For my fourth rotation, I had the pleasure of being in Pediatrics at Queens Hospital Center (QHC). It was my first experience working with children in a healthcare setting; it was great working with the kids and their parents. There were many new things I learned while on this rotation both about myself as a student and the pediatric population. While it was a great learning experience, my time in pediatrics was not without its challenges. 

First, there is a true art to performing physical exams on children, especially really young ones. Little kids become very nervous and apprehensive when they come to the doctor’s office. Sometimes their fear can be attributed to a prior experience with vaccinations, however, in general it can be scary going to the doctor’s office. In the beginning I found myself having a difficult time trying to perform adequate physical exams on patients because they wouldn’t stay still, or they would cry the entire time and fight me during the exam. History and physical exams are the bread and butter of medicine, so not being able to conduct a thorough exam put me at a disadvantage when presenting to preceptors. However, after being in the pediatrics ER for some time, I learned different tips and tricks from various providers on how to get children to stay still for exams. One thing I learned was listening to kids’ lungs while they are quiet and comfortable in their parent’s arms; when kids cry it’s hard to get a good listen to their lungs, so this was the best way to do it. Another trick I learned to get a good look into the pharynx was to lay the child down on the exam table and hold their arms above their head to lock the head in place, so they don’t move their head around. While I still struggle with performing the physical exams, I now have the tools to apply in the future as I get more practice and experience.

During this rotation I also had the opportunity to spend some time in the NICU where I was able to be present for multiple vaginal and C-section births. I was very excited to be present in the OR for c-sections and I got to be in one on my very first day. While in the OR I witnessed the preparation that goes into receiving a newborn. I also learned how to do a newborn assessment. One interesting thing I found out that I hadn’t known about before was that you calculate the APGAR score at 1 and 5 minutes. I knew that an APGAR score was calculated, but I was confused when the PA I was with said “9 and 9.” I then realized that the 2 numbers represented the score at 1 and 5 minutes. It was fascinating to watch how much the baby changed in just 5 or 10 minutes and then an hour later after delivery. It was rare for a baby to have a perfect score of 10; most babies scored a 9 for cyanosis of the hands and feet at 1 minute. While I am still not sure if I want to work in pediatrics, I can still use this knowledge during my OB/GYN rotation. I am sure I will be able to use this knowledge in a limited capacity since the patient will really be the mothers, but it will help me know what’s going on in a delivery room if someone were to discuss the APGAR scores. 

As a student on this rotation, I’ve realized that practice and patience are really the key to being a good provider. It can be frustrating because your patient is not just the child but the parent as well because, depending on the age, the child may not be able to advocate for themselves; therefore, you must be able to provide reassurance to parents as well. Even though you can rely on parents to explain what’s going on with their child, they cannot accurately depict the pain or symptoms the child is going through, and neither can the child themselves. However, you must do the best you can with the information you are given to provide adequate care, and sometimes that means going the extra mile to discover additional information. Another thing I’ve realized about myself as a student and future provider is that going the extra mile for patients is what sets you apart and makes you a good provider. During my rotation, I was able to use my ability to speak fluent Spanish to communicate with my patients so that they receive the best possible care, and it was probably my favorite part of the rotation. I was able to properly inform patients about what was going on with their child, as well as the proper care and instructions moving forward. One time I even went as far as helping a newly immigrated family navigate the bus system in NY by showing them how to follow directions on a smart phone. 

All in all, I really enjoyed this rotation. I was able to use my experience as a Latina and my ability to speak Spanish to help patients get the best possible care. My eyes were really open to how big of a Latinx population there is in the area of QHC and how sometimes non-compliance can be attributed to miscommunication due to language barriers. While there are interpreters available, I know from firsthand experience that things are not always interpreted correctly.