Alfonso Vargas, MD Vice-Chairman for Education and International Affairs Department of Pediatrics Louisiana State University Health Sciences Center, New Orleans Louisiana State University Health Sciences Center - School of Medicine in New Orleans - LSUHSC-SOM Association of Pediatric Program Directors - APPD South East Regional Meeting All Children’s Hospital – Johns Hopkins Medicine St. Petersburg, FL - Sat. Sept. 8th, 2012

Hurricane Katrina

LSUHSC DEPARTMENT OF PEDIATRICS

NEONATAL TRANSPORT Neonatal Transport

Medical Center of Louisiana – “Charity Hospital” LSU Health Sciences Center

Hurricane Katrina Impact. Tiger Care Clinic (Main LSU Pediatrics Resident Training site) All computers and flash drives were lost, as well as most patient charts

Children’s Hospital Temporarily Closed September 1, 2005 All patients evacuated to various Children’s Hospitals

Present Day Pediatrics in New Orleans, Louisiana RECOVERY AFTER KATRINA

October 10, 2005

Children’s Hospital LSUHSC Pediatrics Administration and most clinics are now located at Children’s Hospital

Research and Education Building The Research Institute for Children - RIC New Orleans

LSUHSC - Department of Pediatrics Clinical Faculty - 72 Research Faculty - Ph.D.’s - 11 Non-clinical Research - 13 Administrative Staff - 7 Fellows - 23 Pediatrics Chief Residents - 2 (PGY-4) Pediatrics Residents - 49 (PGY 1, 2, & 3) Med/Peds Chief Residents - 2 (PGY-4) Med/Peds Residents - 23 (PGY 1, 2, 3, & 4) Coordinators: 2 (1 - Peds; 1 - Med/Peds) Program Directors: Bonnie Desselle, MD - Pediatrics Betty Lo-Blais, MD - Med/Peds Associate Program Directors: Drs. George “Jay” Hescock, Suzanne LeFevre & Rachel Dawkins Department Head: Ricardo Sorensen, MD

THE PEDIATRIC MILESTONE WORKING PROJECT - ACGME & ABP Working Group Advisory Board Carol Caraccio (Chair) Bradley Benson Ann Burke Robert Englander Susan Guralnick Patricia Hicks Stephen Ludwig Daniel Schumacher (*) ACGME Lisa Johnson Jerry Varsilias Caroline Fischer Carol Aschenberger Richard Behrman Timothy Brighman Stephen Clyman Eric Holmboe M. Douglas Jones, Jr. Gail McGuiness Victoria Norwood Robert Perelman William Raszka Theodore Sectish Susan Swing

ACGME & ABP The Pediatric Milestone Working Project Competency - Patient Care 1. Gather essential and accurate information about the patient A. Background Development of Information Gathering Skills: EARLY - INTERMEDIATE - ADVANCED Primary Author: Daniel Schumacher, MD

DEVELOPMENTAL MILESTONES Too little or exhaustive => Analytical reasoning Linkage of signs & symptoms => Deeper analytical reasoning - Pertinent positives & negatives - Broad diagnostic categories Creation of “Illness Scripts” => Specific diagnostic considerations - Early & real time development of a differential diagnosis Well developed “Illness Scripts” => Precise diagnosis to be reached with ease and efficiency Robust “Illness Scripts” => Unconscious gathering of essential and accurate information in a targeted and efficient manner

LSUHSC & Children’s Hospital of New Orleans Pediatrics Chief Residents Nicole McMahon, MD & Chelsey T. Sandlin, MD

Chief Morning Reports Given daily by the two chief residents Focuses on specific patients seen by our residents Encourages audience participation  The chief complaint is provided by the resident who saw the patient.  Residents must ask for further pertinent information and develop their differential diagnosis.  The physical exam is finally given before the audience must decide which tests they want to order.

Chief Morning Reports Residents must develop an appropriate problem definition using specific qualifiers The group then thinks of the top 3-4 differential diagnoses  Residents are split into groups to develop an “Illness Script” for their assigned diagnosis  -Implemented this year based on the 2013 Milestone guidelines  -The interactive style helps to guide adult learning The chief resident ultimately presents a robust “Illness Script” for the actual diagnosis as well a brief presentation that contains the ABP Content Specs for the chosen topic.

Symptoms Acute /subacuteChronic LocalizedDiffuse SingleMultiple StaticProgressive ConstantIntermittent Single EpisodeRecurrent AbruptGradual SevereMild PainfulNonpainful BiliousNonbilious Sharp/StabbingDull/Vague Problem Characteristics Ill-appearing/ Toxic Well-appearing/ Non-toxic Localized problemSystemic problem AcquiredCongenital New problem Recurrence of old problem Semantic Qualifiers Encourage the residents/students to use these qualifiers when developing their problem definitions!

Illness Scripts Predisposing Conditions  Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) Pathophysiological Insult  What is physically happening in the body, organisms involved, etc. Clinical Manifestations  Signs and symptoms  Labs and imaging

Thanks! LSU