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Hi there @atmeridiem-miger224!

Of course it’s okay for you to reach out--I’m so happy and honoured that you did! (And now I feel all blushy that you enjoy my blog so much!) I will always welcome people dropping me a line, and I will always do my very best to answer.

Ah, PEM! So my first inclination is to say that it was the closest thing I could get to toddlerology (I mean there’s neonatology and adolescent medicine but toddlers are my jam, you know?). PEM is one of the specialties that sees the highest volume of toddlers, because many toddlers are well and in Canada, pediatrics is a consultation service and we don’t do a lot of regular well-child visits. Hence, in the peds ED we see many toddlers since they tend to be otherwise well with minor illnesses, injuries, or... other weird stuff like foreign bodies in various orifices of their bodies or just things that make their parents worried enough that someone needs to see their little bean right now (fortunately, the majority of the time, the kiddo is just fine).

But the actual (more intelligent-sounding) reasons that I provided for my sub-specialty match application were as follows:

I love peds. That’s no secret. Choosing pediatrics was the first step. I love the kiddos so much. Even though a lot of things in medicine--with pediatrics being no exception--can suck (and suck HARD), there is honestly so much joy in working with children that I’m still finding my happiness in every day.

PEM docs are the generalists of generalists in peds. You are not limited to any one organ system (in one shift, you will likely do several cardiac, respiratory, abdominal, neurological, and MSK exams), nor are you limited to any one age group (we get to see all the age groups from the neonates to the adolescents and everyone in between... which is kind of back to the toddlerology point...). We also get to see some cool stuff that never really gets around to general pediatrics, like the obs/gyn concerns (youngest mother I ever met was 14 years old; she had her baby at 13...), the surgical presentations, and the orthopedic issues.

PEM docs are master multi-taskers jugglers (apparently, no one can actually multi-task...) because they are simultaneously: medical experts in the acutely unwell and undifferentiated complaints; front-line patient advocates; medical educators and lifelong learners; clinical resource and department flow managers; communicators  and collaborators with patients/families, allied health professionals, and interdisciplinary medical colleagues; and excellent team leaders as well as team players. Of course, these roles describe any physician in any specialty/sub-specialty, but in the PEM setting you will fulfill most or possibly all these roles in a uniquely fluid way that I personally find tends to be a little bit more compartmentalized in other pediatric sub-specialties.

The shift work actually allows for a really flexible lifestyle that helps you pursue other cool endeavours in your life. A lot of PEM docs I’ve met run sports medicine clinics or global health initiatives, and some really cool community resources as well. And this flexibility also extends outside of medicine--many of the PEM staff I have worked with are avid athletes or artists or hobbyists themselves, and have really interesting lives outside of work. (I... do not have an interesting life outside of work. I’m hoping I get to tack a “yet” at the end of that... but we’ll have to see.)

The Emergency Department has the coolest toys. No other area in the hospital has a slit lamp, casting supplies, suture trays, speculums (for various different purposes...), and cautery loops all in the same place. And don’t forget POCUS (awwwww yissssss!!!!)! This is extra true for the pediatric ED, because our child life specialists are bomb-diggity and they make sure we have tons of cool literal toys for the kiddos we see.

I’ve probably got undiagnosed ADHD, so the pace of PEM is very much suited to my penchant for thinking on my feet and distilling pathophysiology into the simplest possible terms to create the broadest possible differential.

I’ve also got lots and lots of anxiety, so I really appreciate that PEM is one of those sub-specialties where you’re extremely well-supported. Back-up is always available, whether it is inpatient pediatrics, outpatient services, allied health, crisis care, surgical specialties, other sub-specialists, or your PEM colleagues/team members. Weird abdo pain that’s not fitting anything on your differential? You can always run it by someone with a little more expertise.

PEM is very hands-on. There are tons of procedures: you get to do almost everything the PICU docs do with lines and chest tubes and stuff, plus sedations, reductions, casting/splinting, suturing/gluing/stapling, foreign body removals, lumbar punctures... I could go on and on). My hands are always on the go (yes, I’m very much a hand-talker) and so a procedure-heavy sub-specialty was exactly what I was looking for.

A lot of the most acute care in PEM is strongly based on algorithmic approaches, which I like because it reinforces consistency and confidence. Trauma? ATLS (ABCDE’s). Resuscitation? PALS/APLS. Neonatal resuscitation? NRP. 

PEM has an excellent intrinsic model for medical education, because in most hospitals learners of all levels review directly with a staff PEM physician or PEM fellow, meaning lots of individualized one-on-one feedback, observed clinical assessments, and teachable moments. It is also one of the sub-specialties that lends extremely well to (and often has strong leadership) in simulation-based learning, which is a really cool hands-on way to build your skills and knowledge in a low-stakes environment.

Speaking of medical education: Emergency Medicine and Pediatric Emergency Medicine are both really strongly represented in the Free Open-Access Medical Education (FOAMEd) scene. There are tons of great PEM blogs, podcasts, etc. that are excellent resources and generally much more fun and palatable than textbooks, and often will review up-to-date literature, too! (I have a very poor attention span for reading, so this is excellent for me!)

I am very biased, but PEM tends to attract really cool people... so when you work in PEM your colleagues are awesome!