Chapter 2 Inpatient Service
What Will Help Me Be Successful on the Inpatient Service?
Your inpatient experience may be on a general pediatrics service, where patients span the age range from birth through late adolescence and manifest many different diseases and disorders. You may also spend time on a specialty service devoted to patients with specific disorders such as cardiac disease, malignancy, or gastrointestinal problems. The inpatient service occasionally may be limited to a specific age group, such as newborn infants or adolescents. In all instances, you should engage yourself with the activities of the specific service and take every opportunity to develop pediatric-specific skills in the interview and physical examination, as well as in clinical reasoning and communication. As you watch experienced clinicians work with patients and families, ask them to “think out loud” so that you may learn how they approach clinical problems and use clinical reasoning. Ask faculty and residents to observe you and give you feedback about your medical interview and physical examination skills. Request feedback about your write-ups and case presentations. Challenge yourself to make commitments about the differential diagnosis, to think critically about the evaluation process, and to develop a plan for the initial treatment of each patient. If your diagnosis, evaluation, and/or management do not match those of the resident and faculty physicians, challenge yourself to find out why. Do not expect your skills to be perfect, but strive to improve them. The list of key clinical experiences in Chapter 1 can assist you to organize your inpatient rotation.
What Is My Role on an Inpatient Service?
Your major job is to become a competent clinician. The clerkship is your opportunity to develop the basic skills that will be the foundation of your future clinical education and practice. To do this, you must be an active member of the team, not just a scribe, data collector, or “gofer.” As one of a small number of students on the service, you will be highly visible, and your enthusiasm, participation, and motivation will be noted. On busy services, you will have a key role in day-to-day patient management, but if you wait to be “invited” to work up patients, you may be overlooked (or worse, viewed as uninterested). Above all, keep your eyes and ears open: You may be the only one to identify a key finding. You may be the communication link between the patient/family and the team, so talk regularly with your patients and their families, but do not attempt to give information that is beyond your level of experience and knowledge. You may be asked to discuss clinical progress with a patient and family, but a resident or staff physician will usually supervise this closely. You will often be asked to bring information from the literature to the team about specific diagnostic or management issues. The discussion on evidence-based medicine (Chapter 7) will assist with these assignments.
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