Reflection

My Pediatrics rotation at NYPQ was very educational and diverse. Prior to starting PA school, I thought that I wanted to be a Pediatric PA. This clinical experience has helped me recognize that this is a specialty I could certainly see myself working in. There were a few special moments during this rotation that made me come to this realization. One of which included when I was doing my week in Inpatient Pediatrics. A girl was admitted to the hospital the day before her 5th grade graduation, and unfortunately, she would not be able to attend the graduation the following day given that she required close monitoring. The staff on the Inpatient Pediatrics team helped come together to make an unforgettable graduation experience in the hospital for the patient. The residents chipped in to buy a small Carvel Ice Cream cake that said Congratulations. The Child Life staff also created some crafts like a huge poster that said congratulations and even a diploma. We then had the patient walk out of her room to the tune of the graduation song and cheered her on. She was very happy, and it felt good to be a part of brightening her day. Another special moment involved working in the Outpatient clinic. I was seeing a 6yo Boy with newly diagnosed Autism Spectrum Disorder. His mother was explaining that he is typically very reserved and doesn’t interact much with other people. During the visit, I was able to connect with him by performing magic tricks. After that, he was chatting away with me and was very happy – it was a complete change of tune. At the end of the visit, the patient’s mother thanked me for connecting with her son.

During this rotation, I was exposed to several new techniques that are related to Pediatrics and various Pediatric subspecialties. Learning the newborn physical exam was very important, and I got a lot of experience doing this during my week in the NICU. I also learned how to examine particularly fussy children easier. One of the physicians, Dr. Mohammed, explained when he has the patient lay/sit on the examination table versus when he will let the parents just hold the child. Essentially, young children will feel more comfortable when being held by their parents, so it is useful to perform as much of the exam as possible in this manner. Furthermore, I learned techniques like demonstrating to children how the exam will be performed by first demonstrating on the parents, etc. From a technical aspect, I also learned how to vaccinate young children when vaccinations are given in the lateral aspect of the thigh.

Some challenges that I had to overcome during this rotation included interacting with certain patients. For example, during a well-child visit for an adolescent male, he was not giving me his full attention during the visit. Rather, he was using his phone while responding with one- or two-word answers. Prior to his visit, the patient completed the usual PHQ-9 (a depression screening) which showed that he was moderately-severely depressed. It was very difficult for me to try and get this child’s attention. I would have to constantly redirect and ask that he please stop using the phone, etc. After the physician also saw the patient, we encouraged the patient (and the patient’s mother to help) to go for outpatient counseling, rather than just seeing the school counselor, in addition to seeing a Psychiatrist, though he remained rather resistant. Yet another challenge included properly performing a HEADSS assessment, in which the clinician privately asks the patient about home environment, education and employment, activities, drug use, sexual history, and suicidal/homicidal ideation. The different providers I worked with all had different yet effective ways of normalizing these conversations, and it took me some time to adopt my own style. Another challenge that I witnessed multiple times during my Pediatrics rotation occurred in the Inpatient Pediatrics setting. A young adult male with ADHD and autism was admitted for a catatonic episode. During this time, the mother stated that she felt incapable of caring for her son any longer. After CPS meetings, social work meetings, etc., it was decided that the patient would be placed into a care facility. Placement still had not occurred by the time my rotation had ended. The patient had a hospital stay of >50d and may very well still be admitted to the hospital. These complex issues which involve insurance companies, accepting versus denying facilities, etc. were certainly interesting to witness during my rotation.

Memorable experiences from this rotation include performing ABGs on neonates in the NICU, which was technically quite challenging. In addition to the emotionally warming experiences I described above, I can honestly say that I felt generally happy when seeing patients and providing care throughout this entire rotation.

Among the knowledge and experience I’ve gained during this clinical experience, one thing I believe permeates all of Pediatrics is being joyful. When you are interacting with children, they are often scared enough. This rotation was a good reminder of how important a positive, healing personality is and what it can do, even in healthcare. I also learned about how important counseling your patients and their parents is during this rotation. This includes a multitude of things like diet, sleep, and more recently, screen time.

One thing I would want my preceptor and colleagues to notice about my work was the enthusiasm with which I approached it. I hope that it was apparent to the clinicians with whom I worked that I was looking to make the most out of this experience. Furthermore, I hope the team found me to be inquisitive and curious.

For the following rotations, I wish to improve in counseling my patients. During this rotation, I saw how valuable discussions of healthy behaviors truly is. I could further incorporate skills learned during the didactic year into my practice, like using teach back and other techniques.

Overall, my experience at NYPQ for Pediatrics was excellent. I’m thankful for all of the staff that helped make this experience educational AND enjoyable. This is what I hoped Pediatrics would be like.