Pediatrics at Mount Sinai Chicago
1 week in each of 4 clinic settings (2 distant clinics, 1 general clinic in SCI, 1 week of general mixed with subspecialty pediatrics -- cardiology, neurology, infectious disease)
1 week newborn nursery (5th floor main hospital)
1 week NICU (4th floor main hospital, beside L&D)
You’ll almost exclusively be working a M-F week. You’ll be responsible for covering nursery on 1 weekend day at some point during the rotation.
*Any days off, you go to nursery instead
*No other inpatient peds at this site
Lectures every day at noon in the main hospital (unless you are at a distant clinic)
GENERAL: The pediatric rotation is very good at Sinai. There is no residency program which means you will work alongside attendings full-time. The program director at this time, Dr. Bhagi, is phenomenal (a walking UpToDate). She has an evaluation process in place to ensure that we don’t receive generic evals, but it is your responsibility to follow-up with each attending that they actually do them.
Pediatric medicine is really challenging for a lot of people, so don’t slack on studying the material. Unlike adult medicine, congenital disorders show up high on differentials. Infant medicine, in particular, has a wide array of different types of questions (rightly so) and it’ll take practice to nail down all of the developmental milestones.
ORIENTATION: Day 1 orientation is short (2-3 hours max) and then you will be dismissed to your assigned location. So, be prepared to work as of day 1.
Clinic: Each of the 3 main general peds clinics runs a little bit differently. They also use Epic (which you do not have access to). Two of the clinics will have you evaluate patients and present to the attendings. One of the clinics in particular is very fast paced, so you may find that you’re doing a bit more shadowing. Each physician is very fun and approachable, so be sure to ask lots of questions!
Nursery: Dr. Bhagi is the nursery attending during weekdays. She. Is. Fantastic. She is widely intelligent and everything we should strive to be, so take full advantage of the experience. On the weekends you’ll be with the on-call attending.
For nursery you’ll have a Family Medicine resident as your lead. S/he is responsible for all of the babies. You should arrive by 6:30am every morning. There will be 2 newborn lists. One list will be for Sinai babies and the other for Lawndale. Ignore Lawndale (as we do with just about every Lawndale patient in our entire time at Sinai). The reason for this is because Lawndale is its own health system and they send their physicians to our hospital to cover their patients. For that day, split up the babies with the other students (some days it’ll just be 2 of you, others there will be 4-5 of you… remember, if your clinic has a day off, you’re at the nursery). Your primary job in the morning is updating sign-out. You’ll get the information for this from your FM resident on Day 1. Once you’ve reviewed your bab(ies)’ chart, go evaluate. Every baby should have the red reflex checked in addition to following up on hearing and heart screenings. Your physical should evaluate fontanelles, external genitalia, sacral dimpling/hair, Epstein pearls, presence of teeth, and full hip eval. This is the time to really get good at handling babies. Dr. Bhagi usually rounds sometime between 9 and 10, so be ready with printed copies of the sign-out. When you present to her, present as it is laid out on the sign out. The on-call attending for the weekends may round much earlier, so be in contact with the FM resident for this information in case you need to be there even earlier.
Be prepared for the fact that you’ll never be ready to know which topic Dr. Bhagi’s going to pimp you on. You can’t go by the pathology of the current newborns on the floor. That’s not to say you should give up. No, you should aim to impress her with as much of your knowledge as possible. Some helpful topics to know going into nursery include: vaccine schedules, fontanelle names/drawing them out, full newborn exam components, milestones, Down’s/Turner’s characteristics at birth, cyanotic vs acyanotic heart diseases, and fetal vs newborn cardiovascular/pulmonary system. She’s VERY good at making you second guess yourself. Not to undermine you, but to make you more confident in your answers and understanding. She genuinely tries to train the guessing out of the students.
Nursery usually finishes in time to grab lunch and then head to lecture. Your days end after lecture.
Tip for nursery = practice swaddling.
NICU: By far the most challenging part of the rotation. NICU is it’s own beast with a very steep learning curve. The nurses generally can’t help you with the location of the med student guides. You’ll arrive by 7am, immediately scrub in at the sink, then ask reception where the med students usually sit. DO NOT wear your lab coat when you go see the babies and DO NOT bring any personal belongings with you.
In the desk drawer you’ll find NICU sheets for students. These sheets are gold for gathering the pertinent information. You and your partner will split the babies and get all of the information for each sheet. Day 1 is brutal because you will likely not finish by the time the attending arrives. Each attending has a different way of managing the floor so just follow them when they arrive.
Tips for NICU = ask the nurses for help. Do not evaluate a baby without their permission. They know everything going on and they know exactly how to soothe their babies. Also, always properly swaddle the babies and cover any incubators before moving on. In addition to this, try to find a YouTube video or some reading on TPN (total parenteral nutrition). It takes up approximately 50% of the rounding every day because the orders have to be renewed every day. It’s important for you to have the latest labs when you round, as well, in order to do the orders properly.
HOW TO SUCCEED
Like I said, peds is challenging, but it’s not impossible. Study Blueprints, Case Files, and do Uworld. During the second half be sure to also do at least 2 of the NBME practice shelf exams.
Since you’re not documenting very much in this rotation it’s easy to see a lot of patients and forget what you saw. Carry a small notepad with you and write down the age, sex, and diagnoses for each of your patient encounters so you can enter them all into E*Value.
Good luck on your rotations!