welcome to the unc pediatrics clerkship 2014-2015
TRANSCRIPT
Welcome to the UNC Pediatrics Clerkship
2014-2015
Objectives for Orientation
Clearly state expectations for clerkship Participation Clinical activities Assignments Grading Policies
Outline clerkship objectives Address your questions For more information, also see the
clerkship webpage
General Expectations
More than 90% of medical students will not become pediatricians
All medical students must develop a basic level of knowledge and skill regarding pediatrics
More than two-thirds of medical students will go into fields of medicine where they will be asked to participate in medical care for children
Goals for the Clerkship
Top 12 List – Peds Clerkship Objectives Take ownership of your patients – know the
history, exam, and lab results at any given time; follow-up on your patients even when they have technically left your care; be responsible for them so that nothing gets missed.
Learn how to talk with children of different ages and their families both to get complete, accurate histories, and to explain clinical findings and plans. Learn how to reassure.
Learn how to perform the PE of children – how to interpret vital signs at different ages, how the pediatric exam is different than the adult exam, and a basic knowledge of what is normal.
Write a complete H&P, including pediatric-focused items such as development, diet, and growth.
Top 12 List – Peds Clerkship Objectives Present orally on inpatient rounds and begin to
pick out what is most important to convey to the team (i.e., do not repeat the entire H&P).
Assess the development of every patient you see and be able to recognize when it is abnormal.
Be able to chart the weight, height, head circumference, and BMI and recognize obesity or failure to thrive and begin a work-up if indicated.
Talk to families about prevention, including immunizations, safety, violence, sex, and substance use. Using the CDC chart, know what immunizations a child needs at a given age.
Top 12 List – Peds Clerkship Objectives Write prescriptions appropriately for children of
different sizes. Be able to clinically recognize a dehydrated child.
Write orders for both re-hydration and maintenance fluid for children based on size and clinical condition.
Recognize when a child is in need of urgent medical attention. Know how to initiate care and who to call for help.
Outline the approach to diagnosis and management of common pediatric conditions.
Overview of the Clerkship
Outpatient Pediatric Medical Education Director: Rasheeda Monroe, MDInpatient Pediatric Medical Education Director:Steven Pattishall, MDOther members of the Pediatric Medical Education Committee:David Adams, MD Stephen Leinenweber, MD
Clerkship Direction:
Basic Clerkship Clinical Structure
Three weeks Inpatient Pediatrics 2 weekday long shifts One Friday long shift One Saturday or Sunday long shift Coordinate your long shifts and weekends to minmize
overlap with AI’s and other 3rd year student
Newborn Nursery With exposure to neonatal intensive care
Minimum 12 half-days of Ambulatory Pediatrics Some pediatric subspecialty exposure
Basic Clerkship Assignments CLIPP cases
Complete 8 required cases Write ups
Complete a minimum of 2 History and Physicals and 1 Discharge Summary You will be assigned an attending to review your
write ups
Cultural reflection (optional) Didactic sessions Documentation of patient encounters/log
on One45 Midpoint feedback and self-assessment Completion of the Patient Log
Clinical Work in the Clerkship
Clinic Attendings
Mythili Rajan
Rasheeda MonroeMedical Director
Susan Sinden
Carrie Dow-Smith
Betty WitmanSAFE Child
Virginia SchreinerSICC
Ward Attendings
David Adams
Ivy Pointer
Badie Clark
Bridget Donell
Stephen Leinenweber Travis Honeycutt Karen Chilton Steven Pattishall Mark Piehl
Scottie Pate
Jennifer Vick
UNC Chief Residents 2014 - 2015
Mark Connelly
Stephanie Permar
Allison Herndon
Inpatient Pediatrics
Typical patients Well children with acute illness Children with chronic disease presenting for
acute illness or chronic disease management
Children in need of diagnostic management
Inpatient Pediatrics - Student Goals Depth Take ownership of your patients and learn
all you can from them Understand their illness, work up, and
management completely Participate fully in the activities of the
inpatient team Become comfortable with children with
special needs Gain exposure to pediatric subspecialties
and general pediatric hospital care
Inpatient Pediatrics - Patient Write Ups Write a history and physical and/or daily note
on each of your patients each day Write notes daily and meet with your
inpatient attending to evaluate them for additional feedback.
2 formal History and Physicals are required and 1 discharge summary. You will be assigned a faculty mentor. Send write ups via email to your mentor. Due within 72 hours after seeing the patient
A Patient write-up should include: History & Physical 1-2 page written discussion on a topic
related to the patient, with at least 2 references cited
Please refer to the clerkship website for detailed guidelines on the format of patient write-ups
Inpatient Pediatrics – Daily activities
Write a history and physical and/or daily note on each of your patients each day
Write orders for co-signature Meet with your intern right after rounds to
divide and conquer the daily work Ask questions and find answers to those
questions – bring new information to the team!
Inpatient Pediatrics - Long Shift Long shift assigned at least four times
2 week nights 1 Friday 1 Saturday or Sunday
On long shift days, you are expected to stay until 8pm then return the following morning as regularly scheduled
On weekends, round with the team on the post-call morning, present your patients, then leave after post-rounds work is completed
Stick with your intern to learn clinically Admit at least one patient for write up each
long shift, but learn from any patient around
Inpatient Pediatrics - Ward Teams Teaching Team: Usually one attending
per week, One senior resident (2nd or 3rd year), Two interns.
Rounds typically start at 8:15 or 8:30 on 4E
You should have reported to the workroom at 6:30am for patient assignment or updates on existing patient from the night team.
Pre-round on all your patients and prepare for your presentation on rounds.
Talk to your supervising intern
Inpatient Pediatrics - Working with the Team
Take ownership of your patients Be proactive and enthusiastic But be gentle
Meet with your intern right after rounds to divide and conquer the daily work
Ask questions and find answers to those questions – bring new information to the team!
Be a dependable part of the team
To get the most out of your inpatient time…
Learn the roles, and what to expect from whom
Get involved – make yourself important to your team and learn by doing
Balance the amount of time you spend on write ups with the amount of time you spend on more broad learning
Get the most you can out of conferences – they are for your learning
Newborn Nursery
Generally the
happiest place
in the
hospital…
Student Activities in the NBN See the specific orientation information
on the web page Arrive in the mornings at 8:30 am Clarify expectations with your team for
the week Prepare a brief presentation for the last
day in the Newborn Nursery (Friday) on a topic of your choice to present to your preceptor and team
Your physical exam skills will be directly observed
Student Activities in the NBN
To get the most out of the NBN…
This is your best opportunity in third year to be the care provider
Work on developing rapport, talking with families, and communication skills
Practice effective use of an interpreter if applicable
Learn what is normal and what is not Examine lots and lots of babies Build your comfort with normal baby
care Review the Newborn Nursery orientation
website link before your week starts http://www.med.unc.edu/pedclerk/
schedules/clerkship-at-unc/newborn-nursery
Outpatient Pediatrics
Well child care in community outpatient practices
Preventive care, anticipatory guidance Acute illness management Chronic illness management
Outpatient Pediatrics - Student Goals
Breadth Examine lots and lots of children Learn behavior and development,
prevention, common acute illness Clarify expectations on the first day in
each setting with each preceptor Challenge yourself to learn and to do Get a picture of what many general
pediatricians do
To get the most out of your outpatient time…
Make sure to clarify the expectations each day
Be flexible, because each day might be different
Seek learning opportunities Challenge yourself Take time to study and to do the CLIPP
cases Refer to your Patient Log to ensure you
are seeing many of the expected cases
Assignments in the Clerkship
Clerkship Assignments - Overview Write ups
Complete a minimum of 3 2 H&Ps, 1 Discharge summary
CLIPP cases Complete 8 required cases
Cultural reflection (optional) Didactic sessions Documentation and completion of patient
encounters/patient log on One45 Midpoint feedback and self-assessment
Inpatient Pediatrics - Patient Write Ups
2 History & Physicals, 1 Discharge Summary With H&P, 3-4 paragraph written discussion
on a topic related to the patient, with at least 2 references cited
H&Ps - focus on Pediatric-specific content Growth and development (including charts),
labor/delivery, etc Due within 72 hours after seeing the
patient Please refer to the clerkship website for
detailed guidelines on the format of patient write-ups
Email them to site directors upon completion. You will receive feedback on your clinical
documentation.
Outpatient Pediatrics Curriculum
CLIPP cases http://www.med-u.org/
Use your med.unc.edu email to login Interactive, web-based curriculum Do at least 8 assigned cases
Some people do lots more Must be completed by the last
Wednesday of the clerkship One question from each CLIPP case will
be on Pediatric Departmental Exam
8 assigned CLIPP cases
Case # 5: 16 year old girl’s health maintenance
Case # 6: 16 year old boy’s pre-sport physical
Case # 15: Two siblings vomiting, 4 year old and 8 weekold
Case # 18: 2 week old with poor weight gain Case # 25: 2 month old with apnea Case # 28: 18 month old with
developmental delay Case # 29: Infant with hypotonia Case # 30: 2 year old with sickle cell disease
Cultural Competence
We expect your cultural sensitivity to improve during your Pediatrics clerkship
Take the opportunity that our diverse patient population provides to develop your skills in working with patients from different cultural backgrounds
If you have questions about how to do this effectively, ask… This is appropriate learning material.
Your Cultural Competency Monday lecture will be a group discussion – bring examples and be prepared to talk about the effects of culture on pediatric care
Working with Interpreters
You will have plenty of opportunities to practice
Get an interpreter when you need one, we now use an internet based interpreter as well as live interpreters – asked to be shown this new technology
Work even harder to establish rapport Look and speak directly to the patient, not
the interpreter Don’t ever say anything you don’t want
interpreted or understood Pause frequently for interpretation Listen to the patient Be patient – it will take longer Attempt to learn some Spanish
Cultural Reflection
This is an optional assignment that can be completed for extra credit
Write a brief reflection on the influence of culture on the care of one of your patients during the rotation. Email it to [email protected] and your WakeMed preceptor
See details and ideas on clerkship webpage
Be ready to discuss reflective statement during small group session
Documenting Patient Experiences
Be sure to complete your Patient Log (One45) of your required clinical experiences
Your patient log will be reviewed at the midpoint of the clerkship with the clerkship or site director to assure you are on track If you are deficient in core patient
experiences, your clinical schedule may be adjusted to provide those experiences
You must complete your Patient Log by the last day of the clerkship
Conferences in the Pediatric Clerkship Morning Report:
Mondays and Thursdays at 7:30am Hicks’ conference room on 4E
Grand Rounds: 1st and 3rd Wednesday at 8:00am-9:00am Andrews Conference Center
Core Medical Student Lecture: Mondays 12:30 to 1:30 3rd FL Andrews
Med./Resident Lecture: Tues., Thurs., Fri. 12:30 to 1:30pm Hicks’ conference room on 4E, occasionally 3rd
FL Andrews Ask a resident/attending daily to confirm
location
Lecture Schedule:
Monday Tuesday Wednesday Thursday Friday
Week 1 Core #1 Med/Res Med/Res Med/Res
Week 2 Core #2 Med/Res Med/Res Med/Res
Week 3 Core #3 Med/Res Med/Res Med/Res
Week 4 Core #4 Med/Res Med/Res Med/Res
Week 5 Core #5 Med/Res Med/Res Med/Res
Week 6 Review Med/Res Final Exam Final Exam
Core:& Review: 12:30 to 1:30 in 3rd Floor Andrews Med/Res: 12:30 to 1:30 in 4E Hicks’ Conference room, Sometimes 3rd FL Andrews
Core Lectures:
1. Fluids and Electrolytes
2. Child Abuse and Neglect
3. Growth/Development and Common Behavioral Issues
4. Immunizations
5. Cultural Competency (should be week 5)
1. Rasheeda Monroe
2. Travis Honeycutt
3. David Adams
4. Steven Pattishall
5. Chief residents
6. Stephen Leinenweber
7. Melissa Johnson (Growth/Development and Behavior)
Core Lectures Core Faculty
Feedback, Evaluation, and Grading
Feedback
Ask for specific feedback from your residents and preceptors If they say, "good job", follow up for specifics Ask "How are my presentations? Notes? Plans?"
Use the evaluation forms to help you Know that "Good job" DOES NOT mean Honors Continue to push yourself for improvement You will meet with the site director for scheduled
Midpoint Feedback at the end of 3 weeks Update your Patient Log and Self Assessment
prior to your Midpoint Feedback session
Grading in Clinical Education Necessary, but….
often subjective, and sometimes unsatisfying
Most students will NOT get Honors ~30% of students across all the Pediatric
Clerkship Sites will earn Honors UNC, WakeMed, Moses Cone, Carolinas
Medical, Asheville
Grading
Grading system is set-up thoughtfully to evaluate your performance, balancing subjective and objective indicators of performance
Goal is primarily to demonstrate learning of essential material and secondarily to differentiate students
Core Competencies Medical Knowledge Patient Care Professionalism
Practice Based
Learning and Improvement
Systems Based Practice
Communication and Interpersonal Skills
Grading
**Note: The clerkship director reserves the right to adjust final grades if necessary. This is to insure the best consistency possible in student evaluation across all sites.**
Grading is on a 100 point scaleFinal Grade Points Scale NBME Score
Honors 88 - 100 > National Mean
High Pass 75 – 87 >35th percentile
Pass 50 - 74 >10th percentile
Condition 37.5 - 49
Fail <37.5
Grading - Overall
Clinical - Inpatient attending - Inpatient residents - Outpatient total - Newborn nursery
60%30%30%25%15%
Participation 10%
NBME Shelf Exam 20%
Departmental Exam 10%
*This means that one person’s evaluation is never enough to change your grade substantially.
Grading – Participation – 10% Completed by WakeMed Pediatric
Education Committee– Drs. Adams, Chief Resident, Leinenweber, Monroe, & Pattishall Small group participation CLIPP cases completion Cultural reflection completion (optional –
extra credit) Write up evaluations Completion of the Patient Log
Professionalism is pass/fail Failure in professionalism evaluation may
lead to failure of the clerkship
Grading – Shelf Exam – 20%
Shelf test is administered in the afternoon on the last Friday of the Clerkship
The Shelf exam is web-based and administered on-line
Students are required to use their laptops distributed them by the UNC SOM for testing
It is students’ responsibility to ensure their laptops are in appropriate working condition for testing prior to the testing date
Grading – Shelf Exam – 20%
Scores are based on national percentiles NOTE: A shelf test score of <
10%ile will result in an Incomplete grade.
Students who earn <10%ile on the shelf test but pass all other requirements of the clerkship, must retake the shelf test only. Upon successful retake of the shelf exam,
the student will receive a grade of Pass. The Pediatrics shelf test is difficult and
you will need to study appropriately
Grading – Departmental Exam – 10%
Oral portion is administered on last Thursday of the clerkship in individual 15 minute appointments
Written/Multiple Choice portion is given immediately following completion of the Oral portion
Departmental Exam is worth a total of 20 possible points:Oral Exam (6 points)Written Exam (14 points)
6 written questions (6 points)8 multiple choice questions – 1 question based on each assigned CLIPP Case (8 points)
Departmental Exam - Oral
A 10 minute discussion of one of the following possible cases:
A 13 month old with anemia A four month old with failure to thrive A 3 day old with jaundice A 6 month old with lethargy A 1 week old with fever A 9 yo with abdominal pain A 2 yo that refuses to bear weight A 1 week old with vomiting An 18 month old with difficulty breathing A 15 yo girl with weight loss
Departmental Exam – Written
All material is based on Learning Group didactics1. Plot and interpret growth data using
growth curves 2. Write an appropriate maintenance fluid
order for a child of a given size.3. Write an appropriate fluid bolus for a child
of a given size.4. Write an appropriate order for medication,
with use of provided references for dosing.5. Determine necessary immunizations for a
child in a given clinical setting. The immunization chart will be provided.
Departmental Exam – Multiple Choice 1 question from each assigned CLIPP case:
Case # 5: 16 year old girl’s health maintenance
Case # 6: 16 year old boy’s pre-sport physical
Case # 15: 2 siblings vomiting, 4 year old and 8 week old
Case # 18: 2 week old with poor weight gain
Case # 25: 2 month old with apnea Case # 28: 18 month old with
developmental delay Case # 29: Infant with hypotonia Case # 30: 2 year old with sickle cell
disease
Departmental Exam
Oral portion is administered at WakeMed in the 3rd FL Andrews conference room on last Thursday of the clerkship in individual 15 minute appointments
Written/Multiple Choice portion is given immediately following completion of the Oral portion
The End of the Clerkship
Complete clinical responsibilities by the last Thursday of the rotation.
Please remember to turn in your 3 write ups within 48-72 hours of seeing the patient. You should NOT turn in all 3 assignments at the same time during the final days of your rotation. We take time to review your write ups and provide feedback that should be incorporated into the next assignment.
General Principles and Miscellaneous Topics
How to Approach a Child
Interact with the child based on his or her developmental level
Include the parent, but focus on the child Establish rapport before starting the
formal exam Start from a safe distance away
Observe general appearance, respiratory status, all you can while talking
Save the invasive parts of the exam for last
When cooperation vanishes, move quickly
How to Identify a “Sick” Child Learn the vocabulary – “looks sick”,
“lethargic”, “toxic” Yale Observation Criteria:
Quality of cry ColorReaction to parent HydrationState variation Responsiveness
Note all vital signs and compare them to age appropriate norms
Skill will grow with experience
Student Maltreatment
You should not be mistreated during your Pediatrics clerkship
If you experience maltreatment, please bring that to the attention of the clerkship director, the Dean of Student’s office, or one of your assigned liaisons
UNC SOM Ombudsman is Dr. Gary Gala Each clerkship site also has an
ombudsman
Reading
Some textbooks are available for your use Check out http://uncpeds.med.unc.edu/ Read the basics first Add the peer reviewed literature on
selected topics UpToDate has some important limitations
in Pediatrics – make sure you are reading about children
Absences
Note the School of Medicine Absence Policy There are a maximum of 3 excused
absences from the clerkship An excused absence may require make-up
responsibilities based on the clinical duties missed
Absences
If you must be absent for any reason you should: Contact your team (Attending or senior
resident) AND Dr. Monroe (252)375-5170 Call Suzanne Record (919)966-3027regarding
your absence or tardiness Note: Do not email the day of your absence as
this delay notification of the appropriate individuals
All absences are reported to the Dean of Student Affairs (Dr. Georgette Dent) for documentation and approval when necessary.
Evaluating the Clerkship
Please provide us with your feedback throughout and specifically at the end of the rotation
Contacts at WakeMed:
David Adams: [email protected] Stephen Leinenweber:
[email protected] Rasheeda Monroe:
[email protected] Steven Pattishall:
Kim Seibel: [email protected] or 919-350-8493
UNC contact information:
[email protected] [email protected], Mobile – 919-428-
6382 [email protected], Phone –
919-966-3027
Pediatric Education Office located on the 2nd floor of MacNider in Rm 230
Phone – 919-966-3027
HAVE FUN!
Remember, it’s your education!