The student will spend time dispersed between hospital and clinic settings. Almost exclusively, mornings will be spent at the hospital and then the afternoon will be in the clinic.
Each morning, Monday to Friday, the student will come in and round on any nursery babies, and up to 4 inpatients from NICU and pediatric services. They will pre-round on the patients they are following and write daily progress notes on those patients. The hospital has gone to computerized physician order entry and the student will not be allowed to enter orders into the computer. However, practice written orders will be done on all admissions. If time allows, and depending upon the attending of the day, case presentations/didactics can occur toward the later part of the morning. The student can work on CLIPP cases during any down time.
As best learning occurs through continuity, it will be ideal for the student to perform H and P’s on any new admissions and perform daily rounds on those patients until they are discharged. The student will be expected to do their 3 formal H and P write-up, though less informal H and P’s will also occur as the student rounds and then presents patients on morning rounds. Formal H and P’s will include complete history and physical and include a thorough assessment write up (broad differential diagnosis and literature review summary on the diagnosis) and appropriate plan management for the patient—as per the requirement of the UW Core Pediatric curriculum. The student may also be asked to go in to the hospital after their afternoon clinic to do an H and P on an admission that came in during the afternoon.
All efforts will be made to have the student attend delivery resuscitations as well. The student will be need to be available by cell phone after clinic hours M-Th so that if any admissions arise, they will be able to be directly involved in the patient care from initial presentation of the patient. If a patient was admitted from the office during the day, the student will be asked to go after clinic hours to the hospital to do an evaluation/H and P on the patient. On Friday though Sunday, they will be free from after-hours call. If the student is in town on the weekend, it is encouraged that they go in and round just on their assigned patients—independent of the attendings schedule—to maintain continuity. They can call the attending if there are any questions. There will be one academic morning or afternoon per week (see below) where they will not have hospital or clinic requirements.
Each afternoon, starting at 12:45, the student will report to the clinic. The student will initially shadow during well child visits and then increase amount of involvement throughout the rotation. For sick visits or consults, if parents are in agreement, the student will go in first to do a focused history and exam. Student will take notes enough to present the patient to the attending after which the attending will go into the patient room to verify history and repeat exam and discuss assessment and plan with the family. The student will be expected to write up 3 formal clinic SOAP notes during the rotation. A brief differential diagnosis will be included in the write up. A literature review for plan management is expected on each SOAP note to suggest standard of care management for the illness being cared for. These do not need to be as extensive as the formal H and P’s done for the hospital inpatients. The student will ask questions to their attending as they arise regarding developmental milestones—as developmental questions will be included on the final exam.
The student will work with the “late doc” from noon to 8 pm several times during the rotation (on average once a week). These are more acute visits during these times, and the students tend to enjoy these times even though they are later in the day.
Each week one morning or one afternoon will be dedicated as an academic break, allowing the student to study or do CLIPP cases as they see fit.