Clerkship: Pediatrics

The goal of clerkship rotations is for students to acquire a defined body of knowledge, skills and attitudes necessary for the recognition, understanding and management of the common and unique health care problems. During each core clerkship and elective rotation, the PA student will participate, in a supervised capacity, in the care of patients presenting to the specific health care setting (Emergency department, Clinic, in-patient ward, etc).

Pediatric CTU 

  • Location: Niagara Health System – St. Catherines
  • Length: 2 weeks

Pediatric ER 

  • Location: McMaster University Children Centre
  • Length: 2 weeks

A typical shift in Peds CTU

We started our day early in the morning to round on all the in-patients. The clerks begin their rounds in the in-patient ward while the pediatrician rounded on the

IMG_20160328_145107patients in the ICU. If on-call, I would be rounding with the on-call pediatrician in the post-partum ward discharging newborns home. The other clerks and I would divide up the patients. We will see them and chart before reviewing with the pediatrician regarding management and possible discharge. We are responsible for dictating all our discharges and consults.

Rounding usually takes us the whole morning. After lunch, we usually help the on-call pediatrician out with consults.

I commuted from Hamilton every morning to St. Catherines. The drive was about 40 min and no traffic. If I am on call, which usually the ends at 10PM, I just take a call room to stay overnight. I did not want to drive back to Hamilton at night just to sleep for 5 hours and drive back the next morning. I brought enough food for the next day as well. There’s a fridge in the nursing lounge.

IMG_20160329_221408

I wear my clerk coat (because I did not have a “ward purse” at the time:

Newborn exam and discharge parameters:

  • Newborn exam: head to toe
  • Review blood work: bilirubin levels (follow the guideline algorithm)
  • Possible infection: GBS status, duration of delivery
  • Review baby’s weight compared to birth weight: weight loss of <7% is acceptable
newborn_checkup
Picture taken from Google. They are all so cute in their newborn outfit! I love doing the grasp-reflex.

A typical shift in Peds ER

At MUMC, it is shift work. I had a few day shifts, a few nights and one overnight shift (luckily was slow paced). The nurses triage the patients and we pick up whichever chart is first. I let the physician know if I was picking up a CTAS 2 just so that they are aware. I go in, take a history and physical, review with the physician regarding differential and management.

Procedures I performed in Peds ER

  • Casts and splints for FOOSH fractures
  • Cerumen removal
IMG_20160418_224147
My splint job! 🙂

Common medical conditions I encountered on my rotation

  • Bronchiolitis
  • Asthma Exacerbation
  • Hyperbilirubinemia
  • Acute otitis media
  • RASHES!

Some of my most memorable cases

Surprisingly, most were from my CTU rotation. I think it is because, during my time in Peds ER, I mainly saw upper respiratory tract infections.

  • hqdefaultI saw a new born with a coloboma and had to be worked up for CHARGE syndrome. I initially didn’t notice it until mom noted that the pupils were different size. We pulled her lids and saw the key hole defect. What did I learn? Do a THOROUGH head to toe exam so I don’t miss anything – from caput succedaneum to club foot!
  • Vaginal delivery of baby with decreased fetal HR and resuscitation
    • The pediatrician on-call goes into the delivery room should there be any issues with the baby. In the case I saw, the baby was had a decreased fetal HR (due to prolonged vaginal delivery). Once the delivery of the baby was succesScreen Shot 2016-07-27 at 12.24.33 AMsful, he was immediately brought to the table for resuscitation, which involved suctioning of the nose and upper respiratory tract. Initially, the baby was flaccid  and had a low APGAR. I helped with the stimulation (rubbing the baby). After the suctioning, he took his first breath of life and gave us a loud strong cry. APGARS were 8 at 5 min. Mother and baby are well 🙂
  • New Diagnosis of Type 1 Diabetic
    • This was a classic case of Type 1 diabetes. This is a 5-year-old boy who had an upper respiratory tract infection 2 weeks ago. Since then, mom noticed he has been wetting his bottoms even though he is potty-trained. He started wearing pullups again but was going through 10 a day. Mom also noticed he hadiabetes-type-1-diabetes-vs-type-2-diabetes_52fdbc414cd34_w1500s been constantly thirsty and also fatigue, not interested in play. He was brought into the emergency room for assessment as mom felt something was not right. We diagnosed him with type 1 diabetes and told mom that it was likely the respiratory infectio that set things off and if she did not bring him in sooner, he might have gone into DKA (diabetic ketoacidosis). We started him on fluids and slowly with insulin after he was hemodynamically stable, closely monitoring his electrolytes. Mom initially had a hard time hearing this diagnosis; she knew her son will need insulin for the rest of his life. We had a diabetes education nurse see her the next day and it was interesting how she explained to the mom what diabetes is, how the insulin pen works, when to titrate it up and down, and also red flags.

Overall

Before I started this rotation, I was nervous because I know that pediatrics are very different from adult medicine (EVERYTHING is dosed by weight, they can’t tell you their symptoms, etc). Sometimes we have to help the parents as well. I had one stressed father coming in with his child who has febrile neutropenia. It was important to be sensitive and empathetic here. I definitely feel more comfortable with peds after this rotation, though.

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3 thoughts on “Clerkship: Pediatrics

  1. DaniDan says:

    Hi Sandy,
    I have been reading all of your blogs about your PA experience and I am considering applying to PA. I am half way through my undergraduate degree and am also currently working as a technician for an Ophthalmologist. In her opinion, there isn’t really a place for PAs in surgical practice other than surgery Assists. So if I wanted to go into ophthalmology as a PA I’d be doing the exact same stuff I do now. Could a PA obtain the amount of autonomy to perform surgeries? Is the maximum autonomy of a PA at the level of a “technician” to a supervising physician? I love you blog! Thanks,
    Dani

    1. Sandy says:

      Hi Dani, I’m happy that you are considering the profession!

      I am not familiar with the role of a technician to compare it to a Physician Assistant. There is an increasing need for PAs in a surgical practice other than being a surgical assist. PAs work in clinics seeing new referrals and follow-ups – this can easily decrease wait time to see a specialist. My orthopedic surgeon told me how adding a PA to his practice has benefited him: his patients were seen on time; he was able to increase the number of patients he sees in a day and still end clinic at a reasonable time; work disability forms and other medical documentations were completed on time. PAs in other surgical practices also perform therapeutic and diagnostic procedures such as thoracentesis, paracentesis, intra-articular injections, aspirations etc. There is definitely a variety of roles a PA can do in a surgical practice!

      A Physician Assistant can only surgically assist. They cannot perform surgeries on their own as this cannot be a medically delegated act!

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