Pediatrics was my first rotation of 3rd year, and let me tell you -- I was the least excited for this one. I don't have much experience with toddlers or babies and they kind of scared me to be honest. The first week was rough: I picked up a bug from one of the kids at clinic and was profusely vomiting a few days in. Kids carry some nasty germs but it was a solid initiation into the field. That aside, and as time went on, I was really surprised to find that I loved Pediatrics. I loved working with the two ends of the spectrum: the newborns and with adolescents/teenagers. My preceptors let me be really hands on and I was surprised by how interesting I found the cases and how exciting it was to work with so many different sub-specialists (the neonatologists and endocrinologists were my favorite). The rotation lasted one month and I got to work both inpatient and outpatient and LOVED inpatient.
So I guess, rule of thumb - give every rotation about a week before you decide if you like it or not? But regardless, even if you know (or think you know) you don't want to do a certain specialty, keep an open mind and always be engaged and interested, you may completely fall in love with it by the end. I'm a firm believer that you get out of it what you put into it, so if you are engaged and excited, your work will become more engaging and exciting!
Here's a run-down of what my day-to-day schedule looked like:
- 6:00-7:30: Pre-round on newborns in the newborn nursery and patients on the pediatric floor. This included getting a thorough H&P
- 7:30-8:30: Present to attending
- 8:30-12:00: Round on patients with the attending or shadow in the NICU
- 12:00-1:00: Lunch and change from scrubs to business casual
- 1:00-6:00: Outpatient visits (usually Well Child Checks or less acute visits like otitis media, RSV, eczema, bug bites) and shadow pediatric specialists (GI, Endocrine, Surgery, Neuro, Nephro)
- As this was my first rotation, I didn't chart very much and had a hard time getting access to the med rec system for the first few weeks. Sorry I don't have many tips for charting specifically!
Resources used for wards:
Up to Date
Nelsons
Harriet Lane Handbook
Resources used for the shelf exam:
OnlineMedEd
Anki -- didn't use much because of lack of time
Emma Holliday Pediatrics:
Qbanks: UWorld, Comquest, Combank
Or if not enough time, First Aid Step 2 CK (pediatrics section)
Attire:
Outpatient: business casual
Inpatient: scrubs
Optional: white coat (I didn't like to wear it because I think it scared the kiddos)
What to bring:
Stethoscope
Otoscope
Ophthalmoscope
Reflex hammer
ID Badge
Pens
Common cases to read up on and refresh physiology:
Fever
Failure to Thrive
Rashes, eczema, jaundice
Hemangioma, cephalohematoma vs subgaleal
Circumcision techniques
RSV
COVID
Pneumonia
Asthma
Acute abdomen
Gastroenteritis
Know Vaccination schedule and Developmental Milestones
General tips:
It's normal for kids to hate you if they're around 6 months - 1 year old (stranger anxiety)
Start physical exams with cardiopulm and abdominal auscultation. This way you can hear everything you need to before they start crying.
You can use the parents to make exams easier
Social history/questions to ask unique to peds: Developmental milestones, vaccinations, nutrition/diet (breastfed or formula, how many bottles/times), stool/number of diapers, time to feed, TOB use in the home, sick contacts, attending daycare/school, indoor pets, birth history if patient <1yo (can be brief if >1yo)
Newborn Physical Exam checklist:
Sanitize hands, stethoscope, and wear gloves during exam
Start by listening and observing (before they start crying):
General appearance: color, tone, cry, term, respiratory effort (nasal flare)
Listen with both the diaphragm and bell to heart, lungs, abdomen
Check murmur in axilla and between scapula
Use finger to check sucking
How is baby responding? Stretching? Crying?
HEENT: head: sunken or full, check anterior and posterior fontanelle and molding, ear: pits or cracks, facial asymmetry, mouth: lesions, pearls teeth, eyes: red reflex
Neck: cysts, clavicle fractures
Reflexes: Moro, grasping fingers
Palpate abdomen
Brachial and femoral pulses
Labia, testicles, need diaper change? Meconium present?
Knees: Barlow and Ortolani
Feet: creases, Babinski
Back: spinal alignment, dimples
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