I just finished my first week of clinical rotations, and there is so much to report!
The first thing on my mind after such an exciting and full week is… SLEEP. Between jet-lag and excitement, it was impossible to go to bed early, which made waking up at 5:15am pretty painful. My new schedule requires me to be at the hospital 6:30am-5:45pm Monday-Friday, and stay 6:30am-10pm one weekday and one weekend day. That’s a lot of hours at the hospital. It’s still under the 80-hour limit for medical students and residents, but for a rookie who doesn’t quite know my way around yet, it was a LONG week.
Despite being exhausted, I’m thrilled to begin my clinical journey. The doctors and residents are surprisingly kind and friendly, not to mention encouraging teachers. The program is well-organized, so everybody has clear responsibilities. My goals are to get-to-know my assigned patients well; build rapport with the patient, family, nurse and social worker; examine and interview them; write progress notes; and present them at “rounds.” Pediatrics rounds are in the morning from 9-11am when everybody on our ward’s medical team gathers to visit and speak about every patient in our care.
In every teaching hospital there are a lot of doctors and students working on the medical team. The highest member is the “Attending,” then the “Head Resident” (a 3rd-year resident), followed by the “Interns” (1st year residents), and finally the medical students (like me). Residents are new doctors who train for 3-5 years after graduating from medical school to become fully licensed, so all residents are MD’s. Every patient to whom I am assigned is also assigned to an Intern, the Head Resident, AND the Attending (and of course we can’t leave out all the amazing nurses too). This is the system of care in teaching hospital.
Our goal is to work together to provide the best care. Considering there are many brains involved, this type of care is great for detailed learning, especially when patients have complicated conditions. The drawbacks are that the patient might feel overwhelmed by the number of doctors, or frustrated that they have to keep repeating their story to different people. But, patients get more medical attention and often this results in a higher level of care.
I was assigned to two patients this week. This doesn’t sound like much, but it was enough to overwhelm me. At first, I felt totally incompetent. I felt like I’d forgotten so many facts, and was making a lot of mistakes. For example, I confused dermatitis herpetiformis with dermatitis herpeticum. Then during my first presentation at rounds, I announced that my patient had received 7,000 mL (7 Liters, or about 3.5 gallons) of IV fluids during the night. Oops!
But then, I started feeling slightly better by the end of the week. I wrote my first “SOAP” note that was added to my patient’s chart. A “SOAP” note is a progress note written in this order: S=subjective, O=objective, A=assessment, and P=plan. I made my first oral presentations during rounds. I helped complete electronic medical records, and write new orders for my patients. I consulted a cardiologist. Most importantly, I spent time with my patients and their parents, and started feeling more fulfilled by my presence on the ward.
Tomorrow I’m on call 6:30am-10pm, so I better go finish up all the things I have to do… and then get ready for bed, STAT!
Here is a link to my rotation schedule, if you’re curious: Pediatrics Schedule
