Loosening the training wheels in the Pediatric ICU
Growing up, my street was on a bit of a hill. It was annoying to lose a ball into the road and have it stop rolling a dozen houses down. Learning to ride a bike was especially challenging. During the training wheel transition I had plenty of near misses (and full-blown crashes) with trees, fire hydrants, and mailboxes. Though I got plenty of scrapes and bruises along the way, in the end I somehow managed to master the two-wheel art.
This week I’ve felt my educational “training wheels” begin to loosen. My classmates and I submitted our applications for residency, and some have already started to receive invitations to interview. This month I am doing an acting internship (AI) in the Pediatric Intensive Care Unit (PICU). AI’s are chances for 4th year students to assume the roles and responsibilities of 1st year residents (aka interns). We have the opportunity to manage a larger number of patients and be more involved in the day-to-day plan of care than a student normally would.
I’m working in the PICU at Toledo Children’s Hospital. At first I was a bit nervous about starting in an area that took care of the most critically ill little ones in the hospital. It certainly felt like I was jumping into the deep end of the pool. However I’ve managed to stay afloat so far and learn a great deal. The majority of the kids I saw this week had respiratory problems including pertussis, croup, and status asthmaticus. Fortunately I was able to see most of the little whoopers, croupers, and wheezers improve enough to leave the unit.
As a student it seems I am constantly reminded of how “green” I remain in many areas. I wrote almost all the orders for my patients this week, with an attending physician co-signing them. While there are plenty of equations and protocols for calculating fluids and medication doses, so much of practicing medicine is based on experience and that clinical “gut” instinct. Is this child ready to be taken off continuous aerosol treatments? Should I recheck his potassium level in 6 or 12 hours? Do the steroids alone account for this high blood sugar? Luckily I have gotten some great practical advice from my preceptors and some tremendous nurses. Perhaps realizing just how much there is to learn is the most authentic “intern” experience one can have.
I’m glad to have this acting internship to give me a preview of what residency will be like. There’s a mix of exhilaration and a bit of terror that comes with removing training wheels. I look forward to what this month has in store for me (while hopefully avoiding wayward trees or fire hydrants in the process!)
Tags: acting internship, intensive care, pediatric, PICU, toledo children's hospital
September 8th, 2009at 12:44 pm
Hi Pat:
Your blogs continue to inform one and all about life as a med student. Your reflections about your feelings and thoughts are even more insightful for the hopeful med student. I hope you are keeping copies of the things you write. Maybe one day you can produce a book on “lesson’s learned” as a med student!
September 8th, 2009at 1:46 pm
Hi Pat,
Enjoyed the column! I am glad to see you are having a good experience at TCH PICU. We are grateful for the exceptional educational experiences the docs, nurses and staff deliver at our clinical sites such as the PICU. We are fortunate to have folks who volunteer of their time so that you may have the education you deserve.
For all our students, please let us know when there are educational experiences that need improvement. Also, as in cases such as this one, please let us know of outstanding experiences, docs, staff, nurses so that we may recognize them.
R. Schlievert, MD
Program Director, Pediatric Residency at UT
September 8th, 2009at 1:55 pm
Hi Pat:
Glad to see another of your articles. Besides being educational, they are funny. They hold my interest very well and I look forward to seeing your name and picture whenever I get the UT Update, knowing I have a treat in store. Keep up the great work.
September 12th, 2009at 8:15 am
Loved the analogy of the training wheels but unfortunately we can’t really have you knock off a few patients to learn. I’m glad you started in the PICU because you need to learn not just the “practice” of medicine but the “principle and practice” of medicine. Students learn about the principle and science behind the practice of medicine during med school yet somehow when they reach the clinical part of their training they have a hard time integrating the principle behind the practice. I believe good judgement comes from experience and let’s not substitute “gut instinct” for good judgement. I feel we have failed you if you walk around “practicing medicine on gut instinct”.