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Hello Medical Student Members of the AAP! Wherever you are this summer – enjoying a vacation, doing research, shadowing physicians, serving locally or internationally, or spending time with family – we are excited to bring you this June edition of MedStudentNews. Check out our feature on how to become an outstanding residency applicant as you prepare for application and interview season! We also have great articles spotlighting a pediatric interest group service project and Pediatric Intensive Care as a subspecialty. You are also sure to enjoy this edition’s

reflection, “Exceptional Madelyn,” a personal experience from a student after working with a child

with post-traumatic stress. As we continue this year, we are eager to hear from you and feature your interest group’s events, your examples of advocacy, your

creativity, or your research or case reports! See the last page to find out how to contribute! We hope you enjoy this issue, and perhaps you will find an article or idea that sparks your interest as you prepare for the new academic year!

~Holly, Student Editor

MMEEDDSSTTUUDDEENNTTNNEEWWSS

JUNE

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Student Editor Holly Hodges, MD Pediatrics Resident, PGY-1 Boston Combined Residency Program AAP Medical Student Subcommittee Priyanka Basak, Med 4 University of Pennsylvania School of Medicine Katie Marie Chambers, Med 4 University of South Carolina School of Medicine Elizabeth Keating, Med 4 Mayo Medical School Neha Joshi, Med 3 University of California, San Francisco School of Medicine Christian Pulcini, Med 3 Tufts University School of Medicine Brian Gordon, Med 2 Florida State University School of Medicine Lisa Costello, MD (chair) Med/Peds Resident, PGY-2 West Virginia University School of Medicine

Turn Up the Heat: SUMMER WITH THE AAP

INSIDE THIS ISSUE!

How to Be an Outstanding Residency Applicant

Service Spotlight: Caring for Kids with Special Needs

Subspecialty Spotlight: Pediatric Intensive Care

Trends in Parents’ Use of

Over-the-counter Medications

Reflection: “Exceptional

Madelyn”

NNNNEEEEEWWWWWSSSSS

MED.STUDENT.NEWS June 2012

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Let’s talk pedi in “The Big Easy!”

We want to see YOU at the

AAPExperience National Conference and Exhibition October 20-23, 2012 // New Orleans

Registration opens June 1st, 2012! Amazing plenary speakers! Special Saturday activities devoted to medical students,

residents, and fellowship trainees complete with a keynote address and a panel of program directors to answer your questions, followed by “subspecialty speed-dating!”

Special Conference Track – Embracing every child: combating health disparities in your practice and your community

Check out the full preliminary program: http://www.aapexperience.org/2012/downloads/preliminaryprogram.pdf

MED.STUDENT.NEWS June 2012

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At the2011 AAP National Conference and Exhibition (NCE) in Boston, Dr. Ted Sectish, Program Director of the Boston Combined Residency Program (BCRP) – Children’s Hospital Boston, presented to medical

students his take on “The Match in Pediatrics: Variety, Values, and Fit.” The informative and well-organized presentation outlined the important factors that residency program directors use to evaluate potential residents, as well as what medical students should consider when applying and ranking programs. The presentation itself will not be the focus of this article, as I had the unique opportunity to interview Dr. Sectish in order to ask a variety of specific, student-submitted questions based on his presentation. The Powerpoint presentation is posted online on the AAP website Section on Medical Students, Residents, and Fellowship Trainess (SOMSRFT) section, however, so medical students who were unable to attend the conference can still benefit from Dr. Sectish’s insights. Some of the

questions re-emphasize a topic that was addressed in the presentation; therefore, if there is confusion please refer to the Powerpoint presentation.

1. Many 2nd year medical students are currently receiving or have received their Step I board scores and are beginning to think about where to apply for pediatric residency. In your presentation last October, you showed data from a national survey of program directors both from medicine and pediatrics. Step I scores were ranked as the #2 most important factor for all residency directors outside pediatrics and #8 among pediatric residency directors. Why do you think there is a discrepancy between the two? Also, do pediatric programs typically have cut-offs for how high a Step I score must be for an applicant to be considered?

Dr. Sectish – I can only really comment on

pediatrics and, more specifically, my thoughts

concerning the Step I scores. I personally do not

believe that test scores are an important factor

in becoming an excellent pediatrician. Some

people are better test takers than others, and

some of those who are poor test takers turn out

to be excellent pediatricians. With this in mind, I

believe pediatric residency directors tend to

emphasize other portions of the application

more, as best shown by the study I cited. For

example, Step II scores (Clinical Knowledge and

Clinical Skills) are ranked higher in evaluating

pediatric residency applicants, as they are

better indicators of how proficient individuals

will be as clinicians. In terms of cut-offs for Step

I board scores, our program does not use cut-

offs.

2. Can you please comment further on how much emphasis is placed on research? For example, what type of research is important, and how much research should a medical student complete before applying to residency Dr. Sectish – It is dependent on programs. Some

institutions emphasize research experience over

other factors when evaluating an applicant. This

is usually clear when applying to programs as

those who value research will emphasize it. In

terms of what type of research, it is a common

misconception among applicants that pediatric

research is more important than non-pediatric

research. What is more important for medical

students interested in pediatrics who participate

in research is that they show a commitment to

the research and produce scholarly work in the

How to Become a Competitive Pediatric Residency Applicant: A presentation and conversation with Dr. Theodore Sectish, Program Director of the Boston Combined Residency Program (BCRP), Children’s Hospital Boston By Christian Pulcini, Med 3, Tufts University School of Medicine

MED.STUDENT.NEWS June 2012

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form of publication(s) and/or presenting it at a

conference. Other things that typically impress

program directors are first author publications

and publications in a high-impact journal, but

these are certainly not necessary. Overall, any

scholarly work is looked favorably upon,

whether the focus is in pediatrics or in adult

oncology for example.

3. What other skills, experiences, etc. do program directors generally value? Are there other things that your program generally looks at more favorably in an applicant? Dr. Sectish –It depends on the individual

program. As for our program, we look strongly

for leadership skills in an applicant. An applicant

who shows initiative and starts his or her own

public health program in medical school for

example, or someone who is highly involved

with leadership at the medical school level is

typically looked favorably upon. Showing

initiative and organizational ability are two

important traits for our program overall.

4. Referring back to the survey of national program directors, both medicine and pediatric residency program directors ranked “Grades in

Required Clerkships” as the #1 most important

factor for evaluating medical students. What are your thoughts on why this is #1? Dr. Sectish – It is because the grades are

standardized across the board. Clerkship

directors see hundreds of students and are able

to provide a direct comparison between

students. We want students who have the

potential to be excellent doctors, and excellent

doctors are well-rounded clinicians who do well

in pediatric clerkships and in Ob/Gyn, Surgery,

etc.

5. Are there any particular elective rotations that you would recommend for medical students interested in pediatrics? For example, if a medical school curriculum is not as strong in dermatology, radiology, etc. do you think it is important for medical students to pursue these areas to be a better resident and pediatrician? Dr. Sectish – I know our program does not

generally evaluate elective content for

residency. I do not think there is any special

formula for elective rotations that will make you

a better resident and pediatrician. I would

encourage every student to do what he/she

wants. Most students benefit from sub-

internship electives, and I would highly

recommend these as they can provide evidence

of efficiency in a clinical environment.

6. Do you have any tips for students who become interested in pediatrics later in medical school (as a 3rd year)? Dr. Sectish – I think organizing visiting rotations

and sub-internships is the most important tip for

those who become interested in pediatrics later

in medical school. It is also very important to

show commitment to pediatrics. If applicants

were previously interested in orthopedics (for

example), explain the change in their

application. I would also encourage students to

become involved in their pediatric interest group

and to secure a good advisor in pediatrics as

soon as possible.

How to Become a Competitive Pediatric Residency Applicant By Christian Pulcini

MED.STUDENT.NEWS June 2012

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(continued from previous page)

7. Should residency applicants indicate if they are interested in a specific fellowship/specialty? What are the advantages/disadvantages of speaking with programs about their interests? Dr. Sectish – I think there are several

advantages for a program and an applicant. For

the applicant, it shows the program that he/she

has a well-thought-out plan. For the applicant

and the program, it would be beneficial so the

applicant could be paired up with faculty with

similar interests as soon as possible. For the

program, it could help promote balance in the

class. It would be undesirable for a program to

have 20 residents who all want to be pediatric

cardiologists.

8. Although the next question is not specifically related to how to be a competitive pediatric residency applicant, it is still important for those considering pediatric residency in the future. How will the cuts in federal funding for Children’s Hospital Graduate Medical Education

(CGME) affect your program and other institutions? Do you see this as a serious problem moving forward? Dr. Sectish – As you know, everything is on the

table in terms of health care costs. I think in the

next few years all residency program directors,

even those outside pediatrics, will be forced to

take a look at the size of their programs. I know

children’s hospitals will remain dedicated to

educating future pediatricians, but the size of

the programs will most likely be scrutinized.

9. What are some things about yourself you would be willing to share? Such as – where did you grow up? Where did you attend medical school? Etc. etc. Dr. Sectish – I grew up in Eastern Pennsylvania. I

attended medical school at Johns Hopkins and

did my residency here at Children’s Hospital

Boston. I was a general pediatrician for a

number of years in Salinas, CA, and was also

formerly the residency program director at

Stanford. I came to Children’s for a number of

reasons, including location (returning back to

the east coast), I did my residency here, and

CHB is an excellent hospital with a

distinguished, large program. I still serve as a

hospitalist and make a yearly commitment to be

on service when the new interns arrive.

10. Any last thoughts for medical students pursuing a pediatric residency? Dr. Sectish – Some very important things to

think about are location, finding an

environment that serves your needs, meeting

residents and faculty who you would want to be

colleagues with, and which program would best

stimulate you intellectually.

I, along with the AAP Medical Student Subcommittee, would like to sincerely thank Dr. Sectish for taking time for this interview and for providing the presentation from the national AAP meeting. I encourage all medical students to consult Dr. Sectish’s presentation on the AAP website for further information: http://www2.aap.org/sections/ypn/ms/educ_resources/nce.html or use the direct link here: http://www2.aap.org/sections/ypn/ms/educ_resources/SectishPlenary2011.pdf .

How to Become a Competitive Pediatric Residency Applicant By Christian Pulcini

MED.STUDENT.NEWS June 2012

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As medical students, we often take for granted our talents and capabilities that allow us to be successful in a competitive and powerful profession. At times it takes witnessing the struggle of another person to realize and be grateful for our fortuity. One such instance where this realization is made very profoundly is spending time with persons who have physical and mental disabilities.

The University Of South Carolina School Of Medicine Pediatric Interest Group sought out the opportunity to work with children who have special healthcare needs. The event allowed students to provide respite for parents, allowing them to attend informative seminars during an annual conference related to the challenges faced by parenting a special needs child. This event was important to the Interest Group, as a major goal this year was to build a relationship with an organization called Family Connection of South Carolina.

Family Connection was begun in 1989 by South Carolina parents of children with disabilities and special needs. Their hope was to unite parents who faced similar struggles in order to learn from each other and provide a support system for children and families. The mission of Family Connections of South Carolina is “to

strengthen and encourage families of children with special healthcare needs through parent support” in

order that these children may reach their full potential. Annually, this organization holds the Hopes and Dreams Conference, an event that lasts over two days and provides over 70 informative and encouraging seminars designed for both parents and professionals.

A great need faced by parents wanting to attend the conference is the question of who will care for their children, as finding childcare for children with special needs can be challenging. Pediatrics Interest Group student volunteers decided to help meet this need. The children all had special healthcare needs ranging from

SERVICE SPOTLIGHT: Serving Families with Special Needs By Katie Marie Chambers, Med 4, University of South Carolina School of Medicine

GET INTO ADVOCACY!

2012 SOMSRFT PROJECT:

FOR KIDS!

MED.STUDENT.NEWS June 2012

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mild ADHD to severe physical and mental disabilities. Volunteers divided the children into two groups based on age: children less than 5 years old and older children. Activities and games were planned in advance as a means to keep some of the children occupied and to provide a fun experience for them, so parents did not have to feel guilty about leaving their children behind to attend the seminars. The conference was held over a two-day period, and it took several volunteers to make this service activity possible.

Several students remarked that it was their “favorite event of the year.” One student commented

that he “learned more from the children in two days

than I feel like I taught them.” Another student

described this activity as “challenging to entertain a

hyperactive child” and noted that the event added

insight and “gave a special appreciation for parents and

the struggles that the child with ADHD may present for parents that I will try to take into account as a pediatrician.”

A great story described by a student volunteer was her one-on-one time with an 8-year-old girl with Down Syndrome. The mother appeared anxious as she dropped her daughter off at the conference because she knew what a challenge it could be to care for her daughter. The mother’s concern was appropriate as the

child did not appear interested in the activities at hand. She did not want to wear her glasses that day and made a game out of running around the room and placing the glasses anywhere but on her face. In an effort to try and provide a more entertaining experience for the child, the student volunteer took the child out to the playground area. However, the child noticed the fountain outside the church where the conference was being held and was quickly attracted to it. She raced over to see the fountain and decided to take off her glasses and place them in the fountain along with herself. The student volunteer was slightly embarrassed and frustrated at having to go into the

fountain to rescue the glasses and the child, but then she stopped and thought about the situation and began to chuckle. Here she was, a medical student, splashing in a fountain outside of a church. How ridiculous! In doing so, she noticed how much joy the child seemed to have in that moment for the first time all day. From this experience, she learned to embrace the moment and to be aware that the impact you have on someone sometimes occurs in unexpected ways.

Many students shared similar thoughts and stories and the event proved to be a very moving and growing experience in providing comprehensive care to children. As medical students, we often get limited exposure to children during the course of our training, and when we do, that interaction is often within the confines of a medical facility that solely provides medical care. Experiences that allow us to focus on the emotional, psychological, and social needs of children will make us better pediatricians because they teach us to see the whole child. As future doctors, we need to educate ourselves on how to treat the whole child and not just his or her medical problem. We can do so by giving of our time to children and learning how to meet more than just their medical needs.

SERVICE SPOTLIGHT: Serving Families with Special Needs By Katie Marie Chambers, Med 4, University of South Carolina School of Medicine

MED.STUDENT.NEWS June 2012

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South Carolina School of Medicine Serving Family Connection

MED.STUDENT.NEWS June 2012

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Last Tuesday, I was called to the surgical floor to evaluate a 9-year-old child who was tachycardic on post-op day 1 from a bowel surgery. I knew when I entered the room that she needed to go to the pediatric ICU for what appeared to be septic shock. In the next couple of hours, I had drawn labs and blood cultures, placed a central line, intubated her, placed an arterial line for continuous blood pressure monitoring, given fluids, started epinephrine, added antibiotics, done chest compressions twice briefly when we couldn’t feel

her pulse, called the ECMO team in case she needed to go onto heart-lung bypass, and told the parents of her critical condition. They wanted me to tell them everything would be fine and that their daughter would be well again. I wanted to tell them that as well, but because you can never predict what will happen in the ICU, I could only say that I hoped for the same and that we would do everything we could for her. Their response through tears and dread was one I doubt I will ever forget. They said that as long as I didn’t leave her

bedside, they knew she would be ok. I hoped with them as we waited.

Yesterday, I removed her breathing tube. She was weak, but she was talking to me. She will probably leave the ICU tomorrow, a miraculous and speedy recovery that was unexpected, but wonderful. After I extubated her, her mother said something else that I think will stay with me forever: “Thank you. You saved her life.”

Pediatric critical care can be emotionally difficult, but can also be one of the most rewarding fields in medicine. What other specialty allows you to leave saying you truly saved a child’s life? With significant

medical advances and low unit mortality rates, the vast majority of children admitted to a pediatric intensive care unit in the United States do well, although many are admitted in a state that would be fatal without the

expertise and therapies of the multidisciplinary critical care team.

Critical care medicine developed when other specialties had a need for more attentive care for their most critically ill patients. Pediatric critical care medicine emerged in the 1960s with advances in ventilation, anesthesia, neonatology, and surgical techniques that required more extensive care and monitoring. However, it has only been recognized as a distinct subspecialty since 1987 when the American Board of Pediatrics offered its first sub-board certifying examination.

The first fellowship programs began in the late 1970s and early 1980s, and in 2011 there were 448 fellows training in critical care in the United States (including myself). Nationally, there are less than 1900 board certified pediatric critical care physicians who are caring for children in nearly every state.

Pediatric critical care has several advantages. We are skilled in procedures and thinking on our feet. We care for a wide variety of interesting patients, making us a generalist in many ways. We don’t focus on any one

particular organ system and continue to work closely with all subspecialists. We depend on skilled teamwork and recognize we are only a component in the process.

We also enjoy diversity. Along with having diverse patients and problems to deal with, we also enjoy different days. Sometimes, I am with patients all day in the unit, which may include flying on a helicopter to pick up a patient from another hospital or seeing patients on the floor or in the emergency room for consults. However, on other days I may be giving a lecture to residents or doing simulation training, teaching Pediatric Advanced Life Support to nurses, doing research on outcomes of critically ill children,

SUBSPECIALTY SPOTLIGHT: Pediatric Critical Care Medicine By Maj. Renee I. Matos, MD, MPH, FAAP Fellow, Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh Immediate Past-Chair, AAP Section on Medical Students, Residents, & Fellowship Trainees

MED.STUDENT.NEWS June 2012

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working on my quality improvement project, or volunteering with the AAP. This specialty surely spares boredom, and because it includes some work on nights and weekends, it also means you occasionally have the flexibility of having a weekday to do errands or spend with your family.

Although I have a fixed salary as a member of the uniformed services, according to a recent study in Pediatrics, critical care is among one of only three pediatric subspecialties that is financially beneficial when compared to general pediatrics.1 Additionally, the American Medical Group Association 2009 Physician Compensation Survey reported the median salary for pediatric critical care physicians to be $265,913 (compared to the average salary for general pediatricians of $175,000).2 However, compensation is rarely the motivation for pediatricians.

Ultimately, you need to love what you do. I won’t

say fellowship in pediatric critical care is easy (nor will my husband). However, I do love what I do, and in the end, I get to go home knowing I help to save lives. Although I can’t always succeed in doing so, I can invest

everything in trying and can help families through one of the most difficult experiences they will hopefully have to endure.

1. Rochlin JM, Simon HK. Does fellowship pay: what is the long-term financial impact of subspecialty training in pediatrics? Pediatrics.

Feb 2011;127(2):254-260.

2. Pediatric Salaries. MomMD. Accessed on May 20, 2012 at: http://www.mommd.com/pediatric-salary.shtml

SUBSPECIALTY SPOTLIGHT: Pediatric Critical Care Medicine By Maj. Renee I. Matos

MED.STUDENT.NEWS June 2012

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A social-network friend posted a holiday travel picture of her precious 15-month-old baby girl, pink cheeked and passed-out in her father’s lap on an

airplane. Above the picture was the caption: “Thank

goodness for medicine! It makes the travel easier!” I

found myself pondering the implications of this declaration. In order for this mother to quiet her 15-month-old child on a plane, and to ensure a more pleasant trip, she resorted to the use of a common over-the-counter children’s medication. Several of her

friends, also young mothers, commented on how much they approved of this: “I’m glad that worked!”

Apparently the use of drugs on children for non-medical indications is not uncommon: nearly 1 in 5 mothers admit to doing it at one point in order to get more rest, relaxation, or during a special event like plane travel according to an anonymous TODAY Moms and Parenting.com poll, which asked more than 27,000 mothers.i

Many over-the-counter medications primarily used to treat allergies or even motion sickness are available but are only intended for use in children and for toddlers over 2 years old. For some children, the effects are sedating, but for a subset of them, the effects are energizing and these medications act as a stimulant. The FDA warns that safety and effectiveness of cough and cold medications under two years old is limited and serious adverse effects have occurred including death.3

Giving any medication to an infant or child that is solely for the parent's benefit (whether that benefit is cheap rest, relaxation, or entertainment) and not specifically labeled for treatment of an illness is wrong and could even be considered child abuse. This view is supported by a study done by Dr. Shan Yin in 2010, which focused on pharmaceutical related child abuse claims received by the National Poison Data System between 2000 and 2008.ii Dr. Yin’s data studied 1439

cases of poisoning using sedatives such as cold medicine, allergy relief medicine, or narcotics, of which 172 resulted in severe outcomes including death. Within the reported abuse cases, 17 or 18 deaths were blamed on sedatives. A study done by Pragst et. al in 2006 concluded that diphenhydramine is not safer than other prescribed hypnotics after studying 55 death cases.iii

If you have parents who are considering trying over-the-counter cough or cold medications for easier travel, let them know that there are alternatives. Reinforce good travel planning. Ensure enough assistance when flying, which might include older children and other adults, try to plan non-stop flights, and travel during non-peak times. Encourage parents to try to stay on schedule with naps, snacks, drinks, diaper changes and meals. A portable DVD player, a computer, or even books will often entertain a young child. Remind them to bring snacks for their child, along with the child’s

favorite toy, stuffed-animals or coloring items. Sippy cups can help with cabin pressure changes by relieving inner-ear pressure during take-off and landing. Make sure children are well rested before the trip by putting them to bed early the night before so they are not anxious or irritable on the plane.

The majority of parents have good intentions and are trying their best to raise their children. Pediatricians should support them by avoiding criticisms, but should also send a clear message that there are consequences to using unwarranted medications and that there are safer, more constructive ways to manage children.

i.http://moms.today.msnbc.msn.com/_news/2011/08/09/7318658-whats-your-deepest-darkest-secret-moms-confess-in-our-survey ii. Malicious use of pharmaceuticals in children. Yin S. J Pediatr. 2010 Nov;157(5):832-6.e1.Epub 2010 Jul 21. iii. Poisonings with diphenhydramine-a survey of 68 clinical and 55 death cases. Pragst F, Herre S, Bakdash A. Forensic Sci Int. 2006 Sep 12;161(2-3):189-97. Epub 2006 Jul 20.

Hot Topic: Spotlight on the Startling Trends in Parenting Concerning Over-the-Counter Medication Use By Katherine Wiley, Med 4, Baylor College of Medicine

MED.STUDENT.NEWS June 2012

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“That’s her, right there, wearing that long blue

dress. Madelyn. When lunch is over, I’ll introduce you as

our new classroom helper.”

I nodded, watching the children run across the playground in a manner only kindergarteners can. I’ve

worked with children from many a grade level, and though there are simple quirks about each age group that soften my heart, kindergartners are by far my favorite. For kindergarten is when children learn relationships – the trembling unease of saying goodbye to mom on that first day, the magic of befriending a classmate and watching that companionship grow over the year, the beauty and adulation of having your first formal teacher.

Madelyn was conventionally beautiful – large, round eyes that expressed her better than her own words did, high cheekbones, porcelain skin, and hair in such perfect curls that it reminded me of Ramona Quimby from my childhood books. Ramona, of course, had this inexplicable urge to unwind one of Susan’s

perfect curls and say, “Boing!” as it bounced back into

place. It was in being introduced to Madelyn that I finally understood Ramona’s yearning.

I’m not comfortable with lies, half-truths, or even vagueness in place of the pure candor. It was the nature of this very assignment though, to lie to Madelyn. I wasn’t a classroom helper at all; I wasn’t even going to

be of much help, but rather was there simply to observe her. It was the most intriguing of all my college assignments, and unquestionably became one of my most cherished. Madelyn was a puzzle, I wasn’t allowed

to ask any questions, and the answers that I gained in my ten weeks with her were to determine my fate in the class.

It was called Education for Exceptional Individuals, and the registrar had described it as an exploration of educational policy for the gifted and talented

overachievers. I enrolled because the deviations in a classroom unnerve me – it’s easy to teach to the mean,

but how do you additionally ensure that those falling behind catch up and those already ahead of the curve don’t hit a wall? The class met for four hours at a time,

a bit long, but really, the supposed dogma of the course intrigued me enough to bite the bullet.

On my first day of class, I picked a seat along the window of our Moore Hall seminar room for it looked out onto Bruinwalk and provided the occasional percolation of southern California’s infamous hot Santa

Ana winds. The registrar was rather off; the class focused on various learning disabilities week by week, and the final “learning disability” we’d be discussing

would be a gifted and talented child. Educational policy was not on the map. It wasn’t a bad realization

necessarily, just one I wasn’t expecting. The professor’s

next twist was this assignment – our class would only meet for one hour instead of the allocated four, and the remaining three credit hours would be spent at an elementary school observing an exceptional child. We would be given no back-story on the child, and we weren’t supposed to ask questions of either the teacher

or the child.. The teacher knew our purpose, but it was vital not to single these children out for their disabilities and thus we operated under the disguise of being a “classroom helper.” The only graded components to

this class were a compilation of journal entries from each week with our children, and a final research paper critically analyzing the educational sphere for the specific learning disability our child had. Implicit in all of this was that we had to identify the right learning disability, for our professor had hand-picked the children we would observe; the wrong diagnosis meant your entire paper was decidedly tangential.

REFLECTION: “Exceptional Madelyn” By Neha Joshi, Med 3, University of California San Francisco School of Medicine

MED.STUDENT.NEWS June 2012

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Three weeks and nine hours into the assignment, I had not a clue to Madelyn’s secret. Six weeks later, I

was at the same impasse. We began covering various disabilities in our weekly class meeting; Madelyn didn’t

even come close to fitting into any of them. The professor caught me studying genetics at a table in the Kerckhoff Coffee Shop one afternoon and asked if I had figured out Madelyn yet. I said no; she laughed and said to keep at it. I gave her a half-hearted smile and pointed out we only were discussing a finite number of learning disabilities, so at least I had some boundaries to work within. She furrowed her eyebrows in return, and said there was no such guarantee. When she left, I pulled out my iPhone to check the deadline for dropping a class – it had passed, and I was stuck.

Madelyn did well in school. She was at the expected grade level academically, would easily socialize with her peers, and looked physically normal. Her language capabilities and articulation were no different from anyone else; she could read. She sometimes had trouble concentrating, but there was no pattern to this so it could fall within normal limits too.

The one – and only – thing that became palpable was her love for affection. In addition to my weekly slot, I began spending almost every free hour between my own classes in her classroom for the pressure of my grade was finally getting to me. If we were all sitting in a circle, Madelyn would sit in my lap. If she were reading a book, her head would be leaning up against me. When we walked to lunch, Madelyn held my hand. She made me hers; there was no possibility to continually keep up the façade of being in the classroom equally for everyone. I shared this concern with her teacher, who gave me my first clue – “Her attachment to you is the

best symptom you’ll get.”

Madelyn did better when she was sitting in my lap and my arms were wrapped around her. She read for longer, wrote more introspective sentences in her

journal, and slowly began telling me things I hadn’t

asked for – where she bought her shoes and how her dad tied her ponytail this morning with the wrong color ribbon.

We were sitting at the outdoor wooden lunch table one day, coincidentally having both brought peanut butter and jelly sandwiches for lunch. Hers was soggy, mine wasn’t thanks to a tip I picked up from the tattered Parents Magazine at the gym months before – put peanut butter on both slices before adding the jelly. I let her in on my trade secret, and she remarked rather seriously, “That’s a mommy idea. I’ll teach my daddy

about it.”

I met her dad too. He was young. He had a song for her – sort of like how Bill Clinton sang Chelsea Morning to his daughter when she was young – and he unfailingly sang it every day as he untied and retied Madelyn’s shoes for their walk home. Each day, he met the classroom teacher with a handshake and a subsequent number – 362, 363, 364 – to which she’d

always reply that she was proud of him. On 365, he said, “It’s been a year since I lost her and a year since I found

myself. I don’t know though what it is going to all mean for Madelyn.”

That’s when the disability made sense, and my

paper came together.

Madelyn isn’t her real name; I picked it because the

name somehow conveys sunshine on a rainy day to me.

And that’s exactly how I’d describe her story.

REFLECTION: “Exceptional Madelyn” By Neha Joshi, Med 3, University of California San Francisco School of Medicine

MED.STUDENT.NEWS June 2012

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Are you in need of some fresh new ideas for your medical school’s

pediatric interest group? The Medical Student Subcommittee has worked to

put together a thorough resource guide for that very purpose! Based on

ideas submitted by fellow interest group members across the nation, the

guide addresses advocacy and community service, conferences and

meetings, special events, summer opportunities, and fundraising! Plus it

tells you more about how to get involved with the AAP! Be on the

lookout – it will hit the AAP SOMSRFT website very soon!

Pediatric Interest Group (PIG) Resource Guide !!

MED.STUDENT.NEWS June 2012

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This newsletter is designed to let you know what is going on within the AAP and also to let you know what is going on with medical students across the nation. Do you have a great idea for a newsletter article? We want to know! Have you been involved in something noteworthy for children? Tell us about it! We know that our section has strong students at great medical schools, and we want to share the outstanding things you are interested in and are doing with the other medical students in the AAP. So, if you want to be featured in one of our future newsletters or if you know someone that should be featured, please send any of us an e-mail. All of our e-mail addresses are listed below.

We look forward to hearing from you!

STUDENT EDITOR: Holly Hodges, MD Pediatrics Resident, PGY-1 Boston Combined Residency Program e-mail: hollykhodges@gmail.com

AAP MEDICAL STUDENT SUBCOMITTEE: Priyanka Basak, Med 4 University of Pennsylvania School of Medicine e-mail: pbasak@mail.med.upenn.edu Katie Marie Chambers, Med 4 University of South Carolina School of Medicine e-mail: katie.chambers@uscmed.sc.edu Elizabeth Keating, Med 4 Mayo Medical School e-mail: keating.elizabeth@mayo.edu Neha Joshi, Med 3 University of California, San Francisco School of Medicine e-mail: neha.joshi@ucsf.edu Christian Pulcini, Med 3 Tufts University School of Medicine e-mail: Christian.pulcini@gmail.com Brian Gordon, Med 2 Florida State University School of Medicine e-mail: briangordon2386@hotmail.com Lisa Costello, MD (chair) Med/Peds Resident, PGY-2 West Virginia University School of Medicine e-mail: costello.lisa@gmail.com

Want to Be Featured in a Future Issue? Let Us Know!