You are expected to do rounds every morning and see all the patients we are following plus any new consults. If there is another Learner (Medical Student , or other Resident or Fellow) on the Rotation, divide the patients amongst yourselves. If there is time, the most senior trainee should review patients with the more junior trainees to help them derive a management plan. The PID staff physician will usually join you in the early afternoon. At this point, you can do rounds together on all new consults and all patients with ongoing issues. If there is an urgent question or consult, contact the staff physician or come and find them before these afternoon rounds.
(Please be advised that all outpatients will be seen in Stollery Clinic 2E)
Peds ID clinics are every Wednesday morning. The inpatient list for Peds ID will be forwarded to you through either Connect Care or by email. On Connect Care to access the outpatient clinic list, go to the schedule, click on date (e.g July 13th) then put into the Dept search bar: EDM STO WMC PED INFECTIOUS DIS. and scroll through the list and select this Dept. Dr. Tse-Chang will assign patients to you, so please read and familiarize yourself with those patients. At a minimum, you should read the referral note for new patients and the original PED ID consult letter and recent letters for follow-ups.
The start time is subject to change so best to check Connect Care Wednesday morning. Please note you are expected to be at the clinic at the time patients are scheduled to arrive as 2E clinic staff will not be paging learners. On Wednesday mornings conference room 2E2.05 is reserved for Peds ID, located directly behind the main check in desk. You are welcome to see any patients - you never need to check with the staff doc before going in the room. Unless you are in academic half-day (residents and fellows), you should make yourself available as the outpatient consults often deal with problems not usually seen on the ward. It is inconvenient to have to leave in the middle of doing your rounds on the inpatients, but the outpatient consults provide a unique experience that is important for your training.
If you are the most senior trainee, you can decide who sees which patient in the clinic. Medical students should not be assigned complex new consults if other trainees are available.
You are expected to dictate or write a letter to the referring physician for the outpatients you see in Connect Care the day that you see them and route the letter to the applicable physician.
All learners on the Peds ID service will participate in Stollery Antimicrobial Stewardship Rounds every Tuesday and Friday.
- On Tuesdays, please meet the stewardship physician +/- pharmacist in room 4H2.39(in UAH) at 12:45pm
- On Fridays, please meet in 4H2.39 at 1:15pm
If you arrive and the door is locked, please call switchboard and ask for Security and ask to have the door unlocked.
The Peds ID physician on service is aware that you will be attending AS Rounds and may not be avaialble until 14:00.
You should have been given access to the patient lists - entitled "Stollery AS Rounds" and "Stollery AS Followup". The lists are ready for viewing usually by 9:00am on Tues/Fri Mornings. Please review the list before joining rounds if possible.
Please visit this link to learn more about our mandatory and optional Adult/Peds ID Educational Sessions.
ID Rounds are held weekly on Thursdays from 11:00-12:00 am in CSB 2-193 or online. See block schedule. Attendance is mandatory.
Peds ID Rounds are held weekly on Fridays from 11:00-12:00 am, usually, in room 3-420 ECHA. Attendance is mandatory.
HIV Rounds are held once per month on a Thursday (usually the 4th Thursday of each month ) from 12:30 pm to 1:30 pm on zoom. We discuss all the children we are following who have HIV infections, or were born to HIV infected women, and have not yet seroreverted. These rounds are interesting and useful for you as you will likely have seen many of these patients during the preceding weeks. This is a multidisciplinary conference where discussion of many issues related to the medical decisions and practical management of these patients occurs. Attendance is mandatory unless the staff doc asks you to go see a patient instead.
Each learner will be scheduled for a 15 minute meeting every Friday morning with the physician on service for the week. You will be sent a meeting invite with details.
A. New out-patient consult:
Please dictate a full but concise history, in the following order:
● HPI including travel and dietary history if relevant
● Function Inquiry if relevant
● PMH
● Social History
● Immunizations and Allergies
● Family History if relevant
Physical exam – must always include growth parameters
● It is fine to say something like “Cardiac, Chest, and Abdominal exam was normal” if none are particularly relevant to the suspected diagnosis
Investigations – list relevant results (not all results!), but do not interpret them yet
Impression – fine to give a one line summary but also okay to jump right into the impression
● Explain your differential diagnosis
● Explain planned investigations – clarify if we will arrange them or referring doc needs to
● Explain planned therapy – give drug doses and duration and expected adverse events
● Mention follow-up (if there is none anticipated, say so) and clarify if we will book or the referring doc needs to book it
Remember the referring doc has limited time to read your letter. Be as concise as possible. Do not discuss what the weather was like the day you saw the patient!
Remember one of your goals is to educate the referring doc. Explain things in terms you think are appropriate. If you know of a great website that helped you understand the disease, consider adding that in your impression. If you have done a good job, the referring doc should be able to manage a similar patient in the future with minimal help.
Remember the child or parent may eventually see the letter. Do not put in comments they might find upsetting unless you are certain they are true and there is a reason why those comments need to be in the letter.
B. Repeat out-patient consult (follow-up):
● There is no need to repeat anything that was in previous letters
● It is fine to give a one or two sentence summary
● Exam
● It is fine to say unchanged from previous, but should clarify if you did a full physical exam or a limited one
● Impression
●It is okay to assume that the referring doc has read the previous letter if it was sent to them – might be very brief if original plan has not been altered
C. Format for Consults on ID Inpatients
● You should begin by a concise history of the problem, only mentioning things that are relevant to the suspected ID problem
● Document the physical exam you did.
● Summarize investigations that are relevant to the ID problem.
● You should almost never have to go over one page to do the above.
● Write an impression. You should aim to have this completed before you meet the staff ID doc to review the case if at all possible. Feel free to look up topics in the literature if you have time, but we know that often you do not. Your impression should always include the following:
your working diagnosis
a differential diagnosis where applicable, explaining why you think each is likely or not likely
do not include entities you are not seriously considering unless they are very serious problems (such as necrotizing fasciitis)
investigations or treatment or referrals you would suggest including doses and duration of drugs
At the bottom, say something to the effect that you will review with the ID staff doc. When we see the patient, we will add our attestation to your note. Do not worry if you are way off base when you start the rotation. Writing impressions will train you to think logically and will eventually pay off!
D. Progress Notes
The resident or a student should write a progress note anytime there is something new to say on the patient’s chart. Your review of the chart and examination of the patient should be thorough. However, your progress note should be just a concise summary of the ID issues, laboratory results, and plan. It's great if you make decisions about what you'd like to do with the patient. However, if you have not discussed the plan with the staff physician, either do not write this in the chart or add "will discuss with staff" at the end of your note so it is clear this is not our "final decision".