Clinical Instructors Precepting Handbook 1516

3rd Year Medical Student
Pediatric Clerkship Precepting Handbook
CHILDREN’S NATIONAL
HEALTH SYSTEM
We Stand For Children!!!
Department of Pediatric Medical Student Education

George Washington University
School of Medicine and Health Sciences
Washington, DC
www.childrensnational.org
www.pediatriccareer.org
Welcome to the Pediatric Clerkship Team at
Children’s National Health System for The George
Washington School of Medicine.
As an outpatient preceptor, you are a key to the success of our program. We

hope that you and your student will develop a great working relationship from
which they will achieve the objectives established for this clerkship. Thank
you!!!
This package offers you supportive information and forms that can be used during your experience with your student.
Additional information can also be found on http://www.childrensnational.org/ForDoctors/mse
As a token of appreciation for your effort, based on your appointment as a Clinical Instructor in Pediatrics at The George
Washington University School of Medicine, we can provide access to GW Medical School’s Himmelfarb Library and their vast
on-line collection of journals and textbooks. You will only need your GWID (provided at the time of your appointment) via
www.aladin.wrlc.org. (If you have questions about accessing your GWID, please contact mbraddock@gwu.edu if you do not
have this.) Additional information can be found here: http://himmelfarb.gwu.edu/tutorials/PDF/faculty_orientation.pdf
Benefits of Precepting
In addition to shaping the future of our profession and children’s lives generally by teaching our next
generation of physicians, we can offer these benefits of precepting.
1. Faculty Appointment: Our ambulatory faculty are now being granted a Clinical Instructor’s appointment from
GW. Benefits are described in this link: www.smhs.gwu.edu/faculty/limited-service. Highlights include:
a. GWorld ID card which will allow access to Himmelfarb Medical Library and the University’s Gelman
Library
b. Access to Himmelfarb Library’s on-line journals and texts
c. Ability to attend and participate in all faculty development programs presented by the School of
Medicine and Health Sciences
d. Eligibility to participate in the meetings/conferences/programs presented by the Office of Continuing
Education in the Health Professions (202-994-4285).
2. Teaching CME
a. GW is happy to provide AMA Category 1 CME credit for the self-directed learning that occurs while
preparing for student teaching.
b. Credit is provided for each fraction of an hour that you spent teaching provided that you prepared for
the experience by researching the literature. You will simply need to verify:
i. That you were scheduled to teach the students. We can provide verification, if needed.
ii. That you filled a gap in his/her own learning, by teaching.
c. GW’s office of Continuing Education in the Health Professions can help offer additional insight at
www.smhs.gwu.edu/cehp/ or by email at cehp@gwu.edu . They will be the office to provide the CME
transcript as well.
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Package Contents
 The Pediatric Clerkship Course Overview

 Benefits of Precepting
 The Ambulatory Objectives
 GW School of Medicine Program Objectives
 MedHub.com Evaluation Completion
 Ambulatory Requirements and Reading List
 Required Clerkship Diagnoses (students keep diagnosis logs)
 Guidelines for precepting a 3rd year medical student in your office
 Expectations for “Honors” level clinical performance
 Sample Forms (students have all required forms)
o SCO: Structured Clinical Observation form (4 are required during outpatient)
o Mid-rotation Feedback form (1 is required after first 2 weeks)
o Outpatient Student Log
Please feel free to contact us at any time if you need assistance or if you have a question about the process or a concern about
the student. Thank you for your support of the GWU pediatric clerkship.
Craig C DeWolfe, MD MEd Clarissa Dudley, MD MPH

Director Pediatric Med Stud Education Associate Pediatric Clerkship Director
Assistant Professor of Pediatrics Assistant Professor of Pediatrics
George Washington School of Medicine George Washington School of Medicine
Children’s National Health System Children’s National Health System
Phone: 202-476-5344 Phone: 202-476-6157
e-mail: cdewolfe@childrensnational.org Email: cmdudley@childrensnational.org
Wilhelmina Bradford Mary C. Ottolini, MD, MPH

Program Coordinator, Medical Student Education Professor of Pediatrics
Department of Medical Education George Washington School of Medicine
Children’s National Health System DIO and Vice Chair for Education
Phone 202 476-5692 Fax 202 476 4741 Children’s National Health System
e-mail: wcbradfo@childrensnational.org e-mail: mottolin@childrensnational.org
We have a Careers Blog at www.PediatricCareer.org. Guest posters are welcome. Contact Dr. Terry Kind at
tkind@childrensnational.org or 202-994-9587.
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Pediatric Clerkship Course Overview
The purpose of the Pediatric Clerkship is to provide the 3rd year medical student with inpatient and outpatient pediatric
clinical experiences where students will
 acquire a working knowledge of normal and abnormal growth and development,
 recognize, understand the pathophysiology of, diagnose, and treat the common disorders of infancy,
childhood, and adolescence, and
 develop an understanding of children’s and families’ perspectives of being cared for within our healthcare
system through observation, inquiry, and reflection.
The 3rd year pediatric clerkship consists of an inpatient, outpatient (well, sick, and follow up), and nursery rotation,
including a core pediatric medical student education curriculum from birth through adolescence.
Students are assigned to an inpatient medical unit at Children’s National or at Holy Cross Hospital in Silver Spring,
Maryland and to outpatient Children’s Health Center sites: Adams Morgan, Comp (Shaw), Martin Luther King, Good
Hope Road, Children’s Health Center at Children’s, Adolescent Health Center, or to a private practice in Maryland, DC, or
Virginia. Students will spend approximately 4 days in a newborn nursery at either Holy Cross or GW Hospital. Students
will not have identical exposures to patient problems and should communicate with one another to share what they are
learning about their experiences. There is a minimum set of (22) pediatric diagnoses that a student will see, or for which
he/she will have an alternative learning experience.
During the outpatient and inpatient experiences, students will work with several attending preceptors and have an
opportunity to participate in all activities that occur at the site. One of these attendings is assigned to gather input from
all of your preceptors in order to compile this data and compose your evaluation.
Please refer to Blackboard for information and forms needed during your pediatric clerkship. We encourage you to
share useful articles, websites, and other resources with your fellow students. Let the coordinator know and we will
add the resources to Blackboard.
We value your evaluations of the residents and faculty with whom you work and learn, of the educational sessions, and
of the clerkship overall. Your reinforcing and constructive feedback allows us to continually improve our curriculum
and the quality of our teaching.
Our offices (Med Ed Suite West Wing 3.5 Suite 600) are always open to you for any questions or problems. Please do
not hesitate to stop by just to talk! Also, check out our career blog at www.PediatricCareer.org
Clerkship Learning Objectives:
Clerkship Learning Assessments Mapped Program

Objectives Objectives
 Perform effective  A score of greater than or equal to 3 (out of 5) on the - Patient Care: 1,
age-oriented uniform student clerkship evaluation - clinical skills section, 2, 4
interviews and which assesses student performance on physical and mental - Interpersonal &
physical status examinations and technical/procedural skills, as Communication
examinations on evaluated by faculty and residents. Skills: 1, 8
newborns,  A score of greater than or equal to 3 (out of 5) on the
children, and uniform student clerkship evaluation - communication skills
adolescents. section, which assesses students written and oral
presentation including patient communication skills, as
evaluated by faculty and residents.
 A score of greater than or equal to 3 (out of 5) on the
uniform student clerkship evaluation - professionalism
section which assesses students honesty, responsibility,
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teamwork, empathy, commitment to competence and
excellence, and respect for patients, as evaluated by faculty
and residents.
 A Pass in the newborn nursery experience
 Structured Clinical Observations. Using the "SCO" form,
precepting faculty (and/or residents) observe portions of the
student-patient and/or student-parent interaction (i.e.
history, physical, information giving) and provide brief
immediate feedback to that student. Students are required
to be observed using this tool 8 times throughout the 8
week clerkship.
 Mid-Rotation Self-Assessment and Formative Feedback.
Halfway through the inpatient and halfway through the
outpatient portions of the clerkship, using a mid-rotation
review form, students self-assess their performance and
then meet with their preceptor for formative feedback and
prepare an action plan. Students are required to complete 2
mid-rotation forms (one from inpatient and one from
outpatient).
 Satisfactorily complete the Inpatient Write-Up
 Demonstrate  A score of greater than or equal to 3 (out of 5) on the - Medical
the ability to uniform student clerkship evaluation - cognitive skills Knowledge 3, 6-
develop a clinical section, which asks students to organize and synthesize data 9
assessment and into an assessment and plan, as evaluated by faculty and - Patient Care: 4-
plan in a residents. 6, 8
problem-  A score of greater than or equal to 3 (out of 5) on the - Interpersonal &
oriented fashion. uniform student clerkship evaluation - communication skills Communication
section, which assesses students written and oral Skills: 4, 6
presentation including patient communication skills, as - Practice-Based
evaluated by faculty and residents. Learning &
 A Pass in the newborn nursery experience Improvement:
 Mid-Rotation Self-Assessment and Formative Feedback. 3,4,6
Halfway through the inpatient and halfway through the - Systems-Based
outpatient portions of the clerkship, using a mid-rotation Practice: 2, 5
outpatient).
 Demonstrate  A score of greater than or equal to 3 (out of 5) on the - Medical
clinical skills uniform student clerkship evaluation - clinical skills section, Knowledge 7-9,
typical to the which assesses student performance on physical and mental 12
care of status examinations and technical/procedural skills, as - Patient Care 3-5
newborns, evaluated by faculty and residents. 5, 7, 9
children, and  A Pass in the newborn nursery experience - Practice-Based
adolescents  Mid-Rotation Self-Assessment and Formative Feedback. Learning and
Halfway through the inpatient and halfway through the Improvement 1-
outpatient portions of the clerkship, using a mid-rotation 7
review form, students self-assess their performance and - Systems-Based
Care 2
5
then meet with their preceptor for formative feedback and - Professionalism
prepare an action plan. Students are required to complete 2 2-3
outpatient).
 Satisfactorily complete the Procedure Logs
 Illustrate ways in  Score >60 (pass) on the pediatric shelf exam - Medical
which  A score of greater than or equal to 3 (out of 5) on the Knowledge 1-6,
pathophysiologic uniform student clerkship evaluation - cognitive skills 9
processes can section, which asks students to organize and synthesize data - Patient Care: 8
affect the growth into an assessment and plan, as evaluated by faculty and - Practice-Based
& development residents. Learning &
in children  A Pass in the newborn nursery experience Improvement: 4
outpatient).
 Demonstrate the  A score of greater than or equal to 3 (out of 5) on the - Medical
ability to uniform student clerkship evaluation - cognitive skills Knowledge 7
differentiate well section, which asks students to organize and synthesize data - Patient Care: 7
children from into an assessment and plan, as evaluated by faculty and - Practice-Based
mildly or residents. Learning &
severely ill based  A Pass in the newborn nursery experience Improvement: 4
on their signs  Mid-Rotation Self-Assessment and Formative Feedback.
and symptoms at Halfway through the inpatient and halfway through the
various ages. outpatient portions of the clerkship, using a mid-rotation
outpatient).
 Practice  Score >60 (pass) on the pediatric shelf exam - Medical
preventive  A score of greater than or equal to 3 (out of 5) on the Knowledge 1-2,
pediatrics uniform student clerkship evaluation - cognitive skills 4-7, 9-10
through age- section, which asks students to organize and synthesize data - Patient Care: 4,
appropriate into an assessment and plan, as evaluated by faculty and 8
screening and residents. - Interpersonal &
anticipatory  A score of greater than or equal to 3 (out of 5) on the Communication
guidance about uniform student clerkship evaluation - communication skills Skills: 4, 6
nutrition, section, which assesses students written and oral - Practice-Based
environmental presentation including patient communication skills, as Learning &
influences, evaluated by faculty and residents. Improvement:
safety, and  A Pass in the newborn nursery experience 4-5
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immunizations,  Mid-Rotation Self-Assessment and Formative Feedback. - Systems-Based
in improving Halfway through the inpatient and halfway through the Practice: 1, 3-4
child health. outpatient portions of the clerkship, using a mid-rotation
outpatient).
 Demonstrate  A score of greater than or equal to 3 (out of 5) on the - Interpersonal &
humanistic uniform student clerkship evaluation - cognitive skills Communication
attitudes and section, which asks students to organize and synthesize data Skills: 7
professional and into an assessment and plan, as evaluated by faculty and - Professionalism:
ethical behaviors residents. 2-4
related to the  A score of greater than or equal to 3 (out of 5) on the
pediatric patient, uniform student clerkship evaluation - clinical skills section,
their family, and which assesses student performance on physical and mental
other healthcare status examinations and technical/procedural skills, as
professionals. evaluated by faculty and residents.
uniform student clerkship evaluation - communication skills
section, which assesses students written and oral
presentation including patient communication skills, as
evaluated by faculty and residents.
uniform student clerkship evaluation - professionalism
section which assesses students honesty, responsibility,
teamwork, empathy, commitment to competence and
excellence, and respect for patients, as evaluated by faculty
and residents.
 A Pass in the newborn nursery experience
 Structured Clinical Observations. Using the "SCO" form,
precepting faculty (and/or residents) observe portions of the
student-patient and/or student-parent interaction (i.e.
week clerkship.
outpatient).
 Satisfactorily complete a reflective paper
 Satisfactorily complete the corresponding CLIPP cases
when absent from a session or when assigned as pre-
reading.
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 Demonstrate the  A score of greater than or equal to 3 (out of 5) on the - Interpersonal &
 ability to present uniform student clerkship evaluation - communication skills Communication
a pediatric section, which assesses students written and oral Skills: 3
patient in an oral presentation including patient communication skills, as
and written evaluated by faculty and residents.
format.  A Pass in the newborn nursery experience
outpatient).
 Satisfactorily complete the Inpatient write-up
 Demonstrate - A score of greater than or equal to 3 (out of 5) on the - Interpersonal &
effective uniform student clerkship evaluation - communication skills Communication
communications section, which assesses students written and oral Skills: 1-2, 4-5, 8
with patients and presentation including patient communication skills, as
their families. evaluated by faculty and residents.
- A Pass in the newborn nursery experience
- Structured Clinical Observations. Using the "SCO" form,
precepting faculty (and/or residents) observe portions of
the student-patient and/or student-parent interaction (i.e.
week clerkship.
- Mid-Rotation Self-Assessment and Formative Feedback.
prepare an action plan. Students are required to complete
2 mid-rotation forms (one from inpatient and one from
outpatient).
 Demonstrate a - Mid-Rotation Self-Assessment and Formative Feedback. - Practice-Based
commitment to Halfway through the inpatient and halfway through the Learning &
lifelong learning outpatient portions of the clerkship, using a mid-rotation Improvement:
through inquiry review form, students self-assess their performance and 1-3
and reflective then meet with their preceptor for formative feedback and
practice. prepare an action plan. Students are required to complete 2
outpatient).
- Satisfactorily complete a reflective paper
- Satisfactorily complete the Procedure Logs
- Satisfactorily complete the Inpatient Write-Up
- Satisfactorily complete the corresponding CLIPP cases when
absent from a session or when assigned as pre-reading.
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Required Materials:
 Stethoscope
 White Coat (setting dependent)
 Wall-mounted and hand otoscope/ophthalmoscopes are usually available at outpatient sites and on the units,
but it may be helpful to have your own.
 Access to CLIPP cases online (has been purchased by GW/Children’s National for your use)
Recommended Reading/Resources:
 CLIPP cases (see list of recommended cases; online access has been purchased for your use)
 Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents;
 Nelson Essentials of Pediatrics; Zitelli’s Atlas of Physical Diagnosis; Red Book of Pediatric ID; Harriet Lane
Course Requirements, Deadlines, and Grading Values:

The components of the final grade are:
1) Inpatient clinical evaluation 31.25 %
2) Outpatient clinical evaluation 31.25 %
3) NBME exam 31.25 %
4) Nursery pass/fail must pass in order to pass clerkship
5) Self Directed Learning Portfolio 6.25 %
Site Requirements:
 Procedures for assigning patients to students may vary by site. Typically, after the student has finished evaluating
his/her patient, he/she will present to and call in an attending (or resident) who will review and discuss problems,
assessment and plans, and recheck physical findings. When the chart is complete and plans for diagnosis,
treatment and follow up are implemented and understood by the patient and/or family, the student will sign the
chart, and the supervisor will again review and cosign.
 Students must be observed for brief (can be 5 minute) portions of their history taking and/or physical exam and
then receive brief feedback using the "Structured Clinical Observation" form (SCO) at least 4 times (about once
per week) during the outpatient rotation (students submit these in their self-directed learning portfolio).
 A formal mid-rotation feedback review form (typically the Friday of the 2nd week) must be completed by the
student and the attending to assess progress and plan next steps (students submit these in their self-directed
learning portfolio).
 Provide an opportunity for the student to perform and interpret a developmental assessment (Denver,
ASQ) for a patient
 Provide an opportunity for the student to assist +/- perform a subcutaneous injection or intramuscular
injection on a pediatric patient
 Identify a responsible physician preceptor for collecting information on a student and submitting a grade
with constructive feedback based on the collective experience with the student.
Honor Code:
All conduct, examinations, papers, and other assignments are to occur professionally and in accordance with the George
Washington University School of Medicine and Health Sciences Honor Code.
Disability Support Services:

If you have, or think you might have, a disability that may require an accommodation, please contact the GWU Disability
Support Services office (202-994-8250). Please allow a reasonable amount of time for a review of your circumstances
and a decision about possible accommodation. You may also meet with Dean Goldberg to discuss the process.
Student Mistreatment Policy:

The pediatric department is fully committed to maintaining a safe environment for all learners – especially its medical
students. We fully comply with George Washington University’s Student Mistreatment Policy. If you have any concerns
while on the clerkship, we encourage you to reach out to the chair, director, associate director, coordinator, our
ombudsman, or any faculty member.
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Student Day Educational Sessions ~ (specific schedule may change depending on rotation)
Session & Date Topics for Discussion Readings & Assignments

Week 1: Fever See Syllabus & Blackboard
Mon Orientation Growth Materials on Blackboard
Thurs Student Day Radiology or Physical Diagnosis
Professorial Rounds
Clinical Decision Making
Week 2: Thurs Obesity and Nutrition Materials on Blackboard
Literature in Pediatrics Read “The Use of Force”
Anemia Post reflection on Blackboard
Professorial Rounds
Development
Week 3: Thurs Pain management Materials on Blackboard
Evaluations of the Child w/ Develop Delay
Nephrology or PICU Intro/Walk Rounds
ECG/Cardiology
Week 4: Thurs POM at GW instead of Peds Student Day Keep doing your CLIPP cases!
Week 5: Thurs Rheumatology (Child with a Limp) Materials on Blackboard
Developmental Disabilities
Radiology or Physical Diagnosis
Professorial Rounds
Child Advocacy
Week 6: Thurs Pneumonia Materials on Blackboard
Genetics
Nephrology or PICU Intro/Walk Rounds
Professorial Rounds
Cases in the SIMULATION center
Week 7: Thurs Child Abuse Materials on Blackboard
Intake/Clinical Reasoning
Pulmonary Function Tests
Shelf Exam Review
Week 8: Fri NBME Pediatric Exam
Typical student discussions / lectures / workshops during the inpatient month at Children’s:
 Presenting on Rounds  Diabetes
 Fluids and electrolytes  Health Care Costs
 Antibiotics  Hematology: Bleeding Disorders
 Evidence Based Medicine  Poor Growth
 Dentistry  Malignancy
 Bedside Teaching – Cardiology
Typical discussions during inpatient at HCH:

 Fluids and Electrolytes  Cardiology
 Bronchiolitis  Formulary Antibiotics
 Diabetes  Acute Gastroenteritis
 Febrile Seizures  Student Symposium
 Asthma Education  Others (fever, pneumonia)
 Delivery Room Dilemmas
Note: every teaching session has learner-center outcomes-based objectives listed on Blackboard and in GW’s database
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Required Clerkship Encounter Standards: Pediatrics
Students must maintain their logs in MedHub throughout the clerkship. Their instructions are as follows:
 Preferentially log your involvement with a real patient (someone you or your team cared and for whom you
actively participated in the consideration of any of the following diagnoses). If you are unable to participate in the
care of a live patient, log an alternative learning experience (ALE) (i.e. online CLIPP, standardized patient)
 Minimum level of involvement:
o Assist: Participate in the care of a patient with this condition to include team discussion and/or overseeing
care during a hand-off
o Perform independent assessment and plan or performed the procedure under supervision
Peds clinical encounters with examples of diagnoses Minimum level of Location: ALE
involvement inpt, opportunity if
outpt, no clinical
either encounter
available
Behavior – Advise a parent of a child having problems with: PERFORM independent Either CLIPP case 3 or
sleep, colic, temper tantrums, toilet training, ADHD, encopresis assessment and plan 4
Cardiovascular - Innocent murmur, Congenital Heart Disease, assist Either CLIPP case 18
Arrhythmia
Dermatologic – Viral rash, scarletina, eczema, urticaria, contact PERFORM independent Either CLIPP case 3,11,
dermatitis, atopic dermatitis, seborrheic dermatitis assessment and plan or 21
Development – Language or motor delay, intellectual disability, PERFORM independent Either CLIPP case 2,
cerebral palsy, autism, etc. assessment and plan 14, 18, 26, or SP
Emergent Clinical Problem - Respiratory distress, shock, ataxia, assist Either CLIPP case 16,
seizures, airway obstruction, apnea, child abuse, trauma, fever 23, or 25
without localizing signs.
Gastrointestinal - Nausea, vomiting, diarrhea, abdominal pain, PERFORM independent Either CLIPP case 15,
gastroenteritis, pyloric stenosis, appendicitis, HSP, peptic ulcer assessment and plan 16, 22, or 27
disease, gastroesphageal reflux disease, constipation, IBD,
encopresis
Growth – failure to thrive, obesity, short stature, small for PERFORM independent Either CLIPP case 1, 4,
gestational age, large for gestational age assessment and plan 18, 26, or SP
Health Maintenance - Well INFANT care: (1-12 months) PERFORM independent outpatient CLIPP case 2
assessment and plan
Health Maintenance - Well NEWBORN care: (0-1 month) PERFORM independent outpatient CLIPP case 1
assessment and plan
Health Maintenance - Well TODDLER care: (12-60 months) PERFORM independent outpatient CLIPP case 3
assessment and plan
Health Maintenance - Well SCHOOL-AGED CHILD care: (5-12 PERFORM independent outpatient CLIPP case 4
years) assessment and plan
Health Maintenance - Well ADOLESCENT care: (13-19 years) PERFORM independent outpatient CLIPP case 5 or
assessment and plan 6
Hematologic or oncologic - Iron deficiency anemia, assist Either CLIPP case 2, 3,
megaloblastic anemia, anemia of chronic disease, sickle cell or 5
anemia, thalassemia, idiopathic thrombocytopenia purpura,
coagulopathy, abdominal mass, leukemia, lymphoma, tumor
Lower Respiratory Tract - bronchiolitis, pneumonia, aspiration, PERFORM independent Either CLIPP case 12,
asthma, cystic fibrosis assessment and plan 13, or SP
Fluid Management/ Metabolic / neuroendocrine – PERFORM independent Either CLIPP case 9,
Dehydration, metabolic disorder, hyperammonemia, Diabetes assessment and plan 15, or 16
Type 1 or 2, thyroid dysfunction
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Peds clinical encounters with examples of diagnoses Minimum level of Location: ALE
involvement inpt, opportunity if
outpt, no clinical
either encounter
available
Musculoskeletal - Developmental hip dysplasia, fracture, Legg- assist Either CLIPP case 17
Calve-Perthes disease, nursemaid elbow, Osgood Schlatter
disease, osteomyelitis, septic arthritis, SCFE, transient synovitis,
JIA
Neurologic - meningitis, concussion, seizures, ataxia, closed assist Either CLIPP case
head injury, headache, epilepsy 19.20. 24. or 28
Nutrition - Advise a parent about: breastfeeding vs formula PERFORM independent Either CLIPP case 2 or
feeding, healthy diet for age assessment and plan 3
Unique conditions of adolescence - Risk assessment PERFORM independent Either CLIPP case 5, 6,
(HEADDSS), STD's, chest pain, acne, eating disorders, pelvic assessment and plan or 22
inflammatory disease
Unique conditions of the PERINATAL period - Respiratory assist Either CLIPP case 1, 7,
distress, jaundice, IUGR, congenital infection 8, 9, or SP
Upper Respiratory Tract - Otitis media, otitis externa, PERFORM independent Either CLIPP case 14
pharyngitis, viral URI, herpangina, peritonsillar abscess, allergic assessment and plan
rhinitis, sinusitis
Urogenital - Urinary tract infection, enuresis, nephrotic assist Either CLIPP case 10
syndrome, nephritis, hydrocele, hernia, testicular torsion, or 22
epididymitis
Required Clerkship Procedure Standards: Pediatrics

Opportunities for exposure to IM / SQ injections will be provided during your outpatient rotation. Log is due at the
end of your outpatient experience. 100% completion is due in order to sit for the exam.
Intramuscular (IM) or Subcutaneous (SQ) Injection Assist
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The Ambulatory (Outpatient) Rotation
The overall educational goal in the outpatient pediatric setting is for students to develop history and physical exam skills
and the basics of delivering anticipatory guidance, as it relates to the continuing care of pediatric patients throughout
their growth and development over time (birth through adolescence). This includes well child care, health promotion
and disease prevention, acute care, and follow-up visits.
Outpatient Objectives:
Students will
1. Perform effective age-oriented interviews and physical examinations on newborns, children, and adolescents in the
outpatient pediatric setting for well, sick, and follow-up visits.
2. Demonstrate effective written (electronic) and oral case presentation skills including an ordered, logical
sequence with pertinent positives and negatives for pediatric outpatients.
3. Perform appropriate developmental screening at the pediatric well child visit.
4. Practice preventive pediatrics through age-appropriate screening and anticipatory guidance about nutrition,
behavior, growth and development, immunizations, and injury prevention.
5. Recognize the influence and impact of pathophysiological processes on the growth and development of children
and how this impacts and is impacted by their families.
6. Formulate an appropriate clinical assessment and diagnostic and therapeutic plan including initial and follow-up
care for the pediatric outpatient.
7. Demonstrate the development of humanistic attitudes in dealing with well, acutely ill and chronically ill pediatric
outpatients in context of their families and communities.
8. Identify personal learning objectives for the outpatient pediatric setting based on gaps in knowledge, skills and
attitudes.
9. Establish a pattern of continuous inquiry into the illness and wellness of pediatric outpatients as it relates to
their health supervision, disease prevention, and ongoing management.
10. Apply medical knowledge and clinical skills to patients with common inpatient presentations as described in
the clinical encounter and procedural log.
Procedural Expectations:
a) Procedures for assigning patients to students may vary by site. Typically, after the student has finished evaluating
his/her patient, he/she will present to and call in an attending (or resident) who will review and discuss problems,
assessment and plans, and recheck physical findings. When the chart is complete and plans for diagnosis,
treatment and follow up are implemented and understood by the patient and/or family, the student will sign the
chart, and the supervisor will again review and cosign.
b) Students will be observed for brief (can be 5 minute) portions of their history taking and/or physical exam and
then receive brief feedback using the "Structured Clinical Observation" form (SCO) at least 4 times (about once
per week) during outpatient (submit with your self directed learning portfolio).
c) A formal mid-rotation feedback review form will be completed by the student and the attending to assess
progress and plan next steps (submit with your self directed learning portfolio).
d) Students in CHC/AHC (at Children’s) will follow the noon conference schedule for this rotation (including
“Student Day” on Thursdays).
Charting Expectations:
Students should perform and record a complete and/or focused history and physical examination in the chart or
electronic record. Avoid using medication abbreviations. If using templates, make sure you are responsible for all data
entered. For information on an appropriate H and P on pediatric patients, consult the references listed under the
COMSEP Curriculum.
CDC Immunizations Schedules: see http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
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Ambulatory (Outpatient) Requirements
REQUIREMENTS
 Document feedback on parts of your interview and physical exam by collecting Structured Clinical
Observation (SCO) forms from the attendings and/or residents (8 over 8 weeks)
 Complete Mid-rotation Feedback form with teaching attending/ senior resident
 Enter Procedure and review them at midpoint and wk 7 (due by the shelf)
 Perform and Interpret a developmental assessment (Denver, ASQ) for a patient
 Assist with +/- perform a subcutaneous and/or intramuscular injection on a pediatric patient
We recommend that you also:

 Complete the outpatient CLIPP cases (strongly recommended)
 View "Through the Otoscope" CD (available from coordinator) or NEJM video (Blackboard)
The following list can guide your reading/studying during outpatient. Please see the COMSEP curriculum (online at
www.comsep.org) for an extensive list of pediatric core topics/competencies. Also refer to our pediatric clerkship and
session objectives and the pediatric minimum diagnosis list.
General outpatient pediatrics topics: Health Supervision; Growth; Development; Behavior; Nutrition; Prevention,
Immunization; Issues Unique to Adolescents; Genetics and Dysmorphology; Common Acute Illnesses; Common Chronic
Illnesses; Community Resources
Normal Development
Abnormal Development: Speech Delay; Autism; Mental Retardation; Cerebral Palsy; Learning Disability/School
Problems
Normal Growth and Growth Disorders: Failure to Thrive; Short Stature; Obesity
Anticipatory Guidance: Injury Prevention; Screening: Lead, Anemia, Hearing and Vision, TB
Behavioral issues: Toilet Training; Feeding issues; Sleep problems; Discipline; School failure
Adolescent Medicine: Preventive services; Development; Suicide; Amenorrhea
Genetics: Common malformations and genetic syndromes; Trisomy 21, 18, 13; VATER; Turner's Syndrome; Spina Bifida;
Cleft Lip and Palate; Fetal Alcohol Syndrome
Respiratory Disorders: Upper Respiratory Infection; Sinusitis; Asthma; Pneumonia; Croup; Bronchiolitis; Allergic Rhinitis;
Pharyngitis; Otitis Media; Otitis Externa
GI Disorders: GERD; Constipation/ Encopresis; Gastroenteritis; Colic; Functional Abdominal Pain; Toddler's Diarrhea
GU disorders: Enuresis; Hydronephrosis; Vesico-Ureteral Reflux
Neurology: Headaches; Seizures
Other Infectious Diseases: UTI; Cervical Adenitis; Mononucleosis; Dental Caries
Dermatology: Viral Exanthems; Atopic Dermatitis; Contact Dermatitis; Impetigo; Monilia and tinea; Scabies; Urticaria;
Seborrheic Dermatitis; Drug Reaction; Erythema Multiforme
Bone and Joint: Fracture (Salter Types); Nursemaid’s elbow; JIA; Osgood Schlatter; Legg-Calve Perthes; Slipped Capital
Femoral Epiphysis; Developmental Dysplasia of the Hip
Hematology: Iron Deficiency Anemia; Sickle cell
Cardiology: Innocent Murmurs; ASD; VSD; Valvular Defects; Coarctation of the Aorta
Vision Problems: Myopia/Hyperopia; Strabismus/Amblyopia; Cataract; Retinoblastoma
15
Guidelines for Precepting a 3rd Year Medical Student in Your Office
Welcome:
How you set the tone for the month can make a huge difference regarding the student's approach to learning. A
welcoming email, call, or letter can establish a safe learning environment. A brief orientation on the 1st day of the
rotation helps develop a shared understanding of the opportunities and expectations.
Orientation should include hours the student is expected to be there, expectations, responsibilities, roles, introduction to
staff, introduction to your physical site, what kinds of patients/parents the student will be seeing, reading requirements
on all patients, how you will observe the student, the plan for mid-rotation feedback, the evaluation, and any other
issues you feel are important. (Some of resources are attached to assist you with this, see next pages)
Consider all of your responsibilities as a possible learning experience for the student. For example, you could take the
student on newborn rounds; to hospital committee meetings; spend a half-day with your office manager and the nurse;
sit in on triaging telephone calls; and anything else you feel would add to his/her education.
Schedule the student lightly; approx 5 patients per day. In addition, bring the student in with you when any interesting
problems arise.
Observations: Try to observe the student for 5 minutes each time on several occasions during the month. This will
provide you with valuable information about how he/she obtains a history and does a physical exam. We have
“Structured Clinical Observation” (SCO) forms to assist with this process found later in this document. The student is
required to obtain 4 per rotation.
Attendance: Students are expected to be with you during your workday on Mon, Tues, Wed, and Fri on 3 or 4 weeks of
the month. We will likely schedule the 4th week for the student in an off-site well-baby nursery. Students return to
CNMC for conferences on “student day” which is every Thurs (except on the 4th week of each rotation when it occurs on
a Wednesday). The final exam is the final Friday of the rotation. Students should also be excused for their standardized
patient experience (2 hours or up to half day).
CLIPP Cases online: Students should be encouraged to complete these online computer cases during downtime. These
supplement those experiences that the student may not experience in your office.
Evaluations: Students who are outstanding will go above and beyond what's expected; i.e., talk to you about literature
they are reading, offer to call parents back, make diagnoses that are not straightforward, etc. When you evaluate
students, provide clear descriptions of their performance. Give them feedback midway through the rotation and at the
end, talk about their final evaluation. We have materials to assist you with mid-rotation feedback and with evaluations
provided later in this document. *See the enclosed Pediatrics Clerkship Mid-Rotation Feedback Form.
Grades are criterion based rather than a bell curve. (Please see the attached “Expectations for Honors Level Clinical
Performance”). Over the course of years, you may find that approximately 1/3 of your students may earn a “Pass”, 1/3
earn a “High Pass", and the final 1/3 earn an "Honors" – but again the “Expectations” document should be your official
guide. Your comments are essential in helping us understand the student’s performance. They are also used in
preparing the deans letter in their 4th year. Please write meaningful statements that are descriptive and informative. It is
GW’s expectation that a student will receive a score of 5 for each Professionalism criterion. If you feel your student
should get a score lower than a 5, please write a comment so support the score given.
16
Completing your Evaluations
Evaluations must be completed within 3 weeks of the students’ departure from your office. The LCME is focusing on a
medical schools timeliness of receiving a student’s grade and report the grades to students.
GWU uses an Internet based application, MedHub.com. You will find that it is easy to learn, easy to use, and easy
navigate. Your user ID/logon information will be sent to you via e-mail once you are set up in the system.
You will be required to know your logon to access your evaluations. You can change the logon information at anytime.
If you have trouble logging on, try using all lowercase for your username. Reminders will be sent to your e-mail address
until it is completed.
CPreceptor
See “Logging onto MedHub for Student Evaluations” at the end of this document.
General Information
MedHub.com is e-mail dependent so please let us know if your e-mail address changes or if you have any problems or
questions. Contact the Wilhelmina at wcbradfo@childrensnational.org or 202 476-5692.
1. There are several mandatory comment fields such as: Cognitive Skills, Clinical Skills, Information Presentation,
etc. Please take the time to complete them especially the Overall Performance comments. This information is
used in the student dean’s letter.
2. The section on Integrity is scored either a 5 or a 1. Anything below a 5 requires an explanation. Comments are
not required.
3. Students are allowed to challenge their grades. They are asked to contact you first to discuss their grade before
bringing their concerns to the MSE committee.
Paper Format Completion

Uniform Student Clerkship Evaluation
If you do not have Internet access or you don’t feel comfortable completing the evaluation on-line, let me know so I can
mail/fax you an evaluation.
1. Keep a copy in your files. The printed evaluation is 8 pages long.
2. Please include the students name at the top.
3. Circle your responses.
4. Remember that the section on Integrity is scored either a 5 or a 1. Anything below a 5 requires an explanation.
5. Please write your comments legibly.
6. Then fax me the completed form to 202 476-4741
7. Your scores and comments will be manually entered into E*Value.
17
Malpractice Insurance: Students in the MD degree program at George Washington are required to have personal health
insurance coverage. The George Washington University/Medical Center master malpractice policy covers our students
when they are studying in approved rotations within the United States and internationally. All students have completed
a universal precautions (OSHA) training course and all have received the Hepatitis B vaccination. Students are also
required to have DTP, MMR (2) and Polio vaccinations. PPD testing is also required. All students have completed HIPAA
certification. Students’ immunization records are on file with the GWU Office of Student Health.
Future Placements: If you are interested in being a regular placement site for one of our students, please check the
dates that you would like a student on the facsimile sheet at the end of this document and fax it back to the Student
Coordinator. You will be contacted 2 weeks before the beginning of the rotation to confirm your placement. Thank you
in advance for your consideration in being a regular placement site.
Resources
 CNMC Website
www.childrensnational.org / For Doctors / Medical Student Education
 George Washington University Medical School
http://smhs.gwumc.edu/mdprograms
 Council on Medical Student Education in Pediatrics
www.COMSEP.org/
 Computer-assisted Learning in Pediatrics Program
http://www.med-u.org/
Clinical Encounter (Diagnosis) Logs on MedHub in accordance with GW policy.

GW requires students to log their patient encounters by using the Procedure and Diagnosis (PxDx) log function in
MedHub.com. These “Required Clerkship Encounter Standards” are the types of pediatric patients (diagnoses) we expect
them to gain experience with during the pediatrics clerkship (see table on Required Encounters; there are 24 on
pediatrics, at least one from each category). This provides them with an opportunity to monitor their progress and keep
track of their learning needs and to document procedures and diagnoses they experience during inpatient, outpatient, or
nursery. Alternative (computer or simulated) experiences can also be entered in the MedHub diagnosis log although live
experiences should preferentially be logged.
The preceptor can review the students clinical encounter diagnoses logs during the rotation and provide their student
with guidance where necessary on how to ensure they see/do all that is required to meet the learning objectives in
pediatrics.
Per GW policy, successful completion of each clerkship requires that students document that they have
experienced each of the required clinical encounters or an alternate case. Logs must be 100% completed (in
MEdHub) by the exam in order to take it!
18
Student Expectations for an Honors Level Clinical Performance
Here we clarify the expectations for Honors level performance for the pediatrics medical student on the 3rd year
clerkship, in order to better support consistent evaluation. We use the Reporter, Interpreter, Manager, Educator
(R.I.M.E.)1 stepwise framework to help distinguish between basic and advanced levels of competency. The R.I.M.E.
system is synthetic and integrates student achievement rather than separating out evaluation of knowledge from skills
and behaviors. Furthermore, reaching subsequent levels implies competence at the previous levels. The following is
adapted from Dr Louis Pangaro’s original description of the RIME framework.1 Also known as PRIME with the P for
professionalism.
"Reporter": This student can accurately gather and clearly communicate the clinical facts on his/her own patients. This
requires the basic skills to do a history and physical examination and the basic knowledge to know what to look for. It
emphasizes day-to-day reliability (such as being on time, or following-up on a patient's progress). This requires a sense of
responsibility, and achieving consistency in "bedside” skills in dealing directly with patients. These skills were introduced
to students in their preclinical years, but now they must be mastered in order to “pass” the rotation.
"Interpreter": To make the transition from "reporter" to "interpreter" is a difficult step. At a “basic interpreter” level, the
student must prioritize among problems identified in their time with the patient. The next step is to offer a differential
diagnosis. This would mean offering about 3 reasonable diagnostic possibilities and to commit to, defend, and provide a
rationale for the most likely diagnosis or diagnoses. Follow-up of lab tests provides another opportunity to "interpret"
the data. This step requires a higher level of knowledge and more skills in (1) selecting the clinical findings which support
or refute possible diagnoses and in (2) applying test results to specific patients. The student has to make the transition in
how he/she sees himself/herself from "bystander" to “active participant” in patient care.
"Manager": This step takes even more knowledge, more confidence, and more judgment on the part of the student in
deciding when action needs to be taken, and in proposing and selecting among options for patients. We don’t require
students to be "right” with each suggestion, but we do ask them to provide a reasoned and supported diagnostic and
therapeutic plan. A key element in being an effective manager is to tailor the plan to the particular patient's
circumstances and preferences.
"Educator": Success in each prior step depends on self-directed learning and on a mastery of basics. To be an "educator"
means to go beyond the required basics, to read deeply, and to share new learning with others in the context of the
assessment and plan. The educator has insight to define important questions to research in more depth. The educator
has the drive to look for evidence on which clinical practice can be based, and has the skill to critically evaluate the
evidence and apply it to a given patient. A mature and confident student at this level will assume an advanced role in
educating the team (and even the faculty).
 A student must be a consistent "Reporter" to achieve a pass which on the uniform evaluation form in use at
CNMC/GW is a 3 = Very good, at expected level for a 3rd year GW student.
 A student must be consistent as an "Interpreter" for a High Pass grade, which on the uniform evaluation form is a
4 = Excellent
 The Honors 3rd year pediatrics student is consistently at the “Manager/Educator” level (which includes mastery of
the Reporter and Interpreter levels). These students receive a 5 = Outstanding
Further descriptions are detailed on GW’s uniform evaluation form.

1
Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med.
1999;74(11):1203-7.
CNMC – 02/09
19
GW School of Medicine & Health Sciences Program Objectives
also available at: https://smhs.gwu.edu/academics/md/curriculum/objectives
I. Medical Knowledge
By the time of graduation, students are expected to:
1. Apply the scientific basis of the normal structure, development, function, and relationships among the major
organ systems of the body to concepts of health and disease.
2. Illustrate biochemical, physiological, neurological, and immunological mechanisms to their role in maintaining
body homeostasis.
3. Apply principles of pathophysiology to diseases and disorders.
4. Evaluate the role of immunology and microbiology in health and disease.
5. Contrast the genetic processes and environmental influences on health and on disease and its treatment.
6. Interpret the role of normal human biological, cognitive, psychological, and behavioral development across the
life span as determinants of health and illness.
7. Interpret the clinical, laboratory, pathologic, and radiologic manifestations of common diseases in patient care.
8. Apply pharmacological principles to medical therapeutics.
9. Apply principles of nutrition for maintaining optimal health and managing disease.
10. Apply the principles of epidemiology to the practice of medicine for the individual and the local and global
communities.
11. Illustrate how complementary medicine applies to patient care.
12. Apply the scientific method to research that disseminates and translates new health care knowledge to patient
care.
II. Patient Care

1. Perform a complete and accurate patient history that includes belief systems, spiritual and cultural issues and
incorporate these into the comprehensive care of a patient.
2. Perform an accurate and relevant screening and focused physical and mental status examinations.
3. Perform common clinical procedures.
4. Select appropriate physical examination techniques, laboratory tests, radiologic, and other clinical studies and
interpret the results.
5. Use biomedical information resources and appropriate consultants to support evidence-based medical care.
6. Formulate a differential diagnosis and treatment plan for common medical conditions.
7. Apply appropriate initial care to life-threatening conditions.
8. Employ opportunities for early intervention to educate patients about disease prevention taking into account
barriers to change.
9. Apply the principles of quality and safety to provide efficient and cost-effective care.
III. Interpersonal and Communication Skills

1. Demonstrate empathic patient-centered communication.
2. Demonstrate skills and strategies for communicating the status of the patient's health and condition to the
patient and his/her representatives.
3. Demonstrate the ability to present a coherent summary of the patient's clinical condition based upon the
information obtained from the patient and other sources.
4. Demonstrate shared decision-making with patients including discussing the risks and benefits of medical
interventions and obtaining informed consent.
5. Demonstrate skills and strategies for engaging patients and their families in difficult conversations (e.g. end-of-
life, medical errors, serious diagnosis, etc.).
6. Demonstrate the ability to collaborate with other health care professionals.
7. Demonstrate the ability to negotiate conflicts within health care teams.
8. Apply knowledge of the patient's culture, beliefs, spirituality and level of health literacy in communications.
20
IV. Practice-Based Learning and Improvement
1. Evaluate study design, methods and results as they apply to evidence-based medicine.
2. Use reflection and feedback to improve clinical practice.
3. Use electronic and other resources in the practice of life-long learning.
4. Apply medical standards, clinical practice guidelines, and practice algorithms for individual patients or
populations.
5. Use learner-centered principles to teach colleagues, patients and the community- at-large about health and
medical issues.
6. Critically appraise the effectiveness of diagnostic and therapeutic interventions.
7. Practice techniques that develop self-directed learning skills.
V. Systems-Based Practice
1. Analyze the role of advocacy and healthcare policy in improving patient care.
2. Use system resources available to patients and communities for health education, treatment, and rehabilitation
of medical and psychiatric conditions.
3. Analyze the elements in the healthcare system that lead to disparities in health and access to healthcare.
4. Interpret information about the health of patient populations and communities to identify needs and plan
appropriate interventions in support of population health.
5. Differentiate how culture and belief systems impact perception of health and illness, as well as response to
symptoms, diseases, and diagnostic and treatment interventions.
6. Apply the principles of cost-effective healthcare in patient care.
7. Analyze the organization, financing, and delivery of health care.
8. Relate the role of medical jurisprudence and conflicts of interest to issues that affect the US health care system.
9. Analyze systems of care to enhance care quality and patient safety.
VI. Professionalism
1. Apply the theories and principles that govern ethical decision making.
2. Demonstrate ethical behavior including: compassionate treatment of patients, respect for privacy and dignity,
honesty and integrity, truthfulness, patient advocacy, confidentiality, and accountability.
3. Demonstrate reliability, punctuality, dependability, and integrity in all professional activities.
4. Demonstrate the ability to promote ethical and professional behavior of peers.
5. Analyze personal and professional conflicts of interest.
6. Demonstrate the ability to work effectively and respectfully in an interprofessional team.
7. Demonstrate the qualities and practices required to maintain wellness and sustain lifelong personal and
professional growth.
8. Demonstrate appropriate leadership approaches that enhance team functioning, the learning environment, and
the delivery of care.
9. Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity
in gender identity and expression, age, culture, race, religion, disabilities, health status and sexual orientation.
21
This log is designed to use during outpatient pediatrics. It’s a method for student to track patients they’ve seen during
their rotation with you. It allows students to record both sick visits and WCC. It also allows the preceptor to quickly
visualize deficient patient populations and direct students towards patients they have not yet seen. It should be
reviewed during your mid-rotation feedback session with them.
OUTPATIENT STUDENT LOG
SICK
AGE NB 2mo 4mo 6mo 9mo 12mo

NOTES:
Patient info
AGE 15mo 18mo 2yo 21/2yo 3yo 4yo
Patient info
AGE 5yo 6yo 7yo 8yo 9yo 10yo
Patient info
AGE 11yo 12yo 13yo 14yo 15yo 16yo
Patient info
AGE 17yo 18yo 19yo 20yo 21yo
22
Example of a Completed Log Sheet
23
Structured Clinical Observation (SCO)
We Stand For Children A Tool To Facilitate BRIEF observation and PROMPT feedback
Date: ___ / ___ / ___
Observer: ______________________________ Trainee: ___________________________
Patient Gender:  M  F
Patient age:  Newborn (1-31 days)  Infant (32 days - 11mos)
 Toddler (1-4 yrs)  School-age (5-11 yrs)  Adolescent (>12yrs)
Indicate which PORTION of visit and items observed. Please check all that apply.
 Data Gathering  Physical Exam  Information Giving

 Interim history (well child)  HEENT  Anticipatory Guidance
 CC/HPI  Cardiac  Medical Home
 Diet/Sleep/Elimination  Pulmonary  Diagnosis explanation
 PMH/Health Maint/CAM  Abdominal  Management
 ROS/HEADSS  Genitourinary  Follow-up instructions
 Development/School History  Orthopedic  Other ___________
 Family History  Neurological
 Social/Cultural History  Other ________
Key Feedback Points: Please identify at least 1 reinforcing behavior (“positive”) and another corrective
behavior (“constructive”) during the 5 minute observation.
1. _____________________________________________________________________
_____________________________________________________________________
2. _____________________________________________________________________
_____________________________________________________________________
3. _____________________________________________________________________
_____________________________________________________________________
Adapted from L Lane, MD and R Gottlieb, MD, Jefferson Medical College

By E Hamburger, MD, S Cuzzi, MD and D Coddington, MD, Children’s National Health System
(Update - JUNE 2008 by T Kind, MD, MPH, Children’s National Health System)
24
Structured Clinical Observation (SCO): Skills Guidelines
DATA GATHERING (ACGME competencies: Patient Care, Communication Skills)

Allows patient/parent to complete opening statement
Starts with open ended questions
Avoids use of leading questions
Limits questions with multiple parts
Explicitly elicits patient’s/parent’s beliefs about causes of the illness or problem
Asks about remedies or therapies used to address chief complaint
Asks about non-traditional remedies and therapies
Asks specific questions about cultural, religious, spiritual, or ethical values
Asks about life events & circumstances that might affect the patient’s health/ treatment
Asks about family members or significant others who live in the home or care for the child
Asks for clarification if necessary
Explicitly elicits patient’s/parents expectations regarding the visit
Proceeds with logical sequencing of questions
INTERPERSONAL SKILLS (Communication Skills, Professionalism)

Introduces self
Addresses parent / patient by name after initial introductions
Appropriately includes child in interview
Avoids interrupting parent/ patient
Actively listens using nonverbal techniques (e.g. eye contact, nodding)
Expresses empathy (e.g. using tone of voice, “That must be hard for you”)
Explicitly recognizes patient’s/parent’s feelings or concerns (e.g. “you seem upset, sad, angry”)
Deals effectively with language barriers
Demonstrates sensitivity to health beliefs and religious or spiritual issues
PHYSICAL EXAMINATION (Patient Care)

Washes hands
Matches sequence of exam to cooperation level
Includes all appropriate elements of exam
Leaves out irrelevant elements
Demonstrates correct technique for all portions of the observed exam
INFORMATION GIVING (Patient Care, Communication Skills, Professionalism)

Explains confidentiality to adolescent and/or their parent
Limits use of jargon and/or explains medical terms if used
Explains diagnosis
Explains management plan
Explains need for follow-up
Uses visual reinforcement (e.g. pictures, models, demonstrations)
Uses written reinforcement (e.g. written instructions, handouts)
Explicitly asks for patient/parent input in management plan
Adapts plan as needed to suit individual circumstances, cultural or health beliefs
Asks patient / parent for their understanding of treatment plan
Solicits questions
Asks about patient/parent’s ability to follow treatment plan
Explains when, why, how family should contact physician
Provides summary of discussion
25
Student: _______________________ Physician Preceptor:____________________
Date: ___________________ Rotation # _____

We Stand For Children
Pediatrics Clerkship Mid-Rotation Review (Feedback) Form

OVERALL GOAL: To provide mid-rotation feedback and determine an action plan for student.
STUDENTS: Before meeting with your preceptor, complete a self evaluation by marking off with an “S” where on the spectrum you think you are
currently. See example below.
PRECEPTORS: Please obtain input from other faculty and residents who have worked with this student. Then rate the student’s performance by
marking off with a “P” where on the spectrum you think the student is currently. Then discuss the student’s strengths and areas for improvement.
Record comments.
EXAMPLE (S=Student’s self evaluation; P=Preceptor) unacceptable S P

performance very good outstanding
(conditional) (pass) (honors)
History & Physical: Is the student identifying and pursuing problems? Is the exam technically correct, thorough, and efficient? Is the written record
organized and of an appropriate length?
unacceptable
Comments:
Academic Resources: Is the student using academic resources (texts, journals, electronic sources) to study patient problems and make clinical
judgments?
unacceptable
Comments:
Patient-Physician Relationship: Is the student empathetic, compassionate, caring, supportive, and reassuring? Is there effective communication
and education between student and families?
unacceptable
Comments:
Verbal Reports: Does the student communicate clearly and succinctly? Is the information complete and organized? Is the rationale included?
unacceptable
Comments:
26
Attitude and Professionalism: Is the student self-motivated, responsible, positive, and professional?
unacceptable
Comments:
Synthesis of Information and Differential Diagnosis: Does the student obtain and use information from clinical sources
and apply it to patient problems? Are the pathophysiology and plan reasonable?
unacceptable
Comments:
Treatment Plan and Follow up: Does the student develop appropriate treatment plans? Recognize the need for urgent
treatment? Does the student continuously monitor the patient and follow through appropriately?
unacceptable
Comments:
Course requirements: Discuss if the student is making appropriate progress in completing the following:
General
 SCO’s (observation forms) – need 4 forms completed during each 4 week block
 CLIPP Cases (see Blackboard for recommended cases)
 LOGS: diagnosis, procedure, and duty hour logs in E*value: review progress, identify gaps
Inpatient Only:
 2 H&P’s with write-ups (H&P plus discussion) reviewed by Attending during inpatient
Outpatient Only (recommended):
 View “Through the Otoscope” CD (check out from student coordinator) or see NEJM video
 Administer and interpret a “Denver Developmental” or other (ASQ) Screening Tool
COMMENTS AND ACTION PLAN:
Attending/Resident Signature:__________________________________________________________
CNMC Pediatric Clerkship TKind - 2014
27
Logging onto MedHub for Student Evaluations
1. The website is: https://gwu.medhub.com

a. For those of you who also evaluate residents remember this is a different MedHub account it
should say GWU
2. You should get a reminder that looks like this in your email:
3. The logon page looks like this:
28
4. After logging in, look for INCOMPLETE EVALUATIONS in upper left hand corner under URGENT TASK. You should
be able to click on that link to see any incomplete evaluations you have.
29
Department of Medical Education
Craig DeWolfe MD, MEd
Pediatric Medical Student Education Director
Clarissa Dudley, MD, MPH

Associate Pediatric Clerkship Director
For Ambulatory Placements
Wilhelmina Bradford
Medical Student Education Program Coordinator
Children’s National Health System
Updated January 2016
30

Clinical Instructors Precepting Handbook 1516

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3rd Year Medical Student

Pediatric Clerkship Precepting Handbook

We Stand For Children!!!

Department of Pediatric Medical Student Education

As an outpatient preceptor, you are a key to the success of our program. We

 The Pediatric Clerkship Course Overview

Craig C DeWolfe, MD MEd Clarissa Dudley, MD MPH

Wilhelmina Bradford Mary C. Ottolini, MD, MPH

Clerkship Learning Objectives:

Clerkship Learning Assessments Mapped Program

Course Requirements, Deadlines, and Grading Values:

Disability Support Services:

Student Mistreatment Policy:

Session & Date Topics for Discussion Readings & Assignments

Typical discussions during inpatient at HCH:

Required Clerkship Procedure Standards: Pediatrics

Intramuscular (IM) or Subcutaneous (SQ) Injection Assist

CDC Immunizations Schedules: see http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

We recommend that you also:

Paper Format Completion

Clinical Encounter (Diagnosis) Logs on MedHub in accordance with GW policy.

Further descriptions are detailed on GW’s uniform evaluation form.

II. Patient Care

III. Interpersonal and Communication Skills

OUTPATIENT STUDENT LOG

AGE NB 2mo 4mo 6mo 9mo 12mo

AGE 15mo 18mo 2yo 21/2yo 3yo 4yo

AGE 5yo 6yo 7yo 8yo 9yo 10yo

AGE 11yo 12yo 13yo 14yo 15yo 16yo

AGE 17yo 18yo 19yo 20yo 21yo

Date: ___ / ___ / ___

Observer: ______________________________ Trainee: ___________________________

 Data Gathering  Physical Exam  Information Giving

Adapted from L Lane, MD and R Gottlieb, MD, Jefferson Medical College

DATA GATHERING (ACGME competencies: Patient Care, Communication Skills)

INTERPERSONAL SKILLS (Communication Skills, Professionalism)

PHYSICAL EXAMINATION (Patient Care)

INFORMATION GIVING (Patient Care, Communication Skills, Professionalism)

Date: ___________________ Rotation # _____

Pediatrics Clerkship Mid-Rotation Review (Feedback) Form

EXAMPLE (S=Student’s self evaluation; P=Preceptor) unacceptable S P

COMMENTS AND ACTION PLAN:

CNMC Pediatric Clerkship TKind - 2014

1. The website is: https://gwu.medhub.com

3. The logon page looks like this:

Clarissa Dudley, MD, MPH

Das könnte Ihnen auch gefallen

Date: _ / _ / ___

Observer: ____ Trainee: _

Date: _______________ Rotation # _