Pediatrics: mean pedia (Gr. Pais, Paidos = child), trics (Gr. iatrike = medicine)
v Branch of medicine which is concerned about the child and its development and care; and about the diseases of children and their treatments.
v In some countries “child health” or “child health and life” is substituted for (Pediatrics)
This course is designed to provide you with a good chance of building up your knowledge and clinical skills in pediatrics and to prepare you to function as a competent intern.
It is impossible to cover all topics in details in this course. However, emphasis is put on graduating general physicians who have enough basics in pediatrics.
he following is a concise outlook of the curriculum:
1.1. General Objectives:
To graduate a physician who:
1.1.1 is aware of the personal qualities and attitudes required by a physician caring for children and their families e.g. empathy, concern, gentleness, etc.
1.1.2 has acquired adequate basic knowledge and skills in pediatrics which enable him/her to proceed into subsequent general practice, specialty training or research activities.
1.2. Specific Objectives:
At the end of the course the student is expected to:
1.2.1 Perform, record and interpret a full pediatric history
1.2.2 Carry out, record and interpret a complete physical examination in all pediatric age groups
1.2.3 Identify and solve common clinical problems in pediatrics by providing a provisional diagnosis and appropriate differential diagnosis.
1.2.4. Recognize urgent and emergency situations in pediatrics and be able to outline an appropriate plan of action.outline a general plan of investigations and management of common pediatric problems as they relate to Saudi Arabia.
1.2.5 Demonstrate an understanding of how to use the laboratory to reach a diagnosis of common pediatric problems .
1.2.6 Demonstrate knowledge of community problems related to child health.
1.2.7 Demonstrate knowledge of preventive aspects of childhood health problems and to implement them.
1.2.8 Recognize his limitations concerning management of pediatric patients and the need to consult and cooperate with others to provide optimum care.
1.2.9 Interact with children and their parents or relatives in a gentle, emphatic and appropriate manner.
II. Instructional strategies
2.1 Lectures and Tutorials
Series of lectures covering selected topics in pediatrics will be delivered to all students together during the whole course. Eight tutorials each will be given 4 times. Each time will include one major group (A, B, C, or D). Students are expected to come fully prepared for the tutorial sessions. The tutors were encouraged to distribute handouts to the students before the tutorials to help them prepare.
TOPIC CONTENTS OF THE COURSE
I. Development and behavior in pediatrics
1.1 Normal development
1.2 Developmental assessment
1.3 Developmental delay (excluding mental retardation(
1.4.1 Normal versus abnormal
1.4.2 Common behavioral problems (e.g., temper tantrum, attention seeking, etc)
2.2 Bottle feeding
2.3 Normal nutritional needs
2.4 Protein-calorie malnutrition
2.5 Failure to thrive
2.7 Vitamin deficiency (e.g. Vit. D deficiency(
3.1 Normal newborn
3.2 Common disorders; respiratory distress, sepsis, others
4.1 Basics of inheritance
4.2 Approach to dysmorphic children
4.3 Examples of common syndromes e.g., Trisomy 21, 13, 18; Turner syndrome
V. Metabolic disorders
5.1 Presentation and detection
5.2 Approach to suspected metabolic diseases e.g., galactosemia, aminoacidopathies, organic academia, storage diseases
VI. Allergy, Immunology and Immunization
6.1 Basics of immunity
6.2 Common Allergic conditions
6.3 Common immune deficiency disorders
6.4 Active and passive immunization
VII. Rheumatic and autoimmune disorders
7.1 Juvenile rheumatoid arthritis
7.2 Systemic lupus erythematosus
7.4 Henoch-Schonlein purpura
7.5 Kawasaki syndrome
VIII. Infectious Diseases
8.1 Common infections: Measles, chicken pox, rubella, scarlet fever, stomatitis, tonsillitis, otitis media, URI, sinusitis, infectious mononucleosis, cellulites, congenital infections, poliomyelitis, tetanus
8.2 Serious infections: Meningitis, encephalitis, osteomyelitis, tuberculosis, brucellosis, malaria, leishmaniasis, HIV infection
IX. Gastroenterology and hepatology
9.1 Acute and chronic diarrhea and constipation
9.2 Structural and functional disorders of the GI tract
9.3 Childhood liver diseases (infantile cholestasis, hepatitis, liver failure and metabolic liver disease(
X. Respiratory Tract Diseases
10.1 Disorders of the upper airway
10.2 Disorders of the lower airway
XI. Congenital and Acquired Heart Diseases
11.1 Common congenital defects
11.2 Rheumatic fever
11.3 Infective endocarditis
11.4 Heart failure
11.5 Common arrythmias in children
12.1 Common hematological problems (anemias)
12.2 Disorders of hemostasis
13.1 Pediatric malignancies
13.2 Side effects of chemotherapy
XIV. Diseases of Urinary System
14.1 Nephrosis-nephritis-renal failure
14.2 UTI and obstructive uropathies
XV. Fluid, electrolytes and acid base disturbances
16.1 Seizure disorders
16.2 Mental retardation and cerebral palsy
16.3 Neuromuscular disorders and hypotonia
XVII. Endocrine Disorders
17.1 Thyroid, adrenal and bone mineralization disorders
17.2 Polydipsia, polyuria and blood sugar disorders
17.3 Disorders of growth and puberty
18.2 Neonatal skin rashes
18.4 Skin infections
19.4 Other common pediatric emergencies
20.3 Environmental hazards
2.2 Clinical Teaching:
2.2.1 Formal teaching
Two (2) bedside teaching sessions are conducted by a teaching staff each week. Usually cases are prepared by students who present it to the group for discussion to demonstrate the relevant historical data and physical findings. Activity takes place from 9:00 – 12:00 PM.
Students will be divided into 12 groups to be posted into different hospitals for them to swap posting at a certain time of the cycle.
2.2.2 ER, OPD, Nursery & Ward rotations
During rotations, students in each subgroup are divided into small groups of 3-5 students each. They rotate through: Ward, ER, OPD, or Nursery (level 1 and 2 only).
During the ward rotation, each student should follow 1-2 patients at a time. The student is expected to function as a “sub-intern” with direct involvement in patient care. They are expected to clerk patients, observe different aspects of inpatient care and share in the rounds with the team.
In OPD or Nursery sessions each subgroup is divided into 2, one half attends in the morning and the other in the afternoon.
In ER sessions each sub group is divided into 3, each will attend a 4 hours shift: 8-12, 12-4, and 4-8. The shifts should rotate in different sessions.
3.2 Attending the continuous medical education in the department.
(See attached schedule)
1. Students who are doing ward and those who are having clinical sessions, except those who are preparing cases, are required to attend the morning report at 8:00 in the Pediatric Seminar Room.
2. Each student should:
a) Wear white coat
b) Wear his / her I.D.
c) Bring his / her own equipment
d) Dress according to the dress code assigned by the college.
3. Evaluation of students
During each rotation, medical students will be evaluated by:
1) Continuous Assessment Evaluation – which holds 40% of the total marks and consists of:
a) Attendance of all activities – 5 marks
b) Presentation and discussion during clinical sessions – 4 marks
c) Clerking of clinical cases (3) – 6 marks (on 2nd and 3rd clerking
d) Written examination (MCQs)* – 25 marks
2) Final Examination – which holds 60% of the total marks and consists of:
a) Written examination (MCQ)* - 40 marks
b) OSCE - 20 marks
* Some MCQs are based on pictures.
§ Student who score ³ 60 marks out of 100 (total course mark) will pass the course.
§ Five (5) marks for attendance of lectures, clinical sessions, tutorials, ER, OPD, nursery and ward. 0.25 marks will be deducted for each absence from any of these sessions.
§ The absence from every form of activities (lectures, tutorials, clinical sessions, ER, OPD, ward, or nursery) will be accounted for. If the cumulative absence rate exceeds 20 activities, which is more than 25% of total course activities, a letter regarding the concerned student will be sent to the Vice Dean of Academic Affairs and the student will not be allowed to take the final examination.
RECOMMENDED BOOKS FOR THE PEDIATRIC COURSE 473
AUTHOR(s) / EDITOR
1. Illustrated Textbook of Paediatrics: Tom Lissauer, Graham Clayden
2. Nelson Essential Pediatrics: Kliegman / Marcdantel / Jenson / Behrman
3. Pediatric Clinical Examination: Gill and O’Brien
4. Illustrated Self Assessment in Pediatrics: Graham Roberts/Caroline Foster/ Michael Coren/Tom Lissauer
GUIDELINES FOR CLERKING
The purpose of the case study is mainly to train the student to take a thorough history and perform a comprehensive physical examination. In addition the student, through this exercise, writes down his/her thoughts about the patient’s problem(s) and formulates his/her plan of action to solve it. It helps the students think critically in a problem solving manner. The student can look at the patient’s file (chart) and should discuss the case with the treating team as well.
Starting with the patient’s demographic data and presenting complaint and its detailed history, the student takes a full history as he is taught to do so and according to the guidelines.
It is important that the student examines the patient thoroughly as he/she has learned it, and according to the acceptable medical standard. Often times a thoroughly performed physical exam can discover some findings that may or may not be related to the patient’s problem. Accordingly, a complete physical examination must be performed or at least attempted. It is wise, however, to do a problem oriented physical examination more in depth to better delineate the patient’s problem.
A brief summary of the history and physical examination is advisable here.
All the problems that the patient has as obtained by the history and the physical examination need to be listed down at this stage. It is important to put down the most important problems (e.g. most serious, most urgent, or most agonizing to the patient) at the top of the list.
All problems that the patient has especially those that affect his well-being whether organic or psychosocial need to be listed own.
Provisional diagnosis and differential diagnosis
The provisional diagnosis is the one that best explains the patients’ symptoms and signs and encompasses as many of the patients problems as possible.
The differential diagnoses are alternative possibilities that fit the symptoms and signs but to a lesser degree.
Each diagnosis, whether the prime one or the alternatives (differential) ones, needs to have the supportive evidence and negating points mentioned.
Management includes investigations and treatment:
The student must suggest the investigations required whether hematological, other boy fluids or tissues or radiological. Each investigation suggested must be accompanied by sound reasoning’s as to why it should be done. Investigations need to be prioritized.
The help of other services or sub-specialties can be mentioned if need be.
Base on the aforementioned information and findings the student is expected to write down his plan of treatment with sound rationalization.
At this stage the student is allowed to look at the patient’s file. The student is expected to compare his findings, thoughts, and plans with those in the file and to give his comments.
On a daily basis the student has to report on the patient’s condition as well as any plans after discussion with the team, following the patient. Daily progress notes should be written using the SOAP format.
The SOAP format should be used as follows:
§ S (Subjective): Changes in the patient status, in the patient’s or his guardian’s words.
§ O (Objective): Vital signs, examination of concerned system(s), and new investigations results.
§ A (Assessment): Your interpretations and evaluation of the patient condition based on the subjective and objective data.
§ P (Plan): Your decisions based on the assessment (e.g. order a new investigation, add or stop a medication)
Prognosis and future plan:
The student has to give his/her opinion regarding the prognosis. The student, as well, must write down the future plan for the patient (irrespective of whether the patient has been discharged or not)
The student is required to write down a brief comment on the overall management care and plans for the patient.