The Pediatric Clerkship

What Does the Pediatric Clerkship Emphasize?

The pediatric clerkship emphasizes human growth and development, common clinical problems, uncommon but important disease processes, prevention of illness, and promotion of health. You will participate in clinical activities that take place in outpatient and inpatient services and that are supervised by both general pediatricians and subspecialists. Many clerkships also provide the opportunity to work with community-based pediatricians in practices outside the medical center. More than 90% of the pediatric clerkships in the United States are based on the Council on Medical Student Education in Pediatrics (COMSEP) General Pediatric Clerkship Curriculum (http://comsep.org). This book is also based on that curriculum.

How Should I Approach the Pediatric Clerkship?

Your career plans may not include a primary focus on children, but you are likely to use skills that you gain from the pediatric clerkship to interact with ill and healthy children in both your professional and personal lives. Enthusiasm, a commitment to learning, and dedication to the well-being of your patients will be crucial to your success. Time and perseverance will provide the experiences that will eventually help you achieve competency beyond your initial expectations. If you make the effort, you will develop an ability to interact successfully with infants, children, and adolescents (and their parents).

How Should I Assess My Readiness for the Clerkship?

At the start of the clerkship, take an inventory of your competency with the basic medical interview, the general physical examination, and clinical decision making, because these are the foundations for pediatric-focused skills. “Real world” experiences with healthy children, such as being a baby-sitter, lifeguard, coach, camp counselor, teacher, sibling, aunt, uncle, or parent, will give you a perspective on the patients and families with whom you will work. Clinically focused experiences with children (e.g., as an emergency medical technician or a laboratory technician) will complement the clinical skills that you will be expected to master in the clerkship. Use the clerkship objectives and a table of core clinical experiences (such as the one in Table 1-1) to make a self-assessment of your pediatric-specific knowledge and your experiences with pediatric clinical problems (e.g., none, some, a lot).

How Can I Learn Most Effectively on the Clerkship?

This text and others can assist you to expand knowledge. A list of core pediatric experiences such as the one developed by COMSEP (Table 1-1) can be used to ensure that your clinical encounters are comprehensive. Your clerkship is likely to have a specific list of core experiences in the handbook or on the Web site. The Computer-assisted Learning in Pediatrics Program (CLIPP: http://clippcases.org) is based on the COMSEP Curriculum and provides Web-based virtual clinical experiences to aid learning and to supplement clinical encounters.

What Clinical Skills Are the Most Difficult to Master?

To some extent, the challenges that you will face depend on your prior experiences with children and their medical care. Almost all medical students have at least some anxiety about examining children, especially newborns and toddlers. Often, students worry that they will be “exposed” as lacking in experience or ability, even if they feel quite confident about their clinical skills with adults. Many students express concern that they might frighten or hurt a young child because they lack experience with examination techniques. To adapt your skills to young patients, you may find it necessary to relearn the medical interview and the physical examination. Vital signs, laboratory tests, and imaging studies also must be interpreted taking age and development into account. Many of the reference (“normal”) values for children depend on variables such as gestational age, size, muscle mass, and pubertal stage. Do not accept “normal” without checking its relevance to your specific patient.

What Resources Should I Have on Hand?

The clerkship director will likely provide suggestions for reading and also may have developed a clerkship Web site with links to good review articles and reputable print and electronic resources. Your medical library may provide access to MDConsult, Access Medicine, InformationRetriever, and a MEDLINE search engine such as Ovid, PubMed, or Grateful Med. General medical journals such as the New England Journal of Medicine and JAMA often have review articles about pediatric topics. Table 1-2 lists a sample of pediatric journals and online resources. You will benefit from access to a compendium of child-specific information, such as The Harriet Lane Handbook and the Red Book of the American Academy of Pediatrics, both of which are available in print and electronic versions. Handheld devices can provide access to many resources, including medication compendia, growth charts, immunization schedules, and many texts (Table 1-3). Numerous Web sites provide medical resources for handheld devices, both free and commercial. Some medical centers have placed formularies, laboratory data, and other resources into electronic databases that are accessible by computer or can be downloaded into handheld devices.

Table 1-2 Pediatric Resources

Table 1-3 Software for Handheld Devices

KEY POINTS