Review Of Year 3 Pediatrics Clerkship
Review of Year 3 Pediatrics Clerkship Clerkship occurs in Year 3Clerkship Directors– Adam Weinstein and Alison HolmesClerkship Coordinator– Sharon FrenchClerkship Length – 8 weeks, 6 cycles– 2 Weeks Inpatient, 1 Week Nursery, 4 Weeks Outpatient (change from 201415)Sites used– Inpatient: DH, CHOC, CPMC, Concord, Elliot– Outpt: Regional, Maine, Ft. Defiance– Nursery: DH, CPMC, CMCClerkship was last reviewed in June 2014Current Review Team: 3/25/26: Drs. Dick and Friedman (GAME), MEC studentmember Marietta Smith
Action Plan from Prior Review Objectives:– Remove “complex procedures” from the following objective “Perform andexplain the indications, complications, and limitations, of simple procedures(e.g. throat cultures, hearing tests) in children (and to assist with complexprocedures (e.g. lumbar puncture) in children DONE– Reconciled objective discrepancies-- ILIOS and CANVAS now match - DONEClinical Skills:– Add “Age Appropriate HPI and PE” (replace “HPI Relevant to this Clerkship”) –DONE– Remove Throat Culture—not being done by all of our outpatient practices asno longer a routine physician task - DONE– Add “Correctly write a pediatric prescription, dosing by weight, for amedication.” - DONE
Action Plan (cont) Duty Hours-- midway through the year, we recognized the call schedule at CHOC—sometimes the nightshift week, while it complies with resident duty hours, did not complywith the Geisel duty hours (because of averaging for residents)– We created a personal hours log for our students rotating at CHOC. If they approach the80 hour cut-off during their nightshift week, they are instructed to take Sunday off fromthat week so they do not exceed 80 hours. - DONE– Our site director is overseeing this and making sure residents and faculty are aware-- asthere are also UC Irvine students who don’t have this limitation. Busy Work: We reduced number of write-ups and discussion assignments to 2 (instead of the3) for the coming year; we have consolidated our tracking/logging forms and systems toeliminate some previous redundancy. - DONE High Value Health Care assignment will begin this coming academic year. - DONE
Course ObjectivesCourse Objective1 Apply age appropriate and pediatric problem based knowledge to patient care bridging andintegrating basic science, clinical science and multi-disciplinary aspects of delivery of patientcare.How Student isAssessedPerformanceEvaluationsFinal ExamCase DiscussionsWrite Ups2 Describe (Apply?) current knowledge of pediatric disease prevention, risk factor modification, Performancemedical ethics, and medical-legal issues to clinical problems in children and families.EvaluationsFinal ExamWrite UpsLearning ActivityWardsClinicsCLIPPCase DiscussionsWrite Ups3 Gather history, counsel and incorporate in the care plan the social, economic, cultural andPerformancepersonal factors which effect the healthcare needs of children and their families, describingEvaluationsbarriers for pediatric patients and their families to access to basic health services and its effect Write-upson vulnerable populationsWardsClinicsCLIPPWrite UpsCase DiscussionsWardsClinicsWrite-upsFOSS4 Establish comfortable and mutually respectful student-patient and student-family relationships Performancewith diverse patients and families and establishing a respectful basis for the doctor-patientEvaluationsrelationship.Structured ClinicalObservationsWardsClinicsStructured ClinicalObservation5 Interview and counsel pediatric patients and their families skillfully, utilizing an agePerformanceappropriate and pediatric problem based history including either a comprehensive or focused Evaluationshistory.Structured ClinicalObservationsSkills FormWardsClinicsStructured ClinicalObservation
Course Objectives6Demonstrate a complete “age appropriate” physical exam of children, withPerformanceappropriate attention to skill, cleanliness, infection control, patient comfort, privacy Evaluationsand developmental capacity.Structured ClinicalObservationsSkills FormWardsClinicsStructured ClinicalObservation7Define and prioritize the pediatric patient's problems accurately and generate anappropriate differential diagnosis for childhood conditionsPerformanceEvaluationsStructured ClinicalObservationsWrite-ups8Perform and (Remove Perform and use only explain) explain the indications,complications, and limitations, of simple procedures (e.g. throat cultures, hearingtests) in children.Clinical EvaluationsWardsClinicsCLIPPStructured ClinicalObservationWrite-upsCase DiscussionsWardsClinics9Assess and interpret abnormalities and findings on common diagnostic tests andstudies including chest x-rays, EKGs, blood tests, and urinalysis.PerformanceEvaluationsFinal ExamWrite-upsWardsClinicsCLIPPWrite-upsCase Discussions
Course Objectives10Demonstrate ability to inform patients and families and assess their understandingof their treatment options and motivating them to make healthy behavioral andtreatment choices.Performance EvalsSkills FormStructured ClinicalObservationsWardsClinicsCase DiscussionsStructured ClinicalObservation11Communicate effectively with patients of different social, economic and culturalbackgrounds around individual factors that impact health. (NOT in current Ilios!!)Performance EvalsStructured ClinicalObservationsWardsClinicsStructured ClinicalObservationFOSSCase Discussions12Communicate effectively and collegially with physician colleagues and othermembers of the health-care team verbally, in writing and in the electronic medicalrecord as it relates to pediatric patients.Performance EvalsWrite UpsSkills FormStructured ClinicalObservations13Behave respectfully and responsibly towards patients, families, colleagues, and allmembers of the health-care team and empathize and be respectful of each patientPerformance EvalsProfessionalism Points14Adhere to high ethical and moral standards, accept responsibility for personalactions, accept constructive criticism and respect patient confidentiality, placingpatient interests first, being mindful of personal opinion and bias.Performance EvalsProfessionalism PointsWardsClinicsWrite UpsCase DiscussionsStructured ClinicalObservationWardsClinicsCase DiscussionsFOSSWardsClinicsCase DiscussionsFOSS
Course Objectives15Take responsibility for his or her own medical education, and develop the habits of Performance EvalWardsmindfulness and reflection and maintaining one's own health ( remove this as it is Professionalism Points Clinicsnot something the clerkship is responsible for or evaluating)Case Discussions16Incorporate constructive suggestions during peer review. (might be considered in14 above and could be removed)Write UpsWrite Ups17Identify and critically evaluate relevant information about evidence-based, costconscious strategies in the care of pediatric patients and populations and to applythis to pediatric patient care and to continuous updating of skills.Performance EvalsIn-Depth DiscussionWardsClinicsCase DiscussionsIn Depth DiscussionHigh Value Health CareAssignment18Identify and utilize appropriate resources to support pediatric patient care andcompare the roles of and collaborate with all members of the pediatric interprofessional team.Performance EvalsWardsClinics19Discuss the larger environment and the physician's role in which healthcare occurs Performanceincluding the effect on underserved population and regional variations in theEvaluationsdelivery of healthcare.WardsClinicsHigh Value Health CareAssignment
Course Objectives – Comments Appropriate number, understandableCovers over-arching Geisel competenciesMinor language changes suggestedCANVAS clinical skills objectives needs updating (stillcontains “assist with complex procedures”)
Format of Course & Session Objectives Course objectives are provided in the syllabus– Appreciate how they are broken down by GeiselCompetency Course objectives are written in the correct format Session objectives are provided in the coursematerials Session objectives are mostly written in the correctformat– HVHC – “Understand” would change to a moremeasureable verb
How do Y1/2 courses prepare for Y3 Questions asked at end of clerkship– 1 poor and 5 excellent Open ended– More Peds in general– More info on Vaccines– Common vs uncommon diseases (too much perceivedemphasis on the latter) Trend shows improvement in preparation forcommunication and PE skills, less so for medicalknowledge
Results: EDSPSYCHSURGGAMNEURO
Results: MMEDOBPSYCHSURGPEDSGAMNEURO
Results: CHSURGGAMNEURO
Results: Medical OBPEDPSYCHSURGGAMNEURO
Issues of Redundancy Are there major issues of redundancy with othercourses?– NO– “Anticipatory Guidance” Ilios search – only covered inpediatrics clerkship– Fortunate to have On-Doc co-director as clerkship directorto ensure appropriate repetition
Essential SkillsSkillComplete exam, age appropriateCounseling: normal/abnormal developmentHEENT examHPI, age appropriateNewborn examObesity-Weight or Nutrition/Diet counselingOral presentation, ambOral presentation, inpt admitTanner staging examWrite pediatric prescription, dosing by weightWriten note, ambWritten note, inpt admitWritten note, inpt progressOverlap Are these appropriate for this clerkship? Yes Would you add or subtract any? No Are there major issues of redundancy with other clerkships? NoLevel ExpectedPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with SupervisionPerform with Supervision
Essential VFailure to ThriveFever (source unknown)HeadacheHeath maintenance (13-17)Health maintenance (1 m - 12 y)MurmurNewborn visit (0-30 days)ObesityOtitis mediaPharyngitisRashURIViral syndrome OverlapYes (CFM)Yes (MEDI)Yes (NEURO)Yes (CFM, GAM)Yes (CFM, GAM)LevelManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceManage with AssistanceAre these appropriate for this clerkship? YesWould you add or subtract any? NoAre there major issues of redundancy with other clerkships? Appropriate
Exploration of Ethics and CulturalCompetencies FOSS (From the other side of the stethoscope)– Session at end of clerkship for all students that includeethical discussions (appropriate information sharing withfamilies and young patients) High Value Health Care session– Includes ethical issues
Course Learning Opportunities Clinical experiences– 2 weeks inpt, 1 week Nursery, 4 weeks outptSmall Group Sessions (orientation and Friday afternoons)– Topical and Case Based reasoningAssignments– CLIPP cases (32 cases)– High-Value Health Care assignment– 2 write ups (inpt and outpt) Peer review of write ups Primary literature review with write ups– Embryology group activity Structured clinical observations (3) Simulation– Critical care simulations in Sim Center
Assessment Each competency assessed using various methods––––––MK: 50% final exam / 50% Clinical EvaluationsPC: 50% Clinical Evals / 50% write upsCPLI: 50% Clinical Evals / 50% In Depth DiscussionCS: 50% CE / 50% Write upsPMCHS: 33% CE / 67% Nursery AssignmentsProfessionalism: clinical evals, assignments
Measures of Quality – AAMC GQ“Rate the quality of your educational experiences in the following clinical clerkships.”[1 poor; 2 fair; 3 good; 4 excellent]Geiselmean 2011Geiselmean 2012Geiselmean 2013Geiselmean 7SURG3.02.82.93.1Measures ofQuality –AAMCGQGeiselmean 2015All schoolsmeans 20153.53.33.63.53.13.13.13.13.63.43.63.33.33.3
Measures of Quality – AAMC GQPercent answering Yes to question (goal is 100%)PEDIGeisel 2014Measures of90Quality–AAMC91.995.2GQGeisel 2015Observed taking relevant portions of pthistory?96.497.3Observed performing relevant portions ofphysical or MSE?97.695.9Provided with mid clerkship feedback?98.8100All Schools 2015
Measures of Quality – AAMC GQScale: Strongly Disagree – 1 to Strongly Agree - 5PEDIGeisel 2014Measures ofQuality –4.4AAMC4.3GQGeisel 2015Faculty provided effective teaching4.44.4Residents provided effective teaching4.44.4All Schools 2015
Measures of Quality – Step II CK*values depicted are SD above the US/Can mean for Geisel mean scores
Measures of Quality – Course EvaluationClerkshipsMeasures ofQuality –AAMCGQOverall Satisfaction AY BGYN4.2NEURO4.0scale [1 poor; 2 fair; 3 good; 4 very good; 5 excellent]
Measures of Quality – Course Evaluationscale [1 poor; 2 fair; 3 good; 4 very good; 5 excellent]Pediatrics2013-142014-152015-16Overall Experience4.24 (I: 4.19 / O: 4.46)4.51 (I: 4.18 / O: 4.54)4.22 (I:4.17Objectives well defined and clearly presented4.33 / 4.414.34 / 4.544.41Ability for Y1 and 2 to prepare me for thisclerkship3.023.263.54Expectations well defined and clear4.21 / 4.334.20 / 4.534.17 / 4.59Volume adequate for learning4.21 / 4.584.15 / 4.554.31 / 4.7Variety of dx adequate for learning4.38 / 4.084.32 / 4.234.36 / 4.19Quality of teaching by attendings4.33 / 4.484.32 / 4.634.75 / 4.7Quality of teaching by residents4.18 / 4.524.14 / 4.844.36 / 4.78Directors responsive to concerns4.59 / 4.614.49 / 4.784.29 / 4.84Methods used to eval student performancemade clear4.08 / 4.254.07 / 4.44.114.06 / 4.294.11 / 4.34.14 / 4.57Quality of mid-clerkship feedback
Measures of Quality – Student CommentsStrengthsAreaAY15-16AY14-15Breadth of clinicalexperiences2436Teaching &Didactics2028Representative Quote“I think I was able to get a wide-range of exposure(different practices, different patient populations)”“All of the residents and attendings with whom I workedwere great teachers, happy to have me on their teams, andgave great feedback to help me grow.”“[Didactics] were typically short, interactive, and to thepoint -- very helpful all around. Loved jeopardy at the end!”Organization,Clerkship Directors,& Sharon French7CLIPP520“This is a very well-constructed clerkship that is balancedand exceptionally-designed.”“The weekly emails were UBER helpful”11“CLIPP cases were helpful in covering many diagnoses that Ididn't see in clinic.”
Measures of Quality – Student CommentsSuggestions for ImprovementsAreaNumber ofAssignments &Due DatesAY15-1623AY14-1513Representative Quote“I think right now there are ever-so-slightly too many parts that lead to toomuch overhead for the student. While manageable, it is just barely; consider allthe juggling: 3 separate sites, HVHC, FOSS, Inpatient write-up with in-depth,outpatient write-up with in-depth, 32 CLIPPs, newborn nursery embryologyproject coordinated among 4 people spread across the country and doing theirnursery rotations at different times, 3 librarian chats (also trying to coordinatewith multiple people, across timezones), 2 structured clinical feedbacks, thepurple form, mid-clerkship feedback sessions.there's a lot of things stuffedinto 7 weeks”“It was hard to keep track of all the assignments and due datesespecially when the canvas site and emails stated different dates.”Structure(Inpatient,Outpatient, &Nursery)Write-UpGuidance14620-1Requests for increased inpatient time, possibly decreased nurserytime“for those not coming off of medicine, write-ups were difficult tounderstand what went into a "good" academic write up.perhapshaving an optional workshop to discuss the elements withexamples of what you are looking for”
Measures of Quality – Student Comments Other issues from student comments– Resolve technology problems for students connectingremotely– Moving NICU/PICU Sims to earlier in clerkship– Knowledge or Skills in Year 1 & 2 More time could be dedicated to common pediatric conditions– “I think a large part of the problem is random lectures thrown in themiddle here and there that often lump a bunch of stuff together andmaybe get brushed aside because of relative unimportance on exams(2-3 questions per final).”– “The pedi stuff was so scattered that it was tough to put it all backtogether in the clinic.”
Recommendations Course Objectives– Minor word changes to better align with intended learning Obj 2: Describe current knowledge of pediatric disease prevention,risk factor modification, medical ethics, and medical-legal issues toclinical problems in children and families. - Change Describe toApply Obj 4: Establish comfortable and mutually respectful studentpatient and student-family relationships with diverse patients andfamilies and establishing a respectful basis for the doctor-patientrelationship. – Remove phrase in red text as the language isredundant. Obj 6: Demonstrate a complete “age appropriate” physical examof children, with appropriate attention to skill, cleanliness,infection control, patient comfort, privacy and developmentalcapacity. - Add age appropriate
Recommendations Course Objectives– Obj 8: Perform and explain the indications, complications, andlimitations, of simple procedures (e.g. throat cultures, hearing tests) inchildren. - remove perform as expectation at 3rd year level is really tounderstand and explain, not perform.– Obj 14 and 16: Adhere to high ethical and moral standards, acceptresponsibility for personal actions, accept constructive criticism andrespect patient confidentiality, placing patient interests first, beingmindful of personal opinion and bias. - add accept constructivecriticism to Obj 14 and remove from 16 to condense– Obj 15: Take responsibility for his or her own medical education, anddevelop the habits of mindfulness and reflection and maintainingone's own health ( remove this as it is not something the clerkship isresponsible for or evaluating)
Recommendations Vertical Integration– Discuss adding material to years 1 and 2 on common pediatric cancers(especially leukemia), vaccinations, and more emphasis on pediatricconditions most commonly seen in the clinic.Learning Activities– Better define amount of time expected to be spent on group embryologyproject– Increase time on inpatient rotations in CA given implications of student travelto an from these site.Assignments– Given number of assignments and 3 different rotations in short amount oftime, continue to be very clear on due dates as many students felt this wasdifficulty to keep track of
Action Plan Will change course objectives as suggested (see nextslides) Cont to work with SBM– Acute Lymphoblastic Leukemia (latest conversation was re:a PBL case in 2 to 4 year old with this condition)– Will also review discuss collaborate with SBM ID directorabout vaccines– Recently revised SBM ID session to emphasize morecommon infections (RSV, Otitis, etc ) over less common(HIV) in children– Will review content with other pediatric presenters in SBMto emphasize the common clinical illnesses anticipated inthe pediatric clerkship
Action Plan Learning activities– Revising instructions for write-ups, discussions, and embryologyproject so expectations more clear– In 16-17 students at CHOC and CPMC will be doing 3 weeksinpatient, 3 weeks outpatient, 1 week nursery in response tostudent as well as site director feedback on this Assignments– Sharon will continue to send weekly emails about assignmentsand due dates Duty Hours– At CHOC, the UC Irvine students follow resident ACGME dutyhours; our students do not (we have a differe
Review of Year 3 Pediatrics Clerkship Clerkship occurs in Year 3 Clerkship Directors – Adam Weinstein and Alison Holmes Clerkship Coordinator – Sharon French Clerkship Length – 8 weeks, 6 cycles – 2 Weeks Inpatient, 1 Week Nursery, 4 Weeks Outpatient (change f
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