UC COM :: M3/M4 Course Syllabi

M3/M4 Course Offerings

2017-2018 M3/M4 Course Syllabi

Pediatrics

COURSE NUMBER:

16 01 28

TITLE:

TRANSITION MEDICINE
Transition is defined as the “purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered care to adult-oriented health-care systems.” The need for transition planning is highlighted in multiple childhood diseases, including cystic fibrosis, juvenile diabetes, hemophilia, sickle cell disease, childhood cancer, spina bifida, cerebral palsy, genetic disorders, and congenital heart disease. In this elective you will participate in the transition preparation and planning, medical care and post transfer medical care of individuals with chronic childhood pediatric conditions. The goal of this rotation is to provide a theoretical and practical experience in the transitional care of adolescents across multiple disciplines and disorders. This will be a primarily outpatient elective with opportunities to participate in inpatient consults.

PREREQUISITES:

Has completed all year three clerkships.

expand all

GENERAL INFORMATION

COURSE YEAR:

CREDIT HOURS:

CREDIT WEEKS:

DOMESTIC VISITING:

INTERNATIONAL VISITING:

GRADED:

Honors/High Pass/Pass/Fail

COURSE QUALIFICATIONS:

COURSE TYPE:

Clinical

STATUS:

Full-Time
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: YES

COURSE LENGTH:

2 or 4 Wks

DIRECTOR:

Jason Woodward, MD, MS
jason.woodward@cchmc.org
513-803-4793
Medical Office Building

ADMINISTRATIVE SUPPORT PERSON:

Mimi Pence
Mimi.Pence@cchmc.org
636-0339
Kasota Building, 7th Floor at CCHMC, BN7.727

INSTRUCTOR:

Abigail Nye, MD

SITE(S):

CCHMC - Cincinnati Children's Hospital

MAX ENROLL:

ROTATIONS:

Rotation	Dates	Max
1	07/03/2017 - 07/14/2017	0
1	07/03/2017 - 07/28/2017	0
1	07/17/2017 - 07/28/2017	0
2	07/31/2017 - 08/11/2017	0
2	07/31/2017 - 08/25/2017	0
2	08/14/2017 - 08/25/2017	0
3	08/28/2017 - 09/08/2017	0
3	08/28/2017 - 09/22/2017	0
3	09/11/2017 - 09/22/2017	0
4	09/25/2017 - 10/06/2017	0
4	09/25/2017 - 10/20/2017	0
4	10/09/2017 - 10/20/2017	0
5	10/23/2017 - 11/03/2017	0
5	10/23/2017 - 11/17/2017	0
5	11/06/2017 - 11/17/2017	0
6	11/27/2017 - 12/08/2017	0
6	11/27/2017 - 12/22/2017	0
6	12/11/2017 - 12/22/2017	0
7	01/02/2018 - 01/12/2018	0
7	01/02/2018 - 01/26/2018	0
7	01/16/2018 - 01/26/2018	0
8	01/29/2018 - 02/09/2018	0
8	01/29/2018 - 02/23/2018	0
8	02/12/2018 - 02/23/2018	0
9	02/26/2018 - 03/09/2018	1
9	02/26/2018 - 03/23/2018	1
9	03/12/2018 - 03/23/2018	1
10	03/26/2018 - 04/20/2018	0
11	04/23/2018 - 05/18/2018	0
12	05/21/2018 - 06/22/2018	0

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)

WORKING HOURS:

8 am - 5 pm, one or two nights/month will be 6:30 pm with one possible evening clinic from 4pm-8pm

REPORT 1^ST DAY:

S Building Room 2.313 (may be Trans Med Clinic - depending on 9 am

INSTRUCTION

LEARNING ACTIVITIES:

Case-Based Instruction/Learning
Clinical Experience - Inpatient
Conference
Patient Presentation--Faculty
Patient Presentation--Learner
Research

LEARNING ENVIRONMENT POLICIES:

UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.

ORIENTATION:

Dr. Abigail Nye, Elective Director or core faculty member

TEACHING:

90%	Attending Physician
10%	Other Allied Health Professional(s)

FEEDBACK:

Elective director

ASSESSMENT:

FINAL GRADE:

60%	Clinical work performance evaluations
20%	Attitude, e.g., professionalism, motivation etc
20%	Topic presentation

GRADE ASSIGNED BY: Elective director

OBJECTIVES

Attitudes :

· Exhibit professional behaviors at all times.

· Demonstrate sensitivity and empathy for patients and families as the time of transition to adulthood in medical care and outside of medical care is often emotionally challenging for individuals pediatric onset special health care needs as well as their families

· Exhibit active learning: including demonstrating that active reading of internet resources and literature is occurring, asking questions of preceptors/faculty when something is unclear, active participation in patient care opportunities

· Arrive on time for clinics and didactic sessions

Curricular Resources :

Bloom, S. R., K. Kuhlthau, et al. (2012). "Health Care Transition for Youth With Special Health Care Needs." Journal of Adolescent Health.

Oskoui, M. and C. Wolfson (2012). "Current Practice and Views of Neurologists on the Transition From Pediatric to Adult Care." J Child Neurol.

Grant, M., D. Economou, et al. (2012). "Educating Health Care Professionals to Provide Institutional Changes in Cancer Survivorship Care." J Cancer Educ

Dickerson, A. K., J. Klima, et al. (2012). "Young adults with SCD in US children's hospitals: are they different from adolescents?" Pediatr Blood Cancer 58(5): 741-745.

Sawicki GS, Whitworth R, Gunn L, Butterfield R, Lukens-Bull K, Wood D. Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health. Pediatrics. 2011

Schwartz, L. A., L. K. Tuchman, et al. (2011). "A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions." Child: Care, Health and Development 37(6): 883-895.

Nishikawa, B. R., T. P. Daaleman, et al. (2011). "Association of provider scope of practice with successful transition for youth with special health care needs." J Adolesc Health 48(2): 209-211.

Cooley WC, Sagerman PJ. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128(1):182-200. Epub 2011/06/29.

van Staa, A., H. A. van der Stege, et al. (2011). "Readiness to Transfer to Adult Care of Adolescents with Chronic Conditions: Exploration of Associated Factors." Journal of Adolescent Health 48(3): 295-302.

Sable, C., E. Foster, et al. (2011). "Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues: A Scientific Statement From the American Heart Association." Circulation 123(13): 1454-1485.

Moola, F. J. and M. E. Norman (2011). "'Down the rabbit hole': enhancing the transition process for youth with cystic fibrosis and congenital heart disease by re-imagining the future and time." Child Care Health Dev 37(6): 841-851.

Maturo, D., A. Powell, et al. (2011). "Development of a protocol for transitioning adolescents with HIV infection to adult care." J Pediatr Health Care 25(1): 16-23.

Tuchman, L. K., L. A. Schwartz, et al. (2010). "Cystic Fibrosis and Transition to Adult Medical Care." Pediatrics 125(3): 566-573.

Tuchman, L. K., G. B. Slap, et al. (2008). "Transition to adult care: experiences and expectations of adolescents with a chronic illness." Child Care Health Dev 34(5): 557-563.

Tong, E. M. and S. Kools (2004). "Health care transitions for adolescents with congenital heart disease: patient and family perspectives." Nurs Clin North Am 39(4): 727-40.

Bjornsen, K. D. (2004). "Health care transition in congenital heart disease: the providers' view point." Nurs Clin North Am 39(4): 715-26.

Olsen, D. G. and N. L. Swigonski (2004). "Transition to adulthood: the important role of the pediatrician." Pediatrics 113(3 Pt 1): e159-62.

Rosen, D. S., R. W. Blum, et al. (2003). "Transition to adult health care for adolescents and young adults with chronic conditions: position paper of the Society for Adolescent Medicine." J Adolesc Health 33(4): 309-11.

Merrick, J. and I. Kandel (2003). "Adolescents with special needs and the transition from adolescent to adult health care." Int J Adolesc Med Health 15(2): 103.

Neuberger, J. M. (2003). "Transition of care between paediatric and adult gastroenterology. Liver transplantation." Best Pract Res Clin Gastroenterol 17(2): 277-89.

Reiss, J. and R. Gibson (2002). "Health care transition: destinations unknown." Pediatrics 110(6 Pt 2): 1307-14.

A Consensus Statement on Health Care Transitions for Young Adults with Special Heath Care Needs. Pediatrics. 2002;110(6):1304-6.

Blum, R. W. (2002). "Introduction. Improving transition for adolescents with special health care needs from pediatric to adult-centered health care." Pediatrics 110(6 Pt 2): 1301-3.

Betz, C. L. (2000). "California healthy and ready to work transition health care guide: developmental guidelines for teaching health care self-care skills to children." Issues Compr Pediatr Nurs 23(4): 203-44.

More available on request or can be tailored to specific interests as well – congenital heart disease, individuals with developmental disabilities, etc.

Knowledge/Skills:

Identify the principles of transition
Describe the issues and interactions that result from concurrent transitions in:
1. Pediatric health care to adult oriented health care
2. High school to work or college
3. Living at home to living in the community
Identify the barriers to successful transitions secondary to:
1. Adolescent
2. Family
3. Providers
4. Resources
Describe the legal, financial, and public policy issues surrounding transition.
Appreciate the emotional and mental health issues affecting the adolescent and their family during transition.
Identify print and internet resources available to adolescents, families, and providers that assist in the transition process.
Conduct a focused patient history identifying the health care, vocational/ educational and community service needs of an adolescent with special needs.
Identify the self-care and self-advocacy skills needed by an adolescent with special health care needs and refer or counsel the adolescent/family on appropriate skills development.

Main Course Topics :

Identify the principles of transition
Describe the issues and interactions that result from concurrent transitions in:
1. Pediatric health care to adult oriented health care
2. High school to work or college
3. Living at home to living in the community
Identify the barriers to successful transitions secondary to:
1. Adolescent
2. Family
3. Providers
4. Resources
Describe the legal, financial, and public policy issues surrounding transition.
Appreciate the emotional and mental health issues affecting the adolescent and their family during transition.
Identify print and internet resources available to adolescents, families, and providers that assist in the transition process.
Conduct a focused patient history identifying the health care, vocational/ educational and community service needs of an adolescent with special needs.
Identify the self-care and self-advocacy skills needed by an adolescent with special health care needs and refer or counsel the adolescent/family on appropriate skills development.

Objectives:

Other Resources - Audiovisuals:

N/A

Other Resources - Computer resources:

All resources will be listed on blackboard and made available to students rotating

Other Resources - Other :

All resources will be listed on blackboard and made available to students rotating

Procedures:

1. Interview and begin to develop care plans with patients, families, and providers in the following clinical areas(this will primarily be in the outpatient setting for opportunities to participate in inpatient care if desired by the student):

a. Autism

b. Cerebral Palsy

c. Childhood Cancer Survivors

d. Congenital Heart Disease

e. Cystic Fibrosis

f. Hemophilia

g. Mental Retardation and Non-Specific Developmental Disabilities

h. Spina Bifida

i. Genetic disorders

j. Sickle Cell Disease

2. The student will observe the vocational transition process through:

a. Direct observation of the vocational counseling with CCHMC vocation/education coordinator

b. Direct observation of an appropriate community vocation training program and a protected workshop

c. Review and discussion of the transition plan of the Transition Clinic patients’ Individualized Education Plans

3. The student will review, evaluate, and discuss community transition process through:

a. Direct observation of the Transition Clinic social worker interview of patients and families.

b. Review and discussion of the MRDD “My Plan” community service plan of the Transition Clinic patients.

4. The student will supplement direct observation and clinical time with the following additional resources:

a. Review of internet resources for transition and self-care skills development

b. Review of articles from reading list

c. Presentation on topic of choice pertaining to transition and transfer from pediatric to adult care

d. Weekly didactics and discussions with core transition medicine faculty and guest speakers

SAMPLE WEEK

Monday:

8:00AM	12:00PM	Sickle Cell Clinic at UC Med Peds
1:00PM	5:00PM	Peds HIV Clinic

Tuesday:

8:00AM	12:00PM	Adult HIV Clinic with Dr. Lehmann
1:00PM	3:00PM	On non-n St. Joe's day - Special Needs Clinic at Libery 1-5; Third Tuesday of the month leave early to go to St. Joe's
3:00PM	5:00PM	Round at St. Joe's 3pm - finish -- usually by 5 pm. Third Tuesday only

Wednesday:

8:00AM	12:00PM	Transition Medicine Clinic
1:00PM	5:00PM	Adult Cancer Survivor Clinic/Congential Heart Disease Clinic

Thursday:

8:00AM	12:00PM	Adolescent and Adults with Congenital Heart Disease Clinic (with Transition Med Faculty)
1:00PM	2:00PM	Didactic session with core faculty
2:00PM	6:00PM	Transition Med Clinic: Adult Multidisciplinary Clinic with DDBP 2pm-finish (no later than 6:30 pm)

Friday:

8:00AM	12:00PM	Transition Medicince Clinic
1:00PM	5:00PM	Library/Independent reading time

SCHEDULE NOTE:

Wednesday: alternate every other Wednesday from 1-5 between Adult Cancer Survivor Clinic and Adolescent and Adults with Congenital Health Disease Clinic (with Transition Med Faculty)

Thursday: Transition Med Clinic rotates between Spina Bifida, Down Syndrome, Autism, DD NOS)

ATTENDANCE AND ABSENCE POLICY

Session Attendance for M4 Students

Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
Excused Absences - The following will be considered excused absences:
- Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
- Personal illness, accident or a major catastrophic event
- Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
The following items are explained in detail in the Medical Student Handbook:
- Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.