Want Peds residency -- suggestions for 4th year elective rotations?

[elidel23]

Hi everyone,

This is my first post logged in...it's only taken me 3 years of med school to jump in the water and start a thread.

Can anyone offer suggestions about rotations you felt were helpful prior to starting your Peds residency? ENT and derm have been 2 widely recommended ones, but what are some others that you felt were helpful?

Thanks so much.

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[TexasRose]

Hi everyone,

This is my first post logged in...it's only taken me 3 years of med school to jump in the water and start a thread.

Can anyone offer suggestions about rotations you felt were helpful prior to starting your Peds residency? ENT and derm have been 2 widely recommended ones, but what are some others that you felt were helpful?

Thanks so much.

I thought my Pedi ID elective was very, very useful and learned a ton. Pedi Sub-I was also very valuable, though that may not be considered an elective.

 

[Stitch]

ID and emergency medicine (if dedicated peds ED) are my suggestions. I actually don't think ENT or derm will give you as good a 'general' peds experience. There was at least one thread on this not too long ago, so definitely see if you can search it out.

 

[twilightdoc]

Can anyone offer suggestions about rotations you felt were helpful prior to starting your Peds residency? ENT and derm have been 2 widely recommended ones, but what are some others that you felt were helpful?

I think that radiology is also useful, particularly if you can do primarily Peds radiology. But in terms of your electives, I would resist the temptation to do "all peds". Remember that you will have to pass USMLE Step 3, and there is only a modest amount of Peds content on that exam. Sometimes the electives will help you firm up your knowledge in other areas of medicine. And the elective year of med school is probably the last year where you can "dabble" in a variety of areas (other than pediatrics).

 

[oldbearprofessor]

ID and emergency medicine (if dedicated peds ED) are my suggestions. I actually don't think ENT or derm will give you as good a 'general' peds experience. There was at least one thread on this not too long ago, so definitely see if you can search it out.

This is one I think we've disagreed on before....Your residency training will be filled, really filled with pedi EM, so I don't see the need to spend a month on it as a 4th yr. Use your electives year on something different. For pedi electives, ID is usually the best, for non-pedi, go with derm and rads. PM&R is another good one.

Another good idea is to go overseas for a month on an elective if you can arrange it.

 

[TopsyKrett]

This is one I think we've disagreed on before....Your residency training will be filled, really filled with pedi EM, so I don't see the need to spend a month on it as a 4th yr. Use your electives year on something different. For pedi electives, ID is usually the best, for non-pedi, go with derm and rads. PM&R is another good one.

Another good idea is to go overseas for a month on an elective if you can arrange it.

Curious, what about ID makes it the best?

 

[oldbearprofessor]

Curious, what about ID makes it the best?

You get a very good idea what it's like to work incredibly hard and get paid very little.

Seriously, a couple of things...

First, you get to see in depth what goes on throughout the hospital - you'll spend quality time in the NICU, PICU, heme/onc, etc. ID goes everywhere.

Second, the choice of antibiotics, sepsis evals, etc that you'll learn, although you'll pick it up during residency, is a good head start.

Third, although they work hard, pedi ID docs are really nice and love to teach.

But, the pay and the hours are not so good.

 

[Stitch]

This is one I think we've disagreed on before....Your residency training will be filled, really filled with pedi EM, so I don't see the need to spend a month on it as a 4th yr.

Yup.

Our interns only get 1 month of peds EM, so it's hard to say it will be 'filled.' On the other hand we spend 4-5 months doing neo instead.

The reason I suggest peds EM is that there's a good mix of true general peds and sick kids. One of your objectives as an intern is to identify sick versus not sick, and in the ED you'll see both. It gives you a wide exposure to pediatrics and you may also get a shot at suturing or an LP, something that will make your life as an intern a little easier.

Just my 2 cents though.

 

[oldbearprofessor]

Our interns only get 1 month of peds EM, so it's hard to say it will be 'filled.' On the other hand we spend 4-5 months doing neo instead.

Lucky folks!!!

I can't remember offhand, but isn't critical care (NICU and PICU) limited to a total of 6 months during the 3 year residency? If they are doing 4-5 months as interns, that seems over the limit?

 

[elidel23]

Thanks for your feedback everyone!

 

[rock_climber]

Would a month of peds surg be useful? Considering adding that to my schedule since I won't see it from that perspective as a peds resident. It would replace my month of peds cards so I am not sure which would serve me better. Thanks!

 

[Stitch]

Lucky folks!!!

I can't remember offhand, but isn't critical care (NICU and PICU) limited to a total of 6 months during the 3 year residency? If they are doing 4-5 months as interns, that seems over the limit?

I think they get away with it by redefining critical care. Interns get
1-2 months of NICU (if one month, then it's 2 months of level 2)
1-2 months of level 2 nursery. They don't consider this critical care though we get a few kids on vents there. The level 2 teams carries the delivery pager, not the NICU resident.
1 month of level 1, which is an elective in the afternoon, so they may count it as elective. However, if you're level 1 intern, then you take q4 call to cover the level 2 nursery all month.
When you are on your 1 month of elective during intern year, you're called to cover the NICU for call periodically.

Then as a second year, you get 6 weeks as level 2 senior (3 weeks days, 3 weeks nights). And of course you spend time covering level 2 as senior throughout the year during weekends. Plus one final month in the NICU.

Hence I'm very comfortable with neonates, lines and deliveries.

 

[settingshadow]

I'm only an intern, but I would say NICU was the best rotation -- it got me comfortable with SICK patients (and vents), comfortable with procedures and comfortable picking up and handling babies.

I also did peds ED (OK but not necessary, especially if you get a lot of sick visits in outpatient peds), peds ID (super fantastic -- antibiotics and infectious disease is a huge part of peds), radiology with exposure to peds films (useful and easy to skip to go to interviews) and peds GI (fun, but not that helpful, particularly because I did it at a really tertiary center)

 

[kristing]

Peds residencies are not required to give you all peds EM experience, so yes, that can be VERY useful.

Minimum requirement of peds residency- ICU = 3 NICU and 2 PICU so you will get minimum of that in residency.

I did 2 weeks of ENT (peds heavy practice) and 2 weeks of pedi Ophtho as a 4th year, experiences I learned a TON in and never really got that info in residency... loved those.

I did peds EM and learned a bunch (and since my ER months were combined with adults, yes, that month was very useful).

I did NICU. And while you will get 3 months of NICU in residency, this month was exceptionally useful, since I did it at another place, a possible rank list contender... The NICU is routinely the most miserable rotation in peds. Peds residents hate NICU a lot of time. (And yes, this is a generalization, but there were few places where NICU was the best month in my experience. Most places, the residents said - we get through it)... so in this vain, I realized it was useful to see how the residents were treated and dealt with the most stressful month. It helped me rank that place lower, for sure.
And I felt A LOT more comfortable in the NICU going into residency. So I don't regret that one.

I did a month of Peds endo. Made me look like a superstar with the endocrinologists when I got to residency. I liked what I learned.

I did derm as a resident and nearly cried myself to tears I was so bored. Maybe 2 weeks would be useful but a whole month was painfully boring.

I also did allergy for a month in residency. That was super useful. So I would recommend that.

 

[kristing]

I meant to say my peds ER month in residency were combo with adults...

 

[oldbearprofessor]

Peds residencies are not required to give you all peds EM experience, so yes, that can be VERY useful.

There are really Pedi residencies in which you are forced to see adult ER patients? I didn't know this was allowed. I'd run fast from that type of situation.

Minimum requirement of peds residency- ICU = 3 NICU and 2 PICU so you will get minimum of that in residency.

Reference? I do not think this is an accurate statement of the rules, but would like to see the ACGME guidelines to be sure. It's a bit late for me to go digging them up.

The NICU is routinely the most miserable rotation in peds.

Everyone has a right to their opinion, but I'm entitled to disagree. I'm unaware of any survey data supporting this view, nor do I think it reflects the changes in pedi residencies and supervision in the NICU that have widely occurred throughout the country in the last 5 to 10 years. I don't particularly think the NICU, a fairly isolated place in many hospitals, is a good reflection of the culture of a residency program. Again, YMMV but I'm entitled to a different opinion.

My most miserable rotation was adolescent medicine and I liked the docs and most of the patients even. It was doing adolescent gyn that made it the worst for me.

 

[kristing]

There are really Pedi residencies in which you are forced to see adult ER patients? I didn't know this was allowed. I'd run fast from that type of situation.

Places without freestanding peds hospitals don't necessarily all have peds ERs and we disagree on this. Not unexpectedly.

Reference? I do not think this is an accurate statement of the rules, but would like to see the ACGME guidelines to be sure. It's a bit late for me to go digging them up.

http://www.acgme.org/acWebsite/RRC_320/320_prIndex.asp
Page 30 of the peds link discusses it:

Everyone has a right to their opinion, but I'm entitled to disagree. I'm unaware of any survey data supporting this view, nor do I think it reflects the changes in pedi residencies and supervision in the NICU that have widely occurred throughout the country in the last 5 to 10 years. I don't particularly think the NICU, a fairly isolated place in many hospitals, is a good reflection of the culture of a residency program. Again, YMMV but I'm entitled to a different opinion.

My most miserable rotation was adolescent medicine and I liked the docs and most of the patients even. It was doing adolescent gyn that made it the worst for me.

I had a feeling someone would come back with this. In 4/5 places I interviewed for residency, in the academic institution I was most recently an attending in, this was the case. I don't say this to be a butt. I say it because when you work in a stressful environment, you learn the real nature of people and organizations. I said it to show that even a rotation that is unliked by a lot can be useful. I obviously did not make that clear.

(That said It was NOT my least favorite rotation. I actually liked my NICU months a lot. But the majority of the residents where I trained and the places I interacted with, I determined this to be the least favorite rotation. I determined it by ASKING the residents what their least favorite months were and why.)

 

[oldbearprofessor]

Places without freestanding peds hospitals don't necessarily all have peds ERs and we disagree on this.

Just so I understand, at your program, categorical pediatric residents routinely worked in a mixed pedi/adult ER and saw adult patients, including being the first doc to see MI's, elderly dementia or stroke patients, and even OB?

No, I do not think this is appropriate and we can continue to disagree on that point. Keep in mind that unlike FM, EM, IM and surgery residents, categorical pedi residents do not have outpatient adult medicine/surgery or ward/ICU months on which to build a knowledge base for managing those types of patients. I don't believe it would be impossible to separate out which patients are seen by the pedi residents in a mixed ER if one wanted to.

I wonder if the ACGME rules discuss this or place a maximum on the % time categorical pedi residents can spend seeing adults who have no "pedi" illnesses (e.g. CF, CHD).

 

[kristing]

Just so I understand, at your program, categorical pediatric residents routinely worked in a mixed pedi/adult ER and saw adult patients, including being the first doc to see MI's, elderly dementia or stroke patients, and even OB?

No, I do not think this is appropriate and we can continue to disagree on that point. Keep in mind that unlike FM, EM, IM and surgery residents, categorical pedi residents do not have outpatient adult medicine/surgery or ward/ICU months on which to build a knowledge base for managing those types of patients. I don't believe it would be impossible to separate out which patients are seen by the pedi residents in a mixed ER if one wanted to.

I wonder if the ACGME rules discuss this or place a maximum on the % time categorical pedi residents can spend seeing adults who have no "pedi" illnesses (e.g. CF, CHD).

The program I was in, yes, peds residents worked in a mixed ER. We often could cherry pick out peds patients but sometimes we did get to see an 80 year old dizzy lady. It was not fun.

And I don't agree it was IDEAL or even PLEASANT. I disagreed with you when you said "I'd run fast from that type of situation". There are many things to look for in a program, and having to see a mixed bag of adults/kids for 2 months may be a small price to pay if that program is suited for you otherwise.

 

[oldbearprofessor]

The program I was in, yes, peds residents worked in a mixed ER. We often could cherry pick out peds patients but sometimes we did get to see an 80 year old dizzy lady. It was not fun.

And I don't agree it was IDEAL or even PLEASANT. I disagreed with you when you said "I'd run fast from that type of situation". There are many things to look for in a program, and having to see a mixed bag of adults/kids for 2 months may be a small price to pay if that program is suited for you otherwise.

Well, one great thing about SDN is that you learn something new all the time. In over 25 years in pediatrics I'd never heard of a program that routinely forced categorical pediatric residents to do real adult medicine. Live and learn. I entirely stand by my opinion that this is a bad idea and that I (emphasis on the I here), would run fast from that type of situation (ie would not rank such a program). You get 36 months to learn pediatrics, being forced to see 80 year folks to r/o TIAs is not something I would agree to regardless of any other aspect of the training program being ideal unless this was the only program I could go to for family reasons.

 

[J-Rad]

Though it is a small subset of total peds residencies, AFAIK some-to-all military peds residencies require one month of mixed ED plus two months of dedicated peds ED.