Pediatrics Electives

Program Director: Sheree Kuo, MD
Location: NICU, Kapiolani Medical Center for Women and Children

Objectives:

• Develop an understanding for the general problems that occur in the NICU, i.e. care of the extremely premature infant and the spectrum of problems facing infant and family, especially the necessity and stresses of a prolonged hospitalization.
• Appreciate the multidisciplinary team care approach in the NICU, and the value of all members involved in the care of infants and their families.
• Acquire an appreciation of the role of the NICU in a tertiary center involved in the transport of sick infants, telephone consultation 24 hours a day, training of health care team members at various levels of education-student, nurse practitioner, hospitalist, fellow; and coordination of specialty consultation for the family.
• Acquire technical and diagnostic skills in the assessment and treatment of neonatal problems, viz. Respiratory distress and ventilator management, birth asphyxia, congenital anomalies, sepsis neonatorum, intraventricular hemorrhage, enteral and parenteral nutrition, nosocomial infection, chronic lung disease in the preterm infant, persistent pulmonary hypertension of the newborn screening, and long-term outcomes.
• Develop an appreciation of family centered care in the NICU, the evolution of developmentally supportive care in the NICU, and the areas of major progress and major obstacles in neonatal intensive care.
• Provide specific experience with the late preterm infant, experience in discharging planning, and familiarity with management of long term complications of extremely low birth weight infants: e.g. ROP,. NEC, posthemorrhagic ventricular dilation, cholestatic jaundice.

Method:

• Sub-internship is encouraged as the most fruitful experience to attain the stated objectives. This would include taking call with a resident rotating through the NSCU, making rounds, writing orders, family meetings, etc.
• All students will be under the direct supervision of the faculty and house staff physicians. Night call will be approximately once a week, varying around resident night call and may also include some weekends. Schedules can be individualized with the attending as resident coverage is variable at different times of the year.

Evaluation:  Ongoing feedback to the student will be provided by the faculty and the house staff throughout the rotation. A written evaluation will be completed and sent to the Student Affairs Office at the end of the rotation. The attending physicians during the elective period will be responsible for student evaluation.

Program Director: Leah Dowsett, MD
Location(s): Hawaii Community Genetics, Kapiolani Medical Center for Women and Children, The Queen’s Medical Center, Shriners Hospital

Objectives:

• Determine key concepts related to common patterns of inheritance (autosomal dominant and recessive, X-linked, mitochondrial, multifactorial).
• Identify common referral reasons for newborn, pediatric, adult and prenatal genetic evaluation.
• Describe common methods of genetic diagnosis, including molecular, cytogenetic and biochemical testing.
• Identify internet resources for further information regarding genetic conditions.
• Preform a thorough physical examination with emphasis on identifying major and minor congenital anomalies which may be signs of underlying genetic syndromes.
• Collect an appropriate family history for common genetic disorders.
• Recognize urgent and/or severe conditions related to genetics and inherited metabolic disorders.
• Describe the laboratory evaluation for a child with a suspected inborn error of metabolism.
• Recognize the role of the Newborn Metabolic Screening program, the types of disorders screened for in Hawaii, appropriate resources, and appropriate follow up of a positive newborn screen.
• To describe the indications for prenatal genetic counseling, prenatal screening tests, techniques utilized for prenatal diagnosis including limitations and risks, as well as reproductive options and issues related to pregnancy termination.

Method:

• A four-week elective that involves evaluation and follow up of neonates, children and adults with known or suspected genetic conditions including chromosome disorders, single and multiple birth defects, single gene disorders, teratogenic disorders, hemoglobinopathies and inborn errors of metabolism.
• The elective rotation will include exposure to both inpatients and outpatients. Patients may be seen at the HCG clinic, Queen’s Comprehensive Genetic Center, KMCWC, QMC, and Shriners Hospital.
• Students will work closely with a team including medical geneticist, genetic counselors and metabolic nutritionist. There are also opportunities to work independently conducting literature and genetic database searches, a syndrome identification project and end-of-rotation special topic (chosen by student) presentation to the genetic team (10-15 minutes).
• Students will attend genetic lectures given by members of the genetic team to medical students, residents, or other audiences when appropriate.

Evaluation:  Performed at the conclusion of the rotation by the preceptor with input from other team members. Feedback will also be given throughout the rotation as appropriate.

Program Director: Venu Reddy, MD
Location: Kapiolani Medical Center for Women & Children

Objectives:

• Acquire clinical skills in the diagnosis and management of congenital and acquired heart disease in children and adolescents.
• Develop basic knowledge in the use of diagnostic modalities such as EKG, X-ray, echocardiography and catheterization data in the evaluation of heart disease in children.
• Better understand the pathogenesis of cardiovascular disorder and improve the techniques of counseling patients and their families with cardiovascular disorders and innocent heart murmurs.
• Exposure to pediatric cardiac surgery and experience with post-operative management of cardiac patients.

Method:

• Students will see patients in the program director’s office or in the KMCWC Pediatric Cardiology Clinic on a one-to-one basis in a tutorial learning experience. After such initial experience, patients will be assigned to the student for work up. After evaluation, student will present the case to the program director and the patient will be seen jointly and discussed with review of any labs such as EKG, chest x-ray and echocardiography.
• Students will participate observing cardiac catheterization and open heart surgery when possible.
• Topics in pediatric cardiology will be assigned to the students for study. These topics may include cyanotic and acyanotic congenital heart disease, congestive heart failure, cardiomyopathy, cardiac arrhythmias, rheumatic fever and others. After preparing the topics from pediatric cardiology texts and journals, student will present and discuss with program director.

Evaluation:  Ongoing discussions with each student will provide feedback. A written evaluation with multiple choice questions will be provided to the student.

Program Director: Paul Eakin, MD
Location: Pediatric Emergency Department, Kapiolani Medical Center for Women and Children

Objectives:

• Acquire the ability to systematically assess and manage common problems that present to a Pediatric Emergency Department: cardiopulmonary resuscitation, medical emergencies, trauma, toxicology, orthopaedics, and wound care.
• Learn the pathophysiologic principles involved in the assessment and stabilization of any acutely ill child.
• Be able to quickly establish a differential diagnosis based on the history and the physical examination.
• Gain experience in those technical skills and procedures (i.e. intubation, vascular assess techniques, wound care, suturing, lumbar puncture, splinting, etc) which are required in the management of acutely ill children.
• Learn proper documentation of the ED assessment, managements and follow-up from both the medical and legal standpoints.

Method:

• This four-week, exciting and fast-paced elective in Pediatric Emergency Medicine is designed for those students who are considering careers that involve the care of children with acute illness (Pediatrics, Emergency Medicine, Family Practice, Surgery and Medicine-Pediatrics).
• Students will be given the opportunity to utilize a syllabus of selected topics from the field of Pediatric Emergency Medicine. Each day there are multiple opportunities for one-on-one case discussions and other didactic sessions with the Attending Physician.
• Each student is required to do 16 shifts during this 4-week elective. The exact dates and times of these shifts will be arranged through the Program Director.

Evaluation:  Ongoing feedback to the student will be provided by all of the ED attending faculty on a daily and weekly basis. A composite written evaluation will be completed at the end of the rotation. In addition to this written evaluation, one-on-one feedback sessions will also be provided by the Program Director on the request of the student.

Program Director: Darryl Glaser, MD
Location: Kapiolani Medical Center for Women and Children

Objectives:

• Acquire skills in evaluating and treating inpatient pediatric hematology and oncology patients and consults.
• Develop clinical laboratory skills pertaining to pediatric hematology and oncology.
• Develop skills in evaluation and ongoing treatment of hematology and oncology patients on outpatient clinic.
• Participate as a member of the comprehensive pediatric oncology team care unit overseeing the total care of each patient followed at this medical center.

Method:

• The hematology/oncology sub-intern will see all inpatients daily with the Program Director. All appropriate laboratory material will be reviewed daily on the ward or in pathology as dictated.
• Students will daily participate in ongoing care and evaluation of hematology/oncology patients in the clinic or referral hospital setting.
• Students will assist in all blood drawing through catheters and perform bone marrows, spinal taps and other diagnostic studies during the rotation.

Evaluation:  Ongoing feedback to the student will be provided by the Program Director and the Oncology team throughout the student’s rotation. A written evaluation will be available for review by the student.

Program Director: David Kurahara, MD
Location: Kapiolani Medical Center for Women and Children

Objectives:

• Gain an understanding of Pediatric Rheumatologic illness from both an outpatient and inpatient perspective.
• Improve skills in joint examination relating to Rheumatologic disease and overuse syndromes commonly seen in children.
• Develop an understanding of the use of laboratory tests in the Rheumatologic illness for diagnosis and prognostic purposes.
• Achieve a basic understanding of immunologic processes involved in autoimmunity.

Method:

• A four-week elective which involves evaluation and follow-up of children with Rheumatologic illness.
  
  • This includes a variety of disorders, including juvenile Rheumatoid Arthritis, Systemic Lupus Erythematosus, Acute Rheumatic Fever, Fibromyalgia, and other Vasculitides.
  • Work ups include both established patients in follow-ups and new patients referred to the service
• Students will work closely with faculty members in patient evaluation but will also work independently in literature or laboratory research in major topics related to Rheumatology or Immunology.
• Students will be expected to present one topic in-depth to faculty members toward the end of the rotation.

Evaluation:  Will be performed at the conclusion of the rotation by the preceptor with input from faculty members as appropriate. Ongoing feedback will also be given throughout the student’s rotation.

Program Director: Barry Mizuo, MD
Location: Kapiolani Medical Center for Women and Children

Objectives:

• Acquire skills in evaluation of pediatric inpatients admitted to the ward service. This includes performance of a thorough, yet efficient history and physical examination.
• Broaden knowledge of inpatient pediatric problems. This is accomplished through learning from each individual case through hands on care, observation, case discussion with residents and faculty and reviewing the literature.
• Learn more about appropriate use of diagnostic modalities including laboratory studies, radiology, pathology, etc.
• Determine the appropriate referral to sub-specialty physicians.
• Learn about appropriate consultation of pediatric sub-specialty physicians for evaluation of complicated problems.
• Acquire skills in working as a member of a health care team including house staff, hospitalists, private physicians, nursing staff and other hospital support personnel.

Method:

• The ward sub-intern will function as an integral part of the house staff being assigned to the ward teams.
• Sub-interns will be responsible for working up and coordinating the care of a variety of patients.
• The student is assigned admissions in rotation with interns and other sub-interns.
  
  • Sub-interns will be under direct supervision of one of the ward senior residents (PL-II or PL-III) but will communicate directly with hospitalists and private physicians.
• Sub-interns are responsible for completing detailed H & P’s on all patients admitted to the service, communicating daily assessments and plans with the team, communicating any consultants, for writing daily progress notes and otherwise following the clinical progress of these patients.
• Night call is taken every fourth night with the designated team.
• The student also participates in daily rounds and teaching conferences with the house staff.

Evaluation:  Ongoing feedback is provided by the senior resident, Chief Resident and other members of the ward team. There is no written or oral examination. A narrative written evaluation is provided to the Student Affairs Office at the end of the rotation and is available for review by the student.

Program Director: Jeffrey Okamoto, MD
Location(s): Development-Behavioral Pediatrics Clinics, selected School and Early Intervention sites, therapy, and Developmental Disabilities Programs.

Objectives:

• Increase understanding of the medical role for physicians around children with chronic illness, special needs, and disabilities. This would include identification and management (including appropriate referrals) of those health issues in these children. Example of important conditions the student are expected to become familiar with are:
  
  • Children with physical disabilities, for example cerebral palsy and spina bifida;
  • Children with development disabilities, for example mental retardation and autism;
  • Children with behavioral and mental health problems, for example, Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder;
  • Children with Chronic illness causing school issues, for example epilepsy, leukemia and asthma; and
  • Children with complex technological needs transitioning to school.
• Acquire the ability to work fluidly with early intervention systems around children with medical and mental health issues. To be involved as the health consultant in IFSP teams creating plans for these children.
• Be able to access special education resources including therapy (occupational, physical, and speech language). Mental health and nutritional services around children identified with special needs.
• Have knowledge of federal mandates in special education in order to optimize connecting children identified with health problems to appropriate early intervention and special education services.
• Disseminate medical information perceived by early intervention and school systems to be important to their staff and children.
• Learn ways of interacting with special education, school and /or disability resources in future practice.
• Understand problems for individuals with developmental disabilities as adults in order to provide improved services for children with these conditions.

Method:

• Students will be provided with an orientation packet, which informs them of activities and assignments for the elective
• The program director and staff will introduce the student to children with various conditions and disabilities within selected early intervention (E.I.), developmental disabilities division (DDD), and school environments.
• Students will interact with health, school, DDD case managers, and E.I. staff (Primary care provider, teachers, school nurses and aides, therapists, and other specialists) in order to learn comprehensively about access to and provision of services for these children.
• The student will create reports regarding each child after discussions with staff, direct observation of the child, and review of records (child student encounter). Discussion and routine debriefing with program staff will facilitate further understanding.
• Mini talk preparation and presentations to E.I. and program staff, involvement with Developmental Behavioral Pediatric Clinics all facilitate learning this elective.
• Pediatric residents, Developmental/Behavioral Pediatric fellows and Attending Physicians all participate in teaching the student in the carious contexts.
• Involvement with research initiatives is available.

Evaluation:  A pretest and post test is given to all students taking the elective. Ongoing debriefing and feedback to the student will be provided by the program director and project staff on at least weekly basis. A written evaluation will be provided by the student affairs office at completion of the elective.

Program Director: Marian Melish, MD
Location: Kapiolani Medical Center for Women and Children

Objectives:

• Acquire skills in diagnosis and treatment of pediatric patients with a variety of infectious diseases.
• Develop increased body of knowledge about clinical microbiology and infectious diseases.
• Increase skills in the critical evaluation of medical literature by doing in depth research on specific multiple topics.
• Develop skills in communication of scientific information to others in the health care professions through consultations on individuals, informal and formal rounds and teaching conference.

Method:

• A four-week elective which involves evaluation and follow-up of patients with a variety of infectious diseases seen as inpatients and outpatient services at Kapiolani Medical Center for Women and Children and Shriner’s Hospital.
• Students will be expected to work closely with faculty members and house staff in evaluation and care of patients and to work independently in literature and/or laboratory research in multiple major topics in Infectious Diseases.
• Independent patient evaluations, twice daily rounds with preceptor and participation in teaching conferences is expected.
• Students will be expected to present one topic in-depth at the Pediatric Infectious Diseases Conference

Evaluation:  Will be performed at the conclusion of the rotation by the major preceptor with input from all the course faculty when appropriate. This narrative evaluation will be sent to the Student Affairs Office and is available for review by the student.