PACEInpatientIM-Peds

Slide 1: 

College of Medicine Inpatient Internal Medicine-Pediatrics PACE Subcommittee Maria Cannarozzi, M.D. December 16, 2004

Objectives : 

USF College of Medicine Internal Medicine-Pediatrics PACE Subcommittee Maria Cannarozzi, M.D. Objectives “Disease in the context of a lifetime” Incorporate ILC topics via innovative learning experiences Emphasize pathophysiology common to both pediatrics and adult medicine Unify two clerkships Preserve mutual exclusivity Sir William Osler http://www.medicalarchives.jhmi.edu/sgml/osler.html

Components : 

Components Nonintegrated vs Integrated Weekly themes Conferences Integrated longitudinal curriculum

Clerkship Curriculum : 

Clerkship Curriculum Nonintegrated Patient encounters and ward experience Case based conference Integrated Keynote conference ILC Clinical modules ECG lecture series

Weekly Themes : 

Weekly Themes 1 Cardiology – congestive heart failure/cardiac dyspnea 2 Pulmonary medicine – obstructive lung disease/respiratory failure 3 Endocrinology – diabetic ketoacidosis/HHNK physiology 4 Infectious Disease – sepsis/presentations of infection 5 Rheumatology – inflammatory joint pain/SLE/vasculitis 6 Gastroenterology – acute abdomen 7 Nephrology – acute renal failure/fluids and electrolytes 8 Hematology/Oncology – anemias/common malignancies

Conferences : 

Conferences Keynote Case Based Conference ECG

Integrated Longitudinal CurriculumWeekly Task : 

Integrated Longitudinal CurriculumWeekly Task -- Management issues of a simulated case of a sickle cell patient in aplastic crisis who follows the religion of Jehovah’s witness -- Plan a vaccination strategy for influenza season with a limited supply -- Managing the care of a patient with a newly diagnosed terminal illness –“breaking the news” -- Management of a cancer patient with uncontrolled pain -- Attending Tumor Board and presenting a patient/treatment plan -- Spending time in the ER reviewing criteria for admissions for various/specific diagnoses -- Spending a day working with nutrition services, specifically what is involved in preparation of various patient diets, including the formulation of TPN -- Spend a day in hospital administration/hospital operations management in order to appreciate and become sensitive to issues related to administrative aspects of inpatient medical care

Sample Week 2: Pulmonary : 

Sample Week 2: Pulmonary

Electronic Portfolio : 

Student Portfolio A closer look… Electronic Portfolio STUDENT LOGBOOK – PATIENT DATA/PROCEDURES DOCUMENTATION OF WEB-BASED MODULE COMPLETION  DOCUMENTION OF ILC TASK COMPLETION  FACULTY AND RESIDENT PHYSICIAN EVALUATIONS  WEEKLY QUIZ SCORES  COMPREHENSIVE WRITTEN EXAMINATION SCORE CLINICAL PERFORMANCE EXAMINATION SCORES

Inpatient Internal Medicine-Pediatrics On Line Curriculum : 

Inpatient Internal Medicine-Pediatrics On Line Curriculum Weekly Task Keynote Conference Clinical Modules

Assessment : 

Assessment Ward evaluations from attending and residents Weekly quizzes ILC task completion Module completion ECG competency exam Student log (diagnoses and procedures) completion Comprehensive written exam Case-based clinical performance examination

Further Considerations : 

Further Considerations Eight weeks continuous ward service Workload demands and time restraints Ward team responsibilities vs independent learning Balancing didactic education and clinical experience Continual curriculum assessment and improvement

ILC Weekly Task : 

ILC Weekly Task Sir William Osler http://www.medicalarchives.jhmi.edu/osler/oslerroom.htm

Slide 15: 

Sir William Osler http://www.medicalarchives.jhmi.edu/osler/oslerroom.htm “Follow the antibiotic”   Starting with the order entered by a physician, physically track the process of an IV antibiotic or blood product being administered. Identify and record the following items (do not allow your presence to influence the people you are observing): The name and role of every person who reads the order, or touches the medication/blood product The manner in which the medication/blood product is prepared and stored How the order and medication/blood product are verified to match How the medication/blood product is transported to the ward The name and role of everyone on the ward who processes or delivers the medication/blood product to the person who administers it The supplies needed to administer the medication/blood product to the patient The verification process for ensuring the medication/blood product given to the patient is correct The manner in which the medication/blood product is administered including equipment, rates, and site of entry Any counseling or information the patient/patient’s relative received by anyone involved in the entire process regarding the medication/blood product The time for the entire process to occur What benefit/drawbacks does the patient/patient’s relative expect from the medication/blood product

Slide 16: 

Sir William Osler http://www.medicalarchives.jhmi.edu/osler/oslerroom.htm Answer the following questions: Identify 10 possible moments at which unintended error may occur What information do you think should be provided to the patient or their relative regarding the administration of the medication/blood product (be specific)? What is the manufacturer’s listed cost of the medication/blood product? How much does the hospital pay for it?

Keynote Conference Agenda for Week 2: Pulmonary medicine : 

USF HEALTH SCIENCES CENTER Keynote Conference Agenda for Week 2: Pulmonary medicine Representative Faculty:  Pulmonologist, general internist, general pediatrician, basic sciences physiologist, pharmacologist

Keynote Conference Agenda for Week 2: Pulmonary medicine : 

Keynote Conference Agenda for Week 2: Pulmonary medicine Topic: Obstructive pulmonary disease – asthma/COPD   Objectives:   Discuss pathophysiology of obstructive lung disease, including anatomic features, etiologies, risk factors, clinical presentations and management.   Discuss how these physiologic processes differ in the adult and pediatric population i.e. bronchospastic hyperreactive airways vs. structural changes caused by environmental toxins (cigarette smoke) or congenital disorders (cystic fibrosis).   Discuss how patients of varying ages might present.   Discuss management strategies for patients of varying ages and why these strategies might differ. Topic: Respiratory failure in the child and adult   Objectives:   Discuss primary pathologic mechanisms of respiratory failure i.e. hypoxia and hypoventilation – how these might occur and which are more prevalent in pediatric vs. adult populations   Discuss presentation of respiratory failure i.e. warning signs, different age presentations   Discuss the detailed pathophysiology of a selected type of respiratory failure: i.e. hypoxia secondary to diffusion abnormality. Why does this occur in the pediatric vs. adult patient? How do we treat it?   Discuss age-appropriate management strategies for selected respiratory disorders.

Pulmonary Function Test : 

Pulmonary Function Test Spirometry Slow maneuvers Forced maximal maneuvers Lung Volumes Plethysmography Inert gas washout/dilution Planimetry Diffusion Capacity Pulmonary Mechanics NIP, MVV, MEP

Case # 3 : 

Case # 3 A 72-year-old woman with long standing tobacco use (150 pack years) undergoes PFT testing for evaluation of increasing dyspnea.

Slide 21: 

Spirometry Results Flow volume loop Effort loop Severely blunted exp curve Both are smooth in contour

Pronounced air trapping with lung fields below breast shadows : 

Pronounced air trapping with lung fields below breast shadows

Question : 

Question What is the most likely diagnosis? Asthma Asbestosis Neuromuscular weakness COPD