Hospital Rotation

The interns each attend three medical specialty clinics for a half-day apiece per week. Two of the four interns are assigned to each of the following blocks of clinics: (1) asthma, myelomeningocele, HIV or (2) renal, diabetes/ endocrinology, and sickle cell. Children enrolled in these clinics are seen regularly by a multidisciplinary team of health care professionals, including physicians, nurses, psychologists, social workers, dietitians, physical and occupational therapists, and recreational therapists. The exact composition of the team varies from clinic to clinic. Interns are assigned to a clinic block based upon preference, background, and supervisor judgment. The intern learns to provide ongoing evaluation, consultation, and interventions regarding the impact of the specific illnesses upon the child's functioning in school, in the family, and with peers. During the psychology portion of the interview, the intern and supervisor assess adherence to medical regimens, school functioning, peer functioning, family functioning, and any relevant psychopathology; brief interventions are conducted when problems arise. Training and supervision is "hands on" in the sense that the supervisor models conducting the interview with the child and family, then observes the intern conducting the interview, and gradually fades out his/her presence over the course of the rotation. By the end of the rotation the intern is conducting the interview without the supervisor in the room. In most clinics the intern and supervisor participate in team meetings reviewing the status of the patients seen in the clinic. Interns then write brief reports of their patient contacts.

On the consultation liaison service, the intern responds to requests from hospital pediatricians to address the behavioral/ emotional problems of children admitted to Children's Hospital for medical problems. At first, the intern watches the supervisor conduct the consult. Then, the intern conducts the consult while the supervisor observes and gives feedback. By the middle of the year, the intern conducts the consult without the supervisor present and reviews the case with the supervisor afterwards.

Consultation requests include chronic illness adherence and adjustment issues, pain management, conversion and somatoform disorders, differential diagnosis of psychopathology, and family/ environmental concerns. Many of these consults are for patients whom the interns have previously seen in the multidisciplinary clinics, allowing them the opportunity to learn about continuity of care from inpatient to outpatient settings.