I decided on paeds in the gap year before starting med school and I have been pretty much sold on it ever since. Which is why I wanted to do it early on to make sure I actually enjoyed it clinically and not just in theory.
I also chose to stay in the same community hospital I was for OB/GYN. Partly because I felt community paeds would lend a more hands-on experience and also because I didn’t want to have to figure out my way around a new hospital (#directionallychallenged).
Here’s a quick breakdown of what paeds was like for me!
In-patient
Eating Disorders · Asthma · Fever · Rashes · Jaundice · UTIs · Skin infection · Seizures · Vasovagal syncope · Falls
My first three weeks was spent on the wards, generally from 9am – 5pm. Mornings started with an update on each patient from the night team. Each person on the team was responsible for 3-4 patients throughout the day. Before rounds with the rest of the team, I checked in on each patient – asked how their night was, if they had any new concerns, and did a quick physical exam. I usually wrote progress or discharge notes after discussing with the attending. We were also responsible for pediatric emergency consults, which meant going to assess (history, physical, discuss with staff) patients in the ED. These patients were either admitted to our in-patient unit (which meant writing up an admission note) or were discharged from the ED (ED consult note). We also got calls from the Neonatal Follow-up clinic for babies with jaundice needing phototherapy. Unfortunately, there were lot more adolescents with eating disorders than usual, owing a lot to the pandemic. Also, since kids weren’t really going to school or daycare (and exchanging germs), there were less infectious respiratory cases (bronchitis, pneumonia, flu, common colds).
Call Shifts
Deliveries · NICU · Emergency Consults · In-patient
These were 26hrs long, and essentially an extension of ward duty throughout the night. ** So, quick story, call shifts in OB/GYN were actually only 12hrs long (because of COVID), and so this was my first “real call shift”. Anyway, on my first call, I got so dehydrated that I almost passed out while interviewing a patient with my staff, who then insisted on getting me apple juice and tried to get the nurses to take my vitals. Lesson: hydrate, hydrate, hydrate. ** In-patients were usually managed by the daytime so there wasn’t much to do on the ward overnight. We attended a lot of deliveries and to any issues that came up on the Mother-Baby Unit (usually bilirubin or glucose checks).
Here are three of my most memorable moments on call;
1. There usually wasn’t anything going on in the NICU, but I remember one shift where a code pink was called for one of the preemies (she survived thank God) but this was probably the scariest and nerve-wracking medical emergency I had seen so far in my short clerkship career.
2. On another night, I got to watch an umbilical vein catheterization for a baby with severe hypoglycemia.
3. Spent 1 hr ventilating a newborn in the OR who eventually had to be transferred to the NICU, which was a change because most of newborns were completely fine at delivery.
Clinics
Failure to thrive · Plagiocephaly · In-toeing · Vulvovaginitis · Irritable Bowel Syndrome · Tinea Corporis · Cardiac Murmur · Constipation · Enuresis · Follow up from ED/in-patient units
I spent two weeks in the following clinics; general paediatrics, gynecology, and bladder & bowel dysfunction. Clinic days were actually a lot busier than in-patient, sometimes I stayed waaaayyy past 5pm to catch up on notes. I’d say 50% of patients were seen virtually – either via phone or video call (OTN) and all patients were referred, either by their primary care physician, through the ED, or from the in-patient unit. For in-person appointments, based on the kid’s temperament, I usually took the time to do as many components of the physical examination as I could for practice (especially ear examinations using the otoscope). It was also nice to see some of the kids who were discharged from the in-patient unit again.
Neonatal Intensive Care Unit | Neonatal Follow-Up Clinic
Preemies · Low Birth Weight · Infants of Diabetic Mothers · Retinopathy of Prematurity · Jaundice · Periventricular Leukomalacia · Respiratory Distress Syndrome · Transient Tachypnea of the Newborn · Gastroesophageal Reflux
I actually didn’t get to spend that much time in either clinic due to some scheduling changes. I spent about a day in the NICU and another day in the NFU. To be honest, the NICU was really confusing, I can’t even pretend to know what was going on. I attended rounds and tried to keep up as much as I could. A lot of what I learnt was during teachings or from independent studying. I did learn a lot about developmental milestones in the NFU with the neonatologist, occupational therapist, and speech and language therapist. The kids seen in NFU were usually born prematurely or have other risk factors for developmental delay.
Mother-Baby Unit
Newborn exams · General counselling
I spent 3 days on this service and essentially did newborn exams all day, which was nice cause I felt much more comfortable with these by the end of rotation. Also spent some time counselling parents; to book an appointment with a primary care physician within 2-3 days of discharge, on safe sleep practices (i.e. put baby to sleep on back), and to bring baby back to ED if fever within first 3 months of life. My favourite part was getting to watch parents bond with their newborn.
Even with the pandemic, I felt like this was a wholesome rotation. All of the staff and residents I worked with were really amazing and I honestly felt like I learnt so much, especially how to give concise oral reports, formulate a differential diagnosis and write (really) comprehensive notes. It was really busy at times and part of this was probably due to my longstanding infatuation with paeds.
I guess the kiddos stole my heart a long time ago & between this rotation and OB/GYN, I feel like I'm starting to catch some baby fever.
~ GoldRimMD