Curriculum Map for Pediatric Emergency Medicine Fellows from the Children's Hospital in Boston, Massachusetts.

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Curriculum Map for Pediatric Emergency Medicine Fellows from the Children's Hospital in Boston, Massachusetts.

Critical Care and Resuscitation

Acute respiratory distress syndrome (ARDS)
Hypothermia and hyperthermia
Increased intracranial pressure
Invasive and non-invasive monitoring
Pharmacology
- Analgesics
- Pain management in critically ill children
- Inotropic agents
- Intubation medications
- Neuromuscular blocking agents
- Ssedatives
Shock
Post-operative chest tube function
Respiratory failure
Ventilatory management and interpretation of blood gases

Adolescent Medicine and Gynecology, and Obstetrics

Abnormal uterine bleeding
Amenorrhea
Counseling adolescents who are sexually active
Dysmenorrhea
Eating disorders
Pelvic inflammatory disease
Pregnancy issues and high risk pregnancy
- Evaluation and initial management of abdominal pain in a pregnant patient
- Evaluation and initial management of vaginal bleeding in a pregnant patient and dysfunctional uterine bleeding
Sexually transmitted diseases
Straddle injuries
Rape victims
Vaginal foreign bodies

Allergy and Immunology

Basic mechanisms of allergic disease Immune deficiency states and immunologically-mediated disease processes
- Anaphylaxis
- Asthma
- Atopic dermatitis
- Food allergy
- Laboratory tests - Pathology and Radiology / Nuclear Medicine
- Nasal allergy
- Sinusitis
- Urticaria

Anesthesiology

Understanding and utilizing the appropriate pharmacologic agent
- Analgesics
- Anesthetics, topical
- Nerve blocks
- Pain management
- Paralyze a patient via rapid sequence induction
- Procedural sedation
Understanding when it is appropriate to consult with anesthesiology

Behavioral and Developmental Pediatrics and Child Abuse

Normal development and deviations from the normal, especially when injury is involved
Common behavioral problems
Social and psychological aspects of illness in children
Consultation with mental health referrals
Potential difficult situations when treating these patients
- Sedating an autistic child
- Identifying the source of crying or irritability
Suspected victims of non-accidental trauma and their families
- Reporting suspected abuse
- Forensic interviewing and examination techniques
- Understanding the two legal systems, i.e. criminal and dependency
Behavioral and developmental consequences of victimization in children who have been abused and/or neglected
Community resources relating to children
- Blind and hearing impaired and their families
- Child abuse and neglect
- Daycare
- Educational resources
- Education for the special needs child
- Parent education and support
- Mental health resources

Cardiology and Cardiothoracic Surgery

Arrhythmias
Carditis
Cardiomyopathy
Chest pain
Congenital heart disease
Congestive heart failure
Cyanosis
Hypertensive emergencies
Hypotension
Pulmonary/mediastinal anomalies
Shock
Surgery and transplant
- Indications for cardiac surgery and treatment for post-operative complications
- Corrective surgery for congenital heart disease
- Medications used in patients undergoing cardiac/thoracic and transplantation procedures
Syncope

Dental

Normal dental development and care
Indications for emergent dental consultation
Indications for outpatient dental consultation

Dermatology and Burns

Common pediatric rashes
- Atopic dermatitis
- Diaper rashes
- Impetigo
- Infectious rashes
- Petechiae/purpura
- Seborrheic dermatitis
Fungal infections
Lice
Scabies
Recognition of skin lesions indicative of systemic disease
Burn management
- Admission to an inpatient ward or a burn unit
- Debridement
- Fluid resuscitation

Endocrinology

Salt-losing adrenal hyperplasia in the newborn
Ambiguous genitalia
Adrenal insufficiency
Diabetes
- Pathophysiology
- Diagnosis and management
  - Diabetic ketoacidosis
  - Hypoglycemia
Diabetes insipidus
Hypocalcemia
Hypoglycemia
Hypothyroidism - congenital and acquired

Emergency Medical System and Transport Medicine

Organization of local emergency medical systems
Ore-hospital care
- Access
- Limitations of providers
- Transportation systems
Availability of trauma centers and other centers capable of providing care for critically ill children
How to arrange transport to another facility
Physician responsibilities and Emergency Medical Treatment and Active Labor Act regulations (EMTALA, i.e. anti-dumping laws)
Indications for fixed wing versus rotary wing transport vehicles
Transport physiology
Knowledge of emergency medical services skills and emergency medical services protocols

Environmental Injuries

Gastroenterology

Acute and chronic abdominal pain
Constipation
Acute and chronic diarrhea
Upper and lower gastrointestinal bleeding
Conjugated and unconjugated hyperbilirubinemia
Jaundice in the neonate
Liver transplantation and small bowel transplantation
Short gut syndrome
Vomiting

Genetics, Metabolism and Molecular Medicine

Common inborn errors of metabolism and their presentations
- Glycogen storage diseases
- Lysosomal storage diseases
- Organic & fatty acid defects
- Phenylketonuria
- Urea cycle defects
Down syndrome and other genetic syndromes
Metabolic emergencies and management in the emergency department
Genetic therapies
Fasting physiology
Basic principles of molecular diagnosis
- PCR for infectious diseases

Hematology and Oncology

Anemia
Bleeding and bruising
Bone marrow failure
- Aplastic anemia
- Neutropenias
Disseminated intravascular coagulation (DIC)
Hemophilia patients and recognition of emergent complications of hemophilia
Sickle cell disease and recognition of sickle cell crisis
Indications for tranfusion and appropriate choice of blood product
Benign and malignant tumors
Fever and neutropenias
Tumor lysis syndrome

Infectious Diseases

Bite wounds
Cost effective use of the microbiology lab
Common infectious disease disorders
Fever
Kawasaki disease
Hospital infection control including emphasis on hand washing
Opportunistic infections indicative of an underlying immune defect

Neonatology

Apnea
Cyanosis
Fluid and electrolyte management in the neonate
Maternally transmitted infectious diseases
Jaundice of the newborn
Meconium aspiration
Necrotizing enterocolitis
Neonatal seizures
Neonatal sepsis
Ventilator management

Nephrology / Urology

Urological emergencies
- Scrotal pain and/or scrotal swelling
- Torsion of testes and testicular hematomas
Hernias
Hydroceles
Hypospadias
Phimosis, paraphimosis, balanitis
Undescended testes

Neurology

Neurosurgery

Brain tumors
Neurosurgical emergencies
- Head trauma
- Intracranial bleeds
- Increased intracranial pressure
- Spinal cord injury
  - Ventilation
  - Immobilization
  - Glucocorticoids
Headaches
Hydrocephalus and shunts

Ophthalmology

Conjunctivitis
Ocular emergencies
Periorbital versus orbital cellulitis
Ocular manifestations of systemic disease
- Juvenile rheumatoid arthritis
- Genetic diseases

Orthopedics

Extremity anatomy to accurately assess musculoskeletal complaints and physical findings
Fractures or dislocations reduction management and complications
Growth plate injuries
Hand and wrist injuries
Limping child
Limb and back pain
Vascular complications of extremity injury
- Compartment syndrome

Otorhinolaryngology (ENT)

Ear trauma
- Auricular hematomas
Epistaxis
Fractures
- Facial fractures
- Nasal fractures
Sinusitis
Otitis media
Surgical airway see also Anesthesiology
Tracheostomy care
Upper airway obstruction

Pathology

Cost-effective approach to ordering tests
Difference between sensitivity and specificity of a test
Interpretation of common blood tests

Pediatric Surgery

Basic knowledge of abdominal, cervical, and thoracic anatomy and common surgical conditions pertaining to each area
Abdominal mass
Acute surgical abdomen at all ages
Fluid and electrolyte management of surgical patient
Differentiate between incarcerated hernia, reducible hernia, and a hydrocele by history and examination
Pyloric stenosis

Pharmacology

Common drug reactions
Drug interactions
Cardiac, renal, or hepatic disease impact on drug administration and ability to make proper adjustments

Plastic Surgery

Wounds or lacerations that may be repaired by the emergency medicine physician, but requires plastic surgery follow-up
Wounds or lacerations requiring plastic surgery
- Auricular lacerations
- Complex lacerations over the face/lip
- Nasal ala lacerations
Complications of laceration repair and appropriate discharge and follow-up instructions

Psychiatry

Family responses to illness or death
Depression
Psychoses
Psychotropic drugs
Suicidal and homicidal tendency
Endocrine, neurologic, systemic disease as causes of psychiatric illness

Pulmonology

Radiology

Differentiate between disease states and variants of normal
Imaging characteristics of common abnormalities and diseases
Imaging modalities
- Computed tomography
- Fluoroscopy
- Radiography
- Magnetic resonance imaging
- Nuclear scintigraphy
- Real time ultrasound and doppler ultrasound

Rheumatology

Toxicology

Acute toxicologic exposures
- Dermatologic
- Ingestions
- Inhaled exposures
Antidotal treatment
Observation versus decontamination
Oype of decontamination
Ondications for peritoneal dialysis, hemodialysis, and hemoperfusion

Trauma - Emergency Medicine, Critical Care, and Surgery

Traumatic injury and complications of the injury
Complications of traumatic injury after the initial survey
Knowing Advanced Trauma Life Support (ATLS) instruction
- Airway assessment and managing complications
  - Excessive bleeding
  - Disruption of the airway
  - Obstruction
- Breathing and managing complications
  - Pneumothorax
  - Hemothorax
  - Flail chest
- Circulation and managing complications
  - Poor perfusion
  - Shock
  - Vascular compromise
- Neurological status in all ages
- Extremity assessment by exposing the patient, while addressing the environment

Weapons of Mass Destruction (WMD) Management of Biological, Chemical, and Radiation Hazards

Biological WMD
Chemical WMD
Disaster preparedness
- Natural disasters
- Man-made disasters
Nuclear WMD/radiation injuries
Utilization of the hospital system to provide care in the event of a WMD attack

Other/Miscellaneous

Administrative
- Managing the clinical emergency department
  - Administrating the emergency department
  - Managerial skills
  - Regulatory groups
    - Scheduling divisional shifts
      - Quality assurance issues
      - The financial side of the emergency department
      - Basics of the budget and understanding payments
      - Billing and elements of successful quality improvment
Career Planning
- How to look for a job
- Choosing the right job for the person
- How to read a contract
- How to ensure benefits/adequate malpractice insurance
Child Advocacy
- Role of the emergency medicine physician within the community
- Protecting children from abuse and neglect
Developing long-life skills
- Anticipating advancement
- Continuing education
- Evaluation of published information
- Maintaining skills and knowledge
Medical Ethics
- Clinical Trials and phases of evaluation of new treatments I, II, III
- Death and dying and decisions regarding
  - Autopsy
  - End of life issues
  - Resuscitation
- Understanding and determining competence for decision-making
- Hippocratic oath
- Informed consent
- Self-treatment or treatment of ones own family
- When to ask for an ethics committee consultation
Health Care Economics and Cost Containment
- Differences between
  - Health maintenance organizations
  - Managed care
  - Medicaid
  - Medicare
  - Private insurance
- Principles of health care financing
- Pnderstanding costs, charges, cost-shifting
Navigating the medico-legal system
Professional organizations
- Structure, function, and benefits
Referral calls
Research methodology
- Basics of research design
  - Case control studies
  - Cohort studies
  - Meta-analysis
  - Randomized clinical trials
  - Power and sample size calculations
  - Retrospective vs. prospective
- Knowledge of basic statistical methods
  - Sensitivity and specificity
  - Parametric and non-parametric tests
  - Regression
    - Ability to conduct a retrospective or prospective study to completion
    - Ability to critically review journals and presentations
Teaching/Examination
- Developing effective teaching methods
  - Bedside teaching
  - Large group teaching
  - Small group
  - Ream building strategies
  - Developing lecture style teaching methods
  - Preparation for board certification

To read cases from previous months and years, use the calendar in the left column of the page or use the case archives: Cases by Disease, Cases by Symptom, Cases by Specialty, Cases by Age, Cases by Date.