Table Of ContentPEDIATRICS:
A Competency-Based Companion
Maureen C. McMahon MD
Assistant Professor of Pediatrics
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania
General Pediatrician
Nemours/Alfred I. duPont Hospital for Children
Wilmington, Delaware
Lankenau Medical Center, Main Line Health System
Wynnewood, Pennsylvania
Glenn R. Stryjewski MD, MPH
Associate Professor
Department of Pediatrics
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania
Pediatric Intensivist
Nemours/Alfred I. duPont Hospital for Children
Wilmington, Delaware
Series Editor: Barry D. Mann MD, FACS
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
PEDIATRICS: A COMPETENCY-BASED COMPANION
ISBN: 9781416053507
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
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Library of Congress Cataloging-in-Publication Data
Pediatrics : a competency-based companion/[edited by] Maureen McMahon, Glenn
Stryjewski.
p. ; cm.—(Competency-based companion)
Includes bibliographical references and index.
ISBN 978-1-4160-5350-7 (pbk. : alk. paper)
1. Pediatrics. 2. Clinical competence. 3. Patients—Care. 4. Physician and patient. I.
McMahon, Maureen (Maureen C.) II. Stryjewski, Glenn. III. Series: Competency-based
companion.
[DNLM: 1. Pediatrics. 2. Clinical Competence. 3. Patient Care. 4. Physician—Patient
Relations. WS 21]
RJ45.P3976 2011
618.92—dc22
2011005356
Acquisitions Editor: James Merritt
Developmental Editor: Christine Abshire
Publishing Services Manager: Anne Altepeter
Senior Project Manager: Beth Hayes
Project Manager: Louise King
Design Direction: Louis Forgione
For Kathleen and Joseph McMahon
–MCM
For Alison, Sophia, and Isabella, the three most amazing women in the world and the best
teachers a student like me could ever have
–GRS
Educator’s Foreword
Medical education has changed dramatically in recent years. The ultimate goal, to develop
a pediatrician who can practice “competently and independently,” remains the same.
However,theroutetothisendhasbeenaltered.Itisnolongeradequatetoassumethattrain-
ees will learn how to care for patients appropriately and gain the necessary medical know-
ledge for pediatrics just by “showing up” and participating in the daily routine of medical
school rotations and residency training. Medical educators must now prove that they have
included all of the key components of medical training (the six core competencies) in their
programs. They must have evaluation tools to show that their trainees have grasped these
concepts. Likewise, one can no longer assume that medical students and pediatric residents
willcommunicate wellwithpatients andfamilies orthattheywillactprofessionally intheir
dailywork.Educatorsmustnowdemonstratethattheyhavetaughtandassessedtheinterper-
sonal and communication skills and professionalism of their graduates. Furthermore, train-
ees must now learn to function effectively as part of a larger health-care system and use re-
sources effectively. They must evaluate their own patient care and practice evidence-based
medicine.
Changing the culture of medical education is not easy. Medical educators are obligated to
change the way students and residents think. The six core competencies must be incorpor-
atedintothedailylivesoftraineessotheyapproacheachpatientandeachchallengeinmedi-
cine with them in mind.
Pediatrics: A Competency-Based Companion will play a vital role in our changing educa-
tional culture. This is not just another traditional textbook. It is instead a unique guide that
effectively helps readers to tackle pediatric problems in a systematic manner, with the core
competencies in the foreground. The distinctive format encourages trainees to think differ-
ently and logically. Whereas many “old” textbooks supply an arsenal of medical informa-
tion,thiscomprehensivetextcoversmuchmore.Practicalconceptslearnedfromexperience
arecombinedwithevidencefromscientificstudies.Earlychaptersteachhowtosucceedasa
medical student orapediatric resident inclinical settings andindependent study.Othercon-
tributions advise trainees to function as part of a medical team, on inpatient wards and out-
patientclinics.Latersectionsshowhowtoapproachanillchildwithaspecificcomplaintor
medicalproblem.Eachchapteremphasizeswhattodofirstandhowtodevelopadifferential
diagnosis when confronted with a simple or puzzling case. All chapters remind the reader
to treat patients, families, and colleagues with respect and compassion. Authors stress the
importance of including the family in medical decisions. The authors and editors are skill-
ful clinicians and talented teachers. They have a wealth of knowledge and experience to
share.
This important new book will undoubtedly have a great impact on medical education. I
congratulate the authors and editors for having the courage to change our approach to pe-
diatrics. I applaud their effort to modify traditional readings and develop a new thought
process,withaneyetowardcompetenceinallareas.Thisbookisexceptionalandexciting.
Our medical students and pediatrics residents will be better for it.
Steven M. Selbst MD
Pediatric Residency Program Director
Jefferson Medical College/Nemours/Alfred I. duPont Hospital for Children
Pediatrician’s Foreword
In September 1999 the board of the Accreditation Council for Graduate Medical Education
(ACGME) approved the Outcome Project. In the decade that has followed there have been
significant changes in graduate and undergraduate medical education stimulated by the pro-
ject. The Outcome Project is a long-term initiative by which the ACGME intended to in-
creaseemphasisoneducationaloutcomes.Initsroleastheaccreditationagencyforgraduate
medical education programs, the ACGME wanted to shift from looking at the structure and
process of education, which are assessments of potential, to the measurement of outcomes
and actual accomplishments. The project defined the six areas of competence: patient care,
medical knowledge, professionalism, systems-based practice, practice-based learning and
improvement,andinterpersonalandcommunicationskills.Clearly,thesearenotuniqueand
fully distinct areas of competence, but they do define the breadth and depth of what a train-
ee must know to practice in the twenty-first century. Since the launch of the project there
have been many years of moving from concept to program requirements and ultimately to
an understanding of what these terms mean and how to use them for enhanced learning and
improved clinical practice.
From a pediatrician’s point of view, Pediatrics: A Competency-Based Companion takes the
aforementioned training paradigm and moves it into the reality of clinical practice. Using
the competency framework, the authors and editors provide the pediatrician with a concise
setofinformationpointsthatwillhelpguidepractice.Thechapterseachstartwithaclinical
scenario, and that is the vantage point of a practitioner. It is not a starting point of a theory
or a topical matter but the setting of a commonly seen patient in a clinical context. Next
the reader is provided medical knowledge—not an expansive amount of knowledge, but a
quantum the practitioner needs to know for clinical thinking, history, physical examination,
andlaboratorytestingconsiderations.Wherethistextbreaksnewgroundisintheconsidera-
tionofinterpersonalcommunication,professionalism,practice-basedlearning,andsystems-
based practice. These topics place the book uniquely in the twenty-first century and adjust
the practitioner’s thinking and action in important new directions. Beyond the chapters on
all the key well child and ill child conditions, the chapters on giving bad news, difficult en-
counters,teamwork,andpatientsafetyareuniqueandveryimportant.Introductorychapters
on each of the competencies and on how to be successful in the student and resident roles
are also unique.
