My pediatrics rotation at QHC went well and exposed me to many different types of pediatrics care. I had experience in outpatient pediatrics before starting, and this rotation exposed me to pediatrics ED, NICU and neonates, outpatient primary care, and outpatient specialties. The rotation flew by very quickly and I am still surprised with how many different types of patients I was exposed to in such a short amount of time. Being exposed to so many different types of pediatrics care also meant learning how to work with over a dozen different providers and teams in order to provide high quality patient care.

The first two weeks of the rotation I was in the pediatrics ED and saw patients spanning from 10 days old to 21 years old. The providers in the ED allowed me to take histories, examine, assess and form plans for many patients throughout each shift. After seeing each patient I would discuss them with the provider and walk them through what I saw, what diagnoses I suspected, and what I would do for patients. This allowed me to grow as a clinician and get more comfortable with my knowledge and skills. I was also able to do some procedures such as splinting, blood draws, and assisting with suturing. It helped me to learn which patients were more straightforward and needed only supportive care and could be discharged, which patients needed to be monitored and treated before being discharged, and which patients needed close monitoring and admission to the hospital. QHC does not have a pediatric unit to admit patients who need inpatient care, the patients that required hospitalization needed to be transferred to Cohen’s at LIJ. One particular patient at the end of my last ED shift stood out in that regard. A 4 year old with throat pain and difficulty swallowing came into the ED with their mother. Both were frightened but sitting comfortably when telling the history. Upon looking at the child it was obvious that something wasn’t right with their appearance. They were a little overweight but the neck was disproportionately chubby looking. There were palpable lymph nodes and a mass on the right anterior neck. When evaluated with the provider we were unable to tell whether it was the thyroid and a goiter or something else. Regardless, the patient needed a more thorough workup than we were able to provide in the ED and was transferred for admission. I am still curious what ended up happening with that patient but since they were sent to a different hospital system I was unable to see any notes or lab results in the EMR.

The following week I was in the NICU and neonatal unit. The PAs mainly evaluated the newborns that did not require the NICU, and the physicians and NPs oversaw the NICU. I was able to follow with providers on both sides and learn a great deal from them. I did not expect to enjoy my time there as much as I did. The patients are so tiny and initially I was intimidated to evaluate them for fear of missing something critical. By the end of the week I felt more comfortable evaluating and examining the babies, I was able to do procedures such as heel sticks, I was able to hear murmurs, evaluate for hip dysplasia, palpate the fontanelles, and determine APGAR scores. It felt like a very successful week when my evaluations would line up with what the provider would also see.

The final week I was in the outpatient clinic. There I saw patients in primary care as well as specialties including cardiology, endocrinology, neurology, adolescent medicine, and pulmonology. I had a good amount of experience in outpatient primary care pediatrics before starting PA school and I felt comfortable in that environment. A lot of the patients seen were for routine well checks which entailed making sure they’re up to date with vaccinations, meeting developmental milestones, growing in line with the chart, maintaining a healthy BMI, following with other providers such as dentist or specialists when needed, also social things such as doing well in school and having a safe and supportive home environment. The specialty visits were completely different. These visits were very focused on the problem at hand. For example, during my shift with the cardiologist there were a few patients who came due to murmurs heard by their PCP. After getting any history and family history, we would examine the patient. The provider would listen then I would listen and he would ask if I heard anything. I was impressed that I was able to hear the murmurs, even though I couldn’t always tell the type of murmur or grade I could hear that it was present. For one of the patients I was able to hear rapid changes in rate when they inhaled or exhaled due to sinus arrhythmia.

I think my physical exam skills improved greatly throughout this rotation and I hope that the providers noticed how hard I was working to learn the ins and outs of each field. I was familiar with outpatient primary care before starting, but unfamiliar with all of the other areas of pediatric care. I was able to learn the different exam techniques associated with each area as well as the pertinent parts of the history, monitoring, labs, and procedures.

My next rotation is ambulatory medicine at StatCare. I am looking forward to this rotation. It is at an urgent care and I will have the ability to continue to work on my skills as a clinician through history taking, examining and assessing the patients while also potentially having the ability to do more procedures. 

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