4th year not ready for pediatrics residency

[drlove4]

I’m currently a MS4 going into peds and don’t feel prepared for intern year AT ALL, not because of imposter syndrome but because of a huge lack of peds clinical experience. My 3rd year peds rotation was 100% outpatient and mostly shadowing. The rest of 3rd year wasn’t much better and was pure adults. Because we’re not close to a children’s hospital and family reasons, I haven’t been able to do any inpatient pediatrics electives in 4th year, only 3 outpatient peds electives. My school doesnt have a peds sub-I.

Because of this I feel completely unprepared to step on the floor intern year. Even walking into the room on IM I barely understand what they’re hooked up to. Is this normal? What should I do to prepare? Thank you!

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[thumbz]

There must be somewhere in your area where the kiddos get admitted - I would try to grab a preceptor based rotation with a doc who rotates in the peds department (if your school will let you set up a preceptor based rotation). Hopefully someone at your school has a connection with someone in the hospital - if not I would email whoever arranges med student rotations at that hospital saying "I'm matching into Peds and would love a little more inpatient experience." Say this and it'll be more likely a doc will say yes because you're actually interested in their job and not just killing time until you match derm.

Normally I would say "don't worry about it, you'll figure it out fast in intern year" but I agree, I think you want to at least SEE the inside of an inpatient peds floor prior to getting going.

 

[Stitch]

There's a certain expectation that interns will be a little lost. I wouldn't sweat it. As the above poster mentioned, it's worth trying to set something up if you can. When the time comes to start internship, just be very upfront about what you don't know and ask a lot of questions. You will be well supervised. Listen to the nurses as well as the senior residents.

 

[Perrotfish]

I’m currently a MS4 going into peds and don’t feel prepared for intern year AT ALL, not because of imposter syndrome but because of a huge lack of peds clinical experience. My 3rd year peds rotation was 100% outpatient and mostly shadowing. The rest of 3rd year wasn’t much better and was pure adults. Because we’re not close to a children’s hospital and family reasons, I haven’t been able to do any inpatient pediatrics electives in 4th year, only 3 outpatient peds electives. My school doesnt have a peds sub-I.

Because of this I feel completely unprepared to step on the floor intern year. Even walking into the room on IM I barely understand what they’re hooked up to. Is this normal? What should I do to prepare? Thank you!

Honestly no, it isn't normal to go into a Pediatrics residency without having ever been on a Peds floor. Interns are expected to be incompetent but they're also expected to be more competent than the new 3rd years. You'll overcome it during Intern year if you have to, Peds isn't the most competitive of residencies and we're more tolerant of underprepared interns than most other kinds of physicians, but it would be much better to overcome it now rather than being the weak Intern later.

How bad is the family situation that you can't leave? How limited are your resources? Do you have any give in your fourth year schedule at this point? Is there any chance you can still set up at least a single one month away rotation on a Peds floor somewhere? Could you share where you are? At least what part of the country you are in?

 

[crazykarl801]

To be honest, you'll be fine. People come into intern year with a wide range of being "prepared". But in all honesty, none of us knew what we were doing in the beginning and there are attendings, senior residents and nurses who will help you along the way. Don't sweat it, your real learning will come with experience during residency.

 

[Katheudontas parateroumen]

I did IM intern year so not exactly your situation but I had a co-intern prelim that had not done clinical medicine for 2 whole years, just research as she tried to build her resume to get into residency. Yes she seemed overall more needing "help" and was overwhelmed (so was I) but by the end of a couple weeks, we were functioning equivalently. Bottom line is we all needed support to varying degrees but get to where we need with enough effort. Trust the process. It's good you know this of yourself now and hopefully study up/read/shadow as needed. 4th year is for you. Find a program that has a culture of good seniors willing to teach is important for anyone.

 

[physicsnerd42]

I’m currently a MS4 going into peds and don’t feel prepared for intern year AT ALL, not because of imposter syndrome but because of a huge lack of peds clinical experience. My 3rd year peds rotation was 100% outpatient and mostly shadowing. The rest of 3rd year wasn’t much better and was pure adults. Because we’re not close to a children’s hospital and family reasons, I haven’t been able to do any inpatient pediatrics electives in 4th year, only 3 outpatient peds electives. My school doesnt have a peds sub-I.

Because of this I feel completely unprepared to step on the floor intern year. Even walking into the room on IM I barely understand what they’re hooked up to. Is this normal? What should I do to prepare? Thank you!

So, I liked to joke as a peds senior resident that I didn’t expect the interns to know anything, and that’s mostly true. But, you do need to know some things. It’s less a medical knowledge deficit that I worry about (though there is that too) than an inability to do an inpatient H&P or preround on a dozen kids. If you’ve never rounded on peds patients or managed inpatient peds problems then you’re going to be in trouble starting intern year, especially if you start off on a rotation like the PICU (like I did). How does your school even offer a pediatrics core rotation without any inpatient time? That, coupled with a lack of a peds sub-I, really does put you behind everyone else.

I highly recommend you find a way to rotate at a children’s hospital or a hospital that admits peds patients. Heck, if you’ve never done inpatient peds, how do you know peds is even for you? Something like 3/4 of residency is inpatient so I’d recommend that for your own benefit you do at least a couple of weeks of inpatient.


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[psychapp121]

So, I liked to joke as a peds senior resident that I didn’t expect the interns to know anything, and that’s mostly true. But, you do need to know some things. It’s less a medical knowledge deficit that I worry about (though there is that too) than an inability to do an inpatient H&P or preround on a dozen kids. If you’ve never rounded on peds patients or managed inpatient peds problems then you’re going to be in trouble starting intern year, especially if you start off on a rotation like the PICU (like I did). How does your school even offer a pediatrics core rotation without any inpatient time? That, coupled with a lack of a peds sub-I, really does put you behind everyone else.

I highly recommend you find a way to rotate at a children’s hospital or a hospital that admits peds patients. Heck, if you’ve never done inpatient peds, how do you know peds is even for you? Something like 3/4 of residency is inpatient so I’d recommend that for your own benefit you do at least a couple of weeks of inpatient.


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you’ll learn how to do an h and p or round and know which questions to ask..not that hard

 

[drlove4]

Thank you for the responses. I'm still trying to set something up for this year, but if not what else could I do to prepare? To be clear I've done HP, notes, rounded on adults inpatient, just not kids.

 

[NITRAS]

It’s still early. Can’t you set up an inept rotation?

 

[drlove4]

Well, there was a rotation set up that lasted all of four days until COVID. Is there anything I can do to prepare on my own for peds intern year?? Thanks.

 

[tantacles]

Well, there was a rotation set up that lasted all of four days until COVID. Is there anything I can do to prepare on my own for peds intern year?? Thanks.

Nothing can truly prepare you for intern year. No one is ready for it. We all struggle through it and feel bad at times and feel good at times. It's training. And while you may not feel ready, take solace in the fact that you are protected by a network of people who will teach, inspire, scold, listen to, and guide you through the experience. If you got to this point in medical school, you are ready for intern year. Now you just have to start it.

 

[PTPoeny]

It isn't ideal but you will be fine. I was the senior resident in the PICU in July when an intern started who was in a similar situation. It was a problem that he didn't tell me this information until after rounds the first day . But we worked on it together and he picked everything up. As you pointed out you have done inpatient rounding, you just need the peds nuances.

Please proactively let your senior know the situation and ask for a more thorough orientation to your first inpatient rotation than normal and you will be fine.

 

[GoSpursGo]

I agree with everything that has been said above. Honestly, there's a lot more hand-holding in peds than other specialties like surgery or IM because nobody wants to be responsible for a bad outcome in a kid. Just gratuitously ask your seniors and attendings for help, and even if you're a little behind at the beginning things will even out by midway through your first year.

 

[Oso]

It isn't ideal but you will be fine. I was the senior resident in the PICU in July when an intern started who was in a similar situation. It was a problem that he didn't tell me this information until after rounds the first day . But we worked on it together and he picked everything up. As you pointed out you have done inpatient rounding, you just need the peds nuances.

Please proactively let your senior know the situation and ask for a more thorough orientation to your first inpatient rotation than normal and you will be fine.

PICU as the first rotation of residency? That's roughhh

 

[SurfingDoctor]

PICU as the first rotation of residency? That's roughhh

 

[babybrains]

Imo it’s not a big deal - I hadn’t done a peds rotation for about a year prior to starting my first prelim peds year this year, mostly doing neurology electives in 4th year, and you pick it up quickly. If you know how to manage asthma from your adult experiences, and can pick up croup & bronchiolitis management, that’s a pretty big chunk of inpatient gen peds right there.