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Medical Specialty Electives
All interns complete at least one six-month (one day per week) specialty rotation. These rotations occur during the six months that interns are not placed on the Inpatient Psychiatric Units. As noted above, an additional six-month specialty rotation is an option for the elective rotation. It should be noted that consultation and treatment skills are similar with the different medical populations, though the clinical issues may vary. Interns choose from the following, although not all are guaranteed to be offered each year:
Allergy and Immunology
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.
Behavioral Pain Medicine
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.
Endocrinology and Diabetes
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 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.
Pulmonary and Sleep Medicine
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.
Sleep Disorders Clinic
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. 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 Park 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.
Solid Organ Transplant
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 underserved populations, and are committed to training opportunities with exposures to a variety of racial/ethnic, SES and psychosocial presentations.