2021-2022 Core Pediatrics Clerkship Syllabus MEDE 8408

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2021-2022 Core Pediatrics

Clerkship Syllabus MEDE 8408

Clerkship Director Nusrath Habiba, MD, FAAP [email protected]

Clerkship Coordinator

Carolyn Anderson [email protected]

mailto:[email protected]


June 11, 2021 Pediatric Clerkship Syllabus 2

Table of Contents

Page 3 Clerkship Purpose

Page 3 Pediatrics Clerkship Description

Page 3 General Clerkship Competencies

Page 4 Clerkship Specific Competencies

Page 4 Interprofessional Education Page 4 Entrustable Professional Activities (EPAs) for Entering Residency

Page 5 Clerkship Goals & Learning Objectives

Page 8 Required Didactics and assignments

Page 11 Evaluation and Grading

Page 13 Rotation Sites

Page 19 General Responsibilities

Page 24 General Guidelines

Page 267 Disclaimer

Appendix

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Clerkship Purpose

The clinical clerkships affiliated with the Texas College of Osteopathic Medicine serve to provide supervised, high quality opportunities for third and fourth year medical students to apply and transform the declarative medical knowledge and basic clinical skills that they have acquired into procedural clinical competence, while also functioning as learning members of health care teams.

The clinical clerkships promote and support TCOM students in developing clinical competence with emphasis on the core competencies beyond medical knowledge alone. Clerkships are encouraged to seek opportunities for students to provide Health and Wellness counseling, develop improved interpersonal and communication skills, professionalism, as well as practice-based learning and improvement.

The purpose of the Pediatric clerkship is to provide the medical student with an integrated program in which he/she may develop the knowledge and skills necessary to manage a multiplicity of pediatric health care problems. This will be affected through daily, direct patient contact under supervision of the faculty.

Clerkship Description

The Pediatric clerkship consists of four weeks in general pediatrics in the ambulatory care and inpatient settings. It is designed to provide an environment for the acquisition of the pediatric skills and knowledge necessary for competent patient management for students entering internships, residencies, and general/family practice, while encouraging an interest in pediatrics.

The student must comply with all rules, regulations, and policies set forth in the latest editions of the UNTHSC Catalog, the UNTHSC Student Handbook, and the Pediatric Department syllabus.

Clinical Procedures

Each student will be assigned to a faculty mentor. A student’s mentor is there to provide guidance and assistance, as needed. Each mentor welcomes the opportunity to assist with not only academic concerns, but other non-academic/personal issues as they may arise.

General Clerkship Competencies

The objectives of the Clinical Clerkships are to enable TCOM students to achieve competence as graduate osteopathic medical students. As such, the objectives of the clerkship curriculum are represented by the AACOM Osteopathic Core Competencies for Medical Students. For the purposes of the TCOM Clinical Clerkship Competencies, the AACOM 14 Competencies have been condensed into the following 8:

1. Osteopathic Principles and Practices (OPP) 2. Medical Knowledge (MK) 3. Patient Care (PC)


4. Interpersonal and Communication Skills (ICS) 5. Professionalism (P) 6. Practice-Based Learning and Improvement (PBLI) 7. Systems-Based Practice (SBP) 8. Health Promotion/ Disease Prevention (HPDP)

Pediatric Specific Competencies

• Acquisition of basic knowledge of growth and development (physical, physiologic and psychosocial) and of its clinical application from birth through adolescence.

• Acquisition of the knowledge necessary for the diagnosis and initial management of common pediatric acute and chronic illnesses.

• An understanding of the approach of pediatricians to the health care of children and adolescents. • An understanding of the influence of family, community and society on the child in health and

disease. • Development of communication skills that will facilitate the clinical interaction with children,

adolescents and their families and thus ensure that complete, accurate data are obtained. • Development of competency in the physical examination of infants, children and adolescents. • Development of competency in the osteopathic structural examination of pediatric patients. • Development of clinical problem-solving skills. • Development of strategies for health promotion as well as disease and injury prevention. • Development of the attitudes and professional behaviors appropriate for clinical practice. • Development of Interprofessional collaboration in the care of infants and children

Interprofessional Education Course Competencies

Competency Domain 1: Values/Ethics for Interprofessional Service

Competency Domain 2: Roles/Responsibilities

Competency Domain 3: Interprofessional Communication

Competency Domain 4: Teams and Teamwork

Core Entrustable Professional Activities (EPAs) For Entering Residency

These are the skills and behaviors expected of first year residents on day one of their residencies, as described by the ACGME residency directors and described in detail in the AAMC document of the above name. It is hoped that clinical clerkship directors and facilitators will make as much effort as possible to ensure that TCOM students have opportunities to practice these skills and behaviors on all clinical rotations.

1. Gather a history and perform a physical examination.

2. Prioritize a differential diagnosis following a clinical encounter.


3. Recommend and interpret common diagnostic and screening tests.

4. Enter and discuss orders and prescriptions.

5. Document a clinical encounter in the patient record.

6. Provide an oral presentation of a clinical encounter.

7. Form clinical questions and retrieve evidence to advance patient care.

8. Give or receive a patient handover to transition care responsibility.

9. Collaborate as a member of an Interprofessional team.

10. Recognize a patient requiring urgent or emergent care and initiate evaluation and management.

11. Obtain informed consent for tests and/or procedures.

12. Perform general procedures of a physician.

13. Identify system failures and contribute to a culture of safety and improvement.

14. Integrate Osteopathic Principles and Practice into clinical practice.

Our rotation objectives are based on those developed by the national organization of clerkship directors known as the Council on Medical Education in Pediatrics (COMSEP).

For a comprehensive list of clerkship objectives, we ask that you visit the following website:

http://www.comsep.org/educationalresources/currobjectives.cfm

Clerkship Learning Objectives

Our rotation objectives are based on those developed by the national organization of clerkship directors known as the Council on Medical Education in Pediatrics (COMSEP).

For a comprehensive list of clerkship objectives, we ask that you visit the following website:





Learning Objectives

A student should be able to:

AACOM Comp

A. Demonstrate newborn physical exam proficiency by performing an observed 5-minute complete exam on an infant patient at a routine health maintenance visit.

PC,ICS,P

B. Demonstrate the ability to assess a neonate’s gestational age using the Ballard scale and identify key indications of gestational maturity.

PC,ICS,P

C. Demonstrate the ability to measure and assess growth including height/length, weight, head circumference, and BMI, in patient encounters using standard growth charts.

PC,ICS,P

D. Identify failure to thrive and overweight/obesity in a child or adolescent using BMI and other growth measures.

PC,ICS,P

E. Identify variations in vital signs based on age of the patient, presence or absence of disease, and testing modalities (e.g. blood pressure cuff size).

PC,ICS,P

F. Demonstrate an ability to provide age-appropriate anticipatory guidance about nutrition, behavior, immunizations, injury-prevention, pubertal development, sexuality, and substance use and abuse.

ICS,P,PBLI, SBP

G. Accurately identify and interpret major developmental milestones of the neonate, infant, toddler, school-aged child, and adolescent.

MK,PC

H. Demonstrate the ability to interpret the results of the M-CHAT autism screening tool.

MK,PC

I. List characteristics of the history and physical examination that should trigger concern for possible physical, sexual, and psychological abuse and neglect (e.g. inconsistency in the history, unexplained delays in seeking care, injuries with specific patterns or distributions on the body, or injuries incompatible with the child’s development).

MK,PC

J. Demonstrate professionalism, confidentiality, and empathy in obtaining an adolescent social history (HEADSS assessment).

MK,PC ICS, P


K. Explain the differences in appearance of male and female genitalia at different ages and developmental (e.g. Tanner) stages.

MK,PC

L. Demonstrate the ability to obtain the patient’s medical history in an age-appropriate and sensitive manner from a child and/or the accompanying adult.

MK,PC , ICS,P

M. Perform a pediatric physical examination appropriate to the nature of the visit or complaint (complete vs. focused) and the age of the patient.

MK,PC

N. Present a complete, well-organized verbal summary of the patient’s history and physical examination findings, including an assessment and plan, modifying the presentation to fit the time constraints and educational goals of the situation.

OPP, MK,PC PBLI,SBP

O. Document the history, physical examination, and assessment and plan using a format appropriate to the clinical situation (e.g. inpatient admission, progress note, health maintenance visit, acute illness visit).

MK,PC

P. Demonstrate the ability to generate an age-appropriate differential diagnosis and problem list based on the interview and physical exam.

OPP,MK,PC,ICS

Q. Interpret the results of diagnostic tests or procedures, recognizing the age-appropriate values for commonly used laboratory tests, such as the CBC, urinalysis, and serum electrolytes.

OPP,MK,PBLI

R. List the immunizations that are currently recommended from birth through adolescence and describe the rationale and general indications and contraindications of immunizations.

MK,PBLI,SBP

S. Demonstrate the ability to search for relevant information using electronic (or other) databases and critically appraise the information obtained to make evidence-based decisions.

MK,PBLI

T. Collaborate interprofessionally with students of the nutrition programs at TCU and TWU to perform a nutritional assessment on a child and formulate a plan to optimize the child’s nutrition.

OPP,MK,ICS,P


Required Didactics and Study Assignments – All Students

Aquifer is a virtual patient program for the Pediatric Clerkship, accessible through the following webpage: www. https://aquifer.org

Aquifer’s 32 interactive virtual patient cases are designed to encompass the learning objectives listed in the Pediatric Clerkship syllabus. Students are assigned 10-11 Aquifer cases per week, according to the following schedule. Week 1 Pediatric Cases 1, 2, 3, 5, 8, 10, 11, 16, 17, 24 Week 2 Pediatric Cases 4, 6, 7, 9, 18, 19, 21, 22, 23, 29, 30 Week 3 Pediatric Cases 12, 13, 14, 15, 20, 25,26,27,28, 31, 32 Beginning in week 1, students will take a quiz based on that week’s 10-11 assigned Aquifer cases. Students must obtain an overall combined score of 70 to pass this required portion. Final grade will be Pass/Fail. Institute for Healthcare Improvement (IHI.org) Open School

Each student is required to complete the following: PS 103 – Human Factors and Safety Students are required to upload the completion certificate to Canvas

Canvas Didactics – Available on Canvas for All Students Dr. Habiba Nutrition Dr. Bowman Hematology Cases for Medical Students/Interpreting Pediatric Lab Test Dr. Bui Adolescents Dr. Bowman Cardiology Dr. Bui Child Abuse Dr. Tom Rogers Well Infant Exam Dr. Tom Rogers Skin Bites Dr. Tom Rogers Sports Injuries Dr. Tom Rogers Respiratory and GI Office Problems Dr. Sam Selby Orthopedics Dr. Sam Selby Dermatology Dr. Deanna Cross Genetics Dr. Maxie Brewer When a Fever is an Emergency & Pediatric Opthamology Problem Conroe Medical Education

https://aquifer.org/

http://www.ihi.org/


Students attend Residency didactics on Wednesday pm. Lecture every 4th Friday.

Driscoll Children’s Hospital

Morning report every morning Student rounds - Friday Noon conference – Monday through Thursday Grand Rounds – Friday “MSIII Challenge” – Wednesday Christus Good Shepherd Medical Center

Lecture every Tuesday afternoon Morning report weekly educational conferences and Grand Rounds optional

Telemedicine Virtual Visits (All Students)

Each student will be assigned at least one telemedicine visit with a faculty member at UNTHSC in the Pediatric Department. Information regarding instructions for your Telemedicine visit will be sent to you in your Orientation instrcutions. Carolyn Anderson will assign you a date and time for the telemedicine visit.

Objectives: The AAMC has defined the Telehealth Competencies in six domains: D1 Patient Safety and Appropriate Use of Telehealth D2 Access and Equity in Telehealth, D3 Communication via Telehealth, D4 Data Collection and Assessment via Telehealth, D5 Technology for Telehealth, and D6 Ethical Practices and Legal Requirements for Telehealth

Learning Objectives

A student should be able to:

AAMC Domain

A. Explains to patients and caregivers the uses, limitations, and benefts of telehealth — that is, the use of electronic communications technology to provide care at a distance

D1

B. Explains to patients and caregivers the roles and responsibilities of team members in telehealth encounters regardless of modality

D1

C. Describes when patient safety is at risk, including when and how to escalate care during a telehealth encounter (e.g., converts to in-person visit or emergency response)

D1


D. When considering telehealth, assesses the patient’s needs, preferences, access to, and potential cultural, social, physical, cognitive, and linguistic and other communication barriers to technology use.

D2

E. Develops an effective rapport with patients attending to eye contact, tone, body language, and nonverbal cues

D3

F. Assesses the environment such as attending to disruptions related to privacy, lighting, sound, and attire

D3

G. Explains how remote patients’ social supports and health care providers can be incorporated into telehealth interactions and the care plan (e.g., asynchronous communication and the storage and forwarding of data)

D3

H. Obtains history (from patient, family, and/or caregiver) during a telehealth encounter

D4

I. Conducts appropriate physical examination-Inspections and observation or collects relevant data on clinical status during telehealth encounter, including guiding the patient and/or tele-presenter

D4

J. Explains the importance of patient-generated data in the clinical assessment and treatment plan during a telehealth encounter

D4

K. Explains equipment required for conducting care via telehealth at both originating and distant site

D5

L. Explains limitations of and minimum requirements for local equipment, including common patient-owned devices

D5

M. Explains the risk of technology failures and the need to respond to them D5

N. Describes locally relevant legal and privacy regulations for telehealth D6

O. Defnes components of informed consent for the telehealth encounter D6

P. Demonstrates knowledge of ethical challenges and professional requirements in telehealth

D6


Morning Report (Case Report) - DFW Students Only

Each student is required to present a case of their choosing at least one time during their four-week clerkship. The student must have seen the patient himself/herself at any of the approved clerkship sites. The case MUST be prepared and discussed with his/her assigned Morning Report Moderator PRIOR to the session using the provided STUDENT-PATIENT WORKSHEET. The presentation should be in a powerpoint format. It is designed to simulate presentation of a patient on hospital rounds. Each student should strive to make their presentation as complete, organized, and concise as possible. Carolyn Anderson will provide a presentation schedule.

Evaluation and Grading

Evaluation is an important part of any educational experience. The most important part of the evaluation process is the feedback the student receives during the learning process. Each student will be evaluated at the end of his/her rotation by a pediatric faculty mentor with input from other faculty members and complete w the "Clinical Clerkship Evaluation" (CCE). The final pass/fail grade you receive will be based on your performance in three basic areas: It is a direct conflict of interest for an evaluator to provide medical care to a student for whom they are responsible for evaluating. The same person should not be privileged to both academic and medical information about a student. No preceptor should fill out an evaluation form for a student that they provide medical care. It is best practice for medical students to seek their care from physicians not related to their medical education. Clerkship directors and preceptors should refer students to their own PCP or student health clinic for care.

The final grade of honors/pass/fail for the core rotation is derived from successful completion of the following components:

Component Evaluation Tool Minimum Score Required Faculty Assessment

Clinical Clerkship Evaluation Upon completion of this clerkship students should perform the behaviors outlined within the “expected” level of each competency rated on the Clinical Clerkship Evaluation and the AACOM Osteopathic Core Competencies for Medical Students. Student evaluations with ratings of below expected for any competency may result in failure.

Standardized Assessment

NBOME COMAT Exam Minimum Scaled Score of 70

Online Learning Assessment

Aquifer Quizzes Combined average of 70%

IHI – PS 103 Upload to Canvas Complete Case – must upload certificate to Canvas


Honors 2.0 Honors in Core Clerkships Students may be eligible for “Honors”, designated by the Clerkship Director, if they meet all expected requirements to pass the clerkship and:

• Score 91 or above on the COMAT exam for that clerkship. The score will be set and approved on an annual basis by the clerkship director, the assistant dean for clinical education, and the senior associate dean for academic affairs.

• Achieve an “Exceeds Expectation” on at least one of their clinical evaluation competency areas. • Do not have a “Below Expectation” on any clinical evaluation competency area. • Do not violate any Clinical Education policy or procedure while on the rotation, e.g. attendance

policy. • Score 70 or above on each of the 3 Aquifer Quizzes on the first attempt.

The final designation for Honors is at the discretion of the Clerkship Director for Core clerkships and does not apply to elective rotations. COMAT Exam A passing score of at least 70 (scaled) on the Pediatric COMAT exam is a required component of this course. Testing and Evaluation Services will notify students of exam date, location, and start time. Students must be seated in their designated seats prior to the published exam time. Any student arriving late to the COMAT exam will receive no additional time to take the exam. They will be required to stop taking the examination at the published stop time. A student will lose 10 points on the exam for late arrival. If the 10-point reduction results in a score below 70, the student will not be required to remediate the exam. However, the score will be recorded as is. See also section 4.2.1 of Clinical Education Policy and Procedure Manual for COMAT exam and remediation procedures. When all of these requirements are successfully met, the student’s cumulative grade including COMAT score and pass/fail for each exam and an overall clerkship grade of Pass/Fail will be reported to the Registrar for recording on the student’s transcript. If, at any time, during the rotation, the faculty believes that a student is in jeopardy of failing, notification will be given to the student at the earliest possible time. The student will be given a corrective interview by the clerkship director and/or the department chairman, at which time, reasons for the impending failure will be detailed and possible solutions offered.

**WARNING** Students are not permitted to reveal in any manner the content, questions, or other

specific material contained in the NBOME Subject Examination. The penalty is severe with possible disallowance of the individual's test and possible elimination of the institution from future NBOME testing.

The following is a list of pediatric clinical skills that should be performed and evaluated during the rotation.


1. Otoscopic examination 2. Visual Screen (over 5 yr. old) 3. Auditory Screen (over 5 yr. old) 4. Hip evaluation in patient under 1 year 5. Review growth charts and BMI 6. Evaluation & review 1 ADHD patient & medical record 7. Complete developmental milestone review and well child exam for ages 2,4,6 months,

1 yr. & 3-5 yr old; adolescent

Remediation Policy: It is the recommendation of the Department of Pediatrics

a. If a student fails only the clinical portion of the rotation, he/she will be required to repeat the entire rotation including the weekly quizzes and the NBOME COMAT subject exam.

b. If a student passes the clinical portion of the rotation but fails the clinical clerkship rotation because of a failure in the written portion (i.e., a score of less than 70%), he/she will be required to repeat the NBOME COMAT subject exam.

c. If a student fails both the clinical and written portions of the rotation remediation will be as in (a) above.

d. If a student is required to remediate any portion of the rotation because of a failing grade for Aquifer Quizzes and subsequently passes after remediation, a final score of Pass will be submitted to the registrar.

Rotation Sites DFW AREA Health Pavilion Dr. Priya Bui Dr. Toyya Goodrich Dr. Nusrath Habiba (Clerkship Director) Dr. Raheela Hafeez Dr. Sarah Matches Dr. Christina Robinson PA Shadia Osakwe PA Huong Pham 855 Montgomery Street Fort Worth, TX 76107 Student Responsibilities:


Students will spend 1-2 weeks at the Health Pavilion under the supervision of a UNTHSC faculty member. Students are expected to show up to clinic at 8:00 am. Use your best efforts, judgment and diligence in fulfilling the assigned duties and responsibilities in a professional and appropriate manner. John Peter Smith Hospital 1500 S Main St. Fort Worth, TX 76104 Student Responsibilities: Students will spend 2 days at the JPS Newborn Nursery and Labor and Delivery unit. Under the supervision of the attending physicians and family medicine residents, students will learn how to assess and manage the newborn. Students are expected to report to the JPS Newborn Nursery daily at 7AM for newborn nursery rounds. After rounds, students may attend newborn deliveries, circumcisions, and other newborn nursery procedures with the permission of the attending physician and residents. Cook Children’s Medical Center 801 7th Ave, Fort Worth, TX 76104 Learning Activities:

A. Lectures will be given several times a week at the discretion of your preceptor. Please make every effort to attend. Lectures scheduled by your preceptor would preclude any other scheduled events, including Distance Learning and Student Grand Rounds.

B. Attend Grand Rounds in Hochberger Auditorium each Tuesday at 8:00 AM (except for the first Tuesday of the month), unless otherwise directed by your preceptor.

C. Complete the case questions provided by your preceptor by the end of the week. Try to do them without consulting any references. You will be provided with the answers by the end of the week.

Student Responsibilities:

A. Clinical responsibilities- Use your best efforts, judgment and diligence in fulfilling the assigned duties and responsibilities in a professional and appropriate manner.

B. Keep a written record of assigned patients. Students’ notes may not be written in the patients’ charts. Students are still expected to have notes written on progress note paper in the professional/organized manner that would be expected from a note that should be in the chart (e.g. SOAP note, Admission note).

C. Dress code- To comply with the dress code set forth by Cook Children’s Medical Center. No shorts, jeans, open-toed shoes or scrubs. Students should wear clean white coats and badges at all times.

D. Demonstrate respect and professionalism toward patients, staff, residents and attending physicians. Examples of this include, but are not limited to:

1. Turn cell phones off or set them on silent. 2. Arrive on time and prepared with notes written.


3. Make every attempt to examine patients in a timely fashion. It is not acceptable to skip examining the patient, even if they are sleeping.

4. Avoid scheduling appointments or activities that will interfere with the clerkship. Be advised that we only have you for two weeks, so please make the most of it! If appointments must be scheduled, please schedule them for after 4pm.

5. Every effort should be made to participate in all assigned duties, unless in an emergency situation. Examples of unacceptable absences include, but are not limited to: pet illness, personal/spouse/child minor illness, doctor’s appointments, car troubles.

6. Address hospital nurses, patients, families, staff, attending’s, and peers with respect. Remember, most nurses and other ancillary staff know more than you, and are valuable resources!

7. Students should avoid using the computers in the dictation rooms. Multiple providers/specialists need access to these computers and the space is limited. Please find computers in the front or back nurses’ stations.

E. Participate in and provide safe, effective and compassionate care under the supervision commensurate with your level of advancement and responsibility. This includes: 1. Create your own notes/presentations and include your own plan in a clear, organized manner.

Each attending has his/her own writing style, so it is evident when a note is plagiarized. Please avoid doing this.

2. Report all exam findings/labs/vital signs/ ins-and-outs, and then report your interpretation. Reporting them as “normal” without elaborating on what they actually are is not acceptable. Vital signs should be reported as a range over the last 24 hours.

3. Read evidence-based literature about your patients’ diagnoses, preferably before rounds if possible.

4. Please look at plain films and report your interpretation. Use the radiologists’ interpretation as a resource only

F. Comply with all applicable policies, bylaws, rules, and regulations of Cook Children’s Medical Center. G. Promotes and uphold the mission of Cook Children’s Medical Center.

Child Plus Pediatric Health and Wellness - Saginaw Clinic

Dr. Sam Davis 604 E. Bailey Boswell Rd. Saginaw, TX 76131 817-484-6610

Mansfield Pediatrics Clinic Dr. Melody Burton 1825 Cannon Dr. Mansfield, TX 76063 817-453-7770


Texas Natural Pediatrics Dr. Lata Shridharan 2440 Timber Ridge Dr. #101 Frisco, TX 75034 18 And Under Dr. Debra Naylor 3041 Churchill Dr. #300 Flower Mound, TX 75022

Remote sites

Driscoll Children’s Hospital R. Michael Dulaney, MD, Director Mrs. “Dedie” Denise Rosales, Coordinator 3533 South Alameda Corpus Christi, Texas 78411 361-694-4069 Christus Good Shepherd Medical Center Dr. McDonald, Director Lacie Harvey, Coordinator 700 East Marshall Avenue Longview, Texas 75601 903-315-1696 Conroe Medical Center Dr. McKernan, Director Jennie Faulkner, Coordinator 605 S. Conroe Medical Drive Conroe, Texas 77304 936-523-5247 Disclaimer:

The provisions contained herein do not constitute a contract between the student and the College. These provisions may be changed at any time for any reason at the discretion of the Department of Pediatrics. When necessary, in the view of the College and the Department, appropriate notice of such change will be given to the student.

This clinical clerkship is operated in accordance with the policies and procedures of the academic programs of Texas College of Osteopathic Medicine as presented in your class Clerkship Protocol, Student Handbook, and College Catalog.

STUDENT RESPONSIBILITIES


The pediatric clinical clerkship rotation offers an outstanding opportunity for the willing, eager, and interested student to grasp the concepts and learn the skills necessary to be competent in his/her future clinical experiences. It also affords the student exposure to directed self-study modalities, which will improve his/her performance on licensing examinations and aid in the establishment of a lifelong habit of continuous learning. In these areas, the student’s best efforts are expected. A. General: The student, now a member of a health care team, is responsible to the attending physicians, administrative officers, nursing personnel, ancillary personnel, and of the utmost importance - to patients and to their parents. Professional behavior is expected at all times under all circumstances. Likewise, grooming and dress are expected to be commensurate with professional demeanor. Patient confidentiality is to be respected. The Department of Pediatrics believes that self-directed learning is an important aspect of the clinical educational process; therefore, students should read literature germane to their cases, and be prepared to discuss their findings with the attending physician the following day. Reference material may be found in the UNTHSC library, the UNTHSC library website, and in the offices at the Pediatric Clinic. The UNTHSC library also affords the opportunity to review current literature via computer searches. Students are encouraged to utilize this excellent resource with prior approval from departmental faculty after having reviewed the specialty and subspecialty textbooks. The Schwarz Health Sciences Library and staff at Cook Children’s Medical Center are available and eager to help students as well. The recommend textbook for the pediatric clerkship is: Nelson Essentials of Pediatrics. (8th edition). The Harriet Lane Handbook (22nd edition) Other excellent sources are: Pediatrics: A Primary Care Approach by Berkowitz (5th Edition); Pediatrics: An Approach to Independent Learning by Daeschner and Richardson (3rd Edition); If difficulties should arise in interpersonal relations between the student and any health care personnel, including attending physicians, the student is expected to seek the advice and guidance of the clerkship director or department chairman. Failure to do so may conceivably jeopardize the successful completion of this rotation. The students, as a group, will meet on the first Monday of the rotation at 1:00 p.m., with the Carolyn Anderson to review schedules, complete paperwork for Cook Children’s Medical Center in-patient rotation and view Cook’s Code of Conduct video. The course director will complete the orientation. Please be on time. B. On call duties:

Call is scheduled by Cook Children’s Medical Center (CCMC) staff. Currently, students are not taking call on a regular basis, but this is subject to change. Attire for CCMC inpatient rotation is professional attire as is worn in the clinic setting. No scrubs are allowed.

C. Clinic:

The student's exposure to pediatric patients in the clinic setting is felt to be an extremely important aspect of the educational process. The responsibility of the student in the clinical


setting is to obtain an appropriate history and do an appropriate physical on each patient. From this data base, an assessment and plan for management are to be formulated. No patient shall be dismissed from the clinic without being evaluated by the attending physician.

A problem-oriented progress note is to be documented in the EMR prior to seeing the next patient. Clinic records are to be treated in the same manner as legal documents, not to be altered, and they are not, in whole or in part, to leave the clinic premises.

Procedures are to be done only under the approval and direct supervision of the attending physician. When the student enters the examining room, he/she should introduce himself/herself as Student Dr. X___________, and explain that the attending physician will be in to examine the patient after he/she is finished. The student is not permitted to answer medical questions, nor respond with medical advice. These inquiries should be directed to the attending physician.

The clinic opens at 8:00 a.m. and closes at approximately 5:00 p.m., Monday through Friday. Students should be in the clinic at 8:00 a.m. or their designated time and be present in the conference room for morning report on Monday and Thursday at 7:30 a.m. Please be respectful of your faculty and fellow students and arrive on time.

Faculty and Staff

Health Pavilion Priya Bui, D.O., Assistant Professor (Interim Chairman) Nusrath, Habiba, MD. Associate Professor, Clerkship Director Sarah Matches, D.O., Assistant Professor Toyya Goodrich, D.O., Assistant Professor Raheela Hafeez, D.O., Assistant Professor Christina Robinson, M.D., Assistant Professor, Medical Director of the Mobile Clinic Lauren Dobbs, P.A., Assistant Professor Huong Pham, P.A., Assistant Professor Carolyn Anderson, Clerkship Coordinator Child Plus Pediatric Health and Wellness - Saginaw Clinic Sam Davis, MD Mansfield Pediatrics Melody A. Burton, DO Texas Natural Pediatrics


Lata Shridharan, MD 18 and Under Debra Naylor, MD Remote Sites Driscoll Children’s Hospital R. Michael Dulaney, MD, Director Eric Baggerman, MD Good Shepherd Medical Center Dr. McDonald, Director Gregory M. Hortman, MD Vanessa Neiman, MD Conroe Medical Center Dr. Lata Joshi Dr. Daniel Porter Dr. Jonathan Sant Dr. Pamela Ferry Dr. Ra Nae Stanton Dr. Yvette Gordon Dr. Mark Nichols

General Responsibilities

Specific orientation for clinic procedures will be given at your individual clinics. Please refer to your schedules for specific details. General Responsibilities

1. Clinic Hours Patient care hours and schedules vary from clinic to clinic. You are expected to arrive at your assigned clinic no later than one-half hour before the first scheduled patient. This will allow you to tend to any charting, messages, lab results, or other duties and be ready to see your first patient on time.

2. Patient Visits During the patient visit, the student is responsible for:

• Obtaining an appropriate history and physical. This may be v e r y comprehensive or problem focused, depending on the situation.

• Evaluation of pertinent diagnostic tests. • Presenting every patient to the faculty supervisor prior to finalizing

management plans. • After appropriate consultation with the faculty supervisor, initiate all


necessary treatment and management.

3. Medical Record The medical record is a vital part of maintaining a continuity relationship with the patient and being able to provide a preventative approach to the health care of your patients. Updating the medical record each visit is expected of all students. This will include:

• Chronic and acute problem lists • Medication lists • Immunization status • Health maintenance charts

All records should be completed the day of the visit and no medical record shall be removed from the clinic.

4. Diagnostic Tests Laboratory, x-ray, and other diagnostic tests should be viewed as a means to confirm or rule out pathological conditions suspected on the basis of your clinical evaluation. Learning cost-effective health care is an essential part of your medical education. You should be able to justify each test you order. If you cannot give sound reasoning as to why the test should be done, perhaps it is an unnecessary test. All tests should be approved by the faculty supervisor prior to ordering or doing them. Specific orientation on how to order lab and x-rays will be given at the clinic site. You must be specific and follow protocol. There are several managed health care plans that have specific rules. These must be followed. Ask the nursing staff at your clinic if you are unsure of what to do.

5. Lab Procedures Available at the Clinic Site. What lab procedures are done at the clinic is dependent on whether or not CLIA approval has been obtained. All of the UNTHSC clinics are CLIA approved. At the end of the rotation the student should be proficient in performing the following tests:

• Urinalysis. • Urine pregnancy test. • Finger stick glucose. • Throat swabs and nasal swabs for rapid tests • Obtaining specimens for various cultures and PCP

6. Writing Prescriptions

All E-prescriptions must be approved and sent by a supervising licensed physician. Students may not call in prescriptions to the pharmacy.

7. Referrals If you feel that your patient would benefit from a referral to another specialist, you must have pre-approval by the supervising physician. He/she will review with you whether there is sufficient data on the patient's problem, and see if you have done a sufficient work-up


before sending the patient to a consultant. It is your responsibility to arrange the consultations on your patients. You will be given specific orientation at each clinic site. There are specific rules to follow and these will vary according to the type of insurance or managed care plan the patient has. After making the appropriate arrangements for a consultation, the student will be expected to complete a referral form, which shall include all appropriate clinical information necessary to assure continuity of care. This includes copies of all appropriate labs, x-ray and other reports. We encourage the student doctor, whenever possible, to accompany the patient to the consultant in order to determine first-hand what is offered the patient in the way of care. When making the arrangements, ask the consultant's staff if it would be permissible for you to accompany your patient. You are expected to do this as part of the educational experience of this clerkship. Your clinical staff will cooperate in giving appropriate time away from the clinic for this educational activity.

5.2 ATTENDANCE 5.2.1 Absences Absences in 3rd Year The focus of the clinical experience in years 3 and 4 is patient care. 100% attendance is, therefore, required to be certain that continuity of care is maintained. Students may not miss the first day or the COMAT exam of any clinical rotation. It is understood; however, that certain situations may arise that will result in absence from required daily participation. In such instances the following procedures will be observed:

• Students are provided with 5 academic absences to use during third year to attend conferences, RAD, workshops, etc. In the event a student requires more than 5 academic absences, a student may submit for an extension by contacting the Office of Clinical Education. • Students are allowed up to 8 absences in each of the fall and spring semesters total. Any absences beyond that must be made up in period 13 to complete the third year and before progressing to fourth year. 8 week rotations are considered two separate 4-week blocks. • Any combination of time out (including academic) that results in a student missing more than 2 days of a 2-week block, 4 days of a 4-week block, or 6 days of a 6-week block will result in failure of the clerkship. • All absences require submission of the electronic 3rd Year Request for Absence via eMedley by the posted deadline (45 days) before the start of the rotation to allow time for schedule adjustments. • All absence requests entered in eMedley after the posted deadline are considered emergent and require documentation. • Absences due to emergent reasons such, the absence request is due immediately with supporting documentation. Students are required to notify their site/preceptor and clerkship coordinator of all emergent leave. Absences without supporting documentation will be considered neglect of duty.


• Absence due to illness is intended for use only in the event of personal illness/health related condition or to assist a family member who has a verifiable illness/health condition needing medical care. Absence, due to illness, from clerkship duties for more than one (1) day requires documentation from a licensed health care provider in support of students having an excused absence due to illness/health condition. • All absences are subject to approval by the office of Osteopathic Clinical Education. Even if the absence is approved, the Office of Clinical Education/preceptor/site may require the student to complete an additional assignment or for time to be made up. Make up days should be completed within the regularly scheduled rotation. • Students are required to notify their site, preceptor, Clerkship Coordinator, and Clerkship Director of any absences (including pre-approved and emergent). • Attendance on the first day and the COMAT exam dates are required on all rotations. • Students are allowed up to three days for the COMLEX PE exam- 1 day for travel to the exam, the test day, and an additional day for return travel. Requests beyond this may be denied by the Director of Clinical Education. You may not schedule your COMLEX PE exam on a date which causes you to miss the orientation day for a rotation. COMLEX PE is not considered part of your absences and must be requested within 48 hours of scheduling the exam date.

Unapproved absences or absence in excess of the above policy will require remediation or result in a failing grade at the discretion of the Office of Osteopathic Clinical Education. Failure to notify the clerkship director, rotation supervisor and Office of Osteopathic Clinical Education of any absence will be considered neglect of duty and may result in a failing grade for the clerkship. Absences in 4th Year The focus of the clinical experience in years 3 and 4 is patient care. 100% attendance is, therefore, required to be certain that continuity of care is maintained. It is understood; however, that certain situations may arise that will result in absence from required daily participation. In such instances, the following apply:

• Students may not miss the first day or COMAT exam of any clinical rotation. • All absences shall require submission of the electronic absences request form via eMedley a minimum of 10 business days before the start of the rotation for planned absences and within three days of student’s return from absence in the case of an individual or family emergency. • If absence is due to illness, documentation is required, the dates must match those missed and may not be signed by a member of the student’s family. • All absences are subject to approval by the office of Clinical Education. Even if the absence is approved, the Office of Clinical Education/preceptor/site may require an additional assignment or for time to be made up from any student who misses time on their service. Make up days should be completed within the regularly scheduled rotation. • Absence of more than 2 days of a 2-week block or 4 days of a 4-week block, will result in a grade of INCOMPLETE and repeat of the entire rotation will be required. • Unapproved absence or absence in excess of the above policy may require remediation or result in a failing grade at the discretion of the Office of Osteopathics Clinical Education.


• Students are required to notify their site, preceptor, and the Office of Osteopathic Clinical Education of any absences (including pre-approved and emergent). • Failure to notify the Office of Clinical Education & rotation supervisor/preceptor of any absence will be considered neglect of duty and may result in a failing grade for the clerkship. • Students may be granted approval for absence by the Assistant Dean for Osteopathic Clinical Education for participation in select Health Science Center activities. Such approval must be obtained in advance with written notification to the Office of Clinical Education and the site/preceptor. Absences due to COMLEX PE COMLEX PE is a required exam. If a student will miss clinic/rotation days for the COMLEX PE, the following applies: • Students are allowed up to three days for the COMLEX PE exam- 1 day for travel to the exam, the test day, and an additional day for return travel. • Students may not miss the first day or COMAT exam of any clinical rotation. • Registration & scheduling information for the COMLEX PE must be submitted to the Office of Clinical Education with a Request for Absence from Clerkship form within 48 hours of selecting COMLEX PE exam date. • Failure to notify the Office of Clinical Education of COMLEX PE date within 48 hours of scheduling exam will result in COMLEX PE dates counting as absences from the rotation. • Students are required to notify their site/preceptor of any absences due to COMLEX PE. • Failure to notify the Office of Clinical Education & rotation supervisor/preceptor of any absence will be considered neglect of duty and may result in a failing grade for the clerkship.

Absences due to Residency Interviews Residency interviews are a necessary step in the residency process. Students are advised to avoid rotations in which multiple absences adversely affect the functions of the clinical team, particularly in patient care and curriculum delivery settings. If a student will miss clinic/rotation days for a residency interview, the following applies:

• Students are required to notify the Office of Clinical Education within 24 hours of accepting a residency interview. • Students may not miss the first day of any clinical rotation • Students should submit a Request for Absence from Clerkship form to the office of Clinical Education with evidence of interview invitation, agenda for interview, and dates required to be out of clinic. • Students will be excused for the day of the interview and for travel time when the interview requires an overnight stay away from home. • Students may be excused a maximum of 6 days from a rotation for interviews. • Absences of more than 6 days during any 4-week rotation due to residency interviews will result in a grade of INCOMPLETE and repeat of the entire rotation may be required.

Failure to notify the Office of Clinical Education and rotation supervisor/preceptor of any absence due to residency interviews will be considered neglect of duty and may result in a failing grade for the clerkship.


General Guidelines

Health Services -Students may access physical health services at the sites listed below. All students are responsible for carrying health insurance and should check with their insurance company before accessing services.

Students in the DFW & Weatherford area may access health services at the UNTHSC Student Health Clinic.

UNTHSC Student Health Clinic 855 Montgomery St 3rd Floor North Fort Worth, TX 76107 817-735-5051 [email protected]

Students in the Conroe area may access health services at Lone Star Family Health Center’s Spring Location.

Lone Star Family Health Center- Spring 440 Rayford Rd. Spring, TX 77386 936-539-4004 Students in the Longview area may access health services at CHRISTUS Trinity Clinical Internal Medicine.

CHRISTUS Trinity Clinical Internal Medicine 703 E. Marshall Ave Suite 1001 Medical Plaza II Longview, TX 75601 903-753-7291 Students in the Corpus Christi area may access health services at Promptu Immediate Care.

Promptu Immediate Care 5638 Saratoga Blvd Corpus Christi, TX 78414 361-444-5280 Promptu Immediate Care 4938 S Staples Ste E-8 Corpus Christi, TX 78411 361-452-9620



5.1.6 Exposure to Bloodborne Pathogens Universal Precautions: The term “universal precautions” refers to infection control which presumes that every direct contact with body fluids is potentially infectious. The Occupational Safety and Health Administration (OSHA) regulations for health care professionals who are considered to be at risk of occupational exposure to bloodborne diseases can be found at https://www.osha.gov/SLTC/bloodbornepathogens/index.html Bloodborne pathogens refer to pathogenic microorganisms that are present in human blood and can cause disease in humans (e.g. HBV, HIV, etc.). Exposure Incident means “a specific eye, mouth, other mucous membranes, non-intact skin, or parenteral contact with blood or potentially infectious materials.” Contact can occur via a splash, needle stick, puncture/cut wound from sharp instrument, or human bite. Other potentially infectious body fluids other than blood include semen; vaginal secretions; pleural, pericardial, synovial, peritoneal, cerebral spinal, amniotic fluid; saliva during dental procedures; and any other body fluid visibly contaminated with blood. Policy/Procedure: If a TCOM medical student is exposed to bloodborne pathogens either by direct contact with blood or other body fluids via the eyes, mucous membranes, human bite, or sharps (e.g., needle stick, lancet stick, scalpel cut, etc.) while on rotation, it is to be handled as an EMERGENCY SITUATION. Post Exposure Protocol

• Immediately wash exposed areas with soap and water. • If splashed in eyes or mouth, flush with large amounts of water. • Treatment is critical within first 2 hours. • Notify supervisor and follow rotation site exposure protocols (see below for addresses). • If facility is not equipped to handle exposure, contact HSC Health Student Health Clinic or appropriate remote site location listed below. • If SHC or remote site listed is not available, or you are not in the DFW area, go to the nearest ER and use your student health insurance. • You must notify Student Health and the Osteopathic Clinical Education Office of any care received at another facility.

Dallas Fort Worth & Weatherford Area students with exposures to bloodborne pathogens which occur M-F, 8-5 should report to:

HSC Health Student Health 855 Montgomery St., 3rd Floor

Fort Worth, TX 76107 T: 817-735-2273 F: 817-735-0651

For exposures occurring afterhours, students should report to the nearest emergency room and use your student health insurance.

https://www.osha.gov/SLTC/bloodbornepathogens/index.html


Conroe remote site students with exposures to bloodborne pathogens which occur M-F, 8-5, should report to the Nurse Manager at :

Lone Star Family Health Center 605 S. Conroe Medical Dr.

Conroe, TX 77304 936-539-4004

For exposures occurring afterhours, students should report to :

Emergency Department

Conroe Regional Medical Center 504 Medical Center Dr.

Conroe, TX 77304 936-539-1111

Longview remote site students with exposures to bloodborne pathogens which occur M-F, 8-5, should report to:

CHRISTUS Good Shepherd Medical Center Employee Health 1621 N 4th St, Suite 1 Longview, TX 75601

903-315-5154

For exposures occurring afterhours, students should report to:

Emergency Department CHRISTUS Good Shepherd Medical Center

700 E Marshall Ave. Longview, TX 75601

903-315-2000

Corpus remote site students with exposures to bloodborne pathogens should report to: Christus Spohn

OCC Health Nurse at Christus Spohn also immediately report to your attending and Dr Hinojosa

Bay Area report to charge nurse and medical education office proceed directly to emergency room for treatment

Medical Student Use of Chaperones

While on rotations, it is important for you to make your position clear to patients by introducing yourself as a “medical student”. All students should review with their preceptor and site all chaperone policies to ensure they are in compliance on this rotation. Without question, any portion of an exam that


involves breast, pelvic or rectal exams, and even during certain portions of an interview that can involve sexual history, should not be done alone with the patient.

Disclaimer

The clinical clerkship is operated in accordance with the policies and procedures of the academic programs of the Texas College of Osteopathic Medicine as presented in your class’ Clerkship Manual, Student Handbook and College Catalog. Academic Integrity/Honor Code

Enrollment is considered implicit acceptance of the rules, regulations, and guidelines governing student behavior at UNT Health Science Center. It the responsibility of the student to be familiar with all policies governing academic conduct which can be found in the UNTHSC Student Catalog, Student Policy Handbook and the Student Code of Conduct and Discipline which are located on the UNTHSC Internet at http://www.hsc.unt.edu/Sites/DivisionofStudentAffairs/

Academic Assistance

Students may schedule one-on-one academic assistance with faculty through in-person appointments, telephone calls or e-mail communication. Academic assistance is also available through the UNTHSC Center for Academic Performance (CAP). http://www.hsc.unt.edu/CAP

Attendance and Drop Procedure

Course instructors and the School’s administration expect students to attend class. It is the responsibility of the student to consult with the instructor prior to an absence, if possible. Withdrawal from a course is a formal procedure that must be initiated by the student. Students who stop attending class and do not withdraw will receive a failing grade. Students should consult with the instructors prior to withdrawing. In some cases, a perceived problem may be resolved, allowing the student to continue in the course. It is the student’s responsibility to be familiar with the policies and procedures as stated in the Student Handbook and the UNTHSC Catalog located on the UNTHSC Internet at http://www.hsc.unt.edu/departments/studentaffairs/.

Americans with Disabilities Act

The University of North Texas Health Science Center does not discriminate on the basis of an individual’s disability and complies with Section 504 and Public Law 101-336 (American with Disabilities Act) in its admissions, accessibility, treatment and employment of individuals in its programs and activities. UNTHSC provides academic adjustments and auxiliary aids to individuals with disabilities, as defined under the law, who are otherwise qualified to meet the institution's academic and employment requirements. For assistance contact the Assistant Director, Disability Accommodations within the Center for Academic Performance at the Health Science Center. Reference Policy 7.105 Americans with Disabilities Act Protocol in the Student Policies.

Course and Instructor Evaluation


It is a requirement of all students that they are responsible for evaluating each of their courses and instructors as defined in UNTHSC Policy 7.120 Student Evaluation of Courses and Instruction. Please adhere to all guidelines established in the policy.

Course Assessment in some instances, courses will have a course assessment that will provide immediate feedback to the course director regarding progress of the course identifying potential problems and determining if student learning objectives are being achieved. (Provide all pertinent information regarding the specifics of the groups in the syllabus as defined in UNTHSC Policy 7.120 Student Evaluation of Courses and Instruction.)

Syllabus Revision

The syllabus is a guide for this class but is subject to change. Students will be informed of any change content or exam/assignment dates.

Turnitin and the Family Education Rights and Privacy Act (FERPA) – If applicable

NOTE: UNTHSC has contracted with Turnitin.com for plagiarism detection services. Use of Turnitin.com is entirely in the discretion of the instructor, but use of such a service requires that you provide notice (via syllabus) to your students that you are using such services. In addition, instructors who use Turnitin should be sure to remove student identifiable information from the work before sending to Turnitin or receive written permission from the student. There are two methods for using Turnitin for written assignments. Please refer to the wording guidelines and consent form located on the Faculty Affairs website at http://www.hsc.unt. edu/Sites/OfficeofFacultyAffairs/index.cfm?pageName=Turnitin .

Zero Tolerance for Sexual Violence and Harassment

All students should be able to study in an atmosphere free of harassment, sexual violence and gender discrimination. Title IX makes it clear that violence and harassment based on sex and gender is a Civil Rights offense subject to the same kinds of accountability and the same kinds of support applied to offenses against other protected categories such as race, national origin, etc. If you or someone you know has been harassed or assaulted, you can find the appropriate resources on the UNT Health Science Center’s website: http://web.unthsc.edu/info/200304/student_affairs/355/title_ix_reporting

Social Media Policy Statement

Social media has created unique opportunities for interaction, communication, and networking. Students are expected to abide by the Student Code of Conduct &

Discipline and the Health Insurance Portability and Accountability Act (HIPAA) when using social media by not revealing patient/client/research subject information, private content, or proprietary information regarding patients/clients/research subjects of the institution.

The purpose of this policy is to provide students with guidelines and regulations for appropriate social media use in order to uphold confidentiality and privacy laws and agreements.

http://web.unthsc.edu/info/200304/student_affairs/355/title_ix_reporting


https://app.unthsc.edu/policies/Home/GetFile?policyNumber=07.115

We reserve the right to make clinical assignments based on needs and availability.

https://app.unthsc.edu/policies/Home/GetFile?policyNumber=07.115

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2021-2022 Core Pediatrics Clerkship Syllabus MEDE 8408

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