Ambulatory Curriculum

George Washington University’s Goals for the MD Curriculum

The MD curriculum must reflect the best thinking of our faculty, as informed by national and international trends and experts. Its goals, which are to facilitate the learning of our students, must be consistent with the expectations of postgraduate medical educators and licensing and accrediting bodies, and responsive to the public trust. In order to achieve these goals, the faculty and students must together establish a mutually supportive learning community-an educational partnership from which both can benefit and to which both must contribute.

The over-arching goal will be the graduation of physicians with the requisite general knowledge, skills, and attitudes to advance to the next stage of their clinical training and to be able to continue to learn and grow as professionals thereafter. Through continued training and focused learning in postgraduate education, they will ultimately acquire the ability to function responsibly and independently as licensed physicians and attain board certification in their chosen specialties. They will be genuinely devoted to caring for their patients in a scientifically competent, compassionate and humane manner; will be committed to following, and if possible contributing to the advancement of, medical science; and in their areas of work, will be able to function successfully in the diverse roles expected of physicians: those of medical expert, scholar, communicator, collaborator, health advocate, manager, and professional.

Clinical Experience - Outpatient

The overall educational goal in the outpatient pediatric setting is for the student to develop history and physical exam skills and the basics of delivering anticipatory guidance, as it relates to the continuing care of the pediatric patient throughout his/her growth and development over time (from birth through adolescence). This includes well child care, health promotion and disease prevention, acute care, and follow up visits.

Clinical Experience (Outpatient) Objectives

Students will...

  • Demonstrate taking effective and appropriately age-oriented histories on newborns, children, and adolescents in the outpatient setting.
  • Perform comprehensive physical exams on children and adolescents and recognize the differing requirements of each.
  • Perform a developmental screening exam
  • Outline the importance of preventive pediatrics; describe how nutrition, environmental influences, safety, immunizations, and anticipatory guidance improve child health.
    • Demonstrate the provision of basic counseling to families with regard to anticipatory guidance and preventative care.
    • Recognize the influence and impact of pathophysiological processes on the growth and development processes of children and how this impacts and is impacted by their family
    • Explain how community resources affect child health.
  • Develop differential diagnoses skills
    • Recognize the significance of signs and symptoms at various ages and classify children as well, mildly ill, or acutely ill.
    • Formulate a clinical assessment and establish diagnostic and therapeutic plans for each problem, in the context of an outpatient setting with continuity of care.
  • Demonstrate responsibility for the initial and follow‑up care of the pediatric outpatient in a longitudinal context
  • Demonstrate the development of humanistic attitudes in dealing with well, acutely ill and chronically ill patient, recognizing the role of the child in the family unit.
  • Identify learning objectives for the outpatient pediatric setting through experience by recognizing gaps in knowledge, skills and attitudes.
    • Establish a pattern of continuous inquiry into the problems of human development, referring to basic texts and current literature.
    • Recognize the role of established research and personal inquiry in advancing pediatric care.

Content: See Ambulatory (Outpatient) Checklist

Procedural Expectations

Procedures for assigning patients to students may vary by site. Typically, after the student has finished evaluating his/her patient, he/she will present to and call in an attending (or resident) who will review and discuss problems, assessment and plans, and recheck physical findings. When the chart is complete (including instruction sheet) and plans for diagnosis, treatment and follow up are implemented and understood by the patient and/or family, the student will sign the chart, and the supervisor will again review and countersign it.

Students will be observed and techniques critiqued using the "Structured Clinical Observation" form (SCO) at least 5 to 6 times during the ambulatory component of the clerkship.

A formal mid-rotation feedback review form will be completed by the student and the attending to assess progress and plan next steps.

Students in CHC/AHC (at CNMC) will follow the conference schedule for this rotation (including “Student Day” on Thursdays).

Charting Expectations

Students should perform and then record a complete history and physical examination in the chart (including descriptions of all pertinent negative findings). For new patients, there is often an “intake” or “initial database” form to be completed. For information on an appropriate history and physical exam on pediatric patients, consult the references listed under the COMSEP Curriculum.

Precepting Procedures

While the student is working in your office please follow these procedures and guidelines:

  • Students will be directly supervised by the attending physician. If an attending is not available, a senior resident or fellow may supervise the student.
  • When a student has finished the evaluation of each patient, he/she will call in an attending (or resident) who will review and discuss problems, assessment and plans, and recheck physical findings.
  • When the chart is complete (including instruction sheet) and plans for diagnosis, treatment and follow up are implemented and understood by the patient and/or family, the student will sign his/her write up, and his/her supervisor will countersign it.
  • Students will be observed and techniques critiqued at least 6 times during the ambulatory component using the "Structured Clinical Observation" (SCO).

Working with Patient Charts

The following can be tailored to your specific office practices.

  • When the student is seeing a scheduled patient, he/she must perform and record a complete database for that area and complete physical examination (including description of all pertinent negative findings).
  • When the student examines a patient whose database forms are not complete, the student will complete those forms.
  • For information on an appropriate history and physical exam on a pediatric patient, consult the references listed under the COMSEP Curriculum.
  • Students should never perform a procedure alone that they have never done before or about which they feel uncomfortable.

Additional Reading

The student is expected to read from a standard pediatric textbook (for example Nelson’s or Oski’s and/or pertinent literature regarding each patient's problems and to report to the preceptor on how this information impacts upon the patient's care. Failure of the student to do this on a consistent basis should be reflected during feedback sessions and ultimately on the final evaluation. For students to demonstrate outstanding performance, they also need to show that they are interpreting, managing, and educating. For further information see Expectations for Honors Level Clinical Performance.

Ambulatory Checklist

The Ambulatory (Outpatient) Checklist document should be used as a guide to direct you to key experiences that the students should have while in your office.