Peds Problem

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namita84

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So I'm a prelim doing my medicine prelim year at a categorical program. For some odd reason, we are forced to do 1 month of pediatrics during the year.

I have been on 3 months of medicine and ICU etc with above average evals throughout.

However, this peds rotation is becoming personal. For whatever reason, the 2 pediatrics upper level residents I am working with have been downright obnoxious and rude to me. It is a terrible program to begin with ( ie q4 overnight call, no caps on patients, we have to schedule ALL outpt appointments on our own by personally calling clinic offices etc) but it is made that much worse with the residents. I am getting literally yelled at on a daily basis for perceived/minor errors. I actually had a medical student on the rotation personally call me when I was post-call to let me know that when I am out of the hospital they are trying to make me a scapegoat and talking about me behind my back.

Examples include getting yelled at on my first call for not seeking out an upper level to tell her that one of her patient's central line clotted o/n, for getting there at 7 AM instead of 6 AM (rounds are at 9 and I had few pts to see), not pan culturing a patient with a temp spike of 100.3.

I understand that I have made some mistakes, but I feel I am being singled out and disproportionately criticised for my mistakes. I have been on the fence about complaining directly to the PD, but I'm not sure whether that would be a good idea. Any advice a wise person can give me? I'm all ears..

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So I'm a prelim doing my medicine prelim year at a categorical program. For some odd reason, we are forced to do 1 month of pediatrics during the year.

I have been on 3 months of medicine and ICU etc with above average evals throughout.

However, this peds rotation is becoming personal. For whatever reason, the 2 pediatrics upper level residents I am working with have been downright obnoxious and rude to me. It is a terrible program to begin with ( ie q4 overnight call, no caps on patients, we have to schedule ALL outpt appointments on our own by personally calling clinic offices etc) but it is made that much worse with the residents. I am getting literally yelled at on a daily basis for perceived/minor errors. I actually had a medical student on the rotation personally call me when I was post-call to let me know that when I am out of the hospital they are trying to make me a scapegoat and talking about me behind my back.

Examples include getting yelled at on my first call for not seeking out an upper level to tell her that one of her patient's central line clotted o/n, for getting there at 7 AM instead of 6 AM (rounds are at 9 and I had few pts to see), not pan culturing a patient with a temp spike of 100.3.

I understand that I have made some mistakes, but I feel I am being singled out and disproportionately criticised for my mistakes. I have been on the fence about complaining directly to the PD, but I'm not sure whether that would be a good idea. Any advice a wise person can give me? I'm all ears..

That bolded part is pretty much the norm. I'm doing a peds intern year before going to anesthesia, and I'd LOVE to have caps on patients, and I'd love to take q8 or q12 call like my counterparts on medicine. Actually, a lot of the things you talk about are normal at the program where I am -- not so much the yelling though.

However, with peds, know that people are generally very protective. If you have questions about anything call the senior.

So I just had to convert 100.3 to celcius since that's what we use. That's nearly considered a fever in a neonate, so once you get to 100.4 (aka 38.0) -- that's a fever for neonates (however, I wouldn't culture a kid for a temp of 37.9). For older kids, if they're basically healthy, we'd wait to 38.5 (101.3), but some attendings consider fevers to be at 38.3 (101).

As for calling for appointments, have your med student help with that if possible. I've spent 2 hours on the phone coordinating appointments for patients once -- when all my other work was done (miraculously). It can be a pain if you have to coordinate appointments for some kids that have like 10 follow ups with different services.

As for when to arrive, that totally depends on the culture of the program. The latest we're allowed to come in is 7; however, most people come in between 6-6:30 because that's when we start taking admissions, and if we get an admission during rounds, it can just mess up the flow. A lot of the schedule is based on assuming that everyone arrives at 7am, even though, no one does (eg, when we stop taking pts, and the on call person starts) The only time I've ever arrived at 7 was when I was on ER for a shift.

You've only got 1 month.
 
Sounds like the peds program at my school and how off-service people are treated there. Are most peds programs obnoxious like this? Anyway, yeah, it's a month, and all you've got to do it pass. Do what they want, consult your senior for everything and come in at 6 just to sit around and not do anything. For some reason that specialty attracts some petty, catty people, so cooperate and then forget about them.
 
Sounds like the peds program at my school and how off-service people are treated there. Are most peds programs obnoxious like this? Anyway, yeah, it's a month, and all you've got to do it pass. Do what they want, consult your senior for everything and come in at 6 just to sit around and not do anything. For some reason that specialty attracts some petty, catty people, so cooperate and then forget about them.

How does having a bad experience at your program doing a core pediatrics rotation generalize to the field of pediatrics attracting "petty, catty people?" Everybody has a bad rotation in clerkships, but I think most of us are mature enough to realize that that doesn't necessarily reflect the entire field.
 
How does having a bad experience at your program doing a core pediatrics rotation generalize to the field of pediatrics attracting "petty, catty people?" Everybody has a bad rotation in clerkships, but I think most of us are mature enough to realize that that doesn't necessarily reflect the entire field.

I have to add my own +1 to the previous poster. I also noticed that peds attracted this variety during my rotation and everyone I know who is going into peds is also like this. The only exceptions were the neonatology fellows / attendings. :love:
 
I have to add my own +1 to the previous poster. I also noticed that peds attracted this variety during my rotation and everyone I know who is going into peds is also like this. The only exceptions were the neonatology fellows / attendings. :love:

Agree with assessment.
 
How does having a bad experience at your program doing a core pediatrics rotation generalize to the field of pediatrics attracting "petty, catty people?" Everybody has a bad rotation in clerkships, but I think most of us are mature enough to realize that that doesn't necessarily reflect the entire field.

Honestly, my feelings are based on my rotation and on the experiences of my classmates at another pediatric residency program (we have two campuses at my school, so two programs) and on conversations I've had with other people who've done pediatrics rotations elsewhere. And the op is clearly not from where I rotated, but her experience sounds exactly like that of the off-service rotators on my home peds program. I've met lots of nice people in pediatrics, so no, you're not all catty, petty people, but I haven't encountered quite as much happiness and friendliness as one would expect in the field.
 
OK, not where you all are yet. . .but, I work in peds critical care as a RN. A lot of this does seem to be the culture. Came out of adults critical care and OHS first. Some of it is like the other person posted--ultra protective--but at times to the point of ridiculously controlling. You really have to work hard to fit into peds in many places. Again, I'm only speaking from my perspective. When I read what the OP wrote, I first said to myself, "Wow. I thought most of this @#$% is in the catty world of nursing. Apparently it not limited to nursing. Don't get me wrong. I've learned a lot, and worked with some great people.
And maybe it is me, but in general, many in peds seem kind of more pulled into their own than other areas--in general less apt to be collaborative--but this is only my POV--and it certainly isn't that everyone is like that. It just seems to take a while to break-in, so to speak. I find it's a very uptight controlling world--and a good amount of that is for great reasons, and the the other amount is just BS and unnecessary.

BTW most peds units I've worked in will rip a nurse or a resident big time if they don't go all culture happy for 38.2. Not kidding.

Anyways, sorry, just another perspective that in general tends to agree with some others here.

So hope all goes well and you get through it. If you want to do peds, you still have to get through it and then pray that enough of the "right" people like you--at least eventually. At the very least, you have to fit into the culture for whatever the duration.
 
I recommend:
-suck it up and don't complain

-come in earlier. If they want you there at 6 a.m., then it's 6 a.m. for you. It's only 1 month, after all.

-Don't go to your PD. He/she probably already knows about this problem and it will just make you look like a complainer. I do think that you should document/mention some of this on your evaluation at the end of the month, so that you have some defense if they trash you (mention specifics like not being told what expectations were and then being yelled at, etc.).

-you probably should have told your senior about the central line being clotted off. Nobody likes being surprised on rounds, and it's ultimately their a-- if the attending gets ticked off.

-I wouldn't have known to panculture a kid with that low of a temp...we probably would not in internal med...if you are not sure, in the future ask the senior resident.

Q3 or Q4 overnight call was the norm at my IM residency. It sounds like yours is more cushy. Having to make f/u appointments for patients can be a pain the a--, but again is the norm at many programs. I would not complain about this because it's not reasonable and you'll only look like a big fat whiner.

I agree that a lot of peds people can be catty and controlling. Also I found them not as "nice" or "happy" as one might assume. I do think that some of this is because treating kids creates a lot of anxiety about "doing things right" and the senior resident has to worry also about the patients' parents, etc.

Lastly, I think I would have jumped off a tall building if I had to do a peds month during my medicine residency. :laugh::laugh:
 
Examples include getting yelled at on my first call for not seeking out an upper level to tell her that one of her patient's central line clotted o/n, for getting there at 7 AM instead of 6 AM (rounds are at 9 and I had few pts to see), not pan culturing a patient with a temp spike of 100.3.

Yeah this is Peds everywhere. You have to call a senior for everything, no matter how trivial. And the pan culture is their God. All children must be brought to the altar of the almighty pan culture. It's just the way it is.

I wouldn't complain. It's only a month and besides it gonna be received as the "lazy" off service doctor complaining. Get to work when they tell you to, call the senior with everything and prepare to be told to pan culture little Becky when you call the senior to say she sneezed two times last night.
 
Exactly, because little 2 month old Becky is going to tell you the probable source of her fever overnight, why she is tachypneic,and maybe she has been having some dysuria or any other pertinent history that you need. And oh if she wasn't sick before she is definitely in the right place.
 
Don't forget the meningitis. Little Becky always manages to pick up meningitis from heaven knows where in the middle of the night. :p
 
I recommend:
Having to make f/u appointments for patients can be a pain the a--, but again is the norm at many programs. I would not complain about this because it's not reasonable and you'll only look like a big fat whiner.

I would bring up this. It would be best if many residents complained about this. Bottom line is the hospital is too cheap to spend the money to hire extra schedulers or to incorporate this into the job description of an ancillary staff member. Doctors should not be physically scheduling appts, this is not what we got trained to do. This does not happen in private practice. Only in residency.

When I was a third year student I noticed interns calling for followup appts at our County hospital. This is no longer the case, we just write an order at discharge for followup appts and it magically happens. I'm sure enough residents complained over the years.
 
I would bring up this. It would be best if many residents complained about this. Bottom line is the hospital is too cheap to spend the money to hire extra schedulers or to incorporate this into the job description of an ancillary staff member. Doctors should not be physically scheduling appts, this is not what we got trained to do. This does not happen in private practice. Only in residency.

I agree that it might be worth banding together with others who have gone through the rotation to see if this can be addressed as a group. Even though this kind of thing is a common occurance in residencies, that doesn't change the fact that it is a huge waste of your time that has no educational value.
I feel very fortunate that my residency program doesn't expect us to do things like this.
 
Hmm... I can't say that it's universal to peds programs.
I'm an ED resident on the general peds service this month and at my hospital they've been pretty nice to me. The senior residents and the attending acknowledged the first day that I'm not a pediatric resident and they understand that the stuff I need to get from the rotation is different from the stuff a categorical pediatric resident needs. They've been kind and partitioned the workload accordingly. I do more of the ED admits and the peds residents do more of the direct-from-the-office admits, the peds residents do more of the scheduling followups and making growth charts, and I do more of the LPs (I'm very happy about that division of duty).

I guess it's hospital dependent.
 
Hmm... I can't say that it's universal to peds programs.
I'm an ED resident on the general peds service this month and at my hospital they've been pretty nice to me. The senior residents and the attending acknowledged the first day that I'm not a pediatric resident and they understand that the stuff I need to get from the rotation is different from the stuff a categorical pediatric resident needs. They've been kind and partitioned the workload accordingly. I do more of the ED admits and the peds residents do more of the direct-from-the-office admits, the peds residents do more of the scheduling followups and making growth charts, and I do more of the LPs (I'm very happy about that division of duty).

I guess it's hospital dependent.

Exactly. I'll go one step further and make, the apparently controversial, statement that pediatricians are no more or less catty than anyone else in medicine. They're human just like the internists, surgeons, pathologists, etc. If you want to make the statement that medicine, as a whole, attracts a fair amount of funny ducks, I'll whole-heartedly agree. But singling out of any specialties for "X" trait always comes off a little narrow minded. Just because some of the adult cardiologists I've interacted with come off as arrogant, ungrateful pricks doesn't mean I think all of them are like that (most of the fellows I've met have been very pleasant, in fact). I've met plenty of nice surgeons and even a few nice OB/GYNs. And I certainly have met some pediatricians that I could have lived without meeting. No one has a lock on saintliness or douchiness.

As for the OP: the idea of a categorical IM intern doing a peds rotation is bizarre to me as well (is this tracked-to-IM osteopathic internship? That might make a little more sense). I don't think most internists would benefit much. However, as DrBob alluded to something can often be learned, if there is a willingness to learn and to teach (something that seems to be missing from the peds end in the OP). Why not focus on caring for the teenagers or slightly younger kids who have chronic diseases that they take into adulthood. Teenagers generally defy the axiom "kids aren't small adults". In a lot of ways, they really are small adults, albeit mentally deficient and emotionally stunted adults. Non-chronic conditions that teens get admitted for are frequently that which younger (20s, 30s) adults get admitted for (pneumonia, complications of eating disorders, non-surgical pain, etc). Since a lot of stuff can be managed conservatively, that's a good a lesson across the practice spectrum. There are chronic conditions that get admitted that you can learn from: CF, sickle cell, asthma, DM1 (and increasingly DM2). A novel learning experience might be the kid with palliated congenital heart disease who needs admission. They're growing up now and a little experience with a Fontan might help when he/she is 23 and coming on your IM floor for something. You'll see plenty of some of the above chronic stuff, but seeing it when the disease is early in life could help esp. when the patients are transitioning to adult care. Not to belabor the point, but there is probably something that can be learned if the rotations through peds must continue. There are plenty of peds residencies that get off-service rotators that make it a beneficial experience for both parties involved (we got rotating residents on call. Because of the structure of Navy internships/residencies these were from anything from transitionals, prelim surgery, and prelim IM. While they were on an outpatient clinic rotations [obviously with inpatient call] occasionally someone would choose to do an inpatient rotation. I don't think this generates many complaints, though a few peds residents weren't known for being all that accepting)
Another few points from the OP: while I think there are a lot of indications of a poorly run rotation for off-service rotators, the OP seems to have made a few mistakes as well. I usually believe that, within reason, it's better to ask for forgiveness than for permission, that only applies when you are in familiar territory (i.e. don't assume you can come in an hour later because of fewer patients. Maybe the cultural norm there is for someone with a lighter load to do something to help those with a heavier load). And what was the circumstance of the line clotting? Was anything done about it (TPA?). What was the line for? Was it really an overreaction or was it an appropriate reaction? And no, pan-culture is not the norm. Yes for pan culture for febrile babies <28 days, yes for some babies 28-90 days (depends on other factors), and sometimes for older febrile infants/kids if clinically indicated. Blood culture for sickle cell with fever x1 and BCx q24hr with fever if neutropenic is normal (isn't this normal in the adult world as well?). A three year old without hardware who has a fever isn't necessarily going to get anything (and if they're comfortable I'm going to argue with the nurse that she doesn't need Tylenol either). Maybe the culture of this particular program is for frequent pan-culture, but this, fortunately, is not the standard.
Good luck and tough out the rotation. See if the PD can push for some improvements to the rotation.
 
Non-chronic conditions that teens get admitted for are frequently that which younger (20s, 30s) adults get admitted for (pneumonia, complications of eating disorders, non-surgical pain, etc). Since a lot of stuff can be managed conservatively, that's a good a lesson across the practice spectrum. There are chronic conditions that get admitted that you can learn from: CF, sickle cell, asthma, DM1 (and increasingly DM2).

I think that this is great advice. As an FP intern, we have to do peds as well as adult medicine, and when I had an adult female with a bad asthma exacerbation while she was in the hospital, I felt more comfortable treating her asthma since I had just come off of peds a few months before. I agree that you can definitely pick up something from a peds month that will help you with your adult months.

Teenagers generally defy the axiom "kids aren't small adults". In a lot of ways, they really are small adults, albeit mentally deficient and emotionally stunted adults.

:laugh::laugh:
 
My residency diretor (pediatric EM fellow-ship trained) likes to say that adults are just big kids, lol (of course doesn't apply to geriatrics)
 
Thanks for the replies guys...

Fastforward almost 3 weeks... I worked my butt off,residents still treated me like dirt but I didn't say a word just took the abuse... Still made a few mistakes here and there but nothing major... Today Im on my new rotation and the PC let's me know that BOTH my specialty and medicine PD want to meet with me to discuss my peds evaluation(which I have not seen)... I'm so upset right now... I have made a
note of all the unprofessional things
that were said to me during the
course of my rotation.... Would it be in my best interest to just slam the way the residents and some faculty treated me? Any advice as to what to do? Help needed!
 
Thanks for the replies guys...

Fastforward almost 3 weeks... I worked my butt off,residents still treated me like dirt but I didn't say a word just took the abuse... Still made a few mistakes here and there but nothing major... Today Im on my new rotation and the PC let's me know that BOTH my specialty and medicine PD want to meet with me to discuss my peds evaluation(which I have not seen)... I'm so upset right now... I have made a
note of all the unprofessional things
that were said to me during the
course of my rotation.... Would it be in my best interest to just slam the way the residents and some faculty treated me? Any advice as to what to do? Help needed!

Absolutely not.

However, if you are faced with an unfair evaluation, *then* you may provide the documentation of the things said to you in a calm and professional manner.

"Perhaps the team had some expectations for me and other off service residents that weren't expressed clearly and they felt that I didn't meet those expectations. I felt I worked hard and learned a great deal however, there were several instances in which I was treated with disrespect...blah blah blah. I understand you have some concerns about my performance and I want to continue working hard to demonstrate that this was an anomaly and perhaps more of a personality difference than a real problem with my clinical skills and knowledge base."

You do not need to "blast" them - you will be much more effective if you simply lay out the instances of what was said to you, emotionless as possible and be professional and courteous, acknowledging (if at all possible) that they may have judged you unfairly(depending on what they were...because there may be some truth).
 
So I had the meeting with both PDs today...

They showed me a copy of my evaluation, which basically trashes me. At the top it says "evaluation compiled by residents, nursing staff, and 3 faculty"

The evaluation is overall exaggerated and incorrect in many aspects. During the meeting I made it clear that I felt I worked hard but there were personal/political issues at play here. I made it clear that I felt I was being unfairly judged and voiced that even still, there is always room for improvement.

My PD basically says, well these kind of evaluations even for a ****ty rotation like peds don't come all the time, so we are going to have to keep an extra careful eye on you. Meanwhile, my Medicine PD said you are a resident in good standing but these kind of things if repeated can put you in counseling/probation status.

So basically, I worked my butt off, took the abuse, received an unfair evaluation and am now being judged for it. Do I have any recourse at this point?

PS. I have documented all unprofessional behavior by residents/staff
 
IMHO you're fine. It's March now, and if your first 7 months (July - January) were completed with good evaluations in medicine, then you have no reason to fear that your last 4 months will be disasters. It was an anomaly.

Remember, this isn't like school. You didn't get a Bad Grade that will be on your Permanent Record forever. You're a preliminary intern getting ready to head into what I presume is either anesthesia or neurology (hence the utility of caring for pediatric patients)-- this is all Pass/Fail. You get the credit or you don't. It sounds like you got trashed on the eval but still "passed," which is ultimately all that matters.

Just shine as best you can from here on out-- in your chosen specialty, which I presume you're naturally more excited about and more comfortable in.
 
IMHO you're fine. It's March now, and if your first 7 months (July - January) were completed with good evaluations in medicine, then you have no reason to fear that your last 4 months will be disasters. It was an anomaly.

Remember, this isn't like school. You didn't get a Bad Grade that will be on your Permanent Record forever. You're a preliminary intern getting ready to head into what I presume is either anesthesia or neurology (hence the utility of caring for pediatric patients)-- this is all Pass/Fail. You get the credit or you don't. It sounds like you got trashed on the eval but still "passed," which is ultimately all that matters.

Just shine as best you can from here on out-- in your chosen specialty, which I presume you're
naturally more excited about and more comfortable in.


I totally understand this...I just feel like I was really taken advantage of in my peds rotation with the end result being an eval that absolutely trashes me as both a doctor and a person. My question is: Should I expose in detail to either my medicine PD or my specialty PD exactly what kind of abuse took place? I feel if I don't than evil will prevail literally
 
You have the right to have a copy of the evaluation and to place a letter in your file which addresses each of the complaints.

IMHO this is important to do, and to do now, because there may come a time, when you are applying for privileges at a hospital and your file is accessed. It may be by someone who is not familiar with you (ie, a new PD), and they can only provide information based on your evals. Now, since you aren't going into Peds, it probably won't happen and/or make a difference but you should document the abuse and address the accusations (especially those that you say are incorrect) and have a copy placed in your file.
 
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