Year 4: Pediatrics Clerkship - Part 5

Books
By now, you would have realized that being a medical student means 10 resource books for 1 topic:

1. Basis of Pediatrics by Pervez Akbar Khan: This book is the mother of all underrated books. All books can be trashed in pediatrics except for this. That Nelson book everyone praises so much? Nothing compared to this book. Granted it isn't updated and you need to study management guidelines from your everyday practice & PBL cases, this sets up your pediatric basics as they should be, not an inverted triangle of basics that topples soon as you start going into details. This is THE go to pediatrics book in this rotation.
2. Nelson's Essentials of Pediatrics: Great for certain topics such as respiratory tract problems and development. Not as comprehensive as everyone makes it seem. 
3. USMLE Step 2 CK by Conrad Fischer: great for revision and summarizing important topics before the finals or during short breaks. By no means exhaustive or comprehensive.
4. First Aid for the USMLE Step 2 CK: more comprehensive than the one above it, but it is merely a book of notes, it does not explain things as you might need to understand them. So, only good for revision or getting an overview of a topic before reading it in depth.

How to study

1. Study every PBL topic before the PBL class and ATTEND every PBL class as they are very important. I can't stress this enough. Don't focus on the unimportant uncommon topics in books. Wanna know the common things? Go to hospitals. Attend PBLs. That is exactly what you will encounter on exams.
2. Practice history-taking and physical examination because they are different than any other. Dealing with children is nerve-wrecking especially during exams. You want to be prepared and well-trained in physically examining them (doctors can detect students who have never touched a child before the exam because nervousness will be evaporating out of every pore of your body). 

Hospitals
Qassimi:

• To put it simply, you won't be taught anything here. I'll give the same advice as OBG:
• This hospital is only for exposure to a variety of cases.
• You can make use of self-directed learning here as it is the only kind you can get. Find willing patients, take history from them and examine them.

Note: you are not allowed to practice hands-on skills on pediatric patients (IV line insertion, etc.)

• Clinics:
• The best clinic I attended was at the pediatric cardiology clinic. I learned many important things about management and clinical presentations of congenital cardiac problems as well as assessing the heart with echocardiography (not required of you, merely curiosity).
• The general pediatric clinic is also useful to attend as you can probably be able to do neonatal physical exams here.

Baraha:

• They'll give you a schedule to follow. During the free time you have, go to patients and take histories and do physical examinations. For some reason, this hospital has cooperative, willing parents more than others.
• Make use of the bedside teachings as they are the best of all hospitals in this aspect. 

Dhaid:

• The most beneficial time you will have is with either of the consultants at this hospital. Write down whatever they tell you on the rounds, bedside teaching. Those are the important things of pediatrics that you'll encounter.

OSCE

• You will not have physical examinations as there are no patients available.
• The exam will be comprised of history-taking, consultations, computer stations.
• Important presentations for history-taking:
• Fever in a newborn, infant or child
• Jaundice in a newborn
• Vomiting in an infant or child
• Seizure in a child or infant
• Cough, strange noise on breathing or shortness of breath in an infant or child
• Diarrhea in a child or infant
• Constipation in a child (mostly in a girl)
• Rash in an infant or child
• Consultations are most likely for a Down Syndrome or autistic child's parents'.
• Computer stations give you a small case scenario with pictures of x-rays or signs on the child to diagnose.

DOCEE
On the exam (and every other clinical exam ever), taking a comprehensive history and doing a physical examination will get you far in the grading department. The rest of the things (differentials, management, information) is all just a decoy.

You can study the common problems (the PBLs) you are likely to encounter but don't bet on it. I got a complicated case no one had imagined. But my history-taking was comprehensive (presentation of fever, abdominal pain, vomiting and seizure. I had to explode each symptom on its own); I did a physical examination for all the systems I thought were important, gave an exhaustive differentials list with the most likely at the top and I scored as well as those with gastroenteritis and bronchiolitis cases (dare I say better?).

Written
Do not rely on the previous years' blueprints. The pediatric doctors are smart enough to change most of the questions (they have a never-ending bank of questions).