Welcome to the UNC
Pediatrics Clerkship
2014-2015
Objectives for Orientation
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Clearly state clerkship expectations
Clinical activities
 Assignments
 Grading
 Participation
 Policies
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Outline clerkship objectives
Address your questions
For more information, see the clerkship webpage
General Expectations
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~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
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Three weeks Inpatient Pediatrics
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Newborn Nursery
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2 weekday long shifts
One Friday long shift
One Saturday or Sunday long shift
With exposure to neonatal intensive care
~12 half-days of Ambulatory Pediatrics
Some exposure to Pediatric Emergency Medicine and other
subspecialties
Inpatient Pediatrics
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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
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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
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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
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Long shift assigned at least four times
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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 postrounds 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
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Green Team - General, Nephrology, & Genetics
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Purple Team – General, Neurology, & Endocrine
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Rounds begin at 8:30am on the 6th floor of the Children’s
Hospital
Red Team - Cardiology and Gastroenterology
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Rounds begin at 8:30am in the conference room on the 6th floor
of the Children’s Hospital
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
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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…
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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
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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…
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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
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Well child care in community outpatient practices
Preventive care, anticipatory guidance
Acute illness management
Chronic illness management
Outpatient Pediatrics - Student Goals
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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…
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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
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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
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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
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Write ups
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Complete a minimum of 3
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CLIPP cases
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2 H&Ps, 1 Discharge summary
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
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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
 Due
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and development (including charts), labor/delivery, etc
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
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http://www.med-u.org/
 Use your med.unc.edu email to login
Interactive, web-based curriculum
Do at least 8 assigned cases
 Some
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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
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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:
Case # 25:
Case # 28:
Case # 29:
Case # 30:
2 week old with poor weight gain
2 month old with apnea
18 month old with developmental delay
Infant with hypotonia
2 year old with sickle cell disease
Cultural Competence
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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
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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
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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
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You must complete your Patient Log by the last day
of the clerkship
Student Conferences in the
Pediatric Clerkship
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Student Didactic sessions: 12:00pm-1:00pm
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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
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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
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Morning Conferences: M, Tu, W, F 7:45am -8:30am
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Thursday: Grand Rounds 8:00am-9:00am
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Curnen-Denny Conference Room
Old Clinic Auditorium
Resident Noon Conference: Daily 12:00pm-1:00pm
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Curnen-Denny Conference Room
Feedback, Evaluation, and Grading
Feedback
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Ask for specific feedback from your residents and preceptors
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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
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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
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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
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Grading is on a 100 point scale
Final Grade
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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
**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.**
Grading - Overall
Clinical
60%
- Inpatient attending
- Inpatient residents
- Outpatient total
- Newborn nursery
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%
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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
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Professionalism is pass/fail
 Failure
in professionalism evaluation may lead to
failure of the clerkship
Grading – Shelf Exam – 20%
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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%
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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.
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The Pediatrics shelf test is difficult and you will need
to study appropriately
Grading – Departmental Exam – 10%
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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 didactics
1.
2.
3.
4.
5.
Plot and interpret growth data using growth curves
Write an appropriate maintenance fluid order for a
child of a given size.
Write an appropriate fluid bolus for a child of a
given size.
Write an appropriate order for medication, with use
of provided references for dosing.
Determine necessary immunizations for a child in a
given clinical setting. The immunization chart will be
provided.
Departmental Exam – Multiple Choice
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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
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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
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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
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If you must be absent for any reason you should:
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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
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All absences are reported to the Dean of Student
Affairs (Dr. Georgette Dent) for documentation and
approval when necessary.
Evaluating the Clerkship
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Please provide us with your feedback throughout
and specifically at the end of the rotation
Contacts
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Contact information:
 richard_hobbs@med.unc.edu
 wmills@med.unc.edu,
Mobile – 919-428-6382
Education Office located on the 2nd floor of
MacNider in Rm 230
 Pediatric
HAVE FUN!