Pediatrics Clerkship


Introduction­­­­­­­­­­­­­

 

The Pediatrics Clerkship provides a clinical learning experience that prepares you to communicate effectively with patients and families and learn to evaluate and manage children from newborn through adolescence. The clerkship integrates a foundation of medical knowledge with clinical and communication skills to enable you to identify and provide quality pediatric care. The Department of Pediatrics places special emphasis on professional behavior, as well as, knowledge, interviewing skills, clinical problem solving and the ability to communicate information.

 

This six-week core clerkship allows you to gain clinical experience in evaluating newborns, infants, children and adolescents, both sick and well, through clinical history taking, physical examination and the evaluation of laboratory data. Special emphasis is placed on: growth and development, nutrition, disorders of fluid and electrolytes, common infections, social issues, and preventative care including: immunizations, screening procedures, anticipatory guidance. The student will develop the necessary communication skills to inform, guide and educate patients and families.

 

Pediatric ambulatory and in-patient services provide an opportunity to observe and enter into the care of pediatric medical and surgical disorders. You will learn how to approach the patient and family and communicate effectively as they take admission histories and perform physical examinations. You will then provide the patient and parents with the necessary information and guidance to understand and support the child through the time of illness. You will learn age specific skills regarding interviewing pediatric patients and relating to their parents, and will develop the skills necessary to examine children from newborn through adolescence utilizing age appropriate techniques. The adequacy and accuracy of your knowledge, communication skills, manual skills and professional behavior will be measured and evaluated by their supervising physicians, residents and preceptors. There will be formative evaluations and discussion of your progress throughout the rotation with emphasis on a formal mid-core and end-core assessment.

 

Expectations & Responsibilities

It is expected that there be full and active participation in the multiple learning opportunities: didactic learning, clinical seminars, self-directed learning modules, patient rounds and conferences.

Preceptor sessions are mandatory and take precedence over all other clinical activities. You should excuse themselves from their other assignments and attend their preceptor session, unless excused by their preceptor. All of these components are designed to expand your concept of how to provide quality care for pediatric patients.

 

Professionalism and Dress

ID cards should be worn at all times above the waist and visible.

All Pediatric Students must dress in business attire. Students are never permitted to wear sneakers. Anyone who is required to wear sneakers for medical purposes must provide a doctor’s note with Dx, start and end dates. All males must wear a shirt, tie and dress slacks. All females must wear dresses, skirts or dress slacks and (business) tops.  Jeans, leggings, tank tops or t-shirts will not be permitted.

If you are required to wear scrubs, they must be put on in the locker room and removed before leaving the building at any time. While wearing scrubs you should have a white lab coat on at all times. If you wear a shirt under scrubs, sleeves must be shorter than scrubs.

Students are required to act courteous and professionally at all times. You must protect patient confidentiality. At no time should there be any discussions of patients in common areas, elevators, in the cafeteria and outside the hospital. You should be familiar with HIPPA laws.

 

Orientation

You will start their rotation by reporting to Diana Calderon, the Medical Student Coordinator. She is located at 5800 3rd Avenue (2nd Ave Entrance). Once you are processed, Dr. Sheikh will welcome and orient you to the Pediatric Clerkship Department.

 

Rotations

You will be involved in all patient care activities in the out-patient facility and inpatient unit. You will observe, and given immediate feedback, as they take a history and perform a physical examination on a newborn and a child. As an absolute minimum, you should examine five term newborns. This includes reviewing the maternal medical record, performing a physical examination on the infant, and talking with the parent about basic care of the newborn and anticipatory guidance.

As an absolute minimum, you should be involved in the care of a child with:

 a. a gastrointestinal illness, such as dehydration

b. a child with a neurological or neurodevelopmental problem

c. a child with a respiratory and/or cardiac problem (chronic illness is preferable)

d. a child with fever

e. a child suspected as being the victim of child abuse/neglect or where the differential diagnosis includes child abuse/neglect.

There should be a discussion of the recognition and reporting requirement and the child protection response and services.

 

Involvement in these cases should include taking a history, performing a physical examination, discussing the differential diagnosis, formulating a plan for laboratory/radiologic studies and deciding on a treatment plan. These cases may be from the inpatient units, the nursery, the Emergency Room, or the out-patient setting.

Depending on circumstances, in cases of child abuse, participation may be limited to participation as an observer, especially in cases of sexual abuse.

 

As an absolute minimum, you will participate in the care of two adolescents. This includes taking a history and performing a physical examination as well as reviewing the immunization record and assessing the adolescent’s health, behavior, educational and environmental issues. It is preferable that one of the two adolescents described will have a chronic illness.

 

You will give, at a minimum, one major presentation during the rotation. The presentation will be evaluated by the preceptor.

 

Thursdays are Non-Clinical Days, report to NYU Lutheran Medical Center Conference Room for Pediatric Grand Rounds, then follow Teaching Rounds, Conferences , Lectures and Grand Rounds Scheduled

 

Emergency Department- One week

Emergency department and urgent care experiences permit the student to be the first to evaluate infants and children with acute illnesses. Emphasis is placed on the evaluation of febrile illnesses, and common emergencies of childhood (e.g. poisonings, injuries). If you are on evening shift, you do not have to report to topic discussions. Please see calendar for ED Rotation Scheduled.

 

Out Patient Services- Clinic and Private Offices- Three weeks

In the out-patient services, the student learns the milestones of growth and development, infant feeding, child nutrition, preventative care (including immunization, screening procedures, anticipatory guidance), the common ailments of childhood and diagnosis of rare and unusual illnesses. In the pediatric sub-specialty clinics, the student will observe the progression and participate in the management of a wide variety of serious and chronic pediatric illnesses.

 

Labor and Delivery/Nursery and Pediatrics- One week each

The initial management of the newborn is learned in the delivery room. Students then practice the examination of the newborn and learn about the initiation of feeding, neonatal physiological changes, and common newborn conditions. In the newborn intensive care unit, the student is an observer of the management of the premature and term infant with serious illness. Emphasis is placed on observing and understanding the role of the pediatrician in the multidisciplinary team approach to critical care.

 

 

Independent Learning (ASK-ME)

Modules (SGU Students)

The students are responsible for completing the introductory modules of the Communication Skills course prior to the start of the 3rd year core rotations. This self-directed learning computerized course can be accessed through the SGU website at My SGU (click Communication Skills course, upper left corner).

In addition, the modules required for the pediatric rotation are:

#21. Communication and Relationships with Children and Parents. #22. The Adolescent Interview.

 

The student will participate in the self-directed web-based learning course, CLIPP (Computer-Assisted Learning in Pediatric Programs).  The 25 assigned will be completed during the 3rd and 4th years.

 

Third Year Cases Fourth Year Cases

Nursery: 1, 7, 8. Week 1: 11, 12

Ambulatory Care: 2,3,4,5 Week 2: 16,17

Inpatient: 10,13,19,25,30 Week 3: 20,23

Other: 21,26,27,28,31 Week 4: 24, 32

 

The course is accessed through Sakai on the SGU website under the heading “Lessons”. The student will be directed to the Med-U website for case content and will complete all of the questions in the module. The student will then go back to the SGU website to answer 5 questions. The student must get 80% of the questions correct to receive credit for the module.

Completion of the cases will be monitored through the Office of Distributive Education. The preceptors are able to monitor the students’ progress.  Completion of this course is required and will be monitored through the 3rd and 4th year.

There are an additional 7 cases in the CLIPP program that are not on the required list. You may do these on your own or as directed by your preceptor.  You may do the 4th year cases during your 3rd year or any case directed by your preceptor.

 

 

 

Conference Schedule

Thursdays are Non-Clinical Days, report to NYU Lutheran Medical Center Conference Room for Pediatric Grand Rounds and follow scheduled below.

Type of Rounds

Frequency

Time

Location

Bedside Rounds

Daily

7:00am to 8:00am

Pediatric unit

Attending Rounds

Daily

8:30am to 9:30am

Pediatric Unit Playroom

Topic Discussions*

Monday, Tuesday, Wednesday, Friday

12:00pm to 1:00pm

Room 6128

Grand Rounds

1st, 2nd, 4th & 5th Thursdays

8:30am to 9:30am

Executive Board Room

Perinatology Conference

3rd Thursday

Please refer to Grand Rounds Scheduled, Subject to change.

9:00am to 10:00 am

Auditorium

Preceptor Sessions**/ Case Presentations

Thursdays

(excluding last week)

10:00am to 12:00pm

Room 6128

Radiology Rounds

Thursdays

12:00pm to 1:00pm

Dr. Gudy’s Office

Review of Shelf Exams

Thursdays

2:00pm to 4:00pm

Room 6128

 

*All students in Pediatrics Nursery and or ED should report to Case Presentations & Topic Discussions Monday, Tuesday, Wednesday and Thursday.

 

**You must attend the Preceptor Sessions. The Preceptor Sessions will include clinical discussions that focus on problem solving, decision making and adherence to bioethical principals. You should come prepared with your Case Presentations to these sessions. These preceptor sessions are conducted on Thursdays from 10am to 12pm.

 

 

 

Procedures

a) vision and hearing screening

b) otoscopy

c) administration of inhalation therapy (Metered Dose Inhaler/MDI/Spacer/Nebulizer).

d) throat culture

e) immunizations: intramuscular injection, subcutaneous injection.

f) Mantoux testing: PPD

g) nasopharyngeal swab

h) peak flow measurement

 

 

Exams/Presentations

Clinical Write-Ups / Case Presentations

A minimum of four complete clinical write-ups (case presentations) is required per student. These write-ups will be critiqued by the preceptor and returned to the student. It is preferable that the patients selected for these write-ups be examples of the case mix from you rotations. The write-ups will be handed in at intervals during the rotation and returned promptly so that the student can improve their written expression.

Topic Discussions

You must present two topic discussions, one each while in your Pediatric Floor and Newborn Nursery rotations. The topic discussion will be presented in Power Point format. If you are on that date alone, make the presentation about 20 slides in a 35 to 45 minute presentation. If two persons are to present, cut the presentation to about 10 to 15 slides and keep presentation to 20 to 25 minutes. Included in this discussion should be the definition of the condition, background, clinical assessment and etiological discussion, diagnostic workup, treatment and prognosis.

Email these presentations to Dr. Sheikh before hand. MSheikh@lmcmc.com

 

Mid Core Evaluations

Each student will have a formative mid-core evaluation. You will bring a print out of their Patient Encounter Log to the session. The Log will be reviewed for completeness, quality of notes and mix of cases. The student’s professional behavior will be addressed, as well as progress in attaining the knowledge and skills required to evaluate a patient. There will be appropriate comments and suggestions given to the student to guide them toward improvement. The preceptor will submit a written assessment of the Mid-Core evaluation. These evaluations occur on the Fourth week of rotation. Please refer to Calendar for dates and times.

 

Oral Final Exam

An oral examination, lasting 15 minutes or longer, will be given during the last week of your rotation by Dr. Sheikh. Please refer to Calendar for date and times.

 

Final Exam

The final written examination will be the National Board of Medical Examiners Clinical Subject Examination. This exam will be given the last Thursday or Friday of your rotation.

 

 

Overnight/ On-Call Schedule

  • Call occurs during Pediatric and Regular Nursery Rotations.
  • Call begins at 7am and ends at 7pm.
  • If you are on-call for Saturday or Sunday, the call starts at 8:00am, with Morning report.
  • No one is on-call the last week of your rotation.