1. Welcome to the UNC Pediatrics Clerkship

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

4. Breadth of experience on Pediatrics

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
-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
them to site directors upon completion.
You will receive feedback on your clinical documentation.

23. Outpatient Pediatrics Curriculum
CLIPP cases
Use your med.unc.edu 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
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

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
Practice Based Learning and Improvement
Medical Knowledge
Systems Based Practice
Patient Care
Communication and Interpersonal Skills
Professionalism

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.**
Final Grade
Points Scale
NBME Score
Honors
> National Mean
High Pass
75 – 87
>35th percentile
Pass
>10th percentile
Condition
Fail
<37.5

35. Grading - Overall Clinical 60% Participation 10% NBME Shelf Exam 20%
- Inpatient attending
- Inpatient residents
- Outpatient total
- Newborn nursery
60%
30%
25%
15%
Participation
10%
NBME Shelf Exam
20%
Departmental Exam
*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 Thursday of 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
Note: Do not 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:
Mobile –
Pediatric Education Office located on the 2nd floor of MacNider in Rm 230

49. HAVE FUN!