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Baylor College of Medicine

Pediatrics and the Core Clerkship Curriculum

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ALICE: Alright.

JUAN: Well, welcome. My name is Juan Carlos Ramirez. I’m one of your hosts here at the Baylor College of Medicine Resonance Podcast and I am joined by some wonderful guests today. 

ALICE: Hi, yeah, I'm Alice. I'm also a student at Baylor in the MD/PhD Program and a member of the Resonance Podcast group; and today we’re talking with Dr. Fielder who was the Pediatric Clerkship Director from 2013 to 2019 and is now the Pediatric Residency Program Director.

DR. FIELDER: Hi guys.

JUAN: Welcome.

DR. FIELDER: Thanks.

ALICE: Hi, so Dr. Fielder, can you tell us a little bit more about yourself and your career interests and how they've evolved over time?

DR. FIELDER:  Sure. So first of all, thanks for inviting me. I think this is such an honor and I am a huge fan of podcasts and listen to them every time I get in my car. So yeah, so a little bit about me so I am a pediatric emergency medicine physician at Texas Children's and at Baylor, and I did my undergrad at Texas A&M, whoo! Any Aggies out there? I graduated in 2000 and I did med school at UTMB in Galveston. I went on to do my Pediatrics residency at Arkansas Children's Hospital. So University of Arkansas for Medical Sciences, and then I came back here to Texas, to Baylor, to do my fellowship in pediatric emergency medicine or what we will call PEM. And so I finished fellowship in 2010 and have been here on faculty since 2010 in the Department of Pediatrics and in the specialization of Peds emergency medicine.

So that's sort of my career path and my interests in Pediatrics. It's a good question. I think I was a big fan of everything in med school. I was one of those, when I did my surgery rotation I thought I wanted to be a surgeon and I did internal medicine and thought I wanted to be a medicine physician and, yeah, every subspecialty I liked and I did Peds fairly late in my clerkships. And when I did it, I knew. I knew that it wasn't just a “I love everything I'm going to want to do this too”. It was a different feeling that I got. Yeah, that's sort of my trajectory into Pediatrics.

As far as PEM, or peds emergency medicine that was another one where in my residency I was fortunate enough to train at a hospital where it was very resident driven, Arkansas Children's Hospital has one of the largest or one of the most I think founded or solid Life Flight programs in the nation and they, back in the day, allowed residents to be the physicians on the helicopter in your second year of residency. And you can moonlight for 50 bucks an hour, and I moonlit as much as I possibly could which helped me really hone my skills as an emergency medicine provider or critical care provider and that kind of helped me. I loved that role. I love the ER. I loved the PICU. So towards the end, I decided on emergency medicine just because that's where my mentors were.

ALICE: And that's really awesome. Where along the way did you realize that you also had an interest in student education or teaching because that seems to have played a really big role in your career as well.

DR. FIELDER: Yeah. Absolutely. It's funny. I always loved to teach and along the lines of emergency medicine. I love to teach procedural skills to residents and to my colleagues, my fellows and . . . I think it was my first year out of Fellowship, my last year Fellowship, I developed a curriculum in emergency medicine pediatric simulation focused on the skills that are necessary just as an emergency medicine physician so, you know, suturing, abscess drainage, lumbar punctures in infants, bladder caths, and putting IVs in right. So the basic major
ER, sort of, skills that you need to have in the ER and I've developed that my last year of Fellowship.

Somehow that got me into the educator club and one of my mentors asked me if I was interested in being the director of the Pediatric Emergency Medicine sub rotation of the clerkship, of the Pediatric clerkship, and I kind of looked at him like, “I don't know if I'm the best fit for this, you know, I'm really interested in teaching but I don't know if I want, I don't know if I want a role that I have to be accountable to . . .” and it was a little bit scary to imagine being in that role. But he said, “Elaine, you're great with the students. You're nice. They need someone nice. They need someone who's excited about what they're – what you're doing”. And I was like, “alright, that's totally, okay, so I'll apply”.

And I ended up getting this position and that kind of was the initial snowball effect that kind of continued to roll. And so it's funny, every role I've been in I've really been faced with a new challenge as soon as I come into the role, it seems, that it helped me grow into that role. So as the sub rotation director for PEM and within the clerkship, I was immediately met with “okay, you are going to go from 1 week of PEM to two weeks and double the number of students in your subrotation”. And that is – if anybody out there's curriculum, you know bands, you will understand immediately that that's a huge resource, you know your funds, your people, the time invested is a huge amount of resources that that makes.

So I develop this curriculum, I got a grant for $40,000, I funded a simulation curriculum and that again kind of pushed me more into that educator position when the clerkship director at the time left. She took a position up in Oklahoma. The position came open and everyone was like, “you should apply for it”. And again I was like, “what are you talking – you’re crazy! Like there's no way I could do that”. That's just such an impactful role, and I just didn't see myself in that position, but I took people's words and I went for it and I applied and I got the position of clerkship director. And then LCME came and we got cited for 14 different citations, which was an entirely different level of challenge to make me rise to that occasion. 

ALICE: I see. Was there anywhere along the way where you doubted yourself, where you needed mentors to help guide you along this path? Any time where you're feeling like, maybe you didn't belong, maybe you had made the wrong decision?

DR. FIELDER: Oh, yeah. I mean, I think we all have that impostor syndrome for sure and I gave you those two examples of you know, when I took on that first role and then when I took on the clerkship director role. I continued to have those feelings of doubt and “I think they made a mistake. I don't know if they read through my application completely, I just - I don't know if I am right for this”. But every time I was met with students and learners, they were so appreciative of what I was doing. Then it kind of made me think a little bit about “maybe this is what I was meant to do” and it really, that is the glue that sort of kept me together during some times where it would be very easy to sort of become frazzled. My students, my learners, now my residents too, they just come back to me and they remind me that I am in the place exactly where – for me, where God needs me to be, where I would say where I was meant to be at this time. But yeah, there's always that imposter syndrome that kind of creeps in every time you get some accolades, or you get a new position. You just keep thinking there's something wrong with everyone. Then I go back to my learner's and they try to remind me that I'm doing what's needed to be done. 

ALICE: That's awesome. I guess, did you have any role models in your early life that you think pushed you to go into medicine or maybe influenced your inclination towards Pediatrics? Could you have imagined yourself at all in the position you're in today when you started out on this route?

DR. FIELDER: At so many mentors, I think. Along my path there have been people that have almost helped me pivot in time, those periods of self-doubt. There's always a mentor there. There's always someone it's not ever just me, never ever ever. And you know, I'll say that, you know, my mentors in emergency medicine and residency, specifically, really helped me to choose that specialty. You'll go through medical school and look at your faculty or fellows or even residents that you're working with and just have that moment where you're like, “I want to be like him. I want to be that person and I want to be . . .” For me, it was Doctor Stanford in the Arkansas Children's Hospital emergency room when we were doing chest compressions on a patient and I looked up at him and he goes “this is why I do this. This is exactly why I do this. I I want to help my patients” and that was when I knew I wanted to be this, I want to do this. I want to help, I want to make a difference and have an impact.

Dr. Gordon, she who is the Vice Chair of Education, now the Interim Chair of Pediatrics, was my program director at Arkansas Children's Hospital funnily enough, back in the day, and you know, he came here years before I finished my residency and has continued to be a mentor of mine throughout this path. And what I've learned from him, and I can mention so many other mentors, is it's so important to recognize the people in your life that empower you to make decisions. They empower you to make mistakes, and they love you anyway. You know, they support you because if they understand your vision and what you're trying to do, good mentors will be there to fight for you. They'll be there to take the fall if you do something that isn't exactly fantastic. They'll not necessarily take the blame, but they will fight for you and they will give accolades when it's deserved, and will help you get the resources and the everything that you need to get the job done. And that's what all of my mentors have done along the way. There's not a single Mentor who has given me anything specifically, they've had me fight for what I want and they've helped me get the resources to get those grants or to get that position or to get the resources. But that's the other thing about it. They push you they pushed me to stretch myself a little bit further. That's what amazing people do, amazing mentors do.

ALICE: How did you make the decision to come to Houston and Baylor? You said you trained in Arkansas, right? So, how is the transition like to Baylor? What do you find that's unique about Baylor maybe, or different compared to Arkansas?

DR. FIELDER: Yeah, it's funny. My husband Will and I dated for four or five years before we got married, and we never lived in the same state or the same city until we got married. So we had a long-distance relationship for four or five years and you know, I lived in Galveston and he lived in Dallas, and then I moved to Little Rock and he lived in San Antonio, and then he moved to Oklahoma City and then I moved to, you know, I was still in Arkansas and finally when he proposed he was living in Houston. And so I took a gamble. I came down to Texas Children's and I did a rotation my second year of residency in the ER because I knew I wanted to come here. And I said “Will, we are getting married. I am going to live in Houston. I want to do a fellowship. This is where I want to go. And if I don't match then I'm going to get a job as a generalist in the ER or do some other, something else, and then I'll try again”.

But I came down and I did my month rotation in the ER and I loved it. And I loved the faculty and I loved that my training at Arkansas had prepared me to be so autonomous and so hands-on with all of my patients and I knew how to intubate and I knew how to put lines in and I knew all these things that I felt super great about on this rotation. And when I matched because I suicide-matched if you will, I said, “this is where I'm going” and I matched right? So I was very lucky in that regard, but even had I not matched I would have still come here and done some work, you know at Texas Children's or be, you know, I was planning on being a generalist if I hadn't matched but that's how my fate ended up. 

ALICE: So more getting into your time as the clerkship director for Pediatrics. What considerations did you have when you were designing that curriculum? What did you hope that students might have gained from their experiences? And I want to address the same question to the residency program now that you're that director for that.

DR. FIELDER: Yeah. So I mentioned that when I first came on as the sub rotation director that one part of it, that one week of PEM was now going to be two weeks. So that was the initial challenge, that this rotation is going to have twice the number of students in twice the number of weeks and “okay, go!”. So I had to develop this procedural skills curriculum and that helped me get to know a little bit about what the curriculum overall was, right? Easy to stay in my niche that you know, “this is the ER and this is what we should focus on”, but as clerkship director it is “how can we make sure you guys, my students during this eight-week clerkship, have the foundations necessary to help you make a decision about what you want to do with your life?”. And by no means should you be competent in general pediatrics or pediatric emergency medicine at the end of this eight weeks. But you should know and have been exposed to enough pediatrics from the acute side to the general well child checks to some adolescent medicine to you know, neonatology and inpatient. You should know enough about the broad, general pediatrics world to help you make a decision about what to go on to for the rest of your life.

Not only that – and I know EPAs, or entrustable professional activities aren't necessarily part of our curriculum yet. But “what can we teach you and what can we ensure that you guys are entrusted to do by the time you graduate”, right? So that really shaped how the curriculum was developed overall for the clerkship. And so it did mean taking a broader look at general pediatrics and not just focusing on emergency medicine because I can always come back to, “well where they sick or not sick, what would you do, let's talk about triage and what were their . . .” you know, so it needs to be more, okay, let's go back to general pediatric practices that I know that I'm board certified in and talk about the immunization schedule and talk about, you know, late immunizations. And let's talk about the newborn, care of the newborn and I feel fortunate enough to have that knowledge as a PEM provider to know a little bit about everything in peds. That's sort of my job. Right? I think it was the perfect fit but it did help me stretch and realize that it's more than just me and just the ER, that we have to think about all things from the scope of a general pediatrician.

ALICE: In the same line as that question though, you were talking about trying to give students a broad experience of what Pediatrics is like so they can make a decision. What advice do you have for students who are trying to make that decision when they go through different clerkships?

DR. FIELDER: I think the students can be so hard on themselves and feel like they have to master the material by the end of their clerkship. And I do hope that one day we get to more of a competency-based clinical rotation because it's more “are you, do you feel competent or confident enough to assess a child after/at the end of medical school?” You don't have to know the details of how to take care of each individual problem. But if your neighbor came to you and asked you, if you were going to go into neurosurgery or something, “Hey, can you look at my kid?” I need you to understand, I need you to be able to assess if he was sick or not sick. I think students can be so hard on themselves and feel like they have to master all of the minutiae. And of course it's so important for you guys to match and you have to have perfect, you know in-training exams or you know, your shelf exams, you have to have great board scores, and I think they get so bogged down with the details of assessment that they miss the joy of just learning about peds and just learning about assessing and stabilizing patients, you know. I guess to answer your question because I feel like I went on a tangent . . . 

ALICE: No, it was a great answer! General advice like you mentioned, focus on, you know, understanding and appreciating the art of taking care of patients. But also, how do you make that decision eventually, how do you just know that this is right for you and that you want to do this? Any advice on that as well?

DR. FIELDER: Oh, yeah. Yeah, I wish I could give you some great, validated assessment tool or something that you can use. But honestly, it is more about the people that you're working with and knowing your strengths as a person, right? So I'm a big fan of the Clifton Strengths Finder, I don't know if you guys have heard of Strength Finders . . . the Gallup company developed this survey and it's several, it's a few decades old now, but it looks at 34 strengths that you are usually a combination of. And it'll give you your top five strengths, if you take this survey or this assessment, and if you are using your strengths and this is validated, now by data and there's several studies to back this up. But if you're using your strengths you are going to be happier or you're going to love the people that you work with, you're going to love what you do. And if you find yourself going back to a clinical rotation where you're using your strengths and you're empowered to use your strengths you're going to love it.

So I'll give you my top five strengths are, number one, learner. Okay, so no question about that. I love to learn, I listen to podcasts as soon as I get in my ER – I'm sorry, as soon as I get in my car, and I force my learning sometimes on people like “this is a great book. You've got to read it”. My number two is activator. I like to get projects started and off the ground and running. That's why I think I love the ER so much. I love a challenge, I love to get things going. My third is positivity. In peds, I'm using that strength every single day. If you walk around with a frown on in peds, your patients are going to be scared of you. I mean, you know, you just gotta lighten up and you got to put a smile on and you have to work in a team and be positive and so, you know, and then my fourth and fifth are input and relator. So I love to build those relationships with people. So that's just an example of how I can use my strengths every single day in my field. 

And are the people that I'm working with supportive of me using my strengths, right? Are they okay that I'm a learner? Are they okay that I love to, you know, get new information from different people? Are they okay that I'm so positive and a little Pollyanna at times, or do they hate it, right? Because people have differences, right, and that's part of my personality. I think when you go through all of your rotations you will know, when you go home at the end of the day, are you done after like a week like there is no. “Hey I can do this”. Do you feel drained of energy and your emotions are, you know, do you feel awful or do you love the people you work with, love the environment and the energy and want to go back? So that is the best advice I can give is just know yourself, pay attention to those emotions. And take the Clifton Strengths Finder! No stock in the company. I just love it. 

ALICE: Yeah, I think I might, gonna look at it when we get off this call. It sounds . . .

JUAN: You said the “Clifton Strengths Finder”? 

DR. FIELDER: Yeah. 

JUAN: Just to clarify for folks listening, training, and . . .

DR. FIELDER: It’s so funny. I love it so much that, as the program director, and this is my first years as the residency director, I bought a copy for everyone on my leadership team and we're doing some team building around Clifton strengths. So again, there's no, they're probably be like, “what are you paying these people to . . . ?” but I seriously, it is totally a, it's a personal thing. I love it and it's a great way to understand the people on your team and how each of your individual strengths can complement each other. So while I mention I'm an activator, I like to get projects done, I am not an achiever and “achiever” likes to finish projects. I like to start them, but I'm not so much of a finisher all the time. So I need those people in my team to help me finish the things that I get started.

ALICE: Guess this really transitions well into the next question that I was hoping I would ask you, which is what do you think are some qualities that make a great pediatrician? Is it going to be different for every individual? Do you have any thoughts on any general qualities that you think would be a great match for Pediatrics? 

DR. FIELDER: Yeah, I think having that positive nature is a good thing. I think if you’re a pessimist or – and it's okay to be a realist, right? I mean, we need realists in pediatrics too, but I think having an overall ability to look at the big picture and focus on what we're doing well, and for families, and for patients too. And I've seen some very realistic, some people might call them pessimists, but when they walk into a room with a family that has a child who is sick, it's like a new light shines through, right? That realism and the business side of them that's on the other side of the door completely goes away when they walk in because their strengths, which we may not know about, are really highlighted whenever they work with families and when they're focusing on the good in the situation when it can be a very dire situation.

So I think having some sort of empathetic bone, for sure all of us do or we wouldn't be doing this, right? But we have to be able to look at the entire family dynamic, the social situation, the things that may be preventing families from getting the resources that they need, looking at the big picture, being empathetic to every family’s situation and where they're coming from. And then having some positivity I think is always good.

ALICE: Yeah, that's really important. Especially right now, I think, to be able to do that. And I guess now that you’re residency program director, especially since you transitioned quite recently and now there's such a big challenge in the global community . . . how has that been like and how have you tried to work around that and address some of those challenges? 

DR. FIELDER: Well, you know, I always go back to, every time I'm in a new role something new happens, right? So this year has been especially challenging but fortunately for me, I'm not going to know any different and just going to think all the years that come after this winter, so much easier! It's going to just be so, you know, I think that the biggest challenge – and again, this is more of my positivity coming out, but this this situation has brought forward so many opportunities to learn outside of just our normal PowerPoint, 1-hour noon conference lectures that we've had for 25 years, right? This is a brand-new era. I don't think we will ever go back to required noon conference, “death by PowerPoint”. I just don't think we're going to do that. I think this is giving us so many more opportunities to get to know our residents on such a more personal level. To see inside their homes, to see what their kids are doing or what, you know, the names of their pets and to see what life is like outside of those four walls on the third floor of Mark Wallace Tower, you know? And so I think it's been challenging in its own sense in that, you know, we have to meet certain guidelines, ACGME. Make sure that you know, they are very strict about what rotations residents need to complete before they are board eligible for Pediatrics. They are very, you know, very direct on how many hours of learning must be accomplished, you know, within a three-year residency. With the onset of COVID it's a completely different era and so we have had to be very creative in home learning opportunities, in learning to use Zoom and all of the other cool applications that are available to us, and to document that we are making sure that learning is being done, and that those assessments and those evaluations that they need before graduation are still being completed. 

And so while I think, obviously I think what we're all nervous about, is the learning being completed without those in person one-on-one patient bedside opportunities? Yeah, you can still round with your team from home. You can still look at rashes. You can still look at vital signs. You can still hear an assessment and a plan and give your feedback, right? I think there are just so many amazing opportunities to learn from this and I think things will never be the same. I think education as we know it has been flipped on its head and it's never going to be the same. 

ALICE: Yep. There’s really profound change, I think in a lot of ways. I was also curious as to what your opinion is on whether practice has changed for anyone in Pediatrics? I know kids are not the primary population affected by the pandemic, but have you noticed any changes in the way that you diagnose or treat patients?

DR. FIELDER: Yeah, I think that is something I think is another benefit of all of this, or the positive that's going to come out of all of this. Classically in our emergency room, we’ll have 80 patients in the waiting room. In the waiting room alone. Not to mention the 50 beds that we have in our ER that are full. That won't be the same again. I really don't think that that would be the same. I think that telemedicine, thank the Lord, is now to the place that we have needed it and wanted it to be for the last decade, right? So something had to happen for telemedicine to start blooming and this was it. I don't think we'll ever have 80 patients in our waiting room again. I think that families who had limited resources and then limited ability to seek help, to seek medical help or to seek the advice of their physicians came to the ER, right? And they came after work or after their second job, or they came, you know after they finally got someone to help watch their other children for them. This is a beautiful thing that has happened and I think the ability to do telemedicine visits and tell parents, “Hey, I can see your kid in 10 minutes. If you can jump on we’ll set up the appointment online, we’ll have this appointment and I'll see your child and I'll hear about what's going on and I'll be able to see them as well”. And now they don't have to come all the way here and we don't have to worry about them being able to get back home, transportation back home, right? So the cost savings in the long run for families, and for our medical community is going to be tremendous. 

That being said every learner, every resident, and every student still needs to have those one-on-one interactions with patients. And I apologize if you're hearing crying in the background. That's my three-year-old. Can you hear him?

ALICE: It must be hard. I don't know if he usually has more activities to do right now. I have a brother who's at home and he's ready to get back to school and get busy. 

DR. FIELDER: How old is he?

ALICE: He's 10, so been in school for a while.

DR. FIELDER: So either way I think you have to have those one-on-one bedside interactions, but I do think that, you know, the stress of walking into an emergency room or to a clinic where it's just bursting at the seams with patients who probably don't need to be in that crowded environment, you know, waiting for 10 hours to see someone who's going to see them in 15 minutes and send them home – that will no longer be the case, and I'm so glad. So you know thank goodness that insurance companies through all of this are now reimbursing for telemedicine visits and that is just, people have had to rise to the occasion and I think everyone's done that so well. I can only imagine you know, how much better this is going to be when COVID is even over. Again, I don't think we will ever go back to where we were before.

JUAN: I think it's always interesting, if I may interject, that we’re kind of afraid or we're really afraid of what we would lose from telemedicine, you know that patient physician interaction? But I had a phone call, telemedicine, from a VA Doc and I don't feel like I lost anything. It was maybe 15 minutes, I was driving, you know, and in a way it felt that the connection was still there because this physician called me, you know, and we had the same questions, same interaction. And in a way I kind of felt better because of these new methods being put forth in action during this time. So I thought “whoa, this is kind of cool”. I'm being called, you know personally by the physician I was supposed to see, and everything is still being addressed and we’re saving time, we’re being safe. It’s a new era, it's really cool.

DR. FIELDER: I love it, you know and I think that, so – we went through the application process for residents right? For all the senior students around the nation. We had 350 or so applicants that interviewed in person, and now we are inviting them every week to join us on a Xoom conference and we're getting them oriented to the hospital and the policies and procedures in the rotations. You're talking about a several month orientation for these interns that are going to come in in the fall, that they would have never done before, and I feel closer to those – you know, we have like 48 incoming interns in total. I know each and every one of them not just because I knew them from the interview process – and I loved that part of my job this year – but now I get to know them and what's going on in your house like, “who's your spouse and who are your pets?” and you know, and then give them a tour of the ER and do it every single week and play games with them every week, get to know a little bit about they're fun side. And you know that those are things we've never been able to do, never. We crammed intern orientation into ten days before they started and that was it! And if you got it you got it, and if you didn't, well, you're still starting on June 24th.

But now it's just that closeness that you mentioned, that ability to interact – I mean I know you two now as friends and so the next time I see you in person, I'll be like “yeah, what’s going on?”. I mean being in person, I don't think makes that anymore real. And I feel comfortable, you know sitting and talking with you and it's not anxiety-provoking to have someone sitting right in front of you and like fumbling with their papers and stuff like that. I would feel so uncomfortable. But this is so natural in its own sense.

ALICE: I think a lot of students actually are trying to participate somehow in all of this by helping residents get groceries, watch their kids, wash their pets. So these things that you get right now that the teamwork that's being put in, it's never been done before and I think it is banding together the medical community more than ever before. What's your opinion on student volunteerism in general or student participation in the clinics during this time?

DR. FIELDER: You know, I don't know who spearheaded the group that is helping to watch kids and in volunteering for that. I feel like I should know her name but – is it you Alice? No.

JUAN: It's probably a Baylor student for sure. I think I was I was on the email list for that.

DR. FIELDER: Okay, so when I first read through it, you know, I said, I went back to her and I said “I want to do something nice for the residents, right? For the Peds residence. Let me know what kind of response you get from the Peds residence and I want to offer anybody that has a pet or a you know kids or whatever. I want to pay for their like first two sessions or whatever” and she's like “it's free” and I was like, “oh my gosh, you're doing this for free!?”. My mind was blown, I completely missed that and I emailed her back and I was like, “I am just so impressed by your entrepreneurial, you know spirit without the payment, you're doing this from the goodness of your heart and trying to help, you know, people that need it the most” and I just was so impressed that a group of students got together and did this.

And so I think that people are going to start asking on interviews and in the future, what did you do during COVID? What did you do? And I think that those students and all of you guys. I mean the residents, the students, the people at Baylor everybody has just risen to the occasion and I can't imagine a better group of people to work with. I can't imagine a better time to be in medicine even though it seems just daunting and just overwhelming right now for so many. Each one of us wants to give a little bit to our colleagues and to each other and I think the students at Baylor have just been so tremendous. And they've been that way through Harvey and, you know, Hurricane Ike back in the day. I mean, you know, I've been here through a few catastrophes but this one really, I'm just so impressed with what they've been doing.

ALICE: I know a lot of students are really really hoping to get back to the clinics. I think Baylor has suspended rotations until May 26. Do you believe that students are integral to patient care in the hospitals? Would you hope to see students back on the rotations before the end of the pandemic? This is a quite a controversial question, I think, so if you are not willing to answer I completely understand.

DR. FIELDER: I'll say it this way. I think we all serve a purpose, right? When the time is right, and the patients are there . . . right now in Pediatrics, we don't have the patient volume to support a huge number of students. Do I think that it's not a great learning environment? It might not be right now just because we don't have the volume, right? But, could students help with telemedicine. Could they be, you know, seeing patients for a few hours a day in person and then doing telemedicine or some other in the other hours of the day? I think that we all, again, this is a whole new era now, I think we have to be careful with social distancing and making sure that we don't have people there, learners there just for the sake of learning – well not just for the sake of learner, just for the sake of being present because they have to check the box to finish a rotation. I think we need to be very careful about doing that. 

As we sort of ramp back up and more people are coming back to the hospital, it might be a staged approach just like we do with opening restaurants and you know, you know hair salons and stuff, right? I mean that's just going to be a staged approach. Which students, which residents, which learners need to get those hands-on, in-person, patient interactions before they graduate, right? Or before they move on to their sub-I. Or which residents, which students need to complete their sub-I. Those are going to be the ones that are, I would put them first in line before anyone else does. So sub-I’s, maybe even sub-I’s first and then the clerkship students, right? So I think there's learning to be done. I think having anyone there, residents included, on service just for the sake of “you’re assigned to this rotation and you're supposed to be there” is a bad idea.

Are students integral to the functioning of a medical team? Absolutely. You guys keep us on our toes. You know so much more, you are so ingrained into pathophysiology and you remind us again over and over of what we need to learn and what we need to be fresh on. And you pick up on things in patient encounters that nobody else on the team does. Absolutely, I think you’re integral. Would I want you there just for the sake of having you there? No, because I don't want to put you at risk, but I do think we need to have students and residents back on the wards with us as soon as we can.

ALICE: And that wraps up all the questions I have for you today. Thank you so much for your time again. We really loved having you on the show, really grateful that you were able to be here today and I will leave it up to Juan to wrap this up if you're okay, Doctor Fielder.

DR. FIELDER: Thank you so much. So fun.

JUAN: Thank you for being on. I think one really important thing that I, even during these recording sessions I’ll have my pad and my pen and I think one really awesome thing that I could take away, aside from the Clifton Strengths Finder, is said that it's important to have mentors that will empower you and allow you to make mistakes and will fight for you. Super awesome, loved it. I loved having you on. It's been really awesome learning about everything that's happening.

DR. FIELDER: Thanks.

JUAN: Thank you so much.

DR. FIELDER: And I already subscribed on . . . so I am so excited to hear some of the other podcast you guys have put together and I just love what you're doing.

JUAN: Thank you. Thank you so much. 

DR. FIELDER: Thank you.

ALICE: Thank you.