Pediatrics Rotation

Can I get a BABY FEVER?! Pediatrics was a hand full but it most definitely stole my heart. The kids were ADORABLE. It was my first rotation, and I am so thankful that it was. I was very lucky to have had this preceptor as an adjunct professor for our pediatrics course during didactic year. It eased my nerves to walk into my first day already knowing my preceptor. On my first day, I simply just shadowed the PA to learn the lay of the land and how he approached each patient. By day two, I was knocking on doors on my own and walking into rooms alone.

I learned an incredible amount every day. My preceptor LOVED to teach, which I greatly appreciated. Our typical week consisted of Monday, Tuesday, Thursday, Friday from about 7:45am-4:45pm…sometimes a little earlier and sometimes a little later. We began our mornings with “sick clinic” from 8-10am. Sick clinic was an opportunity for parents to bring their sick children in without an appointment. It was essentially a temporary urgent care throughout the day. After sick clinic, we would see scheduled patients which ranged from well child visits, med checks, and same-day sick appointments. Personally, I LOVED THE SICK CLINIC. I felt that this is where I saw and learned the most. I also got to use my eyes and ears A LOT which allowed me to improve my clinical skills such as using an otoscope.

Overall impression:

I loved pediatrics. I felt very comfortable in the pediatric setting and I loved working with the kids. Personally, I feel that relieving kids of their medical issues and helping them obtain a great quality of life is very rewarding. Also, watching kids grow and develop is special to me. Yes, there are some kids that just don’t want to give you the time of day and there are some parents that ask a million questions, but every area of medicine has their pros and cons. At this point could I see myself working in pediatrics? Most definitely. I would love to explore pediatrics in an inpatient setting or an emergency setting.

Personal tips for pediatrics:

-       Take time to educate the parents! EDUCATION IS SO IMPORTANT IN PEDS! By educating the parents, we can eliminate complications, confusion at home, and worries. Plus, the appointment is much smoother.

-       Try to learn about your key pediatric medications: Benadryl, Claritin, Tylenol, Ibuprofen, Albuterol, Amoxicillin, Augmentin, Cedfinir (Omnicef), Ceftriaxone (Rocephin). These are the medications we most commonly prescribed to our patients.

-       Take every opportunity to looks in kids ears and mouth. The more we see, the better we will be able to recognize normal from abnormal and eventually make a diagnosis. Also, kids can fight the exam so it will allow you to practice how to handle a difficult child.

-       Be goofy! Have fun with the kids and expand out of your comfort zone. Try making jokes or weird noises. My preceptor would whistle when looking in kids ears to imitate birds in the ears. This eased their experience. Shoot, if I could whistle I would definitely do that too.

-       If you don’t know something, look it up! Harriet-Lane is a fantastic pediatric resource.

-       Want to impress your preceptor? Learn the vaccination schedule! PICMONIC (click for the link) has GREAT mnemonics for each age group that I used to remember the schedule. Also, practice your pediatric dosing!

One of the best pieces of advice I received is: The patient/parents don’t know if they are your first patient or you 1000^th patient, so act like it’s your 1000th time. Walk in with confidence, obtain a detailed history, and do your best to perform a detailed physical exam. Every patient is a learning opportunity.

Vaccines:

Vaccines can be a big controversy in a pediatrics speciality. Throughout my time in pediatrics, we had one patient was anti-government and anti-vaccination. The clinic I rotated at did not allow families to be patients there if they were not willing to vaccinate their children because it put other kids at risk. My biggest tip for anti-vacs is to do your best to educate them. At the end of their day, it is there decision and all you can do is try.

Q&A:

-       What were my strengths and weaknesses throughout the rotation?

o   Strengths: diagnosing ear infections and findings ways to help children grow more comfortable in the office

o   Weakness: identifying ulcers in the posterior oropharynx for herpangina and dermatology. Clinically my weakness was examining the mouth (children LOVE to bite down rather than open up)

-       What did I do when I did not know something or was lost?

o   LOOKED IT UP! I carried Harriet-Lane Handbook with me every day and I always had UpToDate pulled up on my computer. It can also create a good conversation with your preceptor after you are done seeing the patient. Its OKAY to not know something. Rotations is the time to learn and expand our clinical knowledge. Clinical medicine can be VERY different from textbook medicine.

-       How did I handle scared/nervous patients and parents?

o   A medical clinic can be a scary place. It is not always easy to ease patients and you are not always successful in your attempts. I would try to find something to identify with the child. For example, if the child was wearing a batman shirt I would talk to the kid about superheroes. I also tried to find ways to engage the child when I was examining them. For example, I would ask them if they had bunny rabbits in their ears while looking in them.

o   We had a patient that got so worked up that they caused a nosebleed to occur. To me this was wild because I had never heard of this before! In this situation, the nurses helped A LOT to ease the patient and calm them down before being seen.

-       What was your hardest case?

o   Emotionally: It was difficult to see young patients struggling with childhood obesity and depression. I also experienced a case where the parent spoke for a child that was capable for speaking for themselves. This was frustrating for me to deal with because I could see the emotional effects on the child.

o   Clinically: Failure to Thrive and dermatology cases.

-       What helped you with diagnosing rashes?

o   This honestly was my weakest area. There is a big difference between describing a rash during didactic year to clinically visualizing the rash and making a diagnosis. My preceptor was great with diagnosing and treating rashes so this allowed me to learn A LOT. Obtaining a detailed history can be very important in determining the etiology of the rash. Do your best to try and describe the rash to yourself. Is it scaly? Itchy? Well-defined border? Raised? Fluctuant? From there, try to establish a differential diagnosis. At the end of the day if you are unsure, say you don’t know but you will do your best to research it and figure out what it is. Worse come to worse, refer them to dermatology.

End of Rotation Exam (EORs)

To study for my EOR exam, I make a study guide that followed the pediatrics blueprint and topic list. I also used ROSH Review for practice question and a practice exam. To me, ROSH IS WORTH IT. I think it has been SO helpful in EORs. I used resources such as PANCE Prep Pearls, SmartyPance, ROSH Review, and my lecture notes to obtain the material for my study guides. I typically spent the first 2-3 weeks creating my study guide. I spent the last two weeks reviewing the material. I would take my ROSH practice test about a week before my EOR date to see the areas that I needed to focus on. A helpful hint is to try to review a topic per day just to stay on top of information.

➜ Want access to my EOR study guide? Click HERE
➜ PAEA Pediatric Blueprint and Topic List: Click HERE 

*Please notify me if these links do not work

What I Saw:

EENT

-       Otitis Media (Middle Ear Infection)

-       Otitis Externa (Infection of canal)

-       Sinusitis

-       Allergic rhinitis (including allergic shiners!)

-       Bacterial Strep Pharyngitis

-       Bacterial and viral conjunctivitis

-       Epistaxis

-       Oral Candidiasis (Thrush)

Infectious Disease

-       Herpangina

-       Hand-Foot-and-Mouth

-       Erythema Infectiosum (5ths Disease)

-       Lots of viral infections

Gastointestinal

-       Gastroenteritis

-       Constipation

-       Encopresis

-       Gastro-esophageal Reflux (GERD)

-       Breast Feeding Jaundice

Pulmonary

-       Asthma and exacerbations

-       Pneumonia

Dermatology

-       Pityriasis Rosea

-       Tinea Corporis

-       Contact Dermatitis

-       Seborrheic Dermatits

-       Atopic Dermatitis

-       Diaper Dermatitis

-       Impetigo

-       Molluscum Contagiosum

-       Verrucae

-       Acanthosis Nigricans

-       Scarlitiform Rash

Genitourinary

-       Henoch-Sh Purpura (HSP)

-       Acute Cystitis (UTI)

-       Hydrocele

-       Epispadias

-       Cryptochordism

Psych

-       ADHD

-       Depression

Growth & Development

-       Failure to Thrive

-       Teething

Endocrinology

-       Childhood obesity

Cardiology

-       Stills murmur

-       Transposition of the Great Arteries