I felt a bit more prepared for the peds shelf than I’d felt for the surgery shelf. Part of this is due to the better hours during this rotation. In addition, the teaching that the house staff did with me on occasion actually helped me study. I remained fairly focused during this test, and although I still found it quite difficult, I walked away confident that I’d done at least a little bit better this time around.
Admittedly, I was once again a bit ambitious where my study schedule was concerned. I often became frustrated with myself when I got behind on work. I felt like I was still struggling under the pressure of my obligations (and my surgery evaluations), despite supposedly having “more time” on this rotation. I realized that I’m basically working full-time (without pay) and going to school (i.e. studying for exams when I’m not “at work”). I wondered–still wonder–how my classmates seem to have more time than me, how they’re able to be social and still get all of their work done. I’m trying not to think too much about all of this, but it’s sometimes hard to overcome the temptation to dwell on it. I digress. I’m learning my lesson about study plans and the like; for the rotations to come, I’m going to try to be a little more relaxed about all of this.
Anyway, here are the books I used for this rotation and my opinions of them:
- Blueprints for Peds: decent for an overview of topics in peds, although since it’s in prose format it’s hard to get through. Took me forever to finish it.
- Casefiles for Peds: 60 cases with information about aspects of workup for different diagnoses, as well as comprehension questions at the end of each chapter. A welcome change from Blueprints.
- First Aid for Peds: this book was easier to get through than Blueprints since it’s in outline form, but it was still fairly dense.
- UWorld QBank: as usual, a must-have. I went through all of the peds questions at least twice.
- Pretest for Peds: the Pretest books consist of hundreds of questions in a format similar to the shelf/step 2 exams. I wanted to get through this one before the exam, but I only went through like 50 out of 500 questions the morning of the exam.
Like I said before, hopefully my evaluations will look a bit better for this rotation; I have high hopes. Anyway, it’s almost midnight here, and I have orientation for the 4-week Psychiatry rotation tomorrow. I should get to bed, but as usual, feel free to hit me up with any questions or comments.
For the peds rotation proper, I spent 2 weeks in the NICU, 2 weeks in Vandy’s acute outpatient clinic, a week on one of the general inpatient teams, and a week in the newborn nursery. I think I might be able to put all of my highlights from this rotation in a single post this time.
- I really enjoyed being in the NICU. I rounded with the two residents, the NICU fellow, and the attending physician, as well as the NICU nurse practitioners. Most of the babies in the part of the NICU I worked in had issues such as prematurity or respiratory distress syndrome. I liked the fairly structured environment; we presented patients in a very particular format on rounds, and there were a number of protocols to abide by when determining plans for each baby. I also accompanied the team for deliveries and c-sections, so I feel like I got a bit of OB/GYN experience too.
- On outpatient peds, I saw tons of kids with fevers, runny noses, and rashes, but I also got to see a few less conventional cases: for example, a kid presenting with abdominal pain, diarrhea, and weight loss; and another child who complained of horrible leg pain with no apparent cause. Some days, I didn’t get to see many patients because the majority were not English-speaking, but on others–like the “Residents’ Day Out” when the majority of the physician workforce was off for the day–I was constantly moving from 8:30 am until the early evening. No matter what, the house-staff were always willing to teach, even if it was a busy day in clinic; I felt that I was studying even when I wasn’t actually “hitting the books.”
- I was assigned to an inpatient team that, unlike other teams, admitted patients from private clinics and from Vandy’s acute care clinic. The Vandy attending would come in to round on her patients, and an attending from another hospital would also be there in the morning to see his patients, but I never met the attendings from the private facilities because they came in to round on their patients later in the afternoon and were mainly updated on patients’ progress by phone. This team also had no interns, so upper-level residents put in all the orders and made all of the phone calls after rounds. Because of the nature of this team, I was able to receive more responsibility; during that week, I pre-rounded on 2 or 3 patients at a time, accompanied the Vandy attending on mid-morning rounds, wrote progress notes, updated the team periodically throughout the day, and even made phone calls to other parts of the hospital. On this part of the rotation, I definitely felt like “part of the team,” able to contribute to patient care instead of just standing around.
- During my last week on pediatrics, I spent 3 of my mornings in the newborn nursery with 3 other students. Our basic task there was to learn how to do a head-to-toe physical exam on a newborn–checking normal newborn reflexes, listening for heart murmurs, making sure there were no deformities such as dislocated hips or fractured clavicles, etc–and present our findings to the rest of the team.
- The 4th morning of our last week, we rounded with the NICU team in the Children’s Hospital. This was not the same unit that I spent 2 weeks in; in the VCH NICU, many of the babies have more complex syndromes or have required surgical intervention–in fact, some of them spend many months on the unit instead of going home soon after birth. We only spent a few hours there, but I feel like we learned a lot from the experience–especially since one of the attendings stole us from the team and taught us all about the causes for cyanosis in newborns!
That pretty much sums up the rotation. At some point during this 6 week stretch, I realized that the majority of kids that I had taken care of had been under the age of 1 year. I keep wondering if this is a sign that I’m going to end up doing neonatology. As a matter of fact, my interest in the medical field first became a reality in the 9th grade, when I did a report on infant mortality. It’ll be interesting to see if this focus on babies will come full circle in the end–for now, I’ll just say that I will miss working in the Children’s Hospital.
For my first two weeks of “pediatrics,” I participated in a brand-new elective called “The Electronically Engaged Pediatric Family Consult.” This elective explores the potential uses for informatics and electronic resources in bettering patient care. I accompanied a number of physicians over the course of the two weeks–one physician in pediatric surgery clinic, one on a general inpatient team, and a few in the NICU.
As part of my duties on this elective, I signed some patients’ parents up for the My Health at Vanderbilt online portal so that they can communicate with care providers, see lab results, and access other features that may facilitate their child’s care. I also interviewed some parents in an effort to identify resources such as apps and websites that they might be able to use in various aspects of managing their children’s conditions. For example, I found some websites, forums, and social media groups that might be useful for the family of a child with juvenile idiopathic arthritis–I also found a “pain diary” app that could help the child characterize her symptoms for her care providers. The whole process of interviewing families, finding resources, and proposing solutions in person and on paper was quite rewarding; I became really close with the mother of one particular patient and through multiple conversations had the opportunity to learn about her fears and frustrations in dealing with her daughter’s diagnosis. The girl was discharged from the hospital not too long ago, so I’ve sadly lost contact with the mom for now, but I still think about that family quite a bit.
All told, this was a great elective. I not only got to get a head-start on what inpatient peds might be like but also realized an interest in informatics that I hadn’t noticed before. In fact, I asked the course director to be my mentor for the research requirement I’ll be completing in early 2015.
You know what this post means…I’m done with another rotation, and now I’m going to tell you all about it!! I did 2 weeks on an elective (not directly related to the rotation), 2 weeks on a pediatric subspecialty, 2 weeks in outpatient clinic, 1 week on an inpatient general pediatrics team, and 1 week in the newborn nursery.
I loved peds. I came in to med school thinking that I wanted to be some sort of pediatrician. After this rotation, after the sadness of chronically sick kids and the frustration of screaming babies who refuse to be examined, I haven’t been scared away. I don’t know if it’s what I’ll end up doing, but it’s definitely still an option.
Here’s what pediatrics looks like at Vandy:
- If you’re on inpatient, you usually show up around 6am to hear the resident who was on call for the night “sign out” to the resident who’s on call for that day, relaying any lab results, acute events, or other pertinent information about the patients. Then, before “morning report” starts at 7:45, you pre-round on your patients. If you’re on outpatient at Vandy, you go to morning report and then show up for your clinical duties. If you’re doing something off campus, you’re usually not required to go to morning report first.
- At 7:45, there’s typically some sort of conference for students to attend. Sometimes the med students meet together with the clerkship directors and discuss interesting cases. Other times we join the residents for their conferences, or for Grand Rounds where a guest lecturer gives a presentation.
- Around 8:30, students on inpatient rejoin whatever team they’re on to present patients on rounds. Rounds take a bit longer than on surgery, especially if family members are present, because the team discusses the plan for the patient by systems (neuro, cardiovascular, etc) and the attending briefly examines the child and updates the family on his/her progress. Sometimes, medical students will have tasks to complete after rounds, like calling radiology for a report on an MRI, or asking a nurse to page the team if a family member comes to see a patient. The flow of the rest of the day depends on the team. Usually a student stay around until 4 or 5pm; this time may be spent studying or helping the team with notes, discharges, or gathering information on the patients they’re following.
- For clinic, students come back from morning conference and wait for patients to arrive. Students usually see patients alone at first, take a history and do a physical exam, then present to an attending or resident, who then will go back into the room with the student to see the patient. Depending on the patient load (and, to some extent, the personalities of the superiors) students may be there until 5 or 6pm.
- Of course, there are lectures and other extra-clerkship duties that students are often required to leave their team for. Some of these were interesting, some were extremely practical for shelf studying and patient care, others, quite frankly, were boring. Really depended on the subject, the lecture format, and how much sleep I got the night before.
- Other fun things about Vandy’s children’s hospital:
- every floor is colorful and animal-themed
- on Fridays, people would make “candy rounds” and bring goodies to the different teams
- also, there’s a Ben & Jerry’s in the lobby. So tempting, so wonderful after a hard day. I’m surprised I didn’t blow more money there in my 6 weeks.
I didn’t have as much time as I thought I would to “be a normal person,” as I hoped I would in my last crop of posts. But I definitely enjoyed not having to get to campus at 5am every day like I had to on surgery. I was definitely a happier, better-rested person this time around.
Also, while I was on this rotation, I got my evaluation back for surgery. On paper I passed, but I was honestly pretty discouraged by the end result of my shelf exam and the comments I received. I’m still dealing with these feelings. Maybe one day I won’t get so deflated by these bumps in the road. For now, I have to learn how to pick up the pieces and keep going. In any case I’m hoping for a better outcome from pediatrics!