Residency Revealed: An Experience in Private Practice

In every career, there are individuals you meet that inspire, invest, and advise. They become memorable mentors who have the power and influence to direct your decisions, or even a life path. I have been fortunate to have many mentors in my professional life, and have greatly benefitted from their gifts of generosity and gifts of time.

It is with great honor, therefore, that I am able to “pay it forward” and spend time with some up-and-coming pediatricians. Residents and I spend time together learning about how to best care for our patients, how to prevent injury and illness, and how to effectively communicate our health messages.

And I love to show them how social media helps accomplish all three.

I had the great pleasure of working with second year resident, Catherine Cotney, M.D., from Children’s Mercy Hospital during the past few weeks. She enthusiastically contributes this post, describing her educational experience and observations.

Enjoy.

Residency Revealed

By Dr. Catherine Cotney

Residency is the time when a doctor applies what she has been learning during 4 years of medical school. The main goal of the pediatric resident is to learn, see and do AS MUCH AS POSSIBLE in three years of training before she is sent into the “real world” to be a pediatrician.

Here is a brief summary of my medical training:

• college
• medical school (4 years before officially becoming a doctor)
• residency (3-7 years, depending on what specialty you choose)
• real world or a fellowship (1-3 years)

In most large pediatric programs, including Children’s Mercy Hospital, the majority of training time is spent in the hospital with sick children. Apart from a weekly afternoon clinic, my time has been spent taking care of ill children in the hospital, rotating monthly to different services…ICU, Emergency Department, general pediatric inpatient units, subspecialty pediatric inpatient units, oncology, etc. Undoubtedly, inpatient experience is crucial, as it allows residents to learn how to take care of truly sick patients and learn more about pediatric disease.

It is wonderful to spend time in a Hospital for children. Children’s hospitals are much more friendly and inviting than adult hospitals, and Children’s Mercy is no exception. (Aside...if your child is to be in the hospital, I highly recommend Children’s Mercy!) Decorations, playrooms, staff training… all are child-centered. Having an entire hospital devoted to children is fabulous!  Even so, the hospital can still be a scary place for most families.  Most of the time it is a new environment for patients with unfamiliar (albeit friendly) faces and generally more severe illness. Having a sick child, being in a new place, and many other stressors lead to an entirely different relationship between the healthcare provider and a patient/family in an inpatient setting.

In my first year of residency, also known as the intern year, learning “sick” versus “not sick” was perhaps the most important lesson my fellow interns and I learned while working in the hospital setting. Gaining knowledge, experience, and confidence were other highly significant lessons. Presumably, every child that enters the hospital is sick. There is, though, a distinction between a child who is critically ill in need of intense medical attention, and a child who is not feeling well (but whose admission to the hospital is merited)…hence the term “sick versus not sick.” During my time in the hospital, I was able to form meaningful relationships with patients and their parents, especially those with chronic illnesses or those who had a prolonged hospital stay.  However, those relationships are distinctly different than those I have witnessed in an outpatient/office setting relationship.

After the first 15 months of fast-paced, 80 hour workweeks, sleep-deprived and feeling drained; stepping into the world of private practice pediatrics has been refreshing, rewarding, and yet still challenging. I have the opportunity to see a different side of medicine while working in the office setting with Dr. Natasha. I love it!  In three weeks, I feel like the continuity I have had with patients and their families has rivaled that of my entire first year of residency.

At the office this month, I have enjoyed seeing how wonderful the relationships between patients, their families, and their health care providers can be. This observation has further enabled me to know that I’m in the best medical specialty!  Parents visiting for well-baby/child check-ups have exceptionally practical questions we residents don’t usually get at the hospital, from what kind of potty chair to use, what books are best when discussing puberty with your child, to how to best take the pacifier away from your child. These all involve anticipated steps of development and are issues that occur on a day to day basis….the normal “stuff” of life!

Finally, I cannot ignore how important seeing children who are not feeling well in the clinic setting. These visits provided a time to further foster relationships as parents have someone whom they trust to provide diagnosis, treatment, and reassurance in a comfortable and encouraging surrounding.

Being in the office has reminded me how much trust can be established between a pediatrician and her patients, and I have been consistently reminded of what a privilege and joy it is to be able to take care of children.  Relationships are lasting, and both parties learn from each other.  These are all things that can be missed in the hustle and bustle of the hospital, but both settings are imperative in the training of a good pediatrician!