By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...
Immunization Key Feature 1: Do not delay immunizations unnecessarily (ex: vaccinate a child even if he or she has a runny nose). Skill: Clinical Reasoning Phase: Treatment Key Feature 2: With parents who are hesitant to vaccinate their children, explore the reasons, and counsel them about the risks of deciding against routine immunization of their children. Skill: Patient Centered, Communication Phase: Treatment, History Key Feature 3: Identify patients who will specifically benefit from immunization (ex: not just the elderly and children, but also the immunosuppressed, travellers, those with sickle cell anemia, and those at special risk for pneumonia and hepatitis A and B), and ensure it is offered. Skill: Clinical Reasoning Phase: Treatment, Hypothesis generation Key Feature 4: Clearly document immunizations given to your patients. Skill: Clinical Reasoning, Professionalism Phase: Treatment Key Feature 5: In patients presenting with a suspected infectious disease, assess immunization status, as the differential diagnosis and consequent treatment in unvaccinated patients is different. Skill: Clinical Reasoning Phase: History, Hypothesis generation Key Feature 6: In patients presenting with a suspected infectious disease, do not assume that a history of vaccination has provided protection against disease (ex: pertussis, rubella, diseases acquired while travelling). Skill: Clinical Reasoning, Selectivity Phase: Hypothesis generation Pneumonia Key Feature 9: Identify patients (ex: the elderly, nursing home residents, debilitated patients) who would benefit from immunization or other treatments (ex: flu vaccine, Pneumovax, ribavarine) to reduce the incidence of pneumonia. Skill: Clinical Reasoning, Selectivity Phase: Treatment Well-baby Care Key Feature 6: With parents reluctant to vaccinate their children, address the following issues so that they can make an informed decision:
Phase: Treatment, History Key Feature 7: When recent innovations (ex: new vaccines) and recommendations (ex: infant feeding, circumcision) have conflicting, or lack defined, guidelines, discuss this information with parents in an unbiased way to help them arrive at an informed decision. Skill: Professionalism, Patient Centered Phase: Treatment Today was my Resident As Teacher session, which meant I chose a topic that would be relevant to my colleagues and I to learn about, and then prepared and delivered a teaching session. I chose to focus on immunization, and I had my amateur improv friend collaborate with me to create an interactive learning session via improv games. The meat of the content revolved around the Immunization CFPC Priority Topic, and is outlined below. Key Feature 1 “There are a number of conditions that may be raised as a concern about receiving a vaccine, that in fact should not delay or preclude immunization. For example, routine administration of vaccines should not be postponed in persons with minor illnesses, such as an upper respiratory tract infection, otitis media, mild gastrointestinal illness, or concurrent antibiotic therapy. Repeated infectious illnesses are common in early childhood and will not interfere with the efficacy of vaccines. Generally, if a person is well enough to present for immunization in the outpatient setting, he/she is well enough to be immunized.” Resource: Canadian Immunization Guide Key Feature 2 5 steps to counsel the vaccine-hesitant parent (Resource: Canadian Paediatric Society Position Statement: Working with vaccine-hesitant parents):
Suggested reading: Preparing for Vaccine Questions Parents May Ask Key Feature 3 Vaccination schedules are province-specific. BC has published a set of routine immunization schedules for 3 populations (Resource: BC immunization schedules)
Key Feature 4 & 5 Be a responsible DAD
Key Feature 6 Know that vaccinations don’t guarantee 100% immunity in all people.
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