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 ©Copyright
 Published: 29/11/2011

university of auckland

Guide for 5th Year Medical Student
Attachment in Neonatal Paediatrics

Introductory Seminar – first two days of the attachment

All students to meet in the Liggins Lecture Theatre, 1st floor National Women’s Hospital at 0830 hours on the first day of attachment.

Neonatal Paediatrics

The object of our service is to provide safe care for mothers and their babies. Therefore, about 30% of the attachment is allocated to Neonatal Paediatrics. Arrangements for tutorials and seminars are listed under each hospital.

Fifth Year Assessment - Final Friday of each run

All students will be assessed at National Women’s Health on the final Friday of each run. The assessment will consist of a multiple station OSCE. The objective of the OSCE is to evaluate whether your knowledge and experience acquired in the six weeks met with our expectations. There will also be an opportunity for you to feedback to members of the University Department any positive or negative aspects of your learning experience in the hospital or unit of your attachment. The feedback forms for both O & G and Paediatrics is included at the back of the coursebook.

Students doing their Antenatal/Delivery attachment in Auckland during the final week of the run are expected to return to their hospitals over the last weekend.

Yellow Assessment Forms (5th Year Students) and Log Books MUST be completed by your tutor and handed in at the end of the OSCE. The Head of Department will sign off the log book and yellow form and return to Lesley Murgatroyd, National Women’s Hospital, at the end of your run. It is your responsibility to make sure your supervisor completes this form. If these are not received completed you will not get a grade for the run. Your grade will count towards your final assessment.

5th Year Clinical Attachment in Perinatal Paediatrics

The clinical course on the newborn will take place during your attachment in Obstetrics and Gynaecology and is intended to take about 30% of the time of that attachment.

This is an important part of the medical school's whole course in paediatrics and child health, and this document should be read in conjunction with others from the Department of Paediatrics.

Objectives

At the end of your 5th year attachment in Perinatal Paediatrics you will be expected to:

  • be able to obtain and present a neonatal case history
  • be able to carry out a competent physical examination of the term newborn baby
  • know the normal characteristics and management of the newborn infant and
  • understand the major conditions causing problems in newborn period.

At the time of graduation, the student should have:

1
  1. a good appreciation of the importance of the period before and around birth
  2. an understanding of the effect of pre- and perinatal hazards on long-term development
2 An understanding of the development and function of the fetus and newborn, including:
  1. prenatal development, and factors that may influence it
  2. changes that take place at birth and the physiology of the newborn, at least those aspects relevant to management
  3. growth and development of the newborn and infant, and principles of nutrition
3 A basic competence in the medical management of the newborn baby and the parents.
The student should:
  1. be able to carry out a competent physical examination of the term newborn, and understand the reasons for the examination
  2. know the presenting signs of illness in the newborn, be able to formulate a differential diagnosis and discuss the initial management
  3. know the causes, presentation and initial management of the commoner disorder of the newborn, including asphyxia, birth injury, jaundice, respiratory disorders, feeding difficulties and the commoner malformations and infections.
  4. be able to carry out basic neonatal resuscitation using bag and mask ventilation
    (+/- cardiac compression)
  5. have a good appreciation of the importance of parent-infant relationships, and some understanding of the management of parents in the crises of serious illness, malformation and death of an infant
  6. have an exposure to some important practical procedures in the newborn
4

 At the very least students should have a knowledge and understanding of the newborn baby to the stage where

  1. they know what they do not know - and are prepared when necessary to ask for advice
  2. they reach a stage of competence and confidence that they could manage common neonatal problems until someone more experienced arrives.

Not all of this will be expected by the end of the 5th year (item 3d) especially will come during the trainee intern year) but the student will be expected to have a good basic knowledge at the time of the examination.

This Attachment

The course has the following parts:

  1. Introductory Sessions
    1. General
    2. The neonatal history
    3. Infant feeding
    4. Resuscitation of the newborn
  2. Tutorials on examination of the newborn     (4 sessions + observed examination)
    Click here to open the page on newborn examination
  3. Seminars / Case Presentations                     (5 sessions)
    National Women's Hospital Middlemore Hospital North Shore Hospital

    Click here for a list of seminar topics
  4. Paediatric Study Time, unsupervised
    National Women's Hospital Middlemore Hospital North Shore Hospital
  5. Practical Infant Care
    National Women's Hospital Middlemore Hospital North Shore Hospital
  6. Ward Rounds
    National Women's Hospital Middlemore Hospital North Shore Hospital
  7. Other Teaching Sessions
    National Women's Hospital Middlemore Hospital North Shore Hospital
  8. Reading

1: Introductory Sessions

  1. A general introduction to the course
  2. The perinatal history: a review of the blue infant record card (S291). Make sure you know the significance to the baby of each item recorded on it, and the general significance of the card as the foundation of the lifetime medical record.
  3. Infant feeding: an introduction to the basics at when and what to feed.
  4. Resuscitation of the newborn: an introduction to the basics. Your practical experience in resuscitation will be acquired in sixth year.

2: Tutorials on Examination of the Newborn

Weekly tutorials are given by a consultant paediatrician/fellow to each group of 3-4 students. These sessions last about 1½ hours. Your tutor will arrange to meet you for the first session in the Neonatal Intensive Care Unit (NICU).

Click here to open the page on newborn examination

The clinical tutorial will emphasise techniques of physical examination and the eliciting of physical signs, more than the interpretation of abnormal signs (the latter will come in the sessions of case presentations). Before the end of your run you should examine a baby in front of your tutor.

National Women’s Health - Specific Information

3:  Case Presentations/Seminars

These will take place usually on Thursday afternoons in the Bonham Tutorial Room from 1400-1600hrs. They will consist of disease- and problem- oriented topics using a baby's case history to illustrate the major points of a condition or disease. Two to four patients will be presented at each session: each student will have one case to work up and present during the four week attachment. As many as possible of the following problems will be considered during the 4 weeks:

Click here to open the list of topics for Case Presentations/Seminars

Each case presentation should take no more than 20 minutes, and will be followed by general discussion. The presenter will be expected to be able to lead the discussion and to present a reasoned and succinct description of the predisposing factors, aetiology, differential diagnosis, investigation, management and outcome of the topic that has been allocated. Others in the group should be forewarned of the topic and read around it beforehand, so that they can contribute usefully. Use text book/hospital guidelines. If you have difficulty selecting a case contact Neonatal Registrar/Tutor for assistance.

4: Paediatric Study Time

Time will be available during the attachment to be used for unsupervised work e.g. preparing case presentations, reading, and examining babies in your own time. Practise the examination until you have developed a good workable scheme of your own, and have an appreciation of the range of normal variation among babies in the standard physical signs. The paediatric Registrars, House Officers and Charge Nurses have been asked to help you as they are able. Feel free to discuss any queries with the medical staff of the neonatal unit, or your tutor when you next meet them.

5:  Practical Infant Care

It is strongly recommended that you take the opportunity to learn basic neonatal nursing skills (how to feed and change a baby, etc.) during this attachment. You should also make sure you have personally observed a baby breastfeeding.

Objectives of Paediatric attachment to PIN and Community visits

At National Women’s Hospital it is very easy for your experience to be focussed on sick or preterm infants. In order to give more exposure to this normal infant, there is an attachment to the Parent-Infant–Nursery (PIN) in addition to community visits and post natal wards.

The main aim of these sessions is to enable students to observe the "normal" infant and to become comfortable with handling, changing/dressing and feeding well infants. Experience will vary between individual days but it is envisaged that the student would be able to:

  1. observe the normal activity of infants and parents in their own surroundings
  2. observe or perform feeding of infants via breast, bottle or tube (in PIN)
  3. observe the normal pattern of stools including meconium, changing and milk stool
  4. observe the normal pattern of infant sleep
  5. understand normal patterns of weight loss/gain over the first week or so of life

6:  Ward Rounds

These commence at 8.30 each day except Tuesday when they commence after Grand Round. You are expected to attend one round. This can be either Level 3 or Level 2. You may attend more of these if you wish. Please self roster on the notice board.

7:  Other Teaching Sessions

  • Neonatal Grand Rounds 0830 Tuesday in the Neurology Room, Clinical Education Centre, Level 5, ACH
  • Perinatal Case Reviews 1230 Friday in the Level 9 Lecture Theatre, Support Building
  • Neonatal Journal Club 1230 Thursday in the NICU teaching room, NICU Ward 92

The topics for each session are published in the blue monthly Paediatric teaching programme sheet posted on the noticeboard outside the first floor lecture theatre.

You are not required to attend any of these activities, as the emphasis at this stage in your training is on common problems of the newborn, rather than details of newborn intensive care. However you are welcome at all times, and may find the resident medical staff in NICU a particularly valuable resource in preparing case presentations. Recent neonatal texts are also kept as bench books in the nursery.

Reading

During this attachment, you should

  1. Read the handouts, especially Dr Matthews' notes on examination of the newborn.
  2. Read completely one concise text on the newborn baby e.g. Peter Johnston’s "The Newborn Child" (Churchill Livingstone, 1998) and Chapter 9 in Farquhar & Jamieson's "Introduction to Obstetrics and Gynaecology" (University of Auckland 1994). These are held on desk copy in both the Greenlane Hospital and Philson Libraries.
  3. For specific topics, e.g. for your case presentations, read selectively in larger textbooks. Schaffer and Avery's "Diseases of the Newborn" (Saunders, 1991) or Avery, Fletcher & MacDonald "Neonatology" (Lippincott, 1994) are suggested. Be careful to check you are reading up-to-date sources. Newborn medicine is a rapidly changing field.

If any part of the neonatal course is unsatisfactory or you are having problems please discuss with your tutor or the overall course coordinator. Comments from you on the quality and components of the course are helpful in improving the course in the future and will be treated confidentially.

Middlemore Hospital-Specific Information

3:  Case Presentations

These will take place usually on Thursday afternoons in the O&G Lecture Room from 1400-1600hrs. They will consist of disease and problem oriented topics using a baby's case history to illustrate the major points of a condition or disease. Two to four patients will be presented at each session: each student will have one case to work up and present during the four week attachment. As many as possible of the following problems will be considered during the 4 weeks:

Click here to open the list of topics for Case Presentations/Seminars

Each case presentation should take no more than 10 minutes, and will be followed by general discussion. The presenter will be expected to be able to lead the discussion and to present a reasoned and succinct description of the predisposing factors, aetiology, differential diagnosis, investigation, management and outcome of the disease group or topic that has been allocated. Others in the group should be forewarned of the topic and read around it beforehand, so that they can contribute usefully.

Other Learning Opportunities

  1. It is strongly recommended that you take the opportunity to learn basic neonatal nursing skills (how to feed and change a baby, etc.) during this attachment. This will be arranged by the tutor in charge of your small tutorial groups. You should also make sure you have personally observed a baby breastfeeding. Arrange with a Charge Nurse in SCBU, a midwife in the postnatal wards or an experienced mother.
  2. The regular routine on SCBU includes:
  • Ward Rounds 0830 daily
  • Neonatal Grand Rounds / Journal Club – Thursday, 1230, Kidz First Seminar Room 1
  • X-ray rounds – Wednesday, 1200, SCBU
  • Surgery Rounds – 2nd Wednesday, 1100, CT Scan

You are not required to attend any of these activities, as the emphasis at this stage in your training is on common problems of the newborn, rather than details of newborn intensive care.

However you are welcome at all times, and may find the resident medical staff in SCBU a particularly valuable resource in preparing case presentations. Recent neonatal texts are also kept as bench books in SCBU.

North Shore-Specific Information

You will be advised about the details of tutorials and small group sessions on your first introductory session at North Shore.