How did it go? What have you learned? What can you improve? How do you plan to improve these new skills?

Overall, I really enjoyed my pediatric rotation. Because pediatric medicine is quite different from the adult side, it was an eye-opening experience, and I learned a great amount. I gained such an immense amount of knowledge from this rotation because many elements of pediatric medicine could not be classically taught in the classroom, but instead learned via live observation and hands-on experience. Some lessons learned were also taught by providers who have gained this knowledge from many years of experience in this field. For example, multiple clinicians emphasized that cases most of the time do not appear as classically as they do in our textbooks and exam questions. For instance, I remember being told that appendicitis cases often present without fever, and a patient may just present with umbilical pain and lack of fever or leukocytosis. Therefore, I’ve learned to keep my differential diagnoses wide because patients do not have to necessarily hit specific criteria in order to rule in/out conditions. In terms of improvement, I noticed that I was hesitant to perform procedures (such as blood draws or IVs) in this population because many younger children were already so afraid and uncooperative with them. I was more confident in performing these in the adolescent population because they were more cooperative and I knew there was less of a chance that I’d injure them. However, I’ve come to realize that my purpose during clinical rotations is to gain experience, even if they are difficult. I need to be more confident in my abilities and if I feel that a task is too intimidating or difficult, I will simply ask a colleague for help/advice! There is no harm in asking for help.

Types of patients I found challenging in this rotation and what I learned about dealing with them. Exposure to new techniques or treatment strategies – how did that go?

I know this is not a unique experience, but I found the patients that were afraid of strangers or medical staff to be particularly challenging during this rotation. Especially when speaking about the younger children, infants, and patients with autism, these patients are not usually aware of what is going on. They don’t understand why they are at the hospital or what our purpose is as medical staff, so their fear is understandable.  Often, these patients would cry just at the touch of a stethoscope, so trying to do slightly more invasive things, like examining the ear canal with an otoscope was particularly challenging. Some of the most rewarding things I learned on this rotation were the tricks that providers used to position patients in a way that allowed us to safely and effectively exam patients. For example, as I was trying to obtain a throat culture from an infant, we had the patient lay down on the examination bed, and the doctor instructed the parent to hold the child’s arms above and against their head; this prevented the child from moving their head and allowed me to have enough time to effectively obtain the throat culture. I also learned some techniques on how to make patients more comfortable and less likely to get scared. Skills like this are not typically taught in a textbook or lecture but instead learned from experience. Being taught these techniques from experienced providers is something I really valued from this rotation.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

A major learning point that came out of the pediatric rotation was that as a provider you are not only responsible for taking care of the child but much of the attention must go to the parents. A great deal of the role as a pediatric provider is knowing how to converse with and provide recommendations to parents. Education and reassurance is a big part of speaking with the guardians of young patients. And this will follow me to other rotations and disciplines, even with older populations. Many patients are accompanied by family members that have questions and needs that should be addressed. For example, one of my future rotations is in long term care. For the elderly patients, I’m sure I will need to interact with their family members to discuss plans and concerns.

What was a memorable patient or experience that I’ll carry with me?

A young patient was brought in by her mother for ear pain. After diagnosing the patient with otitis externa, the clinician started to hastily explain the instructions for the prescribed ear drops to the patient’s mother. It was clear that the mother did not understand the instructions and had further questions for the clinician. The clinician became obviously frustrated and brief with the mother. I could tell that the mother seemed discouraged, so she stopped asking questions and left the room with the discharge papers. I followed the mother out the door and took her to a separate room where I could speak to her in private and answer her questions. Just by taking a few minutes to explain the instructions for her daughter’s medication, the mother then understood and seemed much more pleased in that moment. She was very grateful for my time and help. I’ll carry this experience with me because it showed me how meaningful it is to take a few minutes out for patient education. Not only does this show compassion and improve patient satisfaction, but it will also reduce medical errors!