We normally come to paeds after a year or two of clinical medicine, once we have learned the basics of being on the wards: your ID badge gets you 10% off in the canteen (and even more at Nando’s); no healthcare professional has ever turned down a biscuit (despite the compulsory wisecracks about T2DM); and the medical student’s most important task is being the tech-savvy millennial (who knows how to turn the COW on and off again).
But there is something about paediatrics that intimidates even the most confident of card-flashers, biscuit-buyers and computer-fixers. Children get sick quickly, dramatically, and in different ways to adults. From Kawasaki to intussusception, there’s a whole range of pathology that you’re unlikely to have encountered before.
Luckily, paeds happens to be one of the most fun, welcoming, and student-friendly places in the hospital. I’d like to think that, over the course of my paeds placement, I went from quaking wreck to vaguely competent clean wee catcher, stealth stethoscope user, and Peppa Pig conversationalist.
A few tips before starting would definitely have made that journey smoother though (and less effluent-filled, had I followed tip #10). So I spoke to seniors, juniors, and other students to get their perspectives on what makes a student’s paeds placement a truly enjoyable and memorable part of med school:
- Be friendly. Now, this should go for any placement, obviously. But the truly dreamy thing in paeds is that your seniors are likely to be friendly in return. Paeds was my first placement where not only did the consultants learn our names (no “medical student three” here!) but one of them actually gave me a nickname. Considering that not even my mum bothers shortening my four-letter name, that took being friendly to another level.
- Know your normal parameters for paediatric vital signs. Even better, print them off and keep them in your ID badge holder. It’s hard not to gulp the first time you see a resp rate of 48. Before you hare off for senior support though, think: if the patient is two months old, that’s probably OK.
- Listen to the parents. If they say the poo they have a picture of on their phone isn’t normal for their child, it isn’t.
- Look up Paediatric BLS before you start. I honestly had no idea that paediatric BLS would be any different to adult, but it makes sense. Knowing how it’s different is important for obvious, life-saving kind of reasons; knowing why it’s different is a useful way in to thinking about differences between adult and child physiology and pathology (e.g. propensity to respiratory vs. cardiac arrest). Which brings us to…
- Remember that children are not just mini-adults. The DDx you have off pat for change in bowel habit in a 70-year-old is probably not going to be that useful for the two-year-old whose dad brought in the picture of their poo in #3 above.
- … except for when they are. On the other hand, we all belong to the same species. A smile goes a long way, nobody likes being stuck in hospital, and a lot of the differences between paediatric and adult medicine are about tweaking what you know already, not learning a whole new discipline.
- Be flexible. Some of the best learning opportunities in paeds happen in the evenings. When you don’t have commitments to childcare, family, or social life, try and stick around for an hour or two a couple of nights a week – I got much more out of going to the library after lunch and then heading to A&E later on when there were plenty of patients, rather than sitting in the doctor’s office clock-watching until five.
- Don’t underestimate how much most kids love bubbles, stickers, and iPads. Never feel guilty deploying these in any combination.
- Get involved. That doesn’t mean cannulating a neonate on the first day of placement, but things like palpating a baby’s fontanelles look terrifying (what if you poke a hole straight into their brain) but become much, much easier with a bit of well-supervised practice.
- Learn how to change a nappy. See above re. effluence.
Ella Hubbard is a 4rd year medical student at St George’s, University of London