PRECEPTORIAL – STUDENT GUIDELU5: Ambulatory Pediatrics Preceptorials

I. DATE AND TIMEThe whole LU5 class will be divided into 8 groups of 20 students each. Each

group will undergo ambulatory pediatrics rotation for 4 weeks starting on August 1, 2011 to April 1, 2012.

II. NAME OF PRECEPTORS AND SECTIONS REPRESENTEDSelected consultants from the ambulatory and subspecialty sections of the

Department of Pediatrics will act as preceptors.

III. PRE-REQUISITESLU5 students are required to pass the minimum requirements in the following:

1. Basic anatomy, physiology, pathology, and pharmacology2. Pediatrics:

1. History-taking - proper skills to conduct an interview2. Physical examination- perform basic maneuvers needed to

carry out an accurate physical examination

IV. OVERVIEW OF THE MODULEWithin their 4-week rotation, the students will rotate in the pediatric out-

patient clinics for preceptorials: the sick child clinic, the well child clinic, and selected subspecialty clinics. A maximum of two students will be assigned to one patient. They are expected to do a complete history and physical examination. Based on their clinical findings, they are expected to come up with a rational working diagnosis and to identify diagnostic and therapeutic plans before they present their respective cases.

Each student will present a minimum of 10 patients (cases) at the end of their 4- week rotation.

V. LEARNING ACTIVITY1. Four students will be pre-assigned to one pediatric consultant-

preceptor.2. The senior pediatric residents or fellows rotating in the out-

patient clinic will assign one patient per 2 students. 3. Students assigned to the patient will obtain pediatric history and

perform appropriate physical examination under the senior residents’ supervision.

4. The students will be allowed to write down their findings in the medical chart: history, physical examination, diagnosis (and differential

diagnoses), and management plan. Growth charts must be accomplished and the patient's nutritional status must be computed prior to presentation.

5. The students will be evaluated individually using a standard grading sheet. Grading sheets must be submitted to the preceptor at the start of case presentation.

6. All four students will present their patient to the pediatric consultant-preceptor en banc in a designated room within the pediatric out-patient complex. A maximum of 30 minutes per patient will be allowed for each patient presentation. Two cases will be presented in one preceptorials session.

7. After presentation, final disposition and management, including discharge instructions and administration of immunizations, will be given by the students under the consultants’ supervision. The preceptor will countersign the accomplished and corrected medical chart at the end of the session.

8. Grading sheets will be filled up by the preceptor and will be placed inside a white letter envelope. The preceptor will seal the white envelope and sign over the flap (to guarantee from tampering).

9. The sealed envelope will be given back to the students before the preceptor leaves the OPD. This will be placed inside a brown envelope bearing the dates of all scheduled preceptorials. The preceptor will sign over the appropriate preceptorial slot as proof of completion of the session and submission of grades.

10. It is their responsibility of the students to turn their grades over to the LU5 secretary at the end of the day.

VI. CASES FOR DISCUSSIONAll new patients consulting in the pediatric sick child and subspecialty clinics;

new or old patients on follow-up for immunizations in the well child clinics will be eligible for case presentation.

Guide Questions:

1. What important part(s) of the history and physical examination were pointed out (or missed)?

2. Demonstrate complete physical examination of the area of primary concern.

3. What is the nutritional status of the patient? Present a duly accomplished growth chart.

4. Enumerate salient features in the history and physical examination and give the most probable diagnosis based on these salient features.

5. Enumerate differential diagnoses and explain why it is considered and/ or eliminated.

6. Itemize plan of management, including laboratory examinations and ancillary procedures, treatment and referrals (if applicable).

VII. EVALUATION1. Students will be evaluated by the consultant preceptor according to

knowledge, skills, and attitudes using a standard evaluation card.2. A feedback sheet on this learning activity will be filled up by the students

at the end of their 4-week rotation.3. Consultant-preceptors shall likewise submit a feedback sheet on this

learning activity at the end of the school year.

VIII. REFERENCES1. Berhman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics

17th Edition. 20022. World Health Organization. Integrated Management of Childhood

Ilnesses (IMCI) handbook3. Philippine Pediatric Society Committee on Childhood Tuberculosis.

Tuberculosis in Infancy and Childhood. 20034. Philippine Pediatric Society. Consensus Guidelines. 2005