9210 - Acting Internship: Pediatric - Childrens Hospital

Course Prerequisites: N/A

Description: The Pediatric Sub-Internship serves as an opportunity for 4^th year medical students interested in pursuing a career in children’s health or other related fields to gain experience working with a pediatric inpatient team.  The 4-week rotation is offered on one of the inpatient units at Children’s Hospital of Michigan and provides a hands-on experience where students function as interns on their assigned teams.

Objectives: Gain medical knowledge through direct clinical exposure and apply knowledge and skills to more autonomous patient care, with guidance from residents and staff.

A.  Knowledge for Practice

• Utilize appropriate resources to increase their understanding of pediatrics.
  • This may be demonstrated through a formal topic presentation or by reading on a patient who they saw and additional learning opportunities were identified.
  • It is the responsibility of the student to report back on their learning.
  • Assessment:  informal presentations on rounds
• Develop the top 3 most likely differential diagnosis following a clinical encounter based on common pediatric signs and symptoms.
  • Assessment:  Written H&Ps; oral presentation; daily progress notes, transfer notes, discharge summaries

B.  Patient Care

• Demonstrate the ability to gather a pediatric history including the following components:
  • Report on the source of the history and understand the importance of this information
  • Obtain a pertinent HPI and review of systems
  • Review core patient histories (birth, medical, surgical, family)
  • Obtain neonatal, developmental, and age-appropriate social histories
  • Assessment: oral presentations; direct observation; H&P and progress notes
• Perform a physical exam
  • Students should be able to interpret pediatric vitals, growth charts and BMI charts
  • Students should be proficient in the following exam components and able to identify and describe abnormal findings: general appearance, vital signs, head, neck, heart, lungs, abdomen, neurologic, musculoskeletal, integumentary
  • Students should be able to perform the following exam components and sometimes able to identify and describe abnormal findings: eyes, ENT
  • Students should be able to perform a GU exam under supervision and be able to perform Tanner staging
  • Assessment: oral presentations; direct observation; H&P and progress notes
• Recognize a patient requiring urgent or emergent care, inform a senior team member, and explain initial steps to escalated care.
  • Assessment:  direct observation
• Determine when to use basic screening tests and interpret the results.
  • For sick patients, this includes BMP, CBC, urinalysis, blood and fluid cultures,
  • Assessment: oral presentations; H&P and progress notes; direct observation
• Develop basic management plans, including immunizations, medication and fluid management.
  • Students should be able to perform weight-based calculations of bolus and maintenance fluids.
  • Students should be able to select appropriate antibiotics and locate information about weight-based dosing.
  • Students should understand the appropriate medications to treat common childhood diseases, such as otitis media, asthma or constipation.
  • Students should be able to determine recognize the indication for standard procedures in pediatrics, including the risks and benefits for each procedure, including:
    • Lumbar puncture
    • Capillary or arterial blood gas
    • Urethral catherization
    • Central line access
    • Nasogastric tube insertion
    • Tracheal intubation
    • Total parenteral nutrition

C.  Practice-based Learning and Improvement

• Utilize appropriate resources to increase their understanding of pediatrics.
  • This may be demonstrated through a formal topic presentation or by reading on a patient who they saw and additional learning opportunities were identified.
  • It is the responsibility of the student to report back on their learning.
  •  Assessment: informal presentations/assignments

D.  Interpersonal and Communication Skills

• Write an encounter note, such as an H&P or a SOAP note, using appropriate clinical language and format. This may be done in EMR or a Word document.
  •  Assessment: H&P, progress notes, transfer notes, discharge summaries
• Orally present an organized clinical encounter that includes all four “SOAP” components.
  • Assessment:  oral presentations

E.  Professionalism

• Demonstrate professional behavior at all times
  • This includes behavior toward patients and families
  • This includes behavior toward residents and attending physicians, and all members of the inter-professional team
  • Attend all clinical and scheduled events as dictated in the syllabus and schedule
  •  Assessment:  direct observation

D.  Systems-based Practice

E.  Interprofessional Collaboration

• Understand the roles of support staff in the inpatient setting, including nurses, patient care associates, respiratory therapists, occupational and physical therapists, nutritionists, chaplains, patient advocates, etc.

F.  Personal and Professional Development

• Utilize appropriate resources to increase their understanding of pediatrics.
  • This may be demonstrated through a formal topic presentation or by reading on a patient who they saw and additional learning opportunities were identified.
  • It is the responsibility of the student to report back on their learning.

Methods: The Peds Sub-I is available every month for a limited number of students. Students are assigned to a pediatric in-patient service team, either on one of the general inpatient teams, an inpatient specialty team or one of the critical care units.  Each team consists of an Attending Physician, 1-2 Senior Residents, interns, and third-year students. The sub-intern’s level of responsibility is on par with a PL-1 resident and as such involves direct patient care responsibility for hospitalized children. Under the supervision of pediatric senior residents and pediatric attendings, students learn by doing and by example.  As a functioning member of the inpatient team, sub-interns participate in all ward rounds, direct patient care, documentation, procedures, consultations, clinical planning and didactic conferences.  On call responsibilities during the sub-internship are the same as that of the pediatric interns on their respective teams, either a combination of short, long and night shifts or a standard overnight call. Sub-intern schedules adhere to the ACGME duty hour requirements.  As this is an intensive, full-time commitment to patient care as an integral member of the inpatient team, this experience is not to be interrupted by vacations, residency interviews, or unexcused absences. 

The sub-internship begins with an orientation in the afternoon of the first day to review the expectations of the rotation.  Sub-interns will also meet with the Associate Clerkship Director and/or the chief residents midway through the month, and finally have an exit interview on the last day.  They are expected to attend the educational sessions along with the pediatric residents and may have some informal teaching sessions with their teams or the sub-intern faculty. 

Recommended Reading/Resources: Pediatrics In Review, Harriet Lane, Lexicomp, Nelson’s

Length: 1 month; combination of short shifts and long shifts with 2 calls/night shifts

Additional Locations: 5^th and 6^th floor CHM main hospital.

Evaluation: Sub-interns are evaluated by their senior residents and attending physicians.  Evaluations are based on the competencies listed below and are aligned with Enstrustable Professional Activities as set forth by the LCME. New Innovations evaluation. 

Preceptor(s): On-service/rounding attending physician

Category: Acting Internship

Recommended Attire: Scrubs or professional attire, white coat optional

EMR System: Cerner/PowerChart