This curricular guide is intended to provide institutions a framework to develop senior medical student pediatric residency preparatory programs (boot camps).  As a base structure, we used the thirteen Entrustable Professional Activities (EPAs) for entering residency and additionally, mapped the corresponding general physician competency domains to each EPA. This curriculum is intentionally broad, meant to be modifiable based on the needs and resources of the institution.

Authors:

Molly Rideout, MD          Rebekah Burns, MD        Erin Pete Devon, MD      Amanda Hartke, MD, PhD

 

EPA 1: Gather a history and perform a physical examination (milestones: PC2, KP1, ICS1, ICS7, P1, P3, P5)

Learning Objectives:

  • Demonstrate focused and effective history-taking
  • Demonstrate effective physical examination skills
  • Demonstrate respectful and clear communication when responding to phone calls from nurses and other health care providers
  • Discuss indications and best practices involved with interpreter use
  • Demonstrate effective communication with the use of interpreter services
  • Demonstrate family-centered approach to patient care

 

Recommended Learning Methods:

  • Simulation, role play, self-reflection, case-based discussion

 

EPA 2: Prioritize a differential diagnosis following a clinical encounter (PC2, PC4, KP2, KP3, KP4, PBL1, ICS2, PPD8)

Learning Objectives:

  • Formulate a differential diagnosis for common pediatric presentations including:
    • Abdominal pain or distention
    • Altered mental status
    • Respiratory distress
    • Fever (including in a young infant; neutropenic patient, unvaccinated child)
    • Fluid and electrolyte disturbances
    • Acid-base disturbances
    • Musculoskeletal pain or swelling
  • Describe illness scripts for common pediatric conditions
  • Discuss common issues involved in the inpatient and outpatient care for medically complex patients
  • Explain developmental milestones and red flags for developmental abnormalities
  • Discuss common parenting concerns and demonstrate a framework for addressing them

 

Recommended Learning Methods:

  • Case-based discussion, simulation, role play, computer assisted modules

 

EPA 3: Recommend and interpret common diagnostic or screening tests (PC4, PC5, PC7, PC9, PBL1, PBL7, ICS1, SBP3)

Learning Objectives:

  • Interpret both normal and abnormal 12-lead electrocardiograms (EKGs)
  • Interpret arterial and venous blood gas analyses (VBG, ABG)
  • Identify normal and abnormal findings on chest and abdominal radiographs (CXR, AXR)
  • Interpret results of cerebrospinal fluid (CSF) and synovial fluid
  • Recognize abnormal vital signs and the related implications
  • Interpret common laboratory tests, including electrolytes and complete blood count
  • Recognize normal and abnormal growth parameters

 

Recommended Learning Methods:

  • Flipped classroom, case-based discussion, simulation, problem sets/worksheets

 

EPA 4: Enter and discuss orders and prescriptions (PC2, PC5, PC6, ICS1, IC2, IC5, P4, SBP3)  

Learning Objectives:

  • Develop prioritized management plans and describe the rationale for them
  • Prepare prescriptions using weight-based dose calculation and all essential elements
  • Demonstrate admission order writing
  • Discuss pharmacologic and non-pharmacologic pain management in pediatrics
  • Identify appropriate use and contraindications of common drugs (antibiotics, pain medications) in a variety of pediatric conditions
  • Calculate fluid requirements for a variety of pediatric conditions including hypovolemia, dehydration, and septic shock
  • Discuss principles of high value care and how to incorporate into practice
  • Develop management plans for common pediatric conditions including:
  • Abdominal pain
  • Altered mental status
  • Anaphylaxis
  • Arrhythmia
  • Brief resolved unexplained event
  • Child abuse
  • Common behavioral concerns
  • Common infections (otitis media, gastroenteritis, upper respiratory infections)
  • Diabetic ketoacidosis
  • Failure to thrive
  • Fever (including in special populations such as neutropenic or neonate)
  • Fluid, electrolyte, and acid-base disturbances
  • Musculoskeletal pain or swelling
  • Neonatal abstinence
  • Respiratory distress
  • Seizures
  • Shock
  • Toxic ingestion
  • Serious bacterial infections (pneumonia, meningitis, bacteremia, osteomyelitis)

 

Recommended learning methods:

  • Simulation, case-based discussion, problem sets/worksheets

 

EPA 5: Document a clinical encounter in the patient record (PC4, PC6, ICS1, ICS2, ICS5, P4, SBP1)

Learning Objectives:

  • Discuss the purpose and format of different types of notes (H&P’s, progress notes, discharge summaries)
  • Identify elements of effective written communication in the electronic health record (ie; DOs and DONT’s)
  • Practice writing and giving feedback on an admission note, progress note, transfer summary, discharge summary
  • Identify and document criteria for admission and discharge from the hospital

 

Recommended learning methods:

  • Flipped classroom, case-based discussion, writing exercise

 

EPA 6: Provide an oral presentation of a clinical encounter (PC2, PBL1, ICS1, ICS2, P1, P3, PPD4, PPD7)

Learning Objectives:

  • Practice summarizing pertinent patient information in an emergency situation
  • Demonstrate a collaborating conversation with PCP/subspecialist/hospitalist about patient plan of care
  • Provide a concise summary of patient hospitalization with a primary care provider
  • Identify pertinent patient information and ask specific questions to effectively call a consultant
  • Discuss indications and preparation for a family meeting and practice using a structured approach to lead a family meeting

 

Recommended learning methods:

  • Simulation, role play, self-reflection, case-based discussion, critical review of sample videos

 

EPA 7: Form clinical questions and retrieve evidence to advance patient care (KP3, KP4, PBL1, BPl3, BPL7, BPL9, ICS2)

Learning Objectives:

  • Describe the concept of diagnostic uncertainty and identify elements that contribute to uncertainty in everyday clinical practice
  • Differentiate between background and foreground questions
  • Compare resources to answer background and foreground questions
  • Formulate a focused PICO question related to patient care (Problem/Population, Intervention, Comparison, Outcome)
  • Incorporate the use of evidence based medicine into clinical management

 

Recommended learning methods:

  • Flipped classroom, individual or group assignments, case-based discussion, self-reflection

 

EPA 8: Give or receive a patient handover to transition care responsibility (PC8, PBL5, PBL7, ICS2, ICS3, P3)

Learning Objectives:

  • Discuss the importance of effective handoffs
  • Identify strategies to improve handoff communication
  • Identify barriers to performing safe handoffs
  • Employ a standard handoff technique such as using a mnemonic or checklist
  • Practice and appraise verbal handoff communications

 

Recommended learning methods:

  • Flipped classroom, critical review of sample videos, simulation, role play, case-based discussion

 

EPA 9: Collaborate as a member of an interprofessional team (ICS2, ICS3, ICS7, P1, SBP2, IPC1, IPC2, IPC3)

Learning Objectives:

  • List interprofessional providers that are commonly involved in patient care
  • Describe the roles of interprofessional providers in the care of patients
  • Demonstrate respectful and clear communication when responding to phone calls from other members of the health care team
  • Practice assessing a patient’s medical status on the phone
  • Identify pitfalls in answering pages regarding a patient
  • Demonstrate effective communication with team-members, patients and families during urgent/emergent settings
  • Incorporate the use of specific communication strategies (SBAR, check-back, call out) in interprofessional team work
  • Display compassionate communication skills and nonjudgmental behaviors

 

Recommended learning methods:

  • Small group interprofessional work, think-pair-share, role play, interprofessional simulation, case-based discussion

 

EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management (PC1, PC2, PC3, PC4, PC5, PC6, ICS2, ICS6)

Learning Objectives:

  • Demonstrate primary and secondary assessment of patients in urgent and emergent settings
  • Practice Basic Life Support skills
  • Discuss and practice principles of Pediatric Advanced Life Support
  • Discuss and practice principles of Neonatal Resuscitation
  • Identify laboratory findings suggestive of clinical deterioration
  • Discuss indications for and practice obtaining emergency vascular access
  • Demonstrate the diagnosis and management of urgent and emergent medical conditions including the following3:
    • Abdominal pain
    • Altered mental status
    • Anaphylaxis
    • Arrhythmia
    • Brief resolved unexplained event
    • Child abuse
    • Common behavioral concerns
    • Common infections
    • Diabetic ketoacidosis
    • Failure to thrive
    • Fever (including in special populations such as neutropenic or neonate)
    • Fluid, electrolyte, and acid-base disturbances
    • Musculoskeletal pain or swelling
    • Neonatal abstinence
    • Respiratory distress
    • Seizures
    • Shock
    • Toxic ingestion
  • Practice delivering difficult news to a patient or family

 

Recommended Learning Methods:

  • Simulation, flipped classroom, case-based discussion, role play

 

EPA 11: Obtain informed consent for tests and/or procedures (PC3, PC6, PC7, ICS5, ICS6, P6, SBP3, PPD7)

Learning Objectives:

  • Discuss the meaning and components of informed consent
  • Explain to a family the risks, benefits and alternatives specific to the following procedures in the pediatric patient:
    • Arterial puncture
    • Blood product, IVIG administration
    • Incision and drainage
    • Intraosseous placement
    • Intravenous catheter insertion/Venipuncture
    • Lumbar puncture
    • Nasogastric tube insertion
    • UAC/UVC placement
    • Urethral catheterization
    • Vaccination administration
    • Circumcision
    • Intubation

 

Recommended learning methods:

  • Flipped classroom, role play, problem sets/worksheets

 

EPA 12: Perform general procedures of a physician (PC1.19, MK2.14, MK2.15)

Learning Objectives:

  • Demonstrate effective infection control practice when caring for patients
  • Describe indications and contraindications for common procedures in pediatrics. See list below.
  • Practice performing the following procedures:
    • Arterial puncture
    • Bag and mask ventilation
    • Gastric tube replacement
    • Incision and drainage
    • Intraosseous placement
    • Intravenous catheter insertion/Venipuncture
    • Lumbar puncture
    • Nasogastric tube insertion
    • Neonatal and pediatric intubation
    • UAC/UVC placement
    • Urethral catheterization
    • Vaccination administration
  • Demonstrate methods used by respiratory therapy for oxygen delivery, airway clearance , and ventilatory support

 

Recommended Learning Methods:

  • Simulation-case scenarios, simulation task-trainers, role play

 

EPA 13: Identify system failures and contribute to a culture of safety and improvement (KP1, PBL4, PBL10, ICS2, P4, SBP4, SBP5)

Learning Objectives:

  • Discuss methods for disclosure of medical errors
  • Discuss systems-based and cognitive biases to prevent medical errors
  • Identify tools for maintaining physician wellness and recognizing fatigue or burnout
  • Recognize unprofessional behavior, including attire, language, boundaries, documentation, and confidentiality, and identify steps to address the behavior
  • List professional pediatric organizations and discuss their role in education, licensure, governing, and advocacy
  • Demonstrate the ability to critically reflect upon one’s own knowledge, skills, and behaviors
  • Describe factors that may impair performance or learning
  • Discuss how to give, receive feedback and incorporate feedback.
  • Discuss ways to incorporate teaching into residency

 

Recommended Learning Methods:

  • Flipped classroom, role play, case-based discussion, guest panel, self-reflection, targeted readings

 

References:

  • COMSEP and APPD Subinternship Curriculum
  • COMSEP Curriculum Task Force, Boot Camp Focus Group consensus
  • Based on the COMSEP and APPD Pediatric Subinternship Curriculum with additional conditions added by focus group consensus and feedback from COMSEP Curriculum Collaboratives

EPA and Milestone mapping based on the Core Entrustable Professional Activities for Entering Residency Curriculum developers Guide from the AAMC