Last Revision 3/11

M3 Pediatric Clerkship: Newborn Intended Learning Objectives

The overall goals for the third year Pediatric Clerkship are listed on the Overall Intended Learning Objectives. Additional specific ILO's for the newborn experience are listed below.

Knowledge: The student will learn:
1) Describe the transition from the intrauterine to the extrauterine environment, including temperature regulation, cardiovascular/respiratory adjustment, metabolic fluctuations, and initiation of feeding.
2) List the information from the history of pregnancy, labor and delivery obtained from the parents or medical record that has implications for the health of the newborn.
3) Describe how gestational age can be assessed with an instrument such as the Ballard scale and identify key indications of gestational maturity. 4) Describe the challenges for parents adjusting to a new infant in the home.
5) List the differential diagnosis and complications for the following common problems that may occur in the newborn: · Jaundice· Respiratory distress
Poor feeding · Large and Small for Gestational Age·Neurological abnormalities such as tremulousness, irritability, lethargy due to sepsis, drug withdrawal, hypoglycemia · Heart Murmurs
6) Describe how gestational age affects risks of morbidity or mortality in the newborn period.

Skills: The student will demonstrate competence in:
1) Communication skills: Give parents of a newborn anticipatory guidance for the following issues: · benefits of breastfeeding vs formula feeding for the newborn and mother · normal bowel and urinary elimination patterns · normal newborn sleep patterns·newborn screening tests including metabolic and hearing screening · appropriate carseat use ·prevention of SIDS · immunizations (Hep B vaccine) · medications (eye prophylaxis, vitamin K)·the role of circumcision
2) History Taking: Obtain appropriate prenatal and peripartum history from mother
3) Physical Exams: Perform a complete exam of the newborn infant

Professionalism: See overall ILO's

NEWBORN STUDENT EXPECTATIONS
Location: team conference room is F-4760. Getting off Mott West elevators, turn right, go few steps, turn right, then take the first/only left. Go through double doors. The door facing you is our room. Code to the door is 7471. Phone is 67222, or page intern at 22229.

Schedule:
Monday- 8 am Student conference. Start newborn at 9 am in our conference room, (page newborn intern 22229 if no one is there.) Tuesday, Wednesday, Thursday, Friday AM- Pre-round at 6:30 am and round with team at 9 am Tuesday 1 PM- Meet with NICU for teaching session Fri after rounds- give a 5 minute talk on a newborn topic In addition, cover deliveries with the NICU team and possibly admit new patients one afternoon

1) Daily expectations: Picking up new patients daily and following patients from previous day. Review maternal and newborn medical records, including daily vitals, feeding and nursing interventions Obtain history and perform exam (all patients) unless attending prefers for you to do during rounds.

2) Cover deliveries with the NICU team
Each day, one student should cover deliveries with the NICU team. Introduce yourself to the on-call NICU team* then rejoin your newborn team. There is a rotating student pager number 3060, change the status of that pager so that your pager is covering it. ** You should wear scrubs on this day.
* go to NICU, ask clerk for delivery team so you can introduce yourself to them. This way they aren’t surprised to see you at a delivery.
** call 66268, enter pager number 3060, enter 2 to change covering, enter 1 to enter new covering number, then enter your pager number.

3) Afternoon "Call"
This is your opportunity for autonomy and practice with the newborn exam. You are expected to obtain a history and physical exam on all new admissions (up to 3 babies) born before 3 pm. The clerks pages the intern with new babies. If a nurse calls the on-call resident to evaluate one of our patients for a problem, you should participate in the evaluation and management decisions with the intern. Discuss with the attending whether he/she would prefer for you to staff the new patients him/her, with the hospitalist on call that afternoon or in the morning. Do not expect to leave before 5:30pm. If no deliveries are pending and there are no other learning opportunities, then it is OK to leave early.

NEWBORN STUDENT REFERENCES
1. Newborn Physical Exam videos The newborn physical exam can be seen on Ctools- M3 peds-resources-teaching materials-newborn. There are four videos- complete exam, Ballard exam, hip exam and abdominal exam. Please view all of these prior to your week
2. Variations and Minor Departures in Infants (booklet)
3. In CTools: Breastfeeding materials

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