My pediatrics rotation at Queens Hospital center was my first ever rotation, so there were a lot of nerves going in already. On top of that, in all my years of working in medicine, I have only dealt with adult medicine, as I have worked in Urgent cares and Emergency rooms. I had no idea what to expect, and went in very nervous about working with kids. Don’t get me wrong, I love kids! But the thought of having them cry or having something go wrong since they are more fragile then adults, was always lingering. However, all my anxiety and stress quickly simmered down after my first few shifts. I was lucky enough to get assigned to work in Queens hospital, in which we got a very well rounded exposure to Pediatrics. At QHC, our first two weeks we were assigned to work in the Pediatric Emergency Department, the third week I was assigned to the Pediatric Clinic (which involved working with Primary care as well as specialist such as genetics, neuro, cardio, endo, and heme), and our final week I was assigned to the NICU. By being able to see all aspects of pediatrics, I am coming out with a very complete understanding of what the Pediatrics field has to offer, and I would like to speak on my experiences in each floor.  

The Pediatric ED had its set of challenges, as well as plentiful learning opportunities. Here we worked with an Attending and the nurse. As there were no residents, and only one nurse, I found myself very involved with every patient case, helping out wherever I could. We acted like Residents in that as soon as a new patient came in, we approached them first and got their history and did a pertinent physical, then presented to the Attending. This really allowed us to get a great head start on practicing presenting histories, and also thinking clinically about differential diagnosis. This was very intimidating at first, as being in the ED, things are already fast paced. However after my first few patients, I found myself getting more and more comfortable. I practiced my open ended questioning skills and allowed the patients to tell me their story. I also was able to practice what questions to ask, that would get to the most pertinent problems. I also learned how important it is to be organized and thorough when presenting to the attending, as often times they go into the rooms and work off the history we gave them, not asking detailed questions of their own. I often found myself forgetting to ask certain questions like “last menstrual cycle” in the older girls, or “how many wet diapers” for the younger babies, and would often have to go back and ask those. This taught me that its ok to miss some information, and that we should’ve be afraid to go back and ask, as the patient is really our only source of information. I also remember that we had alot of adolescent psych patients, some that I did not feel too comfortable with and addressed that with the attending (for example we had one patient that had just sexually abused someone). Also I found that certain teens felt very comfortable with me and told me their whole story because I allowed them to take their time, I learned how important it is to not rush them, or seem that something more important is going on. However in the ED, I need to better myself at keeping the patient more focused and on point of the chief complaint. In the ED, we also had alot of procedures that I learned to do, such as working with the nurse to learn how to do venipuncture sticks, guaiac tests, strep swabs and COVID swabs. This allowed me to get more comfortable working with kids and dealing with them crying and being uncomfortable, while obtaining these tests. Overall I had a great experience in the ED, and learned a great deal.  

The following week, I was in the Pediatric Clinic, this was a very different experience then the ED, as it was a lot more calm, and a lot of follow up and well visit checks. Here we got to do shifts with two different Doctors a day, either a Primary Care Physician, or a Specialist. Working with the PCP, I learned the importance of vaccine schedules, and if the child is achieving all of their milestones. I learned how to keep the kids distracted while doing an exam, but using books and toys. Also I learned how to get over my fear of approaching a crying baby, and using a little gentle force to keep them still while looking at their eyes, ears and mouth. I saw the importance of keeping up to date with timely well visits, and to ensure that the child is where they should be at in the growth and cognitive trends. We also worked with specialists such as Endocrinologist, in which I got to observe conversations with patients with PCOS, and hypothyroidism. I worked with Genetics Doctors and saw who would need genetic testing based on their family tree. With the Neurologist, I saw conversations with patients who have seizure disorder. One eye opening experience was working with the Hematologist, and seeing a patient who had sickle cell disease, who was a teen and was suffering from anxiety from the fear of the disease. We discussed the importance of psychological therapy in these difficult situations. My favorite Clinic experience my far was working with the Cardiologist, because he allowed me to listen for the murmurs and see if I could differentiate them, but then also was able to see the congenital heart diseases on the Echo. I have seen what these VSDs and ASDs look like in textbooks, but to see how different patients present differently and to see these pathologies on the Echo was very eye-opening.  

Our final week, we were in the NICU which was my favorite pediatrics experience by far. I went into this week quite nervous, because the thought of small premature babies with so many tubes coming out always scared me. But wow, to be able to see the strength in these small babies was so overwhelming and encouraging. The human body is incredible, but to see how even in such a small being, the body fights to live and function is amazing. Here we were also able to also be part of the C-sections and Vaginal births. As soon as the baby was born, we would do ur newborn physicals, and APGARs. This was especially a great teaching experience, because the PA allowed me to assess the child and judge the difference between a 9 or 10 score. I also was able to cut a few umbilical cords which was incredible! The biggest challenge for me here was being too gentle with these tiny babies, as I observed that certain exams take a little bit more action, then gently tapping the baby. I really loved seeing how these babies in the NICU, would improve their oxygen and saturation before our eyes, and work themselves up to getting to go home with mommy. We also had a case of toxoplasmosis, and I saw how an infant of a toxo positive mother would be treated.  

Over all I had an incredible first rotation and time in QHC. It was a great learning experience, as I learned the challenges that comes with interviewing a child and adolescent patient. When talking to children and parents, its important to keep the stress level down, and answer all of their questions, and the parents are so anxious when their child is sick. I found the most difficulty in interviewing the adolescents, as they are not so keen on answering all the questions, and often either stay too quite, or are over dramatic. It was the most challenging for me to keep the teens on topic of the chief complaint or having them give me the appropriate information. I also need to work on answering the patients questions and concerns, as if I am unsure of exactly their diagnosis or disposition, it is difficult to give the parents answers without giving them false hope. I need to better myself of confidently saying “ we are not sure at the moment, but we are doing our best.” I also need to be more confident in doing an exam on a crying and fussy child, as they are unaware of what’s happening. I also learned how differently the infant normal vitals are, such as the heart rate is always tachy, and to differentiate any abnormalities.  

For my next rotation, I will focus myself on getting pertinent history from the patient, and even asking the uncomfortable questions such as sexual histories. I will also start a differential list in my head as soon as I hear the chief complaint, so when I discuss the case with the Attending, I already have a working list in my head. I also want to continue improving my venipuncture skills, and work with nurses to practice getting more sticks. I plan on improving these skills, but continuing to ask to do procedures, and by continuing to hone my patient interview skills, and making sure the patient stays on topic. I will also keep practicing interviewing different patients, and I believe that this rotation gave me a great opportunity to do that. I was able to talk to kids, toddlers, parents, teens, as well as psych patients.  

In this rotation I learned that I am more confident then I expected. I was able to ask questions without feeling embarrassed, and I was able to insert myself into doing procedures and ask to practice venipuncture on the older kids wit the nurses help. I would always ask for them to show me once, and I would learn from that. I learned that my clinical skills are more then I gave myself credit for, as I was able to discuss differentials and pathology with the doctors, and was able to answer some questions. I learned how to saw “I am not sure” with confidence, rather then feeling ashamed, and used that as a learning experience to research new topics. It was so helpful to see these diseases and cases that I would read about and do questions of, in person, as they will stick in my head better. Overall, I had a great experience in this rotation, and I look forward to the next ones.