Pediatrics

Pediatrics is 6 weeks long, and you spend 3 weeks in hospital inpatient medicine (inpatient wards plus possibly cardiology and/or nights), 1 week in the ED, 1 week in an outpatient clinic, and 1 week in the St. Joe’s newborn nursery. Pediatrics tends to be one of the more relaxed rotations of third year because you work fewer hours and typically aren’t responsible for writing notes. You will also spend more time shadowing than you do in other rotations. If you don’t already know, the food at PCH is AMAZING and you will get $140 to spend at the cafeteria and hospital Starbucks during this rotation. 

• Students must score greater or equal to the 10th percentile on the NBME exam (110 questions) in order to receive a pass. 

• Students will be evaluated by the residents and faculty with whom they work through MedHub evaluations. You must request these evaluations during some of the weeks of the clerkship.

• You must email one completed note (Hospital H&P) to Dr. Wall for grading. See the recipes for success section below for more details. 

• You will perform a newborn OSCE exam during your Newborn Nursery week at St. Joe’s. See the recipes for success section below for more details. 

• Other course components must be completed in order to pass the course, but are not graded. These include: 

  • 20 completed Aquifer cases. You must complete the 10 specified cases and then you can choose which cases you would like to do for the remaining 10

  • One CEX in the newborn nursery week and one CEX in one of the other weeks of the clerkship 

  • Complete all MedHub cases and procedures 

1. Clinical performance evaluations: 50%

2. NBME Subject (Shelf) examination: 25%

3. Hospital H&P: 25%

4. Newborn OSCE 10%

5. Professionalism: 5% (all or nothing) 

Honors* = 85 - 100%

High Pass = 80 - 84.9%

Pass = 70 - 79.9%

*No limit to the number of Honors per rotation 

Here is what a typical student schedule might look like. Each row of the picture corresponds to a different student, so you are actually seeing five different student schedules in the same block. We included five separate schedules to show the different teams and outpatient clinics you may be assigned to work with. Click here for sample schedule.

You will start either on your three hospital weeks or your ED/outpatient clinic/Newborn nursery weeks. In your hospital weeks, you may work a week of nights and you might also be assigned to cardiology. If you are assigned a week of nights, you will work Monday, Tuesday, Wednesday, and Thursday nights starting at 7pm. Your team might expect you to be there for sign-out at 6 or 6:30pm, so be sure to ask what time to report after the first day. You will help admit patients overnight and your team will typically let you leave around 2-3 am. Some teams will let you leave earlier or you may have to stay later depending on the night. Typically, you will see an admit with a resident and they will have you get the history and do the physical together, then you staff the patient with the physician. 

If you are assigned a cardiology week, you will work with the cardiology fellow and NPs as there are not typically residents on this team. Expect to carry 1-2 patients at first and add patients throughout the week. You will mostly see infants with congenital heart defects so review these and the effects on the heart like murmurs, hypertrophy, etc. 

Inpatient experiences differ based on your team. Brown team is GI, orange is endocrine, gray is neurology, and purple is general pediatrics. But each team still covers general pediatrics if it is specialized.  In orientation, they will give you the team room locations. Typically you will be expected to be there for sign-out at 6 am or soon after depending on your senior resident. You will follow a few patients and present them during rounds. If you are early in clerkships, you can ask your senior residents about rounding expectations or to practice beforehand. The residents are usually very open to teaching and helping if you ask. PCH practices family rounding, so you often will present with the family present depending on your team, attending, and patient situation. When speaking with the family remember to engage them by asking if they have concerns and talking with less jargon. Rounds typically last mid-morning, then in the afternoon you will support your team by making phone calls or updating the family on treatment plans. Typically students are not responsible for writing notes in the electronic medical record. 

The outpatient clinics include genetics, neurology, allergy, and pulmonology. The outpatient weeks will require you to be there from 7am-5pm at the most, and many of the outpatient days are shorter. For the most part, you will be shadowing during this week. If you have an interest in pediatrics, there may be opportunities to explore other outpatient clinics if you ask depending on availability. Some visits may be remote and you may be able to conduct them virtually from your home.

The week in the ED will include 4 shifts from either 10am-4pm or 7am-2pm. You will see patients before your attending and then present your patient and plan to the attending. There are two sections of the ED: the extension and main area. The extension covers lower acuity problems and is usually higher turnover (think respiratory illnesses, fractures, abscesses, etc.). The main area usually covers higher acuity problems or patients with more complex medical history. Typically, you start at the extension and then may have a shift at the main area. 

Newborn nursery is typically the most fun week of the rotation and has the shortest hours. You will start at 7am and leave after rounds, typically by 12pm. You are expected to present 2 patients during rounds. Remember that you must complete a CEX and Newborn OSCE during this week. Ask one of the residents for a copy of the patient worksheets (these are clutch, fill one out for each baby you are assigned). There are many acronyms so ask a resident to run you through them on the first day. St. Joe’s uses a different EMR which takes some getting used to. Again, just nicely ask a resident to help you navigate the information or watch them chart review a patient the first morning so you know for the rest of the week. Glance over the newborn exam before you start this rotation and look up videos on anything you don’t know (reflex exams). 

Every week has 1-2 hours of didactics at varying times. Some didactics have pre-reading, but you do not have to thoroughly read the articles to participate in the sessions. They cover high yield board topics and are usually interactive sessions. These didactics are interesting and low stakes, so don’t worry about them.

• Phoenix Children's Hospital

  • Here are the exact coordinates to the parking lot - just put directly into your GPS and save it!

• Clinical Performance Evaluation

  • Make sure you email preceptors in advance to ask about when to meet, where to meet, and any preparation they expect you to do before you start working with them

  • This should go without saying, but show up on time or early every single day. Ask what you can do to help (the answer may be nothing) and offer to do small tasks without being told (for instance, updating the family on a treatment plan). The best thing you can do to succeed in this or any clerkship is to show up engaged and ready to learn. Ask questions, read about the cases you see, and discuss your reading with the team. There is a lot of downtime in pediatrics, and if you show that you are learning independently during that time, it will reflect really well on you. 

  • Prepare by reviewing the diseases you are most likely to see, along with common work-ups and treatment plans. For instance, if you are on cardiology, review congenital heart defects and treatments. If you are on newborn nursery, understand how to do a newborn exam before the first day.

• NBME Exam 

  • The shelf exam consists of 110 multiple choice questions

  • Tier 1 → You should aim to do all of the UWORLD for Pediatrics - that should be your main goal. If you have extra time you can redo your missed questions or redo the entire bank again. If you do all of UWORLD and nothing else, you will be able to pass and do quite well. Everything beyond this that you can do is a bonus. 

  • Tier 2 → Once you near the last few weeks of the rotation you should do at minimum two practice NBME exams, ideally all four if possible.

  • Tier 3 → If you have extra time you can watch the Online Med Ed or Osmosis videos for Pediatrics before or during the rotation. (choose one or the other, whichever you like best). 

• Hospital H&P 

  • The most important thing you can do to succeed on the H&P is to read and closely follow the rubric. The rubric includes components that aren’t included in a typical note, such as growth curves, so it is really important to reference as you write your note. The rubric goes up to 5 points, but you are only expected to meet the 3 point requirements. 

  • Spend the most time on your assessment and plan section, and be sure that you include all parts of the history in the subjective section. Pediatrics notes contain extra history sections like birth and development history so don’t forget those. You will receive a powerpoint from Dr. Wall in the first week that covers the required history sections in a pediatrics note. 

• Newborn OSCE

  • To get full points on this, you just need to do everything on the checklist. Be sure to review the OSCE checklist and practice earlier in the week. It is also a good idea to do your Newborn CEX before your Newborn OSCE since the CEX is not graded. It may also be a good idea to ask one of the interns to do the OSCE with you since they were just a medical student and will probably be nice. 

• Aquifer Cases

  • You should most definitely click through the Aquifer cases for completion. Feel free to skim them if you feel inclined but do not spend much time on them. Your shelf exam is UWorld based, and although the Aquifer cases are useful in reality, they may not be practical for the time you have in the rotation. Clicking through or reading the case summaries is enough. This should not be your priority.

• Dress code 

  • PCH dress code is generally business casual or scrubs 

  • For ED, you typically wear scrubs 

    • Avoid black scrubs because this is what the Physicians wear to easily identify them in emergency situations 

  • For inpatient and newborn weeks, you typically wear scrubs 

  • For ambulatory weeks, you typically wear business casual 

*most important resources are in red that you should do at minimum to pass

• UWORLD

  • You know where to find that!

  • Question bank is about 630 total questions

  • Do it all at least once!

• NBME Practice Exams

• Emma Holliday High Yield Pediatric Lecture (2 hours)

  • Linked here

• Online MedEd or Osmosis

  • Check their respective websites for the videos

  • Here is the Online MedEd PDF booklet that you can scan quickly for review 

• Use this template and adjust to your own needs! 

• You aren’t expected to write notes in pediatrics! Enjoy the break! 

• Here is a template for rounding & presenting patients. 

  • Arrow at top midline of page = use for progress note rounding

  • Target at top midline of page = use for new patient admits

• Reference the Bright Futures guide for well-child checks.

• Another great resource: https://www.cdc.gov/ncbddd/actearly/milestones/index.html 

• Usefull Phone Numbers:

  • To call for a newborn screen: (602) 364-1409 [provide name and DOB]

  • Surgery resident phone: (480) 450-2189 

• Shelf exam 

• Newborn OSCE 

• Hospital H&P (sent to Dr. Wall) 

• 20 Aquifer Pediatrics Cases 

• 2 CEX Forms - complete one during Newborn Nursery week and one at any other point in the clerkship 

• Send evaluation requests for the providers that you worked with in the outpatient weeks 

• Log work hours in Medhub

• Log cases & procedures in Medhub

• Complete the mid-clerkship evaluation form on Medhub