Seattle Children’s Hospital (SCH) Rotations
Neurodevelopmental Clinic and Fellow Continuity Clinics
(Revised April 2021)
Description of Rotation or Educational Experience
During Neurodevelopmental (NDV) Clinic experiences, the fellow evaluates patients as an active participant the multi-disciplinary clinic. The fellow assumes a variety of roles during these clinics including observing, providing direct patient care, coordinating and consolidating information and recommendations from various medical and surgical subspecialists, and integrating the concerns of patients and families into treatment plans and decisions. The goal of these clinical experiences is to develop the skills in the recognition, evaluation, assessment, and management of children with neurodevelopmental-behavioral and related disorders.
Rotations:
- NDV Faculty Clinic: Fellows work individually with designated faculty seeing patients under supervision. This rotation occurs during the first year of Fellowship, but Fellows with specific interests in certain patient populations may choose to spend more time in their second or third years with particular faculty and their patient panels. Specific expectations regarding this experience can be found HERE.
- NDV Fellow Continuity Clinic: Fellows spend Thursday afternoons each week seeing their own patients in NDV, with support of faculty. They see a variety of developmental concerns and questions including developmental delay, ADHD, Autism Spectrum Disorders, complex genetic and medical conditions, Cerebral Palsy and their co-occurring diagnoses. Fellows are the primary provider for their patients in this clinic, and are responsible for their in-between visit care, as is expected in their future clinical career. Fellows get hands on experience in psychotropic behavioral medication management in this clinic. Specific expectations regarding this experience can be found HERE.
- NDV Provider Call: Fellows spend 3, 1-week sessions taking provider call each six months of their fellowship. Call consists of answering community provider questions, as well as family calls after hours. Average number of total after hours calls each week is 1-2. Inpatient coverage is not part of NDV Provider Call. Specific expectations regarding this experience can be found HERE.
Neurodevelopmental Clinic and Fellow Continuity Clinic
In conjunction with board certified developmental behavioral pediatricians, the fellow provides diagnostic evaluations, assessments and implementation of management plans for children (infancy period to adolescence) with or concern for developmental and / or physical disabilities: developmental delay, cerebral palsy, Tourette’s syndrome, neural tube defects, hydrocephalus, feeding disorders, spasticity management, technology dependence (tracheotomy, ventriculoperitoneal shunts, bowel and bladder ostomies), etc as well as co-occuring conditions including learning disorders, autism spectrum disorders, cognitive disorders, and externalizing and internalizing disorders.
With graduated supervision, Fellows in their continuity clinic serve as primary provider for children coming into Neurodevelopmental Clinic, and follow these patients throughout their fellowship, carrying out a variety of management plans supporting the child and family.
- Patients come from a variety of different cultural and socioeconomic backgrounds, giving fellows a broader experience in delivering medical care to a diverse population.
- Fellows collect, organize and prioritize pertinent information, physical findings and laboratory / radiology date to generate differential diagnoses and make recommendations for further necessary studies.
- Care delivery is provided using a predominantly medical/surgical tertiary care center referral model. This model allows fellows to develop their skills as a consultant and to initiate appropriate strategies to “share” the care of these complex patients with their primary care providers.
- Fellows interact with speech language pathologists, pediatric physical therapists, pediatric occupational therapists, nutritionists, and clinical social workers to diagnose and make recommendations for the patients and their families. Fellows also have the opportunity to interact with specialists in the areas of pediatric neurosurgery, neurology, pediatric urology, pediatric orthopedics, and pediatric rehabilitation medicine.
- Basic concepts of determining and evaluating necessary and appropriate durable medical equipment for these populations are introduced.
- Fellows become familiar with the role of community-based services and programs to support the care of these children in their home and local communities and methods to fund those services.
-Competency Based Entrustable Professional Activities
Patient Care
Entrustable Professional Activities
The Fellow will:
- Perform a through intake history and physical exam a child with a concern for a developmental and behavioral delay or disorder.
- Integrate and document the recommendations of other subspecialists into treatment plans for children with developmental and behavioral delay or disorder.
- Identify and manage a variety of co-occurring conditions which present in children with developmental and behavioral delays or disorders.
- Develop a focused consultation level report that includes referral concerns, pertinent history, neurodevelopmental examination, integration of previous and / or additional diagnostic studies, differential diagnosis and family-focused, community-based recommendations with appropriate follow – up for children with developmental and behavioral conditions.
- Perform and interpret STAT assessment for a child with a concern for Autism Spectrum Disorder.
- Perform and interpret KBIT for a child with a cognitive delay/disability concern
- Perform and interpret KTEA for a child with a learning concern• Perform and interpret the Draw A Person Intellectual Ability Test for a child with a cognitive concern
- Interpret and utilize a wide variety of behavioral health screening tools including but not limited to Vanderbilt, SCARED, Spences Childhood Rating Scale, and PHQ-9 effectively in clinical settings.
Medical Knowledge
Entrustable Professional Activities
The fellow will:
- Demonstrate knowledge of a variety of developmental and Behavioral conditions (examples included below) including presentation, natural history, co-occurring conditions, and outcome:
- Developmental delay.
- Intellectual disability.
- Autism spectrum disorders.
- Speech and language disorders.
- Externalizing and internalizing conditions (in the context of co-occurring other developmental disorders).
- Learning disorders.
- Neural tube defects.
- Cerebral palsy.
- Hydrocephalus.
- Feeding and elimination disorders.
- Major sensory impairments.
- Genetic disorders (Down syndrome, etc.)
- Describe pertinent epidemiologic factors, preventive strategies (if appropriate) and the natural history of a wide variety of developmental and behavioral conditions (see above).
- Demonstrate an understanding of the longitudinal neurodevelopmental risks in children with developmental and behavioral conditions associated with racism, ableism, premature birth, prenatal substance exposures, foster care, non-accidental trauma and poverty.
Practice-Based Learning and Improvement
Entrustable Professional Activities:
The fellow will:
- Incorporate new knowledge into the care of patient in their practice.
- Utilize standard textbooks and directed literature to evaluate and manage patients.
- Independently research innovative therapies and integrate Evidence Based Medicine interventions into patient care and practice management activities.
- Identify personal areas for practice improvement and implement, monitor and modify interventions to effect practice change.
Systems Based Practice
Entrustable Professional Activities
The Fellow will:
- Identify and make appropriate referrals to Birth to Three Programs throughout the WWAMI region.
- Prepare at least a patient and family for transition to an adult model of medical, surgical and social care at 21 years of age.
- Participate in a multidisciplinary team as clinician and /or leader to enhance patient safety and improve the quality of patient care.
- Identify multimodal resources to aid in diagnosing and managing a neurodevelopmental disorder, using physical findings along with laboratory and radiologic examination.
Professionalism:
Entrustable Professional Activities:
The Fellow will:
- Model the collaborative role of the developmental pediatrician in multidisciplinary patient care settings (patient care, conferences, etc.) and in all professional activities / responsibilities.
- Practice sensitivity and responsiveness to the demands and expectation of a diverse patient population. Modify behavior based on feedback from others.
- Identifies gaps and limitations in their own knowledge and seeks support and more information when appropriate.
Interpersonal and Communication Skills
Entrustable Professional Activities:
The fellow will:
- Demonstrate interpersonal and communication skills that result in the effective exchange of information and development of partnerships with patients, their families, and professional associates that is therapeutic and ethically sound.
- Demonstrate timeliness in dictating and reviewing patient notes from SCH, within one week of patient visit.
- Prepare appropriate consultant model clinical reports that are beneficial to families, other medical professionals and external agencies.
- Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills.
Other
Level of Supervision
Fellows in Developmental Behavioral Pediatrics (DBP) are independent, licensed, board certified or board eligible practitioners in General Pediatrics. In all settings, DBP fellows are under the supervision of DBP faculty and providers.
Fellows are assigned to a specific supervisory faculty for each inter-disciplinary clinic. Each case is reviewed with respect to subspecialty history, physical examination, neurodevelopmental assessment, laboratory evaluation, diagnostic assessment and management plans.
Supervisory faculty/providers also will see and evaluate every patient.
It is expected that over the three years of training, the fellow will assume increasing levels of initiative and leadership in directing the evaluation, developing a management plan and conveying that information to the patient and family.
Teaching Methods
- Observe experienced clinicians evaluate and assess patients for neurodevelopmental disorders.
- Directed observation of the fellow by experienced clinicians during patient care experiences with appropriate formative feedback.
- Didactic teaching and review of relevant literature (formal and informal)
- Directed readings: textbooks, article, supplemental texts, web based learning.
Assessment Method (Program Evaluation)
- Semi annual rotation and program evaluations are completed anonymously by the fellow and faculty and reviewed as part of the annual program review
- Curriculum design is updated annually and reviewed during the annual program review.
Assessment Method (Fellow)
- Direct observations and feedback from faculty following patient assessments, presentations and conferences.
- 100% review by attending physician of all patient records completed by the fellow
- Semi-annual evaluation by faculty and 360 evaluations from family and additional specialty disciplines
- Specialty In-service Training Examination.