Leaders in Medical Education

Dr. Janelle Aby, Medical Director at Lucile Packard Children's Hospital

Osmosis Team
Published on Sep 10, 2014. Updated on Invalid date.

Dr. Janelle Aby is a Clinical Professor in Pediatrics at Stanford University and the Medical Director of the Well Newborn Nursery at Lucile Packard Children's Hospital. Her research interests lie in the care and evaluation of newborns. She has also been focusing on improving the educational experience for residents and students in the nursery.

How did you decide on a career in medicine?
My father is a physician, so I grew up with some familiarity of what it means to practice medicine. But I started out determined to be a nurse. Back then, there weren't too many women in medicine, and I didn't know any women physicians. All of my father's colleagues at the time were men. It was my sixth grade teacher, Mrs. Swenson, who first encouraged me to "aim higher". I wasn't immediately convinced that being a doctor was for me, but she planted the seeds. A bad experience with high school biology almost turned dissuaded me from a pre-med college track, but I decided to stick with it, at least temporarily. A particularly good experience with human biology in college during my first year erased all doubt and set me on my way. (Never underestimate the power of teachers, good and bad!)

What made you pick pediatrics as your speciality?
I went to medical school with a completely open mind, without being drawn to any particular area. And as I went through the various clinical rotations, I found lots of things I liked and could have been interested in. Surgery, for example, was a particularly favorite rotation! But ultimately, I was drawn to pediatrics because I love working with children and their families, because I didn't see myself getting tired of treating the most common diagnoses that come to a pediatrician (ear infections and URIs), and because I like the way pediatricians approach medicine. As I was doing all those med school rotations, I noticed some special things about pediatrics -- the wards were brightly colored and decorated (no grey/white walls), medication and equipment was tailored to the size/weight/age of the individual (no one-dose-fits-all mindset), patients were encouraged to bring their special blanket/toy with them to the hospital, and a family member was usually provided a place to sleep right next to the patient's bed. To me, it seemed that pediatrics had the most patient-friendly approach, and I was really attracted to that.

What is one of the most memorable experiences you have had as a pediatrician?
It's hard to pick just one experience. There have been many memorable moments during my career. Some of the most poignant, though, are those that came as a result of mistakes I made. In particular I remember a baby whose spit-up colostrum looked to me liked bilious emesis. I ordered what turned out to be a completely unnecessary abdominal x-ray and caused the family needless worry. I also remember getting a call from a local pediatrician who was seeing a baby in clinic that I had cared for in the nursery. She informed me (rather too curtly I thought) that I completely missed a clavicle fracture in our mutual patient. It was a painful moment. But in fact, those events provided the seeds for the idea to put educational material online, to include lots of pictures, and to include seemingly basic material (like what colostrum actually looks like).

What inspired you to compile pediatric photos for open education purposes?
My collection of photos (and the whole newborn website) grew out of my efforts to meet our educational goals for our own residents and students. Right away, I could see that assessing the newborn with a physical examination was not a strength of our trainees. I felt I needed to help them learn how to spot problems and identify physical findings that might cause concern to parents. But since our medical students only spend 5 days in the nursery, and our residents only have 2 weeks with us in their first year and 2 weeks in the third year, there wasn't much time for them to get clinical experience. In fact, some diagnoses that are relatively common in the nursery (clavicle fracture, for example) might still only appear a couple of times of year. It was entirely possible (likely even) that a resident could finish his/her training and be out in practice without ever seeing a clavicle fracture in a 1 - 2 day old baby. I started out trying to compile a collection of images taken by others. But after spending hours and hours google-ing common nursery findings and coming up with nothing, I decided it was time to bring my camera to work and just start taking pictures of what I wanted to teach about. When I started I didn't imagine that the photos would be used much outside of our own program, but the fact that they have attracted so many visitors in such a short time tells me that this type of content is still not readily available elsewhere.
How do you foresee pediatric medicine change over the next few years? 
I think the biggest changes in pediatric medicine, as in all of health care, will be in the area of technology changing the way we do patient care. Already there are organizations that provide virtual on-line consults for patients, electronic medical records that can incorporate images of various findings right into the chart, and patient apps to motivate behavior and lifestyle changes. I think we'll also be seeing more and more creative applications of these various technologies used not only to deliver good patient care directly but also to address the quandry of providing better care at a lower cost.