INPATIENT ROTATION

The student is expected to obtain a complete data base (history, physical examination) on all patients admitted by the intern.  If the patient is not acutely ill, the student should be allowed to obtain the initial history and perform the first physical examination.  Oftentimes, interns and students have found it productive to work jointly in obtaining the initial information; the method is left to your discretion.  The student is expected to turn in to the student attending a comprehensive write-up on at least three patients per week. (Minimum total of write-ups: 6 for the 3 week in-patient rotation.)  A copy of the write-up is to be made and given to the Student Attending.  Copies can be made by the clerkship coordinator at UMC or, at TMC, a copy machine is available in the library.  The original write-up is to go into the patient's medical record.  The write-up should be completed within 24 hours of the admission.  These write-ups are to be tracked online at http://clerkships.med.arizona.edu/pediatrics/admin/menu.cfm. These logs must be submitted on a weekly basis.

At the beginning of the inpatient rotation, the student will be oriented to the wards by the Chief Resident or Senior Resident on the ward.

The student is responsible for making morning work rounds with the housestaff and for knowing the status of each of the assigned patients.  The student is expected to participate in attending rounds and should present a minimum of one new admission following the night he/she is on call, plus status reports on the other patients.

The student is expected to write daily progress notes on his patients and should have these countersigned by the intern.  The student is expected to make daily sign out rounds as well.  The student is expected to know all patients admitted to the wards.  Although he/she need not write H&Ps on all of the patients, the patients might well be used during the attending's problem solving sessions.

House officers are expected to notify the student on call for every admission to the service.

A.   Responsibilities of PL-1s

The PL-1 should serve as a role model for the students, reviewing and/or supervising their interviews and comparing physical examination findings.  PL-1s should co-sign and supplement the student's daily progress notes and chart orders and discuss patient management.

B.  Responsibilities of PL-2s, 3s 4

PL-3s and PL-2s are expected to assist the PL-1s with their responsibilities to students as listed above.  They are to teach physical examination skills by demonstration of findings on patients; help students complete required tasks, such as behavior counseling, poison counseling; provide mini-lectures (as time permits) covering common problems in Pediatrics and emergency Pediatrics; critique the student's case presentations on rounds, especially problem-solving ability; provide supplemental references; and supervise student's performance of procedures.

C. Responsibilities of Student Attending

1.The student attending will review, correct, and discuss each of the student's write-ups and provide feedback regarding areas that warrant improvement.  The original write-ups are to become part of the patient's medical record.  A copy of the write-up is to be reviewed and returned to the student in a timely manner (24-48 hours).

2. In addition, the student attending is responsible for spending a minimum of three hours per week in problem-solving sessions, discussions, review of physical findings, etc. with the students during which they can focus on the differential diagnosis and work-up of actual patients in greater depth than may be possible during regular rounds.  The preceptor is given latitude in the manner in which these sessions are conducted, but at least one hour per week should be "at the bedside" reviewing physical findings, demonstrating interview skills, etc.  The preceptor is expected to check each student at least once doing a physical examination.

3.The student attending is responsible for dictating a narrative summary of the student's performance including comments on history-taking, physical examination, knowledge base, problem-solving skills, professional attitude, relationships with staff and patients, major strengths and weaknesses, etc., based on his impression as well as those of the faculty, staff and residents with whom the student has worked.  At UMC, the student attending will compose a composite evaluation with input from the ward attending.  (The ward attending will be responsible for forwarding information to the student attending.)  At TMC, the student attending will compose a similar evaluation.  The housestaff will complete an evaluation independently.  The intern with whom the student has worked the most will write up the evaluation with input from the resident(s).

It is important to keep the students informed of their progress throughout the rotation and to offer assistance and remediation if necessary.  This includes giving the student feedback and constructive criticism regarding write-ups, examination, case presentations, critical thinking and attitude on a regular basis throughout your contact. 

The student attending will be responsible to give to the student a verbal mid-segment evaluation about 10 days into the rotation.