My first rotation was at QHC in pediatrics and was broken up into three areas, emergency medicine, mother and baby/NICU, and clinic. Each of these areas provided me with a different vantage point from which to view the practice of pediatrics. In the ED we were concerned with any immediate, threatening illness while in mother and baby we were examining healthy newborns and trying to alleviate any concerns of nervous parents. During my time in clinic I saw mostly well visits which allowed me to observe how different practitioners perform their physical exam which was very beneficial for my own exam because I found that everyone did something a little different while still managing to complete the full physical. Another aspect of clinic that I found particularly interesting is the specialty clinics that were held throughout the week which I was able to sit in on.

As I started my rotation in the peds ED that is where I shall begin. This was probably the part of the rotation that I enjoyed most as I was given the most opportunity to interact with patients. QHC does not have an inpatient pediatrics population so the more emergent cases were transferred to LIJ or Elmhurst which means I saw a lot of virus-related illness with a few strep throats sprinkled in, but I used my time with patients to perform as thorough an exam as possible. Speaking to that, part of what I learned while in the ED was not to overdo it with a history and physical if the presenting complaint is relatively benign and the patient looks well because that can really freak the parents out or get you stuck performing too many tests. My time here definitely made me better at prioritizing my differentials and thinking of those things that are more common and less likely to be of any real danger to the patient. I learned that it is great to have an interesting set of differentials as it can be impressive to your preceptors, but that doesn’t mean that list is applicable to the patient in question.

The ED was the only setting that I was able to perform any procedures and while they were not very exciting – dozens of flu swabs and throat cultures with a couple of IVs started in the adult ED while we were slow – performing the procedures that I did made me more comfortable with making the patient uncomfortable. I know that sounds strange but for me it has always been a hurdle, to get past causing the patient discomfort, sometime mild sometime not, while treating the patient. What I appreciated most about this part of my rotation was that I was able to formulate a differential and plan based on the initial presentation, granted both my differential and plan were usually too elaborate, which was also a big part of what I learned. I saw how extra imaging studies or lab tests could keep the patients in the waiting room for hours and how in the instance of certain patients were unnecessary. It also felt good to me speaking with and examining patients, then presenting them to my preceptors. At first, I would forget certain pieces of information that are more specific to peds like vaccinations or general stuff like sick contacts (important especially in the context of flu season), but towards the end of my time in the ED I was proud of the way I presented my patients. There are always questions that practiced clinicians will ask that I haven’t thought of, but I do believe that the ED was a great start to my pediatric rotation.

Mother and baby/NICU was the next stop in my rotation and while I do see the value of some experience with the tiniest babies I do felt that I could have gained more from remaining in the ED for a couple of more shifts. The experience here is really what you make of it, you can be proactive and see high risk deliveries and do your best to examine the newborns which I highly encourage for all of my classmates. I really learned a lot in this part of my rotation, including the physical characteristics that differentiate preterm infants from full term. What I found to be so interesting in this part of my rotation is that as a clinician you are fully reliant on your physical exam. The baby is new and so the parents aren’t yet attune to their patterns which means that you as the practitioner must be able to differentiate normal from abnormal strictly on exam. Holding tiny newborns can be frightening, but this week gave me more appreciation for how resilient they are.

I rounded out my rotation in the clinic where the majority of patients were presenting for their annual well visit, additionally you are treated as more of an observer while in the clinic. That being said, I was paired with two different doctors each day which gave me a great opportunity to see how different people practice – the way the ask questions, the way they examine and the educate their patients. This portion of the rotation presented its own challenges, I realized that I am not very good at being seen and not heard and that I can tend to think I know best but, seeing seasoned pediatricians at work was really pretty amazing. They took time with their patients which I found to be really refreshing. Each patient encounter lasted at least 20 minutes, and some went as long as 50. The doctors really stressed patient education and took time to make sure the parents (for most of whom English was not a first language) understood what needed to be done to best care for their child.

Overall this was a great rotation for me, I got a little taste of everything, and was able to dip my toe into the waters of patient care (children are definitely a more forgiving patient population). I became more sure of my ability to perform procedures and my method for presenting patients. My differentials, which is something that came easily to me while in school is a struggle for me in practice, but I know with time and experience they will come.

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