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Welcome to the UNC Pediatrics Clerkship Things that are specific to Cone.

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Presentation on theme: "Welcome to the UNC Pediatrics Clerkship Things that are specific to Cone."— Presentation transcript:

1 Welcome to the UNC Pediatrics Clerkship Things that are specific to Cone

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3  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

4  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

5  What is ownership? ◦ 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)  Write orders (pend them in EPIC)

6  Write ups ◦ An H&P should be written for every patient you admit ◦ Two H&P write-ups - 1 copy should be turned in to your ward attending & 1 copy to Dr. Nagappan (for grade) ◦ 1 st WRITE UP DUE THE FIRST FRIDAY of your inpatient time  Just print or email your EPIC H&P and add a 1-2 page discussion  Instructions in your packet of information

7  DC summaries ◦ Third year students do not write DC summaries on patients (even if residents ask you to) ◦ This is a medicolegal issue

8  Conferences ◦ Grand Rounds, Wednesday, 8:30-9:30 ◦ Noon conference daily 12:30-1:30 ◦ Core Curriculum Student Talks Mondays, 1:30 to 4:30  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) http://www.med.unc.edu/pedclerk/schedules/clerkshi p-at-moses-cone/readings-and-resources ◦ Wednesday afternoon sessions, 2p  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/clinical- problem-solving-conferences-readings ) http://www.med.unc.edu/pedclerk/schedules/clerkshi p-at-moses-cone/readings-and-resources/clinical- problem-solving-conferences-readings

9  4 night shifts, 8 pm to ~10 am  call rooms available; start 8- 830 am leave the next day after presenting your patients Stick with your intern  Stay for rounds the next morning and present your patients, then leave for the day  Call changes -- difficult

10 You will do only short shifts  7:30 to 9:00: Pre-round  9:00 (except Wed): Rounds  12:30-1:30p: Noon Conference  4:30p: Sign-out

11  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) 3 rd year med students (UNC)

12  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.”  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 talk 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.”

13  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  NURSE INVOLVEMENT: One of the benefits of FCR is that everyone involved in care is there at one time. Having the nurse present is invaluable

14  HELP FAMILY KNOW THAT YOU ARE SPENDING A LOT OF TIME BEHIND THE SCENES “Dr. X and I are working behind the scenes to come up with the best plan for Zeke”  EXPLAIN CONSULTANTS “We are working with Dr. Elton of Orthopedics. We are the General Pediatricians and we are here to help your child with any general pediatric problems. We are Dr. Elton’s eyes and ears when he is in the operating room.”

15 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

16  Office practices (Mon, Tues, Thurs, Fri) ◦ Clarify expectations on the first day  Seminars (Wed) ◦ 830-930: Grand rounds ◦ 930 – 1130: outpatient seminars (no specific readings for the outpatient seminars) ◦ 200: Meet with director ◦ 230: Clinical cases  Subspecialty Clinics – none assigned, but you may request time there  One weekend shift in the Peds ED (6 hours)  No call/nights during this time

17  Daily activities begin at 8:30 am  Examine lots and lots of babies  Daily notes  Gain exposure to the NICU (brief)

18  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-and- resources/supplemental-readings/newborn- issues http://www.med.unc.edu/pedclerk/schedules /clerkship-at-moses-cone/readings-and- resources/supplemental-readings/newborn- issues

19  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-illness- project

20  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/clinical- problem-solving-conferences-readings http://www.med.unc.edu/pedclerk/schedules/clerksh ip-at-moses-cone/readings-and-resources/clinical- problem-solving-conferences-readings

21  This is covered during the Monday 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/readings- and-resources/supplemental-readings http://www.med.unc.edu/pedclerk/schedul es/clerkship-at-moses-cone/readings- and-resources/supplemental-readings

22  Available for you to borrow (ask Wanda)

23  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 ◦ Chronic Illness Project  Professionalism is pass/fail ◦ Failure in professionalism evaluation may lead to failure of the clerkship

24  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

25  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

26  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)

27  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

28  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)

29  Maltreatment  Needlesticks  If you need to see a doctor here see attached FAQs

30  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 832- 8064  If you have questions…ASK!!!

31  There is an optional shelf test prep review  https://echo2.med.unc.edu:8443/ess/portal/sectio n/bb022d83-f589-4ad5-82fe-78b3e6b53dd6 (use your onyen and password to log in to see this) https://echo2.med.unc.edu:8443/ess/portal/sectio n/bb022d83-f589-4ad5-82fe-78b3e6b53dd6  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.

32  Documentation of patient encounters on One45 (due by 3 rd Friday -midpoint feedback day- and updated by last Friday of clerkship)  Write-ups (2)  (1 st due to ward attending by 1 st Friday of inpt)  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 3 rd Friday - midpoint feedback day)

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