Pediatrics was my second clerkship of third year, roughly September through mid-October. Coming off of medicine I was confident that I knew so many things about management of sick patients and chronic care, you name it, but peds proved to be a whole new world of medicine. Interacting with the whole family unit is one of the biggest things that stood out to me about peds. The patients themselves were so diverse as well; from every socioeconomic class, many different cultures and every age in the peds spectrum. I really hope this post helps some of you budding pediatricians out there or just other MS3's looking for a little more insight!

CLERKSHIP OUTLINE:

• 6 weeks total: 3 weeks inpatient, 3 weeks outpatient (+ 1 week of newborn nursery in the AM during outpatient)


• Scheduled lectures at main campus throughout clerkship


• NBME shelf exam

CLERKSHIP WORK HOURS:

Inpatient: My inpatient weeks took place at the children's hospital. It was so nice actually working as a med student on the wards I that I had volunteered on for seven years in high school and undergrad. It felt very familiar, but different at the same time. Inpatient hours are more challenging from outpatient. I would arrive around 5:45AM in time for morning sign out from the night team. At around 6, the day would start. The day ends around 5:30PM when the team prepares for sign out to the night team again.

Outpatient: I worked mostly in a community clinic that is dedicated to uninsured or underinsured children for most of my outpatient experience. Here the hours were from 8AM to 5:30AM daily with about an hour for lunch.  I worked in the newborn nursery for 1 week during my outpatient experience. I would arrive at the newborn nursery around 7:00AM and leave a little after 12:00PM to return to my clinic in the afternoon. Overall, the hours on outpatient were predictable but definitely left me with less time to study than inpatient.

DAILY LIFE:

Inpatient: I completed the inpatient portion of my clerkship first. After arriving to my team room in the morning, my team and I got sign out from the night team. This includes any significant events from overnight, things that need to be done / ordered, or a simple update that things are going smoothly with our patients. As a med student, the night team isn't really directing the information at you but it's important to write down what's pertinent to patients that you're carrying (typically 2-3, or as little as 1-2 if the service is not as busy as usual) so that you can help your interns / residents during the day. Once sign out is finished, it's time to pre-round on your patients. My interns and residents preferred to join me while I pre-rounded in order to disturb the patient and their parents or families as little as possible. It was also nice to be able to get feedback and come up with a plan with my intern or resident so that what I presented on rounds was an accurate description of what we were really going to do with the patient. Pre-rounding typically happened by 7:30, giving me about an hour to do chart reviews and speak to the overnight nursing staff about my patients. Once pre-rounding was over, I usually had from 8:00AM to 9:00AM to prepare my presentations and a short clinical pearl presentation (Ex: asthma prediction index, short gut syndrome, acetaminophen overdose). Morning rounds last around an hour on peds (much shorter than IM) and the rest of the day is dedicated to following up with patients, getting some studying in, and helping the interns and residents. I always had time for lunch on peds which was really nice. Most days I could study for 2-3 hours throughout the day. On days when I didn't feel like studying I would find a baby to hold, feed, or change - the nurses appreciated it and often would sit and chat with me about their experiences or any advice they had for me. The down time on inpatient can be difficult for some students, but there's ALWAYS something you can be doing to help the team even if no one sees you doing it.

Outpatient: My day started around 8:00AM and the first patient was usually roomed and ready to go shortly after that. Unfortunately, around 80% of my outpatient experience was shadowing. However, many of my friends had amazing outpatient experiences where they were making and implementing care plans with supervision from their attendings. Most of the patients I saw on outpatient were well child visits, viral URI's or constipation. Well child visits can be a lot of fun because every stage of a child's life is characterized by different developmental milestones, nutrition/sleep/fluid requirements, and social implications. I especially enjoyed the well infant visits! The day ends when the last patient leaves on outpatient which is around 5:30pm. During my week in the newborn nursery (aka my FAVORITE week of peds) my role was very unique. I would arrive around 7:00AM and get a new baby to follow, usually one that was born overnight. Since we round at 7:30AM in the nursery, the attendings prefer that we all round together instead of prerounding - this makes it easier on the new moms & dads and, of course, the babies. After rounds, I saw my assigned babies with the residents and helped them with whatever they needed. I also gave "baby talks" to moms and dads that included things to expect when brining the baby home, safety, car seats, SIDS prevention, and reasons to bring the baby back to the hospital (i.e. fever over 100.4).

MOST MEMORABLE MOMENTS:

I loved my peds rotation and took away so many memories. One of my most memorable moments was when I had to mediate between a patient, the care team, and law enforcement regarding a very sensitive situation. My role was important because I was the only one on the peds teams who spoke Spanish. Never would I have thought that I would be discussing suicide and self-harm with a patient, in another language, in such a high-stress environment. It really pushed me to make sure I was helping to give the patient the best care while maintaining confidentiality, confidence and poise. Another memorable moment on peds was in the newborn nursery. I've always had a love and appreciation for infants and their seemingly magical physiology from womb through infancy. I always thought I would be a pediatrician and this clerkship solidified that.

STUDY RESOURCES:

As with all clerkships and NBME shelf exams there are many resources, but I will only speak to what I used. During inpatient I didn't want to be glued to my iPad doing questions and appear unavailable to my team so I used PreTest for Pediatrics. It has 500 questions that cover most areas of pediatrics. It was quick to go through, though significantly less difficult than UWorld. PreTest was a decent resource but it was really useful because I had a paperback copy that, I think, is easier to use on the wards because if your team sees you reading something they won't wonder what you're doing on an iPad or computer. I also used the Pediatrics High Yield PDF / Video by Emma Holliday Ramahi which was incredible at summarizing the most important concepts for the shelf. My favorite resource for the NBME shelf exam was UWorld, though. There just aren't any resources that compare to the level of difficulty and explanations that it offers. I think that mastering the ~380 peds questions on UWorld helped me the most out of all my resources to do well on the shelf.

THINGS I LIKED:

1. The patients. Though the hard days and unfortunate outcomes on peds can be extremely difficult, the good days and happy endings make up for this a hundred times over. I think that pediatrics is a specialty that offers incredible potential - helping a child can result in decades of happiness, smiles and a fulfilling life.

2. The happiness. During my time on peds everyone I worked with was happy doing what they do. From the nurses to the attendings to the overworked residents, they all enjoyed working with our patients. Plus, there were always fun things going on like miniature ponies and guide dogs on the wards, cookies and other treats or decorations just because.

ADVICE:

As with all clerkships, being a good team member and looking for ways to help your residents is essential. On pediatrics, I would recommend working extra hard to make sure the families are comfortable, cared for and made to feel like they are informed and a part of the team. By just sitting with the patients and their families you can learn a lot about more than just medicine. Some of the patients have spent more time in the hospital than at home and it's important that the time they spend with you is as positive as possible. Overall, being compassionate, patient, and hardworking go a long way.