freaking out over starting a peds subI

[mochamuffins]

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I start a peds subI later in the week. I have a couple of days to read to prepare but I still feel clueless of what I need to do since I did not really have inpatient peds during third year. What are some tips to really shine since I am in my number one spot? What are high yield topics I should know before hand or should I just dive in. Besides a pocket calulator and a sethescope, any other type of equipment I should carry?

any advice will be much appreciated

 

[m1234d]

hi, for my subI i also found it very helpful to have a pen light, and something to distract kids with/use to see how well they follow, etc. I also had a card that i photocopied from a book with basic lab values and vitals for age (warning, maxwell is nearly worthless on peds- or at least i think so)

other than that, keys to being basically good at my institution included:
1. problem #1 is health care maintenance, find out who their primary is, including phone and fax numbers (to fax d/c report), if they are up to date on their immunizations.
2. always at least skim through developmental milestones
3. if its a baby/toddler, find out BM vs formula vs. solid foods, make sure age appropriate.
4. no matter how well i knew a topic (or if i just admitted another kid with it that week) i always read nelson's (which is online for free at my institution, and most likely at yours too)
5. if its an NICU grad, try to get the discharge summary, or find out any major complications, make sure they have proper f/u (i had two that had be lost in the system, and we got them reconnected with pt/ot, etc)
6. try to communicate well to the parents, its good practice, and they really appreciate it, some of them appreciated literature about new diagnoses, and sometimes they just want to ask you the same question one more time to make sure they understand (but of course, don't talk over your head, in the event that they ask questions you aren't comfortable answering, decide if this is a topic you can breech after some talking with your senior/attending, or if this is a conversation better left for an attending in which case try to be present for the conversation)

remember, that this is supposed to be fun!! it's nice to have a glimpse of what your life will be in a bit, work hard, but relax. good luck!!

 

[TexasRose]

I want to echo #4 there. I always read/skimmed the Uptodate chapter on my patient's problem before I presented him/her. That way I made sure I'd asked all the important questions in my H&P, maybe looked for relevant labs (and baseline labs, if available) or had an idea of what to order, and had a couple of decent sounding questions to ask.

Have fun with it!

 

[CrazyPeds527]

I just came off a SubI after not having done any peds since August of 3rd year. It wasnt nearly as bad as i thought it would be, in fact, it was AWESOME! Here are some helpful hints:

#1) HAVE FUN! This is a chance for you get to understand what life is like as an intern without having to answer every cross-cover call for tylenol or every page from someone telling you lab values you already know. So enjoy it!

#2) Keep a couple of things organized about all of the patients on your team, not just your own. That way, inevitably, when the post-call intern asks out loud "What was I supposed to do on this patient" and can't remember, you save them a trip to the chart, and you are an awesome team player in the process.

#3) Read at least one article, or UpToDate as previously mentioned, on EACH patient. That way if you get a rule-out-sepsis kid, and you think "this will be cake", but you get asked about the specifics of Rochester's criteria, you at least know what they are talking about, if you haven't memorized the criteria yet (hint: they won't expect you to have memorized it anyway, so anything you know at all makes you look like a STAR!)

#4) Go check out cool physical findings on other team patients. Just because they aren't yours, doesnt mean you cant go see them!

#5) Do NOT be a glorified suck-up. Do not answer questions that the senior resident doesn't know the answer to just to show off...its bad form. Even if you are SURE of the answer. Most attendings ask questions of the med students first anyway, but if not, and the question is not directed at you, dont jump in unless prompted...you might irritate someone.

#6) Everything the other peeps said is true...most of all, hang out with the kids! If you are slow, and you have a patient, go hang out with them, play video games or cards or whatever!! Remember the reasons why you are going into peds and take advantage. 🙂

 

[generic]

Anybody have tips for what to use as a kid distractor?

One of the residents had a really great little cow toy that both lights up and makes "moo" sounds...it worked like a charm on a 2 year old.

On the other hand, the attending just hands over her keys/ID...but the problem with that is you end up putting slobber all up in your pocket. Hmm..

 

[TexasRose]

Anybody have tips for what to use as a kid distractor?

One of the residents had a really great little cow toy that both lights up and makes "moo" sounds...it worked like a charm on a 2 year old.

On the other hand, the attending just hands over her keys/ID...but the problem with that is you end up putting slobber all up in your pocket. Hmm..

Use something you don't mind parting with, if necessary. Keeping some stickers in your pocket might be useful. I've entertained many a baby with my ID badges, but sometimes they fuss when you have to get it back. That's no good! Penlights work too, as do pens with glitter in them or that light up when you press a button. (got a cool one from a rep)

 

[DoctorWannaBe]

How important do you guys think a Sub-I is for preparing you for residency or for getting into a residency? I'm signed up to do a Peds inpatient sub-I in a couple of months but am thinking of dropping it. There are a couple of reasons I'm thinking of not doing it: 1) My school has a campus in two different cities, and I'd have to do the sub-I in another city because the one at my campus isn't that great. Money is a huge issue right now, and I would rather not pay double rent for another month. 2) The grade from my sub-I won't be in my dean's letter and I won't get a letter of recommendation from it due to the timing of the sub-I. 3) I've already done a PICU sub-I where I got experience being the primary caretaker, which I assume is the benefit I would get from doing another sub-I. 4) The hospital where the sub-I is at is not my top choice for residency, so it's not like I'm going there to check out the program.

Are there benefits to doing a sub-I other than for the experience of being like an intern? Will residencies know that I'm not doing an inpatient sub-I and will they care?