My ninth rotation was in pediatrics at Queens General Hospital from November 4 to December 6, 2024. During this rotation, I had the opportunity to work in various settings: three weeks in the Pediatric Emergency Room, one week in the Neonatal Intensive Care Unit (NICU), and one week in the pediatric clinic. These diverse experiences allowed me to work alongside a multidisciplinary team, including primary care physicians specializing in child and adolescent care, pulmonologists, neurologists, and cardiologists.

In the Pediatric Emergency Room, I gained valuable experience stabilizing acutely ill pediatric patients. I managed cases involving dehydration, respiratory distress, and febrile seizures, which enhanced my ability to respond promptly and effectively to emergencies. I also developed proficiency in assessing age-appropriate developmental milestones and identifying delays, critical for early diagnosis and intervention.

In the NICU, I cared for neonates with conditions such as respiratory distress syndrome, deepening my understanding of neonatal physiology and care protocols. Observing and participating in the management of these fragile patients taught me the importance of meticulous attention to detail and teamwork in providing optimal care.

During my week in the pediatric clinic, I learned the importance of routine vaccinations, growth monitoring, and anticipatory guidance in ensuring healthy development. Working closely with specialists, I gained insights into the management of chronic pediatric conditions, such as asthma and congenital heart disease. I also recognized the significant impact of social determinants of health, including housing, nutrition, and parental education, on pediatric outcomes.

Throughout this rotation, I honed my communication skills to effectively engage both young patients and their caregivers. I focused on delivering clear, empathetic explanations while addressing their concerns with sensitivity and reassurance. Despite these achievements, I encountered challenges, particularly in balancing the fast-paced environment of the Pediatric Emergency Room with thorough documentation and follow-ups. Additionally, I recognized the need to better tailor care to align with cultural and familial values, particularly when addressing sensitive topics like vaccinations.

Moving forward, I plan to dedicate time to reviewing evidence-based guidelines, such as the American Academy of Pediatrics (AAP) recommendations, and studying common pediatric conditions frequenly. By doing so, I aim to enhance my clinical knowledge and stay updated on best practices. Furthermore, I will develop strategies to improve task prioritization and time management in high-pressure environments.

By embracing these strategies and committing to continuous learning, I am confident in my ability to grow as a competent and compassionate Physician Assistant, providing high-quality care to pediatric patients and their families.

During my Pediatric rotation at Queens General Hospital from November 4 to December 6, 2024, I participated in two comprehensive site visit evaluations conducted by PA Gary Maida. These evaluations included a midpoint review and a final assessment, each lasting approximately 1.5 hours. Along with two classmates, I presented various components, including two complete History and Physical (H&P) reports, a pharmacological drug card discussion, a patient management discussion, and a journal article presentation.
During the sessions, Professor Maida engaged us in detailed discussions about each other’s drug cards, focusing on mechanisms of action, indications, dosing, and clinical applications. For instance, I discussed amoxicillin, a bactericidal agent that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. This action prevents transpeptidation, an essential step in bacterial cell wall synthesis, disrupting cross-linking and leading to bacterial cell lysis and death. We explored the dosing of amoxicillin for different pediatric conditions: 80-90 mg/kg/day for acute otitis media and 45 mg/kg/day for pneumonia. Professor Maida encouraged us to apply this knowledge in clinical scenarios and quizzed us to deepen our understanding of pharmacological principles.
One of the cases I presented involved a pediatric patient who came in with his mother, reporting right eyelid swelling and pain for one day. This prompted a discussion on the differential diagnosis between preseptal cellulitis and orbital cellulitis. Preseptal cellulitis typically presents with eyelid erythema, swelling, and tenderness without pain on eye movement, proptosis, or vision changes. In contrast, orbital cellulitis presents with similar eyelid symptoms but includes distinguishing features such as pain with eye movement, proptosis, impaired ocular mobility, and potential vision changes or loss. Systemic symptoms such as fever are more common in orbital cellulitis, reflecting its more serious nature. PA Maida provided feedback on refining differential diagnoses and highlighted the importance of thorough history-taking and physical examination in pediatric patients.
The second case I presented involved a pediatric patient with left ear pain and light yellowish discharge for one day. To supplement this case, I presented a journal article titled “Chronic Suppurative Otitis Media: A Comprehensive Review of Epidemiology, Pathogenesis, Microbiology, and Complications.” The article provided a detailed overview of the disease, emphasizing its prevalence, common microbial causes, and potential complications such as hearing loss and intracranial infections. PA Maida appreciated the integration of evidence-based literature with the clinical case and encouraged us to stay updated on current research to enhance our medical decision-making.
The cases presented by my classmates also fostered engaging discussions. One notable case was a pediatric patient with radial head subluxation (nursemaid’s elbow), a common condition caused by a sudden pull on the outstretched arm. This led to a discussion on recognizing the characteristic clinical presentation and the reduction techniques, such as the supination-flexion method or the hyperpronation method.
Throughout the evaluations, PA Maida provided constructive feedback, emphasizing areas for improvement while also acknowledging our strengths. He encouraged us to critically analyze our clinical reasoning and management plans. He also took the time to inquire about our overall experience during the rotation, ensuring we were gaining valuable learning opportunities.
The site visit evaluations were an enriching learning experience that allowed me to sharpen my clinical skills, improve my pharmacological knowledge, and engage in evidence-based discussions. The feedback I received and the collaborative environment fostered by PA Maida and my peers contributed significantly to my professional growth.

Clinical scenario

A 60-year-old West African woman presents to the Emergency Room with severe abdominal pain, rating it an 8 out of 10, accompanied by her 29-year-old son, who acts as her translator. Recently moved to the U.S. seven months ago, she is a Muslim with limited English proficiency and expresses a strong preference for traditional herbal remedies such as bitter Leaf and turmeric and some others., which she believes are more effective than conventional treatments. The patient has experienced worsening pain over the past three days, along with nausea and decreased appetite, but denies any recent trauma or fever. While the son is supportive, he is anxious about the treatment options and struggles to navigate the healthcare system. The healthcare team faces the challenge of respecting the patient’s cultural beliefs while ensuring she receives appropriate medical care, necessitating effective communication and education about her condition and treatment options.

Why It Requires Cultural Awareness/Humility

The patient’s strong preference for traditional herbal remedies indicates that her cultural beliefs are central to her understanding of health and healing. Healthcare providers must acknowledge and respect these beliefs to establish trust and rapport.

Limited English proficiency can create barriers to understanding medical advice. Cultural humility allows providers to recognize their own biases and limitations in understanding the patient’s perspective, which is crucial for effective communication and patient-centered care. This awareness helps them approach patient interactions with an open mind and a willingness to learn from the patient’s experiences.

The patient’s right to make informed choices about her health must be respected, which requires understanding her cultural values and beliefs.

Cultural Factors to Consider

The patient may have a holistic view of health, where traditional remedies are seen as the most effective form of treatment. This contrasts with the biomedical model that emphasizes pharmaceutical interventions. Bitter Leaf herb is traditionally used in Africa to treat various gastrointestinal issues, including abdominal pain and digestive disorders. The leaves can be boiled and consumed as a tea or used in soups. Turmeric is known for its anti-inflammatory properties; turmeric may be used for abdominal pain due to its potential to soothe inflammation in the digestive tract. It can be added to foods or taken as a supplement or tea.

The son acts as a translator and support, indicating that family plays a significant role in the patient’s healthcare decisions. The healthcare team should involve him in discussions and decisions, respecting the family dynamics.

As a Muslim, she may have specific beliefs and practices related to health, diet, and treatment options. Muslims follow dietary laws that dictate what is permissible to eat (halal). Foods must be slaughtered and prepared according to Islamic guidelines, avoiding pork and alcohol. Many Muslims believe in the power of prayer (dua) and may seek spiritual healing through prayer, recitation of the Quran, and consultation with religious leaders or healers. This spiritual component can be an integral part of their coping mechanisms for health issues. Providers should be aware of these to avoid recommending treatments that conflict with her religious practices.

Beliefs That Might Differ from Western Medicine

The patient believes that traditional herbal remedies are more effective than conventional medicine, which could lead to conflicts if providers advocate exclusively for standard medical treatments without considering her preferences.

Many cultures view health as a balance between physical, spiritual, and emotional well-being, which may not align with the Western focus on disease treatment.

Areas Where Conflict Might Develop

If the recommended treatment involves pharmaceuticals that the patient perceives as harmful or ineffective compared to herbal remedies, there may be resistance to adhering to medical advice.

The patient may be hesitant to consent to procedures or treatments that conflict with her beliefs, necessitating thorough discussions about risks and benefits.

If the healthcare team does not address her pain adequately or relies solely on medications, the patient might seek alternative remedies, leading to a disconnect in care.

Expectations for Demonstrating Cultural Competence/Humility

The student should practice active listening to understand the patient’s beliefs, preferences, and concerns, allowing her to express her views without judgment. Create a safe space for the patient to express her beliefs and experiences with traditional remedies. Ask open-ended questions about her preferences and previous uses of herbal treatments.

The student should use everyday language when discussing the patient’s health needs and treatment options. For instance, instead of saying “gastrointestinal discomfort,” the student might say “stomach pain” or “upset stomach. “When introducing new concepts, the student should break them down into simple components. For example, rather than saying “antibiotics are used to treat bacterial infections,” the student can explain, “We will give you medicine that helps fight infections caused by germs.”

The student should maintain an open posture, avoiding crossed arms or legs, which can signal defensiveness. Instead, leaning slightly forward can show engagement and interest in what the patient is saying. Smiling gently and expressing concern through facial expressions can help the patient feel more at ease, encouraging open communication. The student can use nodding and other affirmative gestures to convey understanding and support while the patient is speaking. This nonverbal communication reinforces that the student is listening attentively.

Utilizing the son effectively as a translator while ensuring clear communication about medical options is essential. The student should avoid using family members for sensitive information unless explicitly allowed. If the discussion involves sensitive topics (e.g., mental health issues, sexual health, or end-of-life decisions), it may be more appropriate to have a professional interpreter or to provide this information in a private setting without family present. This helps protect the patient’s privacy and comfort.

The student should provide clear and culturally appropriate education about her condition, treatment options, and the potential benefits and risks of both traditional and conventional treatments. They should discuss how herbal remedies might interact with prescribed medications.

The student can propose a collaborative treatment plan that incorporates both traditional remedies and necessary medical treatments, respecting the patient’s autonomy and cultural beliefs.

The student should avoid making assumptions about the patient’s beliefs or preferences based solely on her background. Each patient is unique, and open dialogue is crucial.

Patient Counseling or Education Required

Explain the patient’s abdominal pain, possible causes, and the importance of timely intervention. Use simple language and visual aids if necessary to enhance understanding.

Present both conventional treatments and how they might work alongside her traditional remedies. Present evidence supporting the effectiveness of certain conventional treatments, but do so respectfully, acknowledging her perspective. For example, explain how certain symptoms might necessitate immediate medical intervention even if she prefers herbal treatments. Emphasized that the goal is her well-being and pain relief.

Validate the son’s anxiety about the healthcare system and provide reassurance about the hospital’s support systems, emphasizing that the team is there to help both the patient and her family. Discuss a follow-up plan to ensure ongoing communication and support, inviting her and her son to ask questions or voice concerns at any time. Teach-Back Method can help confirm that the patient and her son understand the information shared during the interactions.