Introduction

How does one define success on the pediatric clerkship? Getting a high grade and performing well on the examination are important. However, it is equally important to focus on personal growth and strive to become a reflective practitioner who is skilled and engaged in continuous learning and self-improvement. This is the ultimate measure of success.

General Overview of Approach to the Clerkship

The six competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice) introduced by the Accreditation Council for Graduate Medical Education (ACGME) describe core areas in medical practice and the skills within each area in general terms. The challenge for students is to focus on the specific competencies, skills, and learning goals that match their learning level within the pediatric clinical training experience. The pediatric clerkship director is responsible for defining, based on national standards,¹ the expectations for what is to be learned; transmitting this information to students and teachers; and providing appropriate learning opportunities. However, the learning process and eventual outcomes will depend on the student’s approach.²

Most students will have a variety of experiences on the pediatric clerkship. The newborn nursery, inpatient service, outpatient, and subspecialty offices and community sites are all common training areas. Students will have to adapt to new clinical expectations and different team structure and work systems several times within a short time period. This can be especially difficult for students who take time to adapt and feel comfortable in new situations. An orientation given at each training site will decrease “newcomer anxiety”; however, it is very important for students to ask about the specific expectations at a new training locale if orientation is inadequate. Asking recent students is helpful; however, interns, residents, and attending physicians may all have different expectations, and a student may have to ask each of these members of the team to clearly transmit his/her expectations.

It is essential for students to present themselves well and to have a good attitude. Studies show that about half of a student’s grade is based on assessment of their nonverbal behaviors³; therefore always be aware of how others might perceive your behavior. The shy, quiet student may be perceived as disinterested and should be sure to behave in ways that dispel this erroneous impression—for example, offering to do research about a patient problem or staying late to help with patient care. Being pushy, very solicitous, and trying too hard to impress are at the other end of the spectrum and are equally undesirable. Aim to be neither underconfident nor overconfident. Try to find and fit into the rhythm of work of your preceptor or team and intellectually, physically, and emotionally help them care for patients. Students who do this not only gain greater personal satisfaction, but also receive more teaching and more clinical opportunities.

It is imperative for students to monitor their progress and ask their teachers to observe them and give them feedback. Without feedback, students evaluate their performance and progress on self-assessment—which is inaccurate at best. Ideally, observation and feedback should be built into the program. If it is not, the student should suggest to the clerkship director that this part of the teaching program be developed.

Now let’s consider the individual competencies and how a student’s approach to learning within these areas will ensure success. Each competency is listed as follows with elements gleaned from the definitions. See Appendix 1 ACGME General Competencies for a complete listing of the competencies and their definitions from the ACGME.

Medical Knowledge

Elements

Investigatory and analytic thinking

Knowledge and application of basic sciences

One model of learning⁴ describes learning in the following terms: “deep,” “strategic,” and “surface.” Deep learning is based on three motivational factors (intrinsic motivation, vocational interest, and personal understanding) and three learning processes (making links across material, searching for a deeper understanding of the material, and looking for general principles). Strategic learning is motivated by a desire to be successful and leads to patchy and variable understanding. Surface learning is motivated by fear of failure and a desire to complete a course, with students tending to rely on learning by rote and focusing on particular tasks.

Studies show that, of all the learning approaches, medical students who are strategic learners score highest on examinations. Deep learners, however, perform well in clinical situations when working with faculty and residents evaluating and managing patients. Therefore a combination of strategic and deep learning is ideal. Always think rigorously and share your knowledge and insights, but do not be afraid to say “I don’t know” or “I do not understand.”