No field of specialized medicine has broader scope or greater responsibility than has pediatrics, which is distinguished by its major concern with the growth and development of its subjects. Every physician must understand how the medical, surgical, and psychiatric problems of infants and children differ from those in adults, how to manage them and how to encourage the child to achieve an optimal state of mental and physical health. The fundamental purpose of the Department of Pediatrics is to provide the students with a firm foundation of basic knowledge in pediatrics that will serve well in whatever field of medicine is entered.
All programs in pediatrics are designed to assist the student to achieve the learning objectives of the department. The programs are based on the principle that learning is an active process which must be accomplished by the student; the role of the faculty is to provide guidance, stimulation and example.
The student is responsible for determining what he or she needs to read in order to achieve the learning objectives stated by the department as well as meet his or her own learning objectives. A basic suggested textbook is Rudolph’s Fundamentals of Pediatrics which is provided to you. Another recommended text is Nelson’s Textbook of Pediatrics, which is available via MD Consult. However, it should be emphasized that the student may wish to find and read more current information in journal articles.
By the end of the Pediatric Clerkship, it is expected that the student will be able to:
Describe in general terms the course of normal growth and development from conception to maturity.
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.
Describe the major problems of the newborn infant, including those related to premature birth.
Demonstrate a basic understanding of childhood nutrition and fluid and electrolyte balance, including the particular problems of infancy.
Recognize the common infectious diseases of childhood, and describe the principles of management.
Describe the etiology, pathogenesis, major signs and symptoms, and treatment of those conditions and diseases listed in the learning objectives.
Demonstrate a logical approach to the common behavioral disorders of childhood.
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.
Clinical Performance Objectives
The student will be able to:
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.
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.
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.
Develop an appropriate plan of management for patients seen in the hospital or office setting. Objectives 3 and 4 are required for each patient.
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.
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.
Demonstrate respect for cultural, ethnic, and socioeconomic differences.
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.
Assessment Criteria For Pediatric Clerkship Participants
A student's overall evaluations will be based on the following criteria:
Professional Conduct & Attitudes
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. In order to be effective role models, however, faculty must undergo training in order to be able to explain their behaviors explicitly, to foster professionalism and humanism. Clerkship Directors should assure that faculty development occurs in this area. 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 does 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.
Professional conduct extends to the educational process: Students have a personal responsibility for their own education and for development of life-long learning skills. They must interact with all staff, including their peers and their teachers, in a manner that demonstrates respect for each individual and that promotes personal and group learning.
Well-developed data gathering skills, knowledge of ethical principles and a basic understanding of health law issues are essential foundations for the student. Students should have completed an introductory course on medical ethics providing a basic understanding of ethical principles (autonomy, beneficence, non-malfeasance, and justice) and their application in clinical medicine.
A student's overall evaluations will be based on the following criteria:
Professional Conduct and Attitudes Review
In a crowded elevator a fellow medical student begins discussing a fascinating patient that he had seen earlier in the day. How would you respond?
While on attending rounds with the Pediatric Clerkship director (who assigns the final grades for the rotation), you are asked if one of your patients has been febrile during the past 24 hours. You cannot remember if the patient has been afebrile or not. What should you tell the attending?
You and two other students are alone waiting for attending rounds to begin. One of the students makes a racist remark about a patient he had seen earlier in the day. What should you response be?
During a routine health care supervision visit, a sixteen-year-old girl confides to you confidentially that she has been sexually active, has tried marijuana, and on a few occasions snorted cocaine. That evening her mother calls you. She is very concerned about her daughter’s behavior and demands to know if the daughter is using drugs or having sex. What are your ethical and legal obligations? What would you tell the mother?
The mother of a six-year-old boy is upset that you examined his testicles and penis during a well-child examination. She feels that this part of the examination is private and best left to family discussions. What would you say to her?
Brothers aged 10 and 16 present for a routine health care supervision visit with their mother. How would you interview these patients? How would your interview strategy or questions differ?
After informing the mother of a two-year-old infant that the child has a viral infection, the mother demands antibiotic for the child. How would you respond?
A previously healthy 16-year-old girl presents for a routine health care supervision visit with her mother. When you ask the mother to leave the room, she refuses. How would you approach this situation?
The clerkship director has scheduled a mandatory meeting with all the students on the rotation to discuss the final examination. Just before the meeting time, a sixteen-year-old girl with cystic fibrosis whom you have been following on the ward says that she needs to talk with you right away and begins to cry. What should you do?
During bedside attending rounds, a girl admitted the previous night with a diagnosis of cellulitis is diagnosed with pemio. The mother requests more information about this topic. What would you do? What resources are available?
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