Learning Environment

• Supervised clinical practice and active clinical observation are really the absolute core of medical training. Students, residents, and fellows are practicing medicine under a supervising physician’s license. In all clinical pediatric courses learners are empowered to assume the “next up” role with pre-clerkship students striving for the role of an M3, 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.

• Active observation is a major educational strategy we employ in supervised clinical practice. Initially the junior physician is purely in the observer role. As they progress in training and gain more and more scaffolded independence the primary observer role transitions to the senior physician who directly observes and provides directed feedback. 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.

• Security is available to escort students to/from work areas

  • Cardinal Glennon security guards are stationed in the main lobby and in the ED area. They can also be reached by calling the CG operator 314-577-5600 or 0 from a CG phone.

  • SLU Hospital Security can be reached at 314-257-1760 though they do not have vehicles to transport students to their cars/parking lots from the Hospital

  • Campus security. 314-977-3000

• We encourage students concerned about individual safety (weather/driving conditions, car problems, etc) to contact the course director and consider requesting an unexcused absence

• All healthcare team members are expected to show integrity and accountability to patients, society, and the profession of medicine

• Concerns about student’s behavior

  • • Department of Pediatrics along with the rest of the SOM have a responsibility to students, faculty, alumni, and society to graduate competent physicians.

    • Supervising physicians along with students and other team members are expected to discuss any concerns regarding student’s professionalism (along with concerns about medical knowledge and skills) with the course director

    • Unprofessional behavior might result in recommendation for course remediation, course failure, and/or referral to the office of student affairs and/or student conduct committee

    • Clerkship

      • Professionalism counted in the clinical performance grade

      • All students start and expected to stay at full professionalism “credit”

      • Failure to meet professionalism expectations will result in loss of professionalism points. Specific number of points taken off are at the discretion of the clerkship directors

      • Students at risk of professionalism point loss are notified and given an opportunity to discuss

        • • ≥ 90% required for honors

          • ≥ 70% required for pass

• Concerns about behaviors of other team members

  • Students who have concerns about professional behavior of supervising physicians and/or other team members are expected to bring these up to any of the following: course directors, pediatric student education directors, residency director, Office of Student Affairs, Office of Professional Oversight.

• Course/site clinical and group education activities are required.

• Students are expected to work a full week during each clinical course/site

  • • 10 “half days” per typical week

    • Clinics are typically scheduled 8-12 and 1-5. Activities during half days no clinics are held might include participation in division educational conferences, inpatient consults, procedures, Ranken Jordan visits, as well as individual study half days

    • Hospital based courses/sites typically have both an earlier start and an earlier finish to the day

    • Please see site overviews

• Weekends and evenings

  • The pediatric clerkship, acting internships, along with several other courses/sites (ambulatory pediatrics, well baby nursery, PEM, exploring neonatology) include weekend and evening or night expectations.

• Work hour restrictions. SLU (along with the vast majority of other schools) chose to apply the ACGME resident work hour standards to students. Practically this means students should never be expected to spend more than 80hrs a week performing clinical duties. In Pediatric rotations, work tend to be longest during the general inpatient (orange and purple team) part of the pediatric clerkship as well as the pediatric acting internships. Even during those weeks though, it would be extremely unusual for students to exceed the recommended work hours. Students who are concerned about exceeding work hours are advised to contact course directors

• Per SOM policy, all student absences

  • Need to be approved by the course director (NOT by a supervising resident, attending, or clinic staff member).

  • Are tracked and reported to the SOM at the conclusion of each course

• Excused absence make up requirements

  • Absences in excess of 10% of a course’s activities need to made up

    • >2d for typical 4w elective (5d a week=20d total)

    • >3 clinical days for the pediatric clerkship (roughly 30d of clinical practice and 4d of didactics)

  • Missed critical education experiences (defined by the course director) need to be made up.

• Failure to obtain timely course director approval for an excused absence and/or failure to report an unexpected absence are serious breaches of professional responsibility and may result in loss of professionalism points (clerkship), referral to the Dean's Office and/or a grade of Fail for the course.

• In cases where a student is required to complete additional coursework after the end of the course, an Incomplete (I) will be recorded in the official record until the course is

• Per SOM policy, planned absence requests need to be submitted to the course director at least 30d prior to the rotation. These might include professional activities such as conference attendance, residency interviews or personal absences such as important family events and non-urgent medical visits.

• For activities at least somewhat within their’ control (Eg. doctor’s or dentist appointments, residency interviews), we strongly encourage students to pick days/time with least possible impact on the course activities. The course and site overviews include typical schedules which should allow for advance planning

  • • Clerkship ACS days, fOSCE, OSCE and academic half days are set for the year prior to block 1 (see calendar)

    • Subspecialty clinics as well as division educational conferences typically occur on a set schedule. So for instance Monday and Tuesday might be especially clinically heavy meaning NOT good days to miss. (see site overviews)

• Students’ chances of getting ill during Pediatrics are statistically pretty high. Kids catch a lot of viral illnesses are not always the best about washing their hands or covering up when coughing or sneezing. Think of it as an immune system building experience. : ) Other emergencies might come up at times.

• Student unexpected absence reporting expectations

  • Report as soon as possible and before 8AM on the day of absence

  • Use the web based form. This generates an automatic notification to the pediatric student education office. As duration of illness is hard to predict, we ask students to fill the form for each day they are reporting an unexpected absence.

  • Notify* the course director (e-mail, phone, pager). Pediatric clerkship, floor AI, hospital pediatric elective (courses where Dr. King is the director) completing the online form suffices

  • Notify* the clinical team

    • Hospital based services: orange purple, red, blue, well baby nursery, NICU, PICU→contact the resident. If no resident is scheduled (rare), contact fellow or attending.

    • General ambulatory clinic (Danis Midtown)-->contact the TEACH resident Cell phone or pager (amion.com/glennon). During days no TEACH resident is scheduled (rare) call 314-268-2700 x6235 and ask to speak to the attending for the day at 8:00.

• Acute illness. Per SOM pandemic policy in ADDITION to the above unexpected absence reporting students are required to

  • Remove themselves immediately from the healthcare environment

  • Call Employee Health (314-268-5499) and follow its guidance. Employee health call might be very brief for illnesses that are unlikely to be related to COVID-19. Students are still required to call.

  • Notify Student Affairs (tyler.deshon@health.slu.edu)

*Ideally team members would have exchanged cell phone information on day 1. Course director information is found with course/site overviews. Clinical team pager numbers can be found on amion.com. Residents: glennon. Fellows/attendings: cgch.

• As clinical time is difficult to make up we ask students and course directors to be proactive and start thinking of potential contingency plans when approaching the allowed maximum missed days

• Absences should preferentially be made up within the duration of the course. This minimizes “learner overlap” and allows course directors to post a final grade (rather than an “incomplete”) in a timely manner.

• Hospital based services. Making up missed clinical days with clinical work is preferred. Options include weekends and evenings.

  • Students encouraged to review Learners on Pediatrics Spreadsheet to identify potential date/dates

• Ambulatory based service. Clinical make-up options are challenging as clinics are not held during weekends or evenings as as consult are unpredictable. Options might include assigning students to be on-call during specific days and “conferencing in” when responding to calls from families and/or healthcare members, individual work (Eg. article review and presentation to the division, virtual patient cases, etc)

• ID badges. Students (along with medical staff and employees) are required to wear ID badges at all times. We ask students identify themselves to patients and families by given surname and state that you are a "student doctor" or “medical student.”

• Students are required to adhere to SLU and SSM have dress code policies. They are very much common sense: dress professionally: nothing extremely short or revealing, no sleeveless or abdomen exposing shirts, no jeans, no athletic or open toed shoes, no sweatshirts.

• Scrubs

  • Scrub machine locations

    • Cardinal Glennon. 2nd floor bridge connecting Glennon Hall and the hospital.

    • St. Mary’s. 5th floor across from the staff/service elevators

  • Up to 4 pieces allowed out at a time

  • Contact Theresa Friederich (theresa.friederich@health.slu.edu) in case of problems with accesss

  • When to wear them

    • Required. NICU, PICU, well baby nursery (when attending deliveries)

    • Optional. ED, other settings (check with senior residents)

    • As needed. On occasion you might also need to change into scrubs due to exposure to bodily fluids. In addition to not being great about covering up when coughing or sneezing, kids also are not great about warning you if they are going to vomit, pee, or poop.

• White coats. White coats are an ongoing topic of debate. Students are specifically asked to NOT wear a white coat at the well baby nursery NICU, and when visiting Ranken Jordan. They are asked to follow individual site instructions and/or check with supervising physicians regarding white coats in other areas.

• SSM COVID screening

  1. • Needs to be done daily when scheduled to work at any SSM facility

     • We recommend students add the screening link to the home page of your mobile device for quick access

• Students are able see all patients including those who are COVID positive (MS3s update 8/5/20)

• Masks

  1. • Surgical masks in clinical areas

     • Surgical or cloth mask in educational spaces including team rooms and student work spaces

• Face Shields

  1. • Eye protection is required for COVID-19+ patients and patients under investigation. SLU SOM provided approved goggles for all students. We have goggles available to our visiting students in the pediatric student education office

Cardinal Glennon Student Map

Cardinal Glennon Virtual Tour. Recording by class of 2021 Student Chiefs

Lockers: Student lockers are located in the hallway outside of the McGowen Conference Room, North Tower, Ground level.

• They are not assigned

• You must bring your own lock

McGowen Conference Room (ground floor). A large number of our department conferences are held virtually. We recommend students attend these with their team. We additionally have McGowen conference room reserved as an alternative place for students to join in.

• Cardinal Glennon and St. Mary's Access Cards

  • • Pre-clerkship students. Receive cards from the office of pediatric student education

    • Clerkship students. Receive cards during clinical orientation and keep until graduation

• Meal Cards. Courtesy of Cardinal Glennon, all clerkship students as well as all acting interns receive a $50 cafeteria meal card. We ask student to return these before the end of the clerkship as we reuse them

Cardinal Glennon Hospital

• Students asked to park at their usual medical school spot The CG parking lot is reserved for patients and families. The lot is monitored by security and violator cars towed.

Danis Midtown

• Students asked to avoid patient and family parking and directed to park on the street or Ikea parking lot located near clinic.

St. Mary’s Hospital

• Students asked to use the parking in the West garage (east of the hospital on Clayton). Use your access card or show your student badge at the gate

• Amion: http://www.amion.com/

• SSM computers

  • Login: computer number

  • Password: SSM-STL1

• Video Interpreters. CG began utilizing Language Line Video interpreter service in 2021. Ipads on wheels are available in all clinical areas and include instruction sheets. You can also access the instructional video under link.

• McGowen Conference room available to students who wish to participate in virtual conferences

• Insufficient computer workstations as wi-fi access are problems the department as well as SSM leadership are aware of.

• Computer tips

  • Bring a laptop especially when on red or blue teams.

  • Use desktop computers in clinical areas.

• Wifi tips

  • The key is to prevent your laptop for “falling asleep” once you are logged into the guest network. Login to cgcmc-guest wifi before hand-off on laptop around 6:00 a.m. Once connected to the wifi, begin a program that will prevent your laptop from sleeping and run this for the next 24 hours (or until done for the day). Programs suggested by students:

    • Mac Program

    • Windows

  • Tell your device to "forget" the network every day when you log in. Because CG Wi Fi has a required sign in page, when your device remembers the network and tries to automatically connect, it might not pull up the sign in page.

  • Sign in page might get blocked by Ad Blocker. A fix to this is opening an Incognito window and copy/pasting the Wi Fi sign in page and then clicking the Agreement button.

  • Another tip/workaround in case the sign-in page does not pull up when you connect to the wifi: if you type in the address bar 8.8.8.8 you will force the sign-in page open. Once the sign in page opens, you also have to wait until the page is fully loaded (until the rotating loading icon disappears) before you press the sign in button. If you press the button before the page fully loads, it won't work.

  • Use personal “hotspot” from your phone

  • Typically it is better to contact SSM (NOT SLU) IT support if running into issues with clinical access: .

    • From any CG phone, dial, “HELP” (4357) to open a ticket with the IHT’s Technical Service Center. As long as you identify you areat Cardinal Glennon, the ticket will be assigned to SSM team

    • The HELP number is also posted in the upper right hand corner of the wallpaper on the CG desktops

• Students are required to obtain EPIC access prior to starting clerkship block

• Contacts for troubleshooting: EPIC support (314-644-7345), Theresa Friederich (theresa.friederich@health.slu.edu ), Aimee Walker (aimee.walker@health.slu.edu).

• Student login

  • Job: STL Student

  • Department: See individual clinical sites

• The decision regarding SOM closure due to inclement weather comes from the dean’s office not individual course directors. In case of SOM closure, all students are excused from course duties.

• In case SLU SOM remains open but individual students are concerned about being able to safely get to/from clinical site, we recommend they contact the course director and consider requesting an unexpected absence.

• We support nursing moms! Lactation rooms with hospital grade pumps (Medela) are available at CG and St. Mary’s. If you need to take a break to pump, just let your team know

• CG 2255. 2nd floor by the resident lounge. Code 245#

• St. Mary’s

• Event reporting is essential to identify, track, and trend our opportunities for improvement. Reports are reviewed by quality improvement teams who focus on the process which occurred--not necessarily the people involved in the process. We ask--were we set up for success in this event? Was this a personal or system error? Many times we find we need to change or modify a process to prevent the event from recurring.

To report an event

• Cardinal Glennon Computer

• Internet Explorer

• Intranet home page

• "Report an Event:" link is about halfway down the home page on the left side

• The system is fairly self explanatory from there. One area of hang-up can be identifying where the event occurred. All inpatient units fall under "Clinical Patient Care Services".

Blue: a crashing patient

• Go

• If you are the first responder to a code (it does happen occasionally), you should do the ABC’s until a more experienced provider arrives. Do NOT stop your resuscitative measures until someone takes them over.

• If the patient is yours → stay and provide necessary information to the resuscitating team and do whatever else the code leader tells you to do.

• If the patient is not yours and you’re not involved in the code

• • • • your presence is NOT adding to the chaos→ try to stay, observe and learn

      • your presence is adding to the chaos→leave

Red: fire; you can generally ignore this one unless the building is burning down

Pink: someone stole a baby. You may generally ignore this one as well---unless you see someone running down the hall with a baby; you can be a hero, or at least not hold the elevator door for them.

Yellow: a disaster, and is usually a drill. Listen to the overhead announcements for directions. Often they are for every able bodied pediatric doctor to head over to the ED to help with mass casualties.