Welcome to the
UNC Pediatrics Clerkship
at Moses Cone
This is the rotation where…
• You get to have fun
• You get the deep satisfaction of helping
sick kids get better
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More than 90% of medical
students will not become
pediatricians
BUT more than 2/3 of
medical students will go
into fields of medicine
where they will participate
in medical care for children
The goal of this clerkship:
help teach you how to be a
doctor, not necessarily
convince you to be a
pediatrician
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Take ownership of your patients –
know the history, exam, and lab
results at any given time; follow-up
on your patients even when they
have technically left your care; be
responsible for them so that
nothing gets missed.
Learn how to talk with families and
children of different ages both to
get complete, accurate histories,
and to explain clinical findings and
plans. Learn how to reassure.
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Learn how to perform the PE
of children – how to interpret
vital signs at different ages,
how the pediatric exam is
different than the adult exam,
and a basic knowledge of
what is normal.
Write a complete H&P,
including pediatric-focused
items such as development,
diet, and growth.
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Present on inpatient
rounds and begin to
pick out what is most
important to convey to
the team (i.e., do not
repeat the entire H&P).
Assess the development
of every patient you see
and be able to recognize
when it is abnormal.
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Be able to chart the
weight, height, head
circumference, and BMI
and recognize obesity or
failure to thrive and begin
a work-up if indicated.
Talk to families about
prevention, including
immunizations, safety,
violence, sex, and
substance use. Using the
CDC chart, know what
immunizations a child
needs at a given age.
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Write prescriptions appropriately for children
of different sizes.
Be able to clinically recognize a dehydrated
child. Write orders for both re-hydration and
maintenance fluid for children based on size
and clinical condition.
Recognize when a child is in need of urgent
medical attention. Know how to initiate care
and who to call for help.
Outline the approach to diagnosis and
management of common pediatric
conditions.
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Three weeks Inpatient Pediatrics
◦ 4 overnight calls
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Two weeks of Ambulatory Pediatrics
◦ At least 12 half days
◦ Some Subspecialty Clinics exposure
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One week of Newborn Nursery
Chronic Illness Project
Clinical Problem Solving Sessions
Core curriculum conferences
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A list of the kinds of patients we want you to see over
the 6 weeks is on One45
This helps assure you that you are getting to see
fundamental, core pediatric cases
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
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Children admitted to a community hospital
are:
◦ Well children with acute illness
◦ Children with chronic disease presenting for acute
illness or chronic disease management
◦ Children in need of diagnostic evaluation
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Depth
Take ownership of your patients. That means:
◦ You may not know what the next management step is,
but you must know everything going on with your
patient (studies, results, changes in symptoms, etc.)
◦ Look for something to learn on every patient
◦ Follow up what happens to the patient after they leave
(when possible)
Become comfortable with children with special
needs
Understand what needs to be done in the
hospital and what can be done as an outpatient
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Write ups
◦ An H&P should be written for every patient
you admit
◦ Three of the write-ups should be turned in to
your ward attending
◦ 1st WRITE UP DUE THE FIRST FRIDAY of your
inpatient time
 All 3 should include a 1-2 pg discussion
with at least 2 references cited
 Instructions in your packet of information
◦ Please turn in a copy of these 3 H&Ps to Dr.
Nagappan to be graded
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Note writing
◦ Write daily SOAP notes on each of your patients in
EPIC
◦ Your notes will be reviewed by the ward attending
◦ The intern must write an addendum
◦ Make your SOAP notes meaningful – not just a
regurgitation of data
◦ H&Ps and daily notes are very different
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Conferences
◦ Grand Rounds, Wednesday, 8:30-9:30
◦ Noon conference daily 12:30-1:30
◦ Core Curriculum Student Talks daily, 1:30 or 2:30
 Be prepared (readings for each session are on the
website at
http://www.med.unc.edu/pedclerk/schedules/clerkshi
p-at-moses-cone/readings-and-resources)
◦ Friday afternoon sessions, 1:30
 1:30-2 pm: Meet with the clerkship director
 2:30-5 pm: Clinical Problem Solving Sessions
 Be prepared (cases will be handed out to you weekly
and readings are located at
http://www.med.unc.edu/pedclerk/schedules/clerkshi
p-at-moses-cone/readings-and-resources/clinicalproblem-solving-conferences-readings )
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4 calls during your inpatient
month (none during outpatient)
◦ 2 weekdays, 1 Friday, 1
weekend
Call is overnight; call rooms
available; start 8-830 am leave
the next day after presenting
your patients (usually 1030)
Stick with your intern
Weekend rounds start at 9:00
am
Call changes
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730 to 800: Pre-round
900 (except Wed): Rounds
1230-130p: Noon Conference
430p: Sign-out
If weekday call – stay until you have
presented rounds the next am
If weekend call – same pre-rounding time,
stay until you have presented rounds the next
am
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Peds attending (8 of us)
2 senior residents (UNC Peds, Med/Peds, or
Peds Primary Care)
2 interns (Moses Cone FP, or UNC Peds)
1 Acting Intern (usually UNC)
2 (usually) 3rd year med students (UNC)
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ASK every family (each day) whether the family is
willing to have the team round in the room
◦ Helpful phrase: “There is a team of us helping take car
eof your child and, with your permission, I would like to
bring them in with me for rounds this morning so
everyone knows you and your child.”
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LANGUAGE: Using medical jargon can make
families feel excluded.
◦ Use language they can understand.
◦ Summarize important findings in simple language.
◦ Invite the family to correct any information or add
information at any time
◦ Helpful phrase: “We’re going to take about Zeke so that
the day team knows everything about him. If I make any
mistakes or you have anything you want to add, you can
interrupt at any time.”
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PRE-ROUND: FCR does not eliminate the need to
pre-round. For some patients (e.g., child abuse),
it may be helpful to discuss some issues outside
the room prior to entering
TEACHING: Teaching can occur in the patient’s
room during FCR, but there is still the need for
conference room teaching (differential diagnoses,
brief student presentations) which can be done
after rounds
NUSRE INVOLVEMENT: One of the benefits of FCR
is that everyone involved in care is there at one
time. Having the nurse present is invaluable
• Check your login/password today
• Don’t cut and paste forward
• It takes some time to learn – it’s OK to feel “slow” in the
beginning
• Watch out for note bloat
• Route your note to the intern you are working with
• The intern will co-sign and write an addendum that
includes PE and A/P
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Learn the roles, what to expect from whom
Get involved – make yourself indispensable
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 conferences
Remember to wear your badge at all times
This month is time intense
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Well child care
Preventive care,
anticipatory guidance
Acute illness
management
Chronic illness
management
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Breadth
Examine lots and lots of children
Learn behavior and development (review
milestones before well checks), prevention,
common acute illness
Get a picture of what many general
pediatricians do
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Office practices (Mon, Tues, Thurs, Fri
morning)
◦ Clarify expectations on the first day
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Subspecialty Clinics (Wednesday afternoons)
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Seminars (Wed mornings & Friday
afternoon)
◦ Often more shadowing
◦ Exposure to subspecialty pediatrics
◦ Wed: Grand rounds 8:30-9:30 followed by
seminars. There are no specific readings for the
outpatient seminars
◦ Fri: Meet with director (1:30), Clinical cases (2:30)
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One weekend shift in the Peds ED (6 hours)
No call during this time
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CLIPP cases
◦ www.clippcases.org
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Interactive, web-based curriculum
8 cases required
◦ See packet/website for assignment
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There will be one question from each case on
the final departmental exam
Due by the last Wednesday of the clerkship
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This is the time to study
◦ Read the textbook, check your list
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Make sure to clarify the expectations each
day
Be flexible, because each day might be
different
Seek learning opportunities
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Daily activities
begin at 8:30 am
Examine lots and
lots of babies
Daily notes
Gain exposure to
the NICU
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Work on patient relationships, how to talk
with families, developing rapport and
communication skills
Learn what is normal and what is not
Build your comfort with normal baby care
Your physical exam skills will be directly
observed by supervising physicians
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Wed Grand Rounds 830-930 (no seminars
afterward)
Every afternoon you will have focused
sessions on core topics (jaundice, sepsis, etc)
Readings are located here:
http://www.med.unc.edu/pedclerk/schedules
/clerkship-at-moses-cone/readings-andresources/supplemental-readings/newbornissues
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Lots and lots and lots of babies……

Three weeks Inpatient Pediatrics
◦ 4 overnight calls

Two weeks of Ambulatory Pediatrics
◦ At least 12 half days
◦ Some Subspecialty Clinics exposure




One week of Newborn Nursery
Chronic Illness Project
Clinical Problem Solving Sessions
Core curriculum conferences
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A chance to see a patient more than once
(continuity!)
Find out what the role primary care doctors
have in caring for chronically ill children
See details on website
http://www.med.unc.edu/pedclerk/schedules/
clerkship-at-moses-cone/chronic-illnessproject
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During the 1:30-2:30 time, we will fine-tune
your presentation skills, practice the EBM skills
you have already learned
From 2:30 to 430 pm, we will do clinical cases
◦ You will get the cases a week before the session
◦ Prepare by reading about coming up with a
differential diagnosis and reading about the most
likely possibilities
◦ http://www.med.unc.edu/pedclerk/schedules/clerksh
ip-at-moses-cone/readings-and-resources/clinicalproblem-solving-conferences-readings
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This is covered during the afternoon
lectures on your inpatient time and the
morning seminars during your outpatient
time
We will cover the COMSEP curriculum: what
every pediatric student needs to know
Each section of readings on the website
corresponds to one of the core topics
http://www.med.unc.edu/pedclerk/schedul
es/clerkship-at-moses-cone/readingsand-resources/supplemental-readings
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We provide each student with 3 books to use
during the clerkship
These must be returned in good condition at
the end of the clerkship or a student will be
responsible for the full cost of the lost
book(s)
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Ask for specific feedback from your
residents and preceptors
◦ If they say “good job”, follow up for specifics;
how are my presentations, notes, plans?
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You can use the evaluation forms to guide
feedback
Know that “good job” doesn’t mean honors
Dr. Nagappan will give you feedback
midway and at the end of the clerkship. We
will review your patient log on One45 at the
midpoint (make sure it is updated)
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Necessary, but….
imperfect, subjective, and often unsatisfying
Most students will NOT get Honors (usually
about 30%)
Many students will get PASS as a final grade,
and many of those will go on to be fabulous
pediatricians
Note: The clerkship site director reserves the right
to adjust grades as indicated.
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Clinical Evaluations -- 60%
◦ Inpatient Attending – 30% of clinical grade
◦ Resident/Intern Evaluations – 30% of clinical
grade
◦ Outpatient Preceptors – 25% of clinical grade
◦ NBN attending evaluation – 15% of clinical grade
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Participation in seminars & Write-ups & CLIPP &
Chronic Illness & completion of One45 log – 10%
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Departmental exam – 10%
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Shelf Exam – 20%
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**Note: The clerkship director reserves the
right to adjust final grades if necessary. This is
to insure the best consistency possible in
student evaluation across all sites.**
Grading is on a 100 point scale
Final Grade
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
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Shelf test is administered on the last Friday
of the Clerkship at 2:00 p.m. in MBRB
The Shelf exam is web-based and
administered on-line
Students are required to use their laptops
distributed them by the UNC SOM for testing
It is students’ responsibility to ensure their
laptops are in appropriate working condition
for testing prior to the testing date
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Oral exam possible cases: (6 points)
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Written questions. (6 points)
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CLIPP multiple choice questions (8
points)
See details in your packet
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Take ownership of your patients
◦ Be proactive and enthusiastic about helping
◦ But try to recognize your limitations
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Meet with your intern right after rounds to
divide and conquer the daily work
Ask questions – it’s expected!
Be a dependable part of the team
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Nelson’s textbook of Pediatrics (background
knowledge)
Harriet Lane (reference)
The Redbook (infectious disease)
The Clerkship Readings on the website
(core medical student knowledge)
UpToDate has some serious limitations in
pediatrics
Peer reviewed literature
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Get an interpreter when you need one – don’t
take shortcuts
Use professional or phone interpreters – not
relatives, siblings, etc.
Work even harder to establish rapport
Look and speak directly to the patient, not the
interpreter
Don’t say anything you don’t want interpreted
or understood
Pause frequently for interpretation
Listen to the patient
Be patient
Attempt to learn some Spanish
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In Greensboro, you will get experience
working with people from different cultures
Think about how this is affecting your care
Being culturally competent does not
necessarily require having a special set of
knowledge – only that you respect families
wishes and involve them in the care of their
children
You can write a cultural reflection essay for
extra credit (see packet & website)
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No tee shirts with logos or writing on them
(i.e. Hollister)
Fleeces with UNC logos on them are ok
No open-toed shoes in clinical areas
No excessive perfumes/colognes
Long hair has to be pulled up
White coat and/or tie is optional
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You should not be mistreated during your
Pediatrics clerkship
If you experience maltreatment, please bring
that to the attention of Dr. Nagappan or the
Dean of Student’s office or the Greensboro
ombudsman (Dr. Michelle Kane)
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Maltreatment
Needlesticks
If you need to see a doctor here
see attached FAQs
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Wash your hands A
LOT!
Please stay at home if
you are ill. Get in
touch with your
senior resident to let
him/her know that
you will be out and
call the office 8328064
If you have
questions…ASK!!!
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Note the 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
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Promptly notify your clerkship site director or
administrator of absences from clinical
responsibilities.
All absences are reported to the Dean of
Student Affairs (Dr. Georgette Dent) for
documentation and approval when
necessary.
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There is an optional shelf test prep review that we
will send you the link to
The chronic illness presentation is the last
MONDAY of the rotation
The departmental (oral) exam is the last THURSDAY
of the rotation in Greensboro
Complete clinical responsibilities here at 2:00 on
the last THURSDAY of the rotation.
The last FRIDAY of the rotation you will have the
shelf test in the afternoon in Chapel Hill.
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Documentation of patient encounters on One45
(due by 3rd Friday -midpoint feedback day- and updated
by last Friday of clerkship)
Write-ups – minimum of 3
(1st due to ward attending by 1st Friday of inpt; #2&3 due
by end of inpt time)
CLIPP cases – 8 assigned
(due by last Friday of clerkship)
Chronic Illness project
(due by presentation day last Monday of clerkship)
Cultural Reflection Essay
(optional – due by last friday)
Midpoint feedback self-assessment
(due by 3rd Friday - midpoint feedback day)