Pediatric Clerkship Table of Contents and Information
- Growth Chart
- H&P Checklist Card (form)
- History & Physical (example)
- Inclement Weather Policy
- Le Bonheur Security
- Mistreatment Policy
- Needle Stick Injury
- Night Call Card
- Outpatient Information Booklet
- Powerchart (Cerner)
for access call 901-516-0000 #2
- Progress Notes
- SAMPLE NBME Exam
- SLIDE Exam (example)
The pediatric clerkship should foster in the student:
- Acquisition of basic knowledge of growth and development (physical, physiologic, and psychosocial) and of its clinical application from birth through adolescence.
- Development of communication skills that will facilitate the clinical interaction with children, adolescents, and their families and thus ensure that complete, accurate data are obtained.
- Development of competency in the physical examination of infants, children, and adolescents.
- Acquisition of the knowledge necessary for the diagnosis and initial management of common acute and chronic illnesses.
- Development of clinical problem-solving skills.
- An understanding of the influences of family, community, and society on the child in health and disease.
- Development of strategies for health promotion, as well as, disease and injury prevention.
- Development of the attitudes and professional behaviors appropriate for clinical practice.
- An understanding of the approach of pediatricians to the health of children and adolescents.
I. STRUCTURE OF CLERKSHIP
The pediatrics clerkship is divided into two sections: one month of inpatient experience and one month of outpatient experience. You can look on the assignment list to see where you will be and when. Every attempt was made to accommodate requests. Assignments
While on the inpatient month the student will become an integral part of the inpatient ward team, consisting of the attending(s), supervising resident(s), interns and other students. Students will be responsible for writing H&Ps/progress notes and caring for all patients assigned to them.
The ambulatory rotation will be spent rotating through general pediatric and subspecialty clinics evaluating patients and presenting to supervising residents or faculty.
II. RECOMMENDED TEXTBOOKS
This is a misnomer since there is no specifically recommended text in pediatrics. If the student is already sure that he/she will be going into pediatrics as a career, then the more expensive comprehensive text would be most appropriate. However, for simple general review, the less expensive review texts are adequate with no one particular book having any more advantage over the others. The text should therefore be selected for ease of reading and the style that suits the student.
Comprehensive Reference Texts:
- Nelson Textbook of Pediatrics (Behrman and Vaughn) - $115
- Rudolph's Pediatrics (Rudolph, Hoffman and Rudolph) - $150
Fairly Thorough Texts:
- Principles and Practices of Pediatrics (Oski et al.) - $120
- Comprehensive Pediatrics (Summitt) - $10
"Meat and Potato" Text:
- Essentials of Pediatrics (Behrman and Kleigman) - $50
- Handbook of Pediatrics (Merenstein, Kaplan and Rosenberg) - $30
- Annotated Clinical Problems in Pediatrics - $40
- Current Pediatric Diagnosis and Treatment (Kempe) - $60
- Manual of Pediatric Physical Diagnosis (Barness) - $45
- The Harriet Lane Handbook (Greene) - $65
Most Popular Adjunct Texts:
- Case Files- Pediatrics (Toy et al, Lange) - $30
- NMS Pediatrics (Dworkin, Lippincott Williams and Wilkins) - $45
- Blueprints - Pediatrics (Marino and Fine, Lippincott Williams and Wilkins) - $40
|Ambulatory||Pass / Low Pass/ Fail|
|Exam #1 = 3%; Exam #2 = 7%
INPATIENT ROTATION: (50% of total grade)
This grade is determined by your attending(s) and supervising resident(s) with input from your interns based on patient work-ups, daily progress notes, participation in rounds, presentations, etc. To give you an idea of how you are performing, your attending physician(s) will provide written mid-month feedback during your inpatient month. If the faculty fails to provide this feedback, the student is expected to ask the attending for the current evaluation. Mid-month Evaluation
Please carefully review the mid-month and end of inpatient rotation evaluation forms. Note the types of attributes that your attending and residents will be evaluating during your rotation. Listen carefully to the explanation given during orientation concerning how a numerical grade is calculated using these forms. Inpatient Evaluation
AMBULATORY or OUTPATIENT ROTATION: (Pass / Low Pass/Fail)
The purpose of the ambulatory rotation is to give the students a broad exposure to the ways outpatient pediatrics is practiced. Students will rotate through numerous different venues-general pediatric resident clinics, subspecialty clinics, adolescent clinics, developmental clinics, weekly visit with the private practitioner, a week at St. Jude and 4-5 mornings in the newborn nursery.
To get the most out of this experience, it is important that the students come to clinic prepared, having read about the type of patients typically seen in such clinics. They should also be proactive in trying to see patients on their own, keeping in mind the need to avoid disrupting the efficient flow of patients through the clinic.
Slide Examination: At week 3 and week 6 of the clerkship, a slide exam will be given and the score counts: Exam #1 = 3% and Exam #2 = 7% of the clerkship grade. The questions are derived mostly from the CLIPP cases but there are additional ambulatory pediatric issues included as well.
CLIPP cases -The Computer-assisted Learning in Pediatrics Project (CLIPP) is a comprehensive internet-based learning program for use by third year medical students during their pediatric clerkship. CLIPP's 32 interactive cases are designed to cover all of the core content of the curriculum of the Council on Medical Student Education in Pediatrics (COMSEP). It is expected that each CLIPP case will take a student approximately 45 minutes to complete. To access the CLIPP cases go to the CLIPP home Page. There is also a link in the Clerkship Home Page Table of Contents. See directions below for registering.
CLIPP cases to study corresponding with SLIDE Exams
- #1: 2, 5, 8, 9, 11, 19, 23, 25, 29, 32
- #2: 1, 3, 4, 6, 7, 10, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 24, 26, 27, 28, 30, 31
Registering and Logging in
Once you have registered, you can log into the CLIPP cases using your new login and password. Note: please register only once!
Registering to use CLIPP
- Access the CLIPP home page. (www.med-u.org)
- Choose the Sign In icon, which appears at the top of the page.
- Once the box opens, select the Register link.
- The CLIPP registration window will open and you will select the Student option.
- You will then fill out the form accordingly. Please use your UT email address when you register.
- Read the CLIPP Site User Terms and Conditions in the bottom box and select either Accept or Decline.
- If you clicked Accept, the system immediately will send you an email containing a link to complete your registration. The email message will come from firstname.lastname@example.org. Be sure to save the login and password for future use.
Logging into CLIPP after you register
- Go to www.med-u.org
- Choose the Sign In icon, which appears at the top of the page and login with your username and password.
- About mid-page, you will select the CLIPP Pediatric Course icon.
- On the course page, you will select the title of the desired case and the case will open.
Additional directions are available on the CLIPP home page.
Understandably, this format does not lend itself well to critical evaluation of the student’s performance. Consequently, the lion’s share of subjective evaluation for the clerkship is obtained on the inpatient rotation where the students experience the most continuity of evaluators.
Pass- requires documentation of experience and participation in clinic
Fail - 2 or more unexcused absences or serious concerns expressed by various residents or faculty concerning students' performance during the ambulatory rotation.
Low Pass - Multiple concerns expressed by various residents or faculty concerning students' performance during the ambulatory rotation.
Comments from the ambulatory faculty with input from the supervising residents, private pediatrician preceptors, and subspecialty during the outpatient month may be included in the pediatric evaluation that will be sent to Academic Affairs for inclusion in the Dean’s Letter. Once again you are evaluated on patient work-ups, physical examination skills, participation, and preparation prior to the clinic, etc.
The Clerkship Director retains the right to discuss with the attendings any serious infraction, extenuating circumstances or positive behavior not previously known to the attendings and may advise the attendings to alter the student’s grade accordingly.
In contrast to the first two years of medical school where much of a student’s grade is based on objective criteria obtained through written testing, the second two years base much of the grade on subjective evaluation. Perusal of the evaluation form reveals that at least forty percent of the grade is based on evaluation of professional and personal attributes. Physicians-in-training must possess certain necessary attitudes and interpersonal skills. Some of these are inherent, but much can be cultivated particularly in an environment filled with the appropriate role models. The administration of the University of Tennessee feels strongly about this and has published guidelines for Professional Behavior and Conduct in the Centerscope reproduced here.
- Code of Professional Conduct
- General Guidelines for Professional Behavior and Conduct
- Computer Use – It’s become standard that all large corporations monitor the computer use in their businesses. Methodist Hospital, of which Le Bonheur is a part, is no exception. Students can be identified surfing inappropriate websites which will result in dismissal from medical school.
- Students are expected to have completed Cerner training and to have obtained access to the electronic medical record at Le Bonheur prior to the beginning of the rotation. Please inform the clerkship coordinator on the first day of the rotation if you have not accomplished this.
WRITTEN EXAMINATION: (35% of total grade)
At the end of the clerkship the students will take the National Board of Medical Examiners Pediatric Shelf Exam.
A score of less than 59 on this test requires repeat testing. The NBME shelf exam is used as the written re-exam.
Re-examination must occur as follows: if failed during Block 5/6, 7/8, or 9/10 you must retake the exam in January of Block 1 of your M3 year; if failed during Block 11/12, 1/2, or 3/4 you must retake the Shelf exam during May of your senior year.
Failure to be re-examined will result in a failing grade for the rotation. The original test score will be averaged into the final overall grade. Failure of the re-exam or failure of any portion of the clerkship, requires that the entire rotation be repeated. Failure of the first exam, or any segment of the evaluation, negates the ability to receive an “A” as a final grade no matter in what the ultimate grade average results.
Under special circumstances, a student may be able to retake the Shelf exam other than at the regularly scheduled time, and if so, 4 weeks advance notice must be given.
All portions of the pediatrics clerkship including clinics, exams, etc. must be completed and passed within one (1) year of starting the pediatrics clerkship or by September of the senior year, whichever comes first.
The following scale will be used to assign final grades for the clerkship. Grades will not be curved or rounded.
- A: 89.5-100
- B: 78.5-89.49
- C: 67.5-78.49
- F: 67.49 or lower
The standard deviation for final grades is historically very small. Therefore, a difference as small as 0.2 points is significant and will not be curved or adjusted upwards.
Additional Grading Information
When grades are finalized, you will receive an email notifying you that both evaluations and your grading composite are available to view on CORE.
Any student who feels he/she may need an accommodation based on the impact of a disability should contact Student Academic Support Services (SASS) to self-disclose and officially request accommodations. All requests for accommodations must be submitted with supporting documentation and the SASS Self-Disclosure and Accommodation Request Forms. Although students may register for services at any time, please attempt to make arrangements within the first two weeks of the semester as it does take time to process the request and review documentation. For additional information, contact the SASS Disability Coordinator at email@example.com or 901-448-1452.
Student Academic Support Services (SASS) - Any special testing accommodations need to be arranged at the beginning of the rotation. If not it may not be possible to honor requests (i.e. testing in the SASS office, etc.). No special accommodations are necessary for the SLIDE exams.
Students failing to complete and turn in their Pediatric Patient Log cards (white clinic cards), their H&P card, their Night Call card, clinical skills rubrics (all with appropriate signatures), and all duty hours and diagnoses logs within 30 days of the end of the rotation will receive a failing grade for the rotation. Cards are required to be submitted the Wednesday before the Pediatrics Shelf exam. There will be no guarantee that card documentation will be satisfied if cards are submitted at any other time other than the Wednesday before the exam.
Each student is required to complete a Hall S. Tacket evaluation (link will be emailed). These evaluations must be completed before student grades can be turned into the registrar's office. If you do not complete your Hall S. Tacket by the time grades are being reported, an “I” will be submitted for your grade and you will have 1 week from that point to complete it. If you fail to complete your Hall S. Tacket by the end of the week, unless preapproved by the clerkship director, you will receive an “F” for the rotation.
IV. BASIC CLERKSHIP ETIQUETTE
During the week, proper hospital attire is expected.
Daily dress should be business casual (men - trousers, shirts, ties are preferred but optional depending on the attending; women - skirts/slacks, blouses or dresses). No provocative clothing (call me if you don’t know what that means). Scrubs may only be worn after 4pm on call days. You may wear your scrubs post-call and on weekends, however, they should be clean. T-shirts may be worn with your scrub pants, however, shirts with holes, dirt, blood stains, and advertisements are not acceptable.
Scrubs are acceptable in these areas.
Daily dress is business casual. Scrubs should never be worn in the outpatient clinic.
Athletic shoes may be worn if clean and not excessively worn. No open-toed shoes may be worn. Students MUST wear white coats and ID badges at all times.
V. Attendance at Conferences
- PICU Rounds and Chief Resident Rounds: required, not optional. See monthly calendar.
- Jeopardy: While participation is mandatory, the experience is meant strictly for fun and intellectual stimulation.
- Noon Conference: All inpatient students are expected to attend every day.
- Grand Rounds: Mandatory attendance is required of ALL students.
- Clerkship Conference Sessions: On Wednesday and Friday afternoons. Students are required to attend ALL learning sessions. Roll will be taken and will be reflected in your grade.
- Bio-Ethics Rounds: All inpatient students are expected to attend.
- Professor’s Rounds and M&M: All inpatient students are expected to attend.
- Morning Report: All inpatient students are expected to attend every Monday, Tuesday, Thursday, and Friday mornings from 7:30 a.m. to 8:00 a.m.
Conferences meet on Wednesday and Friday afternoons: A schedule is in your orientation packet and on our website (www.uthsc.edu/pediatrics/clerkship). All seminar times are 3:30 – 5:00 pm on Wednesdays and Fridays (only exception is 1:00 seminars for Dr. Wall). Students are expected to read and be prepared to discuss vignettes pertaining to the conference topic. Students are allowed time from 1:30 – 3:00 to accomplish this preparation. Case Conference reading materials are available below for reading. A password is required for each topic. The password will be given to you during orientation and can be found on your case conference schedule.
VI. OUTPATIENT RESPONSIBILITIES
These will be presented by Ms. Wilson in a separate orientation.
Outpatient Rotation Orientation - (See calendar for specific date and location)
Keep in mind that focused exams are only appropriate if you have reviewed the patient’s chart in detail or know the patient well. Otherwise, a more comprehensive evaluation is required so that you can give a complete and accurate presentation to your supervising resident or ambulatory faculty. Remember to develop your assessment, differential diagnosis and management plan before discussing with the supervisor. Students now have access to outpatient Cerner and will be able to access the outpatient electronic medical record.
During normal working hours on weekdays, students must park in their university-assigned parking places. Do not park in the Le Bonheur parking garage or your car will be booted.
For brief periods of relaxation, M3 students are authorized to use the student medical staff lounge located on the 6th floor of the Children's Foundation Research Building. Students are allowed to play video games but are warned that too much playtime could effect their subjective evaluation detrimentally.
Things To Remember
Peds is different. Medical students will experience decidedly less autonomy when dealing with pediatric patients when compared to other clerkships. This should not be taken personally. All efforts are made to limit the procedures performed on children so that painful, frightening intervention is kept to a bare minimum. Students are also advised to make every attempt to attend as many other procedures as possible, such as surgical or radiologic procedures performed on their patients.
Students will be excused from routine duties to be able to attend these procedures provided this privilege is not abused.
The purpose of this rotation is to facilitate the student’s learning about the medicine of Pediatrics, not necessarily to make future pediatricians. If the students have any problems or suggestions on how we can help them learn, they are instructed to call the clerkship director as soon as possible.