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The Children's Hospital at Downstate

Medical Student Pediatric Clerkship 2008

"The patient is the best teacher" – especially in pediatrics. We believe that each patient encounter is chance to learn not only about the presenting illness, but also about normal growth, development, nutrition, and preventive care. To that end, we have kept classroom teaching to a minimum, so that students spend as much time as possible during the 6 all-too brief weeks of the clerkship at the bedside or in the clinic. We place students at a number of clinical sites in the New York City metropolitan area. Although the exact clinical experiences vary according to the site and the student's interest, each student will spend 3 or so weeks in an inpatient pediatric unit, and three weeks in a combination of term baby nursery, well child and specialty clinics, an adolescent medicine clinic, and an acute care service.

While on the inpatient services and the nursery, the student is expected to do the initial, comprehensive history and physical exam, review pertinent medical records, make daily presentations and write-daily progress notes, and speak regularly with the patient and family to keep them updated on the child's progress.

In the outpatient settings, the student will have a number of chances to do most of the history and physical exam on a number of patients, develop his/her own differential diagnosis, and propose a treatment plan. Students are also expected to participate in well child/well adolescent visits, and gain experience in making decisions about screening and counseling families on common pediatric issues.

We have two types of didactic sessions targeted to third year students: a weekly meeting with a group of 3-5 students and an attending preceptor, and a 3 hour weekly lecture/seminar series for all students on the clerkship at that time. The preceptor sessions provide the students with some continuity in their teaching and evaluation. The preceptors are encouraged to do bedside teaching and review clinical skills (oral presentation, progress notes, patient write-ups, literature access and appraisal); the preceptors are also encouraged to do an initial learning needs assessment with each group of students and conduct the sessions accordingly.

Our students have access to a world-class medical library, with over journal 6000 titles available electronically, as well as to the CLIPP (Computer Learning in Pediatrics Program) cases. The department holds regular "Teaching the Teachers" sessions with the faculty and the residents.

The mainstay of student evaluation is the assessment of their clinical work by the residents and attendings. In addition, we give the NBME Pediatric subject exam, and grade a comprehensive patient case report from each student. Students are expected to solicit feedback at the midpoint of the clerkship; we track that this feedback has happened, although we do not track the content (i.e: it is truly formative feedback.)

The Clerkship Director, along with the Assistant Director, is easily available to students and faculty for any problems or questions which arise.

Our students perform at the national average on the NBME subject exam. Over the last several years, 12-15% of our graduating class has chosen a career in pediatrics.