WWAMI Pediatric Clerkship – Missoula, Montana
Introduction
Community Medical Center is a 146 bed hospital, with 4 PICU beds and 8-12 pediatric ward beds.
Admissions average approximately 6,000 each year, and with almost 100,000 outpatient physician visits
annually. Two thirds of patient services are provided to residents of Missoula County; 20% are Ravalli and
Lake County residents, and 15% from elsewhere, including from neighboring states.
The pediatric inpatient service at CMC provides medical and surgical care for the children. The students
will encounter a wide array of diseases and severity of disease from gastroenteritis to respiratory failure.
Our medical staff has representatives of many Pediatric Subspecialties including: (locally) Anesthesiology,
Cardiology, Critical Care, Neurosurgery, Plastic Surgery, Pulmonology, Rehabilitation, Rheumatology, and
Surgery; (regionally) Endocrinology, Genetics, Neurology, and more. Additionally, Seattle Children’s
Hospital provides assistance for complex and critically ill patients.
Medical students will be involved in the direct care of the pediatric patients with the supervision of the
Pediatric Hospitalists and Intensivist, on the Pediatric Unit, and Pediatricians, in the Offices. He/she is
encouraged to assume responsibilities in independent evaluation, differential diagnosis, diagnostic studies,
procedures, therapeutic decisions and discharge planning for each patient, while maintaining good
communication with the supervising physician and primary care provider.
University of Montana and Montana State University nursing students also rotate through the Pediatric Unit
at CMC, as well as local paramedic, respiratory therapy, and pharmacy students.
Competency-based Goals and Objectives
Patient Care
 Gathers essential and accurate information using medical interviewing, physical examination and
diagnostic studies
 Employs good patient communication skills for diagnostic history and physical
 Performs focused patient encounters, and modifies techniques based on age appropriateness
 Counseling patients and families
 Counsels patients about management/therapies in hospital and on discharge
 Communicates bad news to families effectively
 Provides information technology for families
Medical Knowledge
 Knows, critically evaluates, and used current information and scientific evidence for patient care
 Navigates resources for medical knowledge (websites)
 Demonstrates a broad knowledge of general pediatric diagnoses management, such as
bronchiolitis, diabetic ketoacidosis, status asthmaticus, etc.
 Develops clinical problem-solving skills
 Develops a differential diagnosis, based on patient’s history and physical exam
 Selects and interprets results of appropriate diagnostic tests
 Outlines an initial treatment plan
Interpersonal and Communication Skills
 Verbally communicates effectively with physicians, other health professionals, and health related
agencies
 Understands importance of communication with primary care provider and referring
physicians


Communicates with health care team and important resources, such as social workers, case
managers, nursing staff, pharmacists, etc
 Demonstrates patient presentations to staff in a focused, logical manner (complete
presentation for new patients, problem-focused presentation for established patients)
Writes complete and well-organized notes, including:
 Admission notes
 Inpatient progress notes
 Outpatient office notes
Professionalism
 Demonstrates respect for and responsiveness to the needs of patients and society by
 Adherence to ethical principles
 Cultural and socio-economic competency (eg Native Americans)
 Accountability to patients and health care team
 Respect of privacy
Bioethics
 Understand various ethical dilemmas that may present in pediatrics, and demonstrate professional
obligations and decision-making skills
 Cross cultural issues and diverse beliefs
 Parental decision-making
Educational curriculum
1.
CLIPP (22) and paper (5) cases
2.
“Blueprints in Pediatrics, 5th Edition” required reading
3.
Ethics case write-up
4.
History and physical exam write-ups (3)
5.
Observed clinical exams (mini-CEX on newborn and young child)
6.
“Clinical Encounters – Pediatric 3rd Year Clerkship” checklist
7.
Oral or written presentation on pediatric topic of interest
8.
Feedback from staff, oral and written
Procedures
Medical students may have the opportunity to develop skills in the following procedures:
 Hearing and vision screening
 Circumcision
 Electrocardiogram tracing
 Throat culturing
 Immunization administration
 Peripheral intravenous line placement
 Venous/arterial blood sampling
 Nasogastric tube placement
 Bladder catheterization
 Lumbar puncture
 Cardiopulmonary resuscitation (mock and true codes)
Student Roles and Responsibilities
Daily Responsibilities:
Rounds start each day at 8-9 AM on the Pediatric Unit. The medical student is responsible for prerounding and presenting the patients to the team, including patients/families and nursing staff. After family
centered rounds are over, the discussed tasks will be completed, such as discharge planning, and pending
admissions will be addressed.
Lunchtime teaching will begin at approximately noon, though this time may vary. The student will meet
with the physician either in the Offices, Pediatric Unit, or Doctors’ Lounge. In general, teaching will
revolve around didactic talks based on Blueprints chapters or web based CLIPP cases.
Afternoon office visits commence at 1-1:30pm at the respective Clinics, and finish at approximately 5pm.
On the Pediatric Unit, medical students are expected to follow 2-4 inpatients at any given time. Students
are expected to take responsibility for writing H&Ps, progress notes, and managing daily patient care
(ordering/following up labs, studies, consults; communicating with families, etc.)
Oral presentations should be 5-7 minutes on newly admitted patients, and 2-3 minutes for current
inpatients. Written notes should be in SOAP format for daily notes, and in accordance with the Sample
H&P, documented in the Basic Pediatric Clerkship manual from UW SOM.
In the Office, students will fully evaluate and present between 2-4 patients per half day. Patients will be
presented in a brief 2-5 minute oral SOAP format, and an appropriate chart note will be handwritten or
typed in EMR. The note must be completed the same day, since it may need to be dictated at the end of the
day.
It is anticipated that during the first day of week #1in the new office, the student will observe the
Pediatrician. During the rest of weeks #1 and #2, each half day he/she will perform 2-4 patient encounters,
independently or observed. Each week, the number of independent encounters will increase, to a goal of 35 encounters per half day, including 1-2 observed encounters, by the final week.
The basics of doing and recording vital signs on pediatric patients will be done by students, under
supervision, and will include temperature, heart rate, respiratory rate, blood pressure, pulse oximetry,
height/length, weight, and growth chart plotting.
The student will be responsible for completing the Checklist – “Clinical Encounters: Pediatric 3rd Year
Clerkship” throughout the rotation, as he/she interacts with the appropriate patient type. This Checklist will
need to be submitted at the end of the six weeks, as part of the Educational Curriculum.
Newborn physical exams are to be done with the preceptor of the day starting during week 2 of your
rotation. Most of these will be done early in the day at CMC’s Newborn Nursery. One observed physical
exam will be evaluated as the newborn mini-CEX. The Pediatrician will page, or call on the Pediatric Unit,
the student, that morning, if a meeting time has not been previously arranged.
The pediatric mini-CEX may be performed either as an inpatient or outpatient visit.
On-Call Responsibilities:
1.
Each week, the student is expected to take a weekday call. He/she will be notified, via pager, from
the On Call Pediatrician. He/she is not expected to sleep at the hospital, but to be at the hospital
within 15-30 minutes. The Pediatrician will page the student for every hospital patient encounter
he/she attends.
2.
Students will be expected to participate in inpatient admissions and attend deliveries.
3.
Students will be expected to take one weekend call during their 6 week clerkship. This call will
commence at 5pm on Friday evening, and finish at 7am Monday morning. Monday daytime
responsibilities will vary depending on the call night, but will last until, at least, Team Rounds are
over.
Educational Opportunities
1.
Seattle Children’s Hospital web based Grand Rounds Thursdays 9-10am
2.
St. Patrick’s Medical Conferences Fridays 7:30-8:30am
3.
Pediatric Journal Club 2nd Tuesday of each month 12:15-1:15pm
References/Readings:
The Missoula WWAMI Pediatric Clerkship faculty, encourage evidence based medicine through readings
from the most current journals (Pediatrics, New England Journal of Medicine, Journal of Pediatrics,
Archives of Pediatric and Adolescent Medicine, Pediatrics Infectious Diseases, etc) and the use of search
engines to browse the current literature (PubMed, Ovid, etc).
Contacts:
WWAMI Missoula Pediatric Inpatient Clerkship Coordinator
Laurie L. Carter, MD, FAAP
lcarter@communitiymed.org
P: 406/327-4045
WWAMI Missoula Pediatric Outpatient Clerkship Coordinator
Jennifer Hall, MD, FAAP
jhallmt@gmail.com
P: 406/329-7301
Montana WWAMI Clinical Education Executive Assistant
Megan Twohig
megan.twohig@providence.org
P: 406-243-4576