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.

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