Pediatrics Clerkship

Pediatrics is a six-week clerkship during which students develop clinical skills to manage healthy and ill infants, children, and adolescents in collaboration with their families. Clinical experiences occur in the general pediatric wards, pediatric emergency department, newborn nursery, and ambulatory settings.

Pediatrics Clerkship Objectives
At the end of this rotation, the student will be able to do the following:

Medical Knowledge (MK)
Students must demonstrate knowledge about established and evolving basic, clinical and cognate (i.e., epidemiological and social-behavioral) sciences and the application of this knowledge to the practice of medicine.

1. Explain the various causes and pathophysiology of common acute, emergency and chronic pediatric diseases and conditions including developmental (failure to thrive), nutritional (common nutritional deficiencies in infants and children), metabolic, toxic, microbiologic, traumatic, inflammatory, etc. in individual pediatric patients and in populations. (MK3, MK4) See Aquifer cases and Diagnoses Log for conditions/diseases covered in this clerkship
2. Describe the scientific principles underlying diagnostic methods, including laboratory and radiologic testing, and treatment approaches (pharmacologic and non-pharmacologic) that may be applied to major pediatric diseases and conditions. (MK5)
3. Demonstrate knowledge of age-appropriate (vs. abnormal) behavior and common pediatric behavioral/psychiatric issues, including diagnostic and treatment approaches applied to these issues/conditions. (MK6)
4. Explain how preventive measures (like immunization schedules, indications, contraindications), health Behaviors and social determinants affect disease, injury and health in individual pediatric patients and across populations. (MK7)
5. Demonstrate knowledge of the scientific method in establishing causation of pediatric health and disease, the utility of diagnostic modalities, and the efficacy of therapies (traditional and non-traditional) through critical evaluation of current basic and clinical scientific knowledge. (MK8)

Patient Care (PC)
Students must be prepared to provide patient care that is compassionate, appropriate, safe and effective.

1. Obtain essential, accurate, and age-appropriate historical information about pediatric patients using a family- centered approach. (PC1)
2. Obtain essential, accurate, and age-appropriate information from the pediatric physical exam. (PC1)
   • Examine a newborn and assess gestational maturity through use of Ballard Scale or other instrument
   • Examine and assess a well-child (e.g. well child visit, preparticipation sports physical)
   • Examine and assess a child with a focused health concern
   • Examine and assess an acutely ill or unstable patient using evidence-based assessment skills (American Heart Association’s Pediatric Advanced Life Support)
3. Formulate an accurate and comprehensive differential diagnosis that synthesizes relevant patient data. (PC2)
4. Develop an appropriate evaluation and management plan for common chronic, acute, and emergency pediatric conditions incorporating patient preferences, clinical judgment and evidence based guidelines like the American Heart Association’s PALS. (PC3)
5. Provide care and education that is responsive to the patient and the patient’s family, inclusive of culture, ethnicity, spirituality, gender, age, disabilities, and other aspects of personal and/or health beliefs, practices and decisions. (PC5)
6. Counsel and educate patients and families appropriately using accurate, up-to-date information; provide anticipatory guidance consistent with the recommendations by the American Academy of Pediatrics and Bright Futures. (PC5)
7. Partner with patients and families to do the following: (PC5)
   • prevent disease through maintenance of age-appropriate immunizations
   • prevent injury through anticipatory guidance and screen for family violence
   • promote health through proper nutrition and activity (e.g., breastfeeding, childhood obesity prevention)
   • promote health through well-child visits, health screens, assessment and monitoring of growth, development and behavior from infancy through adolescence
8. Perform routine pediatric procedures safely and correctly with appropriate supervision. (PC7)
9. (See Diagnoses and Procedure Log)

Interpersonal and Communication Skills (CS)
Students must demonstrate interpersonal and communication skills that facilitate effective interactions with patients, their families and other health professionals.

1. Communicate effectively with the patient, the patient's family, colleagues and other health care professionals through the use of active listening and appropriate verbal, nonverbal and written skills. (CS1)
2. Foster therapeutic and ethically sound relationships with pediatric patients and patient’s families through respect, empathy and support of emotions. (CS2)

Professionalism (PR)
Students must demonstrate a commitment to professional and personal excellence in all settings, including adherence to ethical principles and sensitivity to a diverse patient population.

1. Demonstrate honesty, integrity, respect and compassion in all interactions with patients, peers, faculty, staff and other health care professionals in all settings. (PR1)
2. Demonstrate ethical, patient- and family-centered decision-making, and respect for the confidentiality of patient information in the context of the care of pediatric patients (i.e., clinical, academic, electronic or web-based). (PR2)
3. Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, race, ethnicity, spirituality, gender, sexual orientation, age, physical characteristics, medical condition, disabilities, socioeconomic status, family-context and other aspects of personal and health beliefs, practices and decisions. (PR3)
4. Demonstrate accountability for academic, patient care and professional responsibilities, and a commitment to continuous professional development. (PR4)

Personal and Professional Development (PD)
Students must demonstrate the qualities required to sustain lifelong personal and professional growth.

1. Acknowledge personal limitations and mistakes openly and honestly, and critically evaluate mistakes to promote professional development. (PD1)
2. Seek and respond to feedback about professional performance. (PD1)
3. Demonstrate strategies for analyzing, identifying and improving personal deficiencies in medical knowledge, clinical and collaborative skills and professionalism. (PD2)
4. Demonstrate a commitment to personal health and well-being, and recognize and address personal attributes, attitudes and behaviors that may adversely influence one’s effectiveness as a physician. (PD3)

Practice-based and Lifelong Learning (PL)
Students must investigate and assess their academic and clinical performance, develop skills for lifelong learning and personal improvement in order to improve patient care.

1. Retrieve, critically appraise and integrate current, evidence-based biomedical information into patient care and clinical decision-making. (PL3)
2. Apply principles of medical informatics, patient safety, including handwashing and infection control precautions, and quality improvement to enhance patient care. (PL4)
3. Apply the foundational principles of basic, clinical and translational research to patient care. (PL5)
4. Describe and apply principles of pediatric population health improvement for specific populations with attention to access, cost and patient-centered clinical outcomes. (PL6)

System-based Learning (SL)
Students must demonstrate an awareness of and responsiveness to the larger context and systems of health care, including barriers and drivers of health and health care access.

1. Describe the pediatric medical home, including the evidence and rationale for continuity of care, comprehensive care and coordinated care for pediatric patients; outline the consequences of irregular or sporadic care. (SL1)
2. Advocate for quality patient care and describe strategies for assisting patients in dealing with system complexities. (SL2)
3. Define the roles of various health professionals in the care of pediatric patients and describe how successful collaboration can improve patient/family care and system performance. (SL3)
4. Describe health disparities and health care disparities and how they affect pediatric outcomes of the health care system. (SL4)

Interprofessional Collaboration (IP)
Students must demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care.

1. Work as members of interprofessional health care teams to provide effective, safe, quality and patient-and family-focused care. (IP2)
2. Demonstrate effective collaboration skills as a member of a team, including learning teams, and health care teams. (IP4)

Pediatrics Clerkship PxDx Log

Diagnosis: Participate in the care of patients with the following diagnoses:	Output or Input
Health Supervision: newborn (0-1 months)	O
Health Supervision: infant (1-2 months)	O
Health Supervision: toddler/preschool (12-60 months)	O
Health Supervision: school-aged (5-12 years)	O
Health Supervision: adolescent (13-19 years)	O
Behavioral Issues (temper tantrums, school problems)	O
CNS Issue (headache, seizures, pain, head injury, ataxia)	O,I
Chronic medical issue (seizures, cerebral palsy, sleep apnea, atopic process, sickle cell, HIV, asthma, diabetes)	O,I
Dermatological issue (rash, acne, thrush, birthmark, abrasions)	O,I
Developmental issue (milestones, delays in skill attainment)	O,I
Emergent issue (shock, DKA, ALTE, status asthmaticus, meningitis, croup, abuse)	O,I
Fever	O,I
GI Issue (gastroenteritis, abdominal pain, reflux)	O,I
Growth Issue (poor growth, overweight, small for gest age)	O,I
Jaundice/increased bilirubin	O,I
Lower Respiratory Tract Infection (bronchiolitis, pneumonia	O,I
Upper Respiratory Infection (viral, sore throat, sinusitis, otitis)	O,I
Nutrition (breastfeeding, vitamins, calcium)	O,I
Procedure	Output or Input
Perform a medication dosage calculation by weight and participate in preparing an/order prescription in the EHR or write a "mock" order/prescription.	O,I
Perform a Fluid Needs calculation	O,I
Perform an interpretation of a pediatric X-Ray	O,I
Interpret a urinalysis (perform)	O,I
Participate in taking a rectal temperature	O,I
Perform a plot growth parameters (height, weight, head circumference)	O,I
Perform a head circumference measurement (occipital frontal circumference)	O,I
Perform a calculation of BMI and plot on chart	O,I
Perform a drawing of a 3-generation pedigree	O,I
Participate in a handoff	O,I
Participate in a child safety discussion with a parent (car seats, injury prevention, poisoning)	O,I
Participate in providing counseling for an adolescent on smoking, drug use, sexual activity, and associated infections	O,I
Participate in a vision screening in a child	O,I
Participate in a developmental assessment for child< 5 years old (gross motor, fine motor, social, language)	O,I
Participate in identifying a proper schedule and technique for administration of immunizations to a pediatric patient and observe the administration of immunizations	O,I
Participate in a Ballard Assessment	I
Participate in anticipatory guidance for a new parent	O,I
Participate in an Interprofessional Experience	O,I
Exam	Output or Input
Perform a general exam on a pediatric patient	O,I