For my third rotation, I was assigned to New York Presbyterian Queens in the Pediatrics Department.  Entering PA school, it was always my plan to go into pediatrics and this rotation for me was very important because it allowed me to ensure that was the case and awarded me the opportunity to treat patients in the pediatric population.  I felt very fortunate to have my rotation at NYPQ in pediatrics as I was able to see patients across a wide variety of specialties with a multitude of varying presenting illnesses.  Going into the pediatrics rotation, I was nervous because I’d only done thorough exams on adult patients and the pediatric exam, while similar has it’s differences that I needed to remember and utilize in practice.

In my first week on the rotation, I was assigned to the outpatient clinic – Theresa Lang Center.  This clinic sees patients for both well visits and walk in sick visits and has many doctors, residents, NPs and nurses working and treating patients.  The first morning I shadowed one of the attendings and worked to understand the flow of how patients are seen in the clinic but also to ensure I was comfortable with the pediatric exam.  That afternoon, I worked with the director of the clinic and she had me seeing my own patients and presenting them to her prior to her evaluation.  During my time in the clinic I was focused on memorizing the milestones and incorporating them into the conversation as to not alienate any parents but also honing my focused and comprehensive physical exams.  I was giving vaccines, doing throat and nasal swabs and helping the team in any way I could to move patients through the office efficiently but also to ensure patients were receiving the best care.

During my second week, I was assigned to the GI team and found the subject matter to be substantially more interesting that I thought it would be in practice.  I worked with three different pediatric gastroenterologists and was interested to see the different styles and approaches they had to treating their patients.  Two of the three doctors let me see my own patients and write the HPIs for the visits, which was nice.  We don’t have access to the outpatient EMR system so this was more challenging (and sometimes frustrating) than I’d initially have thought.  I didn’t always have the opportunity to review charts before the patient came in for that reason and although I tried to obtain access, the hospital does not allow students to have access to this one particular system.  During my week with the GI team, I also went to the offsite GI office and was able to observe several endoscopies and effectively compare them to those I’d seen from the adult population.  I found that pediatric endoscopies / colonoscopies are done less frequently than adults and only when a significant amount of testing had been done to ensure the issues weren’t coming from other etiologic processes.  It was a really great week that I felt fortunate to have while at NYPQ.

My third week was my favorite week of the rotation – spent in the NICU.  It was definitely the longest hours but I truly enjoyed the opportunity.  I found, similarly to the MICU, the NICU has a nice combination of medical management and procedural work.  I was included in rounds each morning and after the first day given a patient each day to present and care for throughout the day.  I got to do an ABG on a baby that was less than an hour old and heel sticks to run labs.  I worked with one of the PAs to review fluid and caloric intake settings for the neonatal populations and discussed vent settings for the children that were intubated or on CPAP.  This week definitely pushed me and made me recognize I still have a lot to learn about vent settings and how they can be used in this population.  In the discussion about total fluid intake, I was definitely challenged to think about inputs and outputs and how weight (which changes quite drastically each day) affects these volumes.  I feel like I still have a lot to learn as it relates to fluid repletion to ensure I understand when volumes need to be increased or decreased and will definitely work on that as I progress through my rotations.

Throughout the fourth week, I rotated through the pediatric specialty clinics and worked with cardiologists, gastroenterologists, neurologists, pulmonologists and nephrologists. During the time in the pulmonology clinic, I could have done better in interpreting the PFTs but worked with the NP and pulmonolgist to try and improve my skills.  With the cardiologist I also spent time with the Echo tech as she completed TTEs and really tried to improve my understanding and ability to read an echo – I definitely still need work there as well! I’d met the neurologist I worked with in the NICU the prior week and was surprised to see he saw majority ADHD, Autistic and Migraine patients in clinic.  I felt like this week would have been better spent with one or two providers and not so dispersed because it didn’t allow me to see the continuity of the provider.

My last week, while short, was spent in the pediatric in patient unit.  I was given patients to present immediately and questioned thoroughly by the attending regarding all of the details.  I was able to answer her questions but definitely wanted to improve on my confidence with answering these questions.  While my answer was right, I became nervous that it wasn’t and my nerves made it seem as if I wasn’t sure.  I need to work on getting over that and doing my best on answering these questions.  My clinical thinking was there but definitely slower than I would have liked it to be while on the spot.  Of course (I hope) that speed with come with time and experience but I want to continue to think clinically to help treat my patient effectively.  I actually felt that studying for the end of rotation exam for this population was helpful because it allowed me to apply what I’d seen in the in patient setting to what I was being questioned on in an exam.  Specifically, the bronchiolitis and RSVs and seeing the severity of these viruses and how they impacted different children differently and how I had to think about worse case scenario – respiratory support. I was asked to talk through varying degrees of respiratory distress and different treatment modalities and approaches we could take to treat each one – from room air to nasal canula to facemask to CPAP to intubation.  This pushed me from a clinical perspective because she wanted me to talk through how a patient would present in each instance and note what would be my indicator to move to the next step.  I personally don’t love the approach of putting you on the spot in front of other people but I certainly won’t forget this information moving forward.

As I continue in my rotations, I’m sure I will come across other patients in the pediatric population but this particular rotation allowed me the opportunity to solidify my interest in pediatrics.  I was shocked to see how much I enjoyed the NICU and will continue to apply what I learned across all the subspecialties in practice.  The ventilation and fluid repletion is used on all populations so definitely transferrable and two things to continue improving upon as I embark on my next rotations.

This entry is licensed under a Creative Commons CC0 1.0 Universal Public Domain Dedication license.