My site evaluator for this rotation was Professor Maida, which was excellent as he taught us Pediatrics.

During my first site evaluation, Professor Maida reviewed two focused H&Ps that I wrote.

One case involved a 2y9mo old male patient that came in with “pimples in his mouth” that were worsening and fevers. When reviewing the case, Professor Maida pointed out how important it was for me to include the strength (dose) of the Amoxicillin the patient had been prescribed from his PMD (as I only wrote the quantity – 5mL). Furthermore, Professor Maida gave me excellent feedback in that he mentioned that when documenting the review of systems, one thing he likes to do is write in non-medical terms. For example, rather than writing “Denies hematemesis,” Professor Maida explained that when you ask these questions to the patient, you are asking them in layman’s terms. What would be more appropriate would be documenting “Denies vomiting blood.” One thing that I missed in my documentation which Professor Maida also pointed out to me was the fact that under the physical exam, for the “Head” portion, I documented that the Anterior and Posterior Fontanelles were soft. However, in a 2y9mo old, the fontanelles should have been, and were closed. This mistake showed me how important it is to review your documentation, particularly when using templates. This patient was diagnosed with a viral stomatitis, and Professor Maida and I discussed the most likely etiology given the patients presentation, coxsackie virus.

The second case involved a 4d old patient that was presenting to establish care with a pediatrician. Professor Maida was happy to see that I included the patient’s birth history. Some of the feedback I received on this Focused H&P included remembering to document the genital exam and extremities. For these two portions, it is important to look for things like imperforate anus, undescended testes, etc. Furthermore, in the extremities is important to document things like Barlow and Ortolani as well as looking for any leg length discrepancy. It is also important to look for syndactyly, polydactyly, club foot, and other abnormalities.

During my second site evaluation, Professor Maida reviewed another case that I presented, this time an 18yo presenting with dysphagia who was later diagnosed with Eosinophilic Esophagitis (EOE). I also presented a New England Journal of Medicine journal article that was a Review of EOE. While presenting this case and the journal article, we talked about how I saw this during my week in Pediatric Gastroenterology, and how you may see some rarer diagnoses in certain settings. We discussed the other team members that would be important in treating patients with EOE including PMD, gastroenterologist, dietitian, and allergist. We reviewed many different “Drug Cards” written by Cara and I. The drug cards included medications like Amoxicillin, Azithromycin, a Pulmonary Surfactant (as I did a week in NICU), Ibuprofen, etc.

My meeting with Professor Maida was very informative. He provided Cara and I with direct feedback about the cases we presented, our write-ups, our knowledge about the “Drug Cards,” etc. We reviewed several different diagnoses and the management of some of them, with a particular emphasis on Pediatrics. I enjoyed the fact that Professor Maida asked Cara and I generally how our rotations were going, if we’ve begun to narrow our interests, etc.