medical problems. (MK)

OBJECTIVES SPECIFIC FOR RESIDENTS AT THE PL-2 AND PL-3 LEVEL:
Demonstrate the necessary supervisory ability to manage effectively an inpatient ward team. This includes the ability to utilize appropriate ancillary services and consultants. (P, MK, I&CS)

Demonstrate the responsibility of being a role model, teacher, and leader for the PL-1 residents and medical students in terms of clinical ability and judgement on the inpatient service. (P, MK, I&CS)

Demonstrate recognition of personal limits of knowledge and experience and demonstrate an appreciation of the role of the supervising attendings and consultants. (PBL)

Demonstrate initiative in finding information (including that available within computer sites) useful for solving specific patient problems. (PBL)

Demonstrate the acquisition of an increasing depth of knowledge and experience, permitting more independent function. (PBL)

Demonstrate an understanding of cost-effective strategies in managing the clinical problems on the ward service. (SBP)

EVALUATION:
Residents will be evaluated by direct observation of their performance. Opportunities for evaluation include work rounds, teaching rounds, specific conferences, written notes, contact with patients, interaction with parents, and interchange at work stations. The general and subspecialty attendings will complete the standard evaluation form for each resident at the end of the rotation. The attending physicians should provide oral feedback throughout the rotation and should have an exit interview with each resident at the end of the rotation.

LEARNING ACTIVITIES OF THE ROTATION:
Learning activities on the inpatient ward service include: direct patient care with supervision and feedback daily; teaching conferences; work rounds; interactions with other professionals; resident noon conferences; grand rounds; and independent study and information seeking activities.