How to Collaborate Effectively with Your Attending: Pediatrics Edition

Welcome to Pediatrics! Get ready; there's a wealth of information to be learned, from well-child checks to acute care visits to managing patients with chronic illnesses and inpatient management on the floor or in the ICU. Fear not! We're here to give you tips and tricks on shining, no matter what phase of training you're in! 

The Preclinical Years

Your preclinical years are about developing foundational skills in taking histories and performing physical exams. Pediatrics is a great space to learn many of these skills. To shine here, you want to identify areas to strengthen, share those with your attending, and then repeatedly cycle between asking for and implementing feedback.

If this seems intimidating, here are some suggestions on where to begin. You can improve your:

• History-taking skills by not missing critical areas of information (e.g., birth history, history of vaccination)
• Communication skills by working with both caregivers and the patient to understand the chief concern
• Physical exam skills by recognizing findings that are within normal limits from pathological findings 
• Presentation skills when delivering the history and exam you took

Excelling in Your Pediatrics Clerkship

As it turns out, kids are not just "little adults"; caring for them requires clear communication skills, patience, and adaptability. Let's talk about some areas you may rotate through and some tips and tricks to help you. 

General Tips and Tricks for Pediatrics

• Use patient-centered language: "Mom says" not, "the patient's mother says." 
  • Pro tip: Consider asking caregivers how they would like to be addressed. Many in peds refer to caregivers by a title (ex. "Mom"), but caregivers are individual people, too. Identifying them by their name may strengthen your relationship with the caregiver and show your ability to see the complexity of their situation. 
• Include the child as best you can by talking to them and explaining what is happening or what you're doing. 
• Demonstrate an exam on the caregiver or a stuffed toy first to reassure the child that it won't hurt.
• Engage the child early, especially if facing a difficult procedure or scenario.

Specific Tips for Inpatient Exposures

• Be on time, be prepared for rounds regarding your patients, and know their info.
• You may feel intimidated because rounds are often family-centered, meaning you present in front of the caregivers and child. To help, before rounds start, identify questions you have about sensitive or tricky information. Then, clarify the answers to those questions with your senior resident. Doing this will help show your senior resident your clinical reasoning. It also opens the door to a learning opportunity!
  • For example, if you're worried a lab finding may indicate cancer (a scary diagnosis), ask your senior resident for advice on how to approach this during rounds. You can explain why you think the lab finding indicates cancer. In return, the senior resident might demonstrate ways to communicate difficult news or discuss what other diagnoses are possible with that lab value. 

Specific Tips for the Well Baby Nursery

• Don't be afraid to examine a baby! They're small and require head support, but examining them is safe if you're careful. 
  • Tip: Always be on the lookout for congenital deformities, including cleft lip/palate, tongue or lip ties, improperly formed fingers or toes, abdominal wall defects like an umbilical hernia, signs of a spinal defect like a deep sacral cleft with or without hair, or GU defects like hypospadias or ambiguous genitalia
• Never leave an infant in a dirty diaper. If you examine an infant and they're soiled, be sure that someone, such as the caregiver or nurse, changes it or take the time to change it yourself. 
  • Tip: Speaking of diaper changes, if that is not your forte, ask a nurse or CNA to show you how to do it. 
  • Note: When working with biological males with a diaper off, watch out for pee! It can arc and hit you, so keep them covered when changing their diaper or performing an exam or procedure. 
• Many newborns will have hyperbilirubinemia, and you can use BiliTool to help you identify if their bilirubin level qualifies them for phototherapy. 

Specific Tips for Outpatient Experiences

• Review the clinic ahead of time, if possible.
• For new patients, look to see if you can find the chief concern, which is sometimes in a nursing note or a referral note. Think of a differential for that chief concern and try to anticipate what questions might be useful to ask to narrow your differential. 
• For returning patients, be sure to look up and read about any diagnoses they have and medications they're on. 
  • If the return visit is for a well-child check or sports physical, you can use The American Academy of Pediatrics' Bright Futures Guidelines to help you know what historical questions are relevant, what milestones to expect for age, what vaccines (if any) are indicated, and what preventative care needs to be discussed. 

Additional resources for your clinical rotations:

• The Osmosis Ultimate Guide to Thriving During Clinical Rotations
• How to Use Osmosis to Help You Thrive During Clinical Rotations
• Tips for Successful Clerkships (AAP)
• How to Impress Your Attending: Internal Medicine Edition

Choosing a Career in Pediatrics

You've passed your pediatrics clerkship and decided this field is right for you. Now what? 

Pediatrics is a rewarding specialty, with the opportunity to care for patients from birth through adulthood and the ability to either generalize or subspecialize. Like any other field, getting into a residency in pediatrics involves many components, but the two most important are finding the right mentor and leveraging Scholarly Project(s). 

Finding the Right Mentor

Having the right mentor is critical. They can provide you with career insight and guidance, advice on applications, and letters of recommendation. Connecting with someone and asking them to mentor you should be done thoughtfully.

Start by considering what you want out of your career. For instance, if you want to pursue primary care in pediatrics, then a pediatrician who is a primary care provider is likely a good fit for a mentor. On the flip side, if you want to go into a subspecialty, like pediatric cardiology, find someone to connect with who's in that subspecialty. 

Then, think about your needs and how that mentor can support you. This can be anything, from general advice on which rotations you should consider after completing your clerkships, requesting letters of recommendation, or even being invited to participate in ongoing research. 

Okay, once you've identified who could be possible mentors and what you hope to get out of the relationship with your mentor, your next step is to approach the person and ask them. If they say yes, see if you can arrange a meeting and go from there. 

Tip: Before you meet with your mentor, put together a Curriculum Vitae and a small personal statement that describes why you're choosing this field, then send these to your mentor. This will give them insight into your background and experiences.

Additional advice on finding a mentor: 

• How to Find the Right Mentor for Your Healthcare Career

Scholarly Projects: Research, Quality Improvement, Advocacy, Education

Tip: Your Scholarly Project is also a great chance to get creative and connect with a mentor. Having a mutual interest, like a project, often opens the door for further conversations. 

More helpful resources on the path to residency:

• The Osmosis Ultimate Guide to the NRMP Match
• Tips On Finding the Right Residency Program for You
• How to Prepare Your Residency Applications

Some Resources to Help You Thrive

Medicine is increasingly less about knowing an enormous number of facts and more about knowing where to find answers. To help you, here are some pediatric-specific resources that can let you shine on your rotations: 

• The American Academy of Pediatrics 
• A general introductory note 
• Pediatrics-in-Review 
• The American Academy of Family Physicians
• Educational search platforms, like ClinicalKey AI
• Question banks, like Osmosis
• Tried and true textbooks
• Red Book
• Harriet Lane

About the Author

Katie Schultz, MD, MEd, FAAP, Osmosis Pediatric Clinical Content Editor, is trained as both a general pediatrician and pediatric rheumatologist and believes in patient-centered holistic care. Dr. Schultz has long held a passion for health professions education, beginning in medical school, where they co-created and taught a course to medical students about caring for patients with disabilities and extending into their graduate training with health professions education research. They have been awarded multiple national and regional grants to support their research. They also obtained a Master's Degree in Medical Education (MEd) and plan to start a PhD in health professions education. When they're not working, Dr. Schultz loves playing board games, watching movies while crocheting, drawing on their iPad, and spending time outside with their wife and two dogs.

References & Resources

• https://bilitool.org/ 
• https://www.aap.org/en/practice-management/bright-futures/bright-futures-materials-and-tools/bright-futures-guidelines-and-pocket-guide/ 
• https://www.aap.org/en/ 
• https://www.aap.org/en/career-resources/medical-students/surviving-pediatric-clerkship/ 
• https://publications.aap.org/pediatricsinreview 
• https://www.aafp.org/home.html