ExamGuru Blog

“Get one of The Big 6 out of the way first.”

That was what my mentor told me when I asked him for advice on how to plan my third year schedule. “The Big 6” stands for the clerkships that are notoriously difficult and add the most weight to your class rank: Internal Medicine, Surgery, Psychiatry, OB/Gyn, Family Medicine, Pediatrics.

“You want to match in a surgical subspecialty? You need A’s in that selective, internal medicine, and surgery. Try to get surgery or OB/Gyn before your selective so you can get in the OR beforehand.”

That bit was from the president of the student interest group of said subspecialty when I asked for her help. Nearly everyone you talk to in medical school for advice has good intentions. In fact, you will be bombarded with advice. The hardest part is picking out which advice is going to work for you. This is a pretty universal truth, but goes double for Step and Shelf studying! Armed with my many resources, I decided what rotation I would choose first. My idea was to do Internal Medicine, thinking I would still have all this knowledge from Step 1 studying (I didn’t). However, all the schedules starting with Internal filled up pretty fast… In the end, I decided to start on Pediatrics.

I’ll be honest- kids aren’t really my thing. That said, I had a lot of fun on this rotation and think it’s a good starting point for third years. Everyone is nice to work with, eager to teach, and kids bounce back from illness pretty well. Plus they’re hysterical. The downside? That shelf exam is brutal. Your Step 1 knowledge is primarily for adult medicine and there are all these calculations that seem incredibly bizarre: pediatric medicine is dosed in mg/kg, calculating fluid balances with 50, 20, 10 rules or 4, 2, 1 rules, figuring out what the heck UOP means, caloric conversions of breast milk and formula… It can be overwhelming while you adjust to this strange world of kid medicine and math. This is also a good rotation to learn how to write SOAP notes, because in pediatrics the H&P can be extremely extensive. You’re getting the history of present illness, past medical history, vaccine history, family history, pregnancy and labor history of the mom, developmental milestones, social history… you’ll learn how to ask the right questions to get the answers you need pretty quickly and how to filter what is important for your notes from what isn’t. In my experience, the attendings are also very good at telling you what they are looking for in your patient presentations and at giving feedback. Really, pediatricians are just nice. They have to be. Can you imagine how much patience someone must have for dealing with fussy kids and scared parents all the time? These doctors are saints.

For the record, never tell a pediatrician that kids are just tiny adults. Never. They will stop being saints.

So let’s talk about this shelf exam. I felt horribly underprepared. There is one downside to starting with peds- it’s summer. That means the census might be low, which is an overall good thing for your patient population but not so great for your learning purposes. You won’t see as many different things as you would in the fall when kids are in school together and getting each other sick. So I’d highly recommend using a supplementary book for this rotation. I used Case Files, but it’s nearly 5 weeks later, and I still don’t know my grade for this rotation so I can’t really speak on its effectiveness. Others I know used pretest and first aid. I will say I was incredibly surprised about how little I felt I knew, because I had used U-World to prepare as well. For those of you who might not know (probably very few of you), U-World is typically considered the go-to qbank for USMLE and Shelf studying… and I feel like it failed me for the pediatric exam. At this time, I didn’t know about ExamGuru so I can’t make a comparison for you. I’m excited to give you comparisons in the future, though!

So here are some important things to know well to look like a rock star on your pediatric rotation:

• How to calculate Ins and Outs. This isn’t nearly as important in adult medicine, but kids need very specific fluid needs. Your attending will ask you about fluid balance. Just expect it.
• Rashes. All the pediatric rashes you learned for Step 1 are also pretty high-yield in the actual clerkship. This was a nice surprise. Who knew Kawasaki disease knowledge was actually something you would use??
• Sepsis workup. More often than not, you’ll have a kid on your service that needs to have bacterial meningitis ruled out. This requires a full sepsis workup, often abbreviated as “SWU.” Blood culture, urine culture, CSF studies and culture… it’s the norm.
• Developmental milestones. Did anyone actually memorize this for Step 1? I sure didn’t. But they’re pretty important here, and there will be multiple questions on your shelf about them.
• Pediatric tumors/cancers. I got to do a week on the pediatric Heme/Onc team and would highly recommend it. The patients and families are great to work with, and you will learn a lot of things that are important for the shelf exam. Remember- Wilm’s tumor is found by someone giving the kid a bath. Always.
• Vaccination schedule. They’re baaa-aaaack! Live? Inactivated? Which month is it given? How many? Which ones are given at birth? So high yield.
• Endocrine disorders. This constituted a surprising portion of my shelf exam. Again, I got lucky with what rotation I was put on for a week and did outpatient endocrinology (which was super interesting!). Precocious puberty and short stature are must-knows. And of course the trisomies will haunt your testing life into eternity.

That’s it from me for pediatrics! I hope this helps you succeed on your medical school journey, and I’ll be back throughout the year to keep you updated on mine!

Author: Dehra McGuire – MS3 at The University of Oklahoma College of Medicine

We have organized a special discount code (PEDS10) for Dehra’s followers to receive 10% off of any subscription, including the already discounted package of six shelf exams during October 2016.