PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Students must have completed all M3 Core Clerkships. The Pediatric Sub-internship may replace the Medicine Sub-internship only for students who intend to pursue a residency match in pediatrics.

GOAL:
To facilitate the professional development of the senior student in the area of inpatient pediatrics.

SITES: Advocate Lutheran General Hospital, Hope Children's Hospital, University of Illinois at Chicago 

PURPOSE:
The purpose of the pediatric sub-internship is to provide the M4 student an intense, broad-based pediatric learning experience at the level of a PL1, utilizing direct patient care as the primary learning forum.

OBJECTIVES:

•  Work towards developing history-taking and physical examination skills at the level of a PL1;
•  Recognize and manage common serious pediatric problems at the initial inpatient presentation;
•  Recognize and manage significant changes in the medical status of pediatric inpatients;
•  Recognize the need and arrange for timely subspecialty consultation;
•  Develop an appropriate discharge plan, including outpatient follow-up;

COMPETENCIES:
It is expected that by the end of the four-week experience, the sub-intern will have achieved the following:
1) A moderate level of competency in performance of the age-appropriate pediatric history and physical examination;
2) A moderate level of competency in the complete work-up and management of children with common diagnoses such as asthma, dehydration, neonatal fever, ALTE, pneumonia, bronchiolitis; and
3) A beginner’s level of competency in procedural skills, which may include, but are not limited to, phlebotomy, IV insertion, lumbar puncture, bladder catheterization, and arterial blood gas sampling.

PROCEDURES/TASKS/RESPONSIBILITIES:
1) A maximum of one M4 student will be assigned to each of two inpatient services per four-week period.
2) The pediatric sub-intern will work up an average of four-six new patients per week, all of whom will be presented either at morning report or during team rounds. The team attending will be responsible for providing feedback on sub-intern write-ups.
3) The M4 student will function in the role of a PL1 (intern) and therefore report directly to the team senior resident.
4) The sub-intern will be expected to participate (where appropriate) in all procedures performed on his patients.
5) All patients must have been seen prior to resident/student work rounds.
6) Active participation in work rounds, morning report, attending rounds and conferences is an
expectation. Participation is facilitated by reading on one’s patients’ problems and developing
clinical questions prior to the rounds or conferences.
7) Ongoing feedback of the pediatric sub-intern is the joint responsibility of the senior resident, the team attending, and the site director, and should be actively pursued by the pediatric sub-intern.

INSTRUCTIONAL FEATURES: The Pediatrics Department at UIH offers comprehensive primary and tertiary care to the children of metropolitan Chicago. This translates into a very rich patient experience for the M4 subintern interested in pediatrics as a career.  There are 3 sites for this subinternship: UIH, Hope Children’s Hospital, and Lutheran General Hospital. The M4 subinternship is an inpatient experience. On the inpatient wards, the children are cared for by medical teams, headed by an attending physician and consisting of senior residents, interns, clerkship medical students and one or more subinterns (if assigned). These teams work closely with pediatric nurses, pharmacists and social workers, as well as attendings, residents, medical students and nurse clinicians from the various subspecialties. The subintern functions as a PL1.  The experience of the M4 subintern differs significantly from that of the M3. The subintern is given the privilege of first line responsibility for all patient-care matters relating to their patients. This includes work-up of inpatient admissions, writing orders, performing procedures, coordinating patient care, and developing appropriate discharge/follow-up plans. Methods of instruction vary from prepared lecture to problem-based learning using the tools of evidence-based medicine. The learning venues vary from structured learning sessions to unstructured learning opportunities at the bedside.
AT UIH ONLY: Pediatrics E&M Conference (E&M = evaluation and management): This is a an educational enhancement specifically designed for the M4 student in Pediatrics - a case-based learning session designed to focus on issues that you likely will face as residents.  All students on the Sub-Internship at UIH will gather at 8am every Wednesday of the four week block, in the 5W Pediatrics conference room on the 5th floor of the hospital. 

ASSESSMENT:
The team attending(s) is responsible for providing feedback informally on a frequent basis and formally at the end of the four-week rotation. The evaluation is submitted in writing with input from the senior resident.