About barryhowe

curious quiet driven

Tips for the pediatric rotation

I just finished my pediatric rotation and have a few tips to pass on.


1. Memorize your vaccination schedule and include vaccines in your assessment/plan if the patient is due.

2. Questions you can’t afford to forget when doing a pediatric history: change in appetite/activity? smoke exposure? pets or animals at home? Sick contacts? Always do a good ROS to find out symptoms the patient/parent forgot to mention!

3. Have at least a few reasonable diagnoses for cough, fever, rash, sore throat, vomiting, diarrhea, and poor feeding/failure to thrive.

4. Be comfortable with the descriptive terms for skin lesions and rashes

5. Learn how asthma is diagnosed and treated (the basics–PFTs, controller/rescue meds, etc)

6. Memorize the developmental milestones. At minimum, know at least one gross motor, fine motor, social, and language milestone for each age bracket.


1. Take some time to figure out when and where you are supposed to be places. You will have morning reports, grand rounds, and various other functions. It is easy to miss something if you are not paying close attention.

2. For team D, learn about protein losing enteropathy, short gut syndrome, the hepatitis differential, and intestinal failure associated liver disease. Also learn the differentials for common GI complaints (obviously) like vomiting, abdominal pain, diarrhea, etc. Peds in Review articles are an excellent resource

3. For team A, learn the lupus criteria, Kawasaki criteria, and Jones Criteria. Also read up on diabetes, (especially type 1) and congenital heart disease.

4. For G and B, pick the brain of someone who worked on these teams.

Mock boards

1. Study more during outpatient! You will not have much time for study during the inpatient part of the rotation. Plan on getting through at least 75% of your study during outpatient.

2. Lange Q&A is widely considered high yield. Everyone has to find their own preferred study book/method, however. The best thing to do is to pick a book and study it well. The exact book you choose probably doesn’t matter that much as long as you put in the time and effort.


For the live patient OSCE, study the example H&P on the Peds Canvas site. From what I could tell, the biggest chunk of your grade comes from doing a thorough history and physical.


I have a handy book for my surgery rotation, entitled Surgical Recall. It’s a review book for the clueless 3rd year medical student. I found a trenchant piece of advice near the beginning, which has stuck with me throughout the rotation. Now, however, I’m beginning to wonder whether the advice is really worth much, hence this blog.

The advice appears under a heading called “The Perfect Surgery Student”. What medical student doesn’t want to be the perfect surgery student? Even the one dreaming of becoming a psychiatrist has a vested interest in passing every rotation with flying colors. Besides, medical students are driven over achievers to begin with. Whether surgery holds the slightest attraction or not, passing the rotation with high grades and well-earned praise not only looks good; it feels good.

According to my dandy review book  “the perfect surgery student” is, among many other things, “never hungry, thirsty or tired”, “always enthusiastic”, “loves scut work and can never get enough”, and “never wants to leave the hospital”. The list is quite long, but to sum it up, my book says that the perfect surgery student is “a high-speed, low-drag, hardcore HAMMERHEAD” and the definition of hammerhead is this:

“A hammerhead is an individual who places his head to the ground and hammers through any and all obstacles to get a job done and then asks for more work. One who gives 110% and never complains. One who desires work”

After six weeks on my surgery rotation, I know first hand that this definition of the perfect surgery student is bang on correct. Residents and attendings love students with these attributes. Success on the wards depends entirely on how closely students approximate the ideal hammerhead. I have, therefore, done my utmost to be a hammerhead. Unfortunately for me, hammerheads are superhuman.  And I am not.

Loma Linda University apparently embodies a simple mission: “to make man whole”. But do hammerheads experience wholeness? Nowhere in the definition of a hammerhead can I see anything about being joyful, fulfilled, or genuinely caring. Is it even theoretically possible? I don’t think so.  Hard work and absolute commitment to excellence are certainly important components of wholeness, but a hammerhead is clearly an obsessive workaholic.

For better or worse, I’ve chosen to reject the hammerhead ideal in favor of the official mission of Loma Linda University. The painful irony of this choice is not lost on me. At least in the short term, the pursuit of wholeness in medical school leads to a certain sacrifice of so called perfection. On the other hand, the unbalanced, uncompromising pursuit of professional medical perfection leads to a certain loss of personal wholeness. I pick wholeness.