3 helpful things to learn in pediatrics.

[The Masked Duck]

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I am a first year DO student and this summer I will be doing the Texas Pediatric Society - General Pediatric Preceptorship Program (http://www.txpeds.org/preceptorship_program/). One of the things they recommend doing before starting the perceptorship is to sign a learning contract. In the learning contract we are required to state three goals we have for the summer Preceptorship.
My question is what are the three basic skills or procedures that all pediatricians should know. The reason I ask this is that my school has a clinical medicine course that mainly covers internal medicine and as such we do not get much exposure to pediatrics. My experiences in pediatrics consisted mainly of shadowing my former pediatrician. I am hoping that I can be more active in the Preceptorship.
Some skills that I had in mind are learning how to do a well child examination, Developmental Evaluation, AD/HD Evaluation, or even learning how to use a growth chart. Hopefully I can also learn some procedures but that will depend on the physician.
Any other ideas?
Mods, feel free to move this thread if it does not belong in Pediatrics.

 

[J-Rad]

There are many critical skills to learn in Peds. You are not going to learn them all in this preceptorship, but your question is a good one. As a 1st yr student you are not yet going to have the requisite knowledge (yet) to learn what I would try to teach, say, a 3rd year med stud. So keeping it training-level appropriate:

1. Keeping a younger child calm enough during an exam to gather useful data.
2. The mechanics of doing pneumatic otoscopy (even a 1st year can recognize the visible structures of the outer and middle ear) without hurting the child and scaring them the least possible.
3. Looking for a red reflex and for signs of esotropia and pseudoesotropia.

The latter two things are pretty much mechanistic skills and can be learned without much depth of knowledge of pathophys or experience (unlike the across-the-age-spectrum cardiac exam and the neurologic exams which I would want the 3rd/4th year to learn but take some deeper knowledge and experience with).

My $0.02

 

[The Masked Duck]

Thanks for the quick reply J-Rad and for keeping it training-level appropriate as the preceptorship is only two weeks. I was hoping to do a longer one but our summer break is only three weeks. 🙁

All three of the items you mentioned look like they can be done in two weeks and will help me in third year.

Two more questions. Were there any books you recommend for working with children or any tips when it come to keeping kids calm during a physical exam.

You also mention the importance of looking for red reflex and esotropia and pseudoesotropia. I understand the importance of the red reflex as you can use it for abnormalities in the back of the eye and for detecting cataracts. I also understand esotropia and pseudoesotropia, my question was how common are these conditions. When I was shadowing my pediatrician I don't remember seeing a child with a strabismus or who had crossed eyes.

Thanks for your help!

The Masked Duck - OMS-1

 

[generic]

I think modeling behavior of experienced pediatricians is essential for things like this. Not that everyone will do a perfect exam or be 100% effective in calming down all the 2-year-olds, but each attending you shadow/see in the future will teach you some piece of the puzzle.

I am finishing my intern year and I think I've only seen 1 child with a new diagnosis of "asymmetric red reflex," can't remember what that went on to be (not retinoblastoma though). So I don't think it's that common.

However, it's definitely worth looking for and it's something you can get pretty good at quickly. I think the mouth/pharyngeal exam is also good to learn--watch how your preceptor looks in mouths of kids of various ages--tongue depressor/no? It can be difficult to get a good long look and so much of general pedi exams depend on ENT findings...

I think learning at least the reflexes from the neuro exam might be fun on the older kids. Also advantageous because the ~3-6 year olds think it's funny to see their knees jerk and I thought it was gratifying as a med student to be able to actually "do something and have it work."

 

[J-Rad]

The funny thing about the red-reflex exam as it relates to retinoblastoma, is that we really start too early, but goshdarnit if you're not supposed to document a +RR by d/c from the newborn nursery. Retinoblastoma presents later and is very rare. I don't feel like checking the numbers, but I'm betting glaucoma and cataracts are more common (OT story: in residency I took signout on a baby [few months old?] in Stitch's ED who was just waiting to be seen by the on-call ophtho resident. Kid's eye had, overnight, turned blue-gray from the previous normal looking pigmentation. Glaucoma; kid had a poor prognosis for the eye. Another OT story: one of my heme-onc attendings in residency had pictures of a patient, the patient's mother as a child, and a grandparent as a child-all of them with asymmetric RR from their retinoblastomas). Esotropia is pretty common, as is psudoestotropia, and surprisingly, is commonly missed. It's an easy pickup if you're looking for it.
👍 on the throat exam advice. To this day it's still my least favorite part of a young-child exam.
OP: no good books that I'd recommend to a 1st year. Wait until you decide if peds is the way you're gonna go down the line. Until then, just borrow a Zitelli to look through for peds preceptorships and rotations (ask your preceptor if there's one at the office).
BTW you'll have looked at enough backs after 1 year of DO school to do a decent scoliosis exam and probably could be pretty facile with a musculoskeletal exam. MSK complaints are common.

 

[Stitch]

The funny thing about the red-reflex exam as it relates to retinoblastoma, is that we really start too early, but goshdarnit if you're not supposed to document a +RR by d/c from the newborn nursery. Retinoblastoma presents later and is very rare.

True, but there are other things to look for. Coloboma (okay okay, the incidence is like 0.5 per 10,000 but still), aniridia, congenital cataracts, esotropia, and of course anopthalmia. One of my classmates missed that once and was pretty embarassed. 😳

 

[J-Rad]

Yeah, this guys doc missed it too:

 

[generic]

no no, that patient clearly has palmophthalmia


much more rare, but you get mad brownie points if you pick it up in the nursery

 

[DickyV]

no no, that patient clearly has palmophthalmia


much more rare, but you get mad brownie points if you pick it up in the nursery

If you miss that in nursery, though, you deserve to fail. Not just your peds clerkship, all of third year.

 

[radiodoc99]

I am a first year DO student and this summer I will be doing the Texas Pediatric Society - General Pediatric Preceptorship Program (http://www.txpeds.org/preceptorship_program/). One of the things they recommend doing before starting the perceptorship is to sign a learning contract. In the learning contract we are required to state three goals we have for the summer Preceptorship.
My question is what are the three basic skills or procedures that all pediatricians should know. The reason I ask this is that my school has a clinical medicine course that mainly covers internal medicine and as such we do not get much exposure to pediatrics. My experiences in pediatrics consisted mainly of shadowing my former pediatrician. I am hoping that I can be more active in the Preceptorship.
Some skills that I had in mind are learning how to do a well child examination, Developmental Evaluation, AD/HD Evaluation, or even learning how to use a growth chart. Hopefully I can also learn some procedures but that will depend on the physician.
Any other ideas?
Mods, feel free to move this thread if it does not belong in Pediatrics.

Know how to do a new born screening exam in nursery (includes a physical, growth chart, immunizations)
Management of bilirubin
Knowledge of congenital conditions for heart, syndromes etc.

You will learn more on a case by case basis, good luck