• Submit clerkship intake form prior to the deadline for a chance to personalize the clerkship (optional). Several weeks prior to the start of the clerkship we build individual schedules for each student based on requests along with our site availability

• Complete student onboarding

• Complete clerkship virtual onboarding

  • • • • Recorded presentation (102min)

        • Slide set (annotated)

  • Attend in-person orientation on the first morning of the clerkship

    • Clerkship in-person orientation slide set

    • Weekend work days (2) and night team experiences (2) will be finalized during in-person orientation

In all clinical pediatric courses learners are empowered to assume the “next up” role with clerkship students striving to be fourth years, interns striving to be seniors, seniors striving to be attendings and attending being the team’s consultant and “safety net” with scaffolding and ground rules. The ultimate goal is for the patient and family to know that others are involved in a supervisory role but to look to the most junior physician team member as their primary physician and contact with the team. There are number safety nets in a teaching hospital. While we encourage scaffolded independence in all learners, students are never alone in managing a patient. There is quite a lot of fluctuation based on patients (diagnoses, numbers, acuity), students (experience, level of preparation), as well as individual supervising physicians. Being the active observer and seeing how others, especially those with more experience perform tasks can be incredibly valuable at all career stages including senior faculty. We ask student to not make the mistake of discounting this opportunity as merely passive shadowing when it presents itself. At the same time clerkship and post-clerkship students should not be limited to exclusively the observer role in any setting. If it is happening, please let us know and we’ll troubleshoot.

• • The Liaison Committee for Medical Education (LCME) requires tracking of core clerkship clinical encounters. Although we expect students to see all of these encounters as real life patients, virtual patient cases are available as both supplemental materials and if needed alternatives. Students are required to document encounters in OASIS by the end of the clerkship. They are encouraged to update the encounters at the end of each clinical site and all the encounters are listed in their pocket Pediatric Clerkship Passport

  • Supervising physicians are encouraged to ask about required encounter progress during feedback sessions

  • Required Pediatric Encounters

1. Well Child Care: Newborn (<1mo)

2. Well Child Care: Infant (1-12mo)

3. Well-Child Care: Toddler/Preschooler (1-5yrs)

4. Well Child Care: School aged (5-12yrs)

5. Well-Child Care: Adolescent/Young adult (>13 yrs)

6. HEADSS History

7. Vaccine consent and administration

8. Newborn delivery care

9. Neonatal Complaint/Condition (Eg. fever, jaundice, brief resolved unexplained event)

10. Developmental/ Behavioral Complaint/Condition (Eg. developmental delay, hyperactivity, poor school performance)

11. Gastrointestinal Complaint/Condition(Eg. vomiting, diarrhea, abdominal pain)

12. Neurologic Complaint/Condition (Eg. seizure, headache, altered mental status)

13. Nutritional Complaint/Condition (Eg. malnourishment, obesity, eating disorder)

14. Upper Respiratory Complaint/Condition(Eg. acute otitis media, croup, pharyngitis)

15. Lower Respiratory Complaint/Condition (Eg. asthma, bronchiolitis, pneumonia)

16. Hematologic/ Oncologic Complaint/Condition (Eg. anemia, leukemia, solid tumor)

17. Musculoskeletal Complaint/Condition (Eg. limp, arthritis, arthralgia)

18. Dermatologic Complaint/Condition (Eg. viral exanthem, eczema, acne)

19. Renal/Urinary Complaint/Condition (Eg. urinary tract infection, acute kidney injury, electrolyte imbalance)

20. Endocrine Complaint/Condition (Eg. diabetes mellitus, hypo/hyperthyroidism, precocious or delayed puberty)

21. Cardiac Complaint/Condition (Eg. murmur, congenital heart disease, palpitations, chest pain)

• Each student has a unique schedule built based on requests and site availability. Schedule is included on individual face sheets. The schedule along with times students are excused from clinical responsibilities (SOM activities including ACS days, clerkship academic half day, fOSCE, OSCE, simulation session) are designated on the Learners on Pediatrics spreadsheet. Student schedules are shared with all “host” divisions.

• The expectation is for students to work a full week (10 “half days” per typical week). During “mini-electives,” activities during half days no clinics are held are at the discretion of the site director and might include participation in division educational conferences, inpatient consults, procedures, as well as individual study half days.

• Weekend work days and night team experiences

• Pediatric Clerkship includes a minimum of 2 weekend work days and 2 night team experiences. At least 1 (and preferably two) weekend work days and at least 1 (and preferably two) night team experience need to be on general inpatient service (orange or purple teams). Additional potential sites for both weekend work days and night team experiences include the ED, well baby nursery, blue team, red team, PICU, NICU. Additional potential sites for weekend work days include the ID consult service. Students finalize these during in-person orientation using the Learners on Pediatrics spreadsheet.

• Why weekends and evenings? Weekends and evenings provide numerous unique educational opportunities

• Cross coverage opportunities. Eg. seeing a patient primarily assigned to a colleague during a weekend and accompanying a night resident (who was NOT present during rounds) as s/he answers questions about patients on the student’s primary team as well as those on other teams.

• Admission. Greater opportunity with fewer learners. Admissions are a great opportunity for both the problem based observed encounters and medical documentation assessments (admission HPs)

• Insight into hospital systems. Many services available during typical business hours are NOT available during weekends and evenings. Working during both gives students added opportunity to gain further insight into hospital systems logistics.

• Preview of future life as a physician. Weekends and evenings are an inherent part of all residency programs and most medical careers.

• Opportunity for other students to leave earlier. We expect at least one student per core hospital based team (well baby nursery, orange, purple) to stay at least until sign-out each day. There intentionally is no designated end time for the students

Activities for late afternoons (until night team sign-out)

• • At least one student per core pediatric hospital based team (Well baby nursery, orange, purple) each weekday. Students are asked to split up days remaining after the night team assignments among themselves.

  • Students are to share the schedule with the team as this will impact admission assignments. Eg. Typically students who are NOT staying late have first choice for earlier admissions

  • Prep for the following day: notes, sign-out, hospital course, etc.

  • Read. As always, make sure you have something to read/study during any downtime. See individual study resources.

  • Actively observe sign-out

Additional tasks during “Night Team Experience” (until ~8PM)

• Night team experiences are designated on the Learners on Pediatrics Spreadsheet

• Students are expected to introduce themselves to the night residents (floors) or the NICU resident (WBN) and share their cell phone number

• While admitting patients primarily to their own team is best for continuity, students can and should assist with other admissions. This will make for a much better educational experience than waiting around for an admission!

• In general, we ask students to stay close to the night resident as s/he manages nursing calls, following up on pending tasks, and checking in on patients and families. As someone who was present on rounds, a student will be able to provide valuable information! Night team experience during the WBN will give students a brief experience in the NICU.

• Head home. We recommend students stay till ~8PM for a fuller evening experience. This is however can definitely vary day to day and is at the discretion of the resident based on "clinical landscape:" expected admissions, transfers, and cross-cover patients.

• Feedback. Students have the option of requesting both informal coaching and/or problem based encounter observation (via the "Pediatric Student Coaching" form) from the night resident.

• • Identifying systems failures and contributing to a culture of safety and improvement is a clerkship objective, a core entrustable activity for entering residency and an activity physicians are expected to be involved with. In the quality improvement assignment, we ask students to identify and briefly describe an opportunity for improvement within Pediatrics: clinical or educational processes and delve into key drivers, potential interventions, and outcome measures. These are posted to a canvas discussion board with students and expert “guests” commenting.

  • The assignment is scored by Dr. King via a standardized rubric and accounts for 10% of the clinical performance grade

  • Supervising physicians are encouraged to help students identify potential opportunities for improvement and ask about QI or critical reflection assignments during feedback sessions

  • We welcome involvement of additional "guest" commentators from among senior students, residents, attendings. Please let us know if you are interested!

• • In the critical reflection assignment students describe and reflect on a pediatric clerkship experience for the purpose of gaining insight into its impact and future approaches to similar situations. Our rationale for this assignment is encouraging reflective practice and deliberately thinking about an experience. Unfortunately much day-to-day physician and medical student work is extremely busy meaning that we often don’t take the time to pause and think about what actually happened and what it means. There is abundant literature showing that reflection improves learning and performance. It also makes the experience a lot more fun and meaningful.

  • At times we ask students' permission to share de-identified critical reflections touching on shared experiences with supervising physicians after grades are finalized. We would like them to realize they've had an impact!

Required Educational Sessions

• • • • Clerkship students are excused from clinical duties during required group sessions. All of them can be found on the calendar as well as Learners on Pediatrics spreadsheet

      • Clerkship Orientation. Held 8-12 on the first day of the block

      • Academic Half Day. Held weekly 1-4 PM on either Wednesday or Friday.

      • Ranken Jordan Visit. 2 students scheduled for visits Monday or Thursday morning

      • Pediatric Simulation Groups of 8 students scheduled during afternoons

      • ACS (Advanced Clinical Skills). All third year students pulled from clerkships for a full Monday every block to attend sessions at the SOM.

Optional Educational Sessions

• Clerkship students are encouraged though not required to attend. We encourage students to attend (in person or virtually) with their respective teams. McGowen conference room is reserved for students scheduled for "mini electives" who wish to attend virtually.

• Department of Pediatrics conferences: resident noon conference, research colloquium, grand rounds/professional development

• Division specific conferences. Student attendance (required vs. suggested) at the discretion of site and course directors

• Honors. Score ≥ 75th percentile nationally

• Near Honors. Score ≥ 50th percentile nationally

• Pass. ≥ 5th %ile

• In Progress. <5th %ile. Remediation: retake the NBME after a minimum 2w study period. After successful remediation grade changed to a pass.

• Fail. <5th %ile on 2nd attempt on the NBME. Requires repeating the clerkship

*NBME grade criteria are set by the SOM and uniform for all clerkships. NBME Percentiles are compared to national cohort of students in the same quartile of clerkship year.

• Honors

  • Met course objectives

  • Professionalism score ≥90%

  • Clinical score in the top 30% of the block*

• Near Honors

  • Met course objectives

  • Clinical score in the top 70% of the block*

• Pass

  • Met course objectives

• IP

  • Came close to meeting course objectives, requires remediation.

  • This grade is considered for students with overall clinical performance scores ≥ 2.5 SD below the meant

*The maximum number H and NH grades within the block are set for all clerkships by the SOM

• Clinical Performance Evaluations by Supervising Physicians: 40%

  • Assigned in OASIS at start of block. Submissions deadline within 2w of course completion

• Objective Structured Clinical Exam: 40%

  • Summative clinical skills exam scheduled in the Clinical Skills Center towards the end of the clerkship

  • Four stations with standardized patients/caregivers. Students are asked to assume the role of a physician working without supervision and to share their initial assessment and plan with standardized patients or standardized caregivers.

  • Standardized patient/caregiver assessment: 50% of the OSCE grade

    • SP completes an observable behavior rubric based on rubric used for direct observation assignment

    • Student points divided by possible points

  • Medical documentation assessment: 50% of OSCE grade

    • Scored by course directors

    • Rubric based on rubric used in the medical documentation assignment

    • Student score/top score for the case for the block

    • At least one student per block per case receives 100% for the note

• Quality Improvement OR Critical Reflection Assignment: 10%

  • • Scored by course directors using standardized rubric

• Professionalism: 10%

  • Students start with full professionalism score. Risk point loss for professionalism concerns (see learning environment/professionalism expectations)

• • Assigned in OASIS to supervising physicians at the start of each block. Physicians completing the evaluation expected to do so based on their own experience and feedback from others

  • Evaluation includes 2 parts

    • Scored items with “anchor” descriptors

    • Narrative comments: things done well, things to work on

  • Weighed formula for each item on the evaluation to derive an evaluation score for ALL clerkships

    • 1–>0.5 points

    • 2→1.5 points

    • 3→2.5 points

    • 4→4 points

    • 5→5 points

  • Supervising physicians have the option to “opt out” of the entire evaluation or individual items

  • Score calculated out of items submitted; not affected by a “not observed” response

  • We strongly encourage supervising physicians to use the full spectrum of scores

    • Evaluation scores “anchored” with behavioral descriptions

    • Scores tend be higher as the year progresses

    • As H/NH assignments made within each block, this does not affect overall grades

  • Outlier evaluations

    • The course grade should represent overall clerkship performance

    • We identify and follow up on evaluations which are statistical outliers for a student once all evaluations have been submitted.

    • If it seems the outlier score did not in fact represent an outlier clinical performance in a given clinical setting, we remove the evaluation and notify students whose clinical score is adjusted

    • We follow up with supervising physicians who are have a pattern of outlier evaluations as part of ongoing professional development and involve the residency and/or fellowship directors if needed.