Welcome to the UNC Pediatrics Clerkship

2014-2015

Objectives for Orientation Clearly state clerkship expectations

Clinical activities Assignments Grading Participation Policies

Outline clerkship objectives Address your questions For more information, see the clerkship

webpage

General Expectations ~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

*See the clerkship webpage for detailed goals and objectives based on the UNC Core Competencies

Clerkship Clinical Structure - Overview Three weeks Inpatient Pediatrics

2 weekday long shifts One Friday long shift One Saturday or Sunday long shift

Newborn Nursery With exposure to neonatal intensive care

~12 half-days of Ambulatory Pediatrics Some exposure to Pediatric Emergency Medicine

and other subspecialties

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 Exposure and 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 – Daily activities

Write a history and physical and/or daily note on each of your patients each day

Write in EPIC as a generic note or progress note

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 Green Team - General, Nephrology, &

Genetics Rounds begin at 8:30am in the conference room on

the 6th floor of the Children’s Hospital Purple Team – General, Neurology, &

Endocrine Rounds begin at 8:30am on the 6th floor of the

Children’s Hospital Red Team - Cardiology and

Gastroenterology Rounds begin at 8:30am at the nurse’s station in

the CICC on the 5th floor of the Children’s Hospital Blue Team - Pulmonary

Rounds begin at 8:30am in the conference room on the 5th floor of the Children’s Hospital

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 student and resident conferences – they are for your learning

Newborn Nursery

Generally the happiest place in the hospital…

Student Activities in the NBN Specific orientation information on the

web page 7am arrival, pre-rounds, rounds, notes,

orders On Monday, discuss daily activities and

expectations Your physical exam skills will be directly

observed by supervising physicians Spend one afternoon in NICU to gain

exposure to critically ill infants (usually T or W)

Prepare a brief teaching presentation on a newborn topic of your choice to present on Friday

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 Learn what is normal and what is not Examine lots and lots of babies 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 life as a general

pediatrician

To get the most out of your outpatient time… Be flexible, because each day might be

different Make sure to clarify the expectations

each day 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

Pediatric Emergency Department Each student is assigned some time in

the Peds Emergency Department One weekend day during the week in the

Newborn Nursery Possible exposure during a subspecialty

week Clarify expectations with your attending

at the start of the shift The major goal is to see a child in need

of urgent medical attention You may also get opportunities to

perform procedures

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 based on 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

Working effectively with interpreters is part of this

If you have questions about cultural competence, ask… This is appropriate learning material.

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 the course directors See details and ideas on clerkship

webpage

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

Student Conferences in the Pediatric Clerkship Student Didactic sessions: 12:00pm-

1:00pm Attendance is mandatory if at UNC In your folder is a weekly schedule of didactics You are not required to attend if you are off-

campus at an outpatient site Learning Group Sessions: Thursdays

2:00pm-5:00pm Attendance is mandatory even if you are away Dr. Hobbs and Dr. Mills Return from outpatient sites for these

Resident Conferences in the Pediatric Clerkship Morning Conferences: M, Tu, W, F 7:45am

-8:30am Curnen-Denny Conference Room

Thursday: Grand Rounds 8:00am-9:00am Old Clinic Auditorium

Resident Noon Conference: Daily 12:00pm-1:00pm Curnen-Denny Conference Room

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 ask good questions

"Good job" does NOT = 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 Grading is on a 100 point scale

**Note: The clerkship director reserves the right to adjust final grades if necessary. This is to ensure the best consistency possible in student evaluation across all sites.**

Final Grade Points Scale NBME ScoreHonors 88 - 100 > National MeanHigh Pass 75 – 87 >35th percentilePass 50 - 74 >10th percentileCondition 37.5 - 49Fail <37.5

Grading - OverallClinical - 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 Clerkship Site Directors

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 an online test Students are required to use their

laptops distributed them by the UNC SOM for testing

It is students’responsibility to ensure 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 - OralA 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

Policies, etc.

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

Absences UNC 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) or outpatient preceptor Call the education office regarding your

absence or tardiness 966-3172 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 Contact information:

richard_hobbs@med.unc.edu wmills@med.unc.edu, Mobile – 919-428-

6382

Pediatric Education Office located on the 2nd floor of MacNider in Rm 230

HAVE FUN!