Transcript Welcome to the Pediatrics Clerkship

Welcome to the UNC
Pediatrics Clerkship
2014-2015
Objectives for Orientation
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Clearly state expectations for clerkship
Participation
 Clinical activities
 Assignments
 Grading
 Policies
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Outline clerkship objectives
Address your questions
For more information, also see the clerkship webpage
General Expectations
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More than 90% of medical students will not become
pediatricians
All medical students must develop a basic level of
knowledge and skill regarding pediatrics
More than two-thirds of medical students will go into
fields of medicine where they will be asked to
participate in medical care for children
Goals for the Clerkship
Top 12 List – Peds Clerkship Objectives
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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 PE 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.
Top 12 List – Peds Clerkship Objectives
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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.
Top 12 List – Peds Clerkship Objectives
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Write prescriptions appropriately for children of different
sizes.
Be able to clinically recognize a dehydrated child. Write
orders for both re-hydration 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.
Overview of the Clerkship
Clerkship Direction:
Outpatient Pediatric Medical Education Director:
Rasheeda Monroe, MD
Inpatient Pediatric Medical Education Director:
Steven Pattishall, MD
Other members of the Pediatric Medical
Education Committee:
David Adams, MD Stephen Leinenweber, MD
Basic Clerkship Clinical Structure
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Three weeks Inpatient Pediatrics
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Newborn Nursery
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2 weekday long shifts
One Friday long shift
One Saturday or Sunday long shift
Coordinate your long shifts and weekends to minmize overlap with AI’s
and other 3rd year student
With exposure to neonatal intensive care
Minimum 12 half-days of Ambulatory Pediatrics
Some pediatric subspecialty exposure
Basic Clerkship Assignments
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CLIPP cases
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Complete 8 required cases
Write ups
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Complete a minimum of 2 History and Physicals and 1
Discharge Summary
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You will be assigned an attending to review your write ups
Cultural reflection (optional)
Didactic sessions
Documentation of patient encounters/log on One45
Midpoint feedback and self-assessment
Completion of the Patient Log
Clinical Work in the Clerkship
Clinic Attendings
Rasheeda Monroe
Medical Director
Mythili Rajan
Susan Sinden
Betty Witman
SAFE Child
Carrie Dow-Smith
Virginia Schreiner
SICC
Ward Attendings
David Adams
Ivy Pointer
Badie Clark
Scottie Pate
Jennifer
Vick
Bridget
Donell
Stephen Leinenweber Travis Honeycutt Karen Chilton Steven Pattishall Mark Piehl
UNC Chief Residents 2014 - 2015
Mark
Connelly
Stephanie
Permar
Allison
Herndon
Inpatient Pediatrics
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Typical patients
 Well
children with acute illness
 Children with chronic disease presenting for acute
illness or chronic disease management
 Children in need of diagnostic management
Inpatient Pediatrics - Student Goals
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Depth
Take ownership of your patients and learn all you can
from them
Understand their illness, work up, and management
completely
Participate fully in the activities of the inpatient team
Become comfortable with children with special needs
Gain exposure to pediatric subspecialties and general
pediatric hospital care
Inpatient Pediatrics - Patient Write Ups
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Write a history and physical and/or daily note on each
of your patients each day
Write notes daily and meet with your inpatient attending
to evaluate them for additional feedback.
2 formal History and Physicals are required and 1
discharge summary. You will be assigned a faculty
mentor. Send write ups via email to your mentor.
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Due within 72 hours after seeing the patient
A Patient write-up should include:
 History & Physical
 1-2 page written discussion on a topic related to the
patient, with at least 2 references cited
Please refer to the clerkship website for detailed
Inpatient Pediatrics – Daily activities
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Write a history and physical and/or daily note on
each of your patients each day
Write orders for co-signature
Meet with your intern right after rounds to divide and
conquer the daily work
Ask questions and find answers to those questions –
bring new information to the team!
Inpatient Pediatrics - Long Shift
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Long shift assigned at least four times
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2 week nights
1 Friday
1 Saturday or Sunday
On long shift days, you are expected to stay until 8pm
then return the following morning as regularly scheduled
On weekends, round with the team on the post-call
morning, present your patients, then leave after postrounds work is completed
Stick with your intern to learn clinically
Admit at least one patient for write up each long shift, but
learn from any patient around
Inpatient Pediatrics - Ward Teams
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Teaching Team: Usually one attending per week,
One senior resident (2nd or 3rd year), Two interns.
Rounds typically start at 8:15 or 8:30 on 4E
You should have reported to the workroom at
6:30am for patient assignment or updates on
existing patient from the night team.
Pre-round on all your patients and prepare for your
presentation on rounds.
Talk to your supervising intern
Inpatient Pediatrics - Working with the Team
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Take ownership of your patients
Be proactive and enthusiastic
 But be gentle
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Meet with your intern right after rounds to divide and
conquer the daily work
Ask questions and find answers to those questions –
bring new information to the team!
Be a dependable part of the team
To get the most out of your inpatient time…
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Learn the roles, and what to expect from whom
Get involved – make yourself important to your
team and learn by doing
Balance the amount of time you spend on write ups
with the amount of time you spend on more broad
learning
Get the most you can out of conferences – they are
for your learning
Newborn Nursery
Generally the
happiest place in
the hospital…
Student Activities in the NBN
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See the specific orientation information on the web
page
Arrive in the mornings at 8:30 am
Clarify expectations with your team for the week
Prepare a brief presentation for the last day in the
Newborn Nursery (Friday) on a topic of your choice
to present to your preceptor and team
Your physical exam skills will be directly observed
Student Activities in the NBN
To get the most out of the NBN…
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This is your best opportunity in third year to be the
care provider
Work on developing rapport, talking with families,
and communication skills
Practice effective use of an interpreter if
applicable
Learn what is normal and what is not
Examine lots and lots of babies
Build your comfort with normal baby care
Review the Newborn Nursery orientation website
link before your week starts
 http://www.med.unc.edu/pedclerk/schedules/clerkship
Outpatient Pediatrics
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Well child care in community outpatient practices
Preventive care, anticipatory guidance
Acute illness management
Chronic illness management
Outpatient Pediatrics - Student Goals
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Breadth
Examine lots and lots of children
Learn behavior and development, prevention,
common acute illness
Clarify expectations on the first day in each setting
with each preceptor
Challenge yourself to learn and to do
Get a picture of what many general pediatricians
do
To get the most out of your outpatient time…
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Make sure to clarify the expectations each day
Be flexible, because each day might be different
Seek learning opportunities
Challenge yourself
Take time to study and to do the CLIPP cases
Refer to your Patient Log to ensure you are seeing
many of the expected cases
Assignments in the Clerkship
Clerkship Assignments - Overview
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Write ups
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Complete a minimum of 3
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CLIPP cases
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2 H&Ps, 1 Discharge summary
Complete 8 required cases
Cultural reflection (optional)
Didactic sessions
Documentation and completion of patient
encounters/patient log on One45
Midpoint feedback and self-assessment
Inpatient Pediatrics - Patient Write Ups
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2 History & Physicals, 1 Discharge Summary
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H&P, 3-4 paragraph written discussion on a topic
related to the patient, with at least 2 references cited
 H&Ps - focus on Pediatric-specific content
 Growth
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and development (including charts), labor/delivery, etc
within 72 hours after seeing the patient
Please refer to the clerkship website for detailed guidelines
on the format of patient write-ups
Email them to site directors upon completion.
You will receive feedback on your clinical documentation.
Outpatient Pediatrics Curriculum
CLIPP cases
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http://www.med-u.org/
 Use your med.unc.edu email to login
Interactive, web-based curriculum
Do at least 8 assigned cases
 Some
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people do lots more
Must be completed by the last Wednesday of the
clerkship
One question from each CLIPP case will be on
Pediatric Departmental Exam
8 assigned CLIPP cases
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Case # 5: 16 year old girl’s health maintenance
Case # 6: 16 year old boy’s pre-sport physical
Case # 15: Two siblings vomiting, 4 year old and 8
weekold
Case # 18:
Case # 25:
Case # 28:
Case # 29:
Case # 30:
2 week old with poor weight gain
2 month old with apnea
18 month old with developmental delay
Infant with hypotonia
2 year old with sickle cell disease
Cultural Competence
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We expect your cultural sensitivity to improve during
your Pediatrics clerkship
Take the opportunity that our diverse patient
population provides to develop your skills in working
with patients from different cultural backgrounds
If you have questions about how to do this effectively,
ask… This is appropriate learning material.
Your Cultural Competency Monday lecture will be a
group discussion – bring examples and be prepared
to talk about the effects of culture on pediatric care
Working with Interpreters
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You will have plenty of opportunities to practice
Get an interpreter when you need one, we now use an
internet based interpreter as well as live interpreters –
asked to be shown this new technology
Work even harder to establish rapport
Look and speak directly to the patient, not the interpreter
Don’t ever say anything you don’t want interpreted or
understood
Pause frequently for interpretation
Listen to the patient
Be patient – it will take longer
Attempt to learn some Spanish
Cultural Reflection
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This is an optional assignment that can be completed
for extra credit
Write a brief reflection on the influence of culture on
the care of one of your patients during the rotation.
Email it to [email protected] and your
WakeMed preceptor
See details and ideas on clerkship webpage
Be ready to discuss reflective statement during small
group session
Documenting Patient Experiences
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Be sure to complete your Patient Log (One45) of
your required clinical experiences
Your patient log will be reviewed at the midpoint of
the clerkship with the clerkship or site director to
assure you are on track
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you are deficient in core patient experiences, your
clinical schedule may be adjusted to provide those
experiences
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You must complete your Patient Log by the last day
of the clerkship
Conferences in the Pediatric Clerkship
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Morning Report:
 Mondays and Thursdays at 7:30am
 Hicks’ conference room on 4E
Grand Rounds:
 1st and 3rd Wednesday at 8:00am-9:00am
 Andrews Conference Center
Core Medical Student Lecture:
 Mondays 12:30 to 1:30
 3rd FL Andrews
Med./Resident Lecture:
 Tues., Thurs., Fri. 12:30 to 1:30pm
 Hicks’ conference room on 4E, occasionally 3rd FL Andrews
 Ask a resident/attending daily to confirm location
Lecture Schedule:
Monday
Tuesday
Wednesday Thursday
Friday
Week 1
Core #1
Med/Res
Med/Res
Med/Res
Week 2
Core #2
Med/Res
Med/Res
Med/Res
Week 3
Core #3
Med/Res
Med/Res
Med/Res
Week 4
Core #4
Med/Res
Med/Res
Med/Res
Week 5
Core #5
Med/Res
Med/Res
Med/Res
Week 6
Review
Med/Res
Final Exam
Final Exam
Core:& Review: 12:30 to 1:30 in 3rd Floor Andrews
Med/Res: 12:30 to 1:30 in 4E Hicks’ Conference room,
Sometimes 3rd FL Andrews
Core Lectures:
Core Lectures
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Fluids and Electrolytes
Child Abuse and
Neglect
Growth/Development
and Common
Behavioral Issues
Immunizations
Cultural Competency
(should be week 5)
Core Faculty
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Rasheeda Monroe
Travis Honeycutt
David Adams
Steven Pattishall
Chief residents
Stephen Leinenweber
Melissa Johnson
(Growth/Development
and Behavior)
Feedback, Evaluation, and Grading
Feedback
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Ask for specific feedback from your residents and preceptors
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If they say, "good job", follow up for specifics
Ask "How are my presentations? Notes? Plans?"
Use the evaluation forms to help you
Know that "Good job" DOES NOT mean Honors
Continue to push yourself for improvement
You will meet with the site director for scheduled Midpoint
Feedback at the end of 3 weeks
Update your Patient Log and Self Assessment prior to your
Midpoint Feedback session
Grading in Clinical Education
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Necessary, but….
often subjective, and sometimes unsatisfying
Most students will NOT get Honors
 ~30%
of students across all the Pediatric Clerkship
Sites will earn Honors
 UNC, WakeMed, Moses Cone, Carolinas Medical,
Asheville
Grading
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Grading system is set-up thoughtfully to evaluate
your performance, balancing subjective and objective
indicators of performance
Goal is primarily to demonstrate learning of essential
material and secondarily to differentiate students
Core Competencies
 Medical
Knowledge
 Patient Care
 Professionalism
 Practice
Based Learning
and Improvement
 Systems Based Practice
 Communication and
Interpersonal Skills
Grading
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**Note: The clerkship director reserves the right to
adjust final grades if necessary. This is to insure
the best consistency possible in student evaluation
across all sites.**
Grading is on a 100 point scale
Final Grade
Points Scale
NBME Score
Honors
88 - 100
> National Mean
High Pass
75 – 87
>35th percentile
Pass
50 - 74
>10th percentile
Condition
37.5 - 49
Fail
<37.5
Grading - Overall
Clinical
60%
- Inpatient attending
- Inpatient residents
- Outpatient total
- Newborn nursery
30%
30%
25%
15%
Participation
10%
NBME Shelf Exam
20%
Departmental Exam
10%
*This means that one
person’s evaluation is
never enough to change
your grade substantially.
Grading – Participation – 10%
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Completed by WakeMed Pediatric Education
Committee– Drs. Adams, Chief Resident,
Leinenweber, Monroe, & Pattishall
 Small
group participation
 CLIPP cases completion
 Cultural reflection completion (optional – extra credit)
 Write up evaluations
 Completion of the Patient Log
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Professionalism is pass/fail
 Failure
in professionalism evaluation may lead to
failure of the clerkship
Grading – Shelf Exam – 20%
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Shelf test is administered in the afternoon on the
last Friday of the Clerkship
The Shelf exam is web-based and administered online
Students are required to use their laptops
distributed them by the UNC SOM for testing
It is students’ responsibility to ensure their laptops
are in appropriate working condition for testing
prior to the testing date
Grading – Shelf Exam – 20%
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Scores are based on national percentiles
NOTE: A shelf test score of < 10%ile will result
in an Incomplete grade.
Students who earn <10%ile on the shelf test but
pass all other requirements of the clerkship, must
retake the shelf test only.
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successful retake of the shelf exam, the student
will receive a grade of Pass.
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The Pediatrics shelf test is difficult and you will need
to study appropriately
Grading – Departmental Exam – 10%
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Oral portion is administered on last Thursday of the
clerkship in individual 15 minute appointments
Written/Multiple Choice portion is given immediately
following completion of the Oral portion
Departmental Exam is worth a total of 20 possible
points:
Oral
Exam (6 points)
Written Exam (14 points)
6
written questions (6 points)
8 multiple choice questions – 1 question based on each assigned
CLIPP Case (8 points)
Departmental Exam - Oral
A 10 minute discussion of one of the following possible cases:
 A 13 month old with anemia
 A four month old with failure to thrive
 A 3 day old with jaundice
 A 6 month old with lethargy
 A 1 week old with fever
 A 9 yo with abdominal pain
 A 2 yo that refuses to bear weight
 A 1 week old with vomiting
 An 18 month old with difficulty breathing
 A 15 yo girl with weight loss
Departmental Exam – Written
All material is based on Learning Group didactics
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5.
Plot and interpret growth data using growth curves
Write an appropriate maintenance fluid order for a
child of a given size.
Write an appropriate fluid bolus for a child of a
given size.
Write an appropriate order for medication, with use
of provided references for dosing.
Determine necessary immunizations for a child in a
given clinical setting. The immunization chart will be
provided.
Departmental Exam – Multiple Choice
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1 question from each assigned CLIPP case:
 Case # 5: 16 year old girl’s health maintenance
 Case # 6: 16 year old boy’s pre-sport physical
 Case # 15: 2 siblings vomiting, 4 year old and 8
week old
 Case # 18: 2 week old with poor weight gain
 Case # 25: 2 month old with apnea
 Case # 28: 18 month old with developmental delay
 Case # 29: Infant with hypotonia
 Case # 30: 2 year old with sickle cell disease
Departmental Exam
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Oral portion is administered at WakeMed in the 3rd
FL Andrews conference room on last Thursday of the
clerkship in individual 15 minute appointments
Written/Multiple Choice portion is given
immediately following completion of the Oral
portion
The End of the Clerkship
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Complete clinical responsibilities by the last
Thursday of the rotation.
Please remember to turn in your 3 write ups within
48-72 hours of seeing the patient. You should NOT
turn in all 3 assignments at the same time during the
final days of your rotation. We take time to review
your write ups and provide feedback that should
be incorporated into the next assignment.
General Principles and Miscellaneous Topics
How to Approach a Child
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Interact with the child based on his or her
developmental level
Include the parent, but focus on the child
Establish rapport before starting the formal exam
Start from a safe distance away
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Observe general appearance, respiratory status, all you
can while talking
Save the invasive parts of the exam for last
When cooperation vanishes, move quickly
How to Identify a “Sick” Child
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Learn the vocabulary – “looks sick”, “lethargic”,
“toxic”
Yale Observation Criteria:
Quality of cry
Reaction to parent
State variation
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Color
Hydration
Responsiveness
Note all vital signs and compare them to age
appropriate norms
Skill will grow with experience
Student Maltreatment
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You should not be mistreated during your Pediatrics
clerkship
If you experience maltreatment, please bring that
to the attention of the clerkship director, the Dean
of Student’s office, or one of your assigned liaisons
UNC SOM Ombudsman is Dr. Gary Gala
Each clerkship site also has an ombudsman
Reading
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Some textbooks are available for your use
Check out http://uncpeds.med.unc.edu/
Read the basics first
Add the peer reviewed literature on selected topics
UpToDate has some important limitations in Pediatrics
– make sure you are reading about children
Absences
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Note the School of Medicine Absence Policy
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are a maximum of 3 excused absences from the
clerkship
 An excused absence may require make-up
responsibilities based on the clinical duties missed
Absences
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If you must be absent for any reason you should:
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Contact your team (Attending or senior resident) AND Dr.
Monroe (252)375-5170
Call Suzanne Record (919)966-3027regarding your
absence or tardiness
 Note:
Do not email the day of your absence as this delay
notification of the appropriate individuals
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All absences are reported to the Dean of Student
Affairs (Dr. Georgette Dent) for documentation and
approval when necessary.
Evaluating the Clerkship
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Please provide us with your feedback throughout
and specifically at the end of the rotation
Contacts at WakeMed:
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David Adams: [email protected]
Stephen Leinenweber: [email protected]
Rasheeda Monroe: [email protected]
Steven Pattishall: [email protected]
Kim Seibel: [email protected] or 919-3508493
UNC contact information:
 [email protected]
 [email protected],
Mobile – 919-428-6382
 [email protected], Phone – 919-9663027
Education Office located on the 2nd floor of
MacNider in Rm 230
 Phone – 919-966-3027
 Pediatric
HAVE FUN!
Remember, it’s your education!