Pediatrics is a 6 week rotation that is all in-hospital. During this time, you will be working in three main areas:

• Pediatric ward with in-patients

• Specialist out-patient clinics (on the same floor as the pediatric ward with visiting Peds specialists), ~one afternoon/week

• Neonatal Intensive Care Unit (NICU)- one floor below Peds floor

Overall, during this rotation you will have a lot of oversight from the pediatricians and nursing staff. You will work closely with your fellow CC3 trackmates and have the opportunity to see the huge scope of pediatrics.

You will be working with the In-Hospital Pediatrician each week. The Pediatrician manages both the Peds and NICU wards, and is responsible for being present for C-Sections or “Code-Pink’s” in Obstetrics (complicated labours where resuscitations of babies may be required). If/when a visiting specialist comes through, you may be put into a clinic with them, and will work with them for (usually) an afternoon. There is usually a family medicine resident, and often a junior or senior pediatrics resident as part of the team.

The flow of pediatrics is similar to that of internal in that you will spend much of the morning/ afternoon rounding on patients and then seeing new consults/ follow-ups in the clinic.The main responsibilities will include:

1. Rounding on current in-patients each morning (Peds and NICU)

   • You will round before attending arrives, then present the patient to the attending as a group when the attending arrives. Each attending has a different style for how they round, so be prepared to be flexible.

2. Seeing new consults/ follow-ups in pediatrics clinic

3. C-Sections/ Code-pinks

   • Includes getting the antenatals, attending C-Section or labour room, and being present to assess the newborn after the C-Section.

Usually you arrive (around 7am) to round on Peds & NICU patients. You will split the list between your team, but will likely follow the same patient throughout their stay. Try to finish rounding before the attending arrives (they arrive at variable times). If there is a scheduled C-section happening, whoever is going to attend it should get a copy of the antenatals and be prepared to brief the attending. These C-sections are usually the first case of the day so will usually happen around 8:30. You can find out when scheduled C-sections are happening at the front desk at labour and delivery.

When the attending arrives, you’ll go through the list of patients together, along with nursing staff. You’ll go through all of NICU, then all of peds (or vice-versa). If you have a patient who is a bit sicker, alert your attending so you can start rounding with them. Once finished that, you take whatever consults and follow-ups come in, address whatever issues come up with patients throughout the day, or attend any emergency C-Sections that are happening.

Call for pediatrics is overnight call. The CTU lead for the week is on call from 7am-4pm, then at 4pm a new pediatrician will start being on-call for overnight. You can see who is on-call on the whiteboard at the Peds nursing station. Make sure to text them and let them know you are on call with them. While on call, you will be seeing consults and attending emergency C-sections and code pinks.

You will be called about problems that happen with both NICU and peds patients, so pay attention to what is generally going on with all patients. Generally, the pediatricians are very involved with patient care and like to be notified about almost everything. Clarify with your attending if they want to be notified (via text vs. call) about a result that may come in overnight- usually they do.

Don’t wake up babies in the NICU if you don’t have to. Usually, if you need to do a physical exam on the baby, it is best to ask the nurse when they are planning to go in and do a check. That is a good time to go in with them and do what you need to do.

Same goes for pediatric patients. If they are sleeping when you go to round on them, just wait and try again later.