Seattle, Washington
3rd Year Clerkship - (Peds 665 P)

Inpatient Ward (also see the document on Expectations for Medical Students on the Inpatient Ward Teams in your orientation manual)

Usual Schedule

Expectations
Work up and admit 1-2 patients when you are on call (q 4th night). Follow at least 2-3 patients at any given time (present on work rounds, write daily progress notes, function as primary provider). If you write orders, please be sure intern or resident co-signs (CPOE).

Curriculum
The pediatric curriculum is a series of 27 cases you received. They are intended to stimulate reading and foster discussion. Some are computerized (CLIPP).

Hints for a successful clerkship:

Think through your own learning objectives. We want you to assume as much of the care as you are willing or able to. Learn and care about your patients. Be assertive--make the most of this opportunity!

1. “Pre-round” on your patients, come in 30 minutes-1 hour before rounds start. Rounds are at 8:30am. Be on time.

   Check the chart for (and be ready to present this information):

   • weight, with change from previous day
   • vital signs: range for T, HR, RR, BP
   • ins and outs (ins as cc/kg/day and as % of maintenance: outs as cc/kg/hour and # of stools)
   • nurses’ notes for significant events
   • resp parameters: oxygen required, oxygen saturation
   • orders/notes from the cross-covering intern written overnight
   • consults or attending notes, if PMD contacted

   Check the medication listing in the computerized medical record.

   Briefly examine the patient:

   • heart, lungs, abdomen or any other pertinent organ systems

   Check the computer for lab results.

2. Read about your patients in any standard pediatric text. Look up clinical entities with which you are unfamiliar (if uncertain, ask us what to read about). Think about differential diagnosis and treatment plan.
3. Conduct of work rounds: the team will meet in the conference room and then walk to the rooms of all “house” patients. Stay with your resident for walk-rounds during which progress reports on each patient and a discussion of the current plan are expected. You will also participate in rounds with subspecialty attendings.
4. Presenting on rounds:

   a. For new patients: summarize the pertinent HPI, PMH, EXAM and LAB findings, assessment and plan. Your presentation should be 3-4 minutes long.

   b. For patients already on your team that you have been following (1-2 minute presentation):

   • Begin: “This is hospital day number 4; day 4 of ceftriaxone, for 2 year old Johnny Smith hospitalized for pneumococcal pneumonia.”
     • Patient’s primary problem and significant changes over the last 24 hours
     • Weight, vitals, exam
     • Lab data
     • YOUR assessment and plan – it doesn’t have to be right but we want to know your plan.
5. Admissions: Initially you may sit in while the intern conducts a history and exam; later you should carry out the H&P yourself. An intern or resident may accompany you to minimize the number of times a child and parent is queried.

   Your write up should include formal HPI, PH, FH, SH, ROS and exam, including a brief developmental assessment and your overall assessment and problem-oriented plan. An example of the complete pediatric database is available in your orientation packet and on the clerkship website. If the patient has had multiple previous admissions, review the information gathered by your predecessors and summarize it, verifying key points with the parents but not re-gathering the data previously documented.

   A written H&P should be on the chart within 6 hours. If you cannot produce one in that time, your intern or resident will write one. Ask the resident to read, critique and sign your completed write-up. Turn in a photocopy of your H&P to your attending to critique.

   Write the admission orders on CPOE. ALL MEDICATIONS MUST BE ORDERED AS A DOSE AND AS DOSE PER KG PER DAY (e.g., for a 12kg child order Ampicillin 600mg IV q6°=200 mg/kg/day).

   Be prepared to present the patient on rounds the next morning. This presentation should be 3-4 minutes long.

6. Fluids: maintenance is 0-10kg 100 cc/kg/d, then 11-20 kg 50 cc/kg/d, then each additional kg 20 cc/kg/d.
7. Don’t hesitate to ask “stupid” questions: If you feel uncomfortable doing something, speak up. If a patient or situation pulls at your heartstrings in a sad or painful way, talk to one of us about it – if something unpredictable comes up and you can’t fulfill your responsibilities, just let us know; we’ll work it out with you.
8. FAQ Where is …?
   
   

   Cafeteria	5th floor
   Radiology Reading Room	4th floor; or “satellite” beside ER
   ER	4th floor
   Lab	6th floor, Pavilion
   Library	6th floor, Whale

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