Pediatrics

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Pediatrics Books What Students Said... Textbooks - Rudolph’s Te Textbook

- Dr. Friday’s Packet

Review Books - Blueprints - Fi First Ai Aid ffo or P Pe ediatr atrics Case Books - Cas Case e Fil Files es for for Ped Pedia iatr tric ics s

Question Books/Resources - Prete retest st for for Pe Pediat diatrrics

Very detail ailed bu but a go good reference for important topics like Cardio, Renal, Pulmonary. You can borrow it from Dr. Friday’s office. It is a MUST to know everything in this packet! She outlines many of the important topics to review. Attend the sessions when she is going over this.

A little wordy, most students do NOT recommend this! Good ou outlined re review so source

EXCELLE EXCE LLENT NT revi review ew of majo majorr top topic ics. s. Try Try to to rea read d twi twice ce with rapid read through second time 2 days before test.

Exc Excellen llentt que quest stiions. ons. Emph Emphas asiz ized ed the major ajor poin pointts of  of  each topic. Probably the best of the pretest series.

- USMLE World for Step 2 CK 

Fill Your Pockets… - Maxwell’s - Tarascon Pharmacopeia - Tarascon Pediatric Emergency Pocketbook Ophthalmoscope/Otoscope

- Stickers

- Mini Mini Spir Spiral al Note Notebo book ok

- Stethoscope

Very useful to have your own so that you do not have to search for it when needed. Many residents carry their own because they’re not easy to find on the floors. Look like a star and carry yours so your residents can borrow it! A little treat for your patient . You have to be creative when you work with kids to get them to relax for you and become comfortable with you examining them. Jot down down note notes s from from the day day to jog your our memory ory. You You can also write down assignments/tasks and stay organized. Usually quite obvious, but make sure you have a good one with a diaphragm/bell that can be used for kids!  You can often hear some awesome pathology pathology in these

little guys!

Other helpful resources - Rainbow CD

Dr. Friday may give you one during orientation or during one of the study guide sessions. Useful for reviewing milestones to assess for before seeing a patient, and for the OSCE. Used to be in a book format, you may have to ask Ms. Scott for this CD specifically if you want it.

What to Do The Weekend Before/the First Few Days Organize your books into the different subjects that you’d like to focus on. Figure out if you want to read straight through your study materials or organize them differently. It is helpful to review examination techniques for kids (especially how to hold an otoscope so that you can see well and don’t perforate kids’ eardrums!) Also, if you have not done IM yet (or don’t feel comfortable with them!) review EKGs, they still come up in kids occasionally. Review chest x-rays and how to read MRIs and CT scans, they do these on kids too! Stages of development are also a good thing to review, as they show up on the OSCE, the shelf and very much so in clinic!

What to Do on the Floors Like in any other rotation, be a part of the team. Also, Dr. Friday does a great job of making sure the residents and attending on each team are aware of our role as students. Round on your patients in the morning. Making sure the parents’ voices are heard by the residents/interns is a place where students can be very useful. We have more time to chat with the family and convey their concerns to the team during rounding. Offer to help accomplish tasks at the end of rounds. Try to be aggressive with being involved in any procedures. Letting the team know you are interested goes a long way when it comes time for evaluations. If you have some down time, play with the kids – it shows the kids you care and helps with parents’ anxiety! In order to improve your examination skills, examine patients who may not even be yours when interesting findings are present. Dr. Friday really does a great job of providing materials and orienting you. She is very dedicated to making your Pediatric Rotation a very educational experience, whether you are interested in Pediatrics or not. If you have any questions or feel lost, she is very approachable. She may be a little difficult to track down via email, so just be persistent! Asking Ms. Scott is also a good way to get questions answered.

There is a lot of paperwork! However, doing the work will help you prepare for the OSCE. It is important to keep track of due dates and things to attend so that you do not miss out on honoring clinically for something small like forgetting to turn in an assignment. Periodically review what assignments you have left to do.  The H & P’s take awhile but it is worth the effort – if you get an outstanding the first time you do not have to turn in another one! Make copies of your completed work/assignments to turn in, just in case it is missing later! A typical day: Really depends on your team and your senior, so ask on the first day what is expected of you and what you are to expect. Some attendings round at 7, some don’t start until after grand rounds and meet up at 9. There are usually grand rounds daily every day (of some sort) at 8 AM every day. Some teams may

round through noon, so make sure you get a chance to eat (especially if you’re feeling hypoglycemic!) Some students’ were able to get out early in the day if they started rounding earlier, and if the attending didn’t take a long time to round. However, in general, inpatient can be MUCH busier than outpatient. There are labs to check on, imaging studies to read, tests to schedule, consults to order, the list goes on! Take every opportunity to ask questions, jot them down as they come up and ask the attending when you get a chance – more than likely they will welcome your eagerness and questions!

Picking your outpatient “Specialty” week  If you’re interested in any of the offered specialties (either as a pediatrician or as an adult medicine doc), seek them out! Dr. Pelshaw and Dr. Friday are usually quite accommodating if you show that you’re interested! Some general tips about the clinics/sites: -Cardio: can be quite busy and teaching is very staff dependent. Figure out your best teachers early and seek them out! -PM&R: depending on the week, clinic and activities may be quite light or quite busy. All the attendings are very willing to teach, though, so ask lots of questions!  The kids are also great to work with – a lot of Cerebral Palsy, Spina Bifida, Trauma patients, post- head injuries, and other developmental/congenital anomalies. -GI: good procedure and OR experiences, you might be able to expect earlier days than other students. -Endocrine : nice b/c you have consults and clinic. See many patients with type 1 diabetes, growth hormone deficiencies, but also congenital adrenal hyperplasia and other conditions you may not see on other services. Consults can be variable in terms of how busy you will be, so make sure you always have something to read. Docs are really nice and love students.

Preparing for the Pediatrics OSCE & SHELF OSCE: Dr. Friday will send an e-mail out to you before the OSCE which will mention most, if not all, of the topics for the various stations. Review the topics (found mostly in Study Guide #17) and you should be fine. She also gives you a chance to remediate any stations that you did not fulfill the goals for, but it is not difficult. ALMOST EVERYONE WILL HAVE TO REMEDIATE PARTS OF THE OSCE IN SOME FORM OR ANOTHER so do not worry about it. The Peds OSCE is probably the most intense clerkship OSCE of the year, but the intensity that Dr. Friday presents is probably equal that of the end of year 3 OSCE in intensity and time management. Some important topics to review : rash review pictures (how to describe a lesion), height/weight/head circumference curves, medication dosage calculation; immunization schedules, peds nutrition requirements, physical exam skills, reading a TB test, writing a SOAP note. SHELF : It is important to study throughout the 2 months. Even though the inpatient month may be busier, review a topic everyday. Studying daily is the best way to stay on top of it. If you have the outpatient month first, make sure you are efficient with your time and study as much as you can during this month so you can review during your inpatient month. Read about your patients, and other interesting patients on your team! Regardless of what team you are on (General Peds, Hem/Onc, etc.), you will learn a lot from each patient. Do not worry if you are on the Hem/Onc team. You will see general pediatric principles in practice during your outpatient month. Make sure you still read about the topics that you do not see on the floors. Dr. Friday’s review session is excellent as she goes over the important concepts.

LECTURES: Lectures are required if you are on-site (at Children’s for In-patient or out-patient), but are usually exempt if you are off-site for in- or out-patient. However, most of the answers to the study guides (which are great reviews for the OSCE and the shelf), are given during these lectures/review sessions, so they are very important to attend! Also, Dr. Friday takes attendance and this is part of your “professionalism” grade that makes up part of your clinical grade. INPATIENT vs. OUTPATIENT: Most students try to get their inpatient month first so that they can have more “study time” the second month, but don’t despair if  you have outpatient first. Just schedule your time accordingly and stay on top of  your studying! You will probably see the most “general” peds on one of the general peds inpatient teams, but the most specialized teams (Heme/Onc, ID, etc) are still a good way to see general peds conditions (think sickle cell, anemia, ITP, asthma, etc), and are also a good way to get some awesome teaching by specialists that are dedicated to their fields. Even if you’re not interested in peds, it’s a good way to see some conditions that also present in adult populations.

Pediatric Site-Specific Advice Site Children’s Inpatient

Children’s Outpatient

HFHS Outpatient

Beaumont Oupatient

What Students Said… A great place to learn a lot during your pediatrics rotation. Many interesting patients are transferred from other hospitals to CHM.  The docs are great and love to teach. Helpful that lectures are also at CHM so you can make it. However, logistics may be confusing and it might be a little slow in clinic at times. There may be quite a bit of  shadowing, just make the best of whatever experience you have. All the sites were excellent. You will have 1 week of  newborn nursery, 1-2 days of ER, and 1 week of clinic. Dr. Kumar and Dr. E in newborn nursery are really excellent, and love students. Ask lots of questions! Also, be proactive in newborn nursery and say you would like to do a circumcision , do physical exams. Try and spend some time in the NICU as well. Most people really enjoy their ER time. Again, being proactive goes a long way. Ask to see your patients, and if a patient needs sutures, ask if you can help. Ask to do as many procedures as possible. Clinic sites are for the most part good. The attending are very friendly and approachable and encourage students to see patients on their own, so take the opportunity to do so. If you feel as though you are shadowing, be proactive and ask to see patients on your own. Make sure you communicate with the sites that they know you are coming, and that they are aware of any lectures you might want/have to attend. Dr. Leatherwood at New Center One is excellent. If you are at the Sterling Heights clinic, try to work w/Dr. Rodriguez and Dr. Pollack, as they are both excellent (though everyone is great). Well organized, free food, and not many competition from other students. Staff is laid back and there are a good variety of patients. However, you might have to drive a bit to get to lectures or just to the location (depending on where you live). One down side is that students aren’t expected to do a lot so you’re not pushed as much to learn.

Useful Formulas See Orange Section of Maxwell’s: -Anion gap: Na-(Cl+HCO3) -Fractional Na Excretion: (urine Na x serum Cr)/(serum Na x urine Cr) -Maintenance Fluids: 4mL for each kg 1-10 + 2 mL for each kg 11-30 + 1mL for each kg>30 -Corrected Na: Na +[ (glucose-100) x .016] -Aa Gradient: [713xFIO2)-(PaCO2/0.8)]-PaO2 -ABG Rule: change in 10mmHg PaCO2 = change of 0.08pH -Osmolality: 2 x Na +glucose/18 +BUN/2.8 -Body Water Deficit (liters): [0.6 x wt (kg) x (patient Na-normal Na)]/ (normal Na) -Creatinine Clearance (GRS estimation): [urine Cr x urine volume (mL)]/[serum Cr x time (min)] [(140-age) x wt (kg)(x0.85 for females)]/[72 x serum Cr (mg/dL)] -Corrected total calcium: [0.8x (normal albumin-patient albumin)] + Ca -Mean Arterial Pressure: diastolic BP + [(systolic BP-diastolic bp)/3]

Useful Note Templates 1) There are templates available on medfools.com (under download section) to help keep track of individual and multiple patients. 2) Maxwell’s (Yellow Section): Admit/transfer, progress, and discharge notes . Blue section also has a template for complete history and physical.

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