Goals and Objectives
The Goals and Objectives of the Pediatrics Clerkship are designed to continue the educational endeavors reflected in the Core Competencies of UNC School of Medicine. These Core Competencies are:
1. Medical Knowledge (MK)
2. Patient Care/Clinical Skills (PC/CS)
3. Interpersonal and Communication Skills (I&CS)
4. Professionalism (P)
5. Practice-Based Learning and Improvement (PBL&I)
6. Systems-Based Practice (SBP)
7. Managing the Health of Population (MHP)
- Demonstrate the professional conduct necessary for successful clinical interactions in all aspects of the clerkship. (PBL&I, P, I&CS, SBP)
- Conduct an effective interview and physical exam, adapted for the visit, in a manner that is sensitive to the age of child and the developmental, social and cultural context (I&CS, PC/CS)
- Generate an appropriate initial differential diagnosis and outline an initial evaluation (PC/CS, MK)
- Give suggestions for the therapeutic plan appropriate to the final diagnosis (I&CS, PC/CS, PBL&I, MK)
- Present a complete, well-organized verbal summary of the findings of the patient's history and physical examination, modifying the presentation to fit the situation (I&CS, PC/CS)
- Prepare a complete written summary of the history and physical examination (PC/CS)
- Effectively communicate information about the diagnosis and treatment to the patient and family (I&CS, SBP, P, PC/CS, MK)
- Critically use the medical literature to obtain current information relative to the patient (PC/CS, PBL&I)
- Demonstrate knowledge of how the physician’s responsibility to promote a healthy lifestyle is carried out in health supervision visits as an individual grows from infancy to adolescence, including the appropriate use of screening tools and immunization (SBP, PC/CS, MK)
- Be able to interpret the results of screening tests (PC/CS, PBL&I, MK)
- Provide age-appropriate examples of anticipatory guidance (PC/CS, MK)
- Measure and assess growth in all patient evaluations (PC/CS)
- Plot the data on the most current age- and sex-appropriate growth chart
- Identify growth that deviates from expected patterns, based on the family growth history and the child’s previous growth, and explain the initial assessment (PC/CS, PBL&I)
- Outline the differential diagnosis and the initial evaluation of an infant or child with failure to thrive and a child with obesity (PC/CS, MK)
- Assess body-mass index (PBL&I)
- Include an assessment of development on all patients (MK, PC/CS)
- Interpret a developmental screening test (PBL&I, MK)
- Demonstrate the ability to explain important developmental changes to parents and to patients at all ages (I&CS, PC/CS, MK)
- Elicit age-appropriate behavioral concerns during the health care supervision visit (MK)
- Distinguish between age-appropriate behavior, inappropriate or abnormal behavior, and those that suggest severe psychiatric illness in children of different ages (MK)
- Counsel parents and children about the management of common behavioral concerns (I&CS, MK)
- Obtain a routine infant diet history and determine the caloric adequacy of an infant’s diet
- Provide nutritional advice to families (I&CS)
- Provide advice to families about the prevention of common nutritional deficiencies, specifically iron and calcium (I&CS, PC/CS, MK)
- Discuss prevention in every clinical encounter, including assessment of immunization status, inquiry into safety and injury prevention, and identification of personal and family habits that pose risks, particularly tobacco exposure (I&CS, PC/CS, MK)
- Screen for family violence which serves as an important preventive health practice. In particular, demonstrate the ability to counsel school-age children, adolescent and families about the basics of violence prevention at home, at school, and among peers (I&CS, PC/CS, MK)
- Interview an adolescent patient, using the HEADDS method, to ask sensitive questions about lifestyle choices that affect health and safety (I&CS, PC/CS, MK)
- Identify the sexual maturity of adolescent males and females using the Tanner scale (PC/CS)
- Conduct a pre-participation sports examination and demonstrate the key components of that examination necessary to clear an individual for participation in strenuous exercise (PC/CS)
- Address routine care of the newborn
- Recognize the various causes of malformations and genetic disorders
- Have a basic knowledge of the appropriate diagnostic tests and clinical course for common disorders such as common chromosomal abnormalities, (e.g. trisomy 21, Turner syndrome), syndromes due to teratogens (e.g. fetal alcohol syndrome), patterns with unknown etiology (e.g. VATER syndrome), single malformations with multifactorial etiology (e.g. spina bifida, congenital heart disease, cleft lip and palate), common inborn errors of metabolism (e.g. PKU, Tay-Sachs, MCAD deficiency), and other common genetic disorders (e.g. cystic fibrosis, sickle cell disease, hemophilia) (SBP, PC/CS, MK)
- Discuss the newborn screening program
COMMON AND ACUTE ILLNESS
- The student will demonstrate knowledge of the common acute pediatric illnesses (including salient history, physical exam findings, epidemiology, management, and severity) for each of the following presenting complaints (PC/CS, MK):
Cough - Wheeze - Limp - Heart Murmur - Fever - Hematuria - Headache - Organomegaly - Sore Throat - Vomiting
Seizure - Abdominal Mass - Ear Pain - Diarrhea Petechiae/Purpura - Abdominal Pain - Runny Nose - Rash
Lymphadenopathy - Proteinuria - Pallor - Anemia - Developmental Delay - Vision/Hearing Problems
- Knowledge of the common pediatric chronic illnesses (including salient history, physical exam findings, epidemiology, management and severity) for each of the following: allergies, asthma, sensory impairment, cerebral palsy, cystic fibrosis, sickle cell disease, seizure disorder, diabetes mellitus, childhood malignancy, AIDS (MK, SBP)
- Perform a medical interview and a physical examination for a patient with a chronic illness. Obtain information about the effects of the chronic illness on growth and development, and on the emotional, economic and psychosocial functioning of the patient and family. Elicit information about treatments used, including “complementary and alternative therapies.” (I&CS, SBP, MK, MHP)
- Write a prescription for a common medication such as an antibiotic (PC/CS)
- Calculate a drug dose for infants and prepubertal children, based on body weight (PC/CS)
- Choose the appropriate medication(s) for management common uncomplicated conditions (and also know when it is NOT appropriate to treat with a medication) (PC/CS, MK)
FLUID AND ELECTROLYTE MANAGEMENT
- Assess the hydration status of a child
- Calculate and write orders for intravenous maintenance fluids
- Calculate and write orders for the fluid therapy for a child with severe dehydration caused by gastroenteritis; include “rescue” fluid to replenish circulating volume, deficit fluid, and ongoing maintenance (MK)
- Recognize the consequences of electrolyte disturbances, including hypernatremia, hyponatremia, hyperkalemia, hypokalemia, and severe acidosis (MK)
- Explain to parents how to use oral rehydration therapy for mild to moderate dehydration (I&CS)
- Elicit an appropriate history to evaluate an unintentional or intentional ingestion or exposure to a toxic substance (including the substance, the route of exposure, the quantity, and the timing), demonstrating sensitivity to the emotions of that may be present in the patient, parent, or caregiver (I&CS)
- Demonstrate knowledge of the immediate emergency management of children with toxic ingestions (MK)
- Identify the patient who requires immediate medical attention and intervention using the “ABCD” assessment (PC/CS)
- Demonstrate knowledge of the immediate emergency management of a child following trauma to the head, near drowning, foreign body aspiration, and other common pediatric emergencies (PC/CS, MK)
- Demonstrate the appropriate anticipatory guidance to prevent future occurrences of life-threatening illnesses (e.g. infant positioning for sudden infant death syndrome (SIDS), supervision to prevent poisoning, falls, choking) (PC/CS)
- Know the risk factors for child abuse (MK)
- Summarize the responsibilities of the “mandatory reporter” to identify and report suspected child abuse and know to whom such a report should be made (MK)
- Recognize responses in the history or findings on the physical examination that raise the concern of non-accidental injury (MK)
- Participate with the Medical Team to discuss the issue of suspected abuse and neglect with families (I&CS, PC/CS, SBP, MK)
- Identify a specific pediatric healthcare issue and outline a physician’s approach to advocacy (MK, MHP, SBP)
- Identify opportunities for advocacy during a health supervision visit (I&CS, MK, MHP, SBP)
Pediatric Clerkship Goals- Top 12 List
Take ownership of your patients – know the history, exam, and lab results at any given time; follow-up on your patients even when they have technically left your care; be responsible for them so that nothing gets missed.
Learn how to talk with children of different ages and their families both to get complete, accurate histories, and to explain clinical findings and plans. Learn how to reassure.
Learn how to perform the physical examination of children – how to interpret vital signs at different ages, how the pediatric exam is different than the adult exam, and a basic knowledge of what is normal.
Write a complete H&P, including pediatric-focused items such as development, diet, and growth.
Present orally on inpatient rounds and begin to pick out what is most important to convey to the team (i.e., do not repeat the entire H&P).
Assess the development of every patient you see and be able to recognize when it is abnormal.
Be able to chart the weight, height, head circumference, and BMI and recognize obesity or failure to thrive and begin a work-up if indicated.
Talk to families about prevention, including immunizations, safety, violence, sex, and substance use. Using the CDC chart, know what immunizations a child needs at a given age.
Write prescriptions appropriately for children of different sizes.
Be able to clinically recognize a dehydrated child. Write orders for both rehydration and maintenance fluid for children based on size and clinical condition.
Recognize when a child is in need of urgent medical attention. Know how to initiate care and who to call for help.
Outline the approach to diagnosis and management of common pediatric conditions.