During their fourth year of study, our Albert Einstein College of Medicine medical students complete one core and one selective acting internship. Each of these 4-week acting internships can be completed in the area of pediatrics, and Children’s Hospital at Montefiore Einstein (CHAM) is the main clinical site for this rotation.

OVERALL GOALS OF THE PEDIATRIC ACTING INTERNSHIP

The Pediatric Acting Internship seeks to build on the experience gained from the Clerkship in Pediatrics by transitioning students from a primarily observational role to that of the primary and responsible caretaker for inpatients at CHAM. The overall goals are:

• To improve and refine students’ clinical and interpersonal skills by allowing increased independence, with supervision, in evaluating patients, developing management plans, working as part of a healthcare team and interacting closely with families
• To increase knowledge of general and specialty inpatient pediatric illnesses
• To prepare students for the emotional, physical and clinical challenges of internship

These goals are accomplished by placing the student in a role that completely substitutes that of the intern, yet under close and careful supervision by house staff and attendings. The education of the acting intern is largely based on hands-on experience. Therefore, students will be expected to participate in intern-level duties, including admission, management and discharge of pediatric patients, note and order writing, presentations on rounds, night float, cross-coverage and sign-out. Nurses, social workers, other house staff and attendings will consider the acting intern as the primary medical provider for his/her patients.

PEDIATRICS ACTING INTERNSHIP OBJECTIVES

• Independently perform developmentally appropriate histories and physical examinations which are both focused and comprehensive.
• Describe the epidemiology, pathophysiology and clinical findings of common pediatric conditions that require hospitalization. Identify criteria for admission to and discharge from the hospital.
• Synthesize information to formulate a differential and primary diagnosis based on an assessment of history, exam and diagnostic testing.
• Develop a patient-/family-centered, comprehensive, structurally competent and evidence-based diagnostic and treatment plan that includes consideration of discharge criteria.
• Describe how age and development influence clinical findings and the epidemiology of common conditions, as well as variations in laboratory results and vital signs.
• Reassess patients continuously to triage acute problems from less urgent ones and modify primary diagnosis/differential based on an interpretation of clinical status and diagnostic studies.
• Describe signs and symptoms that suggest deterioration (including signs of shock and respiratory failure) and require the immediate attention of a supervising physician and the escalation of care or improvement of patient’s clinical condition.
• Choose appropriate medications/fluids for common pediatric conditions. Calculate doses and customize fluids based on patient-specific characteristics.
• Demonstrate interpersonal and written communication skills that result in effective information exchange and collaboration with patients and their families across diverse socioeconomic and cultural backgrounds. Recognize situations when interpreter services are needed.
• Demonstrate interpersonal and written communication skills that result in effective information exchange and collaboration with all members of the healthcare team. Deliver organized, focused and accurate oral presentations. Write organized, appropriately focused and accurate patient notes. Convey concise, pertinent information at hand-off. Frame question for consultant and communicate patient information and question effectively.
• Display integrity, respect, accountability, ethical behavior and sensitivity to diversity when interacting with all members of the healthcare team, patients and their families.
• Demonstrate self-directed learning in daily practice, including active reading about common pediatric conditions, application of evidence-based medicine to patient care and education of patients, families and the healthcare team. Solicit and incorporate feedback to improve your practice.