For those of you studying for any of your shelf exams (minus OBGYN) or for the CK, these lectures and powerpoints are a great high yield tool from San Antonio School of Medicine. I feel like it's a perfect run through everything. It should benefit you most once you already have a good grasp of the foundations.
--> http://som.uthscsa.edu/StudentAffairs/thirdyear.asp
Thursday, March 20, 2014
Wednesday, March 19, 2014
Pediatrics at Bronx-Lebanon Hospital
My fourth and last core in New York City. After 15 months of living in the city, I'll be moving out in a week.
I've been absolutely abysmal at keeping this blog updated throughout the year and I'm sure there are plenty of questions people have about clinical life post-island and for whatever reason, I still hold out hope that I'll actually produce some answers for you all sometime soon. It will be more like a generalized comparison between clinicals and basic sciences, but I think that's better than nothing. I remember being on the island and being utterly oblivious about the situation. It's not like you talked to anyone on rotations really... once people leave St. Maarten, they might as well be dead because you never hear from them again (only half-true).
Ah, but alas, still saving that discussion for a rainy day. Today we talk peds.
Pediatrics. Pediatrics. What can I say about pediatrics in the Bronx? Lots of asthma. A whole hell of a lot of asthma. A good amount of Sickle cell in there too, but man tons of asthma.
This has definitely been my strictest rotation, scheduling-wise. Getting through and understanding the service your on, the lectures you have, and the hours for an after school program (just implemented) that you must attend made me bleary-eyed. The rotation is 6 weeks total, in which you spend 2 weeks on the floor for inpatient (1 week days, 1 week nights), 2 weeks in the pediatrics ER (1 week days, 1 week nights), 1 week in a general pediatrics outpatient clinic, and 1 week at the pediatric subspecialties outpatient clinic at POE. You have three days in the nursery and 1 day in the PICU somewhere sprinkled in all that.
You will have morning lectures at 8 am pretty much every day (Tuesdays are ground rounds) and sometimes they even schedule afternoon lectures around 3 pm. And then on select days of the week, you will have to leave which ever service you are on at 2:45 to go help out at an after school program in one of the neighboring schools and you stay there till 5 pm. And I believe that's about it for the schedule.
As luck would have it, I started my first two weeks in the outpatient clinics. Because my first week was essentially orientations and snowstorms I only spent one day in the subspecialty clinic. This made me a little sad because you go to POE (only 3 stops away from BLeb) and you can follow which ever attending you like in the specialty that interests you. I could have gone to peds cardio, immunology, heme, pulm, etc. etc, but I figured why not go to peds neuro since that is what I'm seriously considering for my career. It was an interesting day complete with children with seizure disorders, autism, and abnormal brains, and the attending Dr. S enjoys teaching, so which ever questions I had for him, he was happy to oblige me.
Week 2 was my triumphant return to the Tiffany Clinic. If you remember, I did my 3 weeks of outpatient for Family Medicine there and had a wonderful experience. Turns out that little blog post I wrote a few months back caught the notice of the family medicine department at Bronx Leb. Seems like the resident(s)/attending(s) weren't too happy with what I had to say about my inpatient experience and have subsequently complained about me? I don't know. Apparently a student brought the post to their attention for whatever reason. I realize I write openly and freely on the internet with my name attached. I want to be honest about my experiences, and I try to be respectful while I relay them, but hey if you rather make me hold a phone for you instead of doing something useful with my time, I'm going to have something to say about that. ANYWAY, all the lovely ladies at Tiffany enjoyed my blog post about the place haha. The nurses, secretaries, office managers, are wonderful there. They are definitely a fun, warm, friendly group of people who know how to make people comfortable. Incidentally, I had my 27th birthday on my last day there and they bought me balloons and card. I had made a tres leches cake so we pretty much had a party.
The pediatrics attending there, Dr. M, is great. I've never seen someone so happy and excited about every single baby, toddler, and child she saw. Honestly, it's infectious. I couldn't help but smile and laugh whenever I saw her examine a baby and if you work with her you will know exactly what I mean. As a medical student working with her, she will allow you to see, speak, and examine the patient yourself first. Once you're done, you go to her and present the patient as you would with any attending and then you discuss what he/she may have and what you want to do for the patient. Then you both see the patient together and she ultimately ends up writing the note. It had been a few months since I last presented a patient so I was pretty rusty during my week with her, but I appreciated the freedom she gave me.
Weeks 3 and 4 were spent in the ER. Easily the two busiest weeks of the entire rotation because you are seeing a never ending stream of patients from the moment you walk in. When you are on the week of nights things do tend to quiet down by 1-2 am but you can have a few stragglers stream in every other hour or so. On days... its crazy. Madness. Depending on which attending you are working with they will ask which patient you want to see, then you call them through the loud speaker, bring them to an examination room where you do a history and physical. Once that's done you present to your attending and then you see the patient together and formulate a plan. You write the note and then you call the next one. Of all the rotations I've done, this is the first time I felt like I was truly being useful and actually learning a lot on the job. You are worked like a resident in the ER and honestly, there is no better way to learn than being thrown into that type of environment.
Weeks 5 and 6 was the floor. The inpatient peds unit in Bronx might be the nicest wing in the hospital. It's relatively small with about 16 beds and 4 beds in the PICU, but the halls are brightly painted, the children's play area is sun-drenched with panoramic views of the Bronx, and it's complete with toys, blocks, computers, video games, and a piano. During lunchtime I would go off and play the piano for some of the patients.
When you're on the floor at night you get to do at least one admission yourself, and you present to the attending the next morning during rounds. On days, you just basically do scut work for the residents like running blood to the lab, helping out with blood draws, calling to make appointments. After rounding in the morning, there isn't much happening since the residents are busy doing discharges or blood work. Teaching is better during the days, however, as attendings will teach during rounds or take an hour in the morning or afternoon to go into a topic at length. One of the more friendly attendings I worked with, Dr. M, is highly intelligent, shrewd, and a wonderful teacher. You can tell she really enjoys teaching both the medical students and residents alike, and all the information she imparted was practical and clinically oriented. Listening to her for the last three days made me wish I had more teaching sessions with her throughout the rotation. She was happy to answer any questions, and there was such an approachability to her persona, it was just refreshing rounding with someone like her. Anyone who is fortunate enough to work with her should take advantage of her knowledge and experience.
Things I didn't like about the rotation:
1. Attendance sheet. You are given an attendance sheet at the start of the rotation and are required to have someone sign it for you everyday to say you were present for that day. I forgot about this sheet a lot of the time and I felt pretty silly the few times I had to pull it out and ask my attending to sign it. I know attendance has been a problem for students in the past, but the way I see it is, we are adults responsible for our own decisions. We are roughly paying $5000 a month to live and work at these rotation sites and if we really choose to throw that money away by not coming, not learning, not doing the work we should be doing, then that's our own terrible judgement working for us.
2. Getting 6 Evaluations from 4 attendings and 2 residents. That's a lot of evaluations. And often times it's from people you've only worked one or two days with. Who can really judge your qualifications as a doctor in those few hours? Some people can make great impressions and others have a harder time of it, and I'm not sure how fair it is to those people.
Overall:
This is an excellent rotation for lots of hands-on experience and learning. You honestly work like a first year resident through quite a bit of it. And it also provides many learning opportunities. I enjoyed the majority of the small group lectures we had, as well as the mini teaching sessions during rounds. I recommend this rotation for anyone interested in pursuing pediatrics as a career.
For the lazy man, maybe this one isn't quite for you.
I've been absolutely abysmal at keeping this blog updated throughout the year and I'm sure there are plenty of questions people have about clinical life post-island and for whatever reason, I still hold out hope that I'll actually produce some answers for you all sometime soon. It will be more like a generalized comparison between clinicals and basic sciences, but I think that's better than nothing. I remember being on the island and being utterly oblivious about the situation. It's not like you talked to anyone on rotations really... once people leave St. Maarten, they might as well be dead because you never hear from them again (only half-true).
Ah, but alas, still saving that discussion for a rainy day. Today we talk peds.
Pediatrics. Pediatrics. What can I say about pediatrics in the Bronx? Lots of asthma. A whole hell of a lot of asthma. A good amount of Sickle cell in there too, but man tons of asthma.
This has definitely been my strictest rotation, scheduling-wise. Getting through and understanding the service your on, the lectures you have, and the hours for an after school program (just implemented) that you must attend made me bleary-eyed. The rotation is 6 weeks total, in which you spend 2 weeks on the floor for inpatient (1 week days, 1 week nights), 2 weeks in the pediatrics ER (1 week days, 1 week nights), 1 week in a general pediatrics outpatient clinic, and 1 week at the pediatric subspecialties outpatient clinic at POE. You have three days in the nursery and 1 day in the PICU somewhere sprinkled in all that.
You will have morning lectures at 8 am pretty much every day (Tuesdays are ground rounds) and sometimes they even schedule afternoon lectures around 3 pm. And then on select days of the week, you will have to leave which ever service you are on at 2:45 to go help out at an after school program in one of the neighboring schools and you stay there till 5 pm. And I believe that's about it for the schedule.
As luck would have it, I started my first two weeks in the outpatient clinics. Because my first week was essentially orientations and snowstorms I only spent one day in the subspecialty clinic. This made me a little sad because you go to POE (only 3 stops away from BLeb) and you can follow which ever attending you like in the specialty that interests you. I could have gone to peds cardio, immunology, heme, pulm, etc. etc, but I figured why not go to peds neuro since that is what I'm seriously considering for my career. It was an interesting day complete with children with seizure disorders, autism, and abnormal brains, and the attending Dr. S enjoys teaching, so which ever questions I had for him, he was happy to oblige me.
Week 2 was my triumphant return to the Tiffany Clinic. If you remember, I did my 3 weeks of outpatient for Family Medicine there and had a wonderful experience. Turns out that little blog post I wrote a few months back caught the notice of the family medicine department at Bronx Leb. Seems like the resident(s)/attending(s) weren't too happy with what I had to say about my inpatient experience and have subsequently complained about me? I don't know. Apparently a student brought the post to their attention for whatever reason. I realize I write openly and freely on the internet with my name attached. I want to be honest about my experiences, and I try to be respectful while I relay them, but hey if you rather make me hold a phone for you instead of doing something useful with my time, I'm going to have something to say about that. ANYWAY, all the lovely ladies at Tiffany enjoyed my blog post about the place haha. The nurses, secretaries, office managers, are wonderful there. They are definitely a fun, warm, friendly group of people who know how to make people comfortable. Incidentally, I had my 27th birthday on my last day there and they bought me balloons and card. I had made a tres leches cake so we pretty much had a party.
The pediatrics attending there, Dr. M, is great. I've never seen someone so happy and excited about every single baby, toddler, and child she saw. Honestly, it's infectious. I couldn't help but smile and laugh whenever I saw her examine a baby and if you work with her you will know exactly what I mean. As a medical student working with her, she will allow you to see, speak, and examine the patient yourself first. Once you're done, you go to her and present the patient as you would with any attending and then you discuss what he/she may have and what you want to do for the patient. Then you both see the patient together and she ultimately ends up writing the note. It had been a few months since I last presented a patient so I was pretty rusty during my week with her, but I appreciated the freedom she gave me.
Weeks 3 and 4 were spent in the ER. Easily the two busiest weeks of the entire rotation because you are seeing a never ending stream of patients from the moment you walk in. When you are on the week of nights things do tend to quiet down by 1-2 am but you can have a few stragglers stream in every other hour or so. On days... its crazy. Madness. Depending on which attending you are working with they will ask which patient you want to see, then you call them through the loud speaker, bring them to an examination room where you do a history and physical. Once that's done you present to your attending and then you see the patient together and formulate a plan. You write the note and then you call the next one. Of all the rotations I've done, this is the first time I felt like I was truly being useful and actually learning a lot on the job. You are worked like a resident in the ER and honestly, there is no better way to learn than being thrown into that type of environment.
Weeks 5 and 6 was the floor. The inpatient peds unit in Bronx might be the nicest wing in the hospital. It's relatively small with about 16 beds and 4 beds in the PICU, but the halls are brightly painted, the children's play area is sun-drenched with panoramic views of the Bronx, and it's complete with toys, blocks, computers, video games, and a piano. During lunchtime I would go off and play the piano for some of the patients.
When you're on the floor at night you get to do at least one admission yourself, and you present to the attending the next morning during rounds. On days, you just basically do scut work for the residents like running blood to the lab, helping out with blood draws, calling to make appointments. After rounding in the morning, there isn't much happening since the residents are busy doing discharges or blood work. Teaching is better during the days, however, as attendings will teach during rounds or take an hour in the morning or afternoon to go into a topic at length. One of the more friendly attendings I worked with, Dr. M, is highly intelligent, shrewd, and a wonderful teacher. You can tell she really enjoys teaching both the medical students and residents alike, and all the information she imparted was practical and clinically oriented. Listening to her for the last three days made me wish I had more teaching sessions with her throughout the rotation. She was happy to answer any questions, and there was such an approachability to her persona, it was just refreshing rounding with someone like her. Anyone who is fortunate enough to work with her should take advantage of her knowledge and experience.
Things I didn't like about the rotation:
1. Attendance sheet. You are given an attendance sheet at the start of the rotation and are required to have someone sign it for you everyday to say you were present for that day. I forgot about this sheet a lot of the time and I felt pretty silly the few times I had to pull it out and ask my attending to sign it. I know attendance has been a problem for students in the past, but the way I see it is, we are adults responsible for our own decisions. We are roughly paying $5000 a month to live and work at these rotation sites and if we really choose to throw that money away by not coming, not learning, not doing the work we should be doing, then that's our own terrible judgement working for us.
2. Getting 6 Evaluations from 4 attendings and 2 residents. That's a lot of evaluations. And often times it's from people you've only worked one or two days with. Who can really judge your qualifications as a doctor in those few hours? Some people can make great impressions and others have a harder time of it, and I'm not sure how fair it is to those people.
Overall:
This is an excellent rotation for lots of hands-on experience and learning. You honestly work like a first year resident through quite a bit of it. And it also provides many learning opportunities. I enjoyed the majority of the small group lectures we had, as well as the mini teaching sessions during rounds. I recommend this rotation for anyone interested in pursuing pediatrics as a career.
For the lazy man, maybe this one isn't quite for you.
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