Welcome Students!!

1. Welcome Students!! Children’s Mercy Chief Residents

2. Medicine • Congratulations!! You have chosen an honorable profession • Rewarding career

3. Pediatrics • Important part of your medical training • Main goals in studying Pediatrics: • See interesting pathophysiology • Interact with younger patients • Sharpen history taking skills, presentation skills, and documentation skills • Learn entities specific to pediatrics

4. Our responsibility to you Provide ample educational opportunity Provide basic pediatric knowledge thru both didactics and clinical practice Provide feedback regarding note writing as well as presentation skills Treat you with respect and as a valued member of the team Your responsibility to us Punctuality Professional Behavior Invest in the team and take the initiative Appropriate use of your time: reading, seeking out educational opportunities Communication with your residents: communicate feedback, seek work, follow up on plans Ask for feedback on your performance Responsibilities

5. Inpatient • Calls • You choose 5 days for call until 10 pm • You are required to be here until check out everyday • Days off • You have 4 days off/ month total including weekends • You will discuss with your team appropriate days off • Chairman’s exam • You will have the morning off of your Chairman’s exam • Clinic • You are required to see all your patients prior to your clinic and write notes on them even if that morning you need to be here early • Your senior residents are responsible for filling you in on the plans once you return from clinic

6. Education • Inpatient Report 0700- sit towards the front and be interactive • Medical student lectures first 3 Wednesdays and last Monday pm • Monday noon lectures • Wednesday noon lecture- again please sit toward the front • You are responsible for presenting a minimum of 1 short 5-minute talk to your team once during the month. Your seniors will help coordinate the topic and date • An attending physician will observe a complete history and physical exam once during the month

7. Daily schedule- Inpatient • Arrive no late than 6:30 am so that you can start checking out with the night team at 6:30 • 0700 Inpatient Report M-W • 0800 Grand Rounds Thursday • See your patients and write notes until 0900 • Rounds 0900 • Afternoon: You need to be here until check out at 1600 • follow up on labs, radiology • Do admissions • Read • Prepare presentations • If you are having difficulty finding things to do: • Talk with your intern • Talk with the Chief Residents • Check out at 1600

8. Food • You get call money for the days you are here until 10 pm (1/2 pack per call) • Mondays food is first come, first serve • We have breakfast the first day of our month and one morning in the middle of the month which you are welcome to

9. History and Physical- Documentation • A thorough History and Physical should be performed on all newly admitted patients and to include specifically but not limited to: • Sexual history in adolescent patients • Specific immunization record • Medications and doses • Pertinent positives and Negatives in the ROS • Developmental history • Growth chart plotted

10. Daily progress note documentation • A SOAP note should be completed daily • Write a plan even before rounds, it does not matter if you are correct but you should start thinking of formulating your own plan • The interns can not wait for students to complete notes

11. Presentation • We do family centered rounds- or walk rounds, on general teams often times with busy census SO efficiency is key • You do not need to present all information just the imperative- your notes will reflect the complete knowledge of your patients • EX: (Pt name) is a 4 year old previously healthy (sex) admitted (date) with (diagnosis). Overnight pt did well (or pertinent information). Pt has stable vitals overnight (or pertinent changes), physical exam unchanged or significant for (X). Our plans for today include (by systems):

12. Concerns or Questions • You will receive a mid rotation evaluation from either your senior resident and attending physician • If a senior resident has concerns with your work: they should contact you first. • The Chief Residents will then be involved with discussion to Dr. Talib and your attending • If you have concerns with members of your team please contact the intern or senior resident, then discuss the concern with the attending • The Chief Residents are always here to listen to your concerns and intervene when appropriate

13. Resources available to you • The Health Sciences Library here in the hospital • Up To Date on the computer system

14. Note writing • Your H&P should be as thorough as it ever will be. You should include even the most minute of details • Your SOAP note should detail significant overnight events, vitals, physical exam findings as well as your assessment of the patient and your plan of action • S- subjective, how the patient feels, • O- you concrete findings, vitals, physical exam • A- you comment on what is going on with the patient • P- your plan of attack for the day, be specific especially if you will get a consult- write in your note the specific question

15. Weight and Height • Weight in the Pediatric population is one of THE most important vital signs. We document in kilograms (1kg=2.2lb) • Look at weight everyday and note even subtle changes (Meditech under growth flowsheet) • On admission plot height, weight, head circumference, and BMI as necessary for individual patients • Try to find baseline weights • An infant should gain between 15-30 grams/kg/day

16. Medication dosing • Based on kg weight in pediatric patient • With obese children, based on ideal body weight • Having a dosing handbook with you or near you at all times is normal

17. Fluids: Bolus • Bolus fluids are used when a patient is dehydrated no matter the cause: bleeding, sepsis, volume loss due to vomiting and diarrhea • Bolus fluids are isotonic (NS or LR) without glucose and without electrolytes • Bolus fluids are typically given 20mL/kg

18. Fluids: maintenance • Maintenance fluids are typically used for general run of the mill fluid replacement, pt is NPO for surgery, pt is ill and not eating well, pt is slightly dry • Appropriate fluid options typically include glucose (D5) as well as a ½ Normal Saline, (other fluids may be necessary based in age of patient, kidney function, sodium status, etc…) • Maintenance fluids are typically dosed as follows: • 4mL/kg/hr for the first 10 kg, 2mL/kg/hr 10-20kg, and 1mL/kg/hr every kg above 20 OR • 100mL/kg/day for the first 10kg, 50mL/kg/day 10-20kg, and 10mL/kg/day for every kg above 20

19. Ins and Outs • This information can be found in Meditech under Assessment Forms: then feeding input and output flowsheet • Document input as mL/kg/day and should include PO as well as parenteral nutrition • Calorie counts • Typical formula has 20kcal/ounce and there are 30mL/ounce • Document calories as kcal/kg/day • Normal should be around 100 kcal/kg/day in typical patient • Document output as mL/kg/hr • Normal should be minimum1mL/kg/hr

20. Truman Nursery • Arrive at 0700 and check out 1600 • There is A LOT of paper work so be prepared • You have 2 days off only during those 2 weeks • Your responsibility includes: • Examine discharges and fill out appropriate paperwork • See daily patients and write progress notes • New admissions • Education: • Prepare a talk • Didactic type lectures 2-3 times/week • Observe a circumcision

21. PCC • Arrive 0830 and leave when all patients are seen- last walk in time is 1630 • Didactic lecture M-W am in the PCC, Grand Rounds 0800 Thursdays • Responsibilities: • Pick up charts in a timely fashion • See patients and check out to either attending or 3rd year residents • Present a plan as well • Document appropriately and timely