INPATIENT

Inpatient Ward Service
There will usually be 2 students assigned to each service. Each service is typically staffed by an attending physician, one or two supervisory residents and first year residents. You will be assigned to work with a resident and will be responsible for performing a history and physical examination on assigned patients. You should let your intern and senior resident know that you’d like to play a part in designing the evaluation/management plan and in writing the initial orders.  Set a time on a daily basis to meet with your intern to discuss patient plans for the day and to alert him/her to what your schedule is for that day. You will need to submit a minimum of two written H & P's to your senior residents.

Orders/Workups
All orders need to be countersigned by your resident. Your written workup should be turned in to your senior resident the morning following admission. The senior resident will review and critically evaluate your workups and should return them to you within 48 hours of receipt. Feel free to "pick up" and follow patients even though you were not the one to admit him/her at admission. You should not follow more than four or five patients at one time.

Progress Notes
Progress notes should be written on your patients daily, and they need to be countersigned by your resident. As all of your written notes are part of the official medical record, and therefore have distinct medical and legal implications; therefore, it is important to be both precise and factual. Please refrain from expressing conjecture or opinion; just state the facts. Now is the time to develop the habit of critically evaluating everything you say and/or write for its factual content.

Attendings
The attending physician and supervisory resident are responsible for teaching on each ward. You will be informed of the specific times for rounds and conferences on each ward by your resident. You will be expected to read about your patients' problems and understand the rationale for the evaluation and management of the patient.  If you feel that you are not receiving sufficient attention and teaching, please let me know as soon as possible so I can address these problems.

OUTPATIENT

Community Pediatricians
Please contact the pediatrician with whom you will be working prior to starting the rotation with him/her.Contact information will be provided for you in advance. When you are on the outpatient service, it is not expected that you attend conferences at CMH; you will benefit much more from seeing patients. Most student lectures and conferences will be posted on Blackboard for those of you who are unable to be physically present.  There may be a few conferences that cannot be posted on Blackboard; you should obtain notes from your colleagues for those sessions.

Newborn Assignment
Newborn assignments are at Prentice.  However, many community pediatricians will offer to take you on their newborn rounds.  Please find out if this is the case when you speak to him/her before the start of your outpatient rotation.  This experience can be substituted for the Prentice newborn assignment. Please inform the clerkship coordinator (Grace Alvarado), in advance, if this is the case and you are not planning to attend the assigned Prentice newborn session.

Urgent Care
The Urgent Care section of the Emergency Department at Children's Memorial Hospital sees patients with non-emergent illnesses. You will be assigned to work 2 or 3 shifts in Urgent Care during your outpatient rotation.  Urgent care is quite busy, and the patient turnover is very rapid. I’m certain that you will find the educational experience tremendously valuable.  On weekdays, you should report at 5 pm for your assigned shift. Your shift will end at 10 pm.  You should leave your outpatient office no earlier than 4 pm on your assigned Urgent Care day unless your outpatient site is someplace very far (e.g., Darien, Lake Forest, Deerfield).  If you think you will have difficulty getting to your assigned shift on time, please e-mail me and let me know.  On weekends, please report for your shift at the scheduled time (either 10AM to 3PM, or 3PM to 8 PM). FYI—the Urgent Care is located on the first floor of the hospital.

CONFERENCES

Core Lectures and Interactive Case Conferences for Students
These are discussions and lectures emphasizing core topics in Pediatrics. A schedule will be given to you for these conferences. These are usually on a Monday or Friday, and will usually be held in the NAB-125 conference room.  If you are on the inpatient service at CMH, you are expected to attend these conferences.  For most interactive sessions, the cases that will be discussed are posted on the Blackboard under Interactive Sessions, and it is expected that you will review these before the sessions.

Case Discussions for Students
These are sessions that I will lead in which we will present a case and go through the differential diagnosis and discuss, in detail, all the reasons for coming up with the diagnosis (i.e., analyzing the history, PE, laboratory data).  We will then discuss the final diagnosis and the appropriate therapy.  We will occasionally also have a Jeopardy review session.  These discussions will typically be held on a Tuesday and Thursday (with a few exceptions) in NAB-125.  I will e-mail you the schedule for these sessions the week prior.  If you are on the inpatient service at CMH, you will be expected to attend these discussions unless you are busy with urgent patient care issues.

Morning Report
Interesting admissions from various services are presented by the residents.  The Chief Residents facilitate and teach important facts surrounding the cases presented.  Morning Report takes place in the NAB conference room on Mondays and Thursdays at 8 AM and on Tuesdays and Fridays at noon. If you are on the inpatient service at CMH, you will be expected to attend these discussions unless you are busy with urgent patient care issues.

Monday, Wednesday and Thursday Noon Teaching Conferences
These are general teaching conferences geared primarily to the residents (NAB-127 conference room). If you are on the inpatient service at CMH, you should plan to attend these conferences unless you are busy with urgent patient care issues.

Pediatric Ground Rounds
This conference is held each Friday at 8:00 AM in Bigler Auditorium. You should plan to attend this conference while on the inpatient service at CMH unless you are busy with urgent patient care issues.

FIRM Rounds
This is an in-depth discussion of one case by the pediatric faculty. Although it is primarily geared toward  faculty and residents, this conference is a unique educational experience and should be attended by medical students.  FIRM Rounds are held at 8 AM on Tuesday mornings in the NAB conference room.

Important Things to Remember
Attendance
It is expected that you will be at your assigned location on each day of the clerkship. Exceptions are made if you are sick or if you have urgent personal issues. You need to contact your senior resident (if you are on the inpatient service), your community pediatrician (if you are on the outpatient rotation), and Grace Alvarado at the Medical Education Office if you will be absent.

Night Call
You will be assigned to a night call schedule, approximately every fourth night, while on your pediatric ward rotations. Night call is taken until 11 PM.  This is often your best opportunity to be involved with patient care, and also with a great deal of informal learning with the residents that night. In order to be involved, however, you need to be on the ward. It is far preferable for you to bring reading materials to the conference room on the ward and read there, than to bury yourself in the library. Frequently, problems come up quickly and answers are needed quickly. If you are there, you are involved. It is a good idea to get into the habit of keeping a "to do" list during sign out rounds.   You should offer to pursue tasks to help the team even if they do not pertain to "your" patients. Also, offer to look up pertinent journal articles. In this way, you will quickly be accepted as a valuable member of the ward team.

Scrub Suits are not available to students at CMH.  You may, however, bring your own clean scrubs to wear when you are on call or in the urgent care

Propriety of Clinical Conversation
Please be discreet in your discussion of clinical material, particularly when such discussions occur in hallways, elevators, or in a cafeteria. Also remember that the shuttle bus is used frequently by patients as well as by students and staff; patients can be justifiably offended by foul language or disrespectful discussions of case material.