Pediatrics

The sub-internship in Pediatrics is a four-week rotation during which senior medical students who have completed their clerkships in Pediatrics and Internal Medicine are considered the equivalent of an intern and are directly responsible for the care of their assigned patients under the supervision of resident and attending physicians. Students are assigned to one of the two general pediatric inpatient units at Yale-New Haven Hospital (Medicine/Cardiology and Short Stay). Typically up to two students can be accommodated in the rotation each block. Sub-interns will receive a schedule that is similar to the interns and which includes both daytime and overnight shifts. They are subject to the same duty hour restrictions as the interns.

This rotation is a great opportunity to develop your organizational skills and experience the pace of internship in a supportive environment. An emphasis is placed on being a good team member, taking ownership of one’s patients, and demonstrating improvement in intern skills (clinical reasoning, communicating with patients/families, organization, prioritization, presentation, and efficiency) through incorporation of constructive feedback.

Interested students will receive an introduction to the Pediatric Sub-internship from Dr. David Hersh, the elective director, during the annual medical student sub-internship informational meeting in the Spring. Immediately following that meeting, enrollment will be opened for the next academic year. Block assignments will be made on a rolling, weekly basis. Every attempt is made to place students in their highest preference block, but given the demand for a limited number of slots this may not be possible. It is recommended that students who are not planning on applying for residency in Pediatrics request block 6 and onward. Also remember that applicants to combined Medicine –Pediatrics residency programs do not need to complete sub-internships in both fields prior to the application deadline.

Sub-interns will meet with Dr. Hersh, during the week prior to the start of the rotation to review responsibilities and expectations. Dr. Hersh will contact the student directly to arrange for this meeting.

Length of Rotation: 4 weeks (maximum-2 students)

Scheduling Restriction: Special Contract Scheduling

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Satisfactory completion of 3rd year Pediatric and Internal Medicine clerkships

Accept Visiting Students: yes

Learning Objectives:

1. History skills. Gather the important information that is needed for the general Pediatric history and complete a history in the medical record for at least 20 patients.
2. Physical examination skills. Complete a physical examination for the evaluation of respiratory distress on at least 3 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric conditions requiring inpatient care and the general principles of how to manage such conditions.
4. Attitude: Demonstrate professional responsibility in working as a team member with all members of the multidisciplinary care team, patients and families.
5. Career/context: Know the training/career pathway for Pediatrics.

This subinternship, under the Departments of Surgery and Pediatrics, provides an in-depth exposure to the broad spectrum of pediatric surgical problems. Specific attention is given to identifying the pediatric patient in crisis, a relevant skill whether or not the student pursues a career in surgery. Objectives include understanding the correction of major congenital anomalies, management of trauma, care of the critically ill child, and management of solid tumors. Experience includes in depth exposure to the pediatric OR, training in neonatal and pediatric critical care, and experience in the pediatric surgical outpatient clinic. The sub-intern is an integral part of the pediatric surgical team.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 4th, 5th year

Prerequisite: Completion of third year clerkships

Accept Visiting Students: yes

1. The student will gain familiarity with and understanding of advanced simulation technology and equipment. (Medical knowledge) 2. The student will learn key applications of simulation and debriefing within the complex medical environment. (Systems-Based Practice, Practice Based Learning) 3. The student will participate in educational simulation sessions at 730 Howard Avenue, 733-WP, and situ simulations throughout the hospital. (Practice Based Learning, Interpersonal and Communication Skills) 4. The student will participate in day-to-day activities and strategic operations of the simulation center. (Systems-Based Practice) 5. The student will develop one deliverable curricular module, including scenarios, relevant references, associated goals/objectives, and other curricular materials. This session will ideally be delivered to a peer group of other medical students. This module will be considered shared work product, and the simulation center reserves the right to incorporate it into future or existing curricula. (Medical knowledge, Practice Based Learning, Interpersonal and Communication Skills) 6. The student may opt to participate in novel or ongoing simulation based research projects. Appropriate funding must be identified for new proposals submitted by the student. (Medical Knowledge)

Length of Rotation: 4 weeks (maximum-1 student), based on an approximate participation of 30 hours per week for 4 weeks. Different schedules may be arranged on a case by case basis in concert with core faculty 16-20 hours: Foundations of simulation, 40-60 hours: Participation in simulation activities, 40 hours: Development of deliverable curricular product. Other hospital setting used, SYN:APSE Simulation Center, 730 Howard Ave.

Scheduling Restriction: N/A

Student's Class Level:4th, 5th year

Prerequisite: N/A

Accept Visiting Students:no

Learning Objectives:

1. Medical Knowledge: The student will gain familiarity with and understanding of advanced simulation technology and equipment.
2. System-Based Practice and Practice Based Learning: The student will learn key applications of simulation and debriefing within the complex medical environment.
3. Practice Based learning, Interpersonal and Communications Skills: The student will participate in educational simulation sessions at 730 Howard Avenue, 733-WP, and in  simulation throughout the hospital.
4. Systems-Base Practice: The student will participate in day-to-day activities and strategic operations of the simulation center.
5. Medical Knowledge, Practice based Learning, Interpersonal and Communication Skills: The student will develop one deliverable curricular module, including scenarios, relevant references, associated goals/objectives, and other curricular materials. This session will ideally be delivered to a peer group of other medical students.
6. This module will be considered shared work product, and the simulation center reserves the right to incorporate it into future or existing curricula.
7. Medical Knowledge: The student may opt to participate in novel or ongoing simulation based research projects. Appropriate funding must be identified for new proposals.

This elective is four weeks and will encompass all aspects of Pediatric Cardiology. The student will be expected to make daily inpatient rounds in the PICU, NICU and inpatient floors with the Pediatric Cardiology attending, fellow and nurse practitioner. Observation in the Pediatric Cardiology catheterization laboratory and Pediatric cardiothoracic operating room will be encouraged. The student will also be expected to attend the afternoon outpatient Pediatric Cardiology clinics.

Length of Rotation: 4 weeks (maximum-2 students)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Students are expected to attend all scheduled Pediatric Cardiology conferences, and visiting student applications must be approved by Dr. Bevin Weeks.

Accept Visiting Students: yes - departmental approval

Learning Objectives:

1. History skills. Gather the important information that is needed for the Pediatric Cardiology history and complete a history in the medical record for at least 6 patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the cardiovascular system on at least 6 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric critical care conditions.
4. Procedural skills. Observe echocardiograms and electrocardiograms on at least 8 patients.
5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Pediatric Cardiology care team, patients and families.
6. Career/context: Know the training/career pathway for Pediatric Cardiology.

Senior medical students will have an opportunity to participate as a member of the Pediatric Intensive Care Unit team. During the elective, students are directly responsible for the care of their assigned patients under the supervision of pediatric residents, critical care fellows, and attending intensivists. A core curriculum composed of interactive talks on the major pediatric critical care topics is presented two to three times a week, as well as daily radiology rounds and monthly morbidity and mortality conference.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: no

Learning Objectives:

1. History skills. Gather the important information that is needed for the Pediatric ICU history and complete a history in the medical record for at least 5 patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of respiratory distress on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Physical examination skills. Complete a pertinent physical examination for the evaluation of cardiac function on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
4. Knowledge/diagnostic and treatment skills: Know about common pediatric critical care conditions.
5. Procedural skills. Perform bag-mask ventilation on at least 4 patients or simulation trainers.
6. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Pediatric ICU care team, patients and families.
7. Career/context: Know the training/career pathway for pediatric critical care medicine.

This elective will provide an extensive exposure to various aspects of Pediatric Endocrinology, with an emphasis on disorders of growth, thyroid function, sexual development, diabetes (type 1 and type 2), and obesity. The student will participate primarily in the Outpatient Pediatric Endocrinology Clinics, as well as the inpatient service. The rotation includes participation in weekly pediatric endocrinology conferences as well conferences held jointly with the adult endocrinology service.

Length of Rotation: 4 weeks (maximum-2 students)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: N/A

Accept Visiting Students: yes - must have strong command of English

Learning Objectives:

1. History skills. Gather the important information that is needed for the endocrine/diabetes history and complete a history in the medical record for at least 5 patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of type 1 or type 2 diabetes or the relevant endocrine system on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric critical care conditions.
4. Attitude: Demonstrate professional responsibility in working as a team member with other members of endocrine/diabetes care team, patients and families.
5. Career/context: Know the training/career pathway for pediatric endocrinology and diabetes.

This elective provides a wide variety of experience in the diagnosis and management of malignant diseases and hematologic problems of infancy and childhood. Students on a 4-week elective will spend 2 weeks in outpatient clinics. Students on 2-week electives will spend 1 week on inpatient ward and 1 week in outpatient clinic. Weekly conferences include the multidisciplinary Pediatric Tumor Conference, Hemostatsis Rounds (jointly with Medical Hematology), a Fellows conference, and weekly Pediatric Hematology/ Oncology patient management rounds.

Length of Rotation: 2 to 4 weeks (maximum-1 student*) (*one student per black, either for a clerkship or an elective, not both)

Scheduling Restriction: Not offered 11/18/13-11/29/13

Student's Class Level: 4th, 5th year

Prerequisite: Pediatric clerkship

Accept Visiting Students: yes - departmental approval

Learning Objectives:

1. History skills. Gather the important information that is needed for the Pediatric Hematology Oncology history and complete a history in the medical record for at least 10 patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of a pediatric hematology oncology patient on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric hematology oncology conditions.
4. Procedural skills. Observe a lumbar puncture with chemotherapy administration, bone marrow aspiration, central line access on at least 3 patients.
5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Pediatric Hematology Oncology Team care team, patients and families.
6. Career/context: Know the training/career pathway for pediatric hematology oncology.

Students will participate in pediatric infectious disease rounds by presenting the case study of an inpatient that they have examined to a group of faculty and fellows. Emphasis will be placed on the correlation of the clinical problem and its practical management with principles of infectious epidemiology and clinical microbiology (bacteriology and virology). Consulting rounds are held daily. Teaching rounds in Diagnostic Microbiology are held four times per week at 11:00am. Weekly divisional rounds will last approximately two hours and are held on Thursday afternoons. Students also attend the Pediatric AIDS Clinic.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 4th, 5th year

Prerequisite: Completed Pediatric Clerkship or special permission by ID faculty member

Accept Visiting Students: yes - one visiting student per elective period, departmental approval

Learning Objectives:

1. History skills. Gather the important information that is needed for the overall Pediatrics and Infectious Diseases history and complete a history in the medical record for at least 5 patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of child with a proven or suspected infectious disease on at least 5 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or fellow.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric infectious diseases conditions.
4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Pediatric Infectious Diseases team, patients and families.
5. Career/context: Know the training/career pathway for Pediatric Infectious Diseases.

Students spend two weeks on the step-down service, followed by two weeks on the intensive-care service. On each service students attend medical rounds and follow neonatal patients and write progress notes under close supervision. Students attend delivery room resuscitations and stabilizations, and prenatal consultations. On both services students attend general and student-oriented educational conferences, and attend radiology rounds. Students will also pursue independent study on topics in neonatology and make brief presentations to the clinical team. Additional opportunities, such as attendance at outpatient developmental follow-up exams, are available to students based on interest.

Length of Rotation: 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 4th, 5th year

Prerequisite: Must have a strong command of English

Accept Visiting Students:no

Learning Objectives:

1. History skills. Gather the important information that is needed for the obstetrical and Newborn ICU history and complete a history in the medical record for at least 4 patients.
2. Physical examination skills. Complete a general newborn physical examination and Ballard assessment of gestational age on at least 4 patients, and a pertinent physical examination for the evaluation of respiratory distress on at least 2 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common newborn intensive care conditions.
4. Procedural skills. Assist with newborn resuscitation of at least 6 newborns.
5. Attitude: Demonstrate professional responsibility in working as a team member with other members of the Newborn ICU team, and in interactions with patients’ parents.
6. Career/context: Know the training/career pathway for newborn intensive care medicine.

During the elective, students are exposed to a wide variety of activities in the section of Respiratory Medicine. These include the evaluation and treatment of infants and children with acute and chronic respiratory diseases such as: asthma, cystic fibrosis, bronchopulmonary dysplasia, bronchiolitis, pneumonia, aspiration syndromes and obstructive sleep disorders. The emphasis is on learning how to assess respiratory dysfunction by physical exam and laboratory testing. The basics of mechanical ventilation will be reviewed. Students will have the opportunity to rotate through both the inpatient and outpatient services, Pulmonary Function Laboratory and Children's Sleep Center.

Length of Rotation: 2 or 4 weeks (maximum-1 student)

Scheduling Restriction: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: Students are expected to participate in seminars, journal club and patient rounds. Visiting students must provide CV, copy of application and 2 letters of recommendation.

Accept Visiting Students: no

Learning Objectives:

1. History skills. Gather the important information that is needed for the Pediatric Respiratory Medicine history. Complete a history in the medical record for at least 2 of the patients.
2. Physical examination skills. Complete a pertinent physical examination for the evaluation of the respiratory medicine system on at least 8 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.
3. Knowledge/diagnostic and treatment skills: Know about common pediatric respiratory medicine conditions.
4. Attitude: Demonstrate professional responsibility in working as a team member with other members of the pediatric respiratory medicine care team, patients and families.
5. Career/context: Know the training/career pathway for pediatric respiratory medicine.