Welcome to the UNC Pediatrics Clerkship

Things that are specific to Cone

UNC Clerkship Websitehttp://www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone From the main page, click on the Moses Cone quick link to the right

Three weeks Inpatient Pediatrics◦ 4 overnight calls

Two weeks of Ambulatory Pediatrics◦ At least 12 half days◦ Some Subspecialty Clinics exposure

One week of Newborn Nursery Chronic Illness Project Clinical Problem Solving Sessions Core curriculum conferences

Basic Clerkship Structure

Children admitted to a community hospital are:◦ Well children with acute illness◦ Children with chronic disease presenting for acute

illness or chronic disease management◦ Children in need of diagnostic evaluation

Inpatient Pediatrics

What is ownership?◦ You may not know what the next management

step is, but you must know everything going on with your patient (studies, results, changes in symptoms, etc.)

◦ Look for something to learn on every patient◦ Follow up what happens to the patient after

they leave (when possible) Write orders (pend them in EPIC)

Inpatient PediatricsStudent Goals

Write ups◦An H&P should be written for every patient

you admit◦Two H&P write-ups - 1 copy should be

turned in to your ward attending & 1 copy to Dr. Nagappan (for grade)

◦1st WRITE UP DUE THE FIRST FRIDAY of your inpatient time Just print or email your EPIC H&P and add

a 1-2 page discussion Instructions in your packet of information

Inpatient PediatricsStudent Activities

DC summaries◦ Third year students do not write DC summaries

on patients (even if residents ask you to)◦ This is a medicolegal issue

Inpatient PediatricsStudent Activities

Conferences◦ Grand Rounds, Wednesday, 8:30-9:30◦ Noon conference daily 12:30-1:30 ◦ Core Curriculum Student Talks Mondays, 1:30 to

4:30 Be prepared (readings for each session are on the

website at http://www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/readings-and-resources)

◦ Wednesday afternoon sessions, 2p 2 pm: Meet with the clerkship director 2:30-5 pm: Clinical Problem Solving Sessions Be prepared (cases will be handed out to you

weekly and readings are located at http://www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/readings-and-resources/clinical-problem-solving-conferences-readings )

Inpatient PediatricsStudent Activities

4 night shifts, 8 pm to ~10 am call rooms available; start 8-

830 am leave the next day after presenting your patients Stick with your intern

Stay for rounds the next morning and present your patients, then leave for the day

Call changes -- difficult

Inpatient PediatricsNight float

You will do only short shifts

7:30 to 9:00: Pre-round 9:00 (except Wed): Rounds 12:30-1:30p: Noon Conference 4:30p: Sign-out

Inpatient PediatricsDaily Schedule (during your daytime weeks)

Peds attending (8 of us) 2 senior residents (UNC Peds, Med/Peds, or

Peds Primary Care) 2 interns (Moses Cone FP, or UNC Peds) 1 Acting Intern (usually UNC) 2 (usually) 3rd year med students (UNC)

Inpatient PediatricsTeam Members

ASK every family (each day) whether the family is willing to have the team round in the room◦ Helpful phrase: “There is a team of us helping take car eof

your child and, with your permission, I would like to bring them in with me for rounds this morning so everyone knows you and your child.”

LANGUAGE: Using medical jargon can make families feel excluded. ◦ Use language they can understand. ◦ Summarize important findings in simple language.◦ Invite the family to correct any information or add

information at any time◦ Helpful phrase: “We’re going to talk about Zeke so that the

day team knows everything about him. If I make any mistakes or you have anything you want to add, you can interrupt at any time.”

Inpatient PediatricsFamily Centered Rounding (FCR) -- Tips

PRE-ROUND: FCR does not eliminate the need to pre-round. For some patients (e.g., child abuse), it may be helpful to discuss some issues outside the room prior to entering

TEACHING: Teaching can occur in the patient’s room during FCR, but there is still the need for conference room teaching (differential diagnoses, brief student presentations) which can be done after rounds

NURSE INVOLVEMENT: One of the benefits of FCR is that everyone involved in care is there at one time. Having the nurse present is invaluable

Inpatient PediatricsFamily Centered Rounding (FCR) -- Tips

HELP FAMILY KNOW THAT YOU ARE SPENDING A LOT OF TIME BEHIND THE SCENES “Dr. X and I are working behind the scenes to come up with the best plan for Zeke”

EXPLAIN CONSULTANTS “We are working with Dr. Elton of Orthopedics. We are the General Pediatricians and we are here to help your child with any general pediatric problems. We are Dr. Elton’s eyes and ears when he is in the operating room.”

Inpatient PediatricsFamily Centered Rounding (FCR) -- Tips

Using the EMR (EPIC)• Check your login/password today• Don’t cut and paste forward• It takes some time to learn – it’s OK to feel “slow”

in the beginning• Watch out for note bloat• Route your note to the intern you are working with• The intern will co-sign and write an addendum

that includes PE and A/P

Office practices (Mon, Tues, Thurs, Fri)◦ Clarify expectations on the first day

Seminars (Wed)◦ 830-930: Grand rounds ◦ 930 – 1130: outpatient seminars (no specific readings for

the outpatient seminars)◦ 200: Meet with director ◦ 230: Clinical cases

Subspecialty Clinics – none assigned, but you may request time there

One weekend shift in the Peds ED (6 hours)

No call/nights during this time

Ambulatory PediatricsStudent Activities/Conferences

Newborn NurseryStudent Activities

Daily activities begin at 8:30 am

Examine lots and lots of babies

Daily notes Gain exposure to

the NICU (brief)

Wed Grand Rounds 830-930 (no seminars afterward)

Every afternoon you will have focused sessions on core topics (jaundice, sepsis, etc)

Readings are located here: http://

www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/readings-and-resources/supplemental-readings/newborn-issues

Newborn NurseryDidactics

A chance to see a patient more than once (continuity!)

Find out what the role primary care doctors have in caring for chronically ill children

See details on websitehttp://

www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/chronic-illness-project

Chronic Illness Project

During the 1:30-2:30 time, we will fine-tune your presentation skills, practice the EBM skills you have already learned

From 2:30 to 430 pm, we will do clinical cases◦ You will get the cases a week before the session◦ Prepare by reading about coming up with a

differential diagnosis and reading about the most likely possibilities

◦ http://www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/readings-and-resources/clinical-problem-solving-conferences-readings

Wednesday afternoon Clinical Problem Solving

This is covered during the Monday afternoon lectures on your inpatient time and the morning seminars during your outpatient time

We will cover the COMSEP curriculum: what every pediatric student needs to know

Each section of readings on the website corresponds to one of the core topics

http://www.med.unc.edu/pedclerk/schedules/clerkship-at-moses-cone/readings-and-resources/supplemental-readings

Core curriculum seminars

Available for you to borrow (ask Wanda)

Text Books

Grading – Participation – 10% Completed by Clerkship Site Directors

◦ Small group participation◦ CLIPP cases completion◦ Cultural reflection completion (optional – extra

credit)◦ Write-up evaluations◦ Completion of the Patient Log◦ Chronic Illness Project

Professionalism is pass/fail◦ Failure in professionalism evaluation may lead to

failure of the clerkship

Nelson’s textbook of Pediatrics (background knowledge)

Harriet Lane (reference) The Redbook (infectious disease) The Clerkship Readings on the website

(core medical student knowledge) UpToDate has some serious limitations in

pediatrics Peer reviewed literature

Reading: what resources to use

Get an interpreter when you need one – don’t take shortcuts

Use professional or phone interpreters – not relatives, siblings, etc.

Work even harder to establish rapport Look and speak directly to the patient, not the

interpreter Don’t say anything you don’t want interpreted or

understood Pause frequently for interpretation Listen to the patient Be patient Attempt to learn some Spanish

Working with Interpreters

In Greensboro, you will get experience working with people from different cultures

Think about how this is affecting your care Being culturally competent does not

necessarily require having a special set of knowledge – only that you respect families wishes and involve them in the care of their children

You can write a cultural reflection essay for extra credit (see packet & website)

Cultural Competence

No tee shirts with logos or writing on them (i.e. Hollister)

Fleeces with UNC logos on them are ok No open-toed shoes in clinical areas No excessive perfumes/colognes Long hair has to be pulled up White coat and/or tie is optional

Dress Code

You should not be mistreated during your Pediatrics clerkship

If you experience maltreatment, please bring that to the attention of Dr. Nagappan or the Dean of Student’s office or the Greensboro ombudsman (Dr. Michelle Kane)

Student Maltreatment

Maltreatment Needlesticks If you need to see a doctor here

see attached FAQs

What to do if…

Wash your hands A LOT!

Please stay at home if you are ill. Get in touch with your senior resident to let him/her know that you will be out and call the office 832-8064

If you have questions…ASK!!!

Helpful Hints

There is an optional shelf test prep review https://

echo2.med.unc.edu:8443/ess/portal/section/bb022d83-f589-4ad5-82fe-78b3e6b53dd6 (use your onyen and password to log in to see this)

The chronic illness presentation is the last MONDAY of the rotation

The departmental (oral) exam is the last THURSDAY of the rotation in Greensboro

Complete clinical responsibilities here at 2:00 on the last THURSDAY of the rotation.

The last FRIDAY of the rotation you will have the shelf test in the afternoon in Chapel Hill.

The end of the clerkship

Documentation of patient encounters on One45 (due by 3rd Friday -midpoint feedback day- and updated by last Friday of clerkship) Write-ups (2) (1st due to ward attending by 1st Friday of inpt) CLIPP cases – 8 assigned (due by last Friday of clerkship) Chronic Illness project (due by presentation day last Monday of clerkship) Cultural Reflection Essay (optional – due by last friday) Midpoint feedback self-assessment

(due by 3rd Friday - midpoint feedback day)

Basic Clerkship Assignments(Summary)

HAVE FUN!*

*cupcakes not included on rotation