3rd Year Medical Student Pediatric Clerkship Precepting ...

3rd Year Medical Student Pediatric Clerkship Precepting Handbook

Department of Pediatric Medical Student Education George Washington University

School of Medicine and Health Sciences Washington, DC

www.childrensnational.org

www.pediatriccareer.org

CHILDREN’S NATIONAL HEALTH SYSTEM

We Stand For Children!!!

http://www.childrensnational.org/

http://www.pediatriccareer.org/

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As an outpatient preceptor, you are a key to the success of our program. We hope that you and your student will develop a great working relationship from which they will achieve the objectives established for this clerkship. Thank you!!!

This package offers you supportive information and forms that can be used during your experience with your student. Additional information can also be found on http://www.childrensnational.org/ForDoctors/mse

As a token of appreciation for your effort, based on your appointment as a Clinical Instructor in Pediatrics at The George Washington University School of Medicine, we can provide access to GW Medical School’s Himmelfarb Library and their vast on-line collection of journals and textbooks. You will only need your GWID (provided at the time of your appointment) via www.aladin.wrlc.org. (If you have questions about accessing your GWID, please contact [email protected] if you do not have this.) Additional information can be found here: http://himmelfarb.gwu.edu/tutorials/PDF/faculty_orientation.pdf

Benefits of Precepting In addition to shaping the future of our profession and children’s lives generally by teaching our next generation of physicians, we can offer these benefits of precepting.

1. Faculty Appointment: Our ambulatory faculty are now being granted a Clinical Instructor’s appointment from GW. Benefits are described in this link: www.smhs.gwu.edu/faculty/limited-service. Highlights include:

a. GWorld ID card which will allow access to Himmelfarb Medical Library and the University’s Gelman Library

b. Access to Himmelfarb Library’s on-line journals and texts c. Ability to attend and participate in all faculty development programs presented by the School of

Medicine and Health Sciences d. Eligibility to participate in the meetings/conferences/programs presented by the Office of Continuing

Education in the Health Professions (202-994-4285).

2. Teaching CME a. GW is happy to provide AMA Category 1 CME credit for the self-directed learning that occurs while

preparing for student teaching. b. Credit is provided for each fraction of an hour that you spent teaching provided that you prepared for

the experience by researching the literature. You will simply need to verify: i. That you were scheduled to teach the students. We can provide verification, if needed.

ii. That you filled a gap in his/her own learning, by teaching. c. GW’s office of Continuing Education in the Health Professions can help offer additional insight at

www.smhs.gwu.edu/cehp/ or by email at [email protected] . They will be the office to provide the CME transcript as well.

Welcome to the Pediatric Clerkship Team at Children’s National Health System for The George

Washington School of Medicine.

http://www.childrensnational.org/ForDoctors/mse

http://www.aladin.wrlc.org/

mailto:[email protected]

http://www.smhs.gwu.edu/faculty/limited-service

http://www.smhs.gwu.edu/cehp/


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Package Contents

The Pediatric Clerkship Course Overview

Benefits of Precepting

The Ambulatory Objectives

GW School of Medicine Program Objectives

MedHub.com Evaluation Completion

Ambulatory Requirements and Reading List

Required Clerkship Diagnoses (students keep diagnosis logs)

Guidelines for precepting a 3rd year medical student in your office

Expectations for “Honors” level clinical performance

Sample Forms (students have all required forms)

o SCO: Structured Clinical Observation form (4 are required during outpatient)

o Mid-rotation Feedback form (1 is required after first 2 weeks)

o Outpatient Student Log

Please feel free to contact us at any time if you need assistance or if you have a question about the process or a concern about the student. Thank you for your support of the GWU pediatric clerkship.

Craig C DeWolfe, MD MEd Director Pediatric Med Stud Education Assistant Professor of Pediatrics George Washington School of Medicine Children’s National Health System Phone: 202-476-5344 e-mail: [email protected]

Clarissa Dudley, MD MPH Associate Pediatric Clerkship Director Assistant Professor of Pediatrics George Washington School of Medicine Children’s National Health System Phone: 202-476-6157 Email: [email protected]

Wilhelmina Bradford Program Coordinator, Medical Student Education Department of Medical Education Children’s National Health System Phone 202 476-5692 Fax 202 476 4741 e-mail: [email protected]

Mary C. Ottolini, MD, MPH Professor of Pediatrics George Washington School of Medicine DIO and Vice Chair for Education Children’s National Health System e-mail: [email protected]

We have a Careers Blog at www.PediatricCareer.org. Guest posters are welcome. Contact Dr. Terry Kind at [email protected] or 202-994-9587.







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Pediatric Clerkship Course Overview

The purpose of the Pediatric Clerkship is to provide the 3rd year medical student with inpatient and outpatient pediatric clinical experiences where students will

acquire a working knowledge of normal and abnormal growth and development,

recognize, understand the pathophysiology of, diagnose, and treat the common disorders of infancy, childhood, and adolescence, and

develop an understanding of children’s and families’ perspectives of being cared for within our healthcare system through observation, inquiry, and reflection.

The 3rd year pediatric clerkship consists of an inpatient, outpatient (well, sick, and follow up), and nursery rotation, including a core pediatric medical student education curriculum from birth through adolescence. Students are assigned to an inpatient medical unit at Children’s National or at Holy Cross Hospital in Silver Spring, Maryland and to outpatient Children’s Health Center sites: Adams Morgan, Comp (Shaw), Martin Luther King, Good Hope Road, Children’s Health Center at Children’s, Adolescent Health Center, or to a private practice in Maryland, DC, or Virginia. Students will spend approximately 4 days in a newborn nursery at either Holy Cross or GW Hospital. Students will not have identical exposures to patient problems and should communicate with one another to share what they are learning about their experiences. There is a minimum set of (22) pediatric diagnoses that a student will see, or for which he/she will have an alternative learning experience. During the outpatient and inpatient experiences, students will work with several attending preceptors and have an opportunity to participate in all activities that occur at the site. One of these attendings is assigned to gather input from all of your preceptors in order to compile this data and compose your evaluation. Please refer to Blackboard for information and forms needed during your pediatric clerkship. We encourage you to share useful articles, websites, and other resources with your fellow students. Let the coordinator know and we will add the resources to Blackboard. We value your evaluations of the residents and faculty with whom you work and learn, of the educational sessions, and of the clerkship overall. Your reinforcing and constructive feedback allows us to continually improve our curriculum and the quality of our teaching. Our offices (Med Ed Suite West Wing 3.5 Suite 600) are always open to you for any questions or problems. Please do not hesitate to stop by just to talk! Also, check out our career blog at www.PediatricCareer.org Clerkship Learning Objectives:

Clerkship Learning Objectives

Assessments Mapped Program Objectives

Perform effective age-oriented interviews and physical examinations on newborns, children, and adolescents.

A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - clinical skills section, which assesses student performance on physical and mental status examinations and technical/procedural skills, as evaluated by faculty and residents.

A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - communication skills section, which assesses students written and oral presentation including patient communication skills, as evaluated by faculty and residents.

A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - professionalism section which assesses students honesty, responsibility,

- Patient Care: 1, 2, 4

- Interpersonal & Communication Skills: 1, 8


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teamwork, empathy, commitment to competence and excellence, and respect for patients, as evaluated by faculty and residents.

A Pass in the newborn nursery experience

Structured Clinical Observations. Using the "SCO" form, precepting faculty (and/or residents) observe portions of the student-patient and/or student-parent interaction (i.e. history, physical, information giving) and provide brief immediate feedback to that student. Students are required to be observed using this tool 8 times throughout the 8 week clerkship.

Mid-Rotation Self-Assessment and Formative Feedback. Halfway through the inpatient and halfway through the outpatient portions of the clerkship, using a mid-rotation review form, students self-assess their performance and then meet with their preceptor for formative feedback and prepare an action plan. Students are required to complete 2 mid-rotation forms (one from inpatient and one from outpatient).

Satisfactorily complete the Inpatient Write-Up

Demonstrate the ability to develop a clinical assessment and plan in a problem-oriented fashion.

A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - cognitive skills section, which asks students to organize and synthesize data into an assessment and plan, as evaluated by faculty and residents.





- Medical Knowledge 3, 6-9

- Patient Care: 4-6, 8


- Practice-Based Learning & Improvement: 3,4,6

- Systems-Based Practice: 2, 5

Demonstrate clinical skills typical to the care of newborns, children, and adolescents



Mid-Rotation Self-Assessment and Formative Feedback. Halfway through the inpatient and halfway through the outpatient portions of the clerkship, using a mid-rotation review form, students self-assess their performance and

- Medical Knowledge 7-9, 12

- Patient Care 3-5 5, 7, 9

- Practice-Based Learning and Improvement 1-7

- Systems-Based Care 2

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then meet with their preceptor for formative feedback and prepare an action plan. Students are required to complete 2 mid-rotation forms (one from inpatient and one from outpatient).

Satisfactorily complete the Procedure Logs

- Professionalism 2-3

Illustrate ways in which pathophysiologic processes can affect the growth & development in children

Score >60 (pass) on the pediatric shelf exam






- Medical Knowledge 1-6, 9

- Patient Care: 8 - Practice-Based

Learning & Improvement: 4

Demonstrate the ability to differentiate well children from mildly or severely ill based on their signs and symptoms at various ages.






- Medical Knowledge 7

- Patient Care: 7 - Practice-Based

Learning & Improvement: 4

Practice preventive pediatrics through age-appropriate screening and anticipatory guidance about nutrition, environmental influences, safety, and

Score >60 (pass) on the pediatric shelf exam




- Medical Knowledge 1-2, 4-7, 9-10

- Patient Care: 4, 8


- Practice-Based Learning & Improvement: 4-5

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immunizations, in improving child health.




- Systems-Based Practice: 1, 3-4

Demonstrate humanistic attitudes and professional and ethical behaviors related to the pediatric patient, their family, and other healthcare professionals.




A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - professionalism section which assesses students honesty, responsibility, teamwork, empathy, commitment to competence and excellence, and respect for patients, as evaluated by faculty and residents.


Structured Clinical Observations. Using the "SCO" form, precepting faculty (and/or residents) observe portions of the student-patient and/or student-parent interaction (i.e. history, physical, information giving) and provide brief immediate feedback to that student. Students are required to be observed using this tool 8 times throughout the 8 week clerkship.


Satisfactorily complete a reflective paper

Satisfactorily complete the corresponding CLIPP cases when absent from a session or when assigned as pre-reading.

- Interpersonal & Communication Skills: 7

- Professionalism: 2-4

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Demonstrate the

ability to present a pediatric patient in an oral and written format.




Satisfactorily complete the Inpatient write-up

- Interpersonal & Communication Skills: 3

Demonstrate effective communications with patients and their families.

- A score of greater than or equal to 3 (out of 5) on the uniform student clerkship evaluation - communication skills section, which assesses students written and oral presentation including patient communication skills, as evaluated by faculty and residents.

- A Pass in the newborn nursery experience - Structured Clinical Observations. Using the "SCO" form,

precepting faculty (and/or residents) observe portions of the student-patient and/or student-parent interaction (i.e. history, physical, information giving) and provide brief immediate feedback to that student. Students are required to be observed using this tool 8 times throughout the 8 week clerkship.

- Mid-Rotation Self-Assessment and Formative Feedback. Halfway through the inpatient and halfway through the outpatient portions of the clerkship, using a mid-rotation review form, students self-assess their performance and then meet with their preceptor for formative feedback and prepare an action plan. Students are required to complete 2 mid-rotation forms (one from inpatient and one from outpatient).

- Interpersonal & Communication Skills: 1-2, 4-5, 8

Demonstrate a commitment to lifelong learning through inquiry and reflective practice.

- Mid-Rotation Self-Assessment and Formative Feedback. Halfway through the inpatient and halfway through the outpatient portions of the clerkship, using a mid-rotation review form, students self-assess their performance and then meet with their preceptor for formative feedback and prepare an action plan. Students are required to complete 2 mid-rotation forms (one from inpatient and one from outpatient).

- Satisfactorily complete a reflective paper - Satisfactorily complete the Procedure Logs - Satisfactorily complete the Inpatient Write-Up - Satisfactorily complete the corresponding CLIPP cases when

absent from a session or when assigned as pre-reading.

- Practice-Based Learning & Improvement: 1-3

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Required Materials:

Stethoscope White Coat (setting dependent) Wall-mounted and hand otoscope/ophthalmoscopes are usually available at outpatient sites and on the units,

but it may be helpful to have your own. Access to CLIPP cases online (has been purchased by GW/Children’s National for your use)

Recommended Reading/Resources:

CLIPP cases (see list of recommended cases; online access has been purchased for your use)

Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents;

Nelson Essentials of Pediatrics; Zitelli’s Atlas of Physical Diagnosis; Red Book of Pediatric ID; Harriet Lane Course Requirements, Deadlines, and Grading Values: The components of the final grade are:

1) Inpatient clinical evaluation 31.25 % 2) Outpatient clinical evaluation 31.25 % 3) NBME exam 31.25 % 4) Nursery pass/fail must pass in order to pass clerkship 5) Self Directed Learning Portfolio 6.25 %

Site Requirements:

Procedures for assigning patients to students may vary by site. Typically, after the student has finished evaluating his/her patient, he/she will present to and call in an attending (or resident) who will review and discuss problems, assessment and plans, and recheck physical findings. When the chart is complete and plans for diagnosis, treatment and follow up are implemented and understood by the patient and/or family, the student will sign the chart, and the supervisor will again review and cosign.

Students must be observed for brief (can be 5 minute) portions of their history taking and/or physical exam and then receive brief feedback using the "Structured Clinical Observation" form (SCO) at least 4 times (about once per week) during the outpatient rotation (students submit these in their self-directed learning portfolio).

A formal mid-rotation feedback review form (typically the Friday of the 2nd week) must be completed by the student and the attending to assess progress and plan next steps (students submit these in their self-directed learning portfolio).

Provide an opportunity for the student to perform and interpret a developmental assessment (Denver, ASQ) for a patient

Provide an opportunity for the student to assist +/- perform a subcutaneous injection or intramuscular injection on a pediatric patient

Identify a responsible physician preceptor for collecting information on a student and submitting a grade with constructive feedback based on the collective experience with the student.

Honor Code: All conduct, examinations, papers, and other assignments are to occur professionally and in accordance with the George Washington University School of Medicine and Health Sciences Honor Code.

Disability Support Services: If you have, or think you might have, a disability that may require an accommodation, please contact the GWU Disability Support Services office (202-994-8250). Please allow a reasonable amount of time for a review of your circumstances and a decision about possible accommodation. You may also meet with Dean Goldberg to discuss the process. Student Mistreatment Policy: The pediatric department is fully committed to maintaining a safe environment for all learners – especially its medical students. We fully comply with George Washington University’s Student Mistreatment Policy. If you have any concerns while on the clerkship, we encourage you to reach out to the chair, director, associate director, coordinator, our ombudsman, or any faculty member.

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Student Day Educational Sessions ~ (specific schedule may change depending on rotation)

Session & Date Topics for Discussion Readings & Assignments

Week 1: Mon Orientation Thurs Student Day

Fever

Growth

Radiology or Physical Diagnosis Professorial Rounds

Clinical Decision Making

See Syllabus & Blackboard Materials on Blackboard

Week 2: Thurs

Obesity and Nutrition

Literature in Pediatrics

Anemia

Professorial Rounds

Development

Materials on Blackboard

Read “The Use of Force” Post reflection on Blackboard

Week 3: Thurs

Pain management

Evaluations of the Child w/ Develop Delay

Nephrology or PICU Intro/Walk Rounds

ECG/Cardiology


Week 4: Thurs POM at GW instead of Peds Student Day Keep doing your CLIPP cases!

Week 5: Thurs

Rheumatology (Child with a Limp) Developmental Disabilities

Radiology or Physical Diagnosis

Professorial Rounds Child Advocacy


Week 6: Thurs

Pneumonia

Genetics

Nephrology or PICU Intro/Walk Rounds

Professorial Rounds Cases in the SIMULATION center


Week 7: Thurs

Child Abuse Intake/Clinical Reasoning Pulmonary Function Tests

Shelf Exam Review


Week 8: Fri NBME Pediatric Exam

Typical student discussions / lectures / workshops during the inpatient month at Children’s:

Presenting on Rounds Diabetes

Fluids and electrolytes Health Care Costs

Antibiotics Hematology: Bleeding Disorders

Evidence Based Medicine Poor Growth

Dentistry Malignancy

Bedside Teaching – Cardiology

Typical discussions during inpatient at HCH:

Fluids and Electrolytes Cardiology

Bronchiolitis Formulary Antibiotics

Diabetes Acute Gastroenteritis

Febrile Seizures Student Symposium

Asthma Education Others (fever, pneumonia)

Delivery Room Dilemmas Note: every teaching session has learner-center outcomes-based objectives listed on Blackboard and in GW’s database

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Required Clerkship Encounter Standards: Pediatrics Students must maintain their logs in MedHub throughout the clerkship. Their instructions are as follows:

Preferentially log your involvement with a real patient (someone you or your team cared and for whom you actively participated in the consideration of any of the following diagnoses). If you are unable to participate in the care of a live patient, log an alternative learning experience (ALE) (i.e. online CLIPP, standardized patient)

Minimum level of involvement: o Assist: Participate in the care of a patient with this condition to include team discussion and/or overseeing

care during a hand-off o Perform independent assessment and plan or performed the procedure under supervision

Peds clinical encounters with examples of diagnoses Minimum level of

involvement Location: inpt, outpt, either

ALE opportunity if no clinical encounter available

Behavior – Advise a parent of a child having problems with: sleep, colic, temper tantrums, toilet training, ADHD, encopresis

PERFORM independent assessment and plan

Either CLIPP case 3 or 4

Cardiovascular - Innocent murmur, Congenital Heart Disease, Arrhythmia

assist Either CLIPP case 18

Dermatologic – Viral rash, scarletina, eczema, urticaria, contact dermatitis, atopic dermatitis, seborrheic dermatitis


Either CLIPP case 3,11, or 21

Development – Language or motor delay, intellectual disability, cerebral palsy, autism, etc.


Either CLIPP case 2, 14, 18, 26, or SP

Emergent Clinical Problem - Respiratory distress, shock, ataxia, seizures, airway obstruction, apnea, child abuse, trauma, fever without localizing signs.

assist Either CLIPP case 16, 23, or 25

Gastrointestinal - Nausea, vomiting, diarrhea, abdominal pain, gastroenteritis, pyloric stenosis, appendicitis, HSP, peptic ulcer disease, gastroesphageal reflux disease, constipation, IBD, encopresis


Either CLIPP case 15, 16, 22, or 27

Growth – failure to thrive, obesity, short stature, small for gestational age, large for gestational age


Either CLIPP case 1, 4, 18, 26, or SP

Health Maintenance - Well INFANT care: (1-12 months) PERFORM independent assessment and plan

outpatient CLIPP case 2

Health Maintenance - Well NEWBORN care: (0-1 month) PERFORM independent assessment and plan


Health Maintenance - Well TODDLER care: (12-60 months) PERFORM independent assessment and plan


Health Maintenance - Well SCHOOL-AGED CHILD care: (5-12 years)



Health Maintenance - Well ADOLESCENT care: (13-19 years) PERFORM independent assessment and plan

outpatient CLIPP case 5 or 6

Hematologic or oncologic - Iron deficiency anemia, megaloblastic anemia, anemia of chronic disease, sickle cell anemia, thalassemia, idiopathic thrombocytopenia purpura, coagulopathy, abdominal mass, leukemia, lymphoma, tumor

assist Either CLIPP case 2, 3, or 5

Lower Respiratory Tract - bronchiolitis, pneumonia, aspiration, asthma, cystic fibrosis


Either CLIPP case 12, 13, or SP

Fluid Management/ Metabolic / neuroendocrine – Dehydration, metabolic disorder, hyperammonemia, Diabetes Type 1 or 2, thyroid dysfunction


Either CLIPP case 9, 15, or 16

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Peds clinical encounters with examples of diagnoses Minimum level of involvement

Location: inpt, outpt, either

ALE opportunity if no clinical encounter available

Musculoskeletal - Developmental hip dysplasia, fracture, Legg-Calve-Perthes disease, nursemaid elbow, Osgood Schlatter disease, osteomyelitis, septic arthritis, SCFE, transient synovitis, JIA

assist Either CLIPP case 17

Neurologic - meningitis, concussion, seizures, ataxia, closed head injury, headache, epilepsy

assist Either CLIPP case 19.20. 24. or 28

Nutrition - Advise a parent about: breastfeeding vs formula feeding, healthy diet for age


Either CLIPP case 2 or 3

Unique conditions of adolescence - Risk assessment (HEADDSS), STD's, chest pain, acne, eating disorders, pelvic inflammatory disease


Either CLIPP case 5, 6, or 22

Unique conditions of the PERINATAL period - Respiratory distress, jaundice, IUGR, congenital infection

assist Either CLIPP case 1, 7, 8, 9, or SP

Upper Respiratory Tract - Otitis media, otitis externa, pharyngitis, viral URI, herpangina, peritonsillar abscess, allergic rhinitis, sinusitis


Either CLIPP case 14

Urogenital - Urinary tract infection, enuresis, nephrotic syndrome, nephritis, hydrocele, hernia, testicular torsion, epididymitis

assist Either CLIPP case 10 or 22

Required Clerkship Procedure Standards: Pediatrics

Opportunities for exposure to IM / SQ injections will be provided during your outpatient rotation. Log is due at the end of your outpatient experience. 100% completion is due in order to sit for the exam.

Intramuscular (IM) or Subcutaneous (SQ) Injection Assist

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The Ambulatory (Outpatient) Rotation

The overall educational goal in the outpatient pediatric setting is for students to develop history and physical exam skills and the basics of delivering anticipatory guidance, as it relates to the continuing care of pediatric patients throughout their growth and development over time (birth through adolescence). This includes well child care, health promotion and disease prevention, acute care, and follow-up visits. Outpatient Objectives: Students will

1. Perform effective age-oriented interviews and physical examinations on newborns, children, and adolescents in the outpatient pediatric setting for well, sick, and follow-up visits.

2. Demonstrate effective written (electronic) and oral case presentation skills including an ordered, logical sequence with pertinent positives and negatives for pediatric outpatients.

3. Perform appropriate developmental screening at the pediatric well child visit. 4. Practice preventive pediatrics through age-appropriate screening and anticipatory guidance about nutrition,

behavior, growth and development, immunizations, and injury prevention. 5. Recognize the influence and impact of pathophysiological processes on the growth and development of children

and how this impacts and is impacted by their families. 6. Formulate an appropriate clinical assessment and diagnostic and therapeutic plan including initial and follow-up

care for the pediatric outpatient. 7. Demonstrate the development of humanistic attitudes in dealing with well, acutely ill and chronically ill pediatric

outpatients in context of their families and communities. 8. Identify personal learning objectives for the outpatient pediatric setting based on gaps in knowledge, skills and

attitudes. 9. Establish a pattern of continuous inquiry into the illness and wellness of pediatric outpatients as it relates to

their health supervision, disease prevention, and ongoing management. 10. Apply medical knowledge and clinical skills to patients with common inpatient presentations as described in

the clinical encounter and procedural log.

Procedural Expectations:

a) Procedures for assigning patients to students may vary by site. Typically, after the student has finished evaluating his/her patient, he/she will present to and call in an attending (or resident) who will review and discuss problems, assessment and plans, and recheck physical findings. When the chart is complete and plans for diagnosis, treatment and follow up are implemented and understood by the patient and/or family, the student will sign the chart, and the supervisor will again review and cosign.

b) Students will be observed for brief (can be 5 minute) portions of their history taking and/or physical exam and then receive brief feedback using the "Structured Clinical Observation" form (SCO) at least 4 times (about once per week) during outpatient (submit with your self directed learning portfolio).

c) A formal mid-rotation feedback review form will be completed by the student and the attending to assess progress and plan next steps (submit with your self directed learning portfolio).

d) Students in CHC/AHC (at Children’s) will follow the noon conference schedule for this rotation (including “Student Day” on Thursdays).

Charting Expectations: Students should perform and record a complete and/or focused history and physical examination in the chart or electronic record. Avoid using medication abbreviations. If using templates, make sure you are responsible for all data entered. For information on an appropriate H and P on pediatric patients, consult the references listed under the COMSEP Curriculum. CDC Immunizations Schedules: see http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

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Ambulatory (Outpatient) Requirements

REQUIREMENTS

Document feedback on parts of your interview and physical exam by collecting Structured Clinical Observation (SCO) forms from the attendings and/or residents (8 over 8 weeks)

Complete Mid-rotation Feedback form with teaching attending/ senior resident Enter Procedure and review them at midpoint and wk 7 (due by the shelf) Perform and Interpret a developmental assessment (Denver, ASQ) for a patient Assist with +/- perform a subcutaneous and/or intramuscular injection on a pediatric patient

We recommend that you also:

Complete the outpatient CLIPP cases (strongly recommended) View "Through the Otoscope" CD (available from coordinator) or NEJM video (Blackboard)

The following list can guide your reading/studying during outpatient. Please see the COMSEP curriculum (online at www.comsep.org) for an extensive list of pediatric core topics/competencies. Also refer to our pediatric clerkship and session objectives and the pediatric minimum diagnosis list. General outpatient pediatrics topics: Health Supervision; Growth; Development; Behavior; Nutrition; Prevention, Immunization; Issues Unique to Adolescents; Genetics and Dysmorphology; Common Acute Illnesses; Common Chronic Illnesses; Community Resources

Normal Development

Abnormal Development: Speech Delay; Autism; Mental Retardation; Cerebral Palsy; Learning Disability/School Problems

Normal Growth and Growth Disorders: Failure to Thrive; Short Stature; Obesity

Anticipatory Guidance: Injury Prevention; Screening: Lead, Anemia, Hearing and Vision, TB

Behavioral issues: Toilet Training; Feeding issues; Sleep problems; Discipline; School failure

Adolescent Medicine: Preventive services; Development; Suicide; Amenorrhea

Genetics: Common malformations and genetic syndromes; Trisomy 21, 18, 13; VATER; Turner's Syndrome; Spina Bifida; Cleft Lip and Palate; Fetal Alcohol Syndrome

Respiratory Disorders: Upper Respiratory Infection; Sinusitis; Asthma; Pneumonia; Croup; Bronchiolitis; Allergic Rhinitis; Pharyngitis; Otitis Media; Otitis Externa

GI Disorders: GERD; Constipation/ Encopresis; Gastroenteritis; Colic; Functional Abdominal Pain; Toddler's Diarrhea

GU disorders: Enuresis; Hydronephrosis; Vesico-Ureteral Reflux

Neurology: Headaches; Seizures

Other Infectious Diseases: UTI; Cervical Adenitis; Mononucleosis; Dental Caries

Dermatology: Viral Exanthems; Atopic Dermatitis; Contact Dermatitis; Impetigo; Monilia and tinea; Scabies; Urticaria; Seborrheic Dermatitis; Drug Reaction; Erythema Multiforme

Bone and Joint: Fracture (Salter Types); Nursemaid’s elbow; JIA; Osgood Schlatter; Legg-Calve Perthes; Slipped Capital Femoral Epiphysis; Developmental Dysplasia of the Hip

Hematology: Iron Deficiency Anemia; Sickle cell

Cardiology: Innocent Murmurs; ASD; VSD; Valvular Defects; Coarctation of the Aorta

Vision Problems: Myopia/Hyperopia; Strabismus/Amblyopia; Cataract; Retinoblastoma

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Guidelines for Precepting a 3rd Year Medical Student in Your Office

Welcome: How you set the tone for the month can make a huge difference regarding the student's approach to learning. A welcoming email, call, or letter can establish a safe learning environment. A brief orientation on the 1st day of the rotation helps develop a shared understanding of the opportunities and expectations. Orientation should include hours the student is expected to be there, expectations, responsibilities, roles, introduction to staff, introduction to your physical site, what kinds of patients/parents the student will be seeing, reading requirements on all patients, how you will observe the student, the plan for mid-rotation feedback, the evaluation, and any other issues you feel are important. (Some of resources are attached to assist you with this, see next pages) Consider all of your responsibilities as a possible learning experience for the student. For example, you could take the student on newborn rounds; to hospital committee meetings; spend a half-day with your office manager and the nurse; sit in on triaging telephone calls; and anything else you feel would add to his/her education. Schedule the student lightly; approx 5 patients per day. In addition, bring the student in with you when any interesting problems arise. Observations: Try to observe the student for 5 minutes each time on several occasions during the month. This will provide you with valuable information about how he/she obtains a history and does a physical exam. We have “Structured Clinical Observation” (SCO) forms to assist with this process found later in this document. The student is required to obtain 4 per rotation. Attendance: Students are expected to be with you during your workday on Mon, Tues, Wed, and Fri on 3 or 4 weeks of the month. We will likely schedule the 4th week for the student in an off-site well-baby nursery. Students return to CNMC for conferences on “student day” which is every Thurs (except on the 4th week of each rotation when it occurs on a Wednesday). The final exam is the final Friday of the rotation. Students should also be excused for their standardized patient experience (2 hours or up to half day). CLIPP Cases online: Students should be encouraged to complete these online computer cases during downtime. These supplement those experiences that the student may not experience in your office. Evaluations: Students who are outstanding will go above and beyond what's expected; i.e., talk to you about literature they are reading, offer to call parents back, make diagnoses that are not straightforward, etc. When you evaluate students, provide clear descriptions of their performance. Give them feedback midway through the rotation and at the end, talk about their final evaluation. We have materials to assist you with mid-rotation feedback and with evaluations provided later in this document. *See the enclosed Pediatrics Clerkship Mid-Rotation Feedback Form. Grades are criterion based rather than a bell curve. (Please see the attached “Expectations for Honors Level Clinical Performance”). Over the course of years, you may find that approximately 1/3 of your students may earn a “Pass”, 1/3 earn a “High Pass", and the final 1/3 earn an "Honors" – but again the “Expectations” document should be your official guide. Your comments are essential in helping us understand the student’s performance. They are also used in preparing the deans letter in their 4th year. Please write meaningful statements that are descriptive and informative. It is GW’s expectation that a student will receive a score of 5 for each Professionalism criterion. If you feel your student should get a score lower than a 5, please write a comment so support the score given.

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Completing your Evaluations Evaluations must be completed within 3 weeks of the students’ departure from your office. The LCME is focusing on a medical schools timeliness of receiving a student’s grade and report the grades to students. GWU uses an Internet based application, MedHub.com. You will find that it is easy to learn, easy to use, and easy navigate. Your user ID/logon information will be sent to you via e-mail once you are set up in the system. You will be required to know your logon to access your evaluations. You can change the logon information at anytime. If you have trouble logging on, try using all lowercase for your username. Reminders will be sent to your e-mail address until it is completed.

See “Logging onto MedHub for Student Evaluations” at the end of this document. General Information MedHub.com is e-mail dependent so please let us know if your e-mail address changes or if you have any problems or questions. Contact the Wilhelmina at [email protected] or 202 476-5692.

1. There are several mandatory comment fields such as: Cognitive Skills, Clinical Skills, Information Presentation, etc. Please take the time to complete them especially the Overall Performance comments. This information is used in the student dean’s letter.

2. The section on Integrity is scored either a 5 or a 1. Anything below a 5 requires an explanation. Comments are not required.

3. Students are allowed to challenge their grades. They are asked to contact you first to discuss their grade before bringing their concerns to the MSE committee.

Paper Format Completion Uniform Student Clerkship Evaluation If you do not have Internet access or you don’t feel comfortable completing the evaluation on-line, let me know so I can mail/fax you an evaluation.

1. Keep a copy in your files. The printed evaluation is 8 pages long. 2. Please include the students name at the top. 3. Circle your responses. 4. Remember that the section on Integrity is scored either a 5 or a 1. Anything below a 5 requires an explanation. 5. Please write your comments legibly. 6. Then fax me the completed form to 202 476-4741 7. Your scores and comments will be manually entered into E*Value.

CPreceptor


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Malpractice Insurance: Students in the MD degree program at George Washington are required to have personal health insurance coverage. The George Washington University/Medical Center master malpractice policy covers our students when they are studying in approved rotations within the United States and internationally. All students have completed a universal precautions (OSHA) training course and all have received the Hepatitis B vaccination. Students are also required to have DTP, MMR (2) and Polio vaccinations. PPD testing is also required. All students have completed HIPAA certification. Students’ immunization records are on file with the GWU Office of Student Health.

Future Placements: If you are interested in being a regular placement site for one of our students, please check the dates that you would like a student on the facsimile sheet at the end of this document and fax it back to the Student Coordinator. You will be contacted 2 weeks before the beginning of the rotation to confirm your placement. Thank you in advance for your consideration in being a regular placement site. Resources

CNMC Website www.childrensnational.org / For Doctors / Medical Student Education

George Washington University Medical School http://smhs.gwumc.edu/mdprograms

Council on Medical Student Education in Pediatrics www.COMSEP.org/

Computer-assisted Learning in Pediatrics Program http://www.med-u.org/

Clinical Encounter (Diagnosis) Logs on MedHub in accordance with GW policy. GW requires students to log their patient encounters by using the Procedure and Diagnosis (PxDx) log function in MedHub.com. These “Required Clerkship Encounter Standards” are the types of pediatric patients (diagnoses) we expect them to gain experience with during the pediatrics clerkship (see table on Required Encounters; there are 24 on pediatrics, at least one from each category). This provides them with an opportunity to monitor their progress and keep track of their learning needs and to document procedures and diagnoses they experience during inpatient, outpatient, or nursery. Alternative (computer or simulated) experiences can also be entered in the MedHub diagnosis log although live experiences should preferentially be logged. The preceptor can review the students clinical encounter diagnoses logs during the rotation and provide their student with guidance where necessary on how to ensure they see/do all that is required to meet the learning objectives in pediatrics. Per GW policy, successful completion of each clerkship requires that students document that they have experienced each of the required clinical encounters or an alternate case. Logs must be 100% completed (in MEdHub) by the exam in order to take it!

http://www.childrensnational.org/

http://www.comsep.org/

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Student Expectations for an Honors Level Clinical Performance

Here we clarify the expectations for Honors level performance for the pediatrics medical student on the 3rd year clerkship, in order to better support consistent evaluation. We use the Reporter, Interpreter, Manager, Educator (R.I.M.E.)1 stepwise framework to help distinguish between basic and advanced levels of competency. The R.I.M.E. system is synthetic and integrates student achievement rather than separating out evaluation of knowledge from skills and behaviors. Furthermore, reaching subsequent levels implies competence at the previous levels. The following is adapted from Dr Louis Pangaro’s original description of the RIME framework.1 Also known as PRIME with the P for professionalism.

"Reporter": This student can accurately gather and clearly communicate the clinical facts on his/her own patients. This requires the basic skills to do a history and physical examination and the basic knowledge to know what to look for. It emphasizes day-to-day reliability (such as being on time, or following-up on a patient's progress). This requires a sense of responsibility, and achieving consistency in "bedside” skills in dealing directly with patients. These skills were introduced to students in their preclinical years, but now they must be mastered in order to “pass” the rotation.

"Interpreter": To make the transition from "reporter" to "interpreter" is a difficult step. At a “basic interpreter” level, the student must prioritize among problems identified in their time with the patient. The next step is to offer a differential diagnosis. This would mean offering about 3 reasonable diagnostic possibilities and to commit to, defend, and provide a rationale for the most likely diagnosis or diagnoses. Follow-up of lab tests provides another opportunity to "interpret" the data. This step requires a higher level of knowledge and more skills in (1) selecting the clinical findings which support or refute possible diagnoses and in (2) applying test results to specific patients. The student has to make the transition in how he/she sees himself/herself from "bystander" to “active participant” in patient care.

"Manager": This step takes even more knowledge, more confidence, and more judgment on the part of the student in deciding when action needs to be taken, and in proposing and selecting among options for patients. We don’t require students to be "right” with each suggestion, but we do ask them to provide a reasoned and supported diagnostic and therapeutic plan. A key element in being an effective manager is to tailor the plan to the particular patient's circumstances and preferences.

"Educator": Success in each prior step depends on self-directed learning and on a mastery of basics. To be an "educator" means to go beyond the required basics, to read deeply, and to share new learning with others in the context of the assessment and plan. The educator has insight to define important questions to research in more depth. The educator has the drive to look for evidence on which clinical practice can be based, and has the skill to critically evaluate the evidence and apply it to a given patient. A mature and confident student at this level will assume an advanced role in educating the team (and even the faculty).

A student must be a consistent "Reporter" to achieve a pass which on the uniform evaluation form in use at CNMC/GW is a 3 = Very good, at expected level for a 3rd year GW student.

A student must be consistent as an "Interpreter" for a High Pass grade, which on the uniform evaluation form is a 4 = Excellent

The Honors 3rd year pediatrics student is consistently at the “Manager/Educator” level (which includes mastery of the Reporter and Interpreter levels). These students receive a 5 = Outstanding

Further descriptions are detailed on GW’s uniform evaluation form. 1Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 1999;74(11):1203-7.

CNMC – 02/09

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=10587681&query_hl=2&itool=pubmed_DocSum

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GW School of Medicine & Health Sciences Program Objectives also available at: https://smhs.gwu.edu/academics/md/curriculum/objectives

I. Medical Knowledge By the time of graduation, students are expected to:

1. Apply the scientific basis of the normal structure, development, function, and relationships among the major organ systems of the body to concepts of health and disease.

2. Illustrate biochemical, physiological, neurological, and immunological mechanisms to their role in maintaining body homeostasis.

3. Apply principles of pathophysiology to diseases and disorders. 4. Evaluate the role of immunology and microbiology in health and disease. 5. Contrast the genetic processes and environmental influences on health and on disease and its treatment. 6. Interpret the role of normal human biological, cognitive, psychological, and behavioral development across the

life span as determinants of health and illness. 7. Interpret the clinical, laboratory, pathologic, and radiologic manifestations of common diseases in patient care. 8. Apply pharmacological principles to medical therapeutics. 9. Apply principles of nutrition for maintaining optimal health and managing disease. 10. Apply the principles of epidemiology to the practice of medicine for the individual and the local and global

communities. 11. Illustrate how complementary medicine applies to patient care. 12. Apply the scientific method to research that disseminates and translates new health care knowledge to patient

care. II. Patient Care By the time of graduation, students are expected to:

1. Perform a complete and accurate patient history that includes belief systems, spiritual and cultural issues and incorporate these into the comprehensive care of a patient.

2. Perform an accurate and relevant screening and focused physical and mental status examinations. 3. Perform common clinical procedures. 4. Select appropriate physical examination techniques, laboratory tests, radiologic, and other clinical studies and

interpret the results. 5. Use biomedical information resources and appropriate consultants to support evidence-based medical care. 6. Formulate a differential diagnosis and treatment plan for common medical conditions. 7. Apply appropriate initial care to life-threatening conditions. 8. Employ opportunities for early intervention to educate patients about disease prevention taking into account

barriers to change. 9. Apply the principles of quality and safety to provide efficient and cost-effective care.

III. Interpersonal and Communication Skills By the time of graduation, students are expected to:

1. Demonstrate empathic patient-centered communication. 2. Demonstrate skills and strategies for communicating the status of the patient's health and condition to the

patient and his/her representatives. 3. Demonstrate the ability to present a coherent summary of the patient's clinical condition based upon the

information obtained from the patient and other sources. 4. Demonstrate shared decision-making with patients including discussing the risks and benefits of medical

interventions and obtaining informed consent. 5. Demonstrate skills and strategies for engaging patients and their families in difficult conversations (e.g. end-of-

life, medical errors, serious diagnosis, etc.). 6. Demonstrate the ability to collaborate with other health care professionals. 7. Demonstrate the ability to negotiate conflicts within health care teams. 8. Apply knowledge of the patient's culture, beliefs, spirituality and level of health literacy in communications.

https://smhs.gwu.edu/academics/md/curriculum/objectives

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IV. Practice-Based Learning and Improvement By the time of graduation, students are expected to:

1. Evaluate study design, methods and results as they apply to evidence-based medicine. 2. Use reflection and feedback to improve clinical practice. 3. Use electronic and other resources in the practice of life-long learning. 4. Apply medical standards, clinical practice guidelines, and practice algorithms for individual patients or

populations. 5. Use learner-centered principles to teach colleagues, patients and the community- at-large about health and

medical issues. 6. Critically appraise the effectiveness of diagnostic and therapeutic interventions. 7. Practice techniques that develop self-directed learning skills.

V. Systems-Based Practice By the time of graduation, students are expected to:

1. Analyze the role of advocacy and healthcare policy in improving patient care. 2. Use system resources available to patients and communities for health education, treatment, and rehabilitation

of medical and psychiatric conditions. 3. Analyze the elements in the healthcare system that lead to disparities in health and access to healthcare. 4. Interpret information about the health of patient populations and communities to identify needs and plan

appropriate interventions in support of population health. 5. Differentiate how culture and belief systems impact perception of health and illness, as well as response to

symptoms, diseases, and diagnostic and treatment interventions. 6. Apply the principles of cost-effective healthcare in patient care. 7. Analyze the organization, financing, and delivery of health care. 8. Relate the role of medical jurisprudence and conflicts of interest to issues that affect the US health care system. 9. Analyze systems of care to enhance care quality and patient safety.

VI. Professionalism By the time of graduation, students are expected to:

1. Apply the theories and principles that govern ethical decision making. 2. Demonstrate ethical behavior including: compassionate treatment of patients, respect for privacy and dignity,

honesty and integrity, truthfulness, patient advocacy, confidentiality, and accountability. 3. Demonstrate reliability, punctuality, dependability, and integrity in all professional activities. 4. Demonstrate the ability to promote ethical and professional behavior of peers. 5. Analyze personal and professional conflicts of interest. 6. Demonstrate the ability to work effectively and respectfully in an interprofessional team. 7. Demonstrate the qualities and practices required to maintain wellness and sustain lifelong personal and

professional growth. 8. Demonstrate appropriate leadership approaches that enhance team functioning, the learning environment, and

the delivery of care. 9. Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity

in gender identity and expression, age, culture, race, religion, disabilities, health status and sexual orientation.

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This log is designed to use during outpatient pediatrics. It’s a method for student to track patients they’ve seen during their rotation with you. It allows students to record both sick visits and WCC. It also allows the preceptor to quickly visualize deficient patient populations and direct students towards patients they have not yet seen. It should be reviewed during your mid-rotation feedback session with them. OUTPATIENT STUDENT LOG

SICK

NOTES:

AGE

NB

2mo

4mo

6mo

9mo

12mo

Patient info

AGE

15mo

18mo

2yo

21/2yo

3yo

4yo

Patient info

AGE

5yo

6yo

7yo

8yo

9yo

10yo

Patient info

AGE 11yo

12yo

13yo

14yo

15yo

16yo

Patient info

AGE 17yo

18yo

19yo

20yo

21yo

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Example of a Completed Log Sheet

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Structured Clinical Observation (SCO)

A Tool To Facilitate BRIEF observation and PROMPT feedback

Date: ___ / ___ / ___ Observer: ______________________________ Trainee: ___________________________ Patient Gender: M F Patient age: Newborn (1-31 days) Infant (32 days - 11mos) Toddler (1-4 yrs) School-age (5-11 yrs) Adolescent (>12yrs) Indicate which PORTION of visit and items observed. Please check all that apply.

Data Gathering

Physical Exam

Information Giving

Interim history (well child) HEENT Anticipatory Guidance

CC/HPI Cardiac Medical Home

Diet/Sleep/Elimination Pulmonary Diagnosis explanation

PMH/Health Maint/CAM Abdominal Management

ROS/HEADSS Genitourinary Follow-up instructions

Development/School History Orthopedic Other ___________

Family History Neurological

Social/Cultural History Other ________

Key Feedback Points: Please identify at least 1 reinforcing behavior (“positive”) and another corrective

behavior (“constructive”) during the 5 minute observation. 1. _____________________________________________________________________

_____________________________________________________________________ 2. _____________________________________________________________________

_____________________________________________________________________ 3. _____________________________________________________________________

_____________________________________________________________________

Adapted from L Lane, MD and R Gottlieb, MD, Jefferson Medical College By E Hamburger, MD, S Cuzzi, MD and D Coddington, MD, Children’s National Health System

(Update - JUNE 2008 by T Kind, MD, MPH, Children’s National Health System)

We Stand For Children

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Structured Clinical Observation (SCO): Skills Guidelines

DATA GATHERING (ACGME competencies: Patient Care, Communication Skills)

Allows patient/parent to complete opening statement Starts with open ended questions Avoids use of leading questions

Limits questions with multiple parts

Explicitly elicits patient’s/parent’s beliefs about causes of the illness or problem Asks about remedies or therapies used to address chief complaint Asks about non-traditional remedies and therapies Asks specific questions about cultural, religious, spiritual, or ethical values Asks about life events & circumstances that might affect the patient’s health/ treatment

Asks about family members or significant others who live in the home or care for the child

Asks for clarification if necessary

Explicitly elicits patient’s/parents expectations regarding the visit

Proceeds with logical sequencing of questions

INTERPERSONAL SKILLS (Communication Skills, Professionalism)

Introduces self Addresses parent / patient by name after initial introductions Appropriately includes child in interview

Avoids interrupting parent/ patient Actively listens using nonverbal techniques (e.g. eye contact, nodding) Expresses empathy (e.g. using tone of voice, “That must be hard for you”) Explicitly recognizes patient’s/parent’s feelings or concerns (e.g. “you seem upset, sad, angry”) Deals effectively with language barriers Demonstrates sensitivity to health beliefs and religious or spiritual issues

PHYSICAL EXAMINATION (Patient Care)

Washes hands Matches sequence of exam to cooperation level Includes all appropriate elements of exam

Leaves out irrelevant elements Demonstrates correct technique for all portions of the observed exam

INFORMATION GIVING (Patient Care, Communication Skills, Professionalism)

Explains confidentiality to adolescent and/or their parent

Limits use of jargon and/or explains medical terms if used Explains diagnosis Explains management plan

Explains need for follow-up Uses visual reinforcement (e.g. pictures, models, demonstrations) Uses written reinforcement (e.g. written instructions, handouts) Explicitly asks for patient/parent input in management plan Adapts plan as needed to suit individual circumstances, cultural or health beliefs

Asks patient / parent for their understanding of treatment plan Solicits questions Asks about patient/parent’s ability to follow treatment plan Explains when, why, how family should contact physician Provides summary of discussion

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We Stand For Children

Student: _______________________ Physician Preceptor:____________________ Date: ___________________ Rotation # _____

Pediatrics Clerkship Mid-Rotation Review (Feedback) Form

OVERALL GOAL: To provide mid-rotation feedback and determine an action plan for student.

STUDENTS: Before meeting with your preceptor, complete a self evaluation by marking off with an “S” where on the spectrum you think you are currently. See example below.

PRECEPTORS: Please obtain input from other faculty and residents who have worked with this student. Then rate the student’s performance by marking off with a “P” where on the spectrum you think the student is currently. Then discuss the student’s strengths and areas for improvement. Record comments. EXAMPLE (S=Student’s self evaluation; P=Preceptor) unacceptable S P

performance very good outstanding (conditional) (pass) (honors)

History & Physical: Is the student identifying and pursuing problems? Is the exam technically correct, thorough, and efficient? Is the written record organized and of an appropriate length?

unacceptable performance very good outstanding (conditional) (pass) (honors)

Comments: Academic Resources: Is the student using academic resources (texts, journals, electronic sources) to study patient problems and make clinical judgments?


Comments: Patient-Physician Relationship: Is the student empathetic, compassionate, caring, supportive, and reassuring? Is there effective communication and education between student and families?


Comments: Verbal Reports: Does the student communicate clearly and succinctly? Is the information complete and organized? Is the rationale included?


Comments:

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Attitude and Professionalism: Is the student self-motivated, responsible, positive, and professional?


Comments: Synthesis of Information and Differential Diagnosis: Does the student obtain and use information from clinical sources and apply it to patient problems? Are the pathophysiology and plan reasonable?


Comments: Treatment Plan and Follow up: Does the student develop appropriate treatment plans? Recognize the need for urgent treatment? Does the student continuously monitor the patient and follow through appropriately?


Comments: Course requirements: Discuss if the student is making appropriate progress in completing the following: General

SCO’s (observation forms) – need 4 forms completed during each 4 week block CLIPP Cases (see Blackboard for recommended cases) LOGS: diagnosis, procedure, and duty hour logs in E*value: review progress, identify gaps

Inpatient Only: 2 H&P’s with write-ups (H&P plus discussion) reviewed by Attending during inpatient

Outpatient Only (recommended): View “Through the Otoscope” CD (check out from student coordinator) or see NEJM video Administer and interpret a “Denver Developmental” or other (ASQ) Screening Tool

COMMENTS AND ACTION PLAN: Attending/Resident Signature:__________________________________________________________

CNMC Pediatric Clerkship TKind - 2014

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Logging onto MedHub for Student Evaluations

1. The website is: https://gwu.medhub.com

a. For those of you who also evaluate residents remember this is a different MedHub account it

should say GWU

2. You should get a reminder that looks like this in your email:

3. The logon page looks like this:

https://urldefense.proofpoint.com/v2/url?u=https-3A__gwu.medhub.com&d=BQMCAw&c=Zoipt4Nmcnjorr_6TBHi1A&r=fnRqRrDZkymJpdcY_ux9mMcegD9XiVlpqCi06YawDBc&m=PPSiPjkhnzF2smS65B3v9tqbBt3oZNVdtCOjNaGA8to&s=N9fOItPQ72ACcuEi0lfVgBhAiD67vprMkQtgWVD51OE&e=

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4. After logging in, look for INCOMPLETE EVALUATIONS in upper left hand corner under URGENT TASK. You should

be able to click on that link to see any incomplete evaluations you have.

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Department of Medical Education Craig DeWolfe MD, MEd

Pediatric Medical Student Education Director

Clarissa Dudley, MD, MPH Associate Pediatric Clerkship Director

For Ambulatory Placements

Wilhelmina Bradford Medical Student Education Program Coordinator

Children’s National Health System Updated January 2016

3rd Year Medical Student Pediatric Clerkship Precepting ...

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