Child Health Clerkship

www.ch.missouri.edu

Organization of Rotation• 4 weeks of inpatient care

– 2 weeks on the pediatric wards– 1 week night float (three calls)– Two half days of community

events during night float week– 1 week in newborn nursery

Organization of Rotation

• 4 weeks of outpatient care– 2 weeks of general pediatric outpatient clinics. – 2 x 1 week of pediatric subspecialty clinics

Students doing subspecialty weeks in last two weeks will only attend one subspecialty clinic for both weeks as the 2nd week is a short one with test on Wednesday because of Thanksgiving Holiday

• Continuity clinic half day a week during entire rotation

Continuity Clinic• Half day clinic that will occur every week at the same time and

location supervised by the same attending• This clinic will take priority over ANY other part of the rotation• Please make sure your continuity clinic advisor is aware if you are

leaving town for your two weeks of general pediatrics• Monday AM continuity clinic will start next week, Monday PM

continuity clinic starts this afternoon• Night float is NOT a reason to not attend continuity clinic as schedule

has been set up in order to not have continuity clinic day overlap with night float days

Community Events

• Each student will participate in two half day community events• YOU DO NOT HAVE TO DO VOLUNTEER WORK• Participation should happen during night call week• Time can be spend during day or evening, weekdays or weekend• Coyote Hill should be visited by ALL STUDENTS for a half day,

student needs to arrange date and time with house parent

Community Events• Contact numbers are on list that is in orientation package• PLEASE SCHEDULE IN ADVANCE• Let Ruth know what events you participated in and what you

thought of it so we can keep track of this, NO formal write-up is required

• There is a running list on Child Health student website with comments from all students regarding experiences

After Hours and Weekend

Responsibilities• Three overnight ward calls during night float week

• One evening (5-10 pm) nursery call during nursery week

• Three-four evenings of ER call during outpatient part of rotation

• One weekend day rounding only when in nursery

• One weekend day rounding only during ward weeks

• One weekend day until 5 pm during ward weeks

Nursery Evening/Weekend• Happens during week of nursery• Pick one week night where you will stay until around

22.00 pm (evening not assigned on schedule)• Student will cover one weekend day to round with

attending (on schedule)• Pay attention to the last week of the rotation as

students may switch sites over the weekend instead of switch on Monday

ER Call at WCH• Happens during 4 weeks of outpatient

rotations• Three calls assigned on schedule• Students may switch as long as Ruth

Sypes is notified of changes• Call starts at 17.00 and ends at 22.00 on

week days and weekend days• Please report to pediatric resident in ER at

WCH

Educational conferences• Problem-conference Tuesday at 12:15 at Health Pavilion WCH

must be attended in person• STUDENTS MUST SIT IN FRONT ROWS!!!!!!!!• Tuesday afternoon lecture series after problem conference at

Portland building (Ruth will send updated schedules!)• Peds in Review sessions at 11:00 on certain Tuesdays as arranged

by Ruth, occur at Portland building• Resident EBM presentations on Thursday at 12:30 in Health

Pavilion WCH for on-site students (subspecialty, wards and nursery students)

• Grand Rounds Friday at 08.15 at health Pavilion WCH

Clerkship Grade Make-up Onsite

• CLIPP exam (last day block)• outpatient evaluations (attendings only)• ward inpatient evaluations (attendings and

residents)• nursery evaluations (attending and residents)

Evaluations and Final Grade

• Evaluations are completed online by faculty and residents• Numeric score 1-9 given for subcategories as well as Overall

Evaluation

1-3 is performance below expected

4-6 is performance as expected7-9 is performance that exceeds expectations

• Final clerkship grade determined by average of Overall Clinical Evaluations and CLIPP exam results

Final Grade Determination Onsite

Other Requirements to pass Child Health clerkship

• Attendance at all teaching conferences unless out of town

• Meeting the PLOG minimum patient encounter requirements as specifically set for Child Health

• Completion of all CLIPP cases• Participation in at least one observed History and

Physical patient encounter (does not count for grade calculation), please return completed form to Ruth

• Completion of on-line evaluations (not able to sit for exam if not completed)

American Disability Act

• Please notify the Course Director or Course Coordinator within the first week of the rotation if you have special needs to be addressed under the Americans with Disabilities Act (ADA). Failure to notify us by the end of the first week of the rotation may forfeit your rights to request special accommodations (including but not limited to extended examination time allotments). Reasonable effort will be made to accommodate special needs for which documentation is provided.

Official ADA policy

• If you need accommodations because of a disability, if you have emergency medical information to share with me, or if you need special arrangements in case the building must be evacuated, please inform me or Ruth Sypes immediately.

• To request academic accommodations (for example, a note taker or extended time on exams), students must also have registered with the Office of Disability Services (http://disabilityservices.missouri.edu

HOW TO HUG A BABY

First, spy a baby.

Next you will need to flatten the baby before actually beginning

the hugging process.

The "paw slide" - Simply slide paws around baby and prepare for possible close-up.

Finally, if a camera is present, you will need to execute the difficult and patented "hug, smile, and lean" so as to achieve the best photo quality

CLIPP

Simulated Cases

• http://www.med-u.org/ • Go to the website and follow directions for new

users, your password will be send by E-mail• Clerkship director has access to CLIPP and is able to

view which cases are done, how much time spend on a case and what percentage of cards completed

• Registration fees have been paid by OME• On last day of block the CLIPP final exam (100

multiple choice questions) will be administered• Total of 33 cases• eCLIPP is optional (highly recommended as great

topics, not covered in final exam)

PLOG

PLOG general rules

• Web-based system to document patient encounters• All clerkships use the same basic template so you will have

significant consistency from block to block• Each clerkship faculty have determined what entries will meet

course requirements, the minimum number required to be entered, and what type(s) of participation will count

• Entries can be picked from diagnoses, skills, and special• Green entries will count towards required entries and gray

entries will not count toward required entries for particular clerkship

PLOG general rules• For each patient encounter you can enter up to six items

(diagnoses, skills, special domain, or combination of the three)

• Only three of the items per encounter can count toward clerkship requirements, computer automatically defaults to first three entered but this can be changed

• You can use the remaining 3 items to document diagnoses/symptoms, skills and items from special domains that you would like to track across clerkships and be able to see in your self-generated reports but they will not count towards meeting requirements

PLOG general rules• Green/Gray- Those items in green (“counters”) will count

towards the clerkship’s requirement. • Please note- those items appearing in gray on PLOG2can not

apply/do not count for that clerkship’s requirements• Each encounter must have at least one entry • Each patient encounter can only be counted once per

site/location but may be entered a second time if the patient is seen in a different location or the patient was discharged and readmitted at a later date

• Once entered, a patient encounter can not be edited. If you have entered data in error, please contact your clerkship office and let them know what needs to be edited

•

PLOG general rules

• Not all patient encounters will be able to be entered or meet requirements (i.e. a particular patient encounter may not meet the level of participation required by the clerkship or have one of the measured diagnoses, skills, or special domains)

• You are strongly encouraged to enter data on a daily basis and are required to do so on a weekly basis by 0700 each following Monday. Failure to do so is considered unprofessional behavior and will be so noted by your

clerkship director.

PLOG general rules• The clerkship directors and coordinators, as well as the OME,

can audit for accuracy; falsification of encounter information will be considered an Honor Code violation

• Students should be monitoring their progress towards meeting the course requirements on a regular basis and they will receive feedback on their progress from their clerkship directors. PLOG2 “My Progress” screen makes it easy- green- you have met that requirement, yellow- you have begun meeting the requirement, red- you have made no progress towards meeting that requirement

• PLOG2 closes at noon on the last Thursday of the block. You will not be able to make entries after this time

PLOG General Info

• Full participation means that you obtained history by yourself, performed independent physical exam and formulated differential diagnoses with action plan

• Partial participation means that you actively participated in at least one part of the visit whether that is history, examination or other type of skill

• Remember all entries must be made by Monday 7 a.m. of following week

Unique Child Health PLOG features• Partial participation or observed participation can count towards

meeting requirements for several selected entries• Electronic CLIPP cases can count towards meeting requirements

for several selected entries• For disease/symptom entries use only full participation

encounters except for well child exams from 0-12 years where partial participation and observation is acceptable for entry as well

• For certain skill entries you can have partial participation when you actively participated in one specific element of the visit

• Well child exams occur in clinic, not in nursery or on wards so make sure you seek out these visits during your general pediatrics clinic time

Mid Block Feedback

• For on site students must occur in week 4 or 5 with continuity clinic preceptor

• For rural track students must occur at end of week 4 with preceptor

• Must be documented in PLOG

General Child Health PLOG rules

• Secure Login• See CH student website and PLOG site for more info

Student Evaluation of Clerkship (SEC)

• Students will receive periodic E-mails to electronically evaluate preceptors and lectures

• At end of rotation students will also need to electronically evaluate the overall clerkship

• Responses are anonymous• Completion of evaluations is necessary in order to sit

for the CLIPP exam on last day of block

Pediatric Wards• Students will work in two teams• Teams alternate daily in taking new admissions• Team starts taking admissions from 08:00 AM until 17:00 and

picks up admissions overnight until 08:00 the following morning including PICU transfers during that time

• Students are expected to actively follow up to 5 patients daily• Student is expected to be able to do full admission on two

patients per day when admitting and should try to be involved with as many admissions as possible

• Please pick up newly overnight admitted patients or PICU transfers up the next morning so you can present them during rounds

Daily Ward Schedule

• 6:00 Night float hand-off• 7:00 Intern/med student pre-round with senior• 8:00 Morning report W/Th• 8:30 Multidisciplinary Rounds except Friday• 9:00 Family Centered Rounding• 1:00-5:00 Work time• 5:00 Check out with night floats, day students

do not have to stay for these rounds

Pediatric Wards• Students should write full admission notes and

progress notes on their patients by using Power notes

• All notes should be forwarded to hospitalist attending physician

• Students should give preference to patients from general ward attending but can also admit and follow patients from subspecialists when maximum of 5 patients has not been met

• Students will present their patients during family centered rounds in the patient room

How many weekly EMR notes should a student write during ward daytime?

• Minimum of two admission notes per week• Minimum of five progress notes per week (preferably not

the same patient each day)• Please give printed paper version of these notes to your

general ward attending if you would like feedback on your notes

• You also must forwarded all EMR notes to attending as they have to sign off electronically

• Of course you may write more EMR notes if you want to for practice

Expectations Ward Night Call• Three overnight calls from 17:00 until end

of resident check out rounds the next morning to present newly admitted patients

• Call is three consecutive nights• If there are no admissions overnight the

night-call student does not have to stay for check out rounds

• Night call student in beginning of week is not expected to attend Tuesday afternoon lectures

• Night call student in 2nd half week is not expected to attend Friday Grand Rounds

Overnight Ward Call

• Call student is not expected to do more than two full H&P’s with notes during call period but should be involved with as many admissions as possible

• Overnight call student is not expected to write daily progress notes on patients the following morning and should go home as soon as check out rounds are over. Daily progress notes are the responsibility of the day team

• You are expected to attend continuity clinic the week of night float

Ward weekend responsibilities

• One or two students assigned per weekend day• One student stays till 5:00 pm, other student may leave after

rounds and work is done (see schedule)• Students can switch the rounding only and staying till five

amongst themselves

Admission notes

• All admission notes should include Weight, Height and Head Circumference (under 2 years of age) and include on which percentile growth measurement falls

• Make sure you include FamHx, SocHx, PMHx and ROS on all admission notes

• List immunizations and home medications• Make sure your PE is patient specific and stay away from

jargon, please describe your patient and their unique features• Be reflective in your impression and plan. Do not just list

symptoms but try to put everything together

Daily progress notes• Always start with what hospital day and what antibiotic day• Write your objective as a narrative and start with patient name,

their age, date and reason for admission• Include weight trends where appropriate• Make sure PE is patient specific, stay away from jargon and

describe unique features of your patient• Summarize and interpret laboratory studies and imaging studies,

please do not copy and paste this data every day into notes• Be reflective in your impression and plan and demonstrate your

thought process

• See hand out for more details and exemplary note examples

Observed H & P

• Each student is expected to have one observed H & P done with form filled out by resident or attending

• Be pro-active about this and don’t wait till last day• Does not count towards grade but is used to provide

constructive feedback so the earlier you do it the more beneficial it would be

• Needs to be returned to Ruth

Most Important Rules

• HAVE LOTS OF FUN and LEARN AS MUCH AS YOU CAN ABOUT THE HEALTH OF CHILDREN

• ACTIVELY SEEK FEEDBACK• ASK MANY QUESTIONS• Remember that this is YOUR education so being

engaged and involved benefits YOU• Child Health Website Child Health

09/30/11