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.

 

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

 

 

 

 

NBME Pediatric Subject Exam:  

NBME PEDIATRIC SUBJECT EXAM: All students rotating through Pediatrics 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. Grading for the shelf exam is based on your scaled score and you
will be given a point value from 2-5 that correlates with this score. Minimum passing score is 3
points.

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”, Lange’s “Case Files in Pediatrics” or
Appleton and Lange’s Review of Pediatrics question book.

CLIPP CASES:

Computer-assisted Learning in Pediatrics Project (CLIPP) is a 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. If you do not complete these 17 required cases by 5 pm on the last day of the clerkship, you will not receive any points for this aspect of your grade (see grading scheme
below.) When you complete your Pediatrics 2 rotation, the other cases will be required. By the time you finish Pediatrics 2, you should have completed all 31 cases. If you complete these cases during your Pediatrics 1 rotation, you will not be required to repeat them next year. 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 wait until the last week. CLIPP cases are worth 10% of your grade and the grading for the CLIPP cases is on a pass-fail system – if you complete all the required 17 cases you will pass and get the full 5 points. If you do not complete one or more of the required cases during your Pediatrics 1 rotation, you will
get 0 points for this component of your grade.

Chart Notes:  

One of the more important skills you will be learning during the Clerkship is how to
effectively and efficiently document patient care encounters in the medical record. For every patient you admit to the hospital and will follow subsequently, you are expected to write a full History and Physical (H+P) and enter it into the patient’s chart, to be co-signed by one of your supervising physicians. You should also write a complete progress note for every patient your supervising physician assigns you to follow in the morning for presentation during rounds. If you are involved with admitting a patient but will not be following that patient primarily after the admission, you should ask your supervising physician whether you should write up a full H+P or not. The maximum number of full H+Ps expected for an MS3 to write-up while on-call is 4. This is
due to the fact that you are expected to have a detailed assessment and plan outlining your clinical decision making, which often requires research and time to analyze the information you’ve obtained. Your supervising physician can provide guidance on those patients that offer the most educational value and should therefore be prioritized for written chart documentation.

 

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.  Directions for completing this log can be found in the Pediatrics 1 materials section.

 

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 Lauren Rose/Ellen Stevenson (students at Emanuel) or Elroy Jan/Yolanda Domond (students at St.V’s). For further details about overnight call, please see the Clerkship Orientation Manual.

 

FEEDBACK:  

 

Throughout your clerkship, you will be given feedback regarding your performance
from many people – attendings, residents, interns and even other students. In addition, you will be given a set of 10 feedback notecards for you to give to physicians who supervise you performing history and physicals or oral presentations each week. This is designed to give you quick (<1 minute) feedback on-the-fly immediately after you have completed a task. The physician will then give the card back to you for your professional development. Please write your name and the date the feedback was provided on the back, and then all of your cards should be turned in to the clerkship coordinator at the time of the Shelf Exam the last day of the clerkship. 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 also receive formal mid-term feedback from your 2nd or 3rd week ward attending. 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. 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, 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 that 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.
Professional dress is expected, and includes no open-toed shoes, no tank tops, no showing
umbilicus, no T-shirts, no showing underwear or cleavage; men should wear long pants and shirts
with collars (ties optional); women should wear slacks or skirts/dresses, shirts that cover shoulders
and abdomen; white coats are optional, unless you are wearing scrubs and then they are required.

 

Attendance:

It is an unfortunate reality that during your pediatric clerkship some of you may
share the germs that infect your patients. Respiratory and GI germs are the most popular. In the
event you become ill, we do not want you coming to work to spread the wealth. It’s also true,
however, that the Dean’s Office policy of attendance will be enforced during this clerkship. If you
become ill and cannot come to work for any reason, you must notify 3 people: the Clerkship
Director (via email), Trevor Monteith (via phone or email) and either your senior resident or
your attending (via phone conversation, NOT email or text page). It is not acceptable to notify a
fellow classmate. You must also fill out a “Request for Time Off” form, which may be done after
you return to work. Per Dean’s Office rules, we keep track of all missed days and if you are absent
more than 2 days during the academic year, you must make up that time in order to receive your
final grade. Holidays that fall during your clerkship, except in select circumstances, should be
viewed as normal workdays. If you do not receive notification that you will have a particular
holiday off, you should assume you are working and report as usual. Please clarify any confusion
about holiday schedules with your team well in advance.

 

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

    pedstud@ohsu.edu

    Office: 494-3195

    Pager: 16363

     CDRC: 2114D

    8:00am to 4:30pm

    Monday-Friday