Pediatrics

Trainees will be exposed to a broad array of congenital and acquired heart disease in pediatrics, ranging from fetal to adult congenital heart patients. Over the course of the elective, students will develop a basic understanding of the physiology of normal circulation, as well as the pathophysiology, diagnostic tests, and management of common forms of congenital and acquired heart disease encountered. Students will be exposed to patients over a broad range of settings, from daily inpatient rounds to outpatient continuity clinics. Additionally, there may be opportunities for trainees to observe complex diagnostic and therapeutic management options, including advanced cardiac imaging, cardiac catheterization, and surgical repair of pediatric heart defects.

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

Scheduling Restriction(s): N/A

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

Prerequisite(s): N/A

Accept Visiting Students: Yes

Learning Objectives

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(s): Not offered 01/28/2019 - 02/22/2019, 02/25/2019 - 03/22/2019, 07/15/2019 - 08/09/2019, 08/12/2019 - 09/06/2019

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

Prerequisite: N/A

Accept Visiting Students: Yes

Learning Objectives

Fourth and fifth year students will have the opportunity to evaluate and manage a broad range of acute medical and surgical complaints while honing their clinical skills under direct attending physician supervision during 36 clinical hours per week in the Pediatric Emergency Department. Education during clinical shifts will be augmented by pediatric emergency medicine fellow education conferences and one on one teaching sessions with the Elective Director. Participation in teaching conferences and mock codes are required.

Length of Rotation: 4 weeks (maximum-1 student), 2 and 3 week rotations considered upon request

Scheduling Restrictions: N/A

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

Prerequisite(s): Pediatric clerkship and appropriate Epic training (the computer programs/ordering systems used in the hospital.)

Accept Visiting Students: no

Learning Objectives

This elective will provide an extensive exposure to various aspects of pediatric endocrinology, with an emphasis on disorders of growth and sexual development, thyroid function, diabetes (type 1 and type 2), obesity, and bone and mineral metabolism. The student will participate primarily in the Outpatient Pediatric Endocrinology and Diabetes Clinics, as well as the inpatient service. Many of our clinics are located at 1 Long Wharf Drive, therefore, transportation is necessary. The rotation includes participation in weekly pediatric endocrinology endocrinology conferences as well as conferences held jointly with the adult endocrinology service.

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

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

Prerequisite(s): N/A

Accept Visiting Students: Yes - must have a strong command of English

Learning Objectives

This elective provides a broad experience in the diagnosis and management of pediatric malignancies and hematologic disorders of infancy and childhood. The student functions as part of the inpatient service team, and participates in the outpatient clinic 3-4 mornings each week. Weekly conferences include the multidisciplinary Pediatric Tumor Board, Leukemia and Lymphoma Conference, Section Conference and weekly Pediatric Hematology/ Oncology patient management rounds.

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

Scheduling Restriction(s): N/A

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

Prerequisite(s): Pediatric clerkship

Accept Visiting Students: 4 Week - Yes, 2 Week - No

Learning Objectives

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 11:00 A.M. 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(s): Limited Availability

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

Prerequisite(s): Completed Pediatric clerkship or special permission from ID faculty member

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

Learning Objectives

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(s): None
Student's Class Level: 3rd, 4th, 5th year
Accept Visiting Students: No

Goals/Objectives for Newborn Intensive Care Unit Elective

1. Demonstrate an understanding of tests of fetal well-being (Medical Knowledge)
2. Recognize the importance of temperature regulation in the newborn (Medical Knowledge)
3. Recognize the physical and behavioral characteristics of preterm, term, and post-dates neonates (Medical Knowledge)
4. Understand routine care of the newborn including Vitamin K administration, eye prophylaxis, fluid requirements, and newborn screening (Patient Care, Medical Knowledge)
5. Understand the basic steps of newborn resuscitation in both term and low birth weight infants (Patient Care, Medical Knowledge, Systems Based Practice)
6. Demonstrate an understanding of newborn jaundice including physiologic jaundice and breastfeeding jaundice (Medical Knowledge)
7. Recognize risk factors for poor prognosis in low birth weight infants including intracranial hemorrhage and intra-uterine growth restriction (Medical Knowledge)
8. Understand differential diagnosis and management of respiratory distress and cyanosis in newborn full term and preterm infants (Medical Knowledge)
9. Understand the pathophysiology of bronchopulmonary dysplasia (Medical Knowledge)
10. Recognize infections in the newborn period including sepsis, TORCH infections (Medical Knowledge)
11. Recognize differential diagnosis of GI pathology in the newborn including obstruction, necrotizing enterocolitis, abdominal wall defects (Medical Knowledge)
12. Understand the effects of maternal conditions and medications on the newborn (Medical Knowledge)
13. Recognize sequelae of birth injuries including cephalohematoma, neurologic injuries, brachial plexus injuries (Medical Knowledge)

The Pediatric Respiratory Medicine Elective will provide training and experience in the diagnosis and management of common respiratory and sleep disorders in children and adolescents. Students will participate in the direct patient care and observation of patients on our inpatient service and in the ambulatory pulmonary clinics. They will have the opportunity to go to the operating room to observe bronchoscopies. They will review pulmonary function tests. The inpatient experience will consist of daily bedside rounds and consultations on the wards. Inpatient rounds will be conducted with the attending physician and pulmonary fellow on service. The outpatient experience will occur with the faculty during their office hours and fellows during their continuity clinic. We have a dedicated pulmonary function laboratory for children, a pediatric exercise laboratory, an accredited sleep laboratory and accredited Cystic Fibrosis (CF) Center. Our CF Center in one of only 2 CF Centers in the state of Connecticut and offers a multidisciplinary team approach to providing comprehensive state-of-the-art care for children and adolescents with CF. Students are expected to attend pulmonary conferences and seminars.

At the end of the elective, students should be able to:
1. Elicit, organize, and synthesize a pertinent pulmonary history and perform physical examination;
2. Identify common lung sounds and the discuss physiology associated with the sounds;
3. Classify asthma severity based on National Guidelines for Diagnosis and Management of Asthma and delineate appropriate therapy based on disease classification;
4. List the organ systems most affected by cystic fibrosis (CF), describe the effects of CF on organ systems and delineate common therapies for CF-related disease; and
5. Teach families basic asthma pathophysiology, medication classification, and medication delivery techniques using plain language.
6. Learners have access to neuromuscular clinic
7. Learners have access to aerodigestive clinic
8. Learners are welcome to come to weekly educational conferences on Fridays

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

Scheduling Restriction(s): Not offered December or May

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

Prerequisite(s): N/A

Accept Visiting Students: Yes

Learning Objectives

This elective provides hands-on experience in pediatric rheumatology. This service involves consultation service in the inpatient and outpatient setting as well as long term care for patients with autoimmune conditions. Pediatric rheumatology requires the ability to perform a comprehensive physical examination and history while interpreting laboratory and radiographic studies to develop an often-complex differential diagnosis. Pediatric rheumatology involves patients of all chronologic ages and developmental stages so learners will have the opportunity to develop rapport with patients and families across pediatrics. The student will be exposed to clinical setting in the hospital and outpatient setting and academic opportunity will include participation in rheumatology didactics with the internal medicine group (grand rounds and journal club) as well as with scheduled pediatric didactics (grand rounds, weekly pediatric rheumatology case conference). Where available students will be able to observe arthrocentesis and learn the basics of musculoskeletal point of care ultrasound. Clinical settings include outpatient visits and hospital consultation at Yale New Haven Hospital and participation at satellite clinics will be a shared decision with the student and the attending at the ultimate discretion of the course director. During this rotation, it is necessary to travel back and forth between Y-NHH and Pediatric Specialty Center at Longwharf (1 Longwharf Drive, New Haven); other satellite opportunity will not be required but may be available at the student and course director discretion.

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

Scheduling Restriction(s): none

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

Prerequisite: Pediatrics Clerkship, Ideally Step 1

Accept Visiting Students: Yes

Learning Objectives

Students participate in the evaluation and management of patients on the pediatric inpatient service, pediatric ICU, neonatal ICU and pediatric specialty center. Patient problems encompass the full range of clinical renal disorders, including fluid and electrolyte disturbances, acute and chronic renal failure, various forms of glomerulonephritis and interstitial nephritis, nephrolithiasis, hypertension, intoxications, inherited renal diseases and urinary tract abnormalities. A pediatric nephrology faculty member serves as attending physician at all times, and conducts teaching rounds daily. These teaching sessions provide supervision and training in the practical aspects of patient management, as well as instruction in the basic scientific disciplines that underlie the clinical practice of nephrology.

Students participate in outpatient renal clinics under the supervision of the faculty, gaining experience in the work-up of common renal disorders not initially requiring hospitalization (e.g., proteinuria, hematuria, mild azotemia), the assessment and treatment of childhood hypertension and the long-term follow-up of patients after discharge from the inpatient and transplant services. Our clinics are held in the Pediatric Specialty Centers at WP-2 and at Long Wharf. We also have clinics in Norwalk, Trumbull and Old Saybrook but students are not required to participate in those clinics.

Several teaching conferences are devoted to clinical nephrology. The most important of these is the Friday Pathophysiology Lectures that encompass renal pathology; renal physiology; diseases of the glomerulus, tubules, and interstitium; renal transplantation; electrolyte disorders; and stone disease and is attended by all trainees and faculty in both pediatric and adult nephrology. In addition, a formal Pediatric Renal core curriculum is held every Friday afternoon at 1:00 PM.

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

Scheduling Restriction(s): 01/20/2020 - 02/09/2020

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

Accept Visiting Students: 4 Week Only: Yes

Learning Objectives

This 2-week (or 4-week) elective provides hands-on experience in Pediatric Neurology in both inpatient and outpatient clinical settings. In the mornings, students attend rounds with supervising attending as well as adult and pediatric neurology residents. Students are exposed to acute common as well as rare Pediatric Neurology disorders such as epilepsy, headaches, mental status changes and weakness. The students will obtain histories and perform neurological examinations on newly admitted patients or consult patients. Bedside discussions regarding diagnosis, work up and treatment are encouraged. In the second part of the day, students are given the opportunity to participate in the Pediatric Neurology consultation service or outpatient clinics. The consultation service exposes students to various emergencies in Pediatric Neurology such as seizures, status epilepticus, stroke and other acute neurological issues. Both general Pediatric Neurology as well as subspecialty clinics (such as Epilepsy, Headache, Movement Disorders, Multiple Sclerosis, Neuromuscular, EMG) are available. In addition, students are introduced to different procedures typical for Pediatric Neurology including spinal tap, electroencephalogram, brain and spine imaging techniques and electromyogram.

A certain degree of flexibility exists in arranging the schedule to satisfy student interests. The Elective will generally be exposed to a mixture of outpatient and inpatient clinical care, but may be designed as a purely outpatient clinical rotation.

Travel maybe necessary between YNHH and our Long Wharf location for some of the afternoon clinics.

NOTE: This Elective is a priority for students who are interested in Child Neurology as a career. However, the rotation is also applicable for students who are planning a career in general pediatrics or in adult neurology. Additionally this Elective would apply to those students who did not rotate through Pediatric Neurology as a 3rd-yr medical student or for those who seek additional experience. In general, during this elective will expose students to a mixture of outpatient and inpatient clinical care, but may be designed as a purely outpatient clinical rotation.

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

Scheduling Restriction(s): N/A

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

Prerequisite(s): N/A

Accept Visiting Students: Yes

Learning Objectives

The sub-internship in Pediatrics is a four-week inpatient rotation during which senior medical students who have successfully 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. There are four patient care units in Yale-New Haven Children’s Hospital that students may be assigned to: the Pediatric ICU, the Neonatal ICU and two units with a mixture of general and specialty pediatric patients. Typically, up to four students can be accommodated in the rotation each block. The schedule of shifts will be as that of an intern. All sub-interns regardless of placement will take daytime and evening shifts. No overnight shifts will be assigned. Sub-interns are subject to the same duty hour restrictions as the interns.

This rotation is a great opportunity to develop organizational skills and experience the pace of internship in a supportive environment. An emphasis is placed on being an integrated 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. Heather Collette, the director of the elective, during an informational meeting. Following that meeting, enrollment will be opened for the next academic year. 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.

Length of Rotation: 4 weeks (maximum - 3 students)

Scheduling Restriction(s): Special Contract Scheduling

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

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

Accept Visiting Students: US: Yes; Int'l: No

Learning Objectives