WELCOME
"The care of children is the finest privilege"

The mission of the Department of Pediatrics, UND School of Medicine and Health Sciences, is to serve the people of our area by providing teaching, research, and service in all aspects of pediatric care.

The motto of Pediatrics is "The care of children is the finest privilege." Daily communication with medical students and residents at the bedside, during seminars after rounds and at weekly Grand Rounds as well as during call are always conducted with this credo in mind.

Goals of the pediatric rotation are to learn and understand:

1. The impact of family, community, and society on child health and disease.
2. The impact of disease on child development, emphasizing growth and development, health supervision and common development problems.

• To accomplish these things you will need to acquire basic knowledge of growth and development, you will need to develop your communication skills, you will need to develop competency in physical examination of infants, children and adolescents, and you will need to develop clinical problem-solving skills. You will need to develop attitudes of professional behavior and learn to understand the approach of pediatricians to health care of children and adolescents.

3. The focus for our pediatric training will be a generalist focus. This means common acute and chronic clinical problems will be emphasized. One of the results of this focus means that you will spend 50% of your time in the outpatient setting.
4. We also want you to demonstrate intellectual curiosity, initiative, responsibility and reliability.

Knowledge (Objectives)

The objectives of the pediatric rotation are in the COMSEP Curriculum. The learning in each one of the categories describes what you will need to learn.

TheCOMSEP Curriculm contains learning objectives on:

1.   Professional Conduct and Attitudes
2.   Skills
3.   Health Supervision
4.   Growth
5.   Development
6.   Behavior
7.   Nutrition
8.   Prevention
9.   Issues Unique to Adolescence
10. Issues Unique to the Newborn
11. Medical Genetics and Dysmorphology
12. Common Acute Pediatric Illness
13. Common Chronic Illness and Disability
14. Therapeutics
15. Fluid and Electrolyte Managment
16. Poisoning
17. Pediatric Emergencies
18. Child Abuse
19. Child Advocacy

Students need to review the COMSEP Curriculum and use it as their guides. The COMSEP Curriculum can be accessed by going to the following website:

http://www.comsep/org/Curriculum/CurriculumCompetencies/index.htm

Teaching Rounds

Monday
8:00 a.m.	Monday - Endocrinology Rounds with Dr. Alan Kenien, Meet in the David Todd Conference Room (ward and outpatient students) [Normal Newborn Nursery student should attend if their NNN preceptor has not shown up - have the NNN charge nurse call you at 234-5454 when preceptor arrives - you are excused at that time]
4:00 p.m.	Intensive Care Nursery Rounds, Intensive Care Nursery (ward students only)
Tuesday
7:00 a.m.	Cardiology Rounds with Dr. Rod Rios, David Todd Conference Room (all students). These are held 4 Tuesdays each month.
1:00 p.m.	Ward Rounds with Dr. George Johnson Meet in the David Todd Conference Room (ward students only)
3:30-4:30 p.m.	PICU Rounds with Dr. Wally Storm or Dr. Vytautas Sapiega, M.D., PICU/David Todd Conf. Room (ward students only)
Wednesday
7:00 a.m.	Case-based Pediatric Hematology/Oncology Seminar with Dr. Nathan Kobrinsky, Pediatric Hematologist/Oncologist, Roger Maris Cancer Center Conference Room C (All students) [Normal Newborn Nursery student should attend if their NNN preceptor has not shown up - have the NNN charge nurse call you at 234-5454 when preceptor arrives - you are excused at that time]
12:30 p.m.	Ward Rounds with Dr. Chris Tiongson, Meet in the David Todd Conference Room (ward students only)
Thursday
8:00 a.m.	Ward Rounds with Dr. Stephen Tinguely, Meet in the David Todd Conference Room (ward students only)
12:00-1:00 p.m.	Heme/Onc Case of the Week with Dr. Sandeep Batra in the David Todd Conference Room (ward students and newborn nursery student only)
Friday
7:30-8:30 a.m.	Ward Rounds with Dr. Ted Kleiman, David Todd Conference Room (ward students only)

Call Schedule

1. The medical student will carry a beeper when on-call. The beeper is available through the unit clerk at the Pediatric Ward Desk. Inhouse call until 10:00 p.m.

2. The call schedule is developed as follows:

• The call schedule for students will be no more than every third night. This will mean every third night call for three to four of the eight weeks of the pediatric rotation. This amount of call should maximize student experience on hospital pediatrics.

• Students will cover general pediatrics and PICU.

• No call will be scheduled for medical students on the three-week outpatient assignment and the one-week normal newborn nursery assignment.

3. Students not on call are to sign out their patients to the student on call. When on call, the students are expected to contact the ward clerk in general pediatrics and the PICU with regard to being beeped before your call ends at 10:00 p.m. Note that the ward clerk shift changes at 7 p.m. and you will need to notify the incoming ward clerk as well. Students find it helpful to speak directly by phone with both the pediatrician on call and pediatric intensivist on call.

4. Students requiring a specific weekend off, if approved, should be requested with Kathy Kraft at the UND Office of Pediatrics as soon as possible.

5. Post call relief will not be afforded during the rotation for students.

Inpatient Ward Responsibilities

1. You must work up and write up in detail two-three patients on the pediatric floor each week. The write-ups should be completed within 2 days of seeing the patient. This means you should have 6-8 write-ups completed by the end of your inpatient experience. Please type write-ups in Microsoft Word and submit the write-ups by e-mail as an attachment to Kathy Kraft at kkraft@medicine.nodak.edu . Kathy will forward the write-ups to Drs. Tiongson and myself and we will submit our comments via e-mail.

2.Please conduct a daily review of all patients being followed by yourself prior to ward rounds. Between you and your partners this should include most if not all patients on the Pediatric Floor.

3. Review daily with the attending physician or preceptor the clinical plan for the patient you have worked up or are following. This should be done prior to ward attending rounds.

4. Present concisely on rounds the status and daily plan for each patient being followed.

5.Be prepared to present new patient work-up history and physical examinations, including the working differential diagnosis, within 24-48 hours after admission.

6. Be knowledgeable about all components of the differential diagnosis in patients that you have worked up.

7. Do return to the Pediatric Floor following afternoon seminars or other conferences to see your patients, as you would need to do if you were a practicing physician.

PDA Patient Data Entry

Enter the following patient encounter data into your PDA:

•  All inpatient and outpatient encounters in which you were directly involved and obtained history and performed physical exam.

•  Inpatients for which you write chart notes while on call.

•  All newborn nursery babies examined by you.

•  All procedures, assisted or performed.

Mary Markland, Southeast Campus Librarian, (293-4173, markland@medicine.nodak.edu) is an excellent resource for PDA data entry.

CLIPP Cases

During this eight-week rotation you are to complete all of the 31 interactive CLIPP cases on-line. At the end of the rotation you be required to hand in printout which documents completion of these cases. The website is www.clippcases.org.

These cases cover 95% of the COMSEP Curriculum and its learning objectives.

The CLIPP Cases document that UND School of Medicine & Health Sciences Pediatric Clerkship experience meets the LCME requirements that patient encounters and case experiences are similar and standardized within the clerkship and across all campuses.

The end of rotation oral examination will in part be based on these cases.

You will need to use your UND e-mail address to obtain a password to access these cases.

There are too many cases to leave them until the end of the clerkship, so pace yourself.

References

Nelson's Textbook of Pediatrics
Atlas of Pediatric Physical Diagnosis
Harriet Lane Handbook
Pediatric Clerkship Guide
Journals
     Archives of Pediatrics
     Pediatrics
     Journal of Pediatrics
     Clinical Pediatrics
     MMR (US Morbidity and Mortality Reports)
     Pediatric Infectious Disease
     New England Journal of Medicine
     Pediatric Clinics of North America

There are several pediatric subspecialty texts in the David Todd Room for your use. Dr. Tiongson and I may be able to supply references from the literature that will be appropriate for your case studies. Mary Markland, SE Campus Librarian, will be immensely helpful to you in the pursuit of evidence-based medical literature.

Midclerkship Review

A face-to-face midclerkship review is conducted with each student during the fourth week of the pediatric rotation. A checklist of 12 areas is used to conduct the review. The areas covered are:

1. Positive aspects of the clerkship experience to this point from student's viewpoint.
2. Problems encountered in clerkship to date from student's viewpoint.
3. Feedback on student's performance to this point
   a. History data gathering skills
   b. Physical exam skills
   c. Differential diagnosis formation skills
4. Pediatric shelf exam study strategy.
5. Number of CLIPP cases completed to date.
6. Patient-centered learning and medical literature review and reading.
7. Seminar and lecture experiences from student's viewpoint.
8. Inpatient call experiences from student's viewpoint.
9. Communications with the clerkship director and department staff.
10. Comments from primary preceptor.
11. Professional behavioral expectations.
    a. Timeliness
    b. Respect
    c. Appropriate attire
12. a. Reviewed PDA data with student regarding the number ot types of patients to meet clerkship objectives
    b. Change in clerkship plan required to meet 12a objectives.

Additional questions asked:

1. Goals the student feels needs to be accomplished prior to completion of clerkship.
2. Reviewer's recommendations on accomp.ishing the student's goals.

The reviews are conducted by Dr. Stephen Tinguely, clerkship director, Southeast Campus (Fargo).

Miscellaneous Items

1. READ. Make lists of items you do not understand. Look up specific items. Ask questions of your preceptors, Dr. Tiongson or myself.

2. Remember all patients on the pediatric floor are teaching service patients. This includes all surgical patients, including general surgical patients, pediatric orthopedic patients, and ear, nose and throat patients.

3. Be available, be on time. Dress professionally, wear your lab coat and name tag.

4. MeritCare Pediatric Grand Rounds: You are required to attend these conferences. Each of you will give a case presentation at Pediatric Grand Rounds. Dr.Tiongson and I will assist you in preparing for your presentation.

5. There are lockers available adjacent to the resident/student lounge to store your coats/belongings. Do not leave your belongings in the David Todd Conference Room.

6. Feel free to contact Dr. Tiongson or myself at any time.

7. A brief midclerkship review with Dr. Tinguely will be arranged.

8. Complete course, preceptor, and seminar evaluation forms as instructed by Kathy Kraft.

9. HAVE FUN!

Stephen J. Tinguely, M.D.
Associate Professor and Chair, Department of Pediatrics
UND School of Medicine & Health Sciences