let's start the day as a peds resident

The series continues...

So far I have talked about the workhour limit for residents
Then I explained the call structure in the peds residency program where I trained {most peds residents are similarly structured with a few varieties}

on this post {along with an outfit post... i know!}, I will be talking about a day in the life in the hospital wards. 

day in the life as an intern at the Developmental Pediatrics team

signout is the same for all subspecialties. Rounding times may vary depending on the faculty attending.

7a changeover is BUSY. "when I was a resident," {I just love putting that phrase in quotations! for all those in the medical field, that phrase has some significance and lots of memories. Sorry it's overused, but I will keep using it.} the on call residents and interns meEt with the rest of the team for changeover at the Housestaff lounge. Medical students are also there as they are part of the team. 

Changeover is done efficiently but also thoroughly. It is usually done in 15 minutes, sometimes it can take as long as 25-30 minutes but we try to avoid that as the prerounding should start soon!

Changeover means signing out new admits from the night before and also discussing crosscover issues. Crosscover means what the on-call resident got paged for or did for the other services' patients they were in charge of while the rest of the team went  home. 

7:00A - 7:15A changeover

7:15A - 8:15A prerounding

Prerounding ~ is a quick look at the chart (now EMR = electronic medical record) and then seeing the patients before the whole team rounds. 

our patients were not all in the same floor when I was a peds intern in the Developmental peds team. i had to go to the infant unit on one side of the hospital then go all the way to 4B on the other side of the hospital to see the rest of my patients. 

YSL matelassé WOC
bracelet,  thanks MIL

8:15A-8:45A morning report

We all meet at the conference room for a 30 minute didactic. Usually the on-call team discusses the admits from the night before and we all try to learn something from these cases. 

8:45A-9:00A preround some more, or meet with the medical students to discuss their patients, or write a few notes or grab more coffee (if you're lucky and you have time)

Then rounding starts at 9:00A!

we did bedside family rounds and table rounds in the Developmental peds team. 

We have some special social situations in the  team and some children have a nondisclosure... DCS (Dept of Child services) may be involved or some things are not appropriate to discuss at bedside. Some teaching may be done during table rounds... but we try to limit this to 15 minutes at the most because we still had to see our patients during walk-rounds or bedside rounds. 

9:15A-10:30A (sometimes until 11:15A or 11:30A)
Bedside rounds

we started in the infant unit. 
We saw children with feeding problems, failure to thrive, post-op patients that just received their gastrostomy tube ("G-tube"). We discussed how to start or advance their feeds. We spoke with the parents about the feeding plan and how often oral feeds need to be given...

Besides physicians (attending MD, resident MDs), we have medical students, pharmacist, and social worker who joined us for rounds. 

After the  infant unit, we moved to the other unit where the rest of the children who are mostly with cerebral palsy, congenital brain or body malformations were admitted. These children either came in because of increase in their seizures, respiratory distress due to pneumonia or bronchiolitis, vomiting and not tolerating their G-tube feeds, UTI etc. 

navy dress, thrifted zara
franco sarto wedge pumps, similar
cardi, old

We wrote our orders during rounds using paper orders. But with the introduction of the EMR, we usually walked around with our WOW (workstations on wheels). 

The primary intern presented the patient with overnight events or history of present illness (if it's a new admit), the exam and then pertinent labs and of course the plan. 

The other intern or senior resident would write the orders  using the WOW, start the discharge summary, etc while rounding. 

To not disrupt the flow, if we had to call a consult, we wait until rounds is over. For example if we have to call neurosurgery to see our cerebral palsy child with hydrocephalus and Ventriculoperitoneal shunt (VP shunt) because we are worried that the catheter may be kinked, then we call them after rounds... unless it's something very urgent and needed to be done right then and there at the bedside. 

To review: changeover --> prerounding --> morning report --> table rounds --> bedside rounds...

Stay tuned for the rest of the day of the developmental pediatrics intern. 

Thanks for reading!

Linking up with HollySarahDorandaMorgan, LeanneElizabeth, Elena,  Madeline,  Jaymie,  SydneyDanielleGrace, Brooke.

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1 comment:

  1. So interesting to hear about "a day in the life..."! Love your striped dress and the color of those heels. :)


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