Expectations

	Learn about Pediatrics.  You will need to know some pediatric medicine to pass each step of the USMLE regardless of your future specialty.  And your family and friends will ask your advice regarding their children!
	Participate in the care of your patients.  You will get out of this rotation what you put into it.
	Teamwork is essential!  Work with the nurses, consultants, ancillary staff, etc. to make every patient’s care what you would expect for your child or family member.  The nurses’ station is for the nurses.  Please respect their space; they respect ours.
	Enjoy your time with us.  Kids are fun!  Play with them.  But no white coats or medical equipment in the Playroom, please.
	Professionalism.  No food or drinks at the nurses’ station, in the hallways, or in the patients’ rooms (“patient care areas” is how OSHA words it). If parents ask students medical questions that they feel uncomfortable answering, they should defer these questions to the residents/interns or attending.  Other than on rounds, patients and their diagnoses should not be discussed in public.  Remember to respect your patient’s privacy and to be courteous and polite at all times.

Grading

	10% of your total Pediatrics grade comes from your clinical performance  evaluated in My Evaluations by the attending(s) and the resident on your team.
	10% of your total Pediatrics grade comes from your score on the Ward Quiz.
	10% of your total Pediatrics grade comes from your write ups.

Division into two teams

	Students will be assigned to one of two ward teams: Green Team or Red Team.
	Each ward team consists of one full-time ward attending, an upper level pediatric resident, 1-4 interns/acting intern, plus 3-5 students.

 (Ward Assignments At-a-Glance is on the Assignments page)

	8am :  Morning report or lecture.  Nighttime check out to immediately follow.  Usually in room 5-333.
	10am :  Attending rounds
	11am on Tuesdays:  Professor’s Rounds with Dr. Bocchini
	12pm :  Mandatory noon conference
	1:30pm on Wednesdays:  Mandatory conferences
	4pm :  Afternoon checkout rounds
	8pm :  Nighttime checkout rounds
	During the day and when on call, students are expected to be readily accessible to the pediatric housestaff and assist them in patient care. If the ward is quiet, students should use that time to their best advantage. (i.e. reading about your patients' diagnoses).

What do I do when I get to the ward?

	SEE PATIENT:  No excuses will be accepted on rounds!
	Check orders over the last 24hrs:  This is one way to know what happened to your patients since you left yesterday.
	Check labs (Place on lab flow sheet):  Be able to interpret them on rounds.
	Check X-rays:  look at the x-rays as well as listen to the dictations
	Check Medication Administration Record (MAR):  These are now located in Invision.  Know what medications your patients are taking.  If they have PRN medications but aren’t using them, they need to be discontinued.  If pain medications have been automatically discontinued, do they need to be reordered?
	Review nurses’ notes.
	Write daily SOAP notes to include the usual “SOAP information” as well as the following:  summary of what has happened over the last 24 hours current medications dosage including mg/kg/day ÷ every _?_ hours frequency (especially for PRN orders) Day # or dose # if on antibiotics or something that will be given for a specific time period “See lab flow sheet” if new labs are on the flow sheet or “no new labs” if nothing was done culture results x-ray and other test results anything else pertinent to the care of the patient Students must have their progress notes co-signed by an MD.
	If a patient is to be discharged, the student should write a discharge summary note in the chart.  Small paragraph summarizing the patient’s initial history and presentation, diagnosis, management, pertinent lab results, culture results, and therapy (antibiotics, IV fluids, etc), as well as a list of all discharge diagnoses and discharge medications. Follow-up should also be included and should state what clinic or to whom the patient will return, as well as the purpose of the return visit (i.e. General Peds Clinic in 2 weeks for repeat CXR)  Interns are responsible for dictating discharge summaries, not students.

What do I need for Rounds?

	Students are expected to present their patients to the attending and answer any questions regarding the patients or their conditions. A more detailed history may be necessary for new patients.
	Calculator:  Everything is dosed in mg/kg in pediatrics.
	Labs:  Be able to interpret them
	T-Max for 24hrs/Vital signs:  Be able to interpret them
	In’s and Out’s:  Be able to interpret them Babies should also have cc/kg/day and cal/kg/day calculated every day
	Order Sheets: Extras in case orders need to be written on rounds
	Consult Sheets:  Extras in case consults need to be written on rounds
	Harriet Lane Handbook
	Assessments and Plans:  These do not need to be written prior to rounds, but you need to have an assessment and plan for each of your patients to discuss on rounds.  Make sure your daily notes reflect what was discussed on rounds.  Use addendums.  No patient should have “discuss with team and/or attending” as the plan.  If you write this, make sure you go back and write what was discussed in an addendum.

Write Ups

	Students must submit three (3) ADMIT written history and physicals to their ward attending before the end of the ward rotation.
	These must be done when a patient is 1st admitted.
	Place the completed admit H&P on the patient's chart within 24 hours of the admit.
	Xerox each write-up  (including completed growth chart) and turn it in to your attending.  (Have Peds front office secretaries in med school on 5th floor 5-303 make the Xerox copy for you. DO NOT HAVE OR ASK THE WARD PERSONNEL for help with this.  DO NOT use the fax machine!!) Print your name at the top of the 1st sheet and staple it before turning it in to your attending.
	You are required to turn in one write-up per week, the 1st three weeks of the rotation.
	Good vs. Bad Patients (Historian vs. Chart):  A good HPI is obtained by talking to the patient and/or care-giver.  If nobody is present to talk to or you can’t get any useful information out of them, then that’s a “BAD patient” to write up.  The chart should only be used to supplement what the informant has already told you.  It is not the sole source for your history.  “Protocol” patients should not be used.  They have no true chief complaint and therefore, no true HPI to obtain.
	Use the Pediatric History and Physical format in your handbook that you received at the beginning of this year.
	Differential Diagnoses must be included in your assessment.
	The 1st and 2nd H&P will be critiqued heavily.  The grading on these 2 will be Pass/Fail.
	The 3rd H&P will be graded as follows: 25%:  History of Present Illness 25%:  Other history 25%:  Physical Exam including lab, x-rays, tests and the interpretations of these 25%:  Assessment with differential diagnoses and plan  (Note:  a 2 word assessment and 2 line plan are not worth 25% of your grade and will be graded accordingly) Evaluation form is in My Evaluations
	Allow the ward attending time to provide feedback before turning in the next write-up.  This will prevent you from making the same mistakes repeatedly.
	The student must turn-in all write-ups by the end of their ward rotation. Ward attendings are under no obligation to grade assignments submitted to them after the last day of the student's pediatric ward rotation. Students will be given a zero for all assignments submitted after 5 PM on the last day of the 4-week inpatient portion of the rotation.

I'm On Call?

	Students are required to take daily night call, including weekends.
	The schedule is on the bulletin board in the team room on 5J, each student receives a copy via email before the beginning of the 8-week rotation, and each student receives a copy in the orientation packet on the 1st day of the 8-week rotation.
	Each student will be on call one Friday, one Saturday, one Sunday and 2 weekdays during the 4-week ward rotation.  Call should be no closer together than every 3rd night.  (Exceptions may occur.)
	Call starts at 4:00 pm with check-out rounds on 5J until 8:00 am the following morning, M-F.  If you are on call Sunday-Thursday, you are expected to participate in all daily activities (until 4PM check-out rounds) the next day (M-F).
	Weekend call is from 8:00am until rounds are finished the next morning.  Students on call on weekends should be ready to round at 8 AM.  All patients must have a student and resident note written in the chart before rounds.
	If your name is not on the call schedule for Fri., Sat., or Sun., then you are off for the weekend.
	Call rooms are available on the 9th floor of the hospital.
	Students are required to participate in each admission when on call, assist housestaff and participate in performing procedures.  You may use your personal pager, as long as you let the intern and resident know how to get in touch with you.
	You may switch call amongst yourselves as long as you switch a weekday call ( M-F) for a weekday call or a weekend call for a weekend call (weekend call is Sat & Sun).  Please note any changes on the call schedule posted in the 5J dictation room.
	You are not allowed to be on-call 2 or more consecutive days in a row.