This rotation was split into three parts: emergency department (ED), outpatient pediatric clinic, and the neonatal intensive care unit (NICU). The ED was first and it was also my first ED rotation experience, so there were two learning curves I had to contend with: 1) quickly generating differentials that were relevant to the emergency department setting; 2) eliciting an appropriate pediatric history. Learning how to take a good pediatric history was formulaic and easy to get the hang of, but I realized really quickly that I need to practice and improve on my differential diagnosis. So during my next rotation, I’m going to develop and practice a systems-based approach to creating a differential diagnosis for every patient I see, even if I already know the diagnosis. I’m also going to do the same when doing untimed Rosh Review questions, especially since the answers and context are right there to reinforce my practice.

I also found adolescents to be a uniquely challenging patient population in the ED. Many were not communicative or forthcoming, and I found it a bit more difficult to elicit a history from them. In hindsight though, I think this exercised my history-taking skills pretty well, which is great because those were skills I set out to practice during my first rotation. I also have a feeling that that experience may help me during my future emergency medicine rotation, where I expect to encounter patients who refuse to or cannot provide a history for a multitude of reasons.

The outpatient pediatric clinic was a good change of pace from the ED. It was slower and quieter (which I was surprised to learn that I enjoyed!), and there was also the added benefit of seeing a lot of “normal” patients, which I think is absolutely vital to being able to discern when something is “not normal”. My time in the NICU was short, but it was my first time seeing a more “team” approach to medicine and I’m excited to get more of that on future rotations.