Clinical Rotations

This clinical program follows children who were discharged from the NICU and are thereby at high risk for developmental and behavioral disorders.  Clinics are held weekly at Lucile Packard Children’s Hospital on Monday and Wednesday mornings and also at Dominican Hospital in Santa Cruz on the second Wednesday of every month.   Fellows participate in the Dominican Hospital Program in Years 1 to 3, and work at Lucile Packard Children’s Hospital Years 2 and 3.

Division/Section

R/E

Clinic

Timing

Developmental 
Medicine clinics

R

Developmental consultation program

Year 1-3

 

R

Autism and Social Communication

Year 1-3

 

R

Fellows’ Continuity Clinic

Year 1 (spring)-3

 

R

Outreach High risk infant follow-up (HRIF)

Year 2-3

 

R

High risk infant follow-up (HRIF)

Year 2-3

 

R

Inpatient consultation program

Year 1

 

R

Cerebral palsy at CCS

Year 2 or 3

Child Psychiatry

R

Psychopharmacology Clinic

Year 1

 

R

Consultation and Liaison (Inpatient)

Year 2

 

E

Mood and Affective Disorders

Year 2 or 3

Child Neurology

R

General neurology clinic or epilepsy

Year 1

 

E

Neuropsychopharmacology program

Year 2 or 3

Genetics

R

Down syndrome program

Year 1

 

R

General genetics clinic

Year 2

 

E

Neurogenetics clinic

Year 3

Adolescent Medicine

E

Teen Van

Year 3

 

E

General Adolescent Medicine Clinic

Year 2

 

R

Eating Disorders, In-patient service

Year 2

General Pediatics

 

R

Resident Continuity Clinic Consultations

Year 3

 

E

Healthy Weight Program

Year 3

 

R

San Mateo County Public Health Clinics Rapid Response Team

Year 3

For detailed description of goals and objectives for each experience, please see below:

High Risk Infant Follow-Up (HRIF) and Outreach HRIF Rotations

Description: This clinical program follows children who were discharged from the NICU and are thereby at high risk for developmental and behavioral disorders.  Clinics are held weekly at Lucile Packard Children’s Hospital on Monday and Wednesday mornings and also at Dominican Hospital in Santa Cruz on the second Wednesday of every month.   Fellows participate in the Dominican Hospital Program in Years 2 to 3, and work at Lucile Packard Children’s Hospital Years 2 and 3.   More 

Fellow’s Roles
Year 2:

Fellow works under the close supervision of precepting faculty who may participate in the visit with the fellows

Fellows obtain history, conduct developmental assessments, complete physical and neurological examinations

Fellows discuss management plans and referrals with the supervising faculty member and the interdisciplinary team

Fellows counsel families and provide feedback

Year 3

Fellows work more independently.  They may take history and complete evaluation without the preceptor present.

Fellows present their findings to the preceptor who repeats key sections of the visit.

Fellows discuss management plans and referrals with the supervising faculty member and the interdisciplinary team and present findings and plan to family

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds)Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 2, 3, 23,  57, 60, 64, 67, 74, 79, 92, 98

Vohr BR, O’Shea M, Wright LL. Longitudinal multicenter follow-up of high risk infants: Why, who, when, and what to assess.  Seminars in Perinatology, 27, 333-342.

Hack M, Taylor HG, Drotar D et al, Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birt weight children at school age.  Pediatrics, 2005, 116, 333-341.

Assessment Methods:

Quarterly clinical performance ratings

Preceptor observations and evaluation

360 assessments by patients

360 assessments by members of the interdisciplinary team

Review of clinic reports

 Less 

Developmental Consultation/Autism and Social Communication Rotations

Description: This clinical program assesses children referred by pediatricians or family members because of developmental delays.  Developmental Consultation Clinics are held weekly at Lucile Packard Children’s Hospital on Tuesday morning.  Autism and Social Communication clinics are held Friday mornings.   Children with a diagnosis of autism or problems in the domains of communication and social skills are scheduled if possible for the Autism clinic.  However, often it is necessary to fill Developmental Consultation visit slots.  Children with problems in other domains are preferentially scheduled on Tuesday.  Fellows participate in Programs for all three years of fellowship.   More 

Fellow’s Roles
Year 1:

Fellow works under the close supervision of precepting faculty who may participate in the visit with the fellows

Fellows obtain history, conduct developmental assessments, complete physical and neurological examinations

Fellows discuss management plans and referrals with the supervising faculty member and the interdisciplinary team

Fellows counsel families and provide feedback

Year 2 and 3

Fellows work more independently.  They may take history and complete evaluation without the preceptor present.

Fellows present their findings to the preceptor who repeats key sections of the visit.

Fellows discuss management plans and referrals with the supervising faculty member and the interdisciplinary team and present findings and plan to family

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds)Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 8, 22, 23, 24, 26, 30,35, 38, 39, 40, 51, 54, 62, 66-74, 75-77, 92, 93

Assessment methods

Quarterly clinical performance ratings

Preceptor observations and evaluation

360 assessments by patients

360 assessments by members of the interdisciplinary team

Review of clinic reports

Outcomes

Portfolio of de-identified case reports

Once available, fellows will pass the In-Site Examination

Board certification

 Less 

Psychopharmacology Clinic

Description: This clinical program assesses children referred by Primary Care or community physicians for medical management of psychiatric disorders.  Clinics are held weekly at Lucile Packard Children’s Hospital or Psychiatry and Behavioral Sciences on Monday mornings.  Fellows participate in the clinic throughout Years 1.  Dr. Kyle Hinman is the attending child psychiatrist.   More 

Fellow’s Roles
Year 1:

Fellow works under the close supervision of precepting faculty who typically participate in the visit with the fellows

Fellows obtain history, conduct a mental status exam,  and make a psychiatric diagnosis

Fellows discuss management plans with the supervising faculty member

Fellows prescribe and manage medication under the supervision of the faculty.

Fellows see patients in follow-up to evaluate the management plan.

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds)Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 38, 39, 40, 41, 42, 45, 47, 48, 49, 51, 54, 65, 75, 78, 86, 87, 88, 89

AACAP: Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivitiy disorder. J Am Acad Child Adolesc Psychiatry. 2007: 46(7): pp. 894-920

Parker S: Attention Deficit Hyperactivity Disorder, in: Parker S, et al (eds.), Developmental and Behavioral Pediatrics: A Handbook for Primary Care, 2nd ed., (2005), pp114-123, Phil: Lippincott.

Joshi, SV: Psychostimulants, Atomoxetine, and Alpha-Agonists. In: Steiner H (ed.),Handbook of mental health interventions in children and adolescents. 2004; (pp. 258-286): San Francisco; Jossey-Bass

Assessment methods

Preceptor direct observations at each clinic

Summary preceptor global evaluations quarterly

Review of clinic reports

Annual review of case logs

Outcomes

Fellow will provide psychopharmacologic management in DBP clinics

Fellow will pass the ABP certifying examination

Fellow will provide education to faculty, other fellows and residents on Psychopharmacology at Case Conference and DBP Review

 Less 

Neurology Clinics

Description: This clinical program assesses children referred by Primary Care or community physicians for evaluation and management of neurological disorders.  Clinics are held weekly at Lucile Packard Children’s Hospital at various times.  Fellows participate in the clinics in the second half of Year 1 and first half of Year 2.  More 

Fellow’s Roles
Year 1 and 2:

Fellow works under the close supervision of precepting faculty

Fellows obtain history, complete a comprehensive physical and neurological examination and make a diagnosis

Fellows discuss diagnosis and management plans with the supervising faculty member

Fellows prescribe and manage medication under the supervision of the faculty.

Fellows see patients in follow-up to evaluate the management plan.

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds) Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 8, 22, 27, 66-74, 7683, 84, 85

Assessment methods

Preceptor direct observations at each clinic

Summary preceptor global evaluation

Annual review of case logs

Outcomes:

Fellow will pass boards

Fellows will provide education on neurological conditions at Case Conference or DBP Review course

 Less 

Genetics Clinics and Down Syndrome

Description: This clinical program assesses children referred by Primary Care or community physicians for evaluation and management of genetic disorders.  Clinics are held weekly at Lucile Packard Children’s Hospital at various times.  Fellows participate in the clinics in the second half of Year 1 and first half of Year 2.  In Down syndrome clinic the focus is on management of a complex chromosomal disorder.  In Genetics clinic, the focus is typically on diagnosis of a genetic or metabolic condition.   More 

Fellow’s Roles
Year 1 and 2:

Fellow works under the close supervision of precepting faculty

Fellows obtain history, complete a comprehensive physical and neurological examination, obtain or review a family pedigree

Fellows discuss diagnosis with the attending physician

Fellows generate genetic work-ups and/or management plans with the supervising faculty member

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds) Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 24, 25, 26, 30, 69, 100, 101

Assessment Methods:

Quarterly clinical performance ratings

Preceptor observations and evaluation

 Less 

Adolescent Eating Disorders, In-Patient Rotation

Description:  This one month rotation is an opportunity to work on the interdisciplinary team that assesses and treats adolescents with anorexia, bulimia, and related conditions.  Fellows will function like the residents and fellows on the service, assume primary responsibility for a group of adolescents on the inpatient service under the supervision of the faculty of Adolescent Medicine.   More 

Fellow’s Roles
Year 2:

Fellows obtain history, conduct a mental status exam, physical examinations, and make appropriate diagnoses

Fellows discuss management plans with the supervising faculty member

Fellows participate in interdisciplinary team meetings for planning management and evaluating progress.

Fellows may take call during this month, depending on the needs of the service.

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds)Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 38, 39, 40, 41, 42, 45, 47, 48, 49, 51, 54, 65, 75, 78, 86, 87, 88, 89

Assessment 

Observation of precepting faculty

Discussions in Case Conference and DBP Review

Quarterly evaluations

 Less 

Developmental Care Team, In-Patient Rotation in Neonatal Intensive Care Unit

Description:  This one month rotation is an opportunity to work on the interdisciplinary team that assesses and treats high risk infants in the NICU and their parents.  Fellows will work along with the psychologist, special education specialist, physical and occupational therapist who provide consultation to the medical and nursing staff within the NICU.  More 

Fellow’s Roles
Year 1:

Fellows obtain history, assess the child’s medical status,  physical examinations

Fellows use behavioral assessment tools to improve the accuracy of their impressions

Fellows discuss recommendations with the team preceptors

Fellows participate in interdisciplinary team meetings for discharge planning.

Fellows follow patients and families into the HRIF clinic in Year 2

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds) Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters 2, 3, 7, 8, 78

Assessment methods

Preceptor direct observations

Summary preceptor global evaluation

Multi-source (360) assessments by patients and members of the interdisciplinary team (at least 2/year)

Outcomes

Fellow will pass the ABP Board Certification Examination

Fellow will show compassion and understanding of the issues that high risk infants experience during out-patient HRIF visits

 Less 

Behavioral Health Consultation and Liaison, In-Patient Rotation at LPCH

Description:  This one month rotation is an opportunity for fellows to work on the interdisciplinary team that assesses and treats hospitalized children and their parents for emotional, behavioral, and mental health conditions that arise from or complicate hospitalization.  Fellows become a member of the team of psychiatrists and psychologists who consult throughout the hospital.  They participate in attending rounds, see new consults as the primary physician, complete follow up in-patient visits, and may also follow-up with patients at outpatient visits.   More 

Fellow’s Roles
Year 2:

Fellows obtain history, assess the child’s medical status,  conduct physical examinations

Fellows use assessment tools to improve the accuracy of their impressions

Fellows make psychiatric diagnoses if appropriate

Fellows discuss recommendations with the team preceptors

Fellows participate in interdisciplinary team meetings for hospital management and for discharge planning.

Core Readings

Carey WB, Coleman W, Crocker AC, Elias E, and Feldman HM (Eds) Developmental-Behavioral    Pediatrics, Fourth Edition.  Philadelphia, PA: Elsevier, 2009, Chapters  7, 22, 32,33, 34, 35, 36, 42, 46-50.

Assessment

Observation of precepting faculty

Discussions in Case Conference and DBP Review

Evaluation at conclusion of the rotation

 Less