Before the start of the clinical year, I have had an interest in pediatrics, but I did not plan towards focusing on a specialty. This first rotation in some ways has opened my mind more to the idea of specializing. My first rotation was in pediatrics and in a private office. The majority of the patients I saw were young, with a few older teenagers and “adults.” Many presented for reasons such as routine wellness checks and vaccinations. During the first week of my rotation, I had to adapt very quickly to the environment. I was a little timid at first and was not fully sure of my role in the office so I mostly observed the Dr. to learn and get a better understanding of his approach to patients and to better understand the patient population I would be working with over the next 4 weeks.
The patient population was predominantly Spanish speaking which initially created a language barrier for me but by my second week I developed strategies to help bridge the communication barrier to the best of my abilities and I was more confident in my interaction with patients. The first feedback I received from my supervisor was on the same topic of confidence in my abilities and she encouraged me to not feel afraid to take charge. I took the encouragement and worked on being more involved with the patients. I would get the patients first and would interview them and perform exams as warranted before taking the patients to the Dr. to be further evaluated. I would then obtain feedback from the Dr. on his thoughts my ideas and the patient presentation. During this first rotation, I did not see the patients solely by myself, but for future rotations, if possible, I would like to take full charge in interviewing and providing care to patients before having my preceptor sign off on it.
I was able to work on my H&P-taking skills, but I believe I can still use more work. During my site evaluation, I was reminded to include more details in the social history for pediatric populations such as their involvement in school and extracurricular activities, their level of education (i.e., what grade they may be in, etc.) I also needed to work on my charting skills and to avoid the use of terms such as “unremarkable” when going over the ROS with patients as this does not fully clarify what question I did ask and what issues the patient may have denied or not.
I learned during my rotation that working with the pediatric population can be quite intricate especially when working with younger children who may be more likely to scared or throw tantrums especially when they have to get their routine vaccines. I learned to try different strategies such as trying to calm them down when they are scared (as is expected in children.) I also learned how to interact with children and their care providers. Sometimes parents come in concerned about their child’s wellbeing and it is important to reassure parents that we will do our best to provide care to the patient and determine the underlying issue.
Regarding my critical thinking skills, I feel that I need to work more on my formulation of differential diagnoses. It is one thing to know the information learned from the textbook and in class, but it is another thing to apply that knowledge in real-life scenarios. One of the subject areas I felt I struggled with the most was the area of dermatology. We had a few cases of patients that presented with different dermatological issues, and I found it difficult sometimes to identify and differentiate between the dermatological issues. I need to review my dermatology notes and work on my ability to identify different dermatologic conditions when they are present both through inspection and history taking. However, I think my ability to identify dermatologic issues based on physical appearance will require more clinical practice and experience with patients.
During my rotation, I was happy to be able to practice more clinical skills such as administering injections and venipuncture, as I enjoy hands-on activities and the opportunity to improve my practical skills. I hope that in my next rotation I may be able to continue practicing these skills and maybe practice many other skills as well. Overall, my pediatric rotation was an experience that has opened my mind to explore the field further, but I am still waiting to see how my other rotations go before determining if I would like to specialize and if so in what field exactly.