Post-clerkship block scheduling is completed via three steps. The anchor lottery typically held midway through clerkship year includes acting internship as well as ambulatory and EM clerkship. At the end of the anchor lottery each student is scheduled for these three rotations. Pediatrics offers four different acting internships: general inpatient, PICU, NICU St. Mary’s, and NICU Cardinal Glennon. Ambulatory Pediatrics +/- bioethics rotation fulfills the ambulatory clerkship fulfills the ambulatory clerkship requirement. Students have the opportunity to spend all or part of their EM clerkship on PEM at Cardinal Glennon.

The second step is the elective lottery during which students are scheduled for all other courses. Most Pediatric electives are available through the lottery. With the early start of the post-clerkship year though, several are offered as “waiting list only” as we will not know whether the rotation will be available to an M4 until the faculty and resident schedules are made in late spring.

The last step is the add/drop period. Students have the ability to modify their course enrollment up to 30d prior to each rotation. While we absolutely realize plans change, we ask fourth years to make changes as soon as possible.

• Review Pediatric Onboarding

• Be considerate in making schedule changes (Eg. approval of an for an away rotation, or just a change of interests/plans) as soon as you can. Clinical “spots” are very tight with same sites utilized for fourth year electives, pediatric clerkship, and pediatric CEs. Most likely another student would love that spot!

• Respond to Pediatric Student Education office e-mail soliciting schedule requests in a timely manner. While we give fourth years priority in scheduling (Eg. deciding which weeks you’ll spend on inpatient/consult service vs. clinic), we do not “bump” clerkship students due to late schedule requests.

• Review Learning Environment section regarding schedule expectations and planned absences

• Take the opportunity to shine

  • Think of ALL post-clerkship pre-match list rotations and ESPECIALLY the AI as very prolonged interviews

    • Students often think of this when it comes to visiting rotations and AIs. It is just as true for electives. You are much more “visible” as a fourth year acting intern or an elective student than you were during your pediatric clerkship

    • The good news is that this goes both ways. You are “trying on” a program (including ours) while the program is “trying on” your fit as a potential resident.

    • Asking for resident and faculty input regarding rotating students is common practice among residency programs. They will potentially be working closely with you in the future!

    • Prepare. Read Pediatric Success tips and suggested individual study materials

    • Aim for honors and make every day count

    • Expect to work harder than the residents. They are less interested in impressing supervising physicians so might not be going out of their way to for instance look up articles or teach the team! They are also nice people who were all in your shoes not that long ago meaning they will willingly give you the opportunity to shine, Eg. give you first choice for picking up interesting new clinic visits, admissions, or consults

  • Take third year students “under your wing.” Fourth and third years overlap on numerous sites This is not only the nice thing to do, but also something supervising physicians (and junior students) notice.

• Education Conferences

  • As a reminder, fourth years are encouraged to attend intern academic half day!

• Pay it forward challenge

  • • Given the more limited number of fourth year elective students scheduled for each clinical site and their deeper immersion, we along with future students would especially appreciate if you could take the time to review/update the mirror google docs

• Supervised clinical practice with progressive entrustment is core to medical education. Below are the four ultimate goals for medical students. These are meant as a reference and guide. Learners reach these milestones at different times spanning from third year to residency!

• Be viewed by the patient and family as their primary hospital physician for patients NOT shared with an M3. While they should know others (senior, +/- fellow, attending) are involved in a supervisory manner, the ultimate goal is for the families to view the most junior primary team member as their primary contact with the physician team.

• Be viewed by the team as a strong, experienced intern. There intentionally is no “cap” on the number of patients a medical student can carry. Strong fourth years have successfully carried a patient census of higher number, complexity, acuity, etc. compared to interns.

• Be viewed by the M3s as their “big sib” and go to person for questions. We strongly encourage M4s to take M3s “under their wing.” This includes helping orient them to the team, answering questions about pre-rounding, notes, etc.

• Apply clinical knowledge and teach in real time. Clinical questions come up constantly! (Eg. use of systemic steroids with orbital cellulitis, use of of hypertonic saline or CPT with bronchiolitis, adding topical antibiotics to systemic antibiotics when treating cellulitis with abscess, use of probiotics with gastroenteritis). We challenge students to identify and look up answers in real time, apply them to patient care, and discuss them with the team as well as patients and families. Patient presentations as well as notes are both great opportunities. Families typically appreciate these discussions. These are also much more memorable to other team members compared to topic talks isolated from patient care!