Medical Specialty Electives

The allergy and immunology rotation involves providing services to a diverse population of children and adolescents who are diagnosed with food allergies, environmental allergies, asthma, eczema and primary immunodeficiency disorders. During this rotation, interns will conduct consultation-liaison services during the oral food challenge clinic. Interns will see approximately four to six patients/week ranging in age from infancy to young adulthood. Primary concerns during this clinic are patient and parent anxiety related to potentially experiencing an allergic reaction during the oral food challenge. Interns who participate in this rotation may also see two to three outpatients a week. Primary mental health concerns among this population are anxiety and depressive symptoms related to food allergies and primary immunodeficiency disorders (generally school-age children) and behavior management related to eczema treatment (generally preschool-age children). Interns may also complete brief consultations with parents of young children who need assistance transitioning their child to the school setting for the first time. Therapy includes medical psychoeducation and CBT techniques. The Allergy and Immunology Division serves a wide patient population who live throughout D.C., Maryland, and Virginia. Interns will have the opportunity to collaborate with a social worker to assist families from lower income backgrounds and interpreters to assist with non-English-speaking families.

The Behavioral Pain Medicine Program at Children’s National is a multidisciplinary outpatient program specializing in pediatric chronic pain conditions. The intern will receive training in evaluation and treatment for youth with chronic and complex pain conditions including recurrent abdominal pain, musculoskeletal pain, complex regional pain syndrome, headaches/migraines, and postural orthostatic tachycardia syndrome (POTS), in addition to various somatic symptom related disorders. Physicians, psychologists, physical therapists, nurses and interns work collaboratively to address the complex needs of these patients and their families with the goal of increasing patients’ functioning and improving overall quality of life. Treatment utilizes a multimodal approach with an emphasis on cognitive, behavioral, parent training, biofeedback and acceptance and mindfulness-based interventions. Extensive collaboration with schools is an integral piece of the program.

The Pediatric Dermatology clinic is an embedded subspecialty clinic that provides services to a diverse population of young children through young adults with a variety of dermatological conditions. Interns will gain experience in assessment and intervention skills focused on child and family adherence to medical regimens, symptom management and psychosocial adjustment to a chronic medical condition. Common referral questions include excessive scratching, medical non-adherence, needle phobia, anxiety and depression. Interns have opportunities to provide behavioral consults, short-term treatment and consultation with the medical team comprised of dermatologists, medical residents and nurse practitioners.

The Early Childhood Behavioral Health outpatient treatment rotation involves providing intervention to young children (0-6 years of age) and their families through the Division of Psychology and Behavioral Health. The intern would receive didactics in Parent Child Interaction Therapy (PCIT) and live supervision in implementing PCIT with families from an L1 Certified PCIT trainer. While we cannot guarantee certification as a PCIT-therapist following the training year, this may be a possibility for some interns.

The intern can also gain experience implementing intervention with young children presenting with developmental delays and autism spectrum disorder, including individual treatment and group work. While this is a treatment-focused rotation, interns can also gain experience conducting initial intake interviews and brief consultations with young children and their families. Interns have the opportunity to gain experience working with families with a range of backgrounds with regard to race, ethnicity and insurance status. Training occurs in the Takoma Theatre clinic. Certain cases that are started while on this rotation may be continued as part of the intern’s outpatient therapy caseload for the duration of the year.

The endocrinology/diabetes rotation involves working as part of a multidisciplinary team that provides services to a diverse population of young children through young adults with type 1 diabetes (T1D), type 2 diabetes (T2D) as well as other endocrine disorders. The disciplines involved in children’s care include medicine, nutrition, nursing, social work and psychology. Interns on this rotation have the opportunity to participate in consultation and treatment for children diagnosed with T1D, T2D and a variety of other endocrine disorders. Consultations include meeting with children/families around the time of diagnosis, at medical outpatient clinic visits and as medical inpatients following periods of management difficulties. Outpatient treatment cases present with a variety of concerns including adjustment to illness, medical adherence challenges, mood concerns and family conflict.

The gastroenterology rotation involves working with patients with a wide range of gastrointestinal disorders such as celiac disease, inflammatory bowel disease and functional abdominal pain. Across the rotation, interns will provide diagnostic, consultation and short-term therapy services to families with varied cultural, ethnic and socioeconomic backgrounds. There will be opportunities to observe and conduct brief consultations as part of a multidisciplinary team alongside physicians, education specialists and dietitians, such as in the Celiac Disease Clinic. Outpatient behavioral medicine and therapy services are also provided to assist with medical, emotional and behavioral management of illness. Common referral issues include psychoeducation, gut-brain dysregulation, coping with chronic illness, medical management barriers, anxiety, depression, eating and feeding disorders, and family conflict.

The Hematology, Oncology and BMT rotation involves working as part of a multidisciplinary team. Interns will administer digital psychosocial screeners followed by brief consultation and intervention within our Long-term Follow-Up clinic for survivors of childhood cancer. Interns may also have an opportunity to implement cognitive-behavioral and acceptance-based treatment to enhance pain management in our Sickle Cell Disease Integrative Pain Clinic. Lastly, the intern will carry a small caseload of weekly outpatient therapy cases. Typical presenting issues include difficulty coping with and adjusting to diagnosis, treatment and transitions, anxiety (generalized, anticipatory, and procedural), depression, behavior problems, school reintegration, peer difficulties, nonadherence to medical treatment and pain exacerbated by psychological stressors. Depending on interest and availability, there may be opportunities to conduct pre-BMT psychological evaluations.

The Mood Disorders Program is a multidisciplinary outpatient program that provides services to a diverse population of children and adolescents diagnosed with mood disorders (e.g. major depression, pediatric bipolar disorder, disruptive mood dysregulation disorder), and their families utilizing CBT and DBT techniques. Interns will gain experience in the evaluation and treatment of mood disorders through individual, family and group therapy (optional). The intern will see approximately 3-4 patients on their rotation day. During this rotation, the intern will also receive supervised training in our Comprehensive  Outpatient DBT program, which will include seeing individual patients, participating in weekly consultation team meetings, phone coaching and co-leading skills groups.

The obesity rotation involves providing psychosocial services including consult and assessment for youth undergoing bariatric surgery. A rotation in the obesity subspecialty involves conducting pre- and post-surgical assessment for bariatric surgery readiness, providing consult-liaison services for the medical team prior to and following surgery and providing any ongoing support needed by the surgery patients. The patient population served in this rotation is highly diverse with regard to race/ethnicity, socioeconomic status and psychosocial functioning.

The Division of Pulmonary Medicine and Sleep Medicine provides outpatient and inpatient services for children diagnosed with chronic and acute respiratory conditions including cystic fibrosis, asthma, chronic cough, as well as management of children with respiratory complications associated with other chronic illness (neuromuscular diseases, sickle cell). The internship rotation consists of inpatient consultation/liaison and outpatient therapy, with an emphasis on cognitive/behavioral and parent training approaches. The intern will provide diagnostic, consultation and long-term treatment to patients with a focus on education, coping with chronic illness, treating psychogenic causes of respiratory illness, adherence, evaluation of co-morbid psychiatric and behavioral problems, parent training and family coping.

The Behavioral Sleep Medicine rotation provides interns with the opportunity to work within the multidisciplinary sleep clinic that is housed in the Division of Pulmonary and Sleep Medicine. The sleep clinic team consists of psychologists, pulmonologists, nurse practitioners and sleep technologists who work together to assess, diagnose and treat childhood sleep disorders. Interns participating in this rotation will receive didactic training in the normal development of sleep across the lifespan and gain clinical experience in the diagnosis and treatment of sleep disorders. The location of the clinic in the Children's National Hospital affords interns the opportunity to work with a diverse patient population. By the culmination of this rotation interns will be familiar with the various types of childhood sleep disorders, common mental health comorbidities and empirically support treatment strategies.

The solid organ transplant (cardiology and nephrology) rotation involves participation in multidisciplinary teams that provide pre- and post-transplant care to young children through young adults with chronic kidney disease and advanced cardiac diseases. Interns participating in this clinic will receive training in evaluation, consultation and treatment for children receiving renal replacement therapy (dialysis and transplantation) and advanced cardiac therapies. The rotation consists of services including coping with chronic illness, motivational support to promote adherence and behavioral management in the inpatient unit, cardiac ICU, outpatient clinic, and dialysis unit. Both nephrology and cardiology teams are comprised of faculty and staff from diverse backgrounds, serve diverse and under-resourced populations, and are committed to training opportunities with exposures to a variety of racial/ethnic, SES and psychosocial presentations.

The Trauma and Burn Surgery rotation consists of providing outpatient and inpatient services to patients experiencing injuries (e.g. burns, motor vehicle accidents, dog bites) and their families. The internship rotation consists of inpatient consultation/liaison, multidisciplinary ambulatory clinic participation and short-term therapy. Interns participate in psychosocial screening, brief intervention and referrals within the multidisciplinary clinic. Common presenting concerns include adjustment to injury, procedural anxiety and trauma, posttraumatic stress, mood concerns, adherence difficulties, body image concerns and parenting/family support. There are opportunities for training in trauma-focused cognitive behavioral therapy in this rotation. The trauma service serves diverse and underserved populations across the District of Columbia, Maryland and Virginia and provides training experiences with families from a variety of cultural and psychosocial presentations.