Advice for Outpatient pediatrics vs Inpatient pediatrics

[sjagan1]

Hey everyone! I am an early 3rd year medical student who has finished 3 one month rotations of Internal Medicine. I am looking forward to starting pediatrics in a couple weeks. Pediatrics is a top specialty of mine and I am taking into account enormous emotional discipline needed to safely render care to kids while connecting with their complicated shades of unstructured emotions.

What are common diagnoses in outpatient and inpatient settings I will encounter?
What is your advice to being able to do a thorough History and Physical that successfully leads to accurate differential diagnoses while balancing being humanistic to the child and family?

What are the characteristics that will make or break an excellent evaluation by your attending pediatrician such that he would recommend you for a residency?

I want to do especially outstanding on my rotation, not "just pass to move on to next rotation training".

Thank you

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[sjagan1]

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[jonb12997]

a lot of the same things you do on internal medicine. Be present. Read on your patients. Be involved in rounds. if you don't know something say so and that you'll get an answer and come back. We don't expect you to know anything when you start, we do expect you to learn as you go.
my biggest thing I like to see if when students (and residents) apply their knowledge and new information they learned about one patient, and apply it to another patient...

A few thoughts:
Put some fun stickers on the back of your badge of the popular characters (Daniel tiger's neighborhood, mickey mouse clubhouse, jake and the neverland pirates, etc).
Get on the child's level to examine them, even if that means sitting on the floor of the exam room
if you find a dirty diaper? CHANGE IT!!! no seriously, CHANGE IT!!!
Never wake a sleeping baby without checking with the parents or nurse first. I don't get upset with a medical student who says to me, I didn't want to take the infant/toddler because mom had just gotten them back to sleep, I'd rather wait to examine them together (15 year's old?? That doesn't count!)... however don't take advantage of this, you have to find a balance between considerate and lazy. you'll get it!

 

[deleted564496]

One thing that I got complimented on in my eval was getting down to eye level and introducing myself to the patient before the parents. I had several parents compliment me on that before I left as well. I also think you have an opportunity to make a big difference in some of these kids lives, particularly some of the older ones.. For instance, we had a kid with CF that I would go hang out with for awhile every afternoon. We didn't talk medicine, but rather about everything else.. played video games, etc. It turns out this kid had a terrible life and I really believe that I made a difference, which is hard to do/feel as an M3. Get to know your patients, be real with them, those kids don't care about how much you know, but often need somebody to just talk to... Particularly if they are in the hospital for a long time and have nobody coming to visit them with parents working, etc. Yeah being smart on rounds, etc. is obviously important, but residents/attendings do notice when you do those kinds of things, even if they never see it.

 

[josh's dad]

Don't apologize for being there; parents perceive value and are willing to trust you more when you introduce yourself confidently e.g. "I'm full name, the student doctor on the team and I'm here to get started on Johnny's admission to the hospital" rather than "Hi, I'm first name only the med student, can I ask a few questions?". Obviously, always be honest about who you are and what you do or don't know but confidence, especially when first meeting a patient and family, goes a long way!

 

[GUH]

In inpatient peds we saw a lot of the following:

respiratory stuff: review asthma, bronchiolitis, croup, epiglottitis, tonsilitis, and any other acute respiratory tract diseases you can think of

Neonatal hyperbilirubinemia

Babies born to drug-abusing mothers - meth, alcohol, marijuana, and especially heroin/opiates

This was at a county hospital that refers complicated cases elsewhere so your experience may be different. Also know your milestones, vaccinations, newborn screening tests, and management of infants born to gbs positive or unknown mothers.

 

[HooliganSnail]

Pediatrics is all about the parents.

As a student, exam as many kids as possible, so that you get a feel for the wide range of normal. A lot of kids can't or won't accurately tell you what is going on, so you are basically a veterinarian.

Also, enjoy the myriad of upper respiratory illness you will be suffering through your entire rotation. Almost everyone gets sick several times during Peds

 

[awared2]

One thing that I got complimented on in my eval was getting down to eye level and introducing myself to the patient before the parents.I had several parents compliment me on that before I left as well. I also think you have an opportunity to make a big difference in some of these kids lives, particularly some of the older ones.. For instance, we had a kid with CF that I would go hang out with for awhile every afternoon. We didn't talk medicine, but rather about everything else.. played video games, etc. It turns out this kid had a terrible life and I really believe that I made a difference, which is hard to do/feel as an M3. Get to know your patients, be real with them, those kids don't care about how much you know, but often need somebody to just talk to... Particularly if they are in the hospital for a long time and have nobody coming to visit them with parents working, etc. Yeah being smart on rounds, etc. is obviously important, but residents/attendings do notice when you do those kinds of things, even if they never see it.

How do you do this? Just b-line it to the bedside without acknowledging the parents?