Updated July 26, 2006

General Information
Outpatient Experience
Inpatient Experience
Conferences
Evaluation
Recommended Books
Recommendations for Success
Clerkship Information

General Information

The third year pediatrics rotation is eight weeks long. Students spend four weeks on the inpatient wards at Kosair Children's Hospital (KCH) and four weeks at one of several outpatient clinics (Children and Youth Project, University Child Health Specialists, University Child Health Specialists - South, East Louisville Pediatrics, or Oldham County Pediatrics). During one of the outpatient experience weeks, the mornings will be spent in the newborn nursery at University of Louisville Hospital.

Outpatient Experience

Students work at clinical sites (Children and Youth Project, University Child Health Specialists, University Child Health Specialists - South, or Oldham County Pediatrics) with faculty and residents from the Department of Pediatrics during this four-week rotation.

Outpatient Clinic:

This is a great opportunity to see what a general pediatrician does on day to day basis. Typically, the student will see the patient first, go through the H&P and return to report findings/impressions to a preceptor (faculty) who will return with student to see the patient. Routine colds, ear infections and well child checkups make up a large portion of the experience. Normal development, immunizations and preventative medicine is emphasized with each patient contact.

Newborn Nursery Mornings:

For one week of the four-week outpatient experience, you will spend your mornings (starting at 8 AM) in the newborn nursery at University of Louisville Hospital. On Friday, the newborn nursery experience begins after Pediatric Grand Rounds (located in the Norton Hospital Auditorium). This is an excellent opportunity to learn to assess infants as they make the transition from intrauterine to extrauterine life. Physical exam and writing progress notes are emphasized for junior medical students. Learning how to speak with mothers of newborns and their families is also covered. By the end of the week, you will have the chance to perform a newborn exam on several babies under the observation of an attending faculty member. You will also be asked to speak to newborn mothers about their baby's medical exam and instruct them on how to care for a newborn. Students may watch/assist in male circumcisions. Some attending faculty will ask students and residents to present a pertinent medical topic to the newborn nursery to the rest of the group for group learning.

Inpatient Experience

On this service, the student will spend four weeks on an inpatient team at Kosair Children's Hospital. This team will admit a variety of age groups. There are usually 2-4 medical students, two interns (one is usually a pediatrics resident and the other is usually a Family Medicine or Medicine-Pediatrics resident), an upper-level resident, and an attending faculty member on each team. You will be asked to help one of the interns on your team admit patients (including history and physical), check patients' lab values, write progress notes and discharge summaries, examine and speak with patients, and write consult notes. You will also have an integral part of daily rounds with your team. You will present at least one patient (but up to four patients depending on the census of the hospital) per day to the attending pediatrician and the rest of the team. You may be asked questions by the attending during rounds and asked to research a topic and present to the team on the next day. Morning report occurs every weekday except Friday (due to Pediatric Grand Rounds) at 8:00 AM sharp on the 6th floor in the conference room. It is important to be at morning report on time because promptness is a portion of your inpatient evaluation. At morning report, a case will be presented by one of the residents or acting interns (fourth year medical students) on a team to the rest of the inpatient teams. The morning report is very informal and is "student-friendly" so feel free to ask questions or make comments regarding the case presented. Many patients with pediatric subspecialty problems will be encountered. This intense rotation will allow the student an excellent chance to learn, excel, and develop an in-depth relationship with a faculty attending and with the ward team.

The rotation provides a unique opportunity for the student to function near the intern level under close supervision by an upper-level resident and an attending physician. Call is every fourth night in-house. Call rooms are located on the 6th floor of Kosair Children's Hospital. As long as your clinical responsibilities are done, you may arrive at the hospital whenever you feel necessary before morning report at 8:00 AM (or on Friday before Grand Rounds). The inpatient schedule is as follows:

1. Call Day (remain at the hospital overnight until dismissed after rounding with the attending physician on the post-call day)
2. Post-Call Day (the day after the call day where you are dismissed as soon as the attending has made rounds with your team)
3. Regular Day (perform normal morning duties, round with attending, then finish afternoon duties and wait for dismissal)
4. Pre-Call Day (admit new patients in the morning and dismissed in early afternoon because next call is the following day)

"Golden Weekend"

The "Golden Weekend" is a medical student's fantasy. It only occurs once a month and only a handful of students are privileged enough to share in its glory. If you are on call on Thursday, you get the firsthand experience of the "Golden Weekend." After being dismissed on Friday morning (post-call day), you are not expected to return to the hospital until Monday morning. The exact opposite of a "Golden Weekend" occurs if you are on call on Saturday. Taking call on a Saturday means you only experience at most a half-day of freedom on the weekend (Sunday post-call). All other scenarios indicate that students receive at least one day off of the weekend.

Conferences

All inpatient students should attend morning report Monday through Thursday at 8:00 AM on the 6th floor of Kosair Children's Hospital. Most outpatient settings have a morning conference beginning at 8:30 AM Monday through Thursday. Pediatric Grand Rounds is Friday at 8:00 AM in the Norton Hospital Auditorium. Refreshments are served following. On Thursdays, students should attend the Chairman's Conference/Morbidity & Mortality Conference at noon (12:00 PM) in the Norton Hospital Auditorium. Lunch is provided. Resident conferences at noon on other days are generally open for student attendance. A CLIPP quiz will be given on Wednesdays at approximately 1:00 PM. See the section called "Evaluation" below for more details on CLIPP. There are also two required one-hour lectures following each CLIPP quiz.

Evaluation

The students' grade will be composed of four components A) evaluation of clinical performance (35%), B) the NBME pediatric subject exam (35%), C) completion of and performance on the Computer-assisted Learning in Pediatrics Project (25%), and D) Completion of the Standardized & Simulated Patient cases (5%).

You will be provided formative feedback for each clinical assignment in the block. For each clinical assignment in the Clerkship your clinical performance is evaluated by the supervising attendings, residents and/or fellows of each service. Attendance is most important. Failure to be present and prompt for clinical assignments, conferences, lectures, and grand rounds will be reflected in your evaluation. You may spend more time with some attendings and residents or fellows than with others. However, all of your clinical supervisors may evaluate your clinical performance.

The NBME Pediatric shelf examination is a 2 hour and ten minute exam. To pass the course, students must achieve a MINIMUM RAW TEST SCORE of 62.

CLIPP is a comprehensive Internet-based learning program for use by third-year medical students during their pediatric clerkship. The interactive CLIPP cases are designed to cover all of the core content of the curriculum of the Council on Medical Student Education in Pediatrics (COMSEP). It is expected that each CLIPP case will take a student approximately 45 minutes to complete but most students spend much longer on each case. You will be expected to complete four cases per week for the last seven weeks of the clerkship. There will be a quiz that is based directly on the teaching points and learning objectives of the CLIPP cases. Up to five questions are provided for each case, all using a multiple-choice format and written in a style consistent with that of the NBME. The quizzes will be given in paper form on Wednesdays from 1:00 to 1:30 PM starting the second week. The quiz will cover the four cases from the week before. The last quiz however will be given on the last Tuesday of the block. You will have 30 minutes to complete up to 20 questions. Each completed case (completed in an appropriate time) will give you 0.5% towards your final grade for a total of 14%. To complete a case you must spend an adequate amount of time on each case (> 25 min.) and complete each card of the case. The remaining 11% will come from your performance on the weekly quizzes. To pass the quizzes, students must achieve a MINIMUM PERCENTAGE OF 70% CORRECT ANSWERS.

Each of you will have one half day of standardized encounters at the Paris Center in the Instructional Building. This activity will occur during your outpatient half of the block. You will have up to two SP cases and two SIM cases to run through. The grade is pass/fail. So you will get credit for successfully completing the encounters.

Guidelines for Numerical Percentage Scores

95 - 100 % = A superior student whose examination scores and clinical performance are outstanding.

86 - 94 % = A very good student whose examination scores and clinical performance are above average.

75 - 85 % = An average student whose examination scores and clinical performance are satisfactory.

70 - 74 % = A student whose examination scores and clinical performance are marginal.

< 70 % = A student whose examination scores and clinical performance are unsatisfactory.

HONORS grades in the Pediatric Clerkship course are awarded to students with outstanding clinical performance and examination scores who have excelled in all components of the 8-week Clerkship. They must score an OVERALL NUMERICAL SCORE of 90% or above. As a way of recognizing clearly above average performance, a SPECIAL COMMENDATION will be awarded to students whose OVERALL NUMERICAL SCORE is 86% - 89%. Only COURSE HONORS can be indicated on transcripts. All students who receive course "Honors", or "Special Commendation" receive letters signed by the Chairman of the Department of Pediatrics and the Clerkship Director, with copies placed in their permanent file in the Student Affairs Office.

Each student's final evaluation will be based on the following:

1. Assessment of performance on clinical services - 75%
2. National Board Subject Examination Score - 25%

All interns, residents and attendings who work with you during the six weeks will contribute to the clinical service assessment. Areas evaluated include interpersonal skills, fund of knowledge and clinical skills. A copy of the medical school evaluation for which is used is included on orientation day for your information

The National Board Subject Exam is a board exam about general pediatrics. You must achieve a score at the 8th percentile or more to pass.

Recommended Books

Recommendations for Success

Pediatrics is considered to be much more student-friendly and laid back than some of the other clerkships. The attendings, residents, and nursing staff tends to be very friendly. The patients generally do not resent your care and their parents are often grateful for your services. Plus, the children can be a lot of fun. You have the opportunity to see quite a bit of classic textbook pathologies that you would never appreciate in the adult world (i.e. Tetralogy of Fallot or Hirschsprung's disease). Likewise, chronic diseases (except asthma) are usually not present in this sect of the population. If you do not regularly deal with dirty diapers, crying, or children slobbering all over your name badge, you may find pediatrics daunting. Yes, you may change a dirty diaper in the newborn nursery. Yes, you may get coughed upon in the clinic, hit, or even hugged. Yet, even if you have little or no experience with children, it's easy to pick up on how to interact with them. It's amazing what a sticker and a race car can do for a small child!

If you want less of a patient load, plan on doing your rotation in the late spring, summer, or early fall months. Winter is notorious for a higher hospital census (with RSV and rotavirus especially). Ask your residents and attendings to teach you things you don't understand. The attendings LOVE if students can give an assessment and plan. You can definitely help your cause by looking up some other possibilities to include in a differential diagnosis.

Keep a good attitude and attempt to have some fun. A lot of students tend to get sick while doing the pediatrics rotation. Try to use good hand hygiene and drink plenty of fluids. When you get a chance on the wards, get some rest. Residents do not generally wake up medical students for overnight tasks while on call. If a resident tells you to take a nap or go study for an hour, do it!

As for all third year shelf exams, the question stems are extremely long. Make sure you give yourself enough time to finish.

Clerkship Information