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Clerkship Information


Goals and Objectives (LCME mapping terms)

Patient Care

  • Provide compassionate, patient- and family-centered care to all patients in all clinical settings. (patient care, pediatrics, patient-centered care, family-centered care, interpersonal and communication skills)
  • Demonstrate effective history-taking and physical exam skills for infants, children, and adolescents. (history and physical exam, pediatrics, patient care, medical knowledge)
  • Apply knowledge of human growth and development to the care of pediatric patients at all ages. (patient care, growth and development, pediatrics)
  • Document appropriately encounters for pediatric patients in both inpatient and outpatient clinical settings

Knowledge for Practice (Medical Knowledge)

  • Demonstrate basic knowledge of growth and development (physical and psychosocial) from birth through adolescence. (growth, development, pediatrics, medical knowledge)
  • Explain the disease mechanisms, diagnosis, and initial management of common acute and chronic illnesses in pediatrics patients. (medical knowledge, acute illness, chronic illness, pediatrics)
  • Develop clinical problem-solving skills as evidenced by thoughtful differential diagnoses and assessments. (clinical reasoning, illness scripts, differential diagnosis, medical knowledge, patient care

Practice-Based Learning and Improvement

  • Apply strategies for health promotion, as well as disease and injury prevention to improve the care of pediatric patients. (disease prevention, injury prevention, health maintenance, patient care, medical knowledge, systems-based practice, practice-based learning and improvement)
  • Utilize evidence-based principles to advance the care of pediatric patients. (evidence-based medicine, pediatrics, practice-based learning and improvement)
  • Engage in self-directed learning to encourage the practice of life-long learning. (self-directed learning, life-long learning, pediatrics, practice-based learning and improvement)

Interpersonal and Communication Skills

  • Develop communication skills that will facilitate the clinical interaction with children, adolescents, and their families and thus ensure that complete, accurate data are obtained. (communication skills, professionalism, patient care, interpersonal skills and communication, interprofessional team)
  • Provide anticipatory guidance to parents and caregivers regarding their child’s development and medical illnesses. (interpersonal and communication skills, anticipatory guidance, pediatrics)

Professionalism

  • Develop the attitudes and professional behaviors appropriate for clinical practice. (professionalism, interpersonal skills and communication)

Systems-Based Practice

  • Recognize the illness severity of a patient and effectively communicate this severity to other team members through effective patient handovers. (patient care, illness severity, medical knowledge, patient handover, communication, systems-based practice, pediatrics)
  • Recognize the impact of family, community, and society on the health and wellness of children. (social determinants of health, population health, patient care, systems-based practice, interpersonal skills and communication)
  • Recognize the approach of pediatricians to the health care of children and adolescents. (systems based practice, population health, social determinants of health)

Interprofessional Collaboration

  • Participate as an active team member in multi-disciplinary patient- and family-centered rounds.
General Description

Structure

The 6-week pediatrics clerkship is divided into two sections: 3 weeks of inpatient experience and 3 weeks of outpatient and nights. Please view the Student Assignments for details.

While on the inpatient month, you will become an integral part of the inpatient ward team, consisting of the attending, supervising residents, interns, and other students. The outpatient rotation will be spent rotating through general pediatric, subspecialty clinics, newborn nursery, NICU, and a week of nights.

Things to Remember

Peds is different! 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.

Recommended Text

There is no specifically recommended text in pediatrics. You should choose a resource that best meets your needs, such as a more comprehensive text for those interested in a career in pediatrics and a simple reference text for those wanting a review of the highlights of pediatrics.  Practice questions are also a great adjunct for shelf exam studying.

Comprehensive Reference Texts:

  • Nelson Textbook of Pediatrics (Behrman and Vaughn) - Available on Clinical Key
  • Rudolph's Pediatrics (Rudolph, Hoffman and Rudolph)

"Meat and Potato" Texts:

  • Nelson Essentials of Pediatrics (Marcdante, Kleigman) - Available on Clinical Key
  • Current Diagnosis and Treatment Pediatrics (Lange)

Miscellaneous Reference Texts:

  • Manual of Pediatric Physical Diagnosis (Barness)
  • The Harriet Lane Handbook (Greene) - Available on Clinical Key

Most Popular Adjunct Texts:

  • Case Files- Pediatrics (Toy et al, Lange)
  • Pediatrics PreTest (Yetman and Hormann)
Curriculum

COMSEP Curriculum

The pediatrics clerkship follows the Core Curriculum developed by the Counsel on Medical Student Education in Pediatrics (COMSEP). Here is an outline of the most updated COMSEP Curriculum.

Pediatric Physical Exam

You can view a video on the pediatric physical exam using this Learning Resources link from COMSEP.

Aquifer Pediatrics Cases

The clerkship also utilizes the Aquifer Pediatrics cases, developed by COMSEP, to teach and test the important points of clinical pediatric care. Aquifer is a comprehensive internet-based learning program with 32 interactive cases are designed to cover all the core content of the COMSEP curriculum. It is expected that each Aquifer case will take a student approximately 45 minutes to complete.  To access the Aquifer cases, go to the Aquifer home page. See directions for registering.

We will focus on 10 Aquifer cases during the clerkship, which will be assessed on the Slide exam during Week 3 of the clerkship:

Assigned cases: 2, 8, 11, 12, 15, 17, 18, 19, 21, 25

Instructions for Logging onto Aquifer

General Responsibilities

Inpatient

The inpatient portion of the clerkship is fun but busy. Students should carry 4 patients each day. Daily responsibilities include attending morning checkout and morning report, pre-rounding on patients, writing H&Ps on the patients you admit, writing daily progress notes on each patient, attending daily rounds and presenting your patients, following up on lab tests, diagnostic studies, consultants, seeing patients again in the afternoon.

H&Ps

Students are required to turn in 4 written H&Ps to an attending on the inpatient rotation; roughly one per week of inpatient and nights. Students may turn in multiple H&Ps on their night shift week. H&Ps should contain a complete history and physical exam, as well as a differential diagnosis with discussion, assessment with working diagnosis, and plan with justifications. This is an example of a pediatric H&P.

Progress Notes

Progress notes on the inpatient wards follow the Interim History, Objective, Assessment, Problem list/Plan format.  This is an example of an inpatient progress note.

Discharge Summaries

Practice writing a discharge summary for one or more of your patients being discharged home. This is a critical skill to learn as this is your communication with the patient’s next care provider, usually the primary care physician. Use this discharge summary template to help organize your discharge summary.

Night Shifts

At the Memphis location, students will complete four night shifts during the inpatient month, usually Sunday through Wednesday nights. For the first week of the rotation, nights will be Tuesday through Friday night.  Night shifts will begin at 7:00 pm and end at 8:00 am after morning report. Students are expected to follow the night intern for all cross-cover issues and new admissions. Students should complete an H&P for each admission and turn in at least one formal written H&P to their attending during this week. Students should also briefly present one of their overnight admissions during morning check-out (handover) each morning after a night shift. If you have ANY questions about night shift, please contact Dr. Bettin or Ms. Wilson immediately.

For clinical sites other than Memphis, night shift times and days may vary. Please contact your local clerkship director for more details.

Handovers

Students on days should practice signing out to the night shift student using the I-PASS format. Students on night shift should use the I-PASS format to handover one or more patient(s) during morning handover each day.

Admission Orders

Students should practice writing their own admission orders while on call and compare theirs to those of the admitting resident. This is an example of admission orders.

Presentations

Students may be asked to give 2-4 short presentations (3-5 minutes each) to their team on general pediatrics issues. Choosing topics, which relate to current patients, helps to improve clinical applications of knowledge.

Outpatient

The outpatient portion of the clerkship is designed to provide students with a broad view of outpatient and subspecialty pediatric opportunities. Students will attend clinic one day per week with a general pediatrics preceptor. Students will rotate in the newborn nursery and/or NICU, sub-specialty clinics, and emergency department shifts. To get the most out of this experience, students should be proactive in trying to see patients on their own when permitted. Students are required to have each outpatient attending sign their handbook for EACH CLINIC experience during this month (excluding your community preceptor).

Newborn Nursery/NICU

For information about the Newborn Nursery/NICU, please view the medical students curriculum.

Grading

Distribution

Component Percent of
Final Grade
Inpatient Rotation Evaluation 50%
Shelf Exam 35%
SLIDE Exams 10%
Outpatient/Newborn Evaluation 5%
Outpatient (Ambulatory) Rotation Pass/Low Pass/Fail

Grading Scale

The following scale will be used to assign final grades for the clerkship. Grades will not be 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 adjusted upwards.

Inpatient Rotation

This evaluation is completed by your inpatient attending on eMedley with input from supervising residents and interns based on patient work-ups, daily progress notes, participation in rounds, and presentations. It will be based on EPAs (Entrustable Professional Activities) and accounts for 50% of the final clerkship grade. Inpatient Evaluation

To give you an idea of how you are performing, your attending physician will provide written mid-month feedback halfway through your inpatient rotation. If the faculty fails to provide this feedback, the student is expected to ask the attending for the current evaluation. This form should be turned into the clerkship coordinator at the end of the second week of the inpatient rotation unless otherwise stated during orientation. Mid-Rotation Feedback

During your week of nights, a resident will evaluate your performance using the following form Resident Evaluation. This form should be returned to the clerkship coordinator at the end of your week of nights.

Shelf Exam

At the end of the clerkship, students will take the National Board of Medical Examiners (NBME) Pediatric Shelf Exam as the written exam. This score accounts for 35% of the final clerkship grade. The minimum passing score is 63. The minimum score to be eligible to receive an “A” for the clerkship is 81. The NBME shelf exam is also used as the written re-exam. NBME Sample Exam

Re-examination must occur as follows: if failed during Block C, D, E, or F you must retake the exam in January of Block A of your M3 year; if failed during Block G, A, or B you must retake the Shelf exam by the end of Block 8 of your M4 year.  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’ notice must be given.

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.

Slide Exams

At week 3 of the clerkship, a Slide Exam will be given and will count as 10% of the total clerkship grade. The questions are derived from the topics in the Aquifer Pediatrics cases but there are additional general pediatric issues included as well. Sample Slide Exam

Outpatient/Newborn Evaluation

Students will spend one day per week with their outpatient community preceptor while on the outpatient weeks of the clerkship. Students should participate in both well child care and acute visits during this time. For students rotating in Memphis, there will be a short evaluation for preceptor portion of the outpatient rotation that is to be completed by the community preceptor. For students rotating in Chattanooga or Knoxville, this identical evaluation will be completed in the newborn nursery by the supervising attending. This evaluation will account for 5% of the overall clerkship grade at all sites. Outpatient/Newborn Evaluation

Outpatient Rotation

Understandably, the format of the outpatient rotation 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. Comments from the outpatient/subspecialty faculty with input from the residents, newborn nursery/NICU attendings, and private pediatrician preceptors during the outpatient rotation may be included in the inpatient pediatric evaluation that will be sent to Academic Affairs for inclusion in the MSPE. Once again, students are evaluated on patient work-ups, physical examination skills, participation, and preparation prior to the clinic, etc.

  • Pass- requires documentation of experience and participation in all clinics
  • Low Pass - Multiple concerns expressed by various residents or faculty concerning students' performance during the ambulatory rotation.
  • Fail - 2 or more unexcused absences or serious concerns expressed by various residents or faculty concerning students' performance during the ambulatory rotation.

Important Notes on Grading

The Clerkship Director retains the right to discuss with the attending physicians any serious infraction, professionalism issues, extenuating circumstances, or positive behavior not previously known to the attendings and may advise the attendings to alter the student’s grade accordingly.

All portions of the pediatrics clerkship including clinics and exams must be completed and passed within one (1) year of starting the pediatrics clerkship or by September of the senior year, whichever comes first. Failure of the first shelf exam, or any segment of the clerkship, negates the ability to receive an “A” as a final grade no matter in what the ultimate grade average results.

When grades are finalized, you will receive an email notifying you that your evaluations and grading composite are available to review.

Students are required to turn in all assignments and documentation with appropriate signatures (clinic logs, mastery skills sheet, clinical skills rubrics, duty hours and diagnoses logs) by the last day of the rotation. Students failing to complete assignments by the last day of the rotation will be notified in email of the missing assignments.  If assignments (including duty hours and diagnoses logs) are not completed by 4 weeks after the end of the clerkship, this will result in a drop of 1 letter grade for the final clerkship grade due to professionalism.  Additionally, the Dean of Student Affairs will be notified.  If all assignments are not completed by 8 weeks after the end of the clerkship, this will result in a failing grade for the clerkship and the full clerkship must be repeated.

Hall S. Tacket Evaluations

Each student is strongly encouraged to complete a Hall S. Tacket clerkship evaluation at the conclusion of the clerkship (link will be emailed).

Helpful Links for Grading

SASSI Accommodations

Any student who feels he/she may need an accommodation based on the impact of a disability should contact Student Academic Support Services and Inclusion (SASSI) to self-disclose and officially request accommodations. All requests for accommodations must be submitted with supporting documentation and the SASSI Self-Disclosure and Accommodation Request Forms. Although students may register for services at any time, please attempt to make arrangements within the first week of the clerkship as it does take time to process the request and review documentation. For additional information, contact the SASSI Disability Coordinator at lbrook15@uthsc.edu or (901) 448-1452.

Any special testing accommodations need to be arranged at the beginning of the rotation, otherwise it may not be possible to honor requests (i.e. testing in the SASSI office, etc.) In general, no special accommodations are necessary for the Slide exam.

Professionalism

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 clinical evaluation. Perusal of the evaluation form reveals that a portion 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 reproduced here:

Computer Use

It has 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.

For Powerchart (Cerner) access, call (901) 516-0000 #2.

Conferences and Calendars

Case Conferences

For students rotating in Memphis, Case Conferences (didactics) are Friday afternoons from 1:00pm-4:00pm. A schedule is in your orientation packet and at the top of the website as a quick link. Students are required to attend ALL learning sessions. Roll will be taken and will be reflected in your grade. Please review the appropriate Case Conference reading materials prior to Case Conference. A password is required for each topic and can be found on your case conference schedule. Case conference and didactic schedules for Chattanooga and Knoxville sites vary. Please ask your local clerkship director for details.

Other Conferences (Memphis Location)

All conferences are mandatory for students on the inpatient rotation. Some conferences are mandatory for all students. See Monthly Inpatient Calendar.

  • Patient Checkout and Morning Report: All inpatient students are expected to attend every Monday, Tuesday, Thursday, and Friday mornings from 7:00am – 8:00am, Wednesday morning 7:00-7:30am.
  • Grand Rounds: Wednesday mornings 8:00am-9:00am, Auditorium. Mandatory attendance for ALL students (except students on nights or those with Wednesday morning Germantown clinic).
  • Noon Conference: Daily 12:00pm-1:00pm, Education Classroom. All inpatient students are expected to attend every day. Outpatient students encouraged to attend when possible.
  • Combined Team Rounds: Tuesdays 2:30pm-3:30pm, inpatient students only.
  • Chief Resident Rounds: One Thursday afternoon, inpatient students only.
  • PICU Rounds: One Thursday afternoon, inpatient students only.
Assignments

Clinical Skills Assessments (Rubrics)

Students will complete clinical skills rubrics for the following pediatric skills: 1) otoscopic examination and 2) developmental assessment. Rubrics may be completed either during inpatient or outpatient. You must be directly observed by a faculty member or supervising resident for each skill. Students will have 2 attempts for each skills assessment and must achieve a rating of “able to perform independently” on at least 4 items per rubric in order to pass this assignment. This is a pass/fail assignment that must be completed and turned in to the clerkship coordinator by the end of the clerkship. It is the student’s responsibility to alert the attending or supervising resident to the need for this assessment, and to ensure that both skills assessments are completed prior to the end of the clerkship.

Prior to the skills assessments, students should review the supplemental materials listed below:

  • Otoscopic examination – Aquifer
  • Developmental assessment – Read the following chapter, which can be accessed via Clinical Key on the UTHSC Library website: Caplin, D., Cooper, M. “Child Development for Inpatient Medicine”, Comprehensive Pediatric Hospital Medicine. 2007: 1285-1292.
  • Students will also be provided with a copy of the “Kube card” of developmental milestones, which may be used during the skills assessment. *For Memphis location, these are in your Pediatrics Clerkship handbook.

Observed History and Physical

You are required to have a resident or attending observe your history taking and physical exam skills and sign the appropriate card. If you do not perform the skill adequately, you and the resident/attending should discuss ways to improve then they should observe you again for competence. This observed H&P form should be turned into the clerkship coordinator by the end of the clerkship.

*For Memphis location, this is in your Pediatrics Clerkship handbook.

Diagnoses Logs

In order to ensure that you are seeing a breadth of patients, we require documentation of 19 patient diagnoses located on eMedley. You should be a participant in the patient’s care, not an observer. If you do not see a patient with a particular diagnosis, you should complete the appropriate Aquifer Pediatrics case to fulfill this requirement (How to use the Pediatric Patient Encounter Logs example). If you use an Aquifer Pediatrics case, please mark this as a “simulated patient.”  Go to the iLogin page and log in.

Duty hours will be limited to 80 hours per week averaged over a four-week period, inclusive of all in-house call and patient care activities. Continuous on-site duty, including in-house call, will not exceed 30 consecutive hours. Students may remain on duty additional hours to participate in transferring care of patients, conducting outpatient clinics, maintaining continuity of medical and surgical care, and attending required didactic activities. Students will be provided with one day in seven free from all educational and clinical responsibilities, averaged over the rotation, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, didactic, and administrative activities. Students should be provided with a 10-hour period after in-house call during which they are free from all patient care activities.

Log your duty hours on eMedley.  These will be checked multiple times throughout the clerkship by the coordinator and you will be emailed if you are behind.  All duty hours must be logged by the end of the day on the last day of the rotation (shelf exam day).

White Clinic Cards/Clinic Log

More information about these will be given during the outpatient orientation, but students must have a white card for each clinic and each morning of newborn nursery/NICU they attend during the outpatient portion of the clerkship.

*For Memphis location, these are in your Pediatrics Clerkship handbook.

Additional Information about Assignments

Students are required to turn in all assignments and documentation with appropriate signatures (clinic logs, mastery skills sheet, clinical skills rubrics, duty hours and diagnoses logs) by the last day of the rotation. Students failing to complete assignments by the last day of the rotation will be notified in email of the missing assignments.  If assignments (including duty hours and diagnoses logs) are not completed by 4 weeks after the end of the clerkship, this will result in a drop of 1 letter grade for the final clerkship grade due to professionalism.  Additionally, the Dean of Student Affairs will be notified.  If all assignments are not completed by 8 weeks after the end of the clerkship, this will result in a failing grade for the clerkship and the full clerkship must be repeated.

Miscellaneous Information

Parking

During normal working hours on weekdays (8 a.m. -5pm), students must park in their university-assigned parking places. You are only permitted to park in the Le Bonheur Garage when you are on nights.

Lounge Use

For brief periods of relaxation, M3 students may use the resident lounge located on the 6th floor of the Children's Foundation Research Tower. Please complete the Student Information Sheet contained in your orientation folder and give to the assistant on the 6th floor for access to the lounge.

Policies

Attendance

Important Policies

Dress codes/Scrubs

Pediatrics-specific Policy

During the week, proper professional attire is expected. 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.

Inpatient wards and outpatient clinics

Daily dress should be business casual (men - trousers, shirts, ties are preferred but optional depending on the attending; women – knee length skirts. slacks, blouses or dresses). No provocative clothing.

ED/PICU/NICU/Nights/Weekends

Scrubs are acceptable in these areas and at these times.

Inclement Weather Policy

The administration at UTHSC decides when the campus is closed due to inclement weather. Closure indicates that classes and scheduled meetings are cancelled. In the event that the school is closed, faculty and students with clinical responsibilities are professionally obligated to provide that care even during inclement weather. Students on clinical services are expected to continue to provide care for their patients, provided traveling would not place the student at serious risk of injury. Students should consult with their resident and physician supervisors to determine the risks/benefits involving travel during these periods. Students who are unable to travel to the rotation sites should contact preceptors as soon as possible to advise them of the individual situation and whether the student could reach the site later in the day.

Since weather conditions will vary across the state, clerkship students on the three campuses will follow the schedules dictated by those campuses.

Mistreatment

If you feel you are being mistreated, we encourage you to talk to the person who is mistreating you first. On the inpatient rotation, you should discuss any issues with your supervising resident followed by the attending. If the issue is still not resolved, then you should contact the clerkship director. On the outpatient rotation, you should discuss any issues with the supervising physician then the clerkship director. If the issue is sensitive or you feel uncomfortable addressing the issue with the clerkship director, then discuss the issue with the Dean of Student Affairs. Please refer to the policies below for further details:

Needle Stick Injury

Policy Search Tool

Search for UTHSC policies

Professionalism

Code of Professional Conduct

General Guidelines for Professional Behavior and Conduct in Pediatrics

Religious Accommodations

Accommodations for Religious Beliefs, Practices, and Observances

Security

Student Workload

Student Workload - Clinical Clerkships

Last Published: May 13, 2019