I’m mid-clerkship, and here’s what I found helpful so far:
Pediatric Emergency Playbook. PEMPlaybook.org Your best bet. This is a great podcast by UCLA-based Tim Horeczko, MD. He digs into topics for about 1 h at a time. It’s pretty engaging, and brings in cases, the latest research, and lots of clinical pearls. Many of the topics are high-yield, such as diarrhea, syndromes, otitis media, and strep throat.
Peds in a Pod. This one is by a few fun residents and some attendings. They are making it to review for the pediatrics boards. The episodes vary in length and quality, and are generally pretty good.
Peds Cases. More variable in quality. PedsCases.com. Mostly pretty short.
I’m using BRS Pediatrics as more of a textbook, and I like Pre-Test Pediatrics and Case Files: Pediatrics for lots of questions and for cases followed by questions, respectively.
Special things to bring with you
I clipped a little stuffed animal penguin on my stethoscope. Kids like it and parents think it’s cute.
Stickers are good to stash in your white coat.
As always, stock up on alcohol swabs, and always have a trusty penlight, lots of pens, highlighter, stethoscope, and maybe even a tuning fork. I like a White Coat Clipboard and/or small legal pad too.
I also snagged one of these $2 cards to go on a badge reel with normal vital sign ranges for the various age groups you will see and developmental milestones (can find on eBay, Amazon, etc):
Do you have a big frosty box of Eppendorf tubes where you can’t read the tops? Rubbing of the frost not working?
I found that quickly blowing the tops with a heat gun does the trick, while barely warming up the samples.
You can always get a cheap-o heat gun like this one from Home Depot rather than paying hundreds for a “science” heat gun from a scientific supplier, but it probably will die on you sooner. A hairdryer can work in a pinch.
I liked SOAP for Obstetrics and Gynecologyfor the wards. It’s a handy reference that tells you the questions to ask, physical exam findings, and how to construct an assessment and plan for ~100 different common conditions.
ACOG Practice Bulletins are good sources to read up on specific topics for the wards.
Q-banks: UWorld, UWise (APGO’s Q-bank, provided to students by many med schools)
The best podcast is Dr. Tonya Wright’s The OBG Med Student (Apple). Dr. Wright is the clerkship director at Penn State’s med school, and she recorded twenty-six 10-20 minute episodes with residents and faculty members from Penn State Hershey Medical Center. Each episode uses a great case-based Q&A back-and-forth format that is interesting and engaging. This podcast is specifically focused on APGO learning objectives that are frequently tested on the SHELF exam. It is specifically made for med students. Give it a listen!
Online MedEd is well-received, but I didn’t use it much.
APGO (Association of Professors of Gynecology and Obstetrics) has produced a library of over 50 short (5-10 min) animated YouTube videos about high-yield medical student learning objectives. They’re pretty engaging and well done. Fire up Brave Browser (so you don’t have to watch ads and can earn some crypto) and tune in: https://www.youtube.com/playlist?list=PLy35JKgvOASnHHXni4mjXX9kwVA_YMDpq
The OB/Gyn Podcast is a bit too long-winded and historical in my opinion, but might be good if you have a long car ride and want something to listen to: http://www.obgyn.fm/.
“VEAL CHOP” was a good way to remember fetal heart tracings. This is part of fetal heart monitoring to measure fetal distress. You look at the fetal heart rate (top trace) and uterine pressure (bottom) in these traces.
One of my attendings broke down hypertension in pregnancy like this:
Lastly, for maternal-fetal physiology, remember:
Most stuff goes up like 30%
Everything goes up even more if there are twins, triplets, etc (multiple gestation)
Blood plasma volume goes up even more than Hgb, often leading to a dilutional anemia picture (even though the total RBC mass is up).
Skills to know/learn
OR: know how to:
Get your gloves up, scrub, get bed in/out of room at beginning/end of case, help roll patient to/from bed to table
putting in/taking out Foley catheter,
generally two-hand or one-hand; instrument tying isn’t as common.
The French knot is used to close large skin incisions (e.g., after C-sections), which is able to be buried under the skin, but you probably won’t be expected to learn that one even though it’s easy.
Nice, concise history
All OB patients should be asked the four questions — vaginal bleeding, loss of fluids, contractions, and have you felt the baby move? (note quickening is ~20 wks for primigravida and a few weeks earlier for multips).
Shimadzu LabSolutions Postrun software isn’t always the easiest to use, and the funky translations from the Japanese version don’t help. After a few years using it, I’m sharing what I’ve learned in a quick guide to some of the most important and commonly-used functions for any analyst.
1. Extracted Ion Chromatograms (EICs)
Often, you’ll want to get a trace of when a specific ion’s m/z is seen over time. Basically, you’ll want to extract a chromatogram (signal over time) for a specific ion from all the data. This is in contrast to a Total Ion Chromatogram (TIC), which sums up the total number of counts for all ions with any m/z, and displays it over time. The TIC lets you know when there’s a peak, but it can be misleading if you’re using a dirty column, have impurities from the vials/septa/mobile phases that fly well, etc, and it may obscure small peaks that you are interested in if they are low abundance or don’t ionize well.
Under MS Data, just click “Data View Parameters” in the top left of the sidebar. From there, just type in the desired m/z values. “Event” refers to the polarity — for positive mode, it’s “1” on our system, and “2” for negative. Feel free to get a bunch of EICs for everything you’re interested in using either polarity, and look for many adducts like [M+H]+, [M+Na]+, etc.
If you have many samples you analyzed, select the rows of the MS Data View Parameters window, copy (ctrl-C), and you can paste them into the MS Data View Parameters window of your other data files.
EICs will be displayed below the TICs in the Chromatogram View. If you save the data file, they’ll still be there when you reopen it (i.e., it saves your “MS Data View Parameters” settings).
2. Quick data export with TICs, EICs with peak heights, and mass spectra
LabSolutions has a powerful (yet clunky) report editor that lets you generate whatever report you want, complete with chromatograms, mass spectra, methods info, annotations, etc. However, often you just want to get a quick export of chromatograms and a mass spectrum if you’re just characterizing a compound. For an LC-MS analysis, you may also want some EICs and peak heights (areas are harder — see next section). To get this done without having to click around in the report editor, you simply use the “Print Graph Image” command. This can quickly export a PDF that will have the chromatograms you have displayed, and the mass spectra you have up (one positive, one negative). The mass spectra will be from the positive and negative scans taken at the time where the vertical line is positioned on the chromatograms (controlled by double-clicking, or clicking the Scan < or > buttons.
Here’s an example report that it’ll generate and let you Save As with a single click. Note that it gives a peak height for each EIC. Peak height should be fine for quantification, though it is not considered as sensitive as integrating the peak area (see part 3).
If you use the actual report editor, you can customize everything more. Some key options in this editor to know about are that when you double-click on a mass spectrum:
“Not thin out” check box and threshold (relative abundance in % I think) lets you label more peaks. Often 6-7% is a good threshold.
Feel free to customize the fonts and angles.
You can select the m/z range to zoom in peaks of interest, and pick the rt when you want to show spectra.
3. Peak area
Integrating peak areas in LabSolutions is possible, but pretty clunky. However, it can give you more sensitivity than peak height for quantitative analysis.
Here’s how to do it:
In the bottom right (Method View), go into the compound table and type the name and m/z for the compound(s) of interest
2. Click the “integration” tab. I think you have to pick the compound you want, then move to the area to the left (Results View), click the “Compound” tab, and right-click to perform “Peak integration for All IDs”
3. You can also try the “Peak Table” tab on the left and toggling back-and-forth between “View” and “Edit” on the far right, and possibly changing peak width in the settings in the “integration” tab. But be sure you are using consistent integration parameters for all samples.
Once you have your data, I think you have to copy/paste or type it into its final destination (spreadsheet, etc).