Wards – Clerks are expected to function as a member of the health care team caring for the patients assigned to their clinical service. They are responsible for the care of patients assigned to them under the supervision of the Senior Resident and Attending Pediatrician. The number of patients assigned to the Clerk at one time will depend on the number, acuity and appropriateness of patients on the ward and will not exceed the student's ability to provide care. In general, students can expect to care for 4-5 patients at a time.
When Clerks are assigned a patient, they are expected to obtain a complete history, perform a physical examination and legibly record the information in the patient’s chart. They are expected to record a problem list, differential diagnosis for each problem, management plan and write orders. The patient is to be reviewed with the resident or attending pediatrician and all orders must be countersigned for legal and educational reasons. The clerk is expected to communicate his/her plans with the patient’s pediatrician. Clerks should communicate with all members of the team involved in the care of the patient and with the patient’s physician. The Clerk should also communicate with the patient and/or parents in a timely manner.
Clerks should review their patients before morning rounds and be prepared to present and discuss the patients with the other team members. Daily or more frequent examination as appropriate should be performed and daily progress notes recorded in the patient's chart. Clerks are expected to ensure that results of all lab data and radiological investigations are available as soon as is reasonable and appropriate. All orders must be written with the designation MS3 and cosigned before being presented to the ward clerk for processing for medicolegal and educational reasons.
Technical procedures should be attempted by the clerk only under the supervision of a resident or staff person. The Clerk should not continue to attempt a procedure beyond a reasonable number of times, e.g. two venipunctures on the same patient before deferring to the more senior person.
Ambulatory Clinics– Clerks are expected to attend the clinics to which they are assigned. Charting is required as for inpatients. All patients seen by the Clerk must be reviewed by the supervising physician. During the rotation, Clerks will be assigned to evening shifts in Children’s Emergency and Minor Treatment Area. Clerk attendance is not required to extend beyond 11:00 PM, but will include some weekend time. Cases seen by Clerks must be reviewed by a supervisor and any orders must be cosigned by the physician-supervisor.
During the three weeks on Ambulatory, Clerks will be assigned to various general and subspecialty clinics at Children’s Hospital, ACF – Pediatrics at St. Boniface, or community pediatricians’ offices. Students should be prepared to provide transportation and parking fees as necessary. Clerks will also be expected to prepare one formal presentation for colleagues and preceptors during the rotation as well as participate in service rounds.
Clerks are expected to attend, and at times present at, various educational rounds and other sessions held in the Department. A schedule will be provided at the orientation.
Clerks are required to provide their own medical equipment (stethoscope and otoscope/ophthalmoscope kit).
Specific regulations with regards to the Dress Code can be found here.
The first day of the Pediatrics rotation is devoted to providing the students with the information they require for a successful rotation, as well as whole group teaching sessions. These sessions will help prepare the Clerk for the remainder of their pediatric rotation. Attendance is mandatory and only under exceptional circumstances are Clerks allowed to deviate from the schedule. Clerks will receive a letter from the Undergraduate Pediatrics office approximately one month in advance of their Pediatrics rotation outlining the schedule for the first day and the split between wards and ambulatory care. Further information regarding the objectives, educational sessions, responsibilities while on the rotation and the evaluation process will be provided at the orientation. An extensive student package will be provided during the orientation session.
Course Level Objectives (Pediatrics)
Session Learning Objectives
Session Level Objectives
Academic Half Day
During the ward portion of the rotation the students will complete a midway self-assessment evaluation (mITER) that is to be reviewed, discussed with the senior resident and/or Attending Pediatrician. It is the responsibility of the student to ensure that this midway evaluation is completed within seven working days of the start of the ward rotation. This evaluation allows discussion of the trainee's strengths as well as areas to work on for the remainder of the rotation. This evaluation is to be signed by both the student and the ward evaluator. A final Ward evaluation will occur at the end of this portion of the rotation.
During the ambulatory portion of the rotation, each ambulatory experience is evaluated using a modified daily encounter form (DEF). Students are expected to complete the form at the beginning of each clinic with learning goals for the half day. The students are also expected to comment on learning goals at the end of the clinic. The preceptor is to complete the form with assessment of the learning goals, as well as a selection of the items that map back to the ITER. Each encounter form is different, and should be filled out completely at each encounter.
A final clinical in-training evaluation (FITER) is completed at the end of the entire rotation for all students. This information is compiled from the clinical evaluations on the ward and ambulatory components.
The completed evaluation forms provided to the student must be returned to the Director at the time of the exit interviews. Failure to do so will result in an inability to complete the Pediatric final FITER and an incomplete standing for the rotation.
CLIPP - Students are required to complete a designated number of computer-assisted learning cases (CLIPP) and the Essential Clinical Presentations form provided by the Faculty of Medicine.
Observed History and Physical Examination – Each student will complete a formative observed history and physical on a pediatric patient as pairs. This is to provide an introduction to the pediatric history and physical exam. This will be followed by an individual formal (summative) observed history and physical examination on an assigned patient at a later point of the rotation 1:1 with the same preceptor. The purpose is to monitor how the formative feedback has been incorporated by the learner and to provide the student with further feedback to improve clinical skills. This will be in addition to observation and feedback that will occur on an ongoing basis, and will be a required component.
Attendance - Attendance at all academic half days and tutorials is mandatory. Absences are noted, as well as lateness. Repeated unapproved absences or lateness will reflect on the professionalism evaluation of the FITER.
Written – Third year medical students write the Pediatric NBME II examination on completion of the six-week Pediatrics rotation. Clerks will not be assigned to ward call, Children’s Emergency or Fast Track on the evening prior to the examination. Students will not be required to attend ambulatory clinics or return to the wards after the exam. Students are required to attend an exit interview, scheduled the afternoon after the exam, on the final day of the rotation.
Final Comprehensive Clinical Exam – This exam will be taken at a designated time by all Clerks. The exam will include pediatric-oriented stations.