Pediatric Clinical Rotations

• 18 weeks at Children’s Healthcare of Atlanta-Egleston
• 7 weeks at Children’s Healthcare of Atlanta-Scottish Rite
• 10 weekends of primarily home-based call

Fellows will spend the majority of their fellowship year on the Pediatric Inpatient Consultation Service with the Pediatric Advanced Care Team (PACT) at both the Egleston and Scottish Rite campuses. The team provides consults for children with serious and life-threatening conditions with the goal of improving the suffering associated with these conditions.

Children are followed on a longitudinal basis through the duration of their illnesses. Fellows will see patients and families at times of crisis with tasks focused on communicating with patients, families, and providers; decision making in dire circumstances; symptom management; end-of-life management; and coordinating the medical opinions of multiple specialists.

Fellows will also see patients and families with less intense needs where tasks are focused more longitudinally on developing a therapeutic relationship and providing surveillance for the emergence of new areas of suffering and conflict.

Fellows perform palliative care consultation throughout the hospital for patients both new to the service and those actively followed by the extensive outpatient practice who are admitted to the hospital. There is a 12-bed inpatient palliative care unit on which any patient appropriate for palliative care consultation can receive care. This is an open unit in which patients’ primary house staff teams or hospitalists continue to serve as the primary team for patients and the palliative care team provides close collaborative consultation and multidisciplinary care for patients and families.

The inpatient hospice unit is a 6-bed dedicated hospice unit for adult patients. Fellows will primarily work in the inpatient hospice unit and will also assist with consults throughout the hospital and evaluate patients prior to admission to the inpatient hospice unit. The fellow will have the opportunity to manage patients with terminal illnesses that require an inpatient level of care as defined by the Medicare Hospice Benefit. This rotation will provide exposure to the concepts of adult hospice care in a hospice facility. The hospice physician’s essential role in the inpatient hospice setting is to plan and coordinate care with the hospice nurse and the hospice care team to ensure the coherence of the medical aspects of the plan of care for the hospice population served.

Fellows have the opportunity to follow a panel of patients throughout the year in the Supportive Care Clinic. The clinic provides both initial consultations and follow-up visits following recent hospitalizations at both Egleston and Scottish Rite hospitals. The clinic helps children who have serious illness and their families live as well as possible with the mission to help facilitate care that achieves patients’ goals and promotes hope and well-being at all stages of illness. Depending on the patient’s needs, clinic interventions may include pain management, non-pain symptom management, psychosocial support for patients and their families, shared decision-making, discussion of advanced care planning and goals of care, and discussion of additional home services including hospice when appropriate.

Fellows will serve in the capacity of managing physician for patients on the hospice team and will assume an interdisciplinary team (IDT) participant and leadership role. During the course this rotation, the fellows will also shadow various members of the IDT including nurses, chaplains and social workers on their respective home visits as well as participate in the IDT meetings of the organization.

Fellows will spend four weeks with the Pediatric Physical Medicine and Rehabilitation service. Rehabilitation Services at Children’s Healthcare of Atlanta works in three different settings—an inpatient comprehensive rehabilitation unit (CIRU), a day rehabilitation program, and a number of outpatient clinics. The team takes care of children with many different conditions, from traumatic brain and spinal cord injuries to progressive neurological diseases and other childhood issues resulting from accidents, illnesses, injuries, birth defects, and other serious and life-threatening conditions. Fellows will primarily function as physicians within an interdisciplinary team on the CIRU. Fellows will also have the opportunity to participate in specialty clinics for children with spasticity, cerebral palsy, and muscular dystrophy. They will receive specific experience with the utilization of bone-strengthening interventions, spasticity management techniques, and physical, occupational, and speech therapy services. In addition, they will gain more experience with the use of medical equipment (e.g., wheelchairs, orthotics, and prosthetics and communication devices) aimed at improving the functional ability of the child.

Fellows will spend two weeks rotating with the Acute Pain Service and Team at Egleston which is staffed by anesthesia colleagues. The Pain Team is a multidisciplinary team that offers specialized evaluation and treatment of acute and chronic pain. The team sees inpatients with acute post-operative and chronic pain as well as staffs multiple outpatient clinics centered on the ongoing management of pain in a specific population (e.g., sickle cell disease) as well as chronic pain challenges (e.g., ongoing physiologic pain and chronic pain syndromes such as reflex sympathetic dystrophy). The fellow will gain experience in the use of patient-controlled analgesia, interventional tools for pain management (e.g., continuous epidural analgesia, peripheral nerve blocks, intrathecal injections, etc.) as well as experience observing the placement of interventional pain management tools in the OR setting. In addition, the fellow will develop skills in the use of opioid and non-opioid pain management, appropriate use of opioids in chronic pain management, and effective use of adjuvants in different patient populations.

Fellows will have four weeks of elective experience. The goal of the elective is to augment the fellow’s learning in a specific area of Hospice and Palliative Medicine including competencies in clinical work, program development, academic scholarship, and/or leadership. The fellow will meet with the Program Director and the Assistant Program Director of the Pediatric Track to establish the goals for the elective experience and determine the best experience to accomplish those goals. Pediatric elective options include a supportive care clinic, general psychiatry, radiation oncology, medical oncology, pediatric critical care, clinical administration, pediatric neurology, pediatric physical medicine & rehabilitation, and similar rotations depending on the fellow’s clinical interests.