Pediatrics

Pediatrics at BMC is run by Dr. Ben Siegel and consists of rotations in the inpatient wards, newborn nursery, and outpatient clinics. All students who are in the CCHERS program are required to do their pediatrics rotation at BMC so that their outpatient work can be done in their respective clinics. Those students who are not in CCHERS rotate throughout the BMC specialty clinics and the Pedi ER. Clinics include lead, hematology, GI, pulmonary, cardiology, growth and neurology clinic. Exposure to these specialties provides a unique opportunity to see specific pediatric pathology, but some students complain of a lack of autonomy and teaching in some of these clinics.

One week is spent in the newborn nursery at BMC. This week provides the opportunity to learn the newborn physical exam and the Dubowitz exam to determine newborn maturity. Expectations from the students vary according to the attending physician. At the least, students are expected to follow one newborn from birth to discharge including an interview of the mother. Students then give a presentation to the attending physician at the end of the week.

The inpatient service consists of conferences and lectures on the wards, starting with 8:00 AM rounds that go on for hours. These are followed by radiology rounds and various conferences throughout the day for medical students. Students work most closely with their interns, but have lectures by the attending physician and Chief resident throughout the week. The inpatient ward day usually ends at 4:00 p.m. with a clinical lecture by various attending physicians. Thursday is unique with a developmental lecture series and a physician development series run by Dr. Siegel that involves an hour discussion by students about their experiences on the wards.

Carney Hospital is a 382 bed private hospital located in Dorchester, operated by the Daughters of Charity of Saint Vincent de Paul. There is a 12 bed pediatric ward, but it is rarely full. Carney is a good choice for students who may not want to go into inpatient Pediatrics as a career because there is a great deal of down time and not enough exposure to many inpatients. The inpatient experience is more limited than at Norwood, Framingham, BMC, or North Shore (based on classmates' reports) but you will still see the bread and butter of pediatrics like asthma, pneumonia, dehydration, etc. There are no residents at Carney so you work one-on-one with the attendings who are very nice. This also means that there is very little scut work and what you are asked to do is for your learning purposes only. The strong point for this site though, is its fantastic outpatient experience. You will be pretty busy in the clinic and most of the attendings are very instructive. Here's how the day goes:

Mornings begin at 8:00 AM and are generally spent on ward rounds from 8:00-9:00 AM, and then writing progress notes on your patients, reviewing x-rays, and formal didactic sessions. The reading packet for these sessions is excellent and yours to keep; if you really want these sessions to happen, I found that you have to ask the attendings.

In the afternoon, you will be assigned to either the outpatient clinic; the ward, where you will pick up any new patient who is admitted; an outside clinic; ENT clinic; or reading time. There is a good amount of reading time at Carney.

Call is Q3 until 9:00 PM, and you will spend your time seeing patients in the outpatient clinic and working up any new admissions. When you are on weekend call (12:00 - 8:00 PM), you will be in the outpatient clinic 2 PM - 5:30.There is also a newborn nursery experience at BMC for one week during the clerkship, which was excellent!

The major disadvantage of this clerkship site is that you will have to return to BMC for ethics seminars, and a few other times. You will find that these trips occur in the later part of the afternoon and interfere with the most productive part of your day. If you are on call, you will then have to return to Carney after the session and miss part of your clinic time in the evening as well.

Parking is in the garage in the rear of the hospital and is $1.50/day. If you stamp your parking ticket in the clinic, it is free assuming the parking attendant is cool.

All in all, it is a very nice experience. It was a pretty relaxing atmosphere with plenty of time to read! Have fun and enjoy it.

This rotation is a very well organized, balanced community-based pediatric medicine experience. In short, it is excellent, and it’s very difficult to find any weaknesses with the program. The only weakness in this rotation is the long 30-45 minute commute each way, depending on rush hour traffic. There are four third year students assigned to this rotation, thus making the overnight call every fourth night, including weekends. Over the six weeks, it can get very tiring, and can make outside studying difficult. However, a lot of the educational experience is during the nights that you’re on-call and admitting patients.

The six weeks are divided into three weeks of inpatient pediatrics and three weeks of special care nursery, and two students are assigned to each. The inpatient pediatrics portion of the rotation includes taking care of a wide variety of patients, depending on the season when you do this rotation. Unfortunately, there weren’t many sickle cell, asthma, or other cases that you would normally see in an inner city hospital such as Boston Medical Center. The special care nursery is a Level II nursery that handles high-risk deliveries of premature infants generally no younger than 33 weeks. I felt that the three-week exposure to neonatal medicine was a very special aspect of the program.

The house staff includes three attending physicians, Drs. Mehta, Moore and Bass. There are generally two senior residents, where one is usually assigned as a teaching resident and the other as the floor resident. They are usually either from the Mass General peds or med-peds program or from the Children’s peds program. In any case, they are very enthusiastic about teaching medical students. There are also four interns who are generally not pediatric residents, but are great resources all around. There are plenty of lectures throughout the week. The bigger topics, which generally help for the oral exam, are given by either a staff physician or by the teaching resident.

The experience also includes several days of rotating through the pediatric emergency room and outpatient clinic. The pedi ER attendings are excellent. They are from Children’s and love to teach. The outpatient clinic will include seeing about 2-3 patients a day, aging anywhere from newborn to 18. You will be given plenty of autonomy in the clinic to see and present patients by yourself, generally working with an attending who will be your preceptor for the afternoon. One day is also spent at a private group practice.

In general, this rotation was an excellent introduction to pediatric medicine and I would highly recommend it to anyone, even if you are not considering a future career in pediatrics.

Jason Ouellette, ‘01

Framingham Union hospital is a great place to do your third year pediatric rotation, whether or not you are interested in pediatrics as a career. The residents and attendings do an outstanding job teaching the students on a daily basis. There are many didactic sessions given by various physicians specifically for the students. The weekly schedule includes a wide variety of clinical experience including inpatient pediatrics and special care nursery, outpatient clinic and emergency room. Students also spend a day each at the head start program and with a private practice physician. The hospital itself has a great community hospital atmosphere and they really make you feel at home. The ancillary services are outstanding leading to minimal scut. Overall, it was an excellent experience.

The pediatrics rotation at FCH is an interesting one, although probably better suited for the student not interested in peds, as it does not represent the typical cross-section of peds. Students do sit down rounds with physicians and a team that includes RNs, physician assistants and a nutritionist. The patients on the wards are typically seriously ill children. The student's time is split-3 weeks on wards and 3 weeks in outpatient clinics. Lectures are mediocre, and unlike at other locations, a presentation is required of all students. Some attendings are generous with their time while others are difficult to find when on the inpatient wards. Another thing to remember is that you will have contact with attendings only because there are no residents or interns. This has its pluses-learning from attendings but on the other hand sometimes it is difficult for attendings to fathom the level of knowledge/understanding of students. Finally, FCH has a reputation of being hard graders.

The Pediatrics rotation at North Shore is phenomenal. You work mainly with MGH Pediatrics residents throughout your 6 weeks, and with some of the attendings when you are in the ER. You rotate through 3 different parts of the hospital - inpatient, ER (like urgent care), and the newborn special care nursery (a stepdown from a level I NICU).

You will see bread and butter pediatrics (asthma, RSV, gastroenteritis, etc) when working on the inpatient wards to a point that you could write for the orders and know the treatments and differential diagnoses in your sleep. You also will see interesting cases fairly commonly. A huge variety of things will walk into the ER and you will become very skilled in doing a child exam.

The special care nursery (SCN) is a great experience. You will see mostly premies. At some point, you observe some of the C-sections and will observe intubation/suctioning of the newborn and assigning of APGARs. The attending, Dr. Aurora, will teach you a new skill every day so that you will run a newborn code by the end of the week. Dr. Aurora will also teach you every day as you go along on different topics within pediatrics. You will also present a topic to the nurses at the end of your week in the SCN.

There are many teaching session done by the attendings at NSCH (at least 2-3 times per week). You will also attend rounds that are teleconferenced from MGH. With all of these teaching sessions and impromptu teachings by the MGH residents, you will be well prepared for the exam.

Call is overnight and brutal. You will be lucky if you get to sleep at night. You spend call nights in the very-busy ER but will occasionally round on the floors and check in on patients during the night depending on your residents. You do not take call on Mondays and Tuesdays because of conferences at BU.

NSCH is located about 40 minutes North of Boston in Salem, MA. Parking is free, but you have to sign up for a sticker. Ignore the parking person when they say that you have to park somewhere far off and take shuttle to the hospital. Just use your on-call decal.

NSCH is an excellent workhorse rotation, but I highly recommend it to everyone, especially if they are interested in pediatrics or interested in improving their overall physical exam skills and formulating differential diagnoses.

Norwood is located 20 miles outside of Boston. This rotation is heavily ER oriented, in fact, one would spend about 90% of one’s time in the pediatric ER. The other 10% involves ambulatory pediatrics at private practices and very minimal inpatient experience.

There are some pros to this rotation. The student clerkship director is overall good-natured and does have the best intentions as far as providing his students with a decent pediatrics experience. The attendings are willing to teach the basics. One will leave that rotation with a fundamental idea of basic pediatric diseases; however, not sufficient to do above a passing grade on the oral or the written exams if one were to rely solely on knowledge garnered through seeing patients in the ER.

The minute a case becomes interesting, the patient is promptly (rightfully so) transported to Children’s. In the same vein, there is certainly a lack of variety in pathology.

Students are expected to be at the ER practically at all times. While some attendings (the younger ones) are well aware of the pressures of third year clerkship examinations and will encourage you to read, other are not so gracious and expects you to be at the ER even if you are seeing your 10th bronchiolitis case.

The attendings at Norwood are a part of a group practice employed by the hospital.