Cambridge Hospital
Goals and Objectives
The goal of the Cambridge Hospital pediatric rotation is to develop the ability of residents to evaluate and manage patients from a diverse community population through exposure to a broad range of acute, sub-acute and chronic pediatric problems, in pediatric age groups from the newborn through adolescence, in both an inpatient and outpatient context. The rotation is based in a community hospital with a busy emergency room, a labor and delivery service, and a pediatric ward with patients. Residents are exposed to common neonatal and pediatric problems encountered in the community hospital setting, as well as stabilization of patients requiring transfer to a tertiary setting. Learning will occur in a team-based system that includes residents, attending staff, nursing staff, social work, interpreter services and Harvard medical students. First year residents will be the primary caregivers for their patients, under the close supervision of second year residents, who will serve as team leaders. Residents will benefit from guidance by admitting community pediatricians, as well as the service attending who will round with the team on a regular basis. The objectives of this rotation are designed to further the residents’ development of competency in the following six areas:
I. Patient Care
II. Medical Knowledge
III. Practice-Based Learning and Improvement
IV. Interpersonal and Communication Skills
V. Professionalism
VI. Systems-Based Practice
I. Patient Care
- Residents will care for all pediatric patients in the Cambridge Emergency Department, under the supervision of the ED attendings. Admission and discharge plans will be discussed with Primary Care Pediatricians as indicated. The PGY-1 will have primary duties in the ED with immediate backup available from the PGY-2.
- Patients requiring admission to the pediatric ward will be evaluated by both PGY-1 and PGY-2 residents. Complete histories and physical exams will be performed, and appropriate laboratory tests obtained in conjunction with the admitting pediatrician. The residents will coordinate the patient’s with the family, admitting attending and ward nursing staff. Social Workers, Interpreter Services, and Case Managers will be involved when indicated.
- PGY-2 resident will be responsible for consultation to the Labor and Delivery floor at the request of the Obstetric or Midwifery staff for deliveries or neonatal assessment, as well as to the Child Assessment Unit for new admissions and sick calls.
- Through thoughtful review of diagnostic results and frequent reassessment of the patient, residents will reconsider the differential diagnosis on a continuing basis, making changes to management plans as appropriate. Clinical decisions to transfer patients to a tertiary setting will be made by the residents.
- PGY-2 residents will gain additional labor and delivery experience at Mount Auburn Hospital where a level II nursery allows for care of more complicated neonates outside of the tertiary setting.
- As medically indicated, residents will perform appropriate diagnostic and therapeutic procedures after obtaining informed consent from the patient and/or family. Residents will document procedures in the chart and in their personal logbooks. On this rotation, these may include:
- arterial puncture
- bladder catheterization / suprapubic aspiration
- bag mask ventilation/endotracheal intubation
- intravenous catheter placement
- laceration repair/wound management
- lumbar puncture
- nasogastric tube placement
- splinting joints
- venipuncture
- x-ray interpretation
II. Medical Knowledge
- The resident will continue to develop and refine specific clinical management strategies, including calculation of pediatric drug dosages, techniques for examining babies and children, diagnostic and therapeutic procedures, and skills necessary to obtain an appropriately-detailed pediatric history and physical examination.
- The resident will continue to refine assessment and evaluation skills necessary to effectively and efficiently determine which pediatric patients are acutely ill, and need emergent intervention, under the supervision of the attending physician and other members of the pediatric department.
- The patient population at this community-based hospital includes patients from a diverse population base, including first-generation immigrants and refugees from several ethnic backgrounds. Residents will care for patients from initial presentation until discharge from the emergency room, ward, or nursery. Appropriate follow-up and referral to primary care is arranged when needed, and access to the community health resources is coordinated.
- During this rotation, it is expected that residents will manage patients diagnosed with, but not limited to:
- Acute respiratory illness (asthma, bronchiolitis, croup, pneumonia)
- Cellulitis/ skin infections
- Hyperbilirubinemia
- Fluid and Electrolyte imbalance (dehydration, gastroenteritis)
- Fever, bacteremia
- Pyelonephritis/urinary tract infection
- Acute viral illness (meningitis, enteritis)
- Abdominal pain, appendicitis
- Falls, minor trauma injuries and burns
- Otitis media, head and neck infections
III. Practice-Based Learning and Improvement
- In caring for patients, residents will utilize a broad range of published medical information available through web-based resources, as well as print textbooks and the hospital library. It is expected that decisions about patient care will be informed by review, synthesis and application of studies available in the literature.
- Daily attendance at teaching rounds will serve as another opportunity to discuss evidence-based patient management and current therapies as a team, with the input from senior faculty. The PGY-2 resident will facilitate scholarly discussion of the literature as it applies to current patients being cared for on the inpatient service, as well as challenging patients from the nursery or emergency room.
- Residents will take part regularly in weekly radiology rounds, reviewing radiologic imaging of their patients with pediatric radiology attendings.
- All residents will take an active role teaching third year Harvard medical students rotating on the pediatric service. This will include guiding students through history taking and physical exams, reviewing written notes and assessments, supervising students’ care for patients, and teaching procedures as is appropriate.
- In addition to the teaching from Cambridge Hospital residents and staff, Core Curriculum, Grand Rounds, and Chief of Service conferences will be televised from MGH. Certain topics will be discussed originating from Cambridge and be broadcast to residents at MGH and other teaching sites.
IV. Interpersonal and Communication Skills
- Residents will take part in daily interdisciplinary team rounds, led by the PGY-2 resident that will include attendings, medical students and nurses. In addition, all residents will work closely with team members from social work and interpreter services.
- Medical student teaching will be performed by PGY-1 and PGY-2 residents in the ER and ward settings, with appropriate supervision of history and physical exam, note writing, and procedures. Evaluation of teaching by the attending staff will enhance the skills necessary for becoming an empathic physician and teacher.
- Daily notes in the chart clearly documenting patients’ progress, diagnostic results and ongoing plan will be completed in order to maintain accurate medical records and share information among team members.
- A weekly conference for the PGY-2 resident is held with the teaching attending, course director, and department chairs where 360 degree feedback is given and team operation, caseload, and education are discussed. The resident is the focus of this meeting and operational issues as well as clinical concerns are addressed.
- Informal case discussions with individual pediatric attendings revolving around inpatients afford the resident exposure to different styles of practice and the collective experience of a large community faculty.
- Residents will provide feedback to their co-residents, students and attendings on an ongoing basis throughout the rotation, completing written evaluations at the completion of the rotation. Similarly, they will receive regular verbal feedback and a final written evaluation from the service attending that will be placed in their permanent record. Residents will use constructive feedback to guide their efforts in ongoing learning and self-improvement.
V. Professionalism
- Residents will interact with an extremely diverse patient population who come to this community hospital with different cultural backgrounds and beliefs. The Interpreter Services department provides 24-hour access to trained medical interpreters in over 15 languages.
- Residents will continue to develop compassionate, empathic and culturally sensitive communication with patients and their parents.
- Maintenance of patient confidentiality will be of highest priority.
- Residents will obtain informed consent for procedures or transfer when indicated.
VI. Systems-Based Practice
- Residents are expected to provide high quality, but cost-effective health care. Follow-up outpatient care will be facilitated by the residents, including referral for community services when appropriate.
- Many residents also have continuity clinics based in this community hospital, facilitating ongoing follow-up care in the outpatient setting.
- Residents will communicate regularly with primary care physicians in order to deliver informed, coordinated care for hospitalized patients, and ease transition back to home. This communication will include written notifications for all ER visits, and personal communication for all admissions.
