Goals of the pediatric rotation are to learn and understand:

1. The impact of family, community and society on child health and disease.
2. The impact of disease on child development, emphasizing growth and development, health supervision and common development problems.
   To accomplish these things you will need to acquire basic knowledge of growth and development, you will need to develop your communication skills, you will need to develop competency in physical examination of infants, children and adolescents and you will need to develop clinical problem-solving skills. You will need to develop attitudes of professional behavior and learn to understand the approach of pediatricians to health care of children and adolescents.
3. The focus for our pediatric training will be a generalist focus. This means common acute and chronic clinical problems will be emphasized. One of the results of this focus means that you will spend approximately 50% of your time in the outpatient setting.
4. We also want you to demonstrate intellectual curiosity, initiative, responsibility and reliability.

The objectives of the pediatric rotation are in the COMSEP (Council on Medical Student Education in Pediatrics) Curriculum. The learning objectives in each one of the categories describes what you will need to learn.

The COMSEP Curriculum contains learning objectives on:

1. Professional Conduct and Attitudes
2. Skill Health Supervision
3. Growth
4. Development
5. Behavior
6. Nutrition
7. Prevention
8. Issues Unique to Adolescence
9. Issues Unique to the Newborn
10. Medical Genetics and Dysmorphology
11. Common Acute Pediatric Illness
12. Common Chronic Illness and Disability
13. Therapeutics
14. Fluid and Electrolyte Management
15. Poisoning
16. Pediatric Emergencies
17. Child Abuse
18. Child Advocacy

Students need to review the COMSEP Curriculum and use it as their guides.

Monday

8:00 a.m. Endocrinology Rounds with Dr. Alan Kenien
David Todd Conference Room (all students)

Tuesday

1:00 p.m. Ward Rounds with Dr. George Johnson David Todd Conference Room
(ward students only)

Wednesday

8:00 a.m. Case-based Pediatric Hematology/Oncology Seminar with Dr. Nathan Kobrinsky, Pediatric Hematologist/Oncologist, Roger Maris Cancer Center Conference Room C (all students)

12:30 p.m. Ward Rounds with Dr. Chris Tiongson
Meet at the Pediatric Ward Desk
(ward students only)

Friday

7:00-8:00 a.m. Ward Rounds with Dr. Ted Kleiman

David Todd Conference Room or Hospital 3 W/A

(ward students only)

1. The medical student will carry a beeper when on-call. The beeper is available through the unit clerk at the Pediatric Ward Desk. In-house call until 10:00 p.m.
2. The call schedule is developed as follows:
   • The call schedule for students will be no more than every third night. This will mean every third night call for three of the eight weeks of the pediatric rotation. This amount of call should maximize student experience on hospital pediatrics.
   • Students will cover general pediatrics and PICU.
   • No call will be scheduled for medical students on the three-week outpatient assignment and the one-week subspecialty clinics/normal newborn nursery assignments.
3. Students not on call are to sign out their patients to the student on call. When on call, the students are expected to contact the ward clerk in general pediatrics and the PICU with regard to being paged before your call ends at 10:00 p.m.. Note that the ward clerk shift changes at 7 p.m. and you will need to notify the incoming ward clerk as well. Students find it helpful to speak directly by phone with both the pediatrician on call and pediatric intensivist on call.
4. Students requiring a specific weekend off, if approved, should be requested with Kathy Kraft at the UND Office of Pediatrics before the rotation begins.
5. Post call relief will not be afforded during the rotation for students.

1. You must work up and write up in detail 1 patient on the pediatric floor each week. The write-ups should be completed within 2 days of seeing the patient. This means you should have 3 write-ups completed by the end of your inpatient experience.  A 4th write-up may be required if not enough improvement has been noted. Please submit your write-ups as a Word document and attach it to an e-mail to Kathy Kraft. Kathy will forward the write-ups to Dr. Tiongson and myself and we will submit our comments via e-mail.  (You will also be required to submit weekly write-ups (3) while on outpatient.  Your preceptor will provide verbal feedback.)  Please conduct a daily review of all patients being followed by you prior to ward rounds. Between you and your partners this should include most if not all patients on the Pediatric Floor.
2. Review daily with the hosptialist the clinical plan for the patient you have worked up or are following. This should be done prior to ward attending rounds.
3. Present concisely on rounds the status and daily plan for each patient being followed.
4. Be prepared to present new patient work-up history and physical examinations, including the working differential diagnosis, within 24-48 hours after admission.
5. Be knowledgeable about all components of the differential diagnosis in patients that you have worked up.
6. Do return to the Pediatric Floor following afternoon seminars or other conferences to see your patients, as you would need to do if you were a practicing physician.

Enter the following patient encounter data into your PDA:

1. All inpatient and outpatient encounters in which you were directly involved and obtained history and performed physical exam.
2. Inpatients for which you write chart notes while on call.
3. All newborn nursery babies examined by you.
4. All procedures, assisted or performed.

Mary Markland, Southeast Campus Librarian, (701-293-4173) is an excellent resource for PDA data entry.

The Computer-assisted Learning In Pediatrics Project (CLIPP) is a comprehensive internet-based learning program for use by third-year medical students during their pediatric clerkship. CLIPP’s 32 interactive virtual cases are designed to cover all of the core content of the curriculum of the Council on Medical Student Education in Pediatrics (COMSEP curriculum). During this eight-week rotation you are to complete all 32 interactive CLIPP cases online. At the end of the rotation you be required to hand in a printout which documents completion of these cases.

These cases cover 95 percent of the COMSEP Curriculum and its learning objectives.

The CLIPP Cases document that UND School of Medicine & Health Sciences Pediatric Clerkship experience meets the LCME requirements that patient encounters and case experiences are similar and standardized within the clerkship and across all campuses.

The end of rotation oral examination will in part be based on these cases.

You will need to use your UND e-mail address to obtain a password to access these cases. There are too many cases to leave them until the end of the clerkship, so pace yourself.

Nelson’s Textbook of Pediatrics
Atlas of Pediatric Physical Diagnosis
Harriet Lane Handbook
Journals

• Archives of Pediatrics
• Pediatrics
• Journal of Pediatrics
• Clinical Pediatrics
• MMR (US Morbidity and Mortality Reports)
• Pediatric Infectious Disease
• New England Journal of Medicine
• Pediatric Clinics of North America

There are several pediatric subspecialty texts in the Sanford David Todd Conference Room for your use. Dr. Tiongson and I may be able to supply references from the literature that will be appropriate for your case studies. Mary Markland, SE Campus Librarian, will be immensely helpful to you in the pursuit of evidence-based medical literature.

A face-to-face midclerkship review is conducted with each student during the fourth week of the pediatric rotation. A checklist of 12 areas is used to conduct the review. The areas covered are:

1. Positive aspects of the clerkship experience to this point from student’s viewpoint.
2. Problems encountered in clerkship to date from student’s viewpoint.
3. Feedback on student’s performance to this point
   1. History data gathering skills
   2. Physical exam skills
   3. Differential diagnosis formation skills
4. Pediatric shelf exam study strategy.
5. Number of CLIPP cases completed to date.
6. Patient-centered learning and medical literature review and reading.
7. Seminar and lecture experiences from student’s viewpoint.
8. Inpatient call experiences from student’s viewpoint.
9. Communications with the clerkship director and department staff.
10. Comments from primary preceptor.
11. Professional behavioral expectations
    1. Timeliness
    2. Respect
    3. Appropriate attire
12. Reviewed PDA data with student regarding the number of types of patients to meet clerkship objectives.
13. Change in clerkship plan required to meet #12 objectives.

Additional questions asked:

• Goals the student feels needs to be accomplished prior to completion of clerkship.
• Reviewer’s recommendations on accomplishing the student’s goals.

The reviews are conducted by Dr. Stephen Tinguely, clerkship director.

1. READ. Make lists of items you do not understand. Look up specific items. Ask questions of your preceptors, Dr. Tiongson or myself.
2. Remember all patients on the pediatric floor are teaching service patients. This includes all surgical patients, including general surgical patients, pediatric orthopedic patients and ear, nose and throat patients.
3. Be available, be on time. Dress professionally, wear your lab coat and name tag.
4. Sanford Pediatric Grand Rounds: You are required to attend these conferences. Each of you will give a case presentation at Pediatric Grand Rounds. Dr. Tiongson and Dr. Tinguely will assist you in preparing for your presentation.
5. There are lockers available adjacent to the resident/student lounge to store your coats/belongings. Do not leave your belongings in the David Todd Conference Room.
6. A brief midclerkship review with Dr. Tinguely will be arranged.
7. Complete course, preceptor, and seminar evaluation forms as instructed by Kathy Kraft.
8. Free free to contact Dr. Tiongson and myself at any time.
9. HAVE FUN!