Specialty Search: Pediatrics

Well...THIS IS IT! I finally know what I'm going to do with my life! :)

Coming into medical school, pediatrics was what I 100% wanted to do. Even before medical school, I thought that I "knew" that I needed to work with kids. Before I decided on medicine, I thought that maybe I would be a kindergarten teacher, than a high school science teacher, than a pediatric audiologist...Basically, I knew I needed to work with kids. However, once I got to med school, things changed. I realized 1) liking children wasn't enough to make you like the field of pediatrics, and 2) there were so many fields of medicine that I found fascinating. Specifically, the second I realized how much I loved OB/GYN and how much I enjoyed the 80+ y/o population on my internal medicine rotation, I started questioning everything about what I wanted to do with my life. So, once I FINALLY got to my fifth rotation, I couldn't wait to start the rotation that I knew would ultimately decide my future.

If you have been reading my past blogs (OB/GYN and Family Medicine), you might know that this rotation was really the deciding factor. If I absolutely loved Pediatrics, like I hoped I would, then that would be it. If I hated it, than I would do OB/GYN. If I liked Peds the same amount as OB/GYN, I would consider doing family medicine, as this would give me a little exposure to both fields, along with my beloved 80+ year-old crew. Even though I really don't love adult patients, especially the cirrhotic/heart failure/copd/anxiety/depression/substance abuse male population, I thought maybe the ob, gyn, and peds would make up for it. So, you can see how crucial this rotation was for my life decision making process.

The rotation is basically split in 2: 4 weeks outpatient, 4 weeks in-patient. Further, one week of inpatient is newborn nursery and one week of outpatient is "speciality week." I had a less than ideal schedule, because I started with specialty week and ended with the busiest shift (in patient floor), but what can you do?

Week 1: Specialty Week. Since my first day of the clerkship was orientation, I got 4 days in Specialty week. I was able to rotate through Peds Hematrology/Oncology (which I loved), Peds Orthopedic Surgery, Allergy/Immunology, and Peds Emergency Medicine (which I also loved). Overall, I enjoyed the week, but it was a little weird to start with specialities, as I had yet to actually examine a normal healthy child.

Week 2-4: Out-patient pediatrics. Starting this rotation, I thought the part that I would hate about pediatrics would be well-child visits. From my other colleagues, I have heard that the first few were fun, but they got old fast...well, i couldn't disagree more! I loved everything about out-patient pediatrics. I love that your day is split so that (roughly) half your patients are well-visit check ups and half are sick visits. I loved having a conversation with the parents and the children about what was happening in their lives. I loved how excited new parents were bringing their 4 day old child in to the doctor. I loved counseling parents and children about anticipatory guidance and health maintenance. At this point, I became pretty confident that pediatrics would be my chosen field, but I was not ready to commit until I had a little in patient exposure.

Week 5: Newborn Nursery. THE BEST WEEK OF MEDICAL SCHOOL! Seriously. How can anyone rotate through the newborn nursery and NOT want to do pediatrics? Your day is basically split into three. First, you go in, round on your babies - meaning, you go to the parent's room, ask them how the night was, look at some nursing notes to make sure there we no problems, and do newborn exams all morning. Have I convinced you that its awesome yet? No? Ok, let me keep going. The second part of the day is rushing over to L&D for any high risk deliveries. So, you get to still be involved with both vaginal and cesarian deliveries, but once the delivery occurs, you get handed the baby and provide whatever care the only-seconds-old infant needs. Its. so. fun. Have I convinced you yet? No? Ok how about this... the third part of the day is all procedural. Between Circumcisions and Frenulectomies, the number of mini-surgical procedures you do makes the day go by crazy fast. Finally, guess what happens when there is downtime? You go to the nursery, pick up a baby, sit in a rocking chair and cuddle/feed the babies. Yup, pretty awesome. It truly was the perfect combination of fun newborn exams, patient education (with family discharge planning), obstetrics exposure, and procedures. I LOVED IT ALL.

Week 6-8: In-patient pediatrics (1 week night, 2 weeks days).  I really really liked these weeks too! Pediatrics is a really awesome field because you do get to apply the medicine that you learn in the first two years of medical school. I felt like many times when I was on Surgery or OB/GYN, I ignored so much of what I learned in school, because they are surgical specialities and not "medicine" specialties. Even though Pediatrics is still a specialty, the parts of medicine that aren't focused on as much (copd, heart failure, cirrhosis) just happen to be the things in medicine that I don't particularly enjoy anyways. Further, the variety of the patients we saw was quite impressive. From the 6 weaker who was admitted for Failure to Thrive, to the 6 year old with Cardiofasciocutaneous Syndrome, to the 17 year old sickler, to the 4 year old with HSP, the variety of patients we worked with was enough to keep me intrigued and interested, while being able to avoid the adult diagnoses that I don't really care about. Also, although pediatrics is known to be a field with fewer procedures, there was still a good number of caths and LPs that would satisfy some desire in me for procedures, if i do end up choosing the hospital as my chosen area in pedatrics.

So, thats it folks! I am pretty dang excited to finally have a future! Although I have NO clue if i want to do general pediatrics or subspecialize or if i want to work in outpatient or inpatient, at least I know which field i am (hopefully) headed for residency! So, if all goes well, in 1 year, I will be Dr. Van Stavern, MD, Pediatric resident! Cross your fingers!

Pediatrics Research Day

Last Wednesday, my research group had the opportunity to do a poster presentation at the 13th annual Pediatrics Research Day at the Breslin Center in East Lansing, MI. It was a great day, filled with speakers from the NIH, Rainbow Babies Children's Hospital, the University of Iowa and Children's Hospital of Detroit. We had talks on Pediatric Academics in the 21st century, Cardioprotection mechanisms for pediatric cancer treatments, and genetic approaches to restoring CFTR function. We also had 6 wonderful oral presentations by Pediatric residents, an undergraduate researcher, and a veternarian. These oral presentations were fantastic; I especially was intrigued by one resident's work with Serotonin-knock out rats that involved surgical manipulation of the ileum to apply acetic acid and observe wound healing mechanisms with the serotonin knock out v. wild type rats - fascinating! Lastly, there were 62 posters presented at the conference. It was inspiring to be around so many people interested in Pediatrics and conducting new and exciting research to better the field. 

Our project was a collaboration of six students and our research mentor, Dr. Gold. The project is relatively new, as we have only been collecting data for about 8 weeks, but we thought it was still interesting and important enough to make a poster and get our data out there. It was great to talk about our research to attendings, residents and other students and getting feedback about how our next steps should fall with the project. Ultimately, we left with a good idea of where to go and finished the day feeling optimistic about our project's design and future. 

The last portion of the day was the closing remarks and awards ceremony. They would be giving out 1 award for the best oral presentation and five awards for the top poster presentations. They started with oral presentation, awarding the top prize to a deserving resident. Moving on to the posters, they began calling the top 5 names - First was a resident, Second was a a resident, Third was a resident, Fourth was a resident, Fifth....was us! Our group poster had won an award of distinction! It was such an honor, especially with our research having very preliminary data and especially because we were the only students that were recognized with this award. What a great day!

Specialty Search: Family Medicine

CLERKSHIP #4 = FAMILY MEDICINE 

I had mixed feelings going into this rotation. On one hand, it is known as one of the two rotations (along with Psych) that have SUPER awesome hours. Clinics would be 8:00-5:00 M-F, with the occasional 7:30-5:30 thrown in there. There was also only two half-day weekend shifts! So, I knew life would be good! On the other hand, I had done VERY little out-patient work at this point, so I was a little nervous about what to expect.

Our first two days of the clerkship were school records - SNOW DAYS! MSU is notorious for not every calling snow days, but this year we had two snow days in a row. (Thanks, Polar Vortex!) So, while it was incredibly fabulous to have two full unexpected days off, I was definitely ready to get back to the grind by Wednesday.

When Wednesday arrived, we got our schedules and assigned clinics. I would be spending about 1/3 of my time on campus at the "clinical center" where most of the docs we worked with during our pre-clinical education practiced. This was awesome for two reasons - 1) it was literally 3 minutes driving distance from my apartment and 2) the faculty were very used to working with students. I would be also be spending 1/3 of my time in a community clinic in Lansing with a doc who I heard great things about from our coordinator. Lastly, I'd spend 1/3 of my time in the Family Medicine Residency Clinic in Mason, MI. This clinic was about a 20 min driving distance (which was kind of a bummer), but there would be only 2-3 residents at a time with me being the only student. This meant I would get pulled in to all of the cool procedures and all of the cool cases. So, overall I was pretty stoked about all of my placements.

The rotation was a great one. In just 8 weeks, I felt like I learned A TON. Family Medicine requires you to know bits and pieces of all medical specialities - from pediatrics, to geriatrics, to ob/gyn, to orthopedics, to psychiatry. Although it felt like a steep learning curve at times, every doctor I worked with was phenominal. There were also a lot of extra workshops to be a part of during the clerkship - muskuloskeletal exams, suturing/dermatology clinics, and casting workshops - which were all very fun and educational!

I broke both my wrists :( 

...JUST KIDDING!

When the rotation began wrapping to a close, I realized how much I did enjoy it. I never really thought about being a family doctor, but I could totally see the appeal. 

PROS: GREAT hours, diverse patients, diverse disease processes, and continuity of care. Family doctors are literally the happiest people I have ever met in medicine. They get to see patients from birth until adulthood (if you are practicing long enough). You can tailor your practice to your specific interests. The need for family doctors is everywhere! There are 48 family medicine residency programs in california (yes, i looked this up!). I would be able to do Peds/OB work. Lastly, I actually really did like the out-patient setting, which was a definite surprise to me!

CONS: I really really don't like adult medicine...(is that bad to admit?). Also, anytime you get a patient that is complex (meaning...really cool), many docs that I worked with feel like they should refer. Lastly, I felt like a lot of the time docs were just acting as travel agents, coordinating patient care. In several situations, patients would come in to discuss many health conditions with their PCP, but all of these health conditions were managed by specialists around the city. 

So, as you can see - the pros WAY outway the cons, but there is still something missing for me with family medicine. So, while I haven't totally decided against family med, I think OB/GYN or Pediatrics is still higher in the running for my future specialty choice...but only time will tell! 

Specialty Search: General Surgery

The months of September and October were definitely a challenge. With the start of my 2 month long surgery clerkship, I knew that I was in for a long period of little sleep, high expectations and little sympathy for my complaints. Although I knew it would be difficult, I had absolutely no idea how to prepare myself. Even though S is a surgeon and he gave me as many pointers as he could, there isn't much you can do to learn the etiquette of an OR without just sucking it up and living through the trial and error.

The first week of the clerkship was kind of a joke. It consisted of lectures, suture clinics and IV drawing workshops. The hours were super easy and I loved every minute of it!

Too bad the easiness didn't last...

The next two weeks, I was on Trauma surgery; one week on days and one week on nights. These weeks were pretty good. The mornings consisted of rounding, upon rounding, upon rounding. Around 1PM everyday, the other med student and I would sneak away from even more rounding to go hang out in the ER and wait for trauma activations to roll in. There were a lot of MVCs, some GSWs, and a few burns/explosions. Overall, it was pretty cool! My week of nights was really awesome; when you are on nights, your team is responsible for everything surgical that goes on in the hospital. So, we covered all the traumas, all the pre-op and post-op surgical patients and anyone coming in with emergency surgical problems that needed to be operated on over night. So, we stayed busy and had a decent amount of responsibility, which is good enough for a medical student. Overall, I enjoyed my time on trauma service, but was ready to really get into an operating room and get my sterilized and double-glove-protected hands dirty with surgeries.

For the next 5 weeks, I spent my time alternating between the general surgery service and the "specialty" services that included plastic surgery, pediatric surgery, orthopedic surgery, colorectal surgery and many more! The first few days were awesome...the surgeries were cool, the gave us a decent amount of responsibility, and the majority of people were welcoming to students, which was a happy surprise on this rotation.

The rest of the rotation can be summarized in the good v. bad.

THE GOOD:
Overall, the cases were very cool. I really really liked the OR. I liked having patients that would come in with problems that you could take into a room, cut it out, sew them back together and occassionally fix the problem. It was a big change from Internal Medicine, in which a lot of the cases I just felt like we were playing a waiting game, without actually helping the patients. So, in that sense, I really did enjoy surgery. I also liked that during surgery, medical students have a job. It might just be cutting sutures, or retracting, or occasionally closing the skin...but we were able to use our hands and be apart of the action.

THE BAD:
While I did enjoy a lot of the rotation, there were definitely a lot of negatives. First, and most obvious, were the horrible terrible ridiculous hours. On a good day, we could show up at 6 AM and would be released by 6PM. However, Wednesdays and Thursdays we would have morning didactics, so we would have to be there and start work at 5 AM. What made this even worse, is that every few days, we were on call until 9PM-ish. I was a lucky student that happened to have a lot of Wednesday night calls. So, I would wake up at 3:45 AM, start work at 5 AM, stay until 9PM, get home at 9:30ish, and would have between 9:30PM-3:45AM to get everything I needed to do taken care of, eat and sleep. Yeah. It sucked. I knew that I could survive that short term, but man oh man I could never be a surgery resident that lived that every day. The second thing I didn't really like was everyone's attitude. Even though the residents and attendings were (mostly) all nice, you could just tell they were angry. It has nothing to do with the individual people...its just the culture of surgery that makes you that way. I know that it doesn't have to be that way and that there are many surgeons that this is not true for...but compared to Internal Medicine, there sure seemed to have a larger proportion of angry surgeons than IM docs. Finally, I didn't love the lack of continuity of care. Yeah, sure...there was some. There were patients that came to the service A LOT...like, several times in the two months that we were there. Also, doctors will see clinic patients, operate on them, and see them again for follow-up...BUT, it just wasn't the same. The care, for a majority of patients, seemed fragmented...and I didn't love that.

So, overall....I did enjoy the rotation. I'm 99.9% sure General Surgery is NOT my chosen field...but it was still a good experience. I learned a decent amount..and hey, you have to go through a lot of specialities to cross things off before you can figure out what you're calling is! Right?

Thats all for now!

Step 1

Tomorrow. 06/14/2013 at 8 AM,  I will walk into the Pro-metric Testing Center in East Lansing, Michigan to take the 8-hour long USMLE Step 1 exam. I can't believe its finally here and that tomorrow I am actually going to take the exam that I have spent the last 2 years preparing for.

For these last 4.5 weeks of my intensive study period, I have spent approximately 12-14 hours a day slaving away trying to learn as much as I possible can. I have done more than 5,100 practice questions.  I have read over 1,000 pages of review books and watched/listened to over 40 hours of review lectures.  And in just a short 24 hours, it will all be over. All of time time and preparation I have put in will be put to the test.

I am so nervous, but also feel (hopefully) well-prepared. Now, all thats left is to just sit back, relax, calm my nerves and mentally prepare for the long long day that is ahead of me. Wish me luck!

Animal Procedures Lab

Two weeks ago, I got the opportunity to participate in a really unique learning experience! Every 6 months, the Emergency Medicine residency program at Sparrow Hospital puts on a workshop for their residents to practice some skills that are rare in the emergency room. These procedures are done on anesthetized pigs and include Chest Tube Thoracotomies, Transvenous Pacemaker Insertions, Surgical Cricothryotomies, and Resuscitative Thoracotomies. For these workshops, 8 medical students are invited to come and participate. Because its such a small number of spots for the 200 first and second year medical students at CHM, the opportunity to sign up for a spot goes QUICK...as in, as fast as the Spice Girl's Reunion tour tickets selling out...as in seconds after the email goes out! So, although I really wanted to go, I knew that the chance would be slim. Miraculously, I got one of the 8 spots available during this semester! And...

IT. WAS. AWESOME.

Seriously. Such an amazing experience. For any CHMers that read my blog, you MUST try to go to the next workshop. It was really amazing working 1-on-1 with residents and learning how to conduct these procedures first hand. From lots and lots of suturing practice, to holding a live-beating heart in my hand, to putting my first chest tube in (and having my glove rip while my bare finger was inside the pig's thoracic cavity), it was truly an experience I will never forget!

Suture Clinic

Last week, I went to a skills lab offered by the Emergency Medicine Interest Group to learn how to suture! Even though I don't really think I will be going in to Emergency Medicine, every doctor needs to know how to suture... So, I was really excited to learn this skill.

We worked 3:1 (3 students:1 emergency medicine resident) on our suturing skills and learned several different types of knots. These sutures included a simple knot, a two-layer suture, a horizontal mattress, a vertical mattress, and a running stitch!

My first suture: Simple Stitch

Horizontal Matress and Vertical Mattress

2-layer suture (used dissolvable layer underneath)

Running Suture

I had a really great time and learned a lot...Suturing was definitely not as hard as I thought it would be, but I guess thats because I was suturing on a pig's foot and not a little kid thats moving around while I'm trying to sew...

Intubation Clinic

With the crazyness of my final week/start of spring break, I almost forgot to write about a really awesome Intubation Clinic that the CHM Emergency Medicine Interest Group put on. They invited one of the Emergency docs and about 10 of the Emergency Med residents to come teach a group of 30 of us how to do proper airway management/intubation. The clinic took about 2 hours and was split up into two parts. First, we were taught how to use proper airway adjuncts (Oropharynx Airways and Nasopharynx Airways). We were also taught how to use a BVM (Bag-Valve-Mask) to provide ventilations. Working as a CPR instructor for the last year, I can use a BVM with my eyes closed. Also, in my EMT class, we learned how to do oropharynx and nasopharynx airway adjuncts. So, this portion of the clinic was fun, but not something I hadn't learned yet.

Using an oropharynx airway adjunct

The second part of the clinic was much much cooler! We finally learned how to intubate! Let me tell you, intubation is MUCH harder than you would think. You start out by putting this massive metal light in a tiny little mouth; you have to use crazy arm strength to pry up the mouth, without cranking on the teeth; Finally, you have to make sure that you can crank back the mouth so much that you can slide a tube in the trachea, not the esophagus. It was quite hard at first. I intubated 5 times. My first and second attempts where big fat fails. After "breaking teeth" (aka hearing the mouth click to tell you that you are breaking teeth), I got the tube in, started ventilating and..........the stomach inflated. I intubated the esophagus, not the trachea....wrong. Then, on my third try, I finally saw the tracheal opening and count get the tube into the trachea! Success! It was so exciting.

Bobby intubating...I didn't get a picture of myself. 

It was such a great clinic! It was really fun to learn this skill and also really fun to work so closely with residents. It made me so excited for third year rotations and to learn actual skills that I will be using as a real physician! 

Endocrinology Shadowing

I havent blogged in a few weeks because of my crazy crazy exam schedule. I knew this semester had a lot more exams than last, but its kind of amazing how much material we have already learned and been tested on this far. In fact, I have my first final of the semester, in immunology, this Friday!

Like I mentioned in Fall v. Spring, one of the neat things about the Spring semester is that we get way more clinical experiences. One of these required clinical experiences is shadowing our faculty mentors in either their clinic or in a hospital. My faculty mentor, an endocrinologist, is actually gone for a few months to do research in Florida, so I shadowed one of this partners in his endocrinology clinic. Although I shadowed physicians as an undergrad (as everyone hoping to enter medical school does), I was nervous to see if the expectations and experience would be different now that I'm no longer "pre"-med, but instead a real med student. Well, I definitely was right to fear there would be different expectations....

After first meeting my physician that I was shadowing, I was immediately handed a CBC. Although we "practiced" reading CBCs in biochemistry, when you are handed your first one and asked "whats wrong with this patient", it is much much different. Luckily, my normal guess of "anemia" proved to be correct (point 1 for Kailyne)! After talking about our first patient, we went in the room to see our first patient. After talking with her and examining her, the physician told me to listen to her heart and lung sounds and to tell him 2 things that I find that are abnormal. Well, considering the fact that I am just now learning heart and lung sounds (2 weeks after I shadowed), I had no clue of what to do. My patient was very nice and told me that I should be looking for a murmur, but of course, I still don't really know what that sounds like (negative one point for Kailyne). After this, the next four hours seemed to go up and down like this. I would correctly guess that a patients medicine was causing hyperprolectemia, and then fail at describing Graves Disease (something else I learned just 2 days after this shadowing experience). So, I know that I am not expected to know everything, but every time I would get excited that I knew something, seconds later I would be reminded that I really don't know much...Oh well, I guess I am going to have to get used to it because of the nature of my future career!

In the end, I am really happy that I got this shadowing experience to begin to prepare myself for what I will expect in 3rd year rotations. I realize I will no longer be able to hide in a classroom answering multiple choice questions when I am one-on-one with a physician/resident and in patient rooms. I know I still have more than a year before I will have to face this reality, but I definetely want to get more shadowing experiences under my belt before I have to go in as as a third year, who is really supposed to know what the heck they are doing! *Gulp*

Friendship Clinic

This morning, I volunteered with The "Friendship Clinic." This is a student-run clinic for underserved groups in the Lansing area. Most of the patients that are seen have either Medicare, Medicaid, Ingham County Health Care, or are uninsured. The clinic also receives a large homeless population. I have been thinking about volunteering for a while and was excited to get going!

I arrived to the clinic at 7:30 AM. I was given a tour of the clinic, which was actually a lot nicer than I had imaged it to be! We then began seeing patients. I was given the option of seeing a patient alone (which I was totally not ready for) or seeing a patient with a second year student. I obviously opted for the latter. So, a second year medical student and I went in to see my patient. We helped her complete all of the necessary forms, took a full medical history and family history and gave the patient a full physical. [First time I have ever heard bowel sounds...cool!] After seeing the patient, we went to present to a physician. The physician was fabulous! He not only had a great passion  for his job as a doctor, but also really wanted us students to learn. I had never presented to a physician before, so after the second year and I stumbled through it, he went through exactly how it should sound. He then had us bring in some lab work forms and scripts. I was expecting him to fill them out and give them back to see our patient, but to my surprise, he had us write them! Thats right, I wrote my first script today! It was pretty awesome! Definitely felt like a real doctor for a second! After the patient left, we completed all of the paperwork...which is a lot. I also wrote my first SOAP note, which is a document that includes: Subjective info (what the patient describes, old lab tests, etc), Objective info (things you find in a physical exam), Assessment (what diagnoses we have come up with) and Plan (what treatments and referrals we have given the patient). I know it sounds silly that I was excited about paperwork--scrips and soap notes--and that when I get farther along in this career path, I will dread doing it, but for now I am excited about doing all of these little aspects of a doctor's job.

It really was a great morning! I had such a positive experience with the Friendship Clinic and definitely will be back in the future! :)

White Coat Ceremony!

My White Coat Ceremony was at 3:00 PM on Sunday, August 28th. I was expecting the ceremony to be nice, but it really was so great! The faculty's speeches really did make me feel like I have accomplished something big and it was such a great end to orientation week and a great beginning to the first week of classes. Our Dean, Masha Rappley, who I have already mentioned that I love, gave me another reason to love her. Her speech was amazing! She came up without wearing her white coat (she was the only one not wearing it) and in the middle she asked one of her other faculty members to coat her so that she could join us on this day. So, it wasn't that we were getting White-Coated by the faculty, but it really was like we were joining them. This is such a different concept from how undergrad was, because we were clearly not looked at equally to faculty, but in medical school you are considered a professional and on the same level as all of the physicians and faculty that work at the school. What a great realization that was!

Anyways, here are some pictures!