Category: Years 3-4

Pediatrics Rotation

Hello!

I wanted to give you an inside look on my pediatrics rotation. I am actually really passionate about kids and they just light up my day. I have to say, I usually feel physically tired at the end of the day, but I don’t feel mentally or emotionally drained when I work with kids. It’s really hard to! They are always a joy to be around (for me anyways).

Pediatrics is another core rotation. This means that I will have another shelf or COMAT exam at the end of my rotation. Most students work with a pediatrician in clinic for their core rotation. That way, you get to see a lot of well child examinations and really get a good look at growth through the ages.

I actually had my core rotation with the pediatric hospitalist group! Thankfully, I got to do well child exams and examine newborns during my ob/gyn rotation in family medicine/ob. I also got to do circumcisions during that rotation as well. For this rotation, there was a much different feel as we were inpatient.

Much sicker children.

Much higher acuity.

Note taking is also very different from your typical outpatient notes. It is still a SOAP note (in theory anyways), but your most detailed note is the H&P when they first get admitted. More on that later.

Schedule/Daily Work Hours

This rotation was a little farther away from my last one, so I did have to get up earlier and drive farther. Not my favorite thing to do since I dislike mornings, but you do what you need to!

Around 7:15/7:20am: I get to the hospital and go up to my floor.

7:20-8am: I am reviewing notes on what happened last night and rounding on my patients. The floor can hold 19 rooms (2 kids per room), but they don’t typically like to double up in the rooms unless they have to. As a medical student, if I don’t have any patients that I’m following I MUST round on two of the patients on the floor. And I need to have seen my patients before huddle and before the provider comes to the floor. Some days I was able to push myself and see more than 2 patients.

8 am: Huddle. Huddle involves everyone in each child’s care to be present so everyone knows what is going on and what the plan is. On my floor, the nurses present their patients and any updates overnight to the physician. Pharmacy, social work, nutritionists, and child life (enrichment and counseling) are all present during this.

Depending on when Huddle ends we will start rounding.

8:20/9am -10:30/11am is rounding. This time is very very variable. And if we get a lot of admits in the morning or consults, rounding will be slid in-between. Generally we take this time to check in on each patient and update the parents on what we are going to do. Not all the patients on the floor belong under the hospitalist. Some patients are under trauma (burn and MVC patients), some are under Hem/Onc (cancer patients). Everyone else is under the hospitalist group. We may also have someone in the PICU (down a few floors from us) to see as well.

After rounding the physician usually works on any discharges that they have. I use this time to work on my notes or look up information on the diseases some of our patients have. Some days we have a lot of discharges, others we have maybe one.

After rounding to 3/4pm. This is where we take consults, the provider calls for other consults to help with patient care, and check up on labs/imaging or order anything new. Most of these patients have a lot going on, and usually take up more time than you would expect. Some days we have barely any consults, some days we have a lot.

When the provider or myself isn’t taking a consult, they usually take that time to teach! The busier the day = less teaching. And after each time I take a consult or round on a patient, I need to write a note.

For example, today we had a kid come as a step-down from the PICU to our unit. So I was sent to the PICU to examine the patient and get a history to get things started while the provider did something else. I was also sent down to the ER as the ER wanted us to admit a child. So I again started that history and physical for the physician. At the same time, we had two transfers come in as direct admits; I took one and my provider took the other. And finally we had another ER admit. While that was going on, my provider was also trying to get a specialty consult appointment set up so we could discharge a patient, and consult another child’s geneticist who was being admitted.

They usually send me home around 3pm, unless we were busy and I would stay a little later. The latest I have stayed is around 5 pm. The unit I’m on has a rule about students not really being there past 3 and not to work on weekends. After discussing my hybrid situation with my attending, most of them are okay with me coming in on weekends to spend some extra time learning.

Notes

So note taking is a bit different for inpatient. It is still a SOAP note, but depending on the type of note will depend on how much information you put in it.

H&P: This is the note you write when admitting someone. So if you get a consult to admit from the ED, see the kid after a transfer to the floor from another hospital, or see the kid from a direct admit from their pediatrician, you do this type of note.

It involves a full HPI, ROS (multiple systems), and PE (multiple systems). The more complete = the better. You need to verify PMHx, SHx, meds, allergies, Family Hx, all that jazz. Some physicians also want a good social history; which for kids involves who they live with, if they go to school/daycare, any pets, any activities they do. If they are still infants or young toddlers, you need a birth history from mom.

Assessment for the H&P isn’t always what you end up diagnosing them with. For a lot of kids that fall under “failure to thrive” I usually put poor weight gain. Because one person’s definition of FTT is different from another. And a lot of times physicians use FTT instead of poor weight gain. So my initial assessment/dx is a working dx or a symptom unless something specific was found on workup.

Plan is much more in-depth and usually involves going by system. So a plan for an admit may look like this:

  • Resp: on RA, oxygen, albuterol q.2 hours, etc.
  • CVS: Hemodynamically stable. Will monitor vitals q.8 hours.
  • GI: (usually includes diet). PO diet as tolerated. Consult dietician and SLP for evaluation.
  • Renal/Endo: I never put anything here unless its a specific case for it.
  • ID: If we did a respiratory panel, stool panel, etc we would put findings here. This is also where we may put antibiotic plan here.
  • Neuro: If there I something specific like EEG or MRI or near consult we put that here. Otherwise usually Tylenol/motrin for pain will be put here as well.
  • Social: where we typically put that we’ve updated the parents on plan.

Any labs or imaging can be put under their associated section OR I usually pt it above with a statement to make it nice and neat. It just depends on how you do it.

Progress notes: So this is what you put on a patient that you’ve rounded on. Since insurance only covers one “bill” a day, only the day shift rounds on patients in the mornings. The night doctor doesn’t do any notes that would fall under progress. Some physicians like to add the day # at the top.

HPI for this is usually any updates since last written evaluation. So this can be that management was switched in the afternoon or evening, and how they did overnight. Did they spike a fever? Did they vomit? Diarrhea? How did they sleep? (very important in gauging kids). Did they eat? Can they tolerate PO? Were they playing yesterday? All of that is important.

ROS you don’t typically do for a progress note since the HPI is an update on how they are doing.

PE can be limited to a few systems. If it is a newborn/infant, you need to do a full exam every.single.time. Otherwise, I usually do constitutional, skin, eyes (if old enough), heart, lungs, belly, and neuro. You can add/subtract from there. Or you can do a full exam each time. It’s up to you.

A&P: similar set up as before. You either define/find a better diagnosis or continue to use the previous working diagnosis. Or maybe you use the working diagnosis and add on more based on findings and how the kid is doing. Plan is set up the same way. Any changes to treatment, any added medications, consults, labs/imaging need to be added. If you have an idea of what you are looking for before you discharge them, make sure that is noted in your plan. Otherwise the next attending on may not remember from sign-out what you’ve told them.

Discharge note: This is a brief HPI, PE, pertinent lab/imaging findings, and A&P. Plan should include follow up with their pediatrician and any other specialists, any follow up labs/tests you need them to get, and what symptoms they should look for that would prompt re-evaluation. Any medications you are discharging them with and how to use them along with any patient education needs to be in the plan and patient papers. Most of the subjective can be wrapped up nice and neat in a summarized “present” during their whole time there. Some providers like to have a full few paragraphs on the course of what happened while there. Others do less involved. PE should be pretty damn near normal or as normal as they can get for their condition before sending them home. Like, you shouldn’t be sending home a kid who is in respiratory distress and it shows that on your exam.

Cool things to see on the floor:

  • Trauma (although I didn’t manage any of those and neither did the hospitalist).
  • Burns (also trauma)
  • hem/onc patients (we didn’t manage this, but interesting to look up and study)
  • pyelonephritis
  • asthma exacerbation
  • bronchiolitis/croup/pneumonias. One pneumonia was chlamydia related!
  • appendicitis
  • LOTS of pyloric stenosis at this floor. Like holy crap.
  • omphalitis and cellulitis
  • scalded skin syndrome vs toxic shock syndrome vs weird allergic reaction
  • osteomyelitis
  • diarrheal diseases
  • so much failure to thrive/poor weight gain. Some of them are due to dehydration, some due to poor feeding schedules/too much given by parents/not enough given/not feeding at night. Some are the kids had a virus and everything got out of whack. Some of them are actually from some pretty serious diseases.
  • Febrile seizures was also pretty common to see.
  • Hirshprung’s disease.
  • rule out Kawasaki’s
  • Seizures (several had associated genetic diseases)
  • Duodenal hematoma (that was actually really interesting to look into management)
  • BRUE
  • Seizure management and workup
  • Abuse cases 🙁
  • Kids with genetic metabolic diseases and the fall out/recurrent issues that occur with those.

I most definitely spent time reading during clinic while my providers were doing phone calls or charting. That allowed me to cement a case with what I saw and with the information about it.

What are some major things I learned?

Well besides how inpatient medicine works and learning about kid diseases, I learned more about interacting with patients than I thought I would.

  1. I need to know my cases well, because parents will still ask me questions. I need to do my best to answer with correct information; and if I don’t know, I need to be able to defer it for when my attending arrives.
  2. Just because you are worried about a disease course for a specific disease/problem, doesn’t mean you need to tell the parents all of that. Lesson learned. That mom didn’t like me very much.
  3. You need to do a full exam. Every. Single. Time. As a student, it is time for you to practice. Not good at listening to murmurs? Listen to all the hearts. Not good at finding pulses? Practice. Plus, since your differentials aren’t fantastic yet, it helps you possible catch something you weren’t sure could be helpful!
  4. I have learned that even though you can complaint or discuss something in person, you cannot write certain things in your notes. Even if it is causing you issue with management of a patient. Word truthfully, but without accusing or painting a non-neutral picture in the chart.
  5. I really really like kids. And I really really like babies. Which is NOT helping me push off having children.

Hope this was helpful, and good luck on peds!

Curriculum Vitae

Hello MedHatters!

Today I wanted to tackle going over a curriculum vitae, or a CV as most people call it. You will need to learn how to “buff” up your CV, and continue to add/tweak it as you progress into each stage in your pre-med and medical career. You will use this as your resume as a physician, physician assistant, or pre-med student at every step in your journey and for every medical or science related job you will apply for.

This post will be a bit link heavy, just because all of these documents are on my google drive.

This used to be such a mystery to me. And to be honest, I used my resume for a very long time because it doubled as both my CV and my resume. Big mistake. Mostly because I wanted my resume to stand out, and CV’s are very fact based without much of the frills associated with it. So, here is an edited version of my former resume/CV that I used for a while:

My Old CV. Now, this is several years old. I last updated it while I was in my master’s program (2016-2017) as I was re-applying to medical school. I also wasn’t sure if I would need to apply for a job after obtaining my masters. So a lot of things are out of date, and obviously personal information for myself and others were redacted.

See how beautiful and full of extra frills it is? Great for getting your resume picked/noticed out of a pile of them when applying for jobs, like a regular resume. NOT a good look for a CV.

What is it?

A CV is important this is basically a list of your academic achievements and jobs from the start of your pre-med journey until you basically retire. CV’s are used in science-based careers as a way to showcase all of the work one has done in their field and includes the special skills and talents that you have. It follows everything that you have done for your career, from start to finish.

It is different than a resume however. Some call it a “resume” because everyone knows what a resume is. A resume will usually be shorter, and is solely focused on job experience and what you learned/achieved/pioneered at each job. Yes, there are areas to highlight other skills, but most of the space on a resume is containing what you did at your previous work. You tailor this mostly to fit the job you are applying for (so it may change each time you apply for a new job). You likely won’t keep everything on your resume, because you are trying to highlight certain skills for the particular position you want. With a CV, you usually keep everything. Or most everything.

When you are first starting out (high school, early college), you will end up putting every experience on your resume. That is just how it goes. As a human you haven’t built up enough skills, so every new skill you learn counts as you are entering into the adulting world of jobs. You don’t have enough experience or haven’t worked enough jobs to be able to pick and choose which ones you believe will fit well on your resume either at this point. This will be similar for your CV when you first start out as well.

A CV on the other hand is very field focused. And by field, I mean basically everything in science lol. Usually if you have a CV you are working in some limited subset or certain branches of the sciences. When you first start with your CV, you will have pertinent information from high school and college to help get you into medical school. By the time you are in medical school, you will only keep the more recent things from college or the experiences that you spent a lot of time with on there. The rest will be what you built up in medical school.

As you move on from each stage in your life, you will start to lose the information from your education days and only keep what you’ve learned and done in the field. Or from residency and up. From here you will just tack on everything.

The club I am in charge of this past year has had a CV workshop every fall for the past 3 years. I am using the resources sent to use to give to students for this workshop.  So yes, very credible and not like I just pulled it out of thin air.

Most of these resources on the internet are a bit hard to find. I struggled trying to figure out what I should have on my CV before being apart of this club and being able to even look at a decent example of one. IDK why they are so elusive with trying to teach us how to write these. If you’ve happened to work with someone who has been willing to sit down with you and show you how to write a good CV, OR you have been able to find good resources online, great! I would love for ya’ll to share those resources down below in the comments to help each other out.

But here is a guide to writing resumes & CV’s.

REcommendations

I still recommend you have someone either in the field or whose specific job it is to look at CV’s and resumes review yours. Whether you take part in Joplin-MAOPS’s CV clinics where professors and professionals help you with your CV, or you seek it out with a professional service. Sometimes your undergraduate professors or career counselors are willing to help. I think this is the most invaluable way to help your CV.

Hopefully MAOPS keeps this clinic running after I leave. I found it super helpful and I know a lot of other students did as well!

Breakdown of a CV

Just like a resume, your CV needs to have your name and contact information on it and be in a very easily noticeable and accessible spot. So usually the top of the first page. For those of you that may not realize why this is important, if an employer or lab you want to volunteer with or physician you are trying to get to write you a letter of rec doesn’t have a name that they can easily find (or a name at all), they aren’t going to waste their time. This means no potential job, no potential opportunity to work in that lab, and definitely no letter of rec. They will usually just throw it out. Because there is no way of knowing who you are and how to contact you. Although, if you are asking for a letter of rec from someone you know, they likely don’t need it. But still.

In general, the next best header to use is education. Put your most recent first, even if you haven’t graduated yet. And if you are a medical student, MAKE SURE YOU PUT YOU ARE A CANDIDATE FOR THIS DEGREE OR A CURRENT STUDENT. Because we are dealing with a doctor of osteopathic or allopathic degree, you need to make sure you aren’t lying and saying you are a doctor before you are. This can get you in a lot of trouble. Sometimes just showing that the graduation year hasn’t occurred yet isn’t enough…

Since I attended KCU for both my master’s of science education & currently for my DO education, I broke them into 2. You can keep them as one group though.

There are a lot of other headers on this example CV that I have. You will need to remove headers that don’t apply to you and potentially add some that fit into your journey for the time being. So, if you are a sophomore in undergrad, you won’t need board scores. You likely won’t have any invited lecturers/presentations or publications yet. If you do, again, great! If you just recently started your journey or haven’t been able to beef it up much in awhile, showcase things like recent volunteer work on your CV.

I never went down the road of research and publications because I really dislike it. Which, I have not been shy about stating before. This area of my CV is severely lacking and so I don’t keep it in.

Example CV.  I suggest keeping a copy of this original example somewhere, and then either creating your own or making a copy of it and turning it into your own. You may not need all of these headers right now, right this second. But if you are like me, you’ll forget what other headers there might be. You’ll want it as a reference when you start adding other experience to yours as time goes on!

Also this is a very basic template. It is meant to be filled out by you. If you want more examples, when you are on your search engine type in “science CV”. The science part is important, as it will bring up more examples similar to those in the field you want to work in. Again, disregard any that have fancy frills, pictures, etc. I’ve been told by one of my professors (PhD in biochem) that if he sees anything like that, he isn’t interested in looking at the CV. He stated he wanted to see your experience and accomplishments for what they are.

Do’s and Dont’s

The last bit of advice I have to pass on is some do’s and don’ts. Most of it will be in the form of another linked document to my drive.

But if you are tired of clicking on so many links, there is the quick version of it:

  • It’s okay for your CV to be long. In fact, the longer it is, it means you’ve had more experience because it is a running list. Don’t worry about feeling bad if you don’t have a ton, you are likely just starting out!
  • Yes, you can always edit your CV for a specific job you want. Make sure you keep that information though so you can put it back into your regular CV.
  • Chronological order is a must.
  • Use active verbs! And keep things concise.
  • Again, if using this during undergrad, tailor it for that. If using while in medical school, make sure you are only using medical school and up. Unless you did something for majority of your undergrad or it is a related experience, you shouldn’t need it once you are in medical school.
  • If you find that you have had several similar experiences/jobs, you don’t need to go into every detail of what you did. Explain those details under the first job/experience, then only have 1-2 sentences for the remainder of your similar experiences.

Do’s and Don’ts document

I hope this was helpful to ya’ll. Cheers!