When I first walked in to Children's for this rotation, my first thought was "this is my place." I have no doubt that I will be working with children and families in my career. I find myself swinging back to visit patients even after I've been given the okay to go home for the day. And that says a lot because I've been working 15 hour days! 0400 is my new alarm time and I'm typically home for dinner around 1930 or 2000. As crazy as it's been, I am absolutely loving this year so far! I run around that hospital all day-- usually without stopping for more than an apple and cliff bar for lunch because I don't want to miss out on anything. I hop into the operating room for as many surgeries as I can manage and I find myself constantly reading up on patients and diseases so that I can feel like part of the team.
Starting with pediatric surgery has been challenging (I do not mean that as a polite way of saying bad/torturous.. purely just difficult). Starting with surgery is a steep learning curve. It is typically long hours... scrubbing into a surgery is a new skill.. things can be stressful and people's fuses can be short...
Plus, with pediatric surgery, the patients in your care turnover quickly (for two reasons: they recover and go home quickly or their care is managed by another team like neonatology and we were purely consulted for the operation.) So for the medical student on the team- that means a lot of patients (and time!!) spent reading up on patients and their conditions and trying to keep it all straight.
A little more about grading.. about half of our grade for each rotation is based upon subjective evaluations filled out by the physicians we work with. On this rotation (and probably many others) I spend most of my time interacting with the residents and occasionally the fellows and attending physicians. So you only have short windows of time for each person to get to know you. Also, like any other evaluation, everyone fills them out differently. You know how that goes-- some people always give 4/5 and others rarely give above a 3. So the turnover rate makes it challenging to impress... which leads to the challenge of deciding how to split your time...
Like I said, to keep up with the team and let them see what I am capable of, I need to spend time getting to know the patients. That involves time spent reading their charts, examining them, and often includes reading about their conditions. I really enjoy all three of those things so that is how I typically spend the free time I find.
However, pediatrics is a subspecialty of surgery so there won't be very many questions on the SHELF (the national exam). So, if I want to do well compared to other students in the nation, I need to spend time studying surgery in a more general sense.
Finally, since this is my first rotation, I am still spending a lot of time working on my physical exam and note writing skills. Working with kids was extra challenging for me. Not the exam part-- I like to joke that I am half kid myself so that comes easy for me. Instead of just checking their range of motion I'll turn it into a Simon Says game. I give all the young boys fist bumps. And since I grew up around here I can talk high school sports or activities like the best of them.
But I'll give you an example of a challenge I ran into: there is a part of each note called the review of systems (ROS). When doing a thorough exam, you would ask a patient questions about each specific system in the body (ex: have you experienced any shortness of breath?). Working with kids made this section a challenge for me-- the young ones can't answer questions if they can't speak or tell time or whatever! So I learned you can fill in the section based on what others (nurses, parents, etc) have observed. Problem solved- but still a skill I'm working on.
The other challenge I've had with note writing is adjusting to doing these exams/notes acting as part of the surgery team instead of the primary provider. It's one thing to do a thorough exam/note but I've actually found it more challenging to figure out what would be most important for a specific specialty (ex: surgery). You try to keep the daily notes you write as concise as possible but some of these kids have such an extensive history it is hard to decide what is most relevant. So ya, I've been learning a lot..
Summary: There is a lot of balance and I am just doing my best to learn a little of everything! To be honest, I haven't studied much outside of the hospital. I need to get better about that..
I finish up this rotation at Children's next Thursday and I am already super sad. I caught myself wondering if they would let me have one of the residents on call rooms so that I could spend even more time there- told ya I'm loving it! I've worked with an awesome group of people and even better, I've been able to work with an incredible patient population. You don't walk into an adult's room in the hospital and get offered pizza and invited to stay for their family movie night ;)
Just try to have more fun than I am this week ;)
xo,
Krista
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