Small groups and Pediatrics

A few months ago I participated in a "Small group on Small Groups" during an education retreat for the faculty of the medical school. First of all, I was very excited to see that there was a day for faculty to attend lectures, group discussions and information sessions with the goal of improving the way they teach medical students. It was so interesting to watch and listen as some of my teachers and small group facilitators talked about how to lead discussion sessions throughout our curriculum. (Considering we are in small groups for at least 2 hours a day, it's nice to know educators are thinking about how to do it better.) My takeaways were: discussion leaders want to give students what they need, they need students to participate and take charge of their own learning, and they are willing to change the way small groups are run to meet students where they are. I also learned that our faculty small group leaders can be frustrated with med students' attitudes just as much as I was frustrated with 11th graders' attitudes.

The other opportunity that came out of that session was meeting a pediatric geneticist and being invited to his clinic. So yesterday I spent the afternoon with kids... and I loved it. We don't get much time in pediatrics until we are on the wards, so this was my first real experience interviewing a child, doing a physical exam and maybe most importantly, interviewing their parent.

The cases were mostly children with connective tissue disorders, like Ehlers-Danlos Syndrome where patients have extremely loose joints, hyper-elastic skin that bruises easily and easily damaged blood vessels. These patients have a normal life span, but can be at risk for internal organ rupture or joint pain/arthritis.

I learned the most important and telling question that I will now use as the first question to all of my patients, especially the parents of my patients: "What are you most worried about?" Has a doctor ever asked you that? Wow. That one question gets to why the patient is in your office today, gives you insight into what you need to do or say to make that patient feel good about coming, and allows you to evaluate the weight of the problem in the patients life. I like it.

I also learned that the best way to evaluate a 2 year old for a connective tissue, neurological or muscle disorder is to get down on the floor and play with them! See what they can and can't do like standing, running, getting up from the floor without using their hands, or jumping on one foot... keeping in mind their age and milestones that they should be able to meet. Oh, and make sure you have a colorful toy in your pocket to distract them from your poking and prodding.