Welcome to the UNC Pediatrics Clerkship

1. Welcome to the UNC Pediatrics Clerkship 2014-2015

2. Objectives for Orientation • Clearly state clerkship expectations • Clinical activities • Assignments • Grading • Participation • Policies • Outline clerkship objectives • Address your questions • For more information, see the clerkship webpage

3. General Expectations • ~90% of medical students will not become pediatricians • All medical students must develop a basic level of knowledge and skill regarding pediatrics • More than two-thirds of medical students will go into fields of medicine where they will be asked to participate in medical care for children *See the clerkship webpage for detailed goals and objectives based on the UNC Core Competencies

5. Clerkship Clinical Structure - Overview • Three weeks Inpatient Pediatrics • 2 weekday long shifts • One Friday long shift • One Saturday or Sunday long shift • Newborn Nursery • With exposure to neonatal intensive care • ~12 half-days of Ambulatory Pediatrics • Some exposure to Pediatric Emergency Medicine and other subspecialties

6. Inpatient Pediatrics • Typical patients • Well children with acute illness • Children with chronic disease presenting for acute illness or chronic disease management • Children in need of diagnostic management

7. Inpatient Pediatrics - Student Goals • Exposure and depth • Take ownership of your patients and learn all you can from them • Understand their illness, work up, and management completely • Participate fully in the activities of the inpatient team • Become comfortable with children with special needs • Gain exposure to pediatric subspecialties and general pediatric hospital care

8. Inpatient Pediatrics – Daily activities • Write a history and physical and/or daily note on each of your patients each day • Write in EPIC as a generic note or progress note • Write orders for co-signature • Meet with your intern right after rounds to divide and conquer the daily work • Ask questions and find answers to those questions – bring new information to the team!

9. Inpatient Pediatrics - Long Shift • Long shift assigned at least four times • 2 week nights • 1 Friday • 1 Saturday or Sunday • On long shift days, you are expected to stay until 8pm then return the following morning as regularly scheduled • On weekends, round with the team on the post-call morning, present your patients, then leave after post-rounds work is completed • Stick with your intern to learn clinically • Admit at least one patient for write up each long shift, but learn from any patient around

10. Inpatient Pediatrics - Ward Teams • Green Team - General, Nephrology, & Genetics • Rounds begin at 8:30am in the conference room on the 6th floor of the Children’s Hospital • Purple Team – General, Neurology, & Endocrine • Rounds begin at 8:30am on the 6th floor of the Children’s Hospital • Red Team - Cardiology and Gastroenterology • Rounds begin at 8:30am at the nurse’s station in the CICC on the 5th floor of the Children’s Hospital • Blue Team - Pulmonary • Rounds begin at 8:30am in the conference room on the 5th floor of the Children’s Hospital

11. To get the most out of your inpatient time… • Learn the roles, and what to expect from whom • Get involved – make yourself important to your team and learn by doing • 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 student and resident conferences – they are for your learning

12. Newborn Nursery Generally the happiest place in the hospital…

13. Student Activities in the NBN • Specific orientation information on the web page • 7am arrival, pre-rounds, rounds, notes, orders • On Monday, discuss daily activities and expectations • Your physical exam skills will be directly observed by supervising physicians • Spend one afternoon in NICU to gain exposure to critically ill infants (usually T or W) • Prepare a brief teaching presentation on a newborn topic of your choice to present on Friday

14. Student Activities in the NBN

15. To get the most out of the NBN… • This is your best opportunity in third year to be the care provider • Work on developing rapport, talking with families, and communication skills • Learn what is normal and what is not • Examine lots and lots of babies • Review the Newborn Nursery orientation website link before your week starts • http://www.med.unc.edu/pedclerk/schedules/clerkship-at-unc/newborn-nursery

16. Outpatient Pediatrics • Well child care in community outpatient practices • Preventive care, anticipatory guidance • Acute illness management • Chronic illness management

17. Outpatient Pediatrics - Student Goals • Breadth • Examine lots and lots of children • Learn behavior and development, prevention, common acute illness • Clarify expectations on the first day in each setting with each preceptor • Challenge yourself to learn and to do • Get a picture of life as a general pediatrician

18. To get the most out of your outpatient time… • Be flexible, because each day might be different • Make sure to clarify the expectations each day • Seek learning opportunities • Challenge yourself • Take time to study and to do the CLIPP cases • Refer to your Patient Log to ensure you are seeing many of the expected cases

19. Pediatric Emergency Department • Each student is assigned some time in the Peds Emergency Department • One weekend day during the week in the Newborn Nursery • Possible exposure during a subspecialty week • Clarify expectations with your attending at the start of the shift • The major goal is to see a child in need of urgent medical attention • You may also get opportunities to perform procedures

20. Assignments in the Clerkship

21. Clerkship Assignments - Overview • Write ups • Complete a minimum of 3 • 2 H&Ps, 1 Discharge summary • CLIPP cases • Complete 8 required cases • Cultural reflection (optional) • Didactic sessions • Documentation and completion of patient encounters/patient log on One45 • Midpoint feedback and self-assessment

22. Inpatient Pediatrics - Patient Write Ups • 2 History & Physicals, 1 Discharge Summary • With H&P, 3-4 paragraph written discussion on a topic related to the patient, with at least 2 references cited • H&Ps - focus on Pediatric-specific content • Growth and development (including charts), labor/delivery, etc • Due within 72 hours after seeing the patient • Please refer to the clerkship website for detailed guidelines on the format of patient write-ups • Email them to site directors upon completion. • You will receive feedback on your clinical documentation.

23. Outpatient Pediatrics Curriculum CLIPP cases • http://www.med-u.org/ • Use your med.unc.edu email to login • Interactive, web-based curriculum • Do at least 8 assigned cases • Some people do lots more • Must be completed by the last Wednesday of the clerkship • One question based on each CLIPP case will be on Pediatric Departmental Exam

24. 8 assigned CLIPP cases • Case # 5: 16 year old girl’s health maintenance • Case # 6: 16 year old boy’s pre-sport physical • Case # 15: Two siblings vomiting, 4 year old and 8 weekold • Case # 18: 2 week old with poor weight gain • Case # 25: 2 month old with apnea • Case # 28: 18 month old with developmental delay • Case # 29: Infant with hypotonia • Case # 30: 2 year old with sickle cell disease

25. Cultural Competence • We expect your cultural sensitivity to improve during your Pediatrics clerkship • Take the opportunity that our diverse patient population provides to develop your skills in working with patients from different cultural backgrounds • Working effectively with interpreters is part of this • If you have questions about cultural competence, ask… This is appropriate learning material.

26. Cultural Reflection • This is an optional assignment that can be completed for extra credit • Write a brief reflection on the influence of culture on the care of one of your patients during the rotation • Email it to the course directors • See details and ideas on clerkship webpage

27. Documenting Patient Experiences • Be sure to complete your Patient Log (One45) of your required clinical experiences • 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

28. Student Conferences in the Pediatric Clerkship • Student Didactic sessions: 12:00pm-1:00pm • Attendance is mandatory if at UNC • In your folder is a weekly schedule of didactics • You are not required to attend if you are off-campus at an outpatient site • Learning Group Sessions: Thursdays 2:00pm-5:00pm • Attendance is mandatory even if you are away • Dr. Hobbs and Dr. Mills • Return from outpatient sites for these

29. Resident Conferences in the Pediatric Clerkship • Morning Conferences: M, Tu, W, F 7:45am -8:30am • Curnen-Denny Conference Room • Thursday: Grand Rounds 8:00am-9:00am • Old Clinic Auditorium • Resident Noon Conference: Daily 12:00pm-1:00pm • Curnen-Denny Conference Room

30. Feedback, Evaluation, and Grading

31. Feedback • Ask for specific feedback from your residents and preceptors • If they say, "good job", follow up for specifics • Ask "How are my presentations? Notes? Plans?" • Use the evaluation forms to help you ask good questions • "Good job" does NOT = Honors • Continue to push yourself for improvement • You will meet with the site director for scheduled Midpoint Feedback at the end of 3 weeks • Update your Patient Log and Self Assessment prior to your Midpoint Feedback session

32. Grading in Clinical Education • Necessary, but…. often subjective, and sometimes unsatisfying • Most students will NOT get Honors • ~30% of students across all the Pediatric Clerkship Sites will earn Honors • UNC, WakeMed, Moses Cone, Carolinas Medical, Asheville

33. Grading • Grading system is set-up thoughtfully to evaluate your performance, balancing subjective and objective indicators of performance • Goal is primarily to demonstrate learning of essential material and secondarily to differentiate students • Core Competencies • Medical Knowledge • Patient Care • Professionalism • Practice Based Learning and Improvement • Systems Based Practice • Communication and Interpersonal Skills

34. Grading • Grading is on a 100 point scale • **Note: The clerkship director reserves the right to adjust final grades if necessary. This is to ensure the best consistency possible in student evaluation across all sites.**

35. Grading - Overall *This means that one person’s evaluation is never enough to change your grade substantially.

36. Grading – Participation – 10% • Completed by Clerkship Site Directors • Small group participation • CLIPP cases completion • Cultural reflection completion (optional – extra credit) • Write-up evaluations • Completion of the Patient Log • Professionalism is pass/fail • Failure in professionalism evaluation may lead to failure of the clerkship

37. Grading – Shelf Exam – 20% • Shelf test is administered in the afternoon on the last Friday of the Clerkship • The Shelf exam is an online test • Students are required to use their laptops distributed them by the UNC SOM for testing • It is students’responsibility to ensure laptops are in appropriate working condition for testing prior to the testing date

38. Grading – Shelf Exam – 20% • Scores are based on national percentiles • NOTE: A shelf test score of < 10%ile will result in an Incomplete grade. • Students who earn <10%ile on the shelf test but pass all other requirements of the clerkship, must retake the shelf test only. • Upon successful retake of the shelf exam, the student will receive a grade of Pass. • The Pediatrics shelf test is difficult and you will need to study appropriately

39. Grading – Departmental Exam – 10% • Oral portion is administered on last Thursdayof the clerkship in individual 15 minute appointments • Written/Multiple Choice portion is given immediately following completion of the Oral portion • Departmental Exam is worth a total of 20 possible points: • Oral Exam (6 points) • Written Exam (14 points) • 6 written questions (6 points) • 8 multiple choice questions – 1 question based on each assigned CLIPP Case (8 points)

40. Departmental Exam - Oral A 10 minute discussion of one of the following possible cases: • A 13 month old with anemia • A four month old with failure to thrive • A 3 day old with jaundice • A 6 month old with lethargy • A 1 week old with fever • A 9 yo with abdominal pain • A 2 yo that refuses to bear weight • A 1 week old with vomiting • An 18 month old with difficulty breathing • A 15 yo girl with weight loss

41. Departmental Exam – Written All material is based on Learning Group didactics • Plot and interpret growth data using growth curves • Write an appropriate maintenance fluid order for a child of a given size. • Write an appropriate fluid bolus for a child of a given size. • Write an appropriate order for medication, with use of provided references for dosing. • Determine necessary immunizations for a child in a given clinical setting. The immunization chart will be provided.

42. Departmental Exam – Multiple Choice • 1 question from each assigned CLIPP case: • Case # 5: 16 year old girl’s health maintenance • Case # 6: 16 year old boy’s pre-sport physical • Case # 15: 2 siblings vomiting, 4 year old and 8 week old • Case # 18: 2 week old with poor weight gain • Case # 25: 2 month old with apnea • Case # 28: 18 month old with developmental delay • Case # 29: Infant with hypotonia • Case # 30: 2 year old with sickle cell disease

43. Policies, etc.

44. Student Maltreatment • You should not be mistreated during your Pediatrics clerkship • If you experience maltreatment, please bring that to the attention of the clerkship director, the Dean of Student’s office, or one of your assigned liaisons • UNC SOM Ombudsman is Dr. Gary Gala • Each clerkship site also has an ombudsman

45. Absences • UNC 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

46. Absences • If you must be absent for any reason you should: • Contact your team (Attending or senior resident) or outpatient preceptor • Call the education office regarding your absence or tardiness 966-3172 • Note: Do not email the day of your absence as this delay notification of the appropriate individuals • All absences are reported to the Dean of Student Affairs (Dr. Georgette Dent) for documentation and approval when necessary.

47. Evaluating the Clerkship • Please provide us with your feedback throughout and specifically at the end of the rotation

48. Contacts • Contact information: • richard_hobbs@med.unc.edu • wmills@med.unc.edu, Mobile – 919-428-6382 • Pediatric Education Office located on the 2nd floor of MacNider in Rm 230

49. HAVE FUN!