I spent the past 5 weeks completing my Pediatrics rotation at Premier Pediatrics in Staten Island. This was my second rotation (out of 8 total rotations) that I got to do in an outpatient setting, which definitely helped expand my skills and knowledge in medicine and learn the inner workings of an office. Since the practice was rather small, compared to my experience in hospitals, and I was working in a primary care setting, I got to interact with patients one-on-one, run various tests (e.g. strep, rapid flu, rapid COVID-19 and PCR, and Monospot), perform full physical exams, and discuss treatment plans with the various providers. In the practice, there’s a total of 5 providers (3 physicians and 2 PAs), and each day there were 2-3 providers at the office at a time. Since I was working most days during the week, I got to work alongside and learn from each of the providers. Additionally, since there was another PA student rotating at the office at the same time as me, we would each follow one provider in the morning and then swap in the afternoon. The biggest advantage of this is that I got to see how different doctors/PAs work and learn from each of their knowledge and experiences. 

While there were a lot of hands-on skills I got to practice, most importantly I got to work on creating differential diagnoses and treatment plans. The providers would explain to me their thought processes from the moment they walked in the patients’ rooms, which helped me learn how to create broad differentials and then narrow them down. With that being said, one of the most difficult parts of the rotation for me was learning how to interview and examine the younger pediatric patients, especially with their parents in the rooms. Not only did the presence of parents put an extra bit of pressure on the situation, many of the kids would scream and protest any type of exam or test (e.g. nasal swabs, throat cultures, and ear exams), to the point that they had to be held down. This was especially difficult with some of the older and stronger patients. While many parents did help calm the patients down and position them in a way that made the exam a bit easier, some parents were less cooperative. Essentially, what this experience taught me was that patience and sensitivity are extremely important especially in pediatrics. In pediatrics, if a diagnosis goes missed, it could be detrimental to the child. Although providers must be careful and diligent in all fields of medicine, many diagnoses that are self-limiting and benign in adults can cause major problems for younger kids. For instance, an infant with RSV could present with respiratory distress and require hospitalization, whereas in adults the infection typically causes a runny nose and congestion without many other symptoms. Learning to be patient and not get distracted by the noise or kicking and screaming in the room while examining the patient is definitely something I need to work on, especially if I am ever to encounter a pediatric patient. Finally, I definitely need some more practice with pediatric dosing. Dosing in general is difficult, however I’ve become comfortable with many of the adult dosing from my other rotations. Pediatric dosing is particularly important because making sure the child gets enough medicine without overprescribing can mean the difference between life and death (or other major complications).

Overall, my experience in pediatrics was definitely a positive one! I feel much more comfortable navigating the outpatient setting and interacting with pediatric patients, compared to how I felt one month ago!