Torey here! Pediatrics has always been high on my list of specialties to go into, and this clerkship was something I’ve been looking forward to since starting third-year. My two-month clerkship consisted of 4-weeks of outpatient pediatrics, 2-weeks of inpatient pediatrics, 1-week in the neonatal intensive care unit, and 1-week of pediatric specialty (in my case, endocrine).
Expectations vs. Reality:
Expectation: Less complicated patients. Reality: For the most part less complicated patients. Not always the case, but generally the H&Ps taken were much smaller than the ones taken during internal medicine. The challenging part of it was the sheer variety that accompanies treating children of different ages, sizes, stages of development, etc.
Expectation: Frustrating Anti-Vaxxers EVERYWHERE. Reality: Most of the parents concerned about vaccines were receptive to physician recommendations and trusted their physician. I didn’t encounter the frustrations of these encounters because one of the outpatient offices did not accept patients whose parents not willing to vaccinate their children. While this policy is discouraged by the AAP and it would have been a good experience to have an encounter with a completely non-receptive parent, the reasons behind the practice choosing to adopt the policy was an interesting conversation. Overall, it was encouraging that a higher percentage parents were generally more open-minded then what I expected.
Expectation: Lots of reassurance. Reality: LOTS of reassurance. Reassurance and parent education was a huge part of the outpatient setting, and was one of my favorite parts of pediatrics. You are providing care to a cute, tiny human AND their parents, and seeing parents walk-in worried and walk out reassured is very satisfying.
Additional aspects of H&P. There are certain topics that you will need to add to your H&P that aren’t usually touched upon in adult medicine. Birth history. Breast milk vs formula vs mixed. Breast feeding or bottle feeding? How much milk? Motor, social, and other developmental milestones. How are they doing in school? Up-to-date on vaccinations? Smoke and CO2 alarms in the home? The list goes on and on. To complicate this, these histories vary depending on the age of your patient. As you would expect, the history of a newborn would differ drastically from an 18-year-old about to go off to college. I would advise asking your resident/attending which topics they feel are important to touch upon when taking a history.
Birth history and newborn presentation. Here is a list of topics to cover when presenting a newborn. If you are going to be dealing with a lot of newborns on your rotation, I recommend making SmartPhrase on your EMR to include these topics. This will help streamline your note taking. See my example below for a healthy newborn with no ongoing medical issues.
BabyBoyAsao is an ***-hour-old male/female born on **/**/**** via SVD/C-section at GA **weeks*days to a 22-year-old G*P**** mother. Maternal serologies include HepB negative/positive, GBS negative/positive, VDRL non-reactive/reactive, Gonorrhea/Chlamydia negative/positive, HIV reactive/non-reactive, and Rubella immune/non-immune (per chart review). Maternal drugs taken during pregnancy include *** (for ***). Pregnancy complicated by ***. Delivery complicated by ***. Apgar scores ***/***. Maternal ultrasound unremarkable/remarkable for ***. Vitamin K received/pending/refused, erythromycin received/pending/refused, and HepB vaccine received/pending/refused.
— Most recent bilirubin level: *** at ***-hours of life (up/down from previous *** at ***–hours of life).
Ducky Pen Light: Want to contribute during a newborn exam? Whip this out when your attending is trying to get a look in the patients ear and you may just console (or suprise) the kid long enough for your attending to get a good look.
WhiteCoat MedInfo clipboard. It conveniently fits in my white coat pocket and allows me to keep my notes neat. A little spendy (about $30) but totally worth it.
I ended up spending less time than other rotations doing readings and more of my time with questions. All-in-all I sought out questions from other sources and tried to do a similar number of questions that Internal Medicine U-World covered (1200ish). Leave a comment below with any other resources you found helpful!
U-World: There are fewer available questions than the internal medicine section (about 400 in total) but the questions and explanations are GOLDEN. Make sure you’re not only learning why answers questions are right but also why certain answers are WRONG. I ended up searching for more questions from other sources (BRS, PreTest, and Case Files) but made sure to finish these first and be the most thorough on their explanations.
OnlineMedEd Videos: Great resource for an overview of pediatric topics. Content is available in video (free) and PDF (must have membership) formats. Membership includes other resources (like questions), but I chose to use the free videos and seek out questions elsewhere.
Pediatrics PreTest Self-Assessment: 500 questions that dips into the high- and low-yield pediatric topics. The explanations are shorter than the U-World ones which makes them quicker to go through. I prioritized these questions second to U-World.
BRS Pediatrics (Board Review Series): This book is organized in a bullet-point format and is very thorough! Some of my classmates read through it front-to-back, however I used this more as a reference book for topics I wanted to touch up on and did the questions at the end of each chapter.
Case Files Pediatrics: As the name suggests, this series organizes its topics based on patient presentation. It’ll give you a quick blurb at the beginning of each chapter about a patient presenting with certain symptoms, story, etc, and will go on to elaborate on patient treatment, diagnosis, follow-up, and disease pathophysiology. There are questions at the end of each case, and I eventually gave up on reading each case and just moved to solely doing the questions to identify gaps in knowledge.
If you have any questions, don’t hesitate to shoot us a message on our Instagram page. Feel free to comment on any of your tips you learned on your pediatrics rotation in the comments below!
Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Using common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.