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Pediatrics Sub-Internship

 

Like other sub-internships, you are expected to hit the ground running and carry approximately half the load of a PGY-1 resident (intern). This can vary between institutions, but picture 3-6 patients at a given time. What does this mean? You will be responsible for new admissions, daily follow-ups (physical exams, labs, imaging, etc), discussing your patients with the attendings and specialty consults. You will also, with the help of a resident, be responsible for ordering fluids, medicines, special dietary needs, etc.

 

On a given day:


Arrive between 6:15-6:30AM to begin pre-rounding. This means you will check in with all of your assigned patients and see if there were any significant changes or events overnight, follow-up on vital signs, labs, imaging. Likely, you will chat with the post-call resident and see if anything of note happened. Usually, time permitting, you will write your progress notes which detail over night changes, and give a brief history and pertinent physical exam. From 7:00-8:00AM, you will have rounds with your senior residents, to either do beside assessments of particularly sick or interesting patients, or just to sum up tasks to be accomplished that day. From 8:00-9:00AM, you will attend morning meeting. This varies from institution to institution, but is often an educational/working meeting. Meaning, you will hear about interesting or sick admissions in all the departments, discuss the DDxs, and perhaps have a discussion about the patient. From 9:00-10:00AM, you have attending rounds on the ward. Again, this is an educational/working round. It may include bed-side teaching, or discussion of 'big topics in pediatrics" (DDx and Tx of Fever & Rash...). From 10:00AM- Noon, you will have your time to continue with your work- putting in orders, following up on labs/imaging, physical exams, writing notes, etc.

 

At noon, you attend a one hour 'noon-conference,' an educational opportunity where you can also eat lunch and socialize a bit. From 1:00pm-5/6:00PM, you have your afternoon time to do work, discuss with attendings, etc. Typically, there will be afternoon rounds with specialty teams (Heme/Onc, Liver/GI, pulm, cards, etc). On non-call days, you will try to get out around 6:00PM. Every 4th day or so, you are 'on-call.' This means that at 6:00PM when everyone else goes home, you will stay overnight with the intern and resident and follow the progress of all the patients on the ward. You will take new admissions, follow-up with labs, write notes, etc. You go home the following day around 10AM.

Pediatric Emergency Medicine Elective

 

Pediatric emergency medicine is a great way to improve upon your physical exam, history-taking, and differential diagnosis, while seeing a wide spectrum of pathology at the same time. Busy Children's hospitals will see hundreds of patients a day in the ER, with problems ranging from the benign to the life-threatening. In a month, you are expected to complete approximately 15 shifts, including 2-3 late nights (maybe even overnights). The shifts range from 8-12 hours. I found this to be a great way to improve upon my knowledge in pediatrics. This rotation is all about what you put into it. If you want to make a good impression, really learn something, then dive straight in. Ask to see patients by yourself, then present them to a senior. Ask to help with treatment (medicine administration, sutures, etc), go with your patient to relevant imaging (CT, X-ray, etc). This is not as intense as a ward sub-internship, but it can be a great experience nonetheless.

Pediatrics

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