Welcome to Pediatrics! Having "broken the ice" with a preliminary, albeit brief, exposure to pediatrics in the "Introduction to Clinical Medicine," you will now be able to better develop your skills during the longer clerkship exposure.
The pediatric core clerkship consists of two three-week segments, one based in the Hasbro Children's Hospital inpatient services, and the other in different ambulatory settings arranged through the office of the Clerkship Director. I will coordinate the clerkship for the inpatient and the ambulatory rotations and will orient you briefly before each segment.
Inpatient service
The clerkship should provide you with more hands-on experience, as well as insight into a sampling of the varieties of pediatric illnesses and problems encountered by the house officer and the pediatrician. The depth, extent, and quality of the experience will depend upon the number of patients you see and the degree of involvement you choose in the evaluation, management, and follow-up of the cases assigned to you.
There are four inpatient services in the Hasbro Children's Hospital. Each team admits every other day to all three floors. The inpatient team consists of one to three house officers of different levels of training, an attending physician, and one to two medical students.
Rounds
Each team rounds daily, plans and carries out the appropriate work-up and care plan, and holds didactic sessions and case discussions. By pairing yourself with a house officer, working up your patients under supervision, and making yourself available to the extent possible, you will reap the benefit of a more pragmatic knowledge of pediatrics. When the going is slow, there is a well-stocked library of relevant literature in the Residents' Library on the 4th Floor of HCH. Generally, it is best to stay near your team's house officers on the days and evenings they admit patients and save the reading for the day
they don't admit or when it's quiet. When your team rounds and during sessions with the attending physician, you will be asked to present your patients succinctly with their problems, progress and evaluation and management. Once in a while you may be assigned a topic for discussion. In addition to the history and physical examination you perform and record in the chart, you will learn to develop a differential diagnosis and assessment. You will find a helpful guide concerning the write-up in the syllabus. An attending physician, a respected pediatrician selected for the quality of his/her teaching, is assigned to your team.
Night Call
All students will have night call every fourth evening. This generally lasts until 10:00 PM from
Sunday through Thursday. Students are expected to assist their team in signing out patients to the
Night Float Team. They arrive at 8:00 PM. Friday and Saturday night call generally lasts until midnight.
Students are not required to stay the night, but you may sleep over if room is available that
night in the suite of pediatric residents' rooms (check with thesenior or chief resident).
Night call is a good opportunity to become involved in the evaluation and care of new patients.
Scheduling Conflicts
There are several conferences in the Pediatric Department of interest to medical students. Although most are scheduled at convenient times, some may, in fact, conflict with your activities on the wards. In general, when this occurs, precedence should be given to direct experience of pediatrics on the wards with your patients and supervising resident. If the conference involves a patient of yours, you should attend. If in doubt, consult your team leader.
Didactic Sessions
Besides regularly scheduled teaching conferences which you may attend jointly with house officers, there are two lectures each week specifically for medical students concerning core pediatric topics. These are presented on Thursday afternoons from 3:00-5:00PM in 151B conference room at Hasbro Children's Hospital. Unless otherwise indicated A list of topics is in the syllabus. Your active participation and preparation for these sessions will make learning more pleasant and improve retention.
Examinations:
You will have 2 examinations at the end of the clerkship.
Oral/Performance Exam: to be described by the Clerkship Director.
Written Examination: A set of clinical problems will be given to you at the beginning of the rotation. You will be asked to respond to 12 of those at a written examination on the last day of the clerkship.
Medical Ethics
Medical ethics conference will be incorporated into the lecture series. These sessions are required. The faculty will consist of Professor Ed Beiser, Professor Dan Brock, or Professor Ed Brown, and one of the faculty of the Department of Pediatrics. At least one session will deal with a case relating directly to the experiences of students during their pediatric clerkship.
Preceptors
A faculty preceptor will meet with up to 3 inpatient students on a weekly basis during the inpatient portion of the clerkship. Each student is expected to present at least one case to the faculty preceptor during that time.The faculty preceptor will listen to the case presentation, ask questions of the presenter and the other students, and see the patient with the students. Also, the faculty preceptor will be asked to review one case write-up and one progress note from each of the students. At the conclusion of the clerkship, the faculty preceptor will be asked to evaluate each student based on contact during the weekly sessions. During the outpatient portion of the clerkship, an effort will be made to connect you with a pediatrician practicing in the community--the person with whom you will work the most-- who will be your main faculty contact during the outpatient portion of the clerkship. These persons can also be useful resources with whom to discuss the possibility of incorporating some attention to children's health care in your future career.
Resources
A variety of resources are available to students during the pediatric clerkship. These include videotapes, textbooks, CD-ROMS and other materials listed on a separate page in this syllabus. These resources are available by contacting Helene Felici, Hasbro Children's Hospital, room 124, 444-3406.
Additionally, there are a number of books and audio tapes concerning pediatrics in the Peters Medical Library on the first floor of the Aldrich Building. There is no required pediatric textbook.
Evaluation of your performance
The written evaluation by supervising house officers and attendings, as well
as the performance on your examinations, enter into an assessment of your
overall performance. "Honors" is awarded at the end of each clerkship.
Unsatisfactory performance on either the clinical services or the exams will
esult in an "incomplete," and arrangements must be made to make up the deficiency.
Unsatisfactory performance in both represents failure and requires satisfactory
completion of a rescheduled clerkship.
A clinical performance evaluation form developed to reflect the attainment of Brown's
core clinical competencies will be used to obtain information from faculty and residents
about your performance during the clerkship.An effort will be made to send evaluation forms
to all faculty and housestaff with whom you work, even if that contact is for only one
afternoon in a subspecialty clinic or one shift in an emergency department. The form is
designed to record the extent of contact between you and the evaluator. Because there
are often unanticipated changes in the schedules for you, the housestaff, and the attendings,
please check with Helene midway and at the end of the clerkship to be sure that the right
evaluators have been identified and contacted.
You will have the opportunity to review your written evaluations by attendings and
residents about five to six weeks after your clerkship. Please call Helene (x3406) to
schedule an appointment with Dr. Rockney.
Evaluation of Teaching
On the last Thursday of the clerkship, at the Lecture Series , you will be given evaluation forms concerning
the teaching. Please make every effort to evaluate each and every teacher with whom you have contact
including ones you worked with for only one day. Your candid opinion and suggestions will
help us to assess and improve our teaching program. These will be collected the day of your
written exam, at the Closure Meeting.
Please do not schedule any travel arrangements or other engagements until 3:00 PM on the last day of
your rotation. No exceptions.
Should problems be encountered, please feel free to discuss them with your team leader,
attending, or myself. During your inpatient rotation I will meet with you occasionally
to answer any questions. We all want your encounter with pediatrics to be positive and
a learning experience, even if you don't intend to become pediatricians.
Randy Rockney, M.D.
Pediatric Clerkship Director