1. Children’s Mercy Chief Residents
Welcome Students!!
Children’s Mercy Chief Residents

2. Medicine Congratulations!! You have chosen an honorable profession
Rewarding career

3. Pediatrics Important part of your medical training
Main goals in studying Pediatrics:
See interesting pathophysiology
Interact with younger patients
Sharpen history taking skills, presentation skills, and documentation skills
Learn entities specific to pediatrics

4. Responsibilities Our responsibility to you
Provide ample educational opportunity
Provide basic pediatric knowledge thru both didactics and clinical practice
Provide feedback regarding note writing as well as presentation skills
Treat you with respect and as a valued member of the team
Your responsibility to us
Punctuality
Professional Behavior
Invest in the team and take the initiative
Appropriate use of your time: reading, seeking out educational opportunities
Communication with your residents: communicate feedback, seek work, follow up on plans
Ask for feedback on your performance

5. Inpatient Calls Days off Chairman’s exam Clinic
You choose 5 days for call until 10 pm
You are required to be here until check out everyday
Days off
You have 4 days off/ month total including weekends
You will discuss with your team appropriate days off
Chairman’s exam
You will have the morning off of your Chairman’s exam
Clinic
You are required to see all your patients prior to your clinic and write notes on them even if that morning you need to be here early
Your senior residents are responsible for filling you in on the plans once you return from clinic

6. Education
Inpatient Report sit towards the front and be interactive
Medical student lectures first 3 Wednesdays and last Monday pm
Monday noon lectures
Wednesday noon lecture- again please sit toward the front
You are responsible for presenting a minimum of 1 short 5-minute talk to your team once during the month. Your seniors will help coordinate the topic and date
An attending physician will observe a complete history and physical exam once during the month

7. Daily schedule- Inpatient
Arrive no late than 6:30 am so that you can start checking out with the night team at 6:30
0700 Inpatient Report M-W
0800 Grand Rounds Thursday
See your patients and write notes until 0900
Rounds 0900
Afternoon: You need to be here until check out at 1600
follow up on labs, radiology
Do admissions
Read
Prepare presentations
If you are having difficulty finding things to do:
Talk with your intern
Talk with the Chief Residents
Check out at 1600

8. Food
You get call money for the days you are here until 10 pm (1/2 pack per call)
Mondays food is first come, first serve
We have breakfast the first day of our month and one morning in the middle of the month which you are welcome to

9. History and Physical- Documentation
A thorough History and Physical should be performed on all newly admitted patients and to include specifically but not limited to:
Sexual history in adolescent patients
Specific immunization record
Medications and doses
Pertinent positives and Negatives in the ROS
Developmental history
Growth chart plotted

10. Daily progress note documentation
A SOAP note should be completed daily
Write a plan even before rounds, it does not matter if you are correct but you should start thinking of formulating your own plan
The interns can not wait for students to complete notes

11. Presentation
We do family centered rounds- or walk rounds, on general teams often times with busy census SO efficiency is key
You do not need to present all information just the imperative- your notes will reflect the complete knowledge of your patients
EX: (Pt name) is a 4 year old previously healthy (sex) admitted (date) with (diagnosis). Overnight pt did well (or pertinent information). Pt has stable vitals overnight (or pertinent changes), physical exam unchanged or significant for (X). Our plans for today include (by systems):

12. Concerns or Questions
You will receive a mid rotation evaluation from either your senior resident and attending physician
If a senior resident has concerns with your work: they should contact you first.
The Chief Residents will then be involved with discussion to Dr. Talib and your attending
If you have concerns with members of your team please contact the intern or senior resident, then discuss the concern with the attending
The Chief Residents are always here to listen to your concerns and intervene when appropriate

13. Resources available to you
The Health Sciences Library here in the hospital
Up To Date on the computer system

14. Note writing
Your H&P should be as thorough as it ever will be. You should include even the most minute of details
Your SOAP note should detail significant overnight events, vitals, physical exam findings as well as your assessment of the patient and your plan of action
S- subjective, how the patient feels,
O- you concrete findings, vitals, physical exam
A- you comment on what is going on with the patient
P- your plan of attack for the day, be specific especially if you will get a consult- write in your note the specific question

15. Weight and Height
Weight in the Pediatric population is one of THE most important vital signs. We document in kilograms (1kg=2.2lb)
Look at weight everyday and note even subtle changes (Meditech under growth flowsheet)
On admission plot height, weight, head circumference, and BMI as necessary for individual patients
Try to find baseline weights
An infant should gain between grams/kg/day

16. Medication dosing Based on kg weight in pediatric patient
With obese children, based on ideal body weight
Having a dosing handbook with you or near you at all times is normal

17. Fluids: Bolus
Bolus fluids are used when a patient is dehydrated no matter the cause: bleeding, sepsis, volume loss due to vomiting and diarrhea
Bolus fluids are isotonic (NS or LR) without glucose and without electrolytes
Bolus fluids are typically given 20mL/kg

18. Fluids: maintenance
Maintenance fluids are typically used for general run of the mill fluid replacement, pt is NPO for surgery, pt is ill and not eating well, pt is slightly dry
Appropriate fluid options typically include glucose (D5) as well as a ½ Normal Saline, (other fluids may be necessary based in age of patient, kidney function, sodium status, etc…)
Maintenance fluids are typically dosed as follows:
4mL/kg/hr for the first 10 kg, 2mL/kg/hr 10-20kg, and 1mL/kg/hr every kg above 20 OR
100mL/kg/day for the first 10kg, 50mL/kg/day 10-20kg, and 10mL/kg/day for every kg above 20

19. Ins and Outs
This information can be found in Meditech under Assessment Forms: then feeding input and output flowsheet
Document input as mL/kg/day and should include PO as well as parenteral nutrition
Calorie counts
Typical formula has 20kcal/ounce and there are 30mL/ounce
Document calories as kcal/kg/day
Normal should be around 100 kcal/kg/day in typical patient
Document output as mL/kg/hr
Normal should be minimum1mL/kg/hr

20. Truman Nursery Arrive at 0700 and check out 1600
There is A LOT of paper work so be prepared
You have 2 days off only during those 2 weeks
Your responsibility includes:
Examine discharges and fill out appropriate paperwork
See daily patients and write progress notes
New admissions
Education:
Prepare a talk
Didactic type lectures 2-3 times/week
Observe a circumcision

21. PCC
Arrive 0830 and leave when all patients are seen- last walk in time is 1630
Didactic lecture M-W am in the PCC, Grand Rounds 0800 Thursdays
Responsibilities:
Pick up charts in a timely fashion
See patients and check out to either attending or 3rd year residents
Present a plan as well
Document appropriately and timely