M4 Pediatrics

• MED MD 442: Adolescent Medicine
  The Adolescent Medicine elective will take place at Boston Medical Center's outpatient Adolescent Center, as well as at a handful of community sites. It will be an opportunity for one 4th year medical student per rotation to gain experience caring for adolescents in the outpatient setting. Students will interview and examine adolescent patients with attending physician supervision, and come up with plans for diagnostic evaluation and treatment. Students are expected to work at least 40 hours per week and have various opportunities to interact with attending physicians, mid-level providers, nurses, social workers, and other community providers. This elective will give medical student valuable exposure to common psychosocial and medical health concerns in adolescents such as sexual and reproductive health, disordered eating, reproductive endocrinology, depression and anxiety, substance use, as well as pubertal growth and development. Students will also attend teaching conferences in the Department of Pediatrics at Boston Medical Center when this does not conflict with clinical experiences. This may include, but is not limited to: Noon Conference, Case of the Week, and Grand Rounds - in addition to adolescent specific education sessions as part of the BCRP Keystone block. Students will receive timely feedback from providers as well as formative feed back at the mid-clerkship evaluation to assess their progress in developing the below skills. At the end of the elective, the student will be expected to complete an evidence-based presentation as outlined below, and will have gained the following skills: - To conduct an age and developmentally appropriate interview - To council adolescents regarding common psychosocial concerns, including but not limited to reproductive health, substance use and mental health - To come up with appropriate treatment plans for common adolescent concerns.
• MED MD 500: Developmental and Behavioral Pediatrics
  The focus of this elective will be on gaining an understanding of normal developmental processes; attachment, autonomy, mother-infant interaction, coping, Piaget's cognitive theory, temperament. Different types of screening techniques will also be taught; and Denver Developmental Screening Test skills will be practiced. Structured activities will include supervised consultations, a literature seminar, ongoing child development activities in the Pediatric Department and Division of Developmental and Behavioral Pediatrics and participation in the various clinics. Flexibility in the elective exists for those who wish to gain some experience with children with specific developmental problems, e.g., learning disabilities, prematurity, and in utero substance exposure.
• MED MD 501: Pediatric Gastroenterology
  The pediatric gastroenterology elective is an opportunity for students to learn to recognize and manage common gastrointestinal disorders in children (ages birth to 22 years) including: abdominal pain, constipation, chronic diarrhea, recurrent vomiting, hematochezia, hematemesis, failure to thrive, abnormal liver function tests, etc. The majority of the student's time will be spent in the outpatient GI clinic. The student will be assigned to evaluate patients with an attending during a clinic session, with increasing independence after he/she demonstrates competency in obtaining the core elements of the history and physical exam. Through this experience, students will gain familiarity with both the initial work-up as well as the long-term management of patients with both acute and chronic illnesses as mentioned above. The student will learn the initial approach for new patients as well as long term management of chronic illnesses. The student will also attend endoscopy session one or two morning a week, and will learn the indications for procedures, exposure to normal and abnormal findings, and post-operative care. When there are pediatric GI inpatient consults, the student will be responsible for evaluating and then presenting the new consultations during daily rounds. The student will follow these patients throughout their admission, writing progress notes, reviewing relevant radiologic imaging and finding related journal articles to augment his/her understanding of each patient's gastrointestinal disorder. The student will present relevant journal articles during rounds, communicate consultant recommendations to the floor team and reference applicable material learned in their daily progress notes.
• MED MD 502: Pediatric Infectious Diseases
  The course is designed to assist the student in developing expertise in the diagnosis and management of pediatric infectious diseases with emphasis on the clinical pharmacology of antimicrobial agents and newer modalities of diagnostics. The student will participate in the activities of the pediatric infectious disease group at Boston Medical Center, including in-patient consultation, daily rounds, and conferences. Experiences will include viral, bacterial, and fungal diagnostic labs, as well as Infection Control. Students will have an opportunity to attend Pediatric HIV and International Health Clinics. Students will be evaluated on the basis of their participation in rounds and conferences and one clinical presentation to members of the division at the end of the month.
• MED MD 503: Pediatric Cardiology
  One student will be a member of the cardiology consult team, and will assist in the evaluation, screening and management of patients with known or potential cardiac disease. The student will write initial consult and follow-up notes. Students may explore specialty consult services (e.g., adults with congenital heart disease, cardiac transplantation) for a portion of their rotation. Students are expected to improve ones consultation skills, read pediatric EKGs, and attend an array of didactic sessions covering a wide range of topics in pediatric cardiology. No call is required.
• MED MD 504: Pediatric Nutrition
  The U.S. Preventive Services Task Force recommends that physicians provide nutrition counseling and referral as a standard part of their practice and as a strategy for primary prevention of disease. The Pediatric Department at Boston Medical Center serves a diverse and underserved inner city population with high rates of nutritional related diseases including vitamin D and iron deficiencies, failure to thrive, failure to initiate or continue breastfeeding, and overweight / obesity. The purpose of this evidence-based elective is to increase the nutrition knowledge, attitudes and counseling skills of medical students through hands-on, case-based training in pediatric nutrition and weight management, as well as participation in pediatric nutrition conferences and projects. Students will have the opportunity to work with dietitians, physicians, mental health providers, and lactation consultants, individually and within multidisciplinary teams. They will be exposed to the nutritional management of patients who are enrolled in a variety of programs including the Pediatric Nutrition Support Service, the Nutrition and Fitness for Life (NFL) program, the Grow clinic, Baby Steps, the Pediatric Preventive Cardiology clinic, the Pediatric Endocrine clinic and the Pediatric GI clinic. Students will also have access to other programs based on their specific interests including the Baby Cafe, the Preventive Food Pantry, and the Teaching Kitchen. While a majority of their time will be spent in clinic, students will also have outside reading and web-based modules, complete a project, receive 1-on-1 lectures based on their interests, and attend case series, grand rounds and nutrition seminars.
• MED MD 505: Pediatric Latino Patients: Language, Sensitivity and Cultural Immersion
  This pediatric-focused elective is an opportunity for students to improve their medical knowledge of pediatric medical issues, deliver pediatric primary, and improve their medical Spanish knowledge in this population. The majority of the student's time will be spent seeing patients in the outpatient pediatric clinic at BMC with attendings who are Spanish-speaking and/or Spanish-speaking Latino origin that have a significant proportion of patients whose primary language, either for them or their parents, is Spanish. These clinics may include, but are not limited to the following pediatric settings: Gastroenterology, Neurology, Infectious Disease, Endocrinology, and Primary Care. The student will learn the initial approach for new patients as well as long-term management of chronic illnesses in the designated clinical settings. Discussions with faculty around patient care will focus both on medical management in general, but also with specific attention to elements of the social and cultural influences that affect the quality of medical services and treatment and that can enhance health outcomes for the patient and family. As a clinician, the student will develop skills of more culturally sensitive care both through observation of the approach of the experienced physicians and through active practice and feedback. Complementing the clinic experience and exposure to medical Spanish, the course will have a series of literature discussions developed to cover diverse elements of Spanish-speaking patients and Latino health, cultural awareness and sensitivity, as well as care of patients with limited English proficiency. Students interested in the elective should have a working proficiency of spoken Spanish with capability of, at a minimum, interviewing the patient, gathering pertinent information and performing a pertinent physical exam. Students lacking this level of fluency may enroll in the elective, but should have comprehension of spoken Spanish sufficient to follow the interview and interaction in Spanish between the care provider and the patient. For those interested in receiving attestation of their language proficiency to adequately interview patients in Spanish through the Hospital Interpreter Services an evaluation can be arranged beforehand for such attestation.
• MED MD 506: Pediatric Neurology
  The student will be immersed fully into the Pediatric Neurology team, constituted by Pediatric Neurology and Adult Neurology residents, rotating Pediatrics residents, and one of the staff physicians. This elective provides an opportunity to participate in all inpatient and outpatient activities of the Division of Pediatric Neurology. Students will obtain histories and examine patients seen in clinics, on the wards and in the nurseries, and will then present the case to staff. The staff will provide "hands on" instruction in neurological examination and in clinical management. Additionally, there are weekly Neuroradiology rounds at which cranial and spinal magnetic resonance imaging, cranial computerized tomography, and cranial ultrasound imaging studies are reviewed. EEG rounds are held bi-weekly. Each Friday, 2 hour-long academic sessions are held. The first portion of these Pediatric Neurology Grand Rounds include, on a rotational basis, Journal club, research topics, didactic presentations, case reviews with attending physicians, and topics in psychopharmacology. A live patient presentation and discussion of the child's neurological disorder by a member of the Pediatric Neurology Division occurs during the second hour as the case of the week. In the course of the month, the student is expected to identify a topic to research in-depth and to present the topic as a 20 minute presentation near the end of the elective. The elective is ideally suited for the student who is interested in pediatrics. Prior completion of the BUSM rotation in adult neurology is not required.
• MED MD 507: Child Abuse Pediatrics
  The Child Abuse Pediatrics Elective is an opportunity for a 4th year medical student to gain exposure to child physical abuse, child sexual abuse, and child neglect in the Emergency Department, Primary Care, and Pediatric Inpatient settings. The elective will take place primarily at Boston Medical Center, but the student will also have various placements throughout Boston and the surrounding areas. Students are expected to work at least 40 hours per week, with most of that time being one-on-one with attending physicians, social workers, and other members of the multidisciplinary team as dictated by case load and availability during the rotation. Students will spend at least 20 hours per week in clinical placements with a minimum of two 8-hour ED shifts and one 4-hour well child clinic per week. Students will learn to communicate effectively with families regarding the sensitive issues surrounding child abuse pediatrics, while maintaining a high ethical standard, compassion, and respect for all members of the family. Students will work directly with CPT staff during 51A filings and during weekly case review so as to educate the student about the information required, the basic ethical and legal frameworks, and the specific process of filling. The student will also attend standing case review and multidisciplinary meetings throughout the month and will participate in other related activities outside Boston Medical Center. It is expected at the conclusion of this elective that the student will have an understanding of the variety of ways in which child maltreatment can present in pediatric settings, and begin to develop a repertoire of skills for approaching clinical situations in which child maltreatment is suspected.
• MED MD 508: Pediatric Internship Prep Course
  This elective will prepare students who are planning to enter a Pediatric Residency. It is designed to build specific skills and knowledge to facilitate the transition from medical student to intern. Students will participate in small group activities and didactic learning (see the Curriculum section for specifics). These will take place in the Boston Medical Center Simulation Center (for procedural/simulation sessions) and the Boston University Chobanian & Avedisian School of Medicine (for classroom learning sessions). BUSM IV students will be oriented to the elective on the first day of the rotation during a formal orientation session with the course directors. The expected teaching contact hours will be approximately 9a-5p on weekdays. There will be no weekend activities. The sessions will include a mixture of case-based, small-group classroom learning, as well as hands-on simulation and procedural sessions led by content-expert faculty members and procedurists. There will be no direct patient contact.
• MED MD 509: Sub-Internship: Pediatric Inpatient Medicine
  An experience in inpatient pediatric medicine during which the student will have supervised responsibilities on the pediatric ward at a level which the inpatient team judges to be commensurate with an individual student's abilities. The student will admit and have responsibility for his/her own patients under the direction of the faculty and house staff on the inpatient service. He/she will be an integral member of the inpatient team participating in all levels of activity.
• MED MD 510: Patient Advocacy and Community-Based Resources in Clinical Medicine
  During their time at Boston Medical Center, BUSM students are allowed the unique opportunity to serve a patient population that is reportedly 70% underserved and includes patients who may be low-income, immigrants, non-English speaking, or some combination of all three. The health of these patients is often intimately tied to social, economic, or other non-biomedical circumstances, requiring their medical teams to craft a treatment plan that accommodates these social needs. While health care providers are well trained to address medical issues, this elective is designed to provide more intensive training around social determinants of health and the various ways physicians can advocate for social change to improve the lives of their patients. This elective will focus on helping medical students explore the social determinants of health and how physicians can assess and manage these social determinants of health as part of an inter-professional team. The main faculty mentor will be Dr. Megan Sandel, MD, MPH, who will meet with each student and help to coordinate the clinical setting in which the student will spend the four week block. Students will spend 50-75% of their time in this clinical setting or community based organization devoted to underserved patients (examples include Boston Healthcare for the Homeless Program; GROW clinic, or Project RESPECT Clinic). Students, in collaboration with Dr. Sandel, will choose a BMC faculty mentor at their clinical site who is invested in patient advocacy and a subject expert in the student's area of interest. The other 25-50% of time will be spent doing an advocacy focused research or intervention project. Details of the elective must be worked out in a meeting with Dr. Sandel at least 1 month prior to the start of the elective block.
• MED MD 511: Sub-Internship: Pediatric Intensive Care
  The PICU is a multidisciplinary six bed unit caring for children and adolescents from newborns to 22 years; the sub-intern will work closely on a team with a senior pediatric resident from the Boston Combined Residency Program in Pediatrics (BCRP) and the PICU attending. The sub-I will act as the primary provider for their assigned patients. Major teaching objectives of the rotation are the pathophysiology of childhood critical illness, pediatric advanced life support (PALS), and the various types of intensive care support (i.e. forms of mechanical ventilation, critical care nutrition and coordination of care) as well as psychological and social support for patients and their families.
• MED MD 514: Sub-Internship: Pediatric Emergency Medicine
  This sub-internship in pediatric emergency medicine will provide students with experience in the direct evaluation and management of pediatric patients, ages 0-21yrs. The rotation will focus on clinical problem solving, and will emphasize skills in the differential diagnosis and treatment of acutely ill children. There is no mandatory overnight call, but students may elect to have some weekend shifts in addition to weekday shifts to complete the required complement of shifts during the rotation. Approximately half of your shifts will be during the evening hours of 3-10 pm. During a 4-week block there are 19 required shifts and during the 3-week block (block 14) there are 16 required shifts irrespective of excused absences for residency interviews. Attendance at the Department of Pediatrics conferences and twice monthly resident conferences is encouraged. At the end of their rotation, students will be required to present a case-based evidence based medicine session to evaluate their ability to interpret and incorporate the medical literature into their practice.
• MED MD 515: Pediatric Complex Care
  Pediatric Complex Care
• MED MD 571: Sub-Internship: Neonatology
  The student participates in the work-up and care of high risk babies from the time of their delivery on the Maternity Floor through their NICU course. The Sub-I pre-rounds and examines his/her patients in preparation to present these patients during morning work rounds. The student formulates a care plan with the NICU staff and carries out that plan. Sub-Is participate in procedures, discharge planning and family meetings. Time is available for the student to read in depth about perinatal medicine and to participate in seminars with house staff and senior staff.