Clinical skills
Gather an age-appropriate history, perform a focused exam, and interpret growth and development.
Student orientation & expectations
Learn pediatrics
in the flow of care.
A practical guide to well-child care, concise clinical reasoning, age-appropriate communication, and compassionate partnership with children and families.
Primary preceptor: Michael Wheaton, MD
Your week
- Mon
- Dr. Wheaton
- Tue
- Dr. Wheaton
- Wed
- Dr. Borup
- Thu
- Dr. Lyons tentative
- Fri
- Dr. Wheaton
Start here
A busy clinic. An active role.
Visits are typically 10–20 minutes, and teaching happens during patient care. You are not expected to know everything. You are expected to engage, think independently, recognize uncertainty, and ask for help.
Clinical reasoning
Build a focused differential, support your assessment, and propose a safe plan.
Preventive care
Connect screening, immunization, safety, nutrition, and anticipatory guidance.
Communication
Adapt your approach for infants, children, adolescents, and caregivers.
Three questions for every well visit
- Is this child growing and developing appropriately?
- Are there health, developmental, behavioral, or psychosocial concerns?
- What preventive care and anticipatory guidance matter most today?
Graduated participation
Take the next appropriate step.
Your responsibility increases with readiness, patient preference, educational value, and clinic flow. The supervising physician remains responsible for all care.
Observe & participate
Learn workflow, perform portions of the exam, review charts and screening, and identify one learning point.
Focused evaluation
Obtain a focused history and exam, organize key findings, and present your assessment.
Student-led encounter
Conduct a fuller visit, propose an assessment and plan, and practice supervised counseling.
The 60–90 second presentation
Brief, organized, and thoughtful.
OpenAge + reason for visit
HistoryKey context + pertinent findings
FindingsExam, growth + screening
ThinkImpression + focused differential
PlanTreatment, counseling + follow-up
What do you think is happening? What supports it? What would you recommend—and why?
Pediatric pearls
Make each encounter age-appropriate.
Use these prompts as a flexible structure. Begin with the family’s priorities and close the loop on every concern.
Well-child interview
- Concerns: Ask what the child and caregiver most want addressed.
- Sleep: Routine, duration, night waking, environment, snoring, daytime effects.
- Elimination: Stooling, urination, toilet learning, constipation, pain, accidents.
- Oral health: After 12 months, ask about brushing, fluoride, dental care, bedtime feeding.
- Tantrums: At 18 months and older, explore triggers and responses; reinforce calm, consistent limits.
Sick-visit approach
Infants & toddlers
Interview the caregiver. Observe before touching and use a gentle, least-disruptive exam sequence.
Preschool through adolescence
Begin with the child or adolescent, invite caregiver context, complete the exam, and propose an assessment and plan.
Developmental milestone checkpoints
Ask about caregiver concerns, observe the child, review available screening, and discuss every concern with the supervising physician.
2 mo4 mo6 mo9 mo12 mo15 mo18 mo24 mo30 mo36 mo4 yr5 yr
Clinical objectives
Translate the syllabus into patient care.
Open a section for practical minimum-achievement targets and the original University of Washington objective.
Health supervision & anticipatory guidance+
Nutrition & immunization
- Obtain an age-appropriate dietary history.
- Address breastfeeding, solids at about 4–6 months, and supplementation principles in infancy.
- Discuss bottle transition, milk, and sugary drinks in toddlers.
- Promote fruits, vegetables, and limited sugary drinks or highly processed snacks in older children.
- Review immunizations and use evidence-based communication for hesitancy.
Safety
- Address at least two age-appropriate safety risks.
- Include vehicle, sleep, falls, burns, toxins, fire, choking, water, bikes/scooters, and firearms as relevant.
- For toxic exposure, call Poison Control: 1-800-222-1222.
Growth+
- Measure length/height, weight, head circumference when appropriate, and BMI when indicated.
- Use the appropriate standard growth chart and recognize normal and abnormal patterns.
- If a value looks abnormal, repeat the measurement and recheck the plot.
- Interpret growth during every physical examination.
Development & behavior+
Domains
- Psychosocial
- Language
- Physical maturation
- Motor
- Cognitive
Apply it
- Describe a patient-specific observation in each domain.
- Recognize behavioral concerns and psychosocial stressors.
- Perform a developmentally appropriate exam and recognize a sign of puberty when relevant.
Adolescent care+
Interview
- Attempt private time and explain confidentiality and its safety limits.
- Use HEADSS, SSHADESS, or another structured psychosocial history.
- Screen at least two risk-taking behaviors.
Exam & guidance
- Protect privacy, drape appropriately, and use a chaperone when indicated.
- With supervision, assess sexual maturity rating when clinically relevant and describe scoliosis assessment.
- Counsel on nutrition, exercise, sexuality, substance use, mental health, and safety as relevant.
Newborn care+
Ask & guide
- Feeding plan, duration, frequency, volume, urine, stool, jaundice, smoke exposure, and signs of illness.
- Safe sleep, rear-facing car seat, follow-up plan, and at least two reasons to call.
- Use a nonjudgmental approach to feeding decisions.
Verify & examine
- Hepatitis B vaccine, vitamin K, hearing screen, and newborn screen.
- Perform a complete newborn exam using a calm, warm, least-disruptive sequence.
Fluids, electrolytes & medications+
Volume status
- Ask about intake, output, and losses; assess at least two exam findings and one vital sign.
- Calculate maintenance needs; select appropriate fluid components.
- Recognize isotonic 10–20 mL/kg as a common supervised rescue-bolus range and reassess.
- Use appropriate oral rehydration for mild to moderate volume depletion.
Medication safety
- Use weight- or body-surface-area dosing and confirm the adult maximum.
- Specify medication, formulation, dose, route, frequency, duration, and instructions.
- All calculations and orders require preceptor review.
The acutely ill child+
Recognize
- Circulation: rate, pulses, perfusion, capillary refill.
- Breathing: rate, effort, retractions, apnea, cyanosis, fatigue.
- Mental status: interaction, irritability, agitation, somnolence.
- Appearance: tone, cry, strength, color, and overall impression.
Act
- Use age-appropriate vital signs.
- Distinguish acute, urgent, and emergent needs.
- If unstable or concerning, stop routine workflow and involve the supervising physician immediately.
Core clinical reasoning+
- Identify essential features and red flags.
- Explain the expected natural history.
- Stratify the differential: dangerous, common, less likely.
- Formulate an evidence-based diagnostic and therapeutic approach.
- Adapt the presentation, differential, testing, and treatment to age and developmental stage.
A strong day in clinic
Small, repeatable goals.
These are educational targets, not rigid quotas. Patient care, consent, safety, and clinic flow come first.
- Review the schedule and identify learning opportunities.
- Complete at least two focused histories and exams when feasible.
- Present at least two patients with an assessment and proposed plan.
- Interpret a growth chart or developmental screen.
- Participate in supervised counseling.
- Identify one question to review.
- Ask for one thing to keep doing and one thing to change.
- Apply feedback to the next patient.
Keep learning
Practice Pearls
Open Dr. Wheaton’s protected medical education and coding video library.
Open video libraryTake the guide with you.
Download the complete illustrated orientation guide for printing or offline reference.
Download the PDF