1. 70%:   Clinical Evaluations (from Attendings and Residents)
2. 10%:   Required CLIPP cases
3. 20%:   NBME Pediatric Subject “Shelf” Exam

There are three components to your grade.   You must achieve an overall passing grade (3 points) on your clinical evaluations in order to pass the clerkship.   Additionally, if your combined grade score (all three components calculated together) is less than 3 points (on a 1-5 scale), you will be required to remediate some of the required components of the clerkship, as determined by the Clerkship Director.

1.  Clinical Evaluations (from attendings and residents):  

You will be evaluated by the attendings and senior residents who you work with on your clinical teams.   Combined, these evaluations are worth 70% of your overall grade.   Please see "Grading System" section of this webpage for clinical descriptors of grades.

The breakdown is as follows:

Grade             Points

Manager         5

Interpreter      4

Reporter         3

Observer        2

2. CLIPP Cases:  

Computer-assisted Learning in Pediatrics Project (CLIPP) is a recently created national project that offers students 31 interactive, Internet-based patient simulations to augment their clinical medical education.   All cases offer a standardized curriculum, model clinical reasoning and best practice, and provide links to further information about selected topics.   The use of video and still images greatly enhances this exciting project.   Using your OHSU email address, students can log on at www.clippcases.org using any computer with Internet access to complete the cases.   For Pediatrics 1, 17 cases are required:   case numbers 1, 2, 7, 8, 9, 10, 11, 15, 16, 18, 21, 23, 24, 25, 27, 30, 31.   CLIPP cases are worth 10% of your grade.  Students will receive 5 points by completing all required CLIPP cases by 5 pm on the last day of the clerkship If students do not complete  all 17 required cases by 5 pm on the last day of the clerkship, they will not receive any points for this aspect of their grade.  Any additional cases completed during the Pediatrics 1 rotation will mean less cases to complete next year in Pediatrics 2.   Keep in mind that the CLIPP cases are great preparation for the end-of-rotation Pediatric Subject “Shelf” Exam so the completion of all cases during Pediatrics 1 is highly recommended.   You are strongly encouraged to complete these cases throughout the 5-week clerkship and not to wait until the last week.   There is more information on CLIPP at Pediatrics 1 CLIPP Cases.

3. NBME Pediatric Subject Exam:  

All students rotating through Child Health 1 are required to take the National Board of Medical Examiners (NBME) Pediatric Subject exam at the end of the clerkship.   This is a standardized, multiple choice achievement test that requires medical students to solve scientific and clinical problems.   Although students’ performance on the test will reflect the learning specific to their clerkship experience, students’ test scores will also reflect educational development resulting from the overall medical school experience.   You can get more information on the web site:  www.NBME.org.   This test will be given the last Friday morning of the clerkship.   Because of security reasons, if you are unable to take the exam at this time, you will be required to make up your test with the next rotation, and you will received an Incomplete for the clerkship until the test is taken.

You are strongly encouraged to read frequently during your clerkship.   You are given a pediatric textbook to use as a general reference during your clerkship.   You are also encouraged to obtain and read a pediatric board review book early in your clerkship to help you when taking this exam.   This will also aid you when studying for the USMLE Step 2 exam.   Because it is impossible to teach you everything during the clerkship that could be on this exam, it is important to read generally during the clerkship.   Some examples of board review books include the BRS series “Pediatrics” by Brown and Miller, Blueprints in Pediatrics or Appleton and Lange’s Review of Pediatrics question book.

4.  Other Course Requirements:  

CLERKSHIP PROCEDURE LOG:    

You are required to keep a record of certain patients and educational experiences during your clerkship as instructed by the Dean’s Office.   This log mirrors the clerkship objectives given to you at orientation.   Please turn in your log at the time of the shelf exam on the last day of the clerkship. Please also send an electronic version to Trevor Monteith via email.

CALL:  

You will be required to take overnight call during your pediatric clerkship.   The call schedule is set in advance by the Clerkship Director.   If you are unable to take your call for any reason, you must notify the Clerkship Director to discuss this and design a make-up plan during the clerkship.   You must also notify your team of your absence.   If you and another student would like to switch call nights, you must gain approval of this switch prior to the call night with the Clerkship Director (students at DCH) or Julie Noffsinger or Ann Loeffler (students at Emanuel).   For further details about overnight call, please see the Clerkship Orientation Manual emailed to you prior to the start of the clerkship.

FEEDBACK:  

Throughout your clerkship, you will be given feedback regarding your performance from many people – attendings, residents, interns and even other students.   If you do not feel you are receiving enough feedback, please ask those physicians who supervise you to give you a few suggestions about ways to improve your performance.   You will receive formal mid-term feedback from your 2nd or 3rd week ward attending (DCH students) or Julie Noffsinger (Emanuel students).   This feedback session is designed to give you information about what you are doing well midway through the rotation, and what areas you need to work on for the remainder of the clerkship.   Your evaluator will assess your fund of knowledge, clinical skills and professionalism.   Please use this opportunity to identify areas for academic and professional growth.   You will also be given the opportunity to receive feedback during an observed history and physical on the inpatient unit.   Similarly, your feedback about the clerkship as a whole is welcomed!   If you have suggestions regarding any aspect of your clerkship experience, please contact the Clerkship Director.   We want this clerkship to be the best one you have throughout your MS3 year – please tell us how we can get there!

PROFESSIONALISM:  

As in all clerkships, you will receive a professionalism assessment at the end of your rotation that comments on your honesty, integrity, respect for others and teamwork, and respect for patients.   It is graded as pass/fail.   In the event a student is deemed to be unprofessional during the clerkship, a more detailed Professional Development Evaluation may be completed by the Clerkship Director. If you have a concern regarding any aspect of your clerkship experience or have a conflict with a member of your team you are unable to solve directly, please contact the Clerkship Director immediately.   Additionally, failure to turn in your procedure and patient log by the end of the clerkship will trigger a professionalism concern on your professionalism assessment and your grade will be withheld until the log is completed.

GRADING SYSTEM: 

The (O)RIME Method For Medical Students

The RIME method of grading emphasizes a developmental approach and distinguishes between basic and advanced levels of performance for clinical rotations.  Such a system is “synthetic” rather than “analytic” and each step represents a synthesis of skills, knowledge, and attitudes that have been practiced from the preclinical years of medical school through residency.

Observer:  A student in pre-reporter status, not meaningfully contributing to patient care activities.  First- and second-year medical students largely are observers.

Reporter:  Student can accurately gather and clearly communicate the clinical facts about a patient.  Mastery of this step requires the basic skills to obtain a history and do a physical examination and the basic knowledge of what to look for.  The student “reports” the facts, such as, “the pt has had 3 days of increasing shortness of breath and fatigue”, “the heart rate is 100”, “the liver is 3 cm below the costal margin”, “the sodium is 140.”  This descriptor emphasizes day-to-day reliability – for instance, being on time, or following up on a patient’s progress.  The student at this stage has a sense of responsibility and is achieving consistency in bedside skills in interpersonal relationships with patients.  Reporter is minimum passing criterion in the third-year medical student clerkship.  An OHSU student consistently at the level of “reporter” would receive a clinical grade of “Satisfactory.”  A student not consistently performing at the level of “reporter” by the end of the clerkship would receive a grade of “Marginal” or “Failure” and will be required to remediate the clerkship during their MS4 year.

Interpreter:  Making a transition from “reporter” to “interpreter” is an essential and often difficult step in the professional growth of a student.  An interpreter can report the facts accurately, and also can “interpret” these facts by thinking critically about the clinical data and formulating a differential diagnosis without prodding.  Students at this stage can also advocate or refute diagnostic hypotheses.  An interpreter might say, “2 month old male with unrepaired VSD now with a 2 day history of shortness of breath and poor feeding, and an exam significant for respiratory rate of 60, diffuse pulmonary crackles and liver down 3 cm below the costal margin, CXR remarkable for cardiomegaly and diffuse bilateral pulmonary opacification; therefore the pt most likely has congestive heart failure with fluid overload.”  An OHSU student who is consistently at the level of “interpreter” would receive a clinical grade of “Near Honors.”

Manager:  A student at the “manager” level can not only report and interpret the clinical data, he/she has the knowledge, confidence and judgment to decide on a course of treatment.  This level requires higher-level interpersonal skills and involvement in patient care.  A manager might say, “2 month old male with unrepaired VSD now with a 2 day history of shortness of breath and poor feeding, and an exam significant for respiratory rate of 60, diffuse pulmonary crackles and liver down 3 cm below the costal margin, CXR remarkable for cardiomegaly and diffuse bilateral pulmonary opacification; therefore the pt most likely has congestive heart failure with fluid overload.  I propose we give lasix 1 mg/kg IV x 1 now.”  An OHSU student who is consistently functioning at the level of “manager” would receive the clinical grade of “Honors.”

Educator:   To be an educator, the trainee must be able to go beyond the basics of reporting, interpreting and managing the patient’s clinical care.  An “educator” is a self-directed learner, someone who defines questions to research and searches the literature for evidence on which clinical practice can be based.  An “educator” then shares this information with others.  This is a senior resident- or attending-level skill.  However, students and residents at all levels should strive to be educators.

ENJOY YOUR CLERKSHIP.   HAVE FUN.   LEARN AS MUCH AS POSSIBLE.   TEACH EACH OTHER!

  CONTACT INFO:     

  Tracy Bumsted, M.D., MPH

  Course Director, Pediatrics 1

  bumstedt@ohsu.edu                                   

  Office:   494-5982                                        

  Pager #14793

    Trevor Monteith

    Course Coordinator

    monteith@ohsu.edu

    Office: 494-3195

    Pager: 16363

     CDRC: 2114D

    8:00am to 4:30pm

    Monday-Friday