Schedule and Expectations for Medical Students on the Pediatric Ward
0700-0830Prerounds:
On arrival to ward (0700), print out pt list on the computer and look at the board to see if there is a pt to pick up. The senior resident may have you pick up zero, one or two new pts. Once you have your list of pts to see, check in with the intern and start prerounding on these pts:
- Go to the EPIC chart and look at all orders and progress/consult notes written within the last 24 hours.
- Check in with the pt’s nurse between 0700 to 0730 to see if there were any problems or changes with the child overnight. After 0730, the RN taking care of the pt during the night will have left so it is important to do this before he/she leaves.
- Look at all vitals and I’s and O’s. Note total number and timing of respiratory treatments in last 24 hours, if applicable.
- Examine the pt with the intern and gather information about how the child did during the night from either the pt or parents. It is helpful to try and coordinate your exam with the intern’s to minimize the number of exams each pt receives in the morning.
- Look at the Medication Administration Record (MAR) in EPIC to understand all medications given in the last 24 hours, including prns.
- Look up all labs and any reports of radiological studies for your pt.
- Look at all films yourself to get practice and learn from them. Ask a resident or attending to help you.
0830-0900AM Report: M,T, W, F in 11th floor conference room (Grand Rounds in 11th floor auditorium Thursdays 0800-0900.)
Rounds: ~0915 Hood & Coast Teams (check with your team for exact time):
Hood and Coast rounds usually are at the bedside of each patient for the pts on the general pediatric services. Rounds for the subspecialty pts vary. Ask your senior resident for exact details about the morning rounding schedule for the team.
Presenting your pts during rounds: Because of time constraints, we all strive for concise and effective communication during rounds. This is especially important when presenting at the bedside in front of pts and family members. Your job is to present each pt in an organized fashion, focusing on their problem list, expanding on abnormalities yet avoiding tangents. This takes practice. The purpose of rounds is to assess the issues and plan the best treatment course for each pt. You should discuss the pt presentation and problem list with your intern and/or senior resident prior to bedside rounds. You should offer an assessment of what the diagnosis is (giving a differential diagnosis if it is unclear) and a plan by problems or systems. One caveat to presenting at the bedside: If cancer, Ebola virus or Mad Cow Disease aren’t at the top of your differential diagnosis, it’s OK to leave it off the problem list. Every pt should also have a disposition plan. Please see the presentation guidelines at the end of this handbook.
1100-1145: After rounds, discharge pts, call consultants, write orders, do admissions with interns and resident. Update pt list on computer. Depending on the day, there may be a short didactic or bedside teaching session with the senior resident or attending in the morning after rounds or afternoon.
1145: Get lunch
1200-1300: MS3 Core Lectures (or Resident Noon Conference if no Core Lectures scheduled)
1300-1700: Admissions, complete work, go to procedures with your pts.
1700: Update intern and senior resident about your pts and update the pt list on the computer if needed.
1730: Sign out with team. Go home if you are not on-call
Weekends:
If you are not on-call or post-call, you are not working. If you are on-call, arrive at 0700 and locate the list of pts to pre-round on, usually hanging in the workrooms on the xray view box. The post-call and on-call residents and students see and write notes for all the kids on both the Hood and Coast services. Resident check-out rounds start at 0900 and are in 9301 which is the conference room off the main DCH hallway in between 9N and 9S. The purpose of check-out rounds is to communicate to the on-call team as concisely as possible pertinent information about all the kids on both teams. Ideally, after rounds, the post-call people finish their notes in EPIC, tie up loose ends and go home. If there are discharges that morning, all the computer charting and prescriptions should be filled out ahead of time allowing the on-call team to admit new pts and get other work done. When you are on-call on a weekend day, you will be doing work (discharges, orders, admits) for pts on any one of the three medical teams.
Call:
You will be on-call every 4th-5th night and the clerkship director determines the schedule before the rotation begins. You may wear scrubs when on-call (the scrub machine is in the back hallway of the 8th floor.) A call team consists of one senior resident, one intern and one student. Most of the time, you will admit pts who will be on your ward team. However, this is not a hard and fast rule, especially when one team is getting several admits and the other team isn’t. Remember, you can learn something from every pt so it is universally frowned upon to say that because you’ve already admitted three pts with bronchiolitis during your rotation you do not need to be involved with another one. It is not advisable to hibernate in the call room since you will learn the most from being with the on-call team, helping with cross-cover issues and being present.
For all pts you are actively involved with admitting, you should write a history and physicaland put it in the chart after a resident or intern co-signs it. Your write-up should include an assessment with differential diagnosis and a plan by systems. There is no need to rush. Take your time to write a clear, organized, concise and thoughtful note. You may use abbreviations rather than full sentences. You are the historian – take your reader from the start of when the illness/condition occurred, up to the point at which you are seeing the pt in the hospital room. Included in your HPI should be a summary of any visits to a pt’s PCP or ED (including the day of admit) and reason for admission. Often this requires going through old chart notes or papers that come with the pt from the referring facility. Your admit note should reflect critical thinking. Print your note and give it to the attending and/or senior resident for feedback and critique.
Post-Call Afternoons:
During the clerkship, there may be a few afternoons with scheduled student lectures. If you are post-call, you are expected to stay for these teaching conferences but may leave once the conferences are done. If there are no scheduled conferences the afternoon you are post-call, you may leave after the MS3 Core Lecture.
Learning:
You are here to learn as much pediatrics as you can during your five weeks. Take charge of that concept. Ask residents to “teach on the fly.” Teach each other. Keep lists of learning issues. Create differentials at morning report and for each pt you admit. Do the CLIPP cases early since they are a great way to learn.
