Bronx Pediatrics

My first rotation at Bronx Leb started off with a very quick orientation day which mostly consisted of waiting for clearance, badge ID, and very fast showing of around the Bronx Lebanon hospital to different pediatric units. When you receive your pediatrics rotation you will be scheduled as the following: 

 

  • Floor (one week days, one week nights)

  • Nursery (1 week)

  • ER (1 week + 3 days)

  • Subspecialty (2 days)

  • Inpatients general pediatrics (1 week)

 

Monday-Friday there is mandatory teaching at 8am-9am which is located on the 6th floor directly behind the hospital. As far as dress code goes for the entire rotation, it is MOSTLY business casual :(  All of the residents are also wearing business casual except those that are working nights. This is also the ONLY rotation in the Bronx where you are given a fob for access to the floors you need around the hospital so ENJOY IT. 

 

Floor: 6:15am - sign out (usually around 4-5pm); Nights: 10pm - 9am

Working on the floor in Pediatrics really makes you feel like a resident. You get in the hospital in the morning when all of the other residents get in. You receive sign out from your patients from overnight medical student and go over anything that may or may not have occurred with the patient you have been following. Then you will round on your 1-2 patients you were assigned. At 7am, all of the residents and the chief resident will meet for a more formal sign out which occurs at a back room at a big round table. All of the residents sit around the table, while two medical schools hover over the top and hope to just blend into the background (story of our life).  You will print out a sign out sheet which gives you overnight vitals, admission diagnosis, and consults and then go through each patient and discuss plan, treatment, and possible discharge - make sure you take information on each and every patient because you may change teams and possibly change patients. After morning sign out is over, you head to morning teaching with the other medical students.  At 9am you will head back into the hospital and continue to look up information on your patient prior to rounding with the attending.  Rounding with the attending usually occurs between 10am-11am but honestly depends on the attending.  You will walk outside each room and discuss each case, discuss possible treatment and discharge. Make sure you are presenting at least one case every single time you are rounding. Most of the pediatric attendings on the floor are very good at giving constructive criticism and giving complements on the areas you did well on. This also makes it easy to have an attending write an evaluation for you at the end of your floor rotation.  After rounding with the attending, you will be working with the resident to make sure treatment and discharge run as smoothly as possible. This includes assisting with treatment like venipuncture, running blood down to the lab, and helping council patients on their discharge information.  

 

Nights on the floor consist of Sunday-Thursday 10pm-9am work schedule.  ALSO DRESS CODE IS SCRUBS - YAY, FINALLY.   Most students who start on nights are working with another medical student who is also working days. You will follow the same patients and give sign out to the medical student working days at 6:15am.  Then you will participate in morning sign out at 7am-8am with the other residents working nights.  You then will head to teaching from 8am-9am (and pray it gets canceled for ANY reason) then you will head home to sleep.  A lot of students on this rotation felt like they got a lot of hands on experience during nights because they had lots of one on one time with the resident. If the nights are slow or there isn’t much to do, there is also a resident lounge you can take a quick nap in. There are 2 bunk beds with 4 beds total which medical students have access to. 

 

Nursery: 7am - 2-4pm 

7am when you get in the nursery is honestly one of the most exciting moments of your day.  Arrival at the nursery usually has at least a few newborn babies that were born early that morning. At this time the resident will teach you how to do a thorough examination on a newborn. After you have finished examining all of the newborns you will head to 8am-9am teaching. Upon returning to the nursery, you will gather all the newborn patients with the resident and do newborn examinations with the attending. Attendings will often given you topics to present after rounds/newborn examinations - jaundice, anemia, malformations that are common in newborns since sometimes it can be slower than other floors.  Make sure to ask the resident to teach you how to measure bilirubin and also how to do a heel stick to do basic labs.  These procedures can be added to your evaluations when you are done.  

 

During your last day of nursery, you can ask the head of medical school scheduling to be placed in NICU. This honestly was one of the most exciting times in my entire 6 weeks of Pediatrics.  My day in NICU started with the birth newborn weighing in a only 2lbs 1 ounce.  I walked into the labor and delivery room with the attending and the resident to assist with the newborn. We brought the newborn into the NICU and intubated the patient (obviously I watched, the tools are incredibly tiny it is equivalent to trying to intubate a barbie).  Then I assisted the residents in placing the umbilical central line.  One line in the artery, and one line in the vein (2 arteries, 1 vein are found in the umbilicus in a newborn).  I watched as the attending evaluated an Abdominal X-Ray to make sure the line was placed appropriately - SVC for the umbilical vein and bifurcation of iliac arteries for the umbilical artery.  Then we went through the premature checklist to determine the patients “age”.  Although I did more observing, this was incredible, exciting, and thrilling.  The NICU staff really makes you feel like you are apart of the team and really explains everything they are trying to accomplish.  After this patient was stable, we rushed back over to Labor and Delivery for a gestational diabetes baby being born.  This baby was delivered at 11lbs and miraculously didn’t have too many complications. Going from a premie 2 lb infant and 11 lb infant with maternal gestational diabetes was absolutely mind blowing.  I highly recommend at least trying the NICU to see how two incredible teams work seamlessly together. 

 

Pediatric Emergency Room: 8am - 5pm

Pediatric Emergency Room starts after medical student morning teaching at 9am.  When you arrive in the ER, you will have two attendings throughout the day.  These attendings will tell you which patients you will see while you are in the Emergency Room - usually around 5 per day.   When you are not seeing patients, you will be rounding and observing with the resident.  When you are seeing patients,  these are low risk patients and usually consist of patients with slight asthma exacerbations, food poisoning, and common colds.  Usually the attending will tell you which room you should go visit and you will go on your own and do an entire examination.  When you return from your patient you will present to your attending on the case.  The attending will then follow you back to the room and do their own examination.  After determining treatment, the attending will let you know treatment plan and if they will admit or discharge the patient. During my time in the ER, I was given many opportunities to assist in procedures including venipuncture, IV placement, lumbar puncture, and asthma treatments.  The attendings are very good at teaching and giving you many opportunities to ask questions without repercussions. Overall my experience in the ER was very enjoyable and I learned a tremendous amount of information during my time there. 

 

Subspecialty 8am - 5pm 

You will only be given 2 days to choose a subspecialty - Cardiology, Allergy, Infectious Disease, Pulmonology.  This will be the last 2 days of your second week in your Peds ER rotation.  Your experience during these next two days will vary depending on what subspecialty you choose. I personally choose Cardiology for both of my subspecialty days.  I enjoyed watching Fetal Echos - fetus with cardiac defects done on mothers around 24 weeks pregnant and Echos on NICU infants and young children. I highly recommend on choosing a specialty that you may be interested in the future. 

 

Overall, my experience in Pediatrics was beyond my expectations. I didn’t expect to like pediatrics or enjoy working with children.  Honestly, I enjoyed every single day I was in pediatrics.  I enjoyed all of the children smiling through any illness they may have.  I enjoyed working with all the little fighters in the NICU and seeing how insanely resilient their tiny bodies were. I enjoyed working with complex mind of the teenagers.  There was honestly something to enjoy about every single age group.  This CORE completely confused me.  I have always pictured myself going into Emergency Medicine and I still picture myself going into Emergency Medicine.  But since my rotation has ended, my heart has been completely torn between the two fields. I am really interested to see where my next rotations take me and what field I will actually end up wanting to match in. 

 

Hopefully nothing else tugs at my heart strings. 

T.A.

**Patient information, dates, and hospital information has been changed or modified to protect the privacy of patients in this blog. 

Tropics MD