When I started my pediatrics rotation in the ER at QHC, I realized early on that I was accustomed to seeing my own patients without having anyone tell me to do so, partly because I had a lot of autonomy during my family medicine rotation. In the pediatrics ER, taking the history and performing the physical was a little different due to the nature of the complaint but I was able to adapt quickly and ask questions that pertained to an ER setting. I learned that the attendings were interested in focused exams and would only discuss a maximum of 2 (generally 1) complaints that were most “life threatening”. Depending on the attending that I was assigned to, most attendings allowed me to take a full history and perform the physical, which was important to add to my skillset because I did not see many pediatric patients prior to this rotation. However, there were not many chances to perform procedures (other than swabs) because the patients were so young, unless they were adolescents in which I was able to perform venipunctures and IVs from.

Working in the ER required me to think on my feet often. Attendings would ask me for differentials after I saw each patient and they taught me that it’s okay not to know exactly what’s going on. For example, many patients would present with cough or abdominal symptoms like diarrhea or constipation and we would discharge them with non-specific diagnoses like viral gastroenteritis or upper respiratory infection, unspecified. The main goal of the ER was to stabilize the patients and emphasize the importance of following up with the PCP several days later. I also realized why ER visits can take a long time since there were variables that were out of our control, such as transport time to x-ray and getting results of swabs or bloodwork from the lab. Sometimes, patients would voice their concerns about the wait time but I tried to make them as comfortable as I could and I tried to help expedite whatever result was pending. Because they could see my efforts, the family members were appreciative of me and that in itself was rewarding.

Spending a week in the pediatrics outpatient clinic was both interesting and a little disappointing. I was able to “shadow” specialists like pediatric pulmonologists, cardiologists, and adolescent medicine. I was not able to do much in the clinic, meaning I mostly observed the provider during the entire visit. Although I gained knowledge on what to ask during well visits in terms of milestones and preventing early onset childhood obesity, there was little to no autonomy. As a person that learns better hands on and because I like doing things myself, I wish there were more opportunities to interview the patients and perform the physical with the provider in the room. Last time, I mentioned that I had some difficulty with pediatric patients, especially with the physical exam since it was different than adult physicals. However, through observing the attendings in the ER, NICU, or clinic, I was able to gain a better sense of what to do and what abnormals to look for. However, one of my main challenges is to differentiate between different murmurs, which I hope to work on with additional experience during my future rotations.

Overall, I really enjoyed working in pediatrics because I like working with children. Even at the end of long shifts, they are able to give me boosts of energy from their curiosity or playfulness. It feels rewarding to know that I have partaken in nurturing the youth of our future.

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