By the end of the Pediatric Clerkship, it is expected that the student will be able to:

1. Describe in general terms the course of normal growth and development from conception to maturity.

2. Display an understanding of the importance of health maintenance; prevention of disease, including current immunization practices and the immunologic principles upon which they are based; anticipatory guidance; and the roles of other professional persons, medical and non-medical, in the health care of children.

3. Describe the major problems of the newborn infant, including those related to premature birth.

4. Demonstrate a basic understanding of childhood nutrition and fluid and electrolyte balance, including the particular problems of infancy.

5. Recognize the common infectious diseases of childhood, and describe the principles of management.

6. Describe the etiology, pathogenesis, major signs and symptoms, and treatment of those conditions and diseases listed in the learning objectives.

7. Demonstrate a logical approach to the common behavioral disorders of childhood.

8. Describe the problems associated with chronic illness or physical handicap in the child, and a general approach to management.

Though the basic clinical skills required of all physicians for the care of patients are essentially similar, some additions, exceptions and adaptations are necessary to provide effective and efficient care of pediatric patients. For example, the history must often be obtained from someone other than the patient, the physical examination must take into account the anatomic peculiarities of the infant or child, and laboratory data must be interpreted in relation to the patient's age.

The student will be able to:

1. Obtain a complete history for an infant, child or adolescent patient, incorporating specifically those aspects that tend to differ from the history required from adult patients.

2. Perform a comprehensive physical examination on an infant, child or adolescent patient, with particular attention to those aspects that tend to differ from the examination of adult patients.

3. Develop an appropriate synthesis of data from a patient for whom a history has been obtained and a physical examination performed, including a summary paragraph which states the most likely working diagnosis (rarely diagnoses) along with an indication of the points for or against that opinion. This synthesis must logically lead to objective 4.

4. Develop an appropriate plan of management for patients seen in the hospital or office setting. Objectives 3 and 4 are required for each patient.

5. Be able to pick up and carry a newborn infant in a safe manner, attending to proper hand-washing and gown techniques, adequate support of the head, and avoidance of contact between infant's and examiner's clothing.

6. Be able to communicate clearly and sensitively, not only with the child and parents, but also with the whole team of professionals involved in the care of the child.

7. Demonstrate respect for cultural, ethnic, and socioeconomic differences.

8. When taking the history and physical, the students must be able to organize the available data so that the likely diagnosis is supported, leading to a rational plan for investigation and treatment. Throughout, by all of the methods listed, the appraisal of the student will be focused on ability. The ability to function effectively and to cerebrate clearly is what is desired above all.

A student's overall evaluations will be based on the following criteria:

1. Examinations

   1. NBME Shelf text.

   2. Performance Assessment: Two CCX cases with standardized mothers.

   3. OSCE stations

2. Faculty/Resident Evaluation

   1. Critiques of all student write-ups of the history and physical examinations

   2. Observation of physical examination techniques

   3. Student presentations on rounds.

   4. Participation in rounds, clinics, and streamer sessions.

   5. Clinical ward performance

      1. rounds: resident and attending

      2. clinical progress-attending, resident and nurse educator

   6. Attending evaluation: office experience and newborn nursery.

   7. Faculty mentorloral presentations

3. Honors:

   1. Excellent rating (or greater) in two or more in each of these categories:

      1. Clinical skills

      2. Knowledge and Clinical Reasoning

      3. Noncognitive Behaviors

Knowledge, skills, clinical reasoning, and informed decision making while crucial to a physician's practice of medicine, are insufficient to guarantee successful clinical interactions. A physician must have well-developed interpersonal skills that facilitate communication, and must also demonstrate attitudes, behaviors and beliefs that serve to promote the patient's best interest. Students can learn to be professional, at least to a certain degree, in the abstract, but ,will acquire professional characteristics most effectively through contact with physicians chosen to serve as role models. Ethical principles, likewise, while learned in the abstract, must be applied clinically; the importance of suitable role models cannot be overemphasized.

In particular, each student must recognize that pediatrics poses unique challenges to professional conduct and attitudes. The patient constantly changes as growth and development proceed. The patient's ability to participate actively in the clinical interaction progresses, as do his or her knowledge, experience and concerns. The adolescent presents specific challenges, including such issues as privacy, risk-taking behaviors, confidentiality and personal involvement with health. The role of parents in the clinical interaction, and their knowledge, experience, and concerns also develop and change as an individual child grows and as subsequent children are born. The way a physician communicates can have a lasting effect in how parents, children and adolescents handle situations and interact with the physician.

Cultural, ethnic and socioeconomic factors also affect personal and family traits and behaviors, with varying effects on child rearing practices. Recognition of and respect for difference are important, yet the student must be alert for the child or adolescent at risk in different family environments, given that the physician's primary obligation is to promote the best interest of the patient.

LEARNING OBJECTIVES

COMPETENCIES

Professional Conduct and Attitudes Review