Third Year Medical Student Pediatrics Clerkship

Department Chair: Parameswaran Aiylam, MD
Clerkship Director: Lulua Mandviwala, MD
Clerkship Coordinator: Sandra Neel
Questions About Pediatric Clerkship?
Email: Sandra.Neel@kernmedical.com

Welcome

Welcome to the Third-Year Medical Student Pediatric Clerkship at Kern Medical.

We are excited to have you with us and look forward to a rich learning experience for all involved. During this six-week rotation you will be training through these three sites: Ambulatory Pediatric Clinics at Sagebrush, the Neonatal Intensive Care Unit (NICU) at Kern Medical, and the Pediatric Inpatient Ward and Nursery at Kern Medical.

The varied activities of this rotation have been designed to allow you to meet the learning objectives of the clerkship in a meaningful and enjoyable way. We, as a faculty, are committed to helping you reach these goals to the best of our ability.

To be successful, however, students must organize their time to provide an appropriate balance between clinical activities and independent learning through reading and study. Other essentials are a cooperative, enthusiastic and compassionate attitude; responsibility; a demonstrated interest in patient care; intellectual motivation; and a systematic, organized approach to clinical problems.

The Pediatrics Clerkship is administered at three clinical sites. The clerkship consists of three weeks of ambulatory outpatient pediatrics, three weeks in the newborn nursery and inpatient pediatric ward and one day/week in the Neonatal Intensive Care Unit (NICU). A variety of pediatric problems will be encountered in these settings. In addition, there will be opportunities to explore those aspects of preventive medicine and psycho-social-environmental factors that relate directly to infants, children, adolescents, and their families.

The final assessment for the Pediatric Clerkship consists of a subjective faculty evaluation, a final written examination and the National Board of Medical Examiners (NBME) Pediatric Examination (shelf exam). The Pediatric Departmental Examination is administered the second to last Friday (week 5) of the clerkship and the NBME Pediatric Examination is administered the last Friday (week 6) of the clerkship.

Goals and Responsibilities

Third-year medical students rotating on the Pediatric Clerkship at Kern Medical should strive to achieve these goals:

• 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 children of different ages and their families both to get complete, accurate histories, and to explain clinical findings and plans. Learn how to reassure.
• Learn how to perform the physical examination of children – How to interpret vital signs at different ages, how the pediatric exam is different than the adult exam, and attain a basic knowledge of what is normal.
• Write a complete History and Physical (H&P), including pediatric-focused items such as development, diet, and growth.
• Present orally 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.
• Be able to chart the weight, height, head circumference, and body mass index (BMI) and recognize obesity or failure to thrive and begin a workup if indicated.
• Talk to families about prevention, including immunizations, safety, violence, sex, and substance use. Using the Centers for Disease Control and Prevention (CDC chart), know what immunizations a child needs at a given age.
• Write prescriptions appropriate for children of different sizes.
• Be able to clinically recognize a dehydrated child. Write orders for both rehydration 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.

Learning and Objectives

The Learning Objectives of the Pediatrics Clerkship are designed to continue the educational endeavors reflected in the Core Competencies of our residency programs at Kern Medical. Students should be able to demonstrate the professional conduct necessary for successful clinical interactions in all aspects of the clerkship. Participants should learn how to:

Ambulatory Setting

• Conduct an effective interview and physical exam, adapted for the visit, in a manner that is sensitive to the age of child and the developmental, social and cultural context
• Generate an appropriate initial differential diagnosis and outline an initial evaluation
• Give suggestions for the therapeutic plan appropriate to the final diagnosis
• Present a complete, well-organized verbal summary of the findings of the patient’s history and physical examination, modifying the presentation to fit the situation
• Prepare a complete written summary of the H&P
• Critically use the medical literature to obtain current information relative to the patient
• Demonstrate knowledge of how the physician’s responsibility to promote a healthy lifestyle is carried out in health supervision visits as an individual grows from infancy to adolescence, including the appropriate use of screening tools and immunization
• Include an assessment of development on all patients
• Discuss prevention in every clinical encounter, including assessment of immunization status, inquiry into safety and injury prevention, and identification of personal and family habits that pose risks, particularly tobacco exposure

Newborn/NICU

• Address routine care of the newborn
• Recognize the various causes of malformations and genetic disorders
• Have a basic knowledge of the appropriate diagnostic tests and clinical course for common disorders such as common chromosomal abnormalities, (e.g. trisomy 21, Turner syndrome), syndromes due to teratogens (e.g. fetal alcohol syndrome), patterns with unknown etiology (e.g. VATER syndrome), single malformations with multifactorial etiology (e.g. spina bifida, congenital heart disease, cleft lip and palate), common inborn errors of metabolism (e.g. PKU, Tay-Sachs, MCAD deficiency), and other common genetic disorders (e.g. cystic fibrosis, sickle cell disease, hemophilia)
• Discuss the newborn screening program

Pediatric Ward

• Demonstrate knowledge of common acute pediatric illnesses (including salient history, physical exam findings, epidemiology, management, and severity)
• Perform a medical interview and a physical examination for a patient with an acute and/or chronic illness. Obtain information about the effects of the chronic illness on growth and development, and on the emotional, economic and psychosocial functioning of the patient and family. Elicit information about treatments used, including “complementary and alternative therapies”
• Recognize the consequences of electrolyte disturbances, including hypernatremia, hyponatremia, hyperkalemia, hypokalemia, and severe acidosis
• Demonstrate knowledge of the immediate emergency management of children with toxic ingestions
• Identify the patient who requires immediate medical attention and intervention
• Know the risk factors for child abuse
• Recognize responses in the history or findings on the physical examination that raise the concern of non-accidental injury
• Submit at least one written H&P and progress note (do not copy and paste from CareVue)

Didactics

1. Lectures: Each Wednesday 8-9 am, sometimes between 12-2pm in Conference Room near Columbus Clinic
2. Student presentation: Each Thursday 8-9am in Conference Room near Columbus Clinic

Students are expected to read on a daily basis about their patients’ pathology and review topics that were discussed with the faculty. In addition, each student will provide one 20-minute presentation of their choice of topics as listed here. The students should try to present case scenarios that highlight the important aspects of each topic. The faculty will also be present to review the didactic lectures and provide further input and direction as necessary. Submit H&P on day of presentation.

The following core topics can be chosen for your presentations:

• H&P newborn/child/adolescent
• Prematurity
• Breast-feeding
• Newborn respiratory distress
• Newborn jaundice
• Newborn sepsis
• Newborn screening
• Growth and development stages
• Development disorders/autism
• Immunization practices
• Fluid and electrolytes management
• Gastroenteritis/Dehydration
• Upper airway infections
• Lower airway infection/bronchitis and pneumonia
• Childhood asthma
• Otitis media
• Streptococcus/rheumatic fever
• Fever of unknown origin
• Meningitis
• Febrile seizures
• Tanner staging
• Family and social relationship
• Child abuse and neglect
• Down syndrome
• Evaluation of anemia
• Sickle cell diseases
• Urinary tract infection
• Lead poisoning
• Proteinuria and nephritic syndrome
• Sexual transmitted infections
• Viral hepatitis

The Didactic lectures are mandatory for all students rotating in the clerkship.

Books

• “Essentials of Pediatrics,” 7th edition, 2014
• “The Harriet Lane Handbook”

Resources

• http://newborns.stanford.edu/RNMDEducation.html
• “Nelson Textbook of Pediatrics” 20th Edition
• Up to date
• Blueprints

For Ross Students

Homework assignments to complete 3 Aquifer cases online each week.

Assessment

All third-year students on the Pediatric Clerkship will have a mid-clerkship review at the midpoint of the six-week clerkship. This review will offer assessment of the student to determine either satisfactory progress or demonstrate areas for further improvement. If there are areas for concern, the Clerkship Director will help you develop a personalized plan for continued growth and improvement.

Throughout the Pediatric Clerkship, the faculty will grade you on your performance. This clinical subjective evaluation will include your participation in the clinics and wards and your didactic presentations. This will account for 50 percent of your grade. The remaining aspect of your grade will depend on your performance on the Pediatric Departmental Final Written Exam. This exam will consist of 40 multiple-choice questions similar in style to the National Board of Medical Examiners (NBME) Subject Exam. You will have 60 minutes to complete the exam. The exam is given at the SageBrush Technology Center on the last Thurday of the rotation.

Your medical school will then combine our evaluation with your NBME Subject Exam score to produce your final grade.

Scheduling

Each student will be exposed to the same basic structure of inpatient and ambulatory pediatric care. Students in the Ambulatory setting will be divided into equal A.M. and P.M. shift schedules. The following is an example of the basic Pediatric Clerkship Schedule. (Assuming 12 students, represented by the letters A thru L)

1. Orientation Day: 8 am in the Conference Room at Columbus Clinic
2. Ambulatory: 8 am – about 12:30pm in thePediatric Clinic at Columbus Clinic
3. Ward/Nursery: 6:30am, sign out with the resident in the call room. On Wednesday and Thursday, you will come to evaluate the patients, go to the Conference Room at Columbus Clinic for lectures, then go back to ward/nursery for rounds
4. NICU: Neonatologists usually round around 12pm Tuesday after rounding with Pediatric Attending
5. Pediatric Departmental Final Exam – 5th Friday of rotation
6. Shelf Exam – Last Day of Clerkship, 6th Friday of Rotation