Rotations for Visiting Medical Students

Pediatric Electives

PEDS 4000A: Pediatric Acting Internship (University Hospitals)

The acting intern will be assigned to one of the inpatient pediatric medical teams (excludes ICU teams). He/she will assume the responsibilities approximating those of an intern (see duties below) under the direct supervision of senior level residents and faculty. OBJECTIVE: To provide an inpatient pediatric experience which provides a heightened level of responsibility from the core pediatric clerkship. Students successfully completing this experience will expand their pediatric knowledge base, enhance their clinical judgment and problem-solving skills, and improve their organizational skills. Toward these ends, students will meet with the ward attendings daily, and acting interns meet at least weekly with the elective sponsor for small group learning sessions and mentoring. Acting interns are considered members of the inpatient team. In-house overnight call is every 4th-5th night and the call schedule usually includes one weekend day. On call responsibilities are typically shared between two acting interns, and orders must be co-signed by a resident; in every other way, the responsibilities of the acting intern approximate those of an intern. These responsibilities include inpatient admissions, daily management of patient care plans, presentation of patient information at rounds and conferences, and daily communication with families. NOTE: AI's MAY BE REQUIRED TO BE AT ROUNDS THROUGH THE LAST SUNDAY MORNING OF THE ROTATION. IMPORTANT TO NOTE: You are not allowed to drop the AI once you have committed to it unless you find someone willing to take your spot. Prerequisites: Satisfactory completion of 4 core clerkships to include Medicine and Pediatrics. This applies to both 3rd and 4th year students.

PEDS 4001A: Pediatric Cardiology (University Hospitals)

DESCRIPTION: Students are assigned to almost daily clinics where they are primarily responsible for evaluating the patients. Cases are discussed with the attending who will point out pertinent physical examination features, discuss the previous history, and formulate management depending on the natural history. Inpatient activity begins with morning work rounds which will be made with the cardiology fellow and faculty. Management will be determined regarding all medical cases, and admissions for elective cardiac catheterization and surgery, as well as for postoperative patients. NOTE: Report at 8:00 a.m. first day of clerkship to Pediatric Cardiology, 3rd floor, Rainbow Babies and Children's Hospital. Contact the secretary, Room 380K, 216-844-3528 one week before clerkship to obtain written material. A second month can be scheduled by arrangement with with sponsor. OBJECTIVE: 1) To develop competence in the cardiovascular examination of children, with emphasis on major aspects and understanding of heart sounds. 2)To learn the natural history of common cardiovascular diseases. 3) To relate basic cardiovascular anatomy to hemodynamics and to physical examination and natural history of common problems. 4) To learn the management of common pediatric cardiology problems, including congestive heart failure. 5) To learn how to interpret pediatric electro cardiograms. DUTIES: Student is often the initial person evaluating the patient. However, all management decisions will be reviewed by the cardiology fellow or faculty member. No night call, although students may come in to help evaluate new admissions. PREREQUISITE: Completion of core clerkship in Pediatrics.

PEDS 4002A: Pediatric Hematology/Oncology (University Hospitals)

Description of Course: This elective is designed to allow the student the opportunity to evaluate all aspects of hematology/oncology/bone marrow transplantation in children. The student will perform detailed histories, physical examinations, and evaluation of laboratory procedures. Opportunities to perform procedures, learn morphologic hematology, transplantation biology, chemotherapy, laboratory procedures, etc. can be arranged based on specific interest of student. OBJECTIVE: To provide an opportunity to utilize historical data, physical examination, and laboratory procedures in pediatric hematology/oncology/transplantation problem-solving. Address issues of management of chronic illness in children, ethics, and molecular biology as applied to clinical practice. Participation in outpatient care in the Seidman Cancer Center as well as inpatient rounds and consults. No weekend or night call responsibilities. Prerequisite: Completion of core clerkship in Pediatrics.

PEDS 4003A: Pediatric Pulmonology (University Hospitals)

DESCRIPTION: Students evaluate new out-patient referrals and inpatient consults, and develop a diagnostic and treatment plan in conjunction with the attending staff. Students will gain familiarity with pulmonary function tests, and may participate in fiberoptic bronchoscopies. Special research projects are available. OBJECTIVE: Students will learn the principles of diagnosis and management of diseases of the respiratory tract in infants, children and young adults, especially asthma, chronic obstructive lung disease, cystic fibrosis, bronchopulmonary dysplasia, and acquired and congenital abnormalities of the lungs and airways. Pathophysiology will be reviewed. Students will view bronchoscopic procedures, and operation of the pulmonary function laboratory. Students will gain insight into the significance of the long term patient-physician relationship in chronic diseases. Students with special interests (e.g. orthopaedics, obstetrics, neurology) may review an area of interest (e.g. scoliosis, asthma/COPD in pregnancy, respiratory disease of neuromuscular origin, or other) for informal presentation. DUTIES: There is no assigned night call. PREREQUISITE: Pediatric core clerkship.

PEDS 4004A: Pediatric Endocrinology/Metabolism (University Hospitals)

This is a combined inpatient and outpatient experience. The endocrine/metabolism inpatients at RB&C are followed under the direction of the endocrinology attending for the month. This includes doing consultations on endocrine/metabolism patients admitted on other divisions' services. Inpatient rounds are held 3 to 5 times per week. Weekly didactic sessions are held on topics in pediatric endocrinology/metabolism. The student also attends the division patient management conferences. The student attends two days of outpatient clinics per week. New evaluations and follow-up patients are seen with problems of early or late sexual development, growth problems, thyroid dysfunction, hypoglycemia, inborn errors of metabolism, and insulin dependent diabetes mellitus. Students are asked to prepare a 30 minute discussion on a selected endocrine/metabolism topic. OBJECTIVE: To gain an understanding of the pathophysiology and management of endocrine and metabolic of diseases in children. Special emphasis is placed on issues of normal and abnormal growth and development. DUTIES: Students function like the pediatric residents rotating on the service. PREREQUISITE: Completion of Pediatrics Core Clerkship.

PEDS 4005A: Pediatric Infectious Diseases (University Hospitals)

On the pediatric infectious diseases clinical rotation at Rainbow Babies & Children's Hospital, students will have the opportunity to evaluate and manage patients with a wide variety of infectious diseases. This is not limited to exposure to patients with bone or joint infections, bloodstream infections, pneumonia, or infections in an immunocompromised host, on the general pediatric ward as well as intensive care units. Student will have the opportunity to learn basic bacteriologic, virologic, and serologic techniques utilized in the diagnosis and evaluation of infection in children. The student will: 1) work up and follow patients with infectious diseases under the supervision of the attending; 2) become acquainted with the function and use of clinical bacteriology and virology laboratories; 3) attend and participate in regularly scheduled infectious diseases rounds and conferences; 4) meet with members of the Division of Pediatric Infectious Diseases for in-depth discussion of literature and clinical cases. OBJECTIVE: To provide an opportunity to carry out an active in-depth study of clinical pediatric infectious diseases. This is an inpatient consultative service. Student have the opportunity to attend outpatient infectious diseases clinic if desired. Night call duty is not required. PREREQUISITE: Completion of core clerkship in Pediatrics.

PEDS 4006A: Pediatric Surgery (University Hospitals)

Description of Course: Generally, the student is an integral part of the daily pediatric surgery activities, therefore, she/he will participate in all conferences, daily rounds, patient work-ups, evaluations and operating room activities. Night call is integrated with supervising resident staff and may range from every third to fourth night. A close student-faculty-resident teaching relationship is emphasized. OBJECTIVE: To introduce the student to: 1) common general surgical lesions in children, their diagnosis and management; 2) The common surgical neonatal congenital malformation problems; 3) the surgical aspects of solid tissue neoplasia in children; 4) trauma and infections of a surgical nature in childhood; 5) the principles of the surgical care of infants and children; 6) the unique interaction of surgeon, child and family during the correction of surgical lesions. Prerequisites: Completion of Surgery and Pediatric Core Clerkships.

PEDS 4007A: Pediatric Critical Care Acting Internship (University Hospitals)

DESCRIPTION: Acting interns will join 2nd-year pediatric residents to provide care for critically-ill children under the direct supervision of residents, fellows, and attending physicians. They will carry their own patients and work in concert with the other residents on their clinical team. Acting interns will also participate in noon resident lectures and mock codes. Clinical responsibilities will be individually tailored to suit each student's abilities and needs. OBJECTIVE: To provide experience and introductory training in pediatric critical care medicine by direct participation in patient care. Acting interns will be exposed to a variety of pathologies including respiratory illnesses, trauma, congenital heart disease, and post-operative cases. Students successfully completing this acting internship will expand their pediatric knowledge base with respect to pediatric emergencies, basic ventilator management, and principles of invasive monitoring. They will enhance their clinical judgment and problem-solving skills particularly in the 'sick/not sick' assessment, grow their physical exam skills, and improve their presentations and organizational skills. Mandatory call occurs every 5/6th night, and acting interns will work 3 weekend days. Students must log all of their patients and submit one H&P and one progress note each week; feedback will be provided by the elective faculty sponsor. PREREQUISITE: Successful completion of core clerkship in Pediatrics (for both 3rd and 4th year students).

PEDS 4009A: Child Advocacy And Protection (University Hospitals)

OBJECTIVES: Cleveland and Cuyahoga County continue to rank at the bottom of national studies of child well-being. One of every 3 pre-school children in Cuyahoga County lives in poverty and almost 2 of every 3 Cleveland preschoolers live in poverty. All of the issues that impact poor children are seen at a children's hospital: access to healthcare, poor nutrition, safety, low educational attainment. With the understanding that these factors impact all that we do at the children's hospital, we have stepped outside the walls of our institution through the Office of Child Advocacy and Protection. This elective allows the student to participate in all the activities of the Office, including the legislative affairs which impact the well-being of children and families, and child protection issues, and community advocacy activities. DUTIES: With the Medical Director, the student will attend meetings, strategy sessions, and legislative activities - both in the hospital and community. It is expected that the student will be an active participant in the child advocacy issues and duties may include public testimony at hearings, drafting position papers, and formulating strategies on issues that affect children. The student will attend the monthly city-wide multi-disciplinary child death review meeting at the County Coroner's office. Outpatient activities: 2 half-days in the outpatient ambulatory clinic with the Medical Director and one half-day in Care Clinic (forensic sexual abuse) clinic per week. Other activities: a) directed readings and self instructional materials; b) slide reviews from Care Clinic. Prerequisites: NONE.

PEDS 4010A: Adolescent Medicine (University Hospitals)

Description of Course: Students will spend approximately eight half-days per week in the outpatient Adolescent Clinic at Rainbow Babies & Children's Hospitals, allowing them to expand their knowledge of normal patterns of adolescent growth and development; enhance their clinical skills in diagnosing and managing common adolescent medical problems, including gynecologic and sexuality-based problems; develop skills in interviewing and counseling adolescents and families; and become familiar with social and cultural influences upon adolescent development and behavior. Students will function as the adolescent's primary physician, with supervision by the faculty. Familiarization with community resources for youth is considered an important component of the ambulatory experience in Adolescent Medicine, and students will make multiple site visits during the rotation. Examples of agencies in the Cleveland area that have been selected for tour by students on elective include the Cuyahoga County Juvenile Court, a residential treatment center for chemically dependent youth, and the Cleveland Rape Crisis Center. Didactic presentations and hypothetical patient case histories will provide a forum for addressing important issues in adolescent medicine. Preparation for these conferences will include reading selected references and answering questions regarding aspects of evaluation and management. This elective is a weekday ambulatory service without night call. Completion of core clerkships in Pediatrics and 08/GYN is required . Prerequisites: All core clerkships must be complete.

PEDS 4012A: Aspects Of Peds Neurology (University Hospitals)

The purpose of this elective is to provide an opportunity to for students to experience the various clinical aspects of Pediatric Neurology. This includes: outpatient pediatric neurology and epilepsy clinic, inpatient neurology consult team as well as opportunities for exposure to the subspecialties integral to the care of children with neurological conditions. Clinical experiences will include: general pediatric neurology, pediatric epilepsy, neurodevelopmental disabilities and autism clinic and individualized opportunities for exposure to comprehensive care, neuro-ophthalmology, neuro-genetics/metabolism, neurosurgery, neuroradiology and sleep medicine. At the conclusion of this elective, the student should gain an understanding of the evaluation and management of patients with neurologic diseases and the specialty of pediatric neurology. Prerequisites: None.

PEDS 4013A: Sports Medicine For Children (University Hospitals)

Description of Course: Introduction to Primary Care Sports Medicine for Children, including clinics, event coverage, and exposure to physical therapy and casting. 1) Learn basic joint exam for knee, shoulder, ankle, wrist, hip, and back. 2) Learn to use basic joint exam to develop an appropriate differential diagnosis for joint injuries. 3) Learn appropriate history taking skills for athletes. 4) Understand how to manage medical issues related to sports participation (e.g. Asthma). 1) Attend Primary Care Sports Clinics 2) Attend PT sessions 3) Attend musculoskeletal radiology sessions.

PEDS 4015A: Pediatric Orthopaedics (University Hospitals)

Students are assigned an integral role and will attend all outpatient clinics, participate in in-patient care and will be assigned operating room responsibilities. Teaching emphasis will be on problems encountered in a physician's outpatient clinic, such as in-toeing, out-toeing, the limping child, hip and foot disorders, scoliosis screening, and trauma. The orthopaedic aspects of rehabilitation of children with neuromuscular disorders such as cerebral palsy and meningomyelocele will be covered along with other more complex problems. Weekly reading assignments will be made and supplemented by departmental handouts. Teaching conferences per week include: Fracture Conference; Monday a.m., Orthopedic Grand Rounds Wednesday a.m., and Pre-operative/Post-operative Conference, Friday a.m. Daily informal conferences will be held as frequently as possible to discuss current problems, differential diagnoses, management of individual patients, and to answer other pertinent questions. OBJECTIVE: To provide an in-depth exposure to common musculoskeletal disorders of children and adolescents, and to give the student a better understanding of the growth and development of the musculoskeletal system and the natural history of pediatric orthopaedic problems. DUTIES: Student will have an active role in the care of children on the service. Current outpatient clinics at RB&C include general pediatric orthopaedic, scoliosis, pediatric neuromuscular rehabilitation (meningomyelocele, cerebral palsy) bone disorders, hand, tumor and private clinics. The in-patient service has an average daily census of 10-15 children. Twenty to thirty pediatric orthopaedic operative procedures are performed weekly. PREREQUISITE: Completion of Surgery and Pediatrics Clerkships. Exceptions will be made based on the student's goals and career plans.

PEDS 4016A: Pediatric Comprehensive Care (University Hospitals)

Only students interested in exploring Comprehensive Care as a clinical career are encouraged to apply. Medical student will be exposed to a wide range of comprehensive care problems including the biomedical, clinical, epidemiological, and social-behavioral issues common seen by a neurodevelopmental pediatrician. Emphasis will be placed on understanding the care management of the child with chronic illness and technology dependence in both the inpatient and outpatient settings. Topics will be covered by way of outpatient clinics, attending rounds, specialized readings (syllabus provided), discussions/lectures, resident oral presentations, and observational experiences. GOALS AND OBJECTIVES: 1. Identify the role and general scope of practice of neurodevelopmental pediatrics, 2. Recognize situations where children benefit from the skills of specialists trained in caring for children with neurodevelopmental disabilities, 3. Distinguish normal from pathological conditions affecting neurodevelopmental functions in children, 4. Recognize children with conditions affecting neurodevelopmental function that generally requires referral, 5. Understand the psychosocial impact of chronic illness and disability on a child and family, 6. Review policies and identify resources that pertain to the well-being of children and adolescents with chronic illness and special healthcare needs, 7. Coordinates, orchestrates, and facilitates key events in patient care, such as family meetings, consultation around goals of care, advance directive completion, conflict resolution, and involving other team members as appropriate.

PEDS 4017A: Pediatric Gastroenterology (University Hospitals)

This rotation provides the students a chance to rotate and experience both inpatient and outpatient in Pediatric Gastroenterology. For the inpatient experience, students will be working with our Pediatric GI team of RBC Pediatric Interns, residents, fellow, dietitian, and Pediatric GI attending. He/she will participate in daily morning rounds, perform consults and follow inpatient GI attending for procedures. Outpatient activities: student will attend 2-3 daily outpatient clinics at one or both RB&C satellite subspecialty offices. In general, attempts will be made to schedule the medical student to see new patients with common problems referred for subspecialty evaluation, i.e., diarrhea, constipation, abdominal pain. Students also have an opportunity to rotate in one of our multidisciplinary clinics such as Eosinophilic Esophagitis clinic, Celiac Clinic, Pediatric IBD clinic. Students are encourage to observe specific procedures that aid in the diagnostic work-up of GI patients. Attendance of once-a-week teaching conferences is also required. Objective: Students rotating through the Pediatric Gastroenterology Service should acquire a basic working knowledge of gastrointestinal, liver and nutritional problems in children. This course is available to both 3rd and 4th year students with both the 2 and 4 week options. Prerequisite: Completion of Core Clerkship in Pediatrics.

PEDS 4019A: Neonatal I.C.U. Acting Internship (University Hospitals)

During this rotation you will be caring for newborns in the NICU. The overall goal is for you to acquire and develop the skills to manage critically ill infants with a variety of medical and surgical problems. Neonatology is an intensively team-oriented specialty. As part of your rotation, you will work with and learn from the multiple healthcare professions who care for these babies. Additionally, you will be fully integrated into the medical team, working with residents, fellows, attendings, and nurse practitioners to provide high-quality care to their patients. You will be assigned as the primary caregivers for some of the babies, and will be expected to follow their progress towards discharge as well as communicate with families. Available to Year 3 and 4. Prerequisite: Completion of Core Clerkship in Pediatrics.

PEDS 4020A: Pediatric Palliative Care at Rainbow Babies & Children's Hospital (University Hospitals)

Goals and Objectives: 1. To provide exposure to children facing life threatening and end of life medical issues and for medical students to recognize core communicative skills in facilitating discussions about decision making and end of life discussions. 2. To showcase pain and symptom management in palliative and hospice patients and for students to identify at least three modalities to administer pain medications. 3. To show the diversity and breadth of palliative care and for students to be able to accurately define palliative are and distinguish it from hospice. 4. To demonstrate the many facets of palliative care and for students to be able to recite the working domains of palliative and hospice medicine. Duties: Timeliness, professional attire, and interactions. Journal presentation required for all rotators. Prerequisites: Completion of all Core Clerkships. This elective is held only for students who have a willingness to improve on clinical communication skills, and the ability to think broadly on the best interests of children facing life-threatening conditions.

PEDS 4021A: Developmental Behavioral Pediatrics (University Hospitals)

Students will observe patient interactions with children presenting to a Developmental Behavioral Pediatrician. Site visits (schools, agencies) will be offered when applicable. Students will attend lectures and other learning activities offered to trainees. Objectives: 1. Increase knowledge of normal and abnormal development. 2. Recognize common problems presenting to DB pediatrician. 3. Increase comfort level in physical exam of difficult children. Prerequisites: Successful completion of Pediatric Core Clerkship.

PEDS 4022A: Pediatric Allergy & Immunology (University Hospitals)

ONLY STUDENTS STRONGLY INTERESTED IN PEDIATRIC ALLERGY & IMMUNOLOGY AS A POTENTIAL CAREER PATH SHOULD APPLY FOR THIS ELECTIVE. This 2-week elective at UH Rainbow Babies & Children's Hospital Case Medical Center will provide broad exposure to pediatric allergy and clinical immunology. Each week students will spend 3-4 days in an outpatient pediatric allergy/immunology clinic. On the remaining days students may see consults, attend lectures, or review specific allergy/immunology journal articles. Students will observe and participate in outpatient allergy skin testing and other procedures such as food challenges and antibiotic testing. Students will learn about the evaluation for various pediatric allergy conditions and immunodeficiencies. The grade will be based on the student's performance during the rotation. OBJECTIVES: To provide the student with an opportunity to learn the fundamentals of eliciting the history of pediatric allergic and immunologic problems, to perform physical examinations, and to observe and assist with the methods of laboratory evaluation and the plan of comprehensive management. DUTIES: Student responsibilities as described above. There is no assigned night call. PREREQUISITE: Pediatric Core Clerkship

PEDS 4023A: Pediatric Bootcamp (University Hospitals)

The purpose of this elective is to provide an opportunity for graduating senior students pursuing a career in pediatrics or related specialties to develop the skills and knowledge integral to a successful intern year. The elective encompasses a mix of clinical experiences, simulation, and care based sessions and a didactic lecture series designed to equip the student with the necessary knowledge and skills to hit the ground running for residency. At successful completion of this 2-week elective experience, each student will collaboratively compile a letter detailing his/her skill set and knowledge base for his/her new program director. This elective will only be offered during block 10A each year. Prerequisites: Completion of all core clerkships.

PEDS 4110A: Pediatric Emergency Medicine (University Hospitals)

Pediatric Emergency Medicine - Student Requirements and Responsibilities Medical students are expected to be Accountable and Active in their learning and in the care of their patients. Work Hours: Medical students must be presented with a clinical working environment that supports their learning and safeguards their personal health. Emphasis should be on opportunities to learn within a reasonable framework of clinical activities. Specific considerations: -Student participation in clinical settings should not exceed resident work hour policies Work Load: Students must be presented with clinical workload expectation that support their learning while maintaining an appropriate level of engagement with the clinical environment. -Students will see approximately 4-6 patients per shift depending on patient complexity, patient severity, patient flow/volume, and departmental staffing. -Students will perform histories and physicals, oral presentations including differential diagnoses and management plans, and case write-ups. Students will be responsible for following up on diagnostic testing, response to therapy, and disposition of patient. Safe Contact for Student Concerns (work hours, treatment): Carol Chalkley at 216-368-3783 or cab26@case.edu. Prerequisite: Completion of Core Clerkship in Pediatrics.