Welcome to the UNC Pediatrics Clerkship Things that are specific to Cone.
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Transcript of Welcome to the UNC Pediatrics Clerkship Things that are specific to Cone.
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