Hello everyone! I’m sorry it has been so long. I finished my third year and things got a bit crazy with board exams. I want to finish off my clerkship review then move on to all the exciting things I have been doing since third year finished! Here I am going to review my pediatric rotation. I loved this rotation and I am happy to say that I am currently applying for a residency in pediatrics 🙂 . This is something that I knew I wanted to specialize in for a long time, but wanted some clinical experience before I made up my mind. I love working with kids, and rotating on this service showed me that I enjoy working with them in a medical capacity too. So here is my review and how to do well on your pediatric clerkship!
Pediatrics is a branch of medicine dealing with infants all the way up to adolescents. It is an interesting dynamic field where your medical knowledge has to change based on the age of the patient you are working with. Pediatrics is unique in many ways, as many of your patients can not communicate how they are feeling or what is wrong. Also, treating a child that is not feeling well is different then interacting with an adult that can reason with you even if they don’t like the outcome. Then there is the unique perspective of development. These little guys are always changing and growing, and although there is a general developmental path they take, every child is different. I really love interacting with kids, I get to have fun at work while ensuring the next generation grows up to be healthy and capable.
Goals and Objectives
My pediatrics rotation was 6 weeks long. This included rotations on inpatient pediatrics, outpatient peds, newborn nursery, pediatric emergency and private clinic. I really enjoyed the dichotomy between inpatient and outpatient. I would see children with more acute illnesses on the inpatient ward, sometimes with complex pathology. This allowed me to use my cognitive abilities, trying to come up with the diagnosis and best treatment strategy. In outpatient I was able to see patients in an appointment alone then write up my own notes. The autonomy was great (don’t worry I had a great attending that would let me do my own thing then come and finish off the appointment with me at the end). This allowed me to see what the day in and day out of general clinical appointments would be like. I learned about normal development, screening and immunization schedules. In newborn nursery I developed my skills in newborn examination, something I had never experienced before. Overall, it was a wonderful experience. I loved the emergency department as I always do. Unfortunately I was down there during flu season and ended up getting really really sick. I tried to work with a face mask but I ended up having to take a few days off, hopefully in the future I will have more exposure to peds ED. Throughout this rotation I focused on honing my medical skills as they apply to children. I would suggest focusing on common pediatric pathology and how to diagnose a patient based off physical exam only.
Path to Success
I find people are usually either interested in peds or not. Some people are good at interacting with children or are hiding on the other side of the room during rounds lol. To succeed in pediatrics you really need to foster a foundation with the child and family you are helping. This would be my first tip, create that treatment relationship so that the family feels comfortable with the care you are providing. Secondly, approach pediatric patients slower then you would adults. Most of them are not feeling well, and are really afraid that something is going to hurt (even just using your stethoscope to do a lung exam). My trick is stickers haha, I also let the child hold my stethoscope and play with it before I examine them. This shows them that its not a threatening object and that I’m someone they can trust. Sometimes they try to eat it lol so wash it between rooms. Lastly, someone told me in pediatrics that there is a big difference between feeling a patients pain and being present to help them through their suffering. It is really hard to watch children who are ill, and it is even harder when they pass away. What I have always told people is that I am there to help my patients and if I wasn’t, the outcome would be worse. Therefore, I am there as a positive force and try not to dwell on immersing myself in the pain of seeing a sick child. I try to gear my empathy towards helping them through their illness, with hopefully a positive result at the end.
The Shelf Exam
The pediatric shelf exam is deceptively difficult. I did well but found this test to be one of the harder ones of third year. I believe this is due to all of the developmental and immunization questions you get. Not only do you have to know the pathophysiology of disease but how it apples to each age group, what normal and abnormal development looks like and the neonatal period as well. I used U World of course, and Board Series Review Pediatrics. Looking back now I wouldn’t suggest this book, it is too long for a 6 week rotation. If you are going into pediatrics I would buy it and go through it during your 4th year. I also made tables for normal development and the vaccine schedule (invaluable and I keep them on me to this day).
What I Would Do Differently
I loved this rotation, there isn’t much I would do differently. The two things I would change, would be the book I used for reference (it was too long) and the short time I spent in the ED when I got sick. But you can’t dictate when you get sick I guess haha. I would like more access to procedural components as well but I believe that will come with time and training.
I am applying only in pediatrics come this residency application season. This should tell you how much I enjoyed the clinical aspect of working with children. I feel they are the future and if we can create a healthy platform for them to develop then we can directly affect the outcome of their lives. Coming up I will have a blog on how to plan your forth year and the rotations that I chose. Currently I am in a Pediatric Neurology rotation and loving the subspecialty! Till next time everyone,