1. Welcome to the UNC Pediatrics Clerkship 2015-2016

2. Objectives for Orientation  Clearly state clerkship expectations  Clinical activities  Assignments  Grading  Participation  Policies  Outline clerkship objectives  Address your questions  Setup Devices  For more information, see the clerkship webpage

3. General Expectations  ~85% 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

5. Clerkship Clinical Structure - Overview  Three weeks Inpatient Pediatrics  3 long shifts (or nights at Wake/Cone)  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. Admitting - Long/Night Shifts  Long shift assigned at least 3 times  If doing long shifts, you are expected to stay until 8pm then return the following morning as regularly scheduled  Night shifts schedules at Cone and Wake are per institution  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/night shift, but learn from any patient around

10. 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

11. Newborn Nursery Generally the happiest place in the hospital…

12. Student Activities in the NBN  Specific orientation information on the web page  On Monday, discuss daily activities and expectations  Your physical exam skills will be directly observed by supervising physicians  Spend one evening in NICU to gain exposure to critically ill infants (usually T or W)  Complete the brief NICU assignment that is part of your participation grade. Turn this into your course directors.  Prepare a brief teaching presentation on a newborn topic of your choice to present on Friday (at UNC)

13. 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

14. Outpatient Pediatrics  Well child care in community outpatient practices  Preventive care, anticipatory guidance  Acute illness management  Chronic illness management

15. 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

16. 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 and challenge yourself  Use Bright Futures to guide anticipatory guidance  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  Appreciate the preceptor! Incorporating students is hard and loses money for their practices. Be thankful!

17. 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

18. Assignments in the Clerkship

19. Clerkship Assignments - Overview  Write ups  2 H&P’s  CLIPP cases  Complete 8 required cases  Cultural reflection (optional)  NICU Assignment  Didactic sessions  Documentation and completion of patient encounters/patient log on One45  Midpoint feedback and self-assessment

20. Inpatient Pediatrics - Patient Write Ups  2 History & Physicals  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  Email them to site directors upon completion.  You will receive feedback on your clinical documentation.

21. Outpatient Pediatrics Curriculum CLIPP cases  http://www.med-u.org/  Use your med.unc.edu email 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

22. 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

23. 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.

24. 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  Email it to the course directors  See details and ideas on clerkship webpage

25. 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

26. Feedback, Evaluation, and Grading

27. 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

28. 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

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

30. 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 GradePoints ScaleNBME Score Honors84 - 100> National Mean High Pass75 – 87>35 th percentile Pass50 - 74>10 th percentile Condition37.5 - 49 Fail<37.5

31. Grading - Overall Clinical - Inpatient attending - Inpatient residents - Outpatient total - Newborn nursery 60% 30% 25% 15% Participation10% NBME Shelf Exam20% Departmental Exam10% *This means that one person’s evaluation is never enough to change your grade substantially.

32. Grading – Participation – 10%  Completed by Clerkship Site Directors  Small group participation  CLIPP cases, Patient log, cultural reflection completion (extra credit)  Write-up evaluations  Professionalism is pass/fail  Failure in professionalism evaluation may lead to failure of the clerkship  Part of professionalism is being responsible. If you do not return the iPad, you will not receive your professionalism points.

33. 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

34. 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

35. Grading – Departmental Exam – 10%  Two parts: Oral and Written  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)

36. 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

37. Departmental Exam – Written All material is based on Learning Group didactics 1. Plot and interpret growth data using growth curves 2. Write an appropriate maintenance fluid order for a child of a given size. 3. Write an appropriate fluid bolus for a child of a given size. 4. Write an appropriate order for medication, with use of provided references for dosing. 5. Determine necessary immunizations for a child in a given clinical setting. The immunization chart will be provided.

38. 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

39. Accommodations  If you need special accommodations for shelf testing, make sure that is known with Dr. Ingersoll  If you need extra time for written and oral examinations, this is separate from NBME accommodations and you need to obtain approval through student affairs and your clerkship director and coordinator need to know on day 1 of the clerkship.

40. Policies, etc.

41. 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

42. 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  All absences are reported to the Dean of Student Affairs (Dr. Georgette Dent) for documentation and approval when necessary.

43. Absences  If you must be absent for any reason you should:  Use this link:  http://www.med.unc.edu/md/forms/request-for- administrative-excuse http://www.med.unc.edu/md/forms/request-for- administrative-excuse  Contact your team (Attending or senior resident) or outpatient preceptor  Call the education office regarding your absence or tardiness 966-3172 Note: Do not email the day of your absence as this delay notification of the appropriate individuals

44. Evaluating the Clerkship  Please provide us with your feedback throughout and specifically at the end of the rotation  Be professional in your feedback of our residents and faculty. This means appropriate word choice!  Our goal is that you find this to be the best clerkship all year!

45. HAVE FUN!

46. UNC Specific Information

47. Pediatric Areas at UNC  5, 6, & 7 Children’s  CICC  PICU  NCCC  CSSU  Clinics

48. Communication  Identify yourself to the nurse daily and try to be the first to get information (overnight and updates)  Include the nurse in daily rounds  Update the board and green sheets

49. Security …Because no one wants a Code Pink  HUGS  Sign in and out  Locked Unit  Beware of tailgaters  Employee ID Badge  Visitor Passes  Family Members & guests

50. Pediatric Rapid Response Team  ANYONE can call, including family  Call criteria: - Acute change in HR, BP, RR, O2 sats, or mental status; new or prolonged seizure; difficult to control pain or agitation; “gut feeling” more than enough  Call 6-4111  PRRT is PICU MD, PICU RN, RT, and Pediatric Senior Resident

51. Inpatient Pediatrics - Ward Teams  Green Team - General, Nephrology, & Genetics  Rounds begin at 8:30am in the conference room on the 6 th floor of the Children’s Hospital  Purple Team – General, Neurology, & Endocrine  Rounds begin at 8:30am on the 6 th 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 5 th floor of the Children’s Hospital  Blue Team - Pulmonary  Rounds begin at 8:30am in the conference room on the 5 th floor of the Children’s Hospital

52. 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

53. 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  Curnen-Denny Conference Room

54. Contacts  Contact information:  richard_hobbs@med.unc.edu  wmills@med.unc.edu, Mobile – 919-428-6382  Pediatric Education Office located on the 2 nd floor of MacNider in Rm 230