Ending 3rd year || Pediatric Rotation
Mocha turned 2!
Life after spending 175 hours on the road
I am so glad to be done driving. There were not enough EDM trap playlists, or fantasy romance audiobooks, or podcasts to get me through 3 hours of driving a day. My joints aged 5 years. I requested Physical therapy from my PCP. Is it an overreaction? Maybe. But maybe it’s time to fix my back from powerlifting. Young me definitely didn’t do current me any favors. Anyways, I will never do that again.
I would be happy to never drive again.
Backyard Renovations for our wedding
Mr. Warmly and I did elope back in December, but we (mostly me) wanted to have a wedding at some point. Hey I’m filipino, weddings are important! Though my family size has shrunk over the years, I still wanted to do something small to include all the people that I love. We’re having a backyard wedding in October 2023. I know our backyard looks a little rough right now, but we’re trying to renovate it and revive the grass.
Our latest project is building this backyard cover. I imagine we’ll have our passionfruit trail up the posts and over the top.
Diy Residency Pictures
It’s about that time! I’ll be starting my residency applications this year. Around Christmas time, I heard Jcpenny has deals for professional headshots. I’m terribly awkward. I always need to take hundreds of photos and most of the time I don’t like the outcome. You know it was even a new years resolution for me to learn how to take better photos because I love looking back on memories.
Anyways, I got a ring light, a phone stand, and the background fabric from Amazon. I made this super official and not at-all unstable setup in my bathroom. I actually really like how the pictures came out! I don’t have the latest iPhone, but the quality was still impressive. So if you want to do it on your own, here’s your sign that you can. Help me decide on which one to use! My family says the first one says lawyer and the second one says flight attendant. What do you think?
My Pediatric Rotation
The pediatric core at SGU is 6 weeks long. Like all the other cores, the experience completely depends on the location and the staff. My experience was all outpatient which I loved, but I know others will do mostly inpatient or a mix of both. I rotated with 2 students from SGU (that’s a first!). We worked with a pediatric physician and PA. Being in California, our patients were mostly Spanish speaking (really have to work on my Spanish). We also served a lot of patients without insurance.
I learned I loved working with kids. I used to work as a Behavioral Therapist for children with Autism Spectrum Disorder. I know many people may feel strongly about it, but the families I worked with - the kids I worked with absolutely loved our experience. I mean who doesn’t love playing together and then at the end of it spinning in a circle holding hands listening to Taylor Swift.
Anyways, I really enjoyed working with kids. Though they totally got me sick 2 weeks in. Even with masks and frequent hand washing. It’s hard to stop a kid from coughing at you when you’re inquiring about their cough. Regardless, I love the energy they bring and try to make their experience as enjoyable as possible.
An average rotation day
Our attendings rounded in the morning in the hospitals. Since there had been some issues with people failing the shelf exam, he urged us to use the mornings to prepare for the exam. We would come in the afternoons to the clinic. We had one day to observe then we were seeing patients independently! I was nervous at first. I mean parents can be scary. I used to be a secretary at a concierge pediatric clinic. I totally understand and would also fight in any way to get my child what I thought they needed, but I did get verbally pushed around a bit. However, in my experience the energy you start a visit with influences the experience for everyone a lot. I tried to go in each room warmly and confident in what I could offer and couldn’t.
So our clinic had around 4 patient rooms, a physician office, PA office room, and the medical students would hang out in an old patient room. The days were very polarizing, all busy or slow especially on rainy days. Mondays and Fridays tended to have a lot of walk-in patients. The front office would come in with the paper charts and we usually took turns seeing the patients. Since it’s pediatrics, many time we’d be handed a stack of charts to see a whole family. My record was 3 patients, but one of the other students bravely took on 5. We would see the patients, take their history, write the HPI, and do the physical. We would then present to the physician or PA and they would come in with us to confirm, diagnose, and write out the treatment plan. There’s some good things about paper charts, but I’m not a fan. Especially for patients who came at birth and stayed until 21 or have complex histories - those files were heavy and literally falling apart. Don’t get me started on trying to find something in a file. CTRL+ F please. Please!
I’d see around 3-8 patients a day. Most of the patients were well child checks + immunizations. We also saw acute and walk-in patients. It was late winter, so of course lots of allergies, asthma, colds, and GI bugs. My hands were very dry from all the sanitation. The physician was very encouraging, tried to teach us, and encouraged us to bring our study materials to prepare for the shelf in between patients. I would end the day around 5:30 pm to at the latest 6:30pm.
SGU requirements
Weekly Requirements
This section is pretty much the same as other core blogs, but just in case you came here first here’s the deal. I’ve underlined the unique requirements for Pediatrics.
Firecracker
SGU requires you to sign-up for this website. It attempts to pace out the topics you need to learn. You’re supposed to mark 10 topics a day and review topics through their flashcards and questions. Participation counts towards professionalism. It is required to fo 10-20 questions a day. Though other students have told me they don’t do this and haven’t been docked points so it’s a requirement (?)
Quizzes: The quizzes are done online through Firecracker. They are released on Fridays and are due on Mondays. They are usually 20-25 questions.
Patient Encounter Log (PEL): You can find this google form-esque log on the SGU clinical site. Before the end of the rotation, you need to submit all 14 required encounters. It’s optional to submit a SOAP note in the comment, but the school mentions you can print this log and show it to your preceptor for the final rotation evaluation. My advice, submit a couple of encounters every week so it’s not a rush at the end but I still did it all at the end.
Observed Encounter: You can print the rubric from the Surgery Sakai site. Multiple residents/attendings can sign off competencies. My advice, it all depends on who you ask. Play smarter, not harder.
4 Case write-ups. So far, I haven’t been docked points for this but I’ve written about 1-2 pages which include HPO, PE, lab, and imaging findings with the assessment and plan. The SOAP note takes up most of page. The instructions say it should include supplementary reading.
Pain Management Course: to be completed before graduation
2 Communications courses
300 UWorld Questions
Pediatric Shelf Exam
Signing up
Since this rotation is 6 weeks long, I got an email with the scheduling permit to schedule my Shelf exam around 3-4 weeks in. I have to drive around 40 minutes to the nearest testing center. In SGU’s current policy we get the day of the exam and the day before off. However, some attendings have different policies allowing you to have more time to study.
Grading
Grading for SGU is honors, high pass, pass, and fail. To pass the shelf, you need a 75 percentile. This is much higher than other shelf exams.
How I studied For The Pediatric Shelf Exam
The Pediatric Shelf has a reputation (at least around SGU students and staff) to be a difficult exam. In my opinion, it was more challenging because it’s very general but also children aren’t always little adults - they have their own issues unique to their ages. The high-yield concepts (IMO)
Developmental milestones: they’re usually straightforward and easier points to grab. On the NBME website, they estimate 3-7% of questions are about normal development so would definitely know.
Newborn stuff: what’s normal after birth, neonatal jaundice etiologies
Why babies aren’t pooping: Hirschsprung vs malrotation
Infectious stuff: croup, mono, rubella, varicella, pharyngitis, etc
Genetic diseases including immunodeficiencies
Some tips:
Timing: age matters and sometimes season - pay attention if they mention a month.
How I studied For The Pediatric Shelf Exam
My Shelf studying is pretty routine at this point. Since I have such a long commute, I try to listen to a comprehensive review earlier in the rotation to know the layout of what’s high yield to know. I aim to finish Uworld a week before the exam. So I usually take the total number of questions and divide by the number of study days. I take Sundays off. About 3-4 weeks before the Shelf exam, I try a NBME as a baseline. I will take them weekly to see if I’m staying on track and see where my weak points are. About 2 weeks before the exam, I listen to the comprehensive reviews again: Divine Intervention, Dr. High Yield, and Emma Holiday. And that’s it! Keep it simple, keep it routine.
For cumulative review, I loved these video series:
I watched or listened to them in my car starting about a month away from my Shelf Exam.
Celebration chicken sando!
Dr. High Yield: This one is 2 parts, about ~2 hours total
First Aid for Psychiatry: This pdf was a nice overview of the notes. The Online MedEd notes were also decent.
Qbanks:
Uworld: 632 questions
Amboss: 813 questions for Pediatrics
Times are tough! There is an Amboss Scholarship Program you can apply for. At the very least, they usually give you 1-2 weeks free if they don’t give you a scholarship.
4 NBME practice tests are available for purchase or floating around the internet
Warmly, Rainee
3rd year is over! Next, we’ll be chatting about Step 2. I’m scared, wish me luck!