Peds is definitely a challenge. Everything is just slightly different and you have to rewire your brain to think like a pediatrician. For example, ‘bulging anterior fontanelles’ means increased intracranial pressure (and thus possible meningitis). ‘Spitting up’ warrants GERD on your differential. The ‘classic presentation’ for major diagnoses is varied ever so slightly that it can really throw you off unless you’re used to pediatrics.
The other challenge with pediatrics is that your patients can’t really give you a great history. They are more likely to say ‘yes’ or ‘no’ to every question you ask, whether it is true or not. Or nod… or blankly stare at you. Sometimes you have to rely on mom or dad, which also isn’t the best because it’s not a first hand history. Mom and dad have great intuition about their kids, but they aren’t physically feeling what the patient is feeling.
One more challenge: you get sick constantly (especially if you’re a new med student on service). I was one of the lucky ones that got mono from the kiddos.
WHAT SPECIALTY SHOULD I DO?!?!
For a while, I thought that family medicine was a good fit for me because I wanted to treat adults and kids. However, since being on peds and studying for that brutal peds shelf exam, I am starting to realize the importance of really specializing in peds or really specializing in adults. Family medicine is awesome, but if you really want to treat kids in an acute hospital setting, I definitely feel like 3+ years of pure pediatrics will help tremendously. As opposed to 3 years of splitting between adults, kids, obstetrics, inpatient and outpatient.
There are med/peds residencies, though. You can get double-board certified in both internal medicine and pediatrics. The benefit of this residency over family med is that the residencies are geared more towards inpatient medicine. Family medicine definitely has inpatient medicine, but most residencies are geared towards outpatient medicine. However, you do get obstetrics and gynecology in family medicine; you won’t get this with med/peds. The other benefit of family med is that you are in and out in 3 years with training in kids, adults and ob/gyn.
So I guess the questions to ask are, do you want inpatient or outpatient medicine? Kids, adults or both? Do you want women’s health in your practice? Would you prefer to be more specialized or more broad?… do you like procedures or being in the OR?
To be honest, I change my mind ALL the time when answering these questions. The only constant that I have found thus far is that I love inpatient medicine and I want to be on my feet for the majority of the day. Check out my posts on other specialties of medicine here! So far I’ve done family medicine, surgery, and psychiatry.
Surviving the Pediatrics Rotation
Building rapport is so important in every area of medicine, but it is especially important in pediatrics. If the kid doesn’t like you or trust you, there is no way you’re getting a peek inside their ears. Talk to them, smile, play with them, and let them play with all of the equipment you are going to use before you use it.
Learn all of those little differences between child and adult presentations. There are so many… have fun!
Have the developmental milestones and immunization chart readily available to reference. Eventually you will memorize it, but keep it handy to look at before you go see a patient for a well-child checkup.
Hand sanitizer is your BFF (…but it can still let you down). ALWAYS wash your hands in medicine… but do it even more so in pediatrics to protect yourself. Even after slathering myself in hand sanitzer all day long I still got mono.
The Peds Shelf Exam
This test covers EVERYTHING, but tiny human version. It’s basically a mini board exam with all of those bugs, drugs, leukemias/lymphomas, and basically every aspect of medicine. … but of course just slightly different because its peds. And you have to know all of those developmental milestones and vaccine schedules.
Online MedEd – My go-to resource right now. FREE video resource and it’s awesome. I can’t tell you how many times I’ve watched these videos and for every rotation. They seriously cover every important topic and outline everything so well.
Kaplan Step 2 CK Lecture Notes: Pediatrics – I finally caved and bought a comprehensive book resource. The Kaplan book is broken up into smaller books to make it easier to take notes in and carry around. I went through the whole peds book for the shelf exam.
COMBANK – Question bank. I definitely think UWorld is better, but I am waiting to purchase a subscription closer to COMLEX Level 2. It’s ridiculously expensive.