Overcoming Common Challenges in Pediatrics Clerkships

Pediatrics clerkships are crucial in medical education. They offer students hands-on experience caring for infants, children, and adolescents. As you will hear time and time again, children are not mini-adults! They have their own dedicated speciality for a reason. While pediatrics rotations are rewarding and offer unique learning opportunities, they also present their own set of unique challenges for medical students. In this blog post, we will explore some of the biggest challenges faced by medical students during pediatrics clerkships, strategies for succeeding on pediatrics rotations, common challenges encountered by pediatricians, and whether pediatrics is a competitive residency specialty.

Challenges in Pediatrics as a Medical Student:

One of the biggest challenges medical students face during pediatrics clerkships is the unique patient population. Unlike adults, pediatric patients often present with non-verbal cues, making communication and diagnosis more challenging. Additionally, pediatric patients may be unable to articulate their symptoms clearly, requiring medical students to rely on their observational skills and interpret cues from parents and caregivers. The emotional toll of caring for sick children and communicating with concerned parents can also be challenging for medical students, especially those new to pediatric medicine. It is important to remember that, although you may feel uncomfortable with this patient population, you should feel empowered to fully immerse yourself within this clinical specialty.

How to Succeed in Pediatrics Clerkship and Overcome its Challenges:

Despite the challenges, there are several strategies medical students can employ to succeed in pediatrics rotations. All of the normal strategies employed on your adult rotations are applicable here. However, there are some skills that I hope to emphasize as they are critically important for overcoming the unique challenges of pediatrics clerkships:

Develop Strong Communication Skills:

Effective communication is essential in pediatrics as you will be communicating with both patients and their families. Medical students should practice active listening, empathy, and clear communication to build rapport with patients and caregivers. Additionally, you will need to learn how to communicate to both of these parties in a way that is not only informative, but comforting. Pediatric patients are often scared of being in the hospital, as it is an unfamiliar environment that often involves testing and procedures which are uncomfortable. Parents often struggle with seeing their children undergo everything that we put them through! You must learn how to communicate with both parties, a skill that takes time and effort to develop.

Hone Clinical Skills:

Pediatric patients require specialized care, and medical students should focus on developing clinical skills relevant to pediatrics, such as performing pediatric physical exams, interpreting growth charts, and managing common pediatric conditions. The normal range for pediatric vital signs is extremely different from adults. Learning how to shift your frame of reference takes time and practice. Additionally, preventative medicine is of heightened importance in the pediatric population, specifically around vaccines. While, unfortunately, preventative medicine often takes a backseat role in adult medicine, it is front and center in the pediatric population.

Seek Learning Opportunities:

Take advantage of learning opportunities during pediatrics rotations, such as attending pediatric grand rounds, participating in case discussions, and seeking out diverse patient encounters to broaden clinical exposure. Many institutions practice bedside rounding on pediatric patients, which involves the medical team rounding in front of the family and the patient. This can be an anxiety-provoking activity for many medical students who are uncomfortable using medical jargon or being incorrect around patients and their families; however, this is an approach used to not only make rounds more efficient, but as a way to include the patient and their families in the medical decision making process.

Work Collaboratively:

Pediatrics is a team-based specialty (like all medical specialties). Medical students should collaborate with nurses, residents, and attending physicians to provide comprehensive care to pediatric patients. Be proactive in seeking feedback and guidance from preceptors and colleagues.

Challenges Pediatricians Face:

Now that we have discussed the Pediatrics Clerkship challenges that students often face, we can turn our attention to the distinct set of challenges that pediatricians encounter in their daily practice. Pediatricians often encounter complex medical cases that require thorough evaluation, diagnosis, and management. Managing chronic genetic conditions, rare diseases, and complex comorbidities in pediatric patients can be challenging and requires a comprehensive understanding of pediatric medicine.

Like all healthcare professionals, pediatricians face challenges in maintaining work-life balance and avoiding burnout. Balancing clinical responsibilities with administrative duties, teaching commitments, and personal life can be demanding, requiring effective time management and self-care strategies.

Communication and Preventive Care Challenges in Pediatrics

The overwhelming majority of high-quality, randomized, clinical trials are run in adults. Pediatricians have less evidence at their disposal to guide their clinical decision-making. Some may find this lack of data frustrating as some clinical decisions are founded on physician’s expertise. Communicating with parents and caregivers can be challenging, especially in situations involving difficult diagnoses, treatment decisions, or end-of-life care. Pediatricians must navigate sensitive conversations with empathy, clarity, and respect for parental preferences and cultural beliefs.

In the adult population, many illnesses are secondary to chronic risk factors like obesity, hypertension, and substance use. It is easier for adult clinicians to explain why a patient has a certain condition. However, in the pediatric population, many of the conditions that children have are due to their genetics, inappropriate care of the child, or simply bad luck. Many parents and patients will want to know “why” they have this condition, and it is often difficult to answer these questions.

Additionally, promoting preventive care and healthy lifestyle habits is a cornerstone of pediatric practice. But pediatricians may face challenges in engaging families and implementing preventive interventions effectively. Addressing barriers to healthcare access, promoting vaccination, and advocating for child safety are ongoing challenges in pediatric medicine. The backlash and hesitancy surrounding the COVID-19 vaccine has exacerbated the already difficult task of encouraging parents, to vaccinate their children, which we know is one of the most effective ways to protect your child from infectious diseases.

Is Pediatrics a Competitive Residency Specialty?

Determining if pediatrics is a competitive residency is subjective and depends on your frame of reference. Pediatrics is considered a less competitive residency specialty compared to other specialties such as dermatology, neurosurgery, or orthopedic surgery. While the demand for pediatricians varies by region and practice setting, there is generally a steady demand for pediatric primary care providers to meet the healthcare needs of children and adolescents. However, pediatric subspecialties, such as pediatric cardiology or pediatric critical care, may be more competitive due to limited fellowship positions and specialized training requirements.

Reviewing NRMP Data

When looking at data from the National Resident Matching Program (NRMP). We find that for U.S. MD and DO students, as well as US and Non-US international medical graduates, pediatric match rates are some of, if not, the highest across all medical specialties (Figures 1-3). This signifies that, compared to other medical specialties, pediatrics is less competitive.

Figure 1: Match Rates of U.S. MD Seniors – from the NRMP Charting the Outcomes 2022

Figure 2: Match Rates of U.S. DO Seniors – from the NRMP Charting the Outcomes 2022

Figure 3: Match Rates of International Medical Graduates – from the NRMP Charting the Outcomes 2022

According to the NRMP Charting the Outcomes 2022, applicants to pediatric specialties tend to have:

• Average to lower Step 1 and Step 2 Clinical Knowledge (CK) scores.
  Fewer research experiences, abstracts, presentations, and publications.
  An average number of work and volunteer experiences.

So even though the objective qualifications needed to match into a residency specialty are similar to or slightly lower than that over other specialties, the match rates of those applying into pediatrics are some of the highest.

Together, this supports the notion that pediatrics is a less competitive specialty as compared to others. Why? This is a difficult question to answer but ultimately comes down to factors which impact supply and demand of pediatricians. However, in 2022, there were 3153 total pediatrics applicants and 3016 offered pediatrics positions (an applicant to position ratio of 1.05). Compare this with orthopedic surgery which had 1435 applicants and 875 positions (an applicant to position ratio of 1.64).

Final Thoughts on Pediatrics Clerkship Challenges

In conclusion, pediatrics clerkships offer valuable learning opportunities for medical students but also present unique challenges. By developing strong communication skills, honing clinical expertise, seeking learning opportunities, working collaboratively, and staying organized, medical students can overcome common challenges and succeed on pediatrics rotations. Pediatricians face their own set of challenges. However, pediatrics remains a rewarding specialty dedicated to promoting the health and well-being of children and adolescents.