How to Survive (and Shine!) on your 3rd Year Pediatrics Clerkship
All pediatrics clerkships are structured differently, but in general, you should be prepared to work with children in both the inpatient and outpatient settings. Some programs also have dedicated time in the newborn nursery. These guidelines focus on aspects of medicine that are unique to pediatrics to help you excel with the kids!
Well Baby Nursery
Every child that is born in the hospital must be examined by a pediatrician. Some practices have their own providers come to the hospital where a baby is born; other hospitals have a hospitalist pediatrician who examines all babies.
As a medical student, you will examine babies (often at mom's bedside, since most hospitals have babies at the bedside now to increase breastfeeding rates and parental-baby bonding during the first few days of life) and may be responsible for providing parents with advice before they bring their new baby home for the first time.
This may sound like an important job to leave to the medical student, but once you start talking to new parents, you will be surprised by how much information you have to share with them.
In the outpatient world, you will see a broad spectrum of kids and conditions. You will get experience on newborn/well babies, as well as children from toddlers to adolescents. It’s important to focus on the specific needs and anticipatory guidance for each age stage.
Inpatient pediatrics will be very similar to your internal medicine rotation. You will see patients, admit patients, and present patients on rounds. However, like all things in pediatrics, children's inpatient units present unique challenges.
Your differential diagnoses will have to take the patient's age into account (for example, the differential diagnosis for chest pain is very different in a 6 year old than a 60 year old) and you will be working much closer with the families of your patients than you probably did on internal medicine. In addition to the anticipatory guidance that you provide in the outpatient office, you will also have the opportunity to counsel families on why their child was hospitalized and how they can avoid re-hospitalization.
For those of you who have not been on a pediatrics unit before, there are a few unique things to know. Most units or hospitals are equipped with playrooms, which can be used as motivation to get a child out of bed. However, note that children on any sort of isolation cannot go into the playroom. The playrooms are often run by the Child Life Department, which is a unique department in the pediatric world.
Child Life Specialists have backgrounds in psychology and work to reduce the stress of hospitalization on a child. They accomplish this by maintaining a sense of normalcy for the kids (i.e. the playroom), engaging in medical play (using dolls and pictures to prepare children for procedures), and using distraction techniques to help a child get through a procedure.
In line with that same theme, most pediatric floors have a treatment room. This is a room where the kids go for any bedside procedures (i.e. IV placement, LP, pulling drains). What can be done at the bedside v. what needs to occur in the treatment room varies based on the institution, but the goal is for the kids to feel safe in their rooms. Therefore, we try to have scary or painful procedures occur in a separate space.
Some students find their pediatrics clerkship to be overwhelming because of how different everything is from adult medicine; however, most students will also describe their time in pediatrics as fun and rewarding.
American Academy of Pediatrics