A Day in the Life of a Pediatric Intern

Alexis Georgia

Clemson-Seneca Pediatrics

I interned at CSP from June 1st, 2016 – July 22nd, 2016. At my internship I learned a lot about both pediatric practice and myself. Clemson Seneca Pediatrics is a multi-physician, multi-office pediatric practice with locations in Clemson, SC and Seneca, SC. CSP is associated with the Greenville Hospital System Children's Hospital and according to the CSP website the practice is “dedicated to advancing the care of children and promoting healthy families.” As an intern I worked with the nurses at the Clemson, SC office to assist both the nurses and the physicians with day to day work. In this presentation I will take you through a day in my life as an intern.

http://www.ghschildrens.org/clemson-seneca-pediatrics.php

Every morning Monday through Friday I arrive at CSP at 8am. The physicians normally start seeing patients at about 8:30—9am, so I have to have the office ready before the patients arrive. My duties every morning include changing the paper on the exam tables in every exam room, unlocking the refrigerators containing the vaccinations, checking and recording the room temperature, incubator temperature, private vaccination fridge and freezer temperatures, and Medicaid vaccination fridge and freezer temperatures. I also have to test the Hemocue and record that it is working correctly, clean the counters and record that they are clean, and check and record the oxygen tank levels in the morning.

One of the 6 exam rooms Vaccination freezer thermometer and reminder

Passing morning Hemocue result

I begin pulling patients back before the physicians arrive. I start off by bringing the patient and their parent or guardian back to the room and asking why they are here in our office today. If they are here for a sick visit I record what the problem is, what their symptoms are, and how long the problem has been occurring. If it is a well visit I will ask the patient and their parent or guardian a series of questions which varies based on the age of the patient and record their answers. In both sick and well visits I must ask if the patient has any allergies, is on any medications, and what pharmacy they use.

Well visit questions for patients at different ages

Once I have gotten all the information I need, I will take the patient back to the vitals room to get the patients vitals and any other information the physician will want. This information can include temperature, pulse ox, and heart rate. If the patient is under 3 years of age I will measure length of the patient while lying on the table, weight, and head circumference. If the patient is 3 years or older I will measure height while standing, weight, and blood pressure.

Vitals Room

Taking blood pressure

Scale for children and babies under 30 lbs.

Once I have finished taking the patients vitals I will conduct and run any labs that need to be done on the patient. If it is a sick visit this could mean conducting a strep test, conducting a mono test, or testing a patients glucose. If it is a well visit I will always conduct a hemoglobin and a urinalysis if the patient is over 2 years of age.

When conducting a urinalysis we check the patients urine for a variety of factors, including its specific gravity, pH, and blood content, among others components. A hemoglobin test checks the patients iron content in the blood. To conduct a hemoglobin test I must prick a child's finger and then draw up the blood with a cuvette. This can be difficult because many children will fight you, as they understand blood has to be drawn.

Reading a urinalysis

Putting together a hemoglobin tray

These labs will be run in the lab area. The lab area contains all of the materials the nurses and interns needed to conduct patient tests, draw vaccinations, and prepare cultures.

If the patient is a well check I may also have to check their hearing and vision depending on their age. No matter the age of the patient I check their hearing the same way. I will ask the patient to put on a pair of headphones and I will adjust the level of decibels and hertz. I will ask the patient to tell me when they hear a beep, which sounds when I push a button. I conduct the test and record the results.

Hearing Test

Vision tests vary with age. If the child is very young I will conduct the 4 Dot test. I will ask the child to put on a pair of glasses and tell me how many dots they see in a flashlight and what colors the dots are. If the patient is older but does not yet know their letters, I will conduct a Picture test, asking if they can tell me all what all the pictures on the cards are, and then which picture the lines on the cards are pointing to. If the patient does know the alphabet I will conduct a standard vision test on them.

4 Dot Test

Picture Test Standard Vision Test

After pulling a patient and getting their history of present illness, vitals, and completing any labs and tests I need to run on them, all of the information must be entered into the lab book and the computer. The computerized charting is very importing in alerting the doctor what the patients chief complaint, current vitals, and health history are before they enter the rooms to see the patients.

Tiffany, another intern, entering lab results into the Lab Book.

Charting patient information into the electronic records.

After the doctor has seen the patient they will come out and alert myself and the nurses if the patient needs any shots and what shots they need. I will then look up what type of insurance the patient has, either private or Medicaid, in order to pull the vaccinations from the correct refrigerator. I will then pull and draw up the vaccines. While I can not actually give the vaccinations, I will often observe the nurses administering the vaccines, as well as help the nurses hold down the children in order to keep the children from flailing or reaching for the needles to keep both the nurses and kids safe.

Drawing vaccinations Prepared vaccination trays

There are also other odd jobs I have had to complete throughout the days and weeks at my internship. During the day I am responsible for preparing strep and urine cultures that are done in office when a doctor deems a culture is necessary.

Corbrina, a nurse, plating a strep test to be cultured.

Running rapid Strep tests in Office

In my two months at CSP I also completed a variety of projects including creating a poster board educating the patients on sun protection in the summer months, weekly medication cabinet checks, completing an inspection checklist, checking all the vaccinations for expirations, assisting in vaccination reorders, going through and flagging/correcting patient lab records in the 2014, 2015, and 2016 lab books, and redoing the back wall of the front office.

I thoroughly enjoyed my time spent at CSP. It was a fast paced environment, where I had to work hard and learn quickly, but it was also a fun and interesting environment. I had a great preceptor, who was always willing to take the time to teach me and explain a procedure. Every day was new and interesting, allowing me to learn how to think fast and stay on my toes. I have learned how different working with children and working with adults in a healthcare setting is. Pediatrics was never an area I had considered before starting my internship, but now I could see myself pursuing a career in pediatrics.

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