Pediatrics Clerkship Review
4/29/14
MEC subcommittee:
Geisel Competencies -> Course Learning Objectives -> Assessment of Learning -> Learning Activities
Course Description:
This is a required 8 week clerkship taken in the 3rd year. 7 weeks are clinical. These are
divided into two rotations, inpatient and outpatient. A core curriculum runs through the 8
weeks.
Clerkship Directors:
Dr. Adam Weinstein – Pediatric Nephrology
Dr. Alison Holmes – Pediatric Hospital Medicine
Geisel
Competency
Medical
Knowledge
1a, c, d
1e
1f
Course Objective
(19 total)
apply age appropriate
and pediatric problem
based knowledge to
patient care bridging
and integrating basic
science, clinical
science and multidisciplinary aspects of
delivery of patient care.
Prgm Obj
Links:1a,1c,1d
describe current
knowledge of pediatric
disease prevention,
risk factor modification,
medical ethics, and
medical-legal issues to
clinical problems in
children and families.
Prgm Obj Links:1e
gather history, counsel
and incorporate in the
care plan the social,
ecomonic, cultural and
personal factors which
How Student is
Assessed
Performance
Evaluations
Final Exam
Case
Discussions
Write Ups
Learning Activity
Performance
Evaluations
Final Exam
Write Ups
Wards
Clinics
CLIPP
Write Ups
Case Discussions
Performance
Evaluations
Write-ups
Wards
Clinics
Write-ups
FOSS
Wards
Clinics
CLIPP
Case Discussions
Write Ups
Clinical
Skills
2a
2b
2c
2d
effect the healthcare
needs of children and
their families,
describing barriers for
pediatric patients and
their families to access
to basic health
services and its effect
on vulnerable
populations
Prgm Obj
Links:1f,3c,4k
Establish comfortable
and mutually respectful
student-patient and
student-family
relationships with
diverse patients and
families and
establishing a
respectful basis for the
doctor-patient
relationship.
Prgm Obj
Links:2a,3a,3b
interview and counsel
pediatric patients and
their families skillfully,
untilizing an age
appropriate and
pediatric problem
based history including
either a
comprehensive or
focused history.
Prgm Obj Links:2b
demonstrate a
complete physical
exam of children, with
appropriate attention to
skill, cleanliness,
infection control,
patient comfort, privacy
and developmental
capacity.
Prgm Obj Links:2c
define and prioritize
the pediatric patient's
problems accurately
and generate an
appropriate differential
diagnosis for childhood
conditions
Performance
Evaluations
Structured
Clinical
Observations
Wards
Clinics
Structured Clinical
Observation
Performance
Evaluations
Structured
Clinical
Observations
Skills Form
Wards
Clinics
Structured Clinical
Observation
Performance
Evaluations
Structured
Clinical
Observations
Skills Form
Wards
Clinics
Structured Clinical
Observation
Performance
Evaluations
Structured
Clinical
Observations
Write-ups
Wards
Clinics
CLIPP
Structured Clinical
Observation
Write-ups
Case Discussions
Prgm Obj Links:2d,2e
2f, g
2h
Interpersonal
Communication
Skills
3d
3e, 3f, 3g
perform and explain
the indications,
complications, and
limitations, of simple
procedures (e.g. throat
cultures, hearing tests)
in children (and to
assist with complex
procedures (e.g.
lumbar puncture) in
children)—take out
Prgm Obj Links:2f,2g
assess and interpret
abnormalities and
findings on common
diagnostic tests and
studies including chest
x-rays, EKGs, blood
tests, and urinalysis.
Demonstrate ability to
inform patients and
families and assess
their understanding of
their treatment options
and motivating them to
make healthy
behavioral and
treatment choices.
Prgm Obj Links:3d
Clinical
Evaluations
Wards
Clinics
Performance
Evaluations
Final Exam
Write-ups
Wards
Clinics
CLIPP
Write-ups
Case Discussions
Performance
Evals
Skills Form
Structured
Clinical
Observations
Wards
Clinics
Case Discussions
Structured Clinical
Observation
Communicate
effectively with
patients of different
social, economic and
cultural backgrounds
around individual
factors that impact
health.
Performance
Evals
Structured
Clinical
Observations
Wards
Clinics
Structured Clinical
Observation
FOSS
Case Discussions
communicate
effectively and
collegially with
physician colleagues
and other members of
the health-care team
verbally, in writing and
in the electronic
medical record as it
relates to pediatric
patients.
Prgm Obj
Performance
Evals
Write Ups
Skills Form
Structured
Clinical
Observations
Wards
Clinics
Write Ups
Case Discussions
Structured Clinical
Observation
Links:3e,3f,3g
Formation of
Professional
Identity
4a, 4b, 4e
4c, 4d, 4f, 4g
4h, 4j, 4i
4l
Develop Habit of
Inquiry into and
improvement of
one’s own
personal practice
5a, b, e, f,
behave respectfully
and responsibly
towards patients,
families, colleagues,
and all members of the
health-care team and
empathize and be
respectful of each
patient
Prgm Obj
Links:4a,4b,4e
adhere to high ethical
and moral standards,
accept responsibility
for personal actions,
accept constructive
criticism and respect
patient confidentiality,
placing patient
interests first, being
mindful of personal
opinion and bias.
Prgm Obj
Links:4c,4d,4f,4g
take responsibility for
his or her own medical
education, and
develop the habits of
mindfulness and
reflection and
maintaining one's own
health._
Prgm Obj Links:4h,4j,4i
incorporate
constructive
suggestions during
peer review.
Prgm Obj Links:4l
identify and critically
evaluate relevant
information about
evidence-based, costconscious strategies in
the care of pediatric
patients and
populations and to
apply this to pediatric
patient care and to
continuous updating of
skills.
Prgm Obj
Performance
Evals
Professionalism
Points
Wards
Clinics
Case Discussions
FOSS
Performance
Evals
Professionalism
Points
Wards
Clinics
Case Discussions
FOSS
Performance
Eval
Professionalism
Points
Wards
Clinics
Case Discussions
Write Ups
Write Ups
Performance
Evals
In-Depth
Discussion
Wards
Clinics
Case Discussions
In Depth Discussion
High Value Health
Care Assignment
Links:5a,5b,5e,5f,6c,6h
Systems-based
practice / Science
of healthcare
delivery
6a, 6b
6e, f, g
identify and utilize
appropriate resources
to support pediatric
patient care and
compare the roles of
and collaborate with all
members of the
pediatric interprofessional team.
Prgm Obj Links:6a,6b
discuss the larger
environment and the
physician's role in
which healthcare
occurs including the
effect on underserved
population and
regional variations in
the delivery of
healthcare.
Prgm Obj
Links:6e,6f,6g
Performance
Evals
Wards
Clinics
Performance
Evaluations
Wards
Clinics
High Value Health
Care Assignment
Review Notes:
Blackboard Objectives do not match Ilios objectives – please reconcile.
Essential Skills/Conditions
ESSENTIAL
CLINICAL
CONDITION
Health maintenance
(13-17)
Health maintenance
(1 mo-12 yo)
Newborn visit (0-30
days)
Developmental Delay
Failure to thrive
Fever (? Source)
Obesity
Viral syndrome
Murmur
Rash
Headache
Otitis media
Pharyngitis
URI
Dehydration
Aggregate/diarrhea
or nausea/vomiting
ADHD
Asthma, wheezing
LEVEL OF
STUDENT
RESPONSIBILITY
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
Manage with
assistance
CLINICAL
SETTING
Outpatient
Outpatient
Inpatient /
Outpatient
Inpatient/
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient/
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient/
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient /
Outpatient
Inpatient/
Outpatient
Inpatient /
Outpatient
% Performing at least
1
100
Alternative
Learning
Opportunity
CLIPP
100
CLIPP
99
CLIPP
97
CLIPP
100
CLIPP
99
CLIPP
98
CLIPP
97
CLIPP
100
CLIPP
99
CLIPP
100
CLIPP
99
CLIPP
100
CLIPP
99
CLIPP
100
CLIPP
98
CLIPP
100
CLIPP
NOT ON DMEDS
Structured Clinical
Observations
Write Ups
100
Structured Clinical
Observations
Write Ups
Structured Clinical
Observations
Structured Clinical
Observations
Structured Clinical
ESSENTIAL CLINICAL SKILL
HPI relevant to this
clerkship --- change
to age appropriate
HPI and PE
Developmental
surveillance
HEENT exam
Newborn exam
Tanner staging exam
Perform
Inpatient /
Outpatient
Perform
Inpatient /
Outpatient
Perform
Inpatient /
Outpatient
Perform
Inpatient
Perform
Inpatient /
100
99
100
Outpatient
Complete exam
Throat culture
(simple) -- Remove
Nutrition/diet or
weight change
counseling, including
obesity
Normal/abnormal
development
counseling
Oral presentation,
admission
Oral presentation,
inpt progress
Oral presentation,
ambulatory visit
Written note,
inpatient admission
Written note,
inpatient progress
Written note, SOAP
note
Pediatric medication
order
Perform
Inpatient /
Outpatient
Perform
Outpatient
Perform
Inpatient /
Outpatient
Perform
Inpatient /
Outpatient
Perform
Inpatient
Perform
Inpatient
Perform
Outpatient
Perform
Inpatient
Perform
Inpatient
Perform
Outpatient
Perform
Outpatient/
Inpatient
100
Observations
CLIPP
Structured Clinical
Observations
Write Ups
92
100
Structured Clinical
Observations
Write Ups
99
CLIPP
100
Structured Clinical
Observations
100
100
Structured Clinical
Observations
100
Write Ups
100
100
Write Ups
Review Notes:
You have separate “Learning Expectations” on Blackboard which don’t completely match these essential
clinical skills. Consider adding these to the Essentials or clarifying expectations. Specifically:
 Assess a child’s immunization status by knowing and applying the current recommendations
for immunizations and recommend additional immunizations as appropriate.
o Part of Health Maintenace—already there
 Correctly write a pediatric prescription, dosing by weight, for a medication available in a
syrup or solution form.
o Added
 At least once per week, use the medical literature to answer a question that has arisen in the
course of patient care. Share this information with your preceptor.
o Not needed as clinical skills documentation—as we already have an assignment
which accomplishes (In Depth Discussions)
Learning Assessment Tools:
1) DMEDS – Assess progress on meeting essential skills and conditions
a. You have required inpt (6) and outpt (48) encounters
2) Essential Skills Competency Form – Students assessed as meeting level of skill expected of
3rd year
3) Clinical Performance Evaluation Form – Competency based assessment, completed by
faculty and residents
4) 3 Structured Clinical Observations (inpt, outpt, nursery)
5) 2 Write Ups (Outpt WCC / Inpatient Admission)
6) In Depth Discussion: A one-page focused clinical, scientific or health policy discussion is to
be submitted with each of the two write-ups you will turn in for the clerkship.
7) CLIPP final exam
8) Mid-clerkship feedback forms
9) Final Feedback / Grade narrative
Learning Environments / Activities:

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Orientation
o Thursday – Nuts and Bolts, ILP (individual learning plan), PE Pearls, Newborn
o Friday – Fluids, Sepsis, Vaccine Preventable Illness, Musculoskeletal Exam
Lecture/Small Group Friday Afternoons
o Case Based Learning emphasizing teamwork, clinical reasoning, and thought
process
Wards / Clinic
Computer assisted learning in Pediatrics Program (CLIPP) – 32 cases
o Curriculum developed by COMSEP
Write-Ups
In Depth Discussions
From the other Side of the Stethoscope (FOSS)
o Pediatric FOSS is an opportunity for students to learn from families of children with
serious health concerns – either chronic or newly diagnosed – what they expect,
need and value for their child.
o Students write a reflection of an encounter with a family, post it to blackboard. All
reflections are read by members of the Family Faculty (all of whom have children
with chronic health conditions).
o During the last week of the rotation, students and Family Faculty meet to discuss the
reflections and answer discuss their life experiences.
High Value Health Care Assignment
o Review the pediatric “Choosing Wisely” lists linked to the course Canvas site early in
the clerkship
o During the clerkship, be on the lookout for instances of “waste” in pediatric care
o Write a 250-500 word reflection on your findings with 1-2 references.
o Submit via Canvas by the 5th Friday of the rotation

o Will not be graded, but will be shared and will be basis of HVHC Friday PM seminar
Self Study
o CLIPP, Primary medical literature, Harriet Lane textbook loaned to students
Evaluation and Grading
Student Evaluation and Grading
The components used to assess your Pediatric Clerkship performance are based on the six core
competencies as follows:
1. Medical Knowledge
2. Clinical Skills and Patient Care
3. Continuous Personal Learning and
Improvement
4. Interpersonal and Communication Skills
5. Professional Attitudes and Behavior
6. Practicing Medicine in a Complex Healthcare
System
Honors: Honors performance in all six competencies
High Pass: At least High Pass caliber performance in all six competencies
Pass: At least passing performance in *all* six competencies
Fail: Failure to be considered for failing performance in any single competency
Your final grade and summary of comments will be forwarded to the Registrar and the Dean of
Student Affairs Office for inclusion in your Dean’s Letter. Any concerns about your faculty or
resident evaluations, final examination performance, write-ups, observed H&Ps or pediatric grade
should be discussed as soon as possible directly with Dr. Holmes and/or Dr. Weinstein.
Student Clinical Evaluations




Covers all six competencies
Assign to residents and faculty preceptors/attendings
 At the end of each clinical rotation you are responsible for notifying Sharon French
regarding the faculty and residents with whom you had significant contact.
 We encourage you to ask your faculty or residents to review your evaluation with you
prior to the completion of your time with them.
 Your faculty and residents will complete the evaluations on-line.
 We will monitor your file and send reminders to assigned residents and faculty who
have not yet submitted evaluations.
Comments are selectively used in final grade narrative which becomes part of Dean’s Letter
Ratings in each section contribute to competency specific grades.
Final Exam


The pediatric final exam occurs on the final day of the clerkship.
 You will have 3 hours to complete the examination.
 It is 100 questions, multiple choice
 The questions in the final exam are taken directly and entirely from the CLIPP cases.
Grade contributes to Medical Knowledge competency-specific grade.

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


Honors >/= 87%
HP >/= 80%
Pass >/= 68%
Fail < 68%
Students who have documented special accommodations for examinations must inform Sharon
French by the end of the first week of the clerkship.
It is a violation of the Honor Code to share information about the pediatric final exam with other
students. Such violations will be taken very seriously and will be reported according to policy.
Write-Ups (2 total)


Over the course of the clerkship, 2 write-ups need to be turned in to Canvas for peer review and
then grading by clerkship directors
Grade is Pass-Fail, but exceptional performance with commendation may influence a borderline
grade for: Clinical Skills in Patient Care and Interpersonal and Communication Skills
In Depth Discussion (2 total)


Contributes to Continuous Personal Learning and Improvement competency specific grade.
A detailed description of the evaluation criteria and required format is included in the Canvas
section on required write-ups.
Professionalism






Professionalism is very important and contributes to your overall grade
It includes
 How you interact with patients, colleagues, staff, etc…
 Personal responsibility: attendance, communication, dress
 Timely completion of assignments and evaluations
 Participation in didactics, rounds, mock codes, etc….
It will be specifically commented on in your summative evaluation for inclusion in your Dean’s
Letter.
Concerns of unprofessional behavior – pattern of behavior or significant critical event considered individually, but can be grounds for failure
Professionalism points—everyone starts with 10 points
 H = 9-10 points
 HP = 7-8 points
 P = 5-6 points
 F = 0-4 points
Ways to lose professionalism points:
 Concerns from preceptors/residents/patients
 Case-by-case basis
 We’ll ask for your perspective before taking away any points
 Loss of 1point each for any and all of the following without prior approval by Clerkship
Directors:
 Late write-ups, inadequate DMEDs entry, unapproved absences, missing
evaluations, missing SCOs, incomplete clinical skills
 For late assignments, additional points will be lost for further delays
Complete Structured Clinical Observations [c-SCO] (3 total)
Completion of all 3 required SCOs is required to receive full credit from these exercises. No partial
credit will be given. Additional information about the observed SCOs can be found in a separate
section of the syllabus devoted to this feedback exercise.
Course Planning




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Educational Team Structure
o Two directors, site directors
o One Clerkship Coordinator
Self –Review/ Planning Methods
Method and Frequency of Coordination with Non-DH sites
o Phone regularly
o Emails whenever student starting and completing rotation; also yearly email
update
o Site visits-- Inpatient every 3 years; Outpatient every 5-6 years
Faculty Preparation
o How are faculty members at each site oriented to the course objectives and
grading system?
 Email
Resident Preparation
o Describe process to provide clerkship objectives to residents who will be
teaching students:
 Survey Monkey / Email
o Describe process to prepare residents for their roles as teachers:
 Bimonthly Resident as Coach sessions
 Resident Retreats
 Students provide feedback on their resident teachers
Duty Hours
Have you exceeded the work
hours defined by this policy on
the clerkship you just
completed?
Pediatrics
Inpatient
Medicine
OB/GYN
Surgery
Family
2013-14
YES
3
1
2012-13
YES
2
3
1
1
0
1
31
During this
clerkship, how
many weeks did
you work over 80
hours? 2013-14
During this clerkship,
how many times did
you work beyond 30
consecutive hours?
2013-14
1 2 3 4 5 6
1 2 3 4 5 6
2 1 0 0 0 0
2 0 0 0 0 0
0 0 0 0 0 0
2 0 0 0 0 0
>
7
0
0
2 0 0 0 0 0
1 0 0 0 0 0
0 0 0 0 0 0
1 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0
0
Medicine
Geriatrics/Am
b Med
Neurology
Psychiatry
0
0
0
1
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0
Special Topics
 Topic of Interest and concern for integration across 4 years
o Development of Mind and Body; Illness in Context of Developing
Human
 Opportunities for Inter-professional Education to include all students
o Occurs with bedside rounding at inpatient sites
o Pediatric and Neonatal Resuscitative Simulation with Nursing
Students and Pharmacy Students
 Opportunities for Teaching High Value Health Care to include all
students
o High Value Health Care Assignment
Clerkship Outcomes
AAMC GS 2013 Questionnaire – Pertains to student completing clerkship in AY 2011-12 and
AY 2010-11 (split students).
Rate Quality of educational experiences: (1 = Poor to 4 = Excellent)
Student Feedback – See Attached Report
 Numerical Highlights:
o Overall Experience: Very Good: Overall - 4.25 (12-13)
o Ability of Years 1 and 2 to prepare: Good: 3.14 (12-13)
 30% of students say Fair or Poor
o Site Directors and Clerkship Director: Excellent:
 Inpt 4.63 / Outpt 4.57 (12-13)
o Quality of Teaching by Attendings: Very Good:
 Inpt 4.43 / Outpt 4.39 (12-13)
o Quality of Teaching by Residents: Very Good:
 Inpt 4.26 / Outpt 4.43 (12-13)
 Narrative Themes:
o Too much busy work; discussions with writes up burdensome, too many
CLIPP cases
Site Comparability


See attached Report
Possible Grade distribution Issues at Concord and Woodstock (higher
number receiving Pass)
o 15 students at Concord—wider spread—
 more Honors and more Pass; fewer HP.
 A couple students with known educational “challenges” were
assigned here
o 13 students at Woodstock—this was a one year phenomena
 So far this year: 2 Honors; 3 HP; Zero Pass