Friday, February 13, 2015

Dear pediatrics will you be mine?

[photo credit Terry Kind]

Happy February 14th!

Was it love at first sight? Maybe not. You don't have to have always known that you and pediatrics are a match. You can grow to love each other, to develop a passion for the field. After all, growth and development are key components of pediatric care!

Now for some of you, perhaps this developmental progression meant that at 2 months of age, your social smile was at the very thought of a future career in pediatrics. And at 9 months, your pincer grasp allowed you to turn the pages of the child health journals lying strewn about your home or that of your neighbors. At 18 months you precociously uttered the words "time for my well check please." Flash forward to middle and high school as you went on to spend your summers as a babysitter, a camp counselor, a tutor, a lifeguard...

But if you were like me, back in medical school riding on the NYC subway, looking at the toddler fishing in his mother's oversize bag, or the child engrossed in reading Harry Potter, or the tween on her cell traveling solo, you would ponder about the age of any child in view. You'd play the guess how old that kid is game. You thought if you could estimate even an imprecise age, maybe you had what it takes to be a pediatrician, you're a natural. Back then, I had no idea beyond a mere "not an adult." Rest assured, you get much much better at that, sometimes with an uncanny ability of guestimating a random child's age to the very month!

More notable might have been that I found I was drawn to the kids, to their activities, their behaviors, their joys, and their anomalies. Why was she holding her head tilted that way, why does he have tears welling up, might she have a leg length discrepancy, could that be a median sternotomy scar, did he make up the words to that song, and so on.

Turns out, it may be only as you are making your decision to train in pediatrics that you realize you are drawn to kids; you don't have to have always known this. It may come to you quite by surprise on your pediatrics clerkship. Or afterwards, as you miss those children who tugged on your ID tag and drew you pictures. Or, as you walk through the pediatric emergency department on the way to the adult side. And of course, there's the classic scene, in a c-section you drift over to the newborn being warmed, dried, suctioned, and wrapped, and then linger there, post-partum mother notwithstanding.

Even if your only prior experience with kids is having been one yourself, with an openness to the possibility of a career surrounded by children, the opportunities are endless. To care about them, to care for them, to have an impact on the future.


Sincerely,
Your Valentine

Monday, January 19, 2015

Of all the forms of inequality...

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane," as per Dr. Martin Luther King, Jr.

Let's do something about it.  We are well positioned in pediatrics to advocate for reducing these injustices and for society's youth and future.
 
Please read this wonderful piece in the January 2015 issue of Pediatrics written by residents from Boston, St Louis, Pittsburgh, and Seattle depicting what training in advocacy can look like.  They astutely remind us that, "At the heart of it, advocacy is about endorsing effective solutions." That it is the responsibility of all of us.  And that advocacy is not just to meet an accreditation requirement.  Though only a subset of health care providers will dedicate their careers to advocacy on a larger level, "all pediatricians and pediatric subspecialists are called to advocate for their individual patients on a daily basis."  Let's embrace this call, make a difference, find effective solutions, and reduce inequalities and injustices, both on an individual basis and all across communities. 

Tuesday, December 23, 2014

Tip Tuesday: Reflect back, to move forward

As you approach the final weeks of the year, or the final days of any medical school or residency rotation, think back to day one. It may seem kind of like a long time ago, but in others ways the time just flies by (and then it's already time for a shelf exam or other test or a new rotation).

But do take a moment to reflect back on your experiences, on the things you saw, did, learned, didn't learn, want to emulate, want to avoid, are drawn to, are repelled by... and reflect upon all the ways in which you have grown and changed.   What feedback have you received, and did you really hear and make good use of it?
  • Did you accomplish the objectives that were spelled out for you?
  • Did you accomplish the objectives you set out for yourself on day one?

If not (yet), there may still be time to create such a learning experience.
For example, with a few days left on a pediatric rotation:

  • Ask someone to take you through an otoscopic exam in a toddler.  Provide "back to sleep" guidance and save a life.  Participate in a lactation consult.  Find those undescended testes or that axillary freckling or that sacral dimple.  Identify the slipped capital femoral epiphysis or the scoliosis. Do a (warranted) procedure with guidance. Call for a consult with a well formulated question.  Handle a question about vaccination.  Go to that bronchoscopy or renal biopsy, and know why it is being performed and how to interpret the results.  Get to know your patients even better.  Hold a hand.  Listen and learn. Teach someone something.  Try again. 
 
In some sense, there's always next time (or next year), but there's really no time like the present to be fully present for your patients, to enhance your learning and the care you give.  
 
Reflect back, to move forward.  For now and for next time...

Tuesday, November 25, 2014

Tip Tuesday: Thanking the residency program (and the applicant)

Dear residency program applicant,

Got your thank you note, it was much appreciated, and it told me a tiny bit more about you.

  • It told me you cared enough to follow up on that clinical conundrum or ethical quandary we discussed during the interview.
  • I learned that you spent a few more hours/days in our wonderful city exploring the sites.
  • It showed me that you have nice handwriting; that you are careful enough to avoid typos when emailing; that you sent it from your iPad; that you felt comfortable enough to text me your TY
  • It reiterated to me that you could easily see yourself fitting in to our residency program.
  • Oh wait, I never actually received a thank you note from you at all...

So, students, what have you heard? To send or not to send? To email or not to email?

Some say (even some residency program directors say) that a thank you note is not necessary after your interview. That it doesn't matter. That it neither enhances nor diminishes your chances of matching.

However, what would make your parent/grandmother/great aunt proud? What is your inclination?

I say, do send a thanks. Take a moment to compose a thoughtful thank you. Maybe mention something that occurred on or shortly after the interview day. Or convey something you meant to say during the interview. You can be brief. But be sincere. You could send it immediately, or take a few days if you are pressed for time. Individualize it. You can email, particularly if your interviewer gave you his/her email address (i.e. it was on his/her card or conveyed to you otherwise). Or you can send it the old fashioned way. Wouldn't text or tweet it, though.

TYVM
#thanks

Friday, October 31, 2014

Boo! Making trick or treating not so tricky: Halloween for pediatricians

This holiday just screams of us pediatricians working hard to prevent or avoid: Not trying to put a damper on things. But there are ways to encourage healthy halloweening. Like dressing up as your favorite historical figure, athlete, or book character. Like raising money for organizations that provide children worldwide with health care, clean water, nutrition, education, and emergency relief. Like giving out crayons, coloring books, stickers, toothbrushes, and card games instead of candy. Like participating in dentist candy buy back programs that send it abroad to thank our troops. Like getting some exercise (minus the candy) by walking around your neighborhood. 

Then, perhaps your trick or treating won't be so tricky. Boo! Here are some tips from the AAP and the CDC.

Tuesday, October 7, 2014

Like speed dating, but instead it's the "multiple mini interview" format

She presented me with a scenario, asked me a question, and then I had about 8 minutes to discuss... to give my answer, my response as to how I would address that situation. I hope she likes me and what I have to say. And then the bell rings and I move on to the next station for another interviewer and another scenario. In the process, I aim to make a case for why I would be a suitable match, that is, why that residency program wants me in their new intern class.

It could happen.

Some programs use this "multiple mini interview" format with a series of brief structured interview stations where your non-cognitive traits are assessed. While found to be useful in undergraduate medical school admissions as kind of a "people skills test," it has also been demonstrated to be a reliable and acceptable way to assess residency candidates. If a residency program is using this format, they will surely inform you on the interview day, if not before.

For the "looks good on paper only" applicant, the MMI (or any interview) could be difficult. But don't be that person.

Fortunately, at programs using an MMI interview format, you (the applicant) will have multiple opportunities to interact, communicate, and demonstrate your humanity and empathy. And, you will likely be able to showcase your social skills and problem solving skills and reasoning abilities during the MMI.

Regardless, you want to show who you are and put your best self forward. The real self, the person they want in their residency program. Remember the tips:
  • Have a strong one liner about yourself! What do you want them to know, if you had the chance to simply tell them?
  • Know everything that you've listed on your own ERAS application/CV.
  • Make sure you have a few key points that you want to convey about yourself during the interview, then you can work those in at some point during the interview.
  • But here's another tip, for the MMI or otherwise, do pay attention to the question asked or scenario presented, don't just talk, or just talk about yourself! Remember, you're in this to help other people (probably infants, children, and young adults).
Interviews at the pediatric residency program here at Children's National start today!

Sunday, September 28, 2014

Spotlight on our team at Children's Health Centers at Good Hope Road and MLK

"And you know, we're on each other's team," sings the young New Zealand singer-songwriter Lorde.

Drs Cara Lichtenstein, Terry Kind, and Elshadey Bekele
Here we are (that's me in the middle), posing for the camera, but working hard every day on behalf of the children of southeast DC

What a team!  It takes a village (and listed here in no particular order, though nurses quite deservedly come first!):

They are all my colleagues.  We are all dedicated to serving our young patients and families.  In this medical home.