For my mid-site evaluation, I presented a H&P on a 4-year-old pediatric patient with sickle cell disease who presented to the pediatric emergency department with a fever. Generally, in infants younger than one month of age, fever typically warrants a full septic workup. Due to this patient’s underlying sickle cell disease and prior hospitalization for splenic sequestration with fever of unknown etiology, a full sepsis evaluation was also indicated. This case allowed me to recognize the urgency and severity of febrile illness in patients with sickle cell disease and to consider potentially life-threatening complications such as bacteremia and acute chest syndrome. It reinforced the importance of prompt evaluation and management in this high-risk population.

For my final site evaluation, I presented a history and physical on a pediatric patient with a Salter Harris IV fracture of the anterior right tibia. During the discussion, we reviewed the different subtypes of Salter Harris fractures and their clinical significance, including which fracture patterns are relatively stable versus those that typically require surgical intervention. We discussed that Salter Harris II fractures are the most common in pediatric patients, while type IV fractures are relatively rare, accounting for approximately 3% of cases. I was involved in the patient’s care from the initial assessment through management planning, which helped me better understand how clinical findings and imaging results guide treatment decisions. I also presented a journal article on Salter Harris fractures that emphasized the importance of surgical fixation for type III and IV fractures in order to ensure stability and preserve the integrity of the growth plate.

Throughout the rotation, I received valuable feedback from my preceptors regarding key components of the pediatric history that should be included based on patient age. For example, obtaining a detailed birth history is particularly important in children <2 years old. With feedback obtained from various preceptors throughout the rotation and from my site evaluator, I feel more confident in my ability to evaluate and care for pediatric populations.