KSU Faculty Member websites > سارة سليمان السبيعي > 473 peds
473 peds

 

INTRODUCTION TO PEDIATRIC COURSE

(473 PED)

 

Dear Student,

 

Welcome to

the PEDIATRIC DEPARTMENT!

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.

 

THE CURRICULUM

 

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:

 

I. OBJECTIVES

 

      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 Behavior

 

1.4.1 Normal versus abnormal

            1.4.2 Common behavioral problems (e.g., temper tantrum, attention seeking, etc)

 

 II.      Nutrition

 

2.1 Breastfeeding

 

2.2 Bottle feeding

 

2.3 Normal nutritional needs

 

            2.4 Protein-calorie malnutrition

 

2.5 Failure to thrive

 

2.6 Obesity

 

            2.7 Vitamin deficiency (e.g. Vit. D deficiency(

 

III. Neonatology

 

         3.1 Normal newborn

 

         3.2 Common disorders; respiratory distress, sepsis, others

 

IV. Genetics

 

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

 

7.3 Myositis

 

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

 

XII. Hematology

 

            12.1 Common hematological problems (anemias)

 

12.2  Disorders of hemostasis

 

XIII.   Oncology

 

            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

 

XVI.   Neurology

 

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

 

 XVIII. Dermatology

 

18.1 Description

 

            18.2 Neonatal skin rashes

 

            18.3 Dermatitis

 

            18.4 Skin infections

 

XIX. Emergency

 

         19.1 Coma

 

         19.2 Shock

 

         19.3 Burns

 

         19.4 Other common pediatric emergencies

 

XX. Poisoning

 

         20.1 Treatment

 

         20.2 Prevention

 

         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)

 NOTES:

 

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.

 

4. Absences:

 

§         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

 

BOOK TITLE

 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

Purpose

 

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.

 

History Taking

 

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.

 

Physical examination

 

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

 

Summary

 

A brief summary of the history and physical examination is advisable here.

 

Problem List

 

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 Plan

 

Management includes investigations and treatment:

 

Investigations:

 

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.

 

Other services:

 

The help of other services or sub-specialties can be mentioned if need be

 

            Treatment:

 

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.

 

            Follow-up:

 

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)

 

General Comments:

The student is required to write down a brief comment on the overall management care and plans for the patient.

 

 

 

 

 

King   Saud University. All rights reserved, 2007 | Disclaimer | CiteSeerx