2013/2014
Welcome to Paediatrics!
This manual describes the structure and expectations of the Paediatric block in your clerkship. It includes a detailed list
of objectives, and information about the examination and assessment process. This manual also includes information
that we hope will make it easier for you to adjust to yet another clinical experience lists of phone numbers, names of
faculty and housestaff, dictating instructions, and recommended textbooks and websites.
Please refer to your Clinical Clerkship Handbook for details about general clerkship requirements such as attendance,
call, holidays, appropriate dress and conduct, orders, and procedures.
The faculty and housestaff in London and in our regional sites of Chatham, Sarnia, Stratford, Owen Sound and St.
Thomas are excited about helping you to have a challenging, stimulating and worthwhile experience.
We, along with the Undergraduate Education Coordinator, Suzanne Belanger, are available to you at all times. We are
committed to providing you with an outstanding educational experience. Please contact us with any questions,
concerns, or suggestions for improvements. We welcome your feedback.
Enjoy your rotation!
Table of Contents
ORGANIZATIONOFTHEPAEDIATRICCLERKSHIP
OBJECTIVES
CLINICALTEACHINGUNIT(CTURED&BLUETEAMS)
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EMERGENCY
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13
14
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RURALREGIONALPAEDIATRICS
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Chatham
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St. Thomas
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Sarnia
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Stratford
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TEACHINGSESSIONS
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Attendance
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RECOMMENDEDRESOURCES
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ASSESSMENT
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21
Peer Review
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Mid-Rotation Assessment
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EXAMINATION
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DEPARTMENTOFPAEDIATRICSFACULTY
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PAEDIATRICHOUSESTAFF
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DICTAPHONEDICTATIONSYSTEMLONDONHOSPITALSCITYWIDE
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SCOPEOFACTIVITIESFORSENIORMEDICALSTUDENTSATLHSC
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2 weeks
2 weeks
2 weeks
OR:
Rural Regional Paediatrics
Selective
4 weeks
2 weeks
London Contacts:
Ms. Suzanne Belanger
Education Program Coordinator
Office: B1-431
Phone: 519-685-8500 x. 52328
Fax:
519-685-8156
Email: Suzanne.Belanger@lhsc.on.ca
Dr. Joanne Grimmer
Paediatric Clerkship Director
Phone: 519-685-8500 x. 58379
Fax:
519-685-8156
Email: Joanne.Grimmer@lhsc.on.ca
Dr. Eva Welisch
Paediatric Clerkship Deputy Director
Phone: 519-685-8500 x. 58010
Fax:
519-685-8156
Email: Eva.Welisch@lhsc.on.ca
Rural Regional Contacts:
Ms. Linda Wright
Windsor Campus
Phone: 519 254 5577 x. 56424
Fax:
519 985 2613
Email: lindaw@uwindsor.ca or linda.wright@wrh.on.ca
Ms. Mary Peterson
SWOMEN Rural Regional
Phone: 519-661-2111 x. 86225
Fax:
519-661-4043
Email: Mary.Peterson@schulich.uwo.ca
Objectives
The student is able to:
1. Demonstrate proficiency in acquiring a complete and accurate paediatric history with consideration of the
childs age, development, and the familys cultural, socioeconomic and educational background.
2. Describe differences between the medical management of paediatric patients versus adult patients.
3. Recognize an acutely ill child and describe an initial management plan.
4. Demonstrate an approach to the following core clinical paediatric presentations (see below chart 1).
5. Demonstrate physical examination skills that reflect consideration of the clinical presentation as well as the
comfort, age, development and cultural context of the infant, child, or adolescent.
6. Demonstrate competence with the listed paediatric physical examination skills in addition to general physical
examination skills (see below chart 2).
Core Clinical
Presentation
Abdominal Pain
Key Conditions
Additional Guidance
Appendicitis
Intussception
Constipation
Recurrent abdominal pain of
childhood
Inflammatory bowel disease
Infection (gastroenteritis and UTI)
Henoch Scholein Purpura (HSP)
Altered Level of
Consciousness
Seizure
Poisoning / intoxication
Head injury / concussion
Meningoencephalitis
Hypoglycemia
Metabolic disease (knowledge of
specific diseases is not expected)
Bruising and
Bleeding
Dehydration
Developmental &
Behavioral
Problems
Idiopathic thrombocytopenic
purpura (ITP)
HSP
Hemophilia / von Willebrand
disease
Meningococcemia
Mild / moderate / severe
dehydration
Hypo / hypernatremia
Diabetic Ketoacidosis
Diarrhea
Edema
Gastroenteritis
Celiac disease
Hemolytic uremic syndrome
Inflammatory bowel disease
Cows milk protein intolerance
Toddlers diarrhea
Cystic fibrosis
Nephrotic syndrome and
proteinuria
Nephritic syndrome and hematuria
Acute kidney injury
Fever
Growth Problems
Meningitis
Occult bacteremia / Sepsis (< 1
mon., 1-3 mon and > 3 mon.)
Kawasaki disease
Urinary tract infection
Failure to thrive
Hypothyroidism
Precocious and delayed puberty
Short stature
Obesity
Anorexia
Turners syndrome
Headache
Inadequately
explained injury
(child abuse)
Migraine
Brain tumor
Increased ICP
Physical abuse
Abusive head trauma
Sexual abuse
Neglect
Emotional abuse
Limp / Extremity
pain
Lymphadenopathy
Murmur and/or
cyanosis
Osteomyelitis
Septic arthritis
Juvenile idiopathic arthritis
Rheumatic fever
Transient synovitis
Developmental dysplasia of the hip
Legg Calve Perthes disease
Slipped capital femoral epiphysis
Growing pains
Osgood Schlater disease
Reactive / benign
Cervical adenitis
Malignancy (leukemia / lymphoma)
Mononucleosis
Innocent murmurs (Stills and
venous hum)
VSD
Coarctation of the aorta
ASD
Tetralogy of Fallot
Transposition of the great arteries
PDA
Neonatal Jaundice
Newborn
Pediatric Health
Supervision
Biliary atresia
TORCH infections
Neonatal hepatitis
Sepsis
Breast feeding jaundice
Breast milk jaundice
Physiologic jaundice
Birth trauma/bruising
Isoimmune/hemolysis
Kernicterus
Prematurity
Birth asphyxia
Congenital infections
Respiratory distress
Neonatal sepsis
Large and small for gestational
age
Developmental dysplasia of the hip
Undescended testes
Ambiguous genitalia
Absent red reflex
Vitamin K deficiency
Hypotonia
Neonatal transition
Trisomy 21
Fetal alcohol spectrum disorder
Abnormal newborn screen
Hypotonia
Nutrition
Growth parameters
Hypertension
Healthy active living
Normal development
Immunizations
Anticipatory guidance
Injury prevention
Vision and hearing
Dental health
Discipline / Parenting
Sleep issues
SIDS
Crying / Colic
Sexual development / health
Pallor (anemia)
Rash
Respiratory
Distress / Cough
Seizure /
Paroxysmal event
Iron deficiency
Hemolysis
Inherited hemoglobinopathies
(sickle cell anemia and
thalassemia)
Leukemia
Cellulitis
Varicella
Atopic dermatitis
Diaper dermatitis
Viral exanthems
Scarlet fever
Scabies
Acne
Impetigo
Seborrhea
Urticaria
Drug Eruption
Pneumonia
Bronchiolitis
Asthma
Cystic fibrosis
Pertussis
Croup
Foreign body
Epiglottitis
Tracheitis
Congestive heart failure
Anaphylaxis
Febrile vs. non-febrile seizure
General vs. focal seizure
Status epilepticus
ALTE
Syncope
Breath-holding spell
Sore ear
Otitis media
Otitis externa
Urinary
Complaints
(polyuria /
frequency /
dysuria /
hematuria)
Vomiting
Periorbital cellulitis
Orbital cellulites
Conjunctivitis
Pharyngitis
Peritonsillar abscess
Retropharyngeal cellulitis
Stomatitis
Oral thrush
Diabetes / diabetic ketoacidosis
Urinary tract infection
Enuresis
Post infectious glomerulonephritis
Henoch-Schonlein purpura
Measure and interpret height, weight, head circumference (including plotting on growth curve and calculation of
BMI)
Measure and interpret vital signs
Palpate for fontanels and suture lines
Perform red reflex and cover-uncover test
Perform otoscopy
Inspect for dysmorphic features
Elicit primitive reflexes
Inspect for and describe common newborn skin rashes
Assess for features that distinguish innocent from organic murmurs
Perform infant hip examination
Assess the lumbosacral spine for abnormalities
Assess for scoliosis
Palpate femoral pulses
Examine external genitalia
Assess for sexual maturity rating (Tanner staging)
Newborn exam (this will be covered on the first Monday of the rotation in the afternoon)
Neonatal jaundice (differential diagnosis and treatment)
Sepsis/Meningitis
Fluids
Asthma
Febrile Neutropenia
Failure to thrive
Developmental assessment (generally done as bedside teaching)
Pneumonia
Additional topics are covered during new admissions presentations in the morning and during walk around rounds in
the morning
6. Oral Case Presentation Guidelines
You will be expected to present your patients that you admitted overnight during morning handover.
The purpose of the case presentation is to concisely summarize four parts of your patients presentation:
History
Physical exam
Laboratory results
Clinical reasoning your understanding of the findings
Basic Structure:
Identifying information / chief complaint
History of present illness
Other active medical problems, medications, allergies, immunizations
Physical exam general assessment (well vs. toxic etc.), assessment of growth and key findings only
Investigations (lab and imaging)
Assessment and plan
Important points to remember:
This is a summary and should be between 3 and 5 minutes. The purpose is not to present all information gathered but
rather the pertinent positives and negatives. This is a skill that takes time to learn.
The oral presentation should be delivered from memory with only intermittent referral to your notes. You should try to
maintain eye contact with your listeners during the presentation.
The oral case presentation is different from the written presentation in that the written presentation contains all the
facts, but the oral presentation contains only those facts that are essential for understanding the reason for admission,
differential diagnosis and management plan.
You will be expected to present your patients every morning while on bedside patient rounds. You will be expected to
follow a specific format as follows:
Identification
1 sentence summary of why the patient is in hospital
Current Issues
Plan
Information you should know about your patient (if applicable) when asked:
Vital signs
Fluid balance/urine output (if performed by nurse)
Weight gain/loss, particularly in infants
TFI (total fluid intake) most important in infants/renal patients
How often is child receiving PRN medications e.g. ventolin if prescribed
PO intake
Any fever (how high)
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Example:
Lisa Smith is a 2-month-old girl presenting with a 2-day history of fever, and admitted for a full septic work up.
Current issues include:
Follow up of full septic work-up results
Likely diagnosis of UTI given urine R/M findings.
Plan today is to follow up blood, CSF and urine cultures. Will narrow antibiotic coverage once sensitivities are
available. Renal U/S and VCUG will be arranged if urine culture is positive.
7. On Call
You will be on call with a paediatric resident from 1700-0800. On weekends, the clerks on call are to arrive at the
hospital at 0900 for sign-in rounds. You will be responsible for admissions to the floor and will be expected to assess
the patients, take their history, do the physical exam and come up with a plan with admission orders. The clinical case
and orders will be reviewed with the resident on call.
This can be a busy service so be prepared to be awake most of the night. Fayes Cafeteria is located on D-3 and is
open 24 hours from Sunday at 0630 to Friday at 2100 hours. Saturday hours are 0630-2000 hours. There is a fridge
located in the hallway across from the CTU classroom.
In the morning, it is the on call clerks job to pre round on his/her assigned patients as well as those whom he/she has
admitted overnight. The on call clerk is also responsible for updating the patient list with any newly admitted patients,
as well as printing the list for the team in the morning.
If there are special reasons that you need to switch a call, you are required to arrange a switch with one of
your colleagues and email Suzanne Belanger with your request. All shift changes must be approved at least 3
days in advance.
8. Post Call
Post call clerks are expected to see the more complex patients during rounds and complete handover to the team in
the morning. They will be permitted to leave by 10am. Please do not go home post call until you have paged your
senior resident and updated him/her on your patients.
9. Resources
In the resident room there is a CTU Clerk Education Binder. In the binder are numerous articles and handouts based
on the paediatric clerkship learning objectives. Please feel free to photocopy what you require, but return the binder so
all can use it.
10. Have FUN!!!
Self-Explanatory. Do not be afraid to interact with the children. They will be your most influential teachers!!
If you have any questions or concerns, please dont hesitate to ask the residents on your team.
Remember you are not expected to already know paediatric medicine. Rather, it is our job to teach it to you.
However, you are expected to work hard while on this service. Make sure you know your patients, read around the
cases and be on time. The rest will take care of itself.
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Your name and position, most responsible physician (MRP) on the day of
discharge, patients first and last name, PIN, who should receive this discharge
summary (the referring physician if one is known, the paediatrician or family
physician of the patient (if not the referring physician), and other consultants who
are going to see the patient in follow-up.
Example: This is John Smith, clinical clerk for Dr. X, dictating on patient Get me
Out of Here, PIN 00000000. Please forward copies to Dr. Y, family physician in
London, Dr. Z, Paediatrician in London.
Diagnosis primarily responsible for the patients current admission and relevant
other diagnoses.
4. Additional problems /
relevant past medical history
List other relevant medical issues not primarily responsible for the admission in
brief. For children with multiple and/or chronic medical problems state health
care provider following the child.
Example: - Prematurity: Born at 27+2 weeks of gestation by spontaneous
vaginal delivery, Apgars at 1 and 5 minutes were 2 and 5. The baby had a
complex postnatal history including 52 days of mechanical ventilation and a total
stay of 13 weeks in the Neonatal Intensive Care Unit. Please see NICU
discharge summary for details. Sams development is followed by Dr. A, Thames
Valley Children Centre London.
- Seizure disorder: Seizures controlled with Phenobarbital, last seizure October
2011, followed by Dr. B, Paediatric Neurology, Childrens Hospital London.
5. Clinical findings:
6. Investigations / Interventions
7. Course in hospital:
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8. Medications:
List current home medications on admission and, if applicable state any changes
made to them. List all new (discharge) medications.
Example: Current medications:
- Spironolactone 7.5 mg po q12h
(Increased from 5 mg po q12h)
New medications:
- Cefuroxime 110 mg po BID
10. Closing:
Example: Thank you very much for your referral. It has been a pleasure being
involved in the care of this patient.
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Emergency
In the Paediatric Emergency Department you will perform the initial assessment of patients under the direct
supervision of an attending paediatrician. You will have ample opportunity to evaluate and treat a wide variety of
common paediatric complaints. Utilize this time to develop your physical examination skills and cultivate the skills
pertinent to the examination of children. You will be expected to develop a differential diagnosis and management plan
for common ambulatory problems.
You are expected to complete 8 shifts during your two-week block in the Emergency Department. In order to allow
yourself time to read, rest and attend teaching sessions, you may only work 5 shifts per week. Please note that all
cases are to be reviewed and care completed or signed-over before leaving from your shift. Due to the nature of
emergency medicine, this follow-up care may mean that you leave considerably later than the time your shift is
scheduled to end. Please allow time in your schedule to accommodate this "over-time" work.
At the completion of each shift, please ask the attending physician(s) to complete your assessment form. Please
ensure that the assessment form is given to the staff at least one hour prior to the end of the shift to allow the
staff adequate time to fill it out. This is a wonderful opportunity to receive feedback on a daily basis.
Please note that ALL changes in the shift schedule must be approved by Suzanne Belanger at least three days
prior to the scheduled shift(s).
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wedwards@ckha.on.ca
pfaruqi@ckha.on.ca
gtithecott@ckha.on.ca
St. Thomas
St. Thomas Elgin General Hospital is a medium sized full serviced community hospital. The Emergency Department
handles about 38,000 visits a year averaging 2 to 3 life threatening events each day. As a general hospital, all manner
of things present in ER which is staffed by Emergency specialists. All forms of surgery are performed with the
exception of Neurology and Heart. There are 3 fully trained OB specialists who deliver about 850 infants per year. We
keep mild to moderate cases of prematurity and RDS and have the capability of ventilating infants if need be. There is
a 12 bed paediatric ward, paediatric outpatient area, and a small Neonatal ICU.
Students are shared with the person on-call (one in four weeks) and students go to all four Paediatric offices in a
defined rotation (10.00am to noon, and 1.00pm to 5.00pm) each day, but meet the paediatrician on- call each a.m.
(8.00 to 8.30) to look after hospital cases. Once a week they would be expected to stay in hospital. Circumcisions are
a frequent procedure and a number of students have become quite proficient. Other procedures can be learned
depending on interest. It is hard to predict but the students see what a general paediatrician doing consulting work and
primary care would see, without a lot of other students or residents in the way.
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In general 70% of your time would be spent in an office setting and 30% at the hospital. The first day will involve
getting a parking pass free with a deposit that is returned, free meal plan, registration and a tour of the facilities plus a
rotation guide for the individual offices.
St. Thomas-Elgin General Hospital, 189 Elm Street, P.O. Box 2007, St. Thomas, Ontario, N5P 3W2
Contacts:
Dr. Margaret Bertoldi
426 Talbot Street
St. Thomas, Ontario N5P 1B9
Tel: 519-637-3591
Email: mbertoldi1@gmail.com
Dr. Tariq Ahmed
Dr. Paul Kerr
Dr. Joshua NDur
humtar@yahoo.com
pkoffice@hotmail.com
jndur@stegh.on.ca
Sarnia
Sarnia is a town of approximately 73, 000 people on the shores of Lake Huron. Blessed with some of the best summer
festivals in Southwestern Ontario and miles of beautiful beaches, Sarnia has plenty to offer any student who wishes to
do a rotation here.
You are provided with accommodations in a hospital-maintained residence with other students, located across the
street from the hospital. The house has cable TV, high-speed Internet access (please bring your own laptop),
washer/drier, and full kitchen.
Sarnia has 3 main preceptors, Dr. Tom Lacroix, Dr. Nash Rashed and Dr. Harleen Bhandal. Learning opportunities
will be shared among the 3 paediatricians. There are opportunities to participate in Videoconferencing Rounds,
Interdisciplinary Rounds, Journal Clubs, CMEs, and other opportunities as they arise.
You will have some on call duties (one weekend during your stay and one or two nights per week). The calls are not inhouse.
You will be directly involved with various community agencies including breastfeeding consultants, local health unit
programs, Childrens Aid Society, a childrens mental health centre, and a childrens rehabilitation centre.
Contacts:
Dr. Nashed Rashed
104-704 Mara Street
Point Edward, Ontario N7V 1X4
Tel: 519-344-7819
Fax: 519-344-2599
Email: n.rashed@on.aibn.com
Dr. Tom Lacroix
tlacroix@rivernet.net
Stratford
Stratford is a city with population of 31,000. Stratford General Hospital is regional hospital which services a wider
population of 100,000 - 150,000 and is the secondary referral hospital for the Huron Perth Hospital Alliance and
surrounding hospitals. Outreach clinics are run in Seaforth, Listowel and Wingham.
Clinical clerks are usually assigned to participate in as many outreach clinics as is possible during their rotation. You
will spend time in each of the paediatricians offices, seeing a variety of outpatients for consultation and follow-up. You
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will participate actively in the ward management of admitted paediatric patients. The clerk is expected to do histories
and physical exams. Hands-on experience is encouraged for enthusiastic participants.
We try to provide some experience in Neonatology as well as General Paediatrics. Deliveries are done from 33 weeks
gestation onwards. Babies who require tertiary care are transferred to London. Even opportunities to do various
procedures are there for those willing to try.
On call expectation is 1 call per week, arranged to the trainees preference, but additional shifts are encouraged
because there is no doubt more experience can be gained by seeing the emergencies that come in after regular hours.
If the individual stays in Stratford, arrangements can be made for a more informal call arrangement.
Stratford is a beautiful city, which is the home of the world famous Stratford Festival, lovely shopping downtown and
wonderful restaurants and coffee shops. Were quite proud of our brand new paediatric unit (August 2009), and
beautiful new emergency, ICU, surgery and radiology departments, as of August 2010!
We look forward to seeing you.
Contacts:
Dr. Kirsten Blaine, Chief of Paediatrics
Jenny Trout Centre
342 Erie Street, Suite 113
Stratford, Ontario N5A 2N4
Tel: 519-272-2040
Email: k.blaine@one-mail.on.ca
Dr. Ram Gobburu
Dr. Carolina Montiveros
Dr. Philip Squires
Dr. Shamin Tejpar
ram.gobburu@gmail.com
carolinahelen2003@yahoo.com
squires@mac.com
tejpar@rogers.com
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Teaching Sessions
Paediatric Peer Presentations
Tuesdays from 12:00 1:30pm
Location: B2-116 or E3-201 Childrens Hospital, LHSC
- see below for additional information
Paediatric Clerkship Lectures
Thursdays from 1:00 4:00pm
Location: B2-116, Childrens Hospital, LHSC
- you will receive a lecture schedule for the block at orientation
- attendance is mandatory and there will be a sign-in sheet
- you will be asked to evaluate the lectures
Resident Rounds
Mondays, Tuesdays and Thursdays from 12:00 1:00pm
Location: B6-361, Childrens Hospital, LHSC
- attendance is voluntary, but strongly recommended
Grand Rounds
Wednesdays from 12:00 1:00pm
Location: B2-119 (amphitheatre), Childrens Hospital, LHSC
- attendance is voluntary, but strongly recommended
Attendance
Attendance at lectures is mandatory unless you are post-call from the CTU.
Attendance at peer presentations is mandatory unless are you are post- call from the CTU, placed at CPRI, or placed
in a rural regional site.
If you miss a teaching session you will be required to complete an assignment.
For any unexpected absences it is your responsibility to contact your attending or senior resident first thing
in the morning. You must also notify Suzanne Belanger and Becky Bannerman by email.
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Recommended Resources
You are expected to use a wide variety of peer-reviewed resources. Below are some of the resources that are
recommended for paediatrics.
There are many paediatric textbooks available of varying length. The large textbooks include Nelson's, Avery's and
Rudolph's. These texts are typically about 7kg. in weight and 2000 pages in length. These texts are, with some
exceptions, excellent references, and the purchase of one of these texts should be considered (although not
necessarily entertained at this stage of training) for those planning careers in family medicine or paediatrics.
Required
Essentials of Paediatrics, 6th edition
Marcdante, Karen J. and Waldo E. Nelson
Saunders/Elsever, 2011
Recommended
First Exposure Paediatrics
Gigante, Joseph
McGraw-Hill Companies, 2006
Pediatric Clinical Skills, 4th edition
Goldbloom, Richard B.
Saunders/Elsever, 2011
Pediatrics for the Medical Student, 3rd edition
Bernstein, Daniel and Shelov, Steven
Walters Kluwer/Lipencott Williams and Wilkins, 2012
Year 1 & 2 Child Health Small Group materials
Websites
Canadian Paediatric Society: www.cps.ca
American Academy of Paediatrics: www.aap.org
Council on Medical Student Education in Paediatrics: www.comsep.org
Health Canada: www.hc-sc.gc.ca
EMedicine: www.emedicine.com
UpToDate: www.uptodate.com
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Assessments
Clinical Assessments & Assessment Forms
Your clinical evaluations will contribute significantly to your final grade. It is your responsibility to ensure that staff
physicians and residents complete the forms. The forms are colour-coded:
Green
White
Pink
Blue
Purple
In the Emergency Department, please give your form to the staff physician with whom you reviewed the most patients
during your shift in the last hour of the shift, before the shift ends, to ensure that it will be completed prior to the
physician leaving the department.
For CTU, Selective, and Rural Regional rotations, please give form(s) to the staff person before the last day of your
rotation. All forms are to be filled out by faculty only, not residents.
During the rotation you must complete two observed histories and two observed physical exams. The history and
physical exam may be on the same patient. A minimum of two observations must be made by a faculty member,
not a resident (i.e. both a history and a physical exam on one patient, or two separate patient observations of either a
history or a physical exam). The other two observations may be made by a resident. You are encouraged to get one
observation per week as it becomes very difficult to get them all at the end of the rotation. You are unable to finish
the rotation until they are completed.
All assessment forms must be given to Suzanne Belanger by the last Thursday of the Block PRIOR to the start of the
final oral examination.
Peer Review
The Peer assessment form must be completed on One 45 prior to the last Thursday of the rotation. Completion
of a peer assessment is a mandatory component of the rotation; however, please only evaluate the colleague(s) with
whom you have worked directly.
Mid-Rotation Assessment
On Tuesday of week four each clerk will meet with either Dr. Joanne Grimmer or Dr. Eva Welisch to review all
assessments completed to date, as well as your progress in completing the ED-2 objectives (yellow book). In addition,
any concerns that might exist with the rotation to date will be addressed at this time.
If you are completing four weeks of your paediatric block at a rural regional site you will complete your mid-rotation
with your rural regional preceptor using the Clerkship Mid-Rotation Assessment form included in your orientation
package.
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Examination
The examination will be conducted on the final Tuesday and Thursday of the block. On Tuesday you will have a
multiple choice exam of 100 questions (2.5 hours). On Thursday the oral exam will take place. The questions are
based on the learning objectives in the handbook. All exam questions are objective based and based on content from
the following sources:
Suzanne Belanger will contact you as to the time and location of the exam.
The oral examination questions are an opportunity for you to practice an oral exam. You will be asked two questions
from the following groups: inpatient, outpatient, and emergency. You will be asked to generate a differential diagnosis,
discuss the relevant history, physical examination, investigations and management plan for the patient. You may be
given further information from the examiner.
The oral examination questions are listed here. Clinical clerks have found these questions to be a valuable resource
and have used the questions in several ways:
You are encouraged to discuss these cases with faculty members, residents, and each other.
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6. A 14-month-old child is seen in clinic with the complaint of being increasingly clumsy. The child was the product of
an uneventful term pregnancy and a normal delivery and has been well until about a month ago. Over the past
month, the parents describe the child as having increasing difficulty in walking, crawling and in handling objects.
The child is said to fall to the left when walking.
7. You are asked to see a 14-month-old male brought in by his mother due to a concern of pallor.
8. A 6-year-old boy is admitted to hospital with a history of spontaneous bruising over the past 3 days. He has no
significant past medical history. On physical examination, you find cervical lymphadenopathy, a palpable liver and
spleen, and generalized purpura.
9. A 9-month-old baby is admitted to the hospital with failure to thrive. Please describe your approach to this patient.
His growth parameters at 5 months of age were: Length = 60th percentile; Weight = 50th percentile; Head
circumference = 50th percentile. Now, his growth parameters are: Length = 25th percentile; Weight = 5th percentile;
Head circumference = 40th percentile.
10. A 14-month-old girl is admitted to hospital with severe burns to both soles of her feet. Her mother states that the
child burned her feet while stepping into the bath 3 days ago. The child appears otherwise well, but does not seem
to be comforted by her mother.
Outpatient
1. An 8-year-old boy and his mother come to your office. The parents and the school are concerned with the childs
behaviour. The mother wonders if he could have attention deficit hyperactivity disorder and asks if he should be on
medication.
2. A 5-year-old boy presents to your office with his father. The child has a long-standing history of constipation and
has recently developed watery diarrhea. The child is otherwise well and is growing and developing normally.
3. An 18-month-old child is brought to your office with the complaint that the child has not yet begun to speak.
4. A 3-year-old patient is seen in the office with history of having blood in the urine for the past day. The patient has
been well previously overall, although the child had a sore throat and low-grade fever two weeks ago.
5. A 14-year-old female is brought to your office because of a concern with respect to short stature.
6. You are a third year medical student on call for Paediatrics and you are asked to see a 4-week-old baby boy for
the assessment of jaundice.
7. A 4-year-old child is seen for the assessment of fever and pain in the right ear for two days after a three-day
history of URTI.
8. A 3-year-old child is seen for the assessment of fever, abdominal pain and dysuria for two days.
9. You have been asked to see a 12-year-old child in your office with a long history of asthma, which has been
described as poorly controlled.
10. A 10-year-old child is seen in our office because of poor growth. The child was previously well but over the past
year or so, has grown very slowly. The child also has had weeklong episodes of diarrhea associated with
abdominal pain.
25
Gastroenterology
Dr. D. Ashok
Dr. P. Atkison (+ Transplant)
Dr. K. Bax
Dr. J. Howard
Genetics
Dr. S. Goobie
Dr. J.H. Jung
Dr. C. Prasad
Dr. V. Siu
Haematology/Oncology
Dr. A.E. Cairney
Dr. P. Gibson
Dr. L. Jardine
Dr. S. Zelcer
Dr. A. Zorzi
Infectious Disease
Dr. O. Hammerberg
Dr. M. Salvadori
Neurology
Dr. C. Campbell
Dr. S.D. Levin
Dr. N. Prasad
Neonatology/Perinatology
Dr. K. Coughlin
Dr. O. DaSilva
Dr. V.K.M. Han
Dr. C.F. Kenyon
Dr. D. Lee
Dr. H. Roukema
Dr. D. Yuen
Nephrology
Dr. J. Grimmer
Dr. A. Sharma
Rheumatology & Academic Paediatric Medicine
Dr. R. Berard
Respirology
Dr. A. Price
Dr. D. Radhakrishnan
Surgery
Dr. D. Bartley (Orthopaedic)
Dr. A. Btter (General)
Dr. T. Carey (Orthopaedic)
Dr. L. Cooper (Ophthalmology)
D. M. Husein (Otolaryngology)
Dr. K. Leitch (Orthopaedic)
Dr. D.L. MacRae (Otolaryngology)
Dr. I. Makar (Ophthalmology)
Dr. D. Matic (Plastics)
Dr. A. Ranger (Neurosurgery)
Dr. S. de Ribaupierre (Neurosurgery)
Dr. L. Scott (General)
26
27
Pager #
DAYS
CTU-RED
Senior Resident (R)
17760
15524
15534
Clerk
PGY-4
Name
CTU-BLUE
Pager#
15538
Mbishara2010@meds.uwo.ca
14103
Mdanby2010@meds.uwo.ca
14564
mdoulla@gmail.com
15512
cpz.foo@gmail.com
Attending Physician
15526
Dr. Jennifer LI
15628
jenniferli1112@gmail.com
17703
14106
tinatpittman@gmail.com
Clerk
15525
Dr. Samim AL QADHI
14417
alqadhi.samim@gmail.com
14547
sbelisle@nosm.ca
AFTER 1700
PGY-3
CTU
CTU-1 Resident
(will also page CTU-2)
Clerk
17760
14604
mallory.chavannes@mail.mcgill.ca
15534
18969
Breeanna.chen83@gmail.com
15237
amaryllis.ferrand@gmail.com
15595
(Arrest)
15607
mgharib4@uwo.ca
15906
laramhart@gmail.com
15862
klam011@uottawa.ca
15895
hmlevin@uwo.ca
19189
emilyrose.marcotte@gmail.com
19382
drrohitnagar28@yahoo.com
15781
24 HOURS
Senior Resident
PCCU
First Call
15515
(Arrest)
Harshini.sriskanda@gmail.com
PGY-2
Second Call
19365
3nd1@queensu.ca
19430
alisha_gabriel@hotmail.com
19474
rgpapado@gmail.com
18213
19512
EHOCH035@uottawa.ca
19967
19518
jhuku099@uottawa.ca
19498
eroach3@gmail.com
19158
melissarossoni@gmail.com
19034
fil.scerbo@gmail.com
19865
19062
AVIEI098@uottawa.ca
19972
19787
abeyat.zaman@gmail.com
12824
(Arrest)
Emergency Fellows:
Dr. Natasha GILL
(ngill18@yahoo.ca)
Dr. Amal AL_SHIBLI
(ansalshibli5@gmail.com)
PCCU Fellows:
Dr. Farhana AL-OTHMANI
(f.alothmani@hotmail.com)
Dr. Yasser ALGARNI
(dryasser1403@yahoo.com)
Neonatology Fellows
PGY-1
13199
19275
Richa.agnihotri@gmail.com
15188
19131
Be.brown@mun.ca
15910
19487
nitachauhan@gmail.com
13142
19010
becksterchen@gmail.com
19446
19342
Chloe.davidson@medportal.ca
19279
15875
Alia.fikry@hotmail.com
10686
19540
smarzouk@mun.ca
19414
rennepang@gmail.com
19476
Victoria.pila@medportal.ca
19267
Amanda.ramsaroop@medportal.ca
19003
dyue@qmed.ca
28
29
30