Integration

During the Infant, Child and Adolescent health block, there will be further integration of curricula with courses including but not limited to: Women and Newborns Health, Musculo-skeletal care, Rural and Community care, Urgent/Emergency Medicine, threads and the elective LEADS program.

Women and Newborns’ Health will implement objectives and competencies for perinatal and neonatal medicine, some of which were previously covered during the Pediatric clerkship. We are currently working with block director of Women and Newborns Health to define and implement the educational objectives around newborn health as they relate to the mother-baby dyad.

Because we will partner with Musculo-skeletal care, we will have opportunities to develop case-based instruction that covers objectives for each course. On the afternoon of the first day of the clerkship, we will focus on physical exam skills, including musculoskeletal exam with specific emphasis on the pediatric exam and how that might differ from adults based on developmental age. During the intrasessions we will have an opportunity to integrate radiology and the basic science of bone growth and ossification, and discuss metabolic bone disease, as well as review bone films. On the final day of evaluation, two standardized patients for assessment will include one pediatric focused case involving child abuse, wherein students will be required to interpret an x-ray revealing a broken limb. A second standardized patient will be musculo-skeletal focused with presentation of an adolescent with hip disease that presents as knee pain.

Several Threads objectives will be addressed during intrasessions. We will faciliate one LIVE case of an obese adolescent female of multi-race heritage who presents with depression. Objectives covered with this case include areas of communication, mental health, cultural competency, nutrition and the public health/societal concerns around overweight children and the implications on adult health. Additionally, the basic science of lipid metabolism, adiposity, and hypertension will be discussed in this session. We will also facilitate a case around a family with a child who has physical disabilities. Objectives will include topics of advocacy, health policy, family dynamics, underserved populations.

In both the Rural and Community Health block and Emergency Medical care block, students have opportunities to care for children and learn about pediatric health. In circumstances where they will be better able to address pediatric objectives unique to these settings, we will work with the block directors to define those objectives.

The LEADS elective program places students in community organizations to develop scholarly projects many of which will be related to issues affecting children, adolescents and vulnerable families. Establishing stronger affiliations and ties with community organizations will expand clerkship opportunities and allow integration and development of mentored scholarly projects to begin during the Infant, Child and Adolescent block. In conjunction with LEADS faculty we will develop one more case to be discussed during the intrasession.

The ICAH course will continue to use LIVE cases as an alternative format for enriching the curriculum and ensuring some uniform experiences for practicing and assessing clinical reasoning skills. These online cases are complex allowing for discussion of clinical scenarios with integration of threads content and translational basic science elements. One such example of a LIVE case is an infant with growth failure and dysmorphic features wherein nutrition, genetics, basic science of growth and caloric needs, newborn screening, chronic care, cultural bias are researched, discussed and facilitated by a faculty facilitator. Other cases to be used include: an infant who presents with altered mental status and subsequently a diagnosis of non-accidental trauma; an adolescent with syncope, weight loss, amenorrhea and high risk behaviors with a diagnosis of anorexia nervosa; and an adolescent Latina with obesity and depression. In each of these cases, threads content may be further developed and basic science elements are addressed. Three cases will be completed over the 8-week block; one will be included as part of the intrasession.

Intrasession content is proposed to include: focus on radiology with clinical correlates to basic science of bone growth, ossification, and metabolic bone disease; nutrition ( basic science: growth, caloric needs and obesity); electrolyte balances (fluids, renal, bone); one LIVE case of an obese teen that highlights basic science concepts of insulin pathways and resistance, pancreatic function, fat cell metabolism, liver function; one advocacy/health policy case (to be developed in conjunction with LEADS and threads faculty) that highlights disability, chronic care, culture, society, professionalism, advocacy and health policy.