OUTPATIENT ROTATION

OBJECTIVES:

• To be exposed to normal development of the well child, infant and adolescent.
• To attend scheduled conferences and do any readings assigned by the attending.

PERFORMANCE EXPECTATIONS:

1. To see and do formal write-ups on several clinic patients for each day spent in the clinic; an attempt will be made to give some exposure to both well child care and minor acute illness.
2. To attend scheduled conferences and do any readings assigned by the attending.
3. On call will be in the Kino pediatric clinic (for students assigned to Kino) and in the AHSC OPD (for students assigned to AHSC) as described on your schedule.

PATIENT EVALUATION:

Students will evaluate patients in the general pediatric clinic assigned to them by their faculty or resident preceptor.  For each patient the student is expected to perform the following:

1. Take a history and perform a complete physical examination according to the format described below.
2. Synthesize the data collected from the history, physical examination, lab work, radiological examination, to formulate a differential diagnosis and define a problem list.
3. Present the case to an attending physician/resident; the presentation should be orderly, concise and well organized.
4. With assistance from the attending/resident, formulate a management plan for each patient seen and arrange for follow-up of the patient's problem.
5. Perform specific lab tests under supervision (urinalysis, etc.).
6. Complete the chart write-up in problem-oriented style for each patient seen, including assessment of the clinical problem, the problem list, growth charts, Denver II and other sheets as appropriate.
7. Provide instructions to the patients on the management plan.
8. Order prescriptions as appropriate and have these signed by the attending physician.
9. When presented with lab results from follow-up, take appropriate action to ensure the patient's problem is managed.
   

The extent of historical data gathered from the patient during the encounter depends upon the nature of the patient's problem and the degree of illness of the child.  Students should seek guidance from the attending physician, but the following serve as general guidelines.  In the patient who is acutely ill, the following information will be obtained:

1. A complete account of the presenting problems, including the nature and duration of the symptoms, exposure to contagious disease, etc.
2. A review of main organ systems.
3. Relevant past medical history, including previous hospitalizations, current medications and specific allergies, chronic disease.
4. The immunization status.
5. The usual source of patient care.

When a patient's problem requires a comprehensive history, the following should also be included:

1. History of the pregnancy, delivery, neonatal course (for infants and pre-school children).
2. The milestones for growth and development for all children.
3. The medical history of the family.
4. The social and economic history of the family.

In the three week nursery/OPD rotation, you will be exposed to a variety of attendings and clinical settings.  To help clarify the goals of these three weeks, the objectives, specific student requirements, and attending duties are listed below for each section of the rotation.