PL-3

Welcome to our new series “A Day in the Life!” where you can get to know our residents and see into their daily life.

Jonathan Uhl, currently a PL-3, his camping experience.

As a third-year pediatric resident at the University of Connecticut, I have been preparing for my transition to primary care practice. During my time as a resident, I was fortunate to have a variety of clinical experiences within my curricular pathway. Most recently I spent time as a camp physician at Camp Androscoggin in Wayne, Maine. This experience was among the most valuable of my residency and reinvigorated my interest in primary care. Although camp medicine as a discipline is in its infancy, working as a camp physician is an experience from which all pediatric residents can benefit.

I became interested in camp medicine while daydreaming about summer from a seventh floor window of our children's hospital on an icy January morning. As all residents know, working seventy to eighty hours per week is physically and emotionally taxing. This is especially true during winter when shifts preclude the possibility of sunlight exposure. I kept my spirits up by making plans for when the ice melted. I had worked as a summer camp counselor throughout college and medical school, so I began to envision how I might incorporate this passion into my career. Through Camp Health Consulting, I was introduced to Dr. Jill Baren and she offered to supervise me during a camp rotation. I drafted a rotation proposal and goals which were approved by my residency program. Then I packed my sleeping bag, opened up a map of Maine, and arrived at Camp Androscoggin in July.

Camp Androscoggin is an American Camping Association-accredited all-boys summer camp in rural Maine on the shore of Lake Androscoggin.  Approximately 150 campers attend each summer. Campers participate in land sports, water sports, woodworking, and wilderness excursions. The camp has been in continuous operation for over one hundred years, with a rich history that is visible in black and white photos in the mess hall, narrated through dinnertime chants, and palpable in each camper and staff member who walks its piney grounds.

Camp medicine is an emerging frontier and unaccredited subspecialty within pediatrics. The role of camp physician is to act as a primary care physician for campers and staff – both by treating acute illnesses and injuries, and by ensuring that existing medical issues are properly managed. Although the American Academy of Pediatrics has created recommendations for preparing children for camp and to guide health and safety practices at camp, the 2011 policy statement does not provide practical clinical guidance for camp physicians [1]. Issues such as maintenance of an infirmary, policies for campers and infirmary inpatients, infection control, and laboratory testing / imaging with limited resources remain unaddressed. While pediatric residents are often involved in summer camps for children with specific medical conditions, they are not involved in traditional summer camp experiences. This is unfortunate for several reasons.

Camp medicine is bursting with learning opportunities and has the potential to significantly enhance resident interest in primary care pediatrics. Currently, there is diminishing interest in primary care. In 2002, 30% of graduating pediatric residents entered fellowship. By 2015 that number had climbed to 41%[2]. An opportunity to capture learner interest in primary care should be a priority for residency program leadership.

The full spectrums of social and emotional developmental stages are on display at summer camp. In the absence of their parents, children must mediate their own conflicts, know where to find their own clean socks, and be the primary historians for their own illnesses. In the setting of illness, the agency of even young children is astounding. I recall an eight year-old boy on his third infirmary day, gradually recovering from viral gastroenteritis. He was eager to play his scheduled afternoon tennis match. He reasoned that a few extra hours in the infirmary to re-hydrate might serve him well. We obliged. In the office, parents want to tell us all about their child's symptoms, but often children are capable of providing an accurate history and negotiating their own treatment plans. Returning to my residency program after this experience, I have an enhanced ability to recognize agency in children. I hope to empower my younger patients to play a more active role in their care, and to help parents take a step back.

Camp physicians have the luxury of taking a "wait and see" approach to medical concerns. For example, if the diagnosis of acute otitis media is equivocal in the morning, the camp physician simply calls the child back to the infirmary after dinner for reassessment. In a typical office setting this would not be feasible, potentially leading to more aggressive management. Knowing that nobody will be lost to follow up, camp physicians can make full use of the tincture of time.

The summer camp curriculum also covers concepts in public health. Camp is an isolated environment where everyone swims in the same water, eats the same food, and bunks in groups. Camp physicians must think about their patients not only as individuals, but as members of a community, identifying patterns and anticipating the impact of illness on the camp community. This emphasizes the importance of judicial use of resources. After all, camp physicians work in remote areas with limited medical supplies, often far away from an x-ray machine or emergency department. Accurate diagnosis and triage decisions are paramount.

Compared to modern primary care that is often referral-heavy and reimbursement-driven, camp medicine is a throwback—a simpler and purer form of pediatrics. I encourage residency leadership to consider adding this opportunity to their pathways and would highly recommend the experience to any pediatric resident.

References

"Creating Healthy Camp Experiences". Vol 127, no. 4, 2011, pp. 794-799. American Academy Of Pediatrics (AAP), doi:10.1542/peds.2011-0267.

Dalen, James E. et al. "Where Have The Generalists Gone? They Became Specialists, Then Subspecialists". The American Journal Of Medicine, vol 130, no. 7, 2017, pp. 766-768. Elsevier BV, doi:10.1016/j.amjmed.2017.01.026.

Infirmary Building
Jon Running
The Lake
Jon with Counselors