Exposure to new techniques or treatment strategies – how did that go?
During this rotation, I was definitely more exposed to pediatric immunizations to a great extent. Four year old well visits were particularly challenging because four vaccines [DTaP, IPV, MMR, and VAR] were typically administered [when parents followed the pediatric immunization schedule], and I found that patients, regardless of size, can put up quite a fight during their administration. As a result, I quickly learned the need to hold patients down and become more comfortable in doing so, eventually realizing this applied to all ages, as fear of needles presents in every age group. In addition, I was exposed to the performance of many throat swabs for rapid strep tests. This was another procedure basically every patient hated. However, its completion helped to quickly determine whether a child would be treated with an antibiotic if it was positive versus supportive care if it was negative and more likely viral. Much of the time, patients presented with sore throat, runny nose, and fever, and it was due to a non-COVID-19 viral illness rather than a bacterial one. For these illnesses, Motrin or Tylenol, nebulized saline, and Bromfed DM or Dimetapp were part of the standard of care. Other techniques I was also exposed to included cerumen impaction removal with a mixture of hydrogen peroxide and water, palmar wart removal with a scalpel and liquid nitrogen, tick collection for analysis to determine need for treatment, and stool guaiac testing, as parents would bring in baby diapers concerned about blood in stool. Lastly, because I rotated at an outpatient private office and not at a hospital like all of my previous rotations, prescriptions needed to be written for more extensive blood work [BMP, LFTs, TSH/Free T4, Fasting glucose, HbA1c, lipid panel, Celiac panel] and/or urinalysis/urine culture as well as imaging [primarily x-ray or ultrasound] for which patients needed to complete elsewhere.
Managing new types of patients and the challenges that arise from that.
The pediatric population is a population I had not previously managed during my prior rotations so the entire experience felt new to me. Many parents do not follow the CDC guidelines for scheduled immunizations so it was challenging to learn how to navigate through such situations and determine which vaccines were more important to administer at the visit, and at the same time, consider the appropriate timing for future vaccinations. Additionally, there were children who were wary of having to go see the doctor or PA, or were simply very young, and taking a history relied heavily on obtaining information from parents. This was new for me, as I had interacted with the elderly and adult populations during my prior rotations. Moreover, as previously mentioned, holding down, and in a sense, restraining, some children during both physical exams and vaccinations proved to be challenging as well. Getting them to take deep breaths to get a good listen of their lungs or even getting them to open their mouths and say “ahhh” to get a good look at their throats was not as easy as I had imagined. These situations required a much greater level of patience, though understandably so given their age. Nevertheless, it was definitely a challenge I had learned to adapt to.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
The knowledge I have gained during this rotation could be applicable in other rotations/disciplines, such as the ER or ambulatory care, because they are two other settings in which pediatric patients likely present pretty frequently. In fact, many parents of patients had stated they went to urgent care centers prior to coming to the office. Therefore, I am sure the knowledge I have acquired during this rotation regarding infectious diseases, rashes/exanthems, musculoskeletal complaints, and other dermatologic complaints will serve me well during my next rotation in ambulatory medicine.
What do you want to improve on for the following rotations? What is your action plan to accomplish that?
In my future rotations, I want to improve on completing more procedures, as I felt limited in my capabilities with respect to the comfort level of some parents regarding my hands-on involvement being that I am a student and they are naturally protective of their children. Though, I was able to administer IM vaccinations for both a 20 year old patient and a 4 month old patient, which were very different experiences. After I had administered the IM injection to the 4 month old, my preceptor shared feedback with me to insert the needle and inject in more of a dart-like manner to minimize the duration of pain and/or discomfort for the infant, which will be something I will definitely keep in mind for younger patients in the future. Since my next rotation is in an ambulatory setting, I plan to actively seek opportunities from the medical assistants and providers in order to gain more experience and complete a greater number of procedures so as to increase my competency and hopefully develop muscle memory in the process of doing so.
