PREFACE

Since the last revision of the APA/COMSEP General Pediatric Clerkship Curriculum revision in 2002, medical student educators have had to respond to a variety of external and internal forces. The first was the ubiquitous implementation of the Accreditation Council Graduate Medical Education (ACGME) Outcomes Project. This document specified that graduate medical education should be grouped around six core competencies; patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. A major effect of the Outcomes Project is that most curricula are now specifically organized around competencies. The second major external influence has been the updating and revision of the Liaison Committee on Medical Education (LCME) Standard number 2 (ED-2). This standard clearly states that each clerkship must identify the types and numbers of patients that must be seen during the clerkship, the level of student involvement in the care of those patients, and the setting in which the care occurs. Moreover, each clerkship must have in place a system to monitor whether students are able to see the required number and types of patients and be able to make corrections during the clerkship experience. This has had an enormous impact on clerkships, as clerkship directors can no longer assume that students will have a broad clinical experience. Finally, many have recognized for some time that the Core Curriculum is quite extensive. The curriculum was originally intended to guide the pediatric curriculum during the entire medical school experience. Nonetheless, clerkship directors have struggled with what competencies to address during their clerkships.

To address these issues a great number of COMSEP members have participated in the revision of the Curriculum. The COMSEP Curriculum and Evaluation Task Forces and the APA Medical Student Education Special Interest Group worked together for over two years to finish the current revision. The Clerkship Directors are deeply indebted to the enormous time and energy these individuals dedicated to the project. A listing of the participants can be found in the Appendix.

The 2005 Curriculum differs from the previous curriculum in several important ways. First, the curriculum has been organized explicitly as a competency based curriculum. While the original chapter heading have been retained, the content has been assigned to knowledge or skills-based competencies. Secondly, each competency in the curriculum has been designated as either a universal (U), core pediatric (CP), or mastery (M) level competency. Competencies designated as universal are not unique to Pediatrics but are generally important throughout the medical school curriculum. For example, many professionalism competencies are universal. Core pediatric competencies are those that are essential and or unique to the Pediatric Clerkship experience and should be emphasized during the pediatric clerkship. Students should be able to demonstrate these competencies by the conclusion of the pediatric clerkship experience. Mastery level competencies are those that might be achieved by students interested in entering the field of Pediatrics by the end of the medical school experience but probably not by the end of the clerkship experience. The third major change is that each chapter may include a section titled process, that is, the type of patient or patients that a medical student should encounter during the Pediatric Clerkship experience. The process section has been included to help clerkship directors design a clinical roadmap and meet the requirement of LCME ED-2. These recommendations have been summarized in "Clinical Encounter Table" which can be found in the appendix. This table specifically addresses not only the types of patients to be seen but also the number, setting, and level of student involvement. Use of this table should help ensure that clerkships meet the standards for ED-2.

As the Curriculum is a long, sprawling document some changes have been made to the layout to facilitate its use. The rationale section has been shortened. The prerequisites sections have been streamlined. The original multiple layers of formatting have been removed and is now standardized using Microsoft Word for Windows. Finally, several appendices have been provided. The appendices include a table of the competencies organized according to the ACGME guidelines and a Clinical Encounter Table of core clinical conditions that should be seen during the clerkship so that Clerkship Directors will have a template to help meet the requirements for LCME ED-2. The appendix also includes a list of core common pediatric symptoms, signs, or laboratory values and their differential diagnosis as well as a list of all the diagnosis in the Curriculum that are labeled as core pediatric or universal.

Consistent with the 1995 Curriculum, the 2005 curriculum is not meant to be prescriptive; rather, it attempts to define a central body pediatric knowledge, skills and attitudes which are the fundamental for a general physician, and to provide clerkship directors with a resource for their teaching. The curriculum content can be expanded or modified for institutions with longer or shorter core clerkships.

• Acquisition of basic knowledge of growth and development (physical, physiologic and psychosocial) and of its clinical application from birth through adolescence.
• Acquisition of the knowledge necessary for the diagnosis and initial management of common pediatric acute and chronic illnesses.
• An understanding of the approach of pediatricians to the health care of children and adolescents.
• An understanding of the influence of family, community and society on the child in health and disease.
• Development of communication skills that will facilitate the clinical interaction with children, adolescents and their families and thus ensure that complete, accurate data are obtained.
• Development of competency in the physical examination of infants, children and adolescents.
• Development of clinical problem-solving skills.
• Development of strategies for health promotion as well as disease and injury prevention.
• Development of the attitudes and professional behaviors appropriate for clinical practice.

Definition of terms used in the document:

Rationale: This section outlines the reasons that a specific topic or clinical issue is included in the curriculum.

Prerequisites: Knowledge of the material in this section is assumed. A student should have acquired the knowledge and developed the skills and attitudes listed in this section before the beginning of the pediatric clerkship

Competencies: The knowledge, skills, or attitudes that students should be able to demonstrate.

Universal (U): a skill, attitude, or behavior not specific to pediatrics that is essential to all aspects of clinical medicine

Core Pediatric (CP): a skill, attitude, or behavior specific to pediatrics and expected of students by the end of the clerkship experience

Mastery (M): a skill, attitude, or behavior specific to pediatrics that is expected of students with advanced training in pediatrics not necessarily during the clerkship experience.

Processes: the types of patients, real or simulated, that a student should see during the clerkship experience