welcome to the unc pediatrics clerkship
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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:
[email protected] [email protected], Mobile – 919-428-
6382
Pediatric Education Office located on the 2nd floor of MacNider in Rm 230
HAVE FUN!