Clerkship Ready: Pediatrics

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Clerkship Ready: Pediatrics

Clerkship Ready: Pediatrics is a podcast aimed at medical, PA, and NP students who are entering their clinical rotation in Pediatrics. It covers topics including Your Pediatric Survival Guide - Tips and Tricks, Before Your First Well-Child Check, Peds GI Clinic, and more. Each podcast walks you through a portion of what you’ll experience during your clinical rotations, gives you tips for excelling, preps you for the clinical questioning that’ll occur, and sets you up to overall Honor the rotation! Email podcasts@procedureready.com with comments, questions, and episode ideas. ##Legal Disclaimer## The opinions expressed within this content are solely the speakers' and do not reflect the opinions and beliefs of their employers or affiliates.

  1. EPISODE 1

    Your Pediatrics Survival Guide - Tips and Tricks

    Pediatrics is different from any other rotation that you will do. Children are not just small adults. There is a huge range of ages and developmental stages. This episode will provide you with some general tips and tricks for all clerkships in general and the Pediatrics clerkship specifically, and essential resources that will help you to succeed in your clerkship. Essential Resources  Podcasts: Clerkship Ready-Pediatrics Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed.  Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pediatrics.  Books: Red Book (also an app for AAP members) - the definitive source for pediatric infectious diseases.  Harriet Lane Handbook (also an app) - has drug doses, commonly used charts, and algorithms.   Websites: Peditools for bilirubin  Uptodate CDC website is a great source for vaccine guidelines Apps: PedsScripts App: specifically to work on illness scripts General Tips and Tricks: Be Proactive Know what the expectations are.  Become familiar with the electronic medical record system.  Be Self-sufficient, but ask for help when appropriate.  Know when you should come in to round, who to pre-round on, and where to meet.  Pair up with an intern to pre-round. Ask for feedback.   Pediatric-specific Tips and Tricks: Pediatrics is different from any other rotation.  Huge range of ages and developmental stages. At every age, children act differently - and you need to adjust appropriately. If you can, get as much of the history from the child, but you will likely need to supplement that with history from the parent or guardian.  When you do your physical exam on younger children, have to adjust the order of exam   Vital signs change with age. Look up or ask about what is a normal vital sign in the age you are seeing.  Check weight, length/height and/or head circumference and report both percentiles and trends.

    10 min

  2. EPISODE 2

    Before Your First Day in Newborn Nursery

    This episode will prepare you to see well newborn babies in the newborn nursery on day 1. We will talk about the typical newborn stay, the information you need to gather to successfully give oral presentations on your patients, the newborn physical exam, and the tests and procedures commonly performed on all newborns. Nursery orientation: family expectations and goals of the healthcare team, expected length of stay History  Maternal History: Gs and Ps Prenatal Care: prenatal labs and ultrasounds Past Medical History & medications Social situation/support Baby History: Gestational Age Delivery type and why, resuscitation efforts and complications Growth parameters The complete newborn exam: head to toe During the newborn stay: Ins and Outs Medications and vaccines Routine screening labs and tests Parental discharge education  Discharge criteria and follow up

    20 min

  3. EPISODE 3

    Before Your First Well-Child Check

    This episode will prepare you for your first well child visit. In primary care, about half of a pediatrician's time will be spent in well child visits. We will talk about what you need to review before you walk into the patient's room, the elements of the history (diet, sleep, elimination, development, etc.) that you need to ask about in well child visits, tips to approaching the physical exam in children, and anticipatory guidance. Finally, we will provide an example of an oral presentation for a well child visit.

    15 min

  4. EPISODE 4

    Peds GI Clinic

    In Pediatric Gastroenterology (or GI) clinic, you will see patients with a host of gastrointestinal, pancreatic, liver, and nutrition issues. This episode will discuss specific questions that you will want to cover in your history and the elements of a complete GI exam - which is a lot more than just an abdominal exam! Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues -3yr fellowship after peds residency  Before Clinic  Review what types of patients you will be seeing. It may be a mix of lots of issues, or just a liver transplant clinic. This will tell you what type of prep you should do (conditions to read up on, medications to review, etc) before the day of clinic. On the day of clinic, review expectations with the attending, fellow or resident physician. Do they want you to see patient independently and write notes, just shadow or somewhere inbetween. Review what questions they always want asked, what exams you should do alone vs with your whole team. Setting expectations before you start will set you up for success!  Questions: Pain, the PQRST mnemonic is helpful to better understand the pain Provoked the pain Quality of the pain Radiating Severity  Specific questions to ask in Peds GI:  Does pain wakes the patient at night?  how much school or other activities the Patient has missed because of symptoms?  Does defecation or passage of gas alleviates pain?  Any specific dietary changes already tried? Poop! understand the: Quality of the stool Size and caliber of the bowel movement (Use Bristol stool scale) GERD vs EoE   A complete GI exam– a lot more than the abdomen!

    14 min

  5. EPISODE 5

    Before Your First Outpatient Newborn Visit

    This episode describes how to prepare for a newborn’s first outpatient visit after they have been discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn. Introduction Socio-emotional state of parents Before the visit, you should review Prenatal history Delivery history, gestational age Physical exam at time of birth Preventative treatments Course in newborn nursery or NICU Type of feeding Concerns for infection Bilirubin Screening tests Newborn visit Parental questions and concerns Feeding history and any problems with feeding Elimination  Sleep and safe sleep Social history and parental support system Review of systems – irritability, fever, rashes.  Normal newborn vital signs Infant growth parameters and weight trajectory Physical exam General Head size and shape Eyes – pupil shape, red light reflex, scleral icterus Cardiovascular – murmurs, capillary refill Respiratory Abdominal Genitourinary – testicles, hernias/hydroceles, circumcision, vaginal discharge Musculoskeletal-  clavicles, hip  Skin – jaundice, birthmarks, sacral dimples Neurological: tone, reflexes Anticipatory guidance Fever Safe sleep Prevention of shaken baby syndrome Postpartum depression Appropriate feeding Next follow up ap...

    26 min

  6. EPISODE 6

    Before Your First Adolescent Well Visit

    The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions. Before visit: Review normal psychosocial development of adolescence Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence  Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available.  Vital signs (including BP), height weight, BMI. Any screening questionnaires (e.g., PHQ-9A) During visit: Introduce yourself; ask how they would like to be addressed Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality Direct questions to adolescent as much as possible Concerns from adolescent/parent or from prior visits that require follow up or updates Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview.  Nutrition: number of meals/snacks, dairy intake  Sleep: nighttime and naps Screen time: duration, type(s) Dental: frequency of brushing, last seen by dentist Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses Review medications, allergies, growth chart, vaccines Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety Physical exam Head to toe Discuss acne Need chaperone for breast and genital exam Preparation for oral presentation

    24 min

  7. EPISODE 7

    Before Your First Day on the Wards

    In this episode, we discuss how to best prepare for your time on the inpatient wards, including how to prepare before the rotation, how to pre-round, how to present a patient, and how to be an effective team member. Before the Rotation  Reach out to your team.. Understand what first day expectations are.  Peruse the patient list. Identify what study materials and resources will help you excel. Come ready to learn and have fun!  How to Pre-round Collect information on previous day and overnight events - includes talking with resident or night team, reading all notes from day prior Review all vitals from past day Review and calculate “Ins and Outs” Review all labs Check to see what medications, including PRN meds, your patient got Introduce yourself to patient and family - get their input on how patient is doing  Collect your thoughts, interpret your data, and formulate your assessment and plan for your presentation and note How to Present a Patient on the inpatient wards service Begin with one liner Subjective: interval and overnight events Any patient or caregiver concern or question noted when you prerounded Ins and Outs Vital signs Head-to-toe physical exam Labs, microbiology, and radiology Assessment one-liner Plan How to be an effective team member Touch base with a resident to run through your assessment and plan.  Show initiative Be honest and direct On rounds, listen to all patient presentations, not just your own Follow up on tasks for your patients (and other patients on the team) and make sure they are carried through Revisit your patients to keep them updated Write notes and ask for feedback on your notes

    21 min

  8. EPISODE 8

    Before You Counsel on Vaccines

    Providing vaccines is one of the most important health promotion activities that we do. However, it involves much more than just putting in the orders for the various vaccines. In this podcast episode, we will briefly review how vaccines work, the types of vaccines, what you need to do before the visit, what you should review with families before ordering the vaccines (including precautions and contraindications), and anticipatory guidance about vaccines. We will also talk a little bit about how to handle vaccine hesitancy. List of pediatric vaccines How vaccines work Harmless piece of the pathogen that is enough to create immune response Explaining how vaccines work to parents Emphasis on protecting the community, not just one person Analogy of vaccine being like a software update Analogy of vaccine being like a flame retardant that stops a fire from spreading Analogy of vaccine being like an insecticide that stops bugs from spreading Types of vaccines Live, attenuated vaccines – cannot be given to patients with immunocompromise Vaccines without live, attenuated pathogen – includes mRNA vaccines RSV vaccines Vaccine for older adults and pregnant adults Monoclonal antibody for infants What you need to do before the visit Review the vaccine record Review the medical record for vaccine contraindications What you should review with families before ordering the vaccines (including precautions and contraindications) Current or recent illness Allergies Problems with vaccines in the past Chronic disease History of intussusception, seizures, neurological problems History of blood transfusion, immunoglobulin or antiviral medications Pregnancy Anticipatory guidance about vaccines Common side effects are a sign that vaccines are working Treatment of fever How to handle vaccine...

    27 min
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About

Clerkship Ready: Pediatrics is a podcast aimed at medical, PA, and NP students who are entering their clinical rotation in Pediatrics. It covers topics including Your Pediatric Survival Guide - Tips and Tricks, Before Your First Well-Child Check, Peds GI Clinic, and more. Each podcast walks you through a portion of what you’ll experience during your clinical rotations, gives you tips for excelling, preps you for the clinical questioning that’ll occur, and sets you up to overall Honor the rotation! Email podcasts@procedureready.com with comments, questions, and episode ideas. ##Legal Disclaimer## The opinions expressed within this content are solely the speakers' and do not reflect the opinions and beliefs of their employers or affiliates.

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