Major Rotations

Major rotations are designed to be an in-depth experience within a specific area. By focusing on a single medical service, for six months, interns have the opportunity to become an integral part of the medical team. Interns will play a central and vital role in providing psychosocial interventions and consulting with the medical team. Rotations may vary each year, but at least 3 of the following rotations will be offered each year.

Current possible rotations include:

• Oncology
• Young Child
• Neurology
• Endocrinology

The Oncology rotation involves working with infants, children and teens with many types of cancer and following them throughout their inpatient medical treatment and frequently beyond. It is common on the Oncology Rotation to work not only with patients, but also parents, siblings, and even extended family members at times. The Oncology trainee will work in both the Oncology Intensive Care Unit (where bone marrow transplants are performed) and the general Oncology inpatient floor (as well as on an outpatient basis) to assist families with a new diagnosis, address depression, pain management, anticipatory anxiety and noncompliance, and help patients and families maintain hope throughout their treatment. Fortunately, the majority of children diagnosed with cancer will survive their illness. However, families are also assisted in dealing with issues of loss and grief, as appropriate. Some assessment may be included to establish the patient’s baseline cognitive functioning and to follow any cognitive changes after bone marrow transplantation.

The Oncology rotation has a large interdisciplinary training aspect, as Psychology plays an important role within the Oncology Division, and is involved in ongoing coordination with physicians, nursing, and the other members of the Oncology Psychosocial Team (social workers, child life specialists, CHOC schoolteachers and chaplains).

The Young Child Rotation includes helping screen young children who are at higher risk for developmental delays by using the Bayley. This experience involves working with an interdisciplinary team made up of neonatologists, physical therapists, occupational therapists, speech therapists, dieticians and nurses. Other experiences can include working with those parents/families with an infant in the Neonatal Intensive Care Unit to assist them in managing their anxiety/stress and attaching to the newborn. Interns may also participate in the CHOC Feeding team, which includes nursing, physical and occupational therapists, and physicians. This experience would include participating in multi-disciplinary feeding assessments and will provide knowledge about complex feeding disorders and techniques to treat feeding difficulties. Trainees on this rotation will develop a better understanding of the relationships between prenatal, perinatal, and postnatal complications and related neurodevelopmental outcome.

Interns on the Neurology rotation will work with the Neurology team. The focus will be on inpatient consults, working with children recently diagnosed with seizures, children with nonepileptic seizures, children with brain tumors, traumatic brain injuries, etc. The intern will work with the inpatient Neurology team to develop appropriate interventions in the hospital, as well as recommendations for outpatient care. The intern will also have the opportunity to learn about and observe EEGs, observe brain surgery, and potentially observe WADA testing. In addition the intern will participate in 1 – 2 presurgical epilepsy evaluations and present the findings at Epilepsy Medical Rounds.

Interns on the Endocrinology rotation work closely with the Endocrinology interdisciplinary team, seeing patients with diabetes mellitus type 1 (DM1) and type 2 (DM2), and other endocrine disorders. The team includes physicians, residents, nurses, physician’s assistants/nurse practitioners, nutritionists and social workers. Trainees on this rotation will have the opportunity to work with both inpatients and outpatients. Interns attend a weekly family centered clinic in which they will follow specific patients with DM1 whose psychosocial issues are affecting their medical care. They will also help develop and implement a psychsocial support group for teens with diabetes and their family. Additionally, intern may assist with the initial assessment and education of children newly diagnosed with DM1, as well ask more complicated patients in diabetes ketoacidosis (DKA). Interns on this rotation also attend interdisciplinary team rounds. Other possible unique experiences include participation in a clinic designed to treat children with DM2.

Additional Clinical Activities

Interns will have an opportunity to participate in three minor rotation experiences, each rotation lasting 4 months. While not all rotations are held every year, examples of current and recently offered minor rotations include:

Adolescent Medicine Clinic: This clinic offers an exciting training opportunity since trainees will see cases with medical residents and will be involved in the resident’s training in behavioral issues and psychosocial intervention. The Adolescent Medicine Clinic places a high importance on medical residents learning about psychosocial issues and treatment from the psychology interns. Interns will develop expertise in pediatric/adolescent health psychology issues, and receive exposure to a typical well-adolescent visit within the medical model. Interns have an opportunity to be involved in the clinic’s outpatient treatment program for adolescents with eating disorders.

Adolescent Eating Disorders Clinic: All interns will participate in this outpatient clinic that offers ongoing medical monitoring and psychological support to adolescents who are experiencing difficulties with eating. Patients are generally in the early stages of developing anorexia, but are medically stable enough to remain on an outpatient basis. This clinic is held every other week.

CUIDAR: CUIDAR is innovative program for young children (ages 3 - 5) at risk for attentional problems. The CUIDAR program for Attention and Learning is a collaborative project between CHOC and University of California, Irvine (UCI) which provides early intervention services to preschoolers at risk for Attention Deficit Hyperactivity Disorder (ADHD) and other disruptive behavior disorders. Interns could also opt to participate in co-leading Community Parent Education (COPE) groups, an innovative, evidence-based parent training group intervention. Groups are 10 weeks in length and are held in community settings.. Groups are offered in both English and Spanish.

Hematology: Interns on the Hematology rotation work closely with the Hematology interdisciplinary team. The Hematology Service follows patients with Hemophilia, other congenital bleeding disorders, Sickle Cell Disease, Thalessemias, Aplastic Anemia, ITP, and some forms of congenital immuno-deficiencies. The Hematology team is interdisciplinary in nature and includes physicians, (attendings, fellows, residents, medical students), a physician assistant, nurses, a social workers and a physicial therapist. For this additional experience you will have the opportunity to work with the interdisciplinary team in a comprehensive outpatient clinic. As the psychologist in the clinic, you triage and assess clinic attendees. Problems have included, coping with new diagnosis or treatment, school issues, pain control, compliance, psychological factors affecting medical condition and mood disorders.

Neuropsychological Assessment: Interns who are interested in gaining additional experience with complex neuropsychological cases can participate in this minor rotation. Interns will complete an additional 2 evaluations over the 4 month rotation. These cases will include complex presenting issues such as evaluations for epilepsy surgery, follow-up of patients with brain tumors, etc. Interns may select this rotation twice.

Psychopharmacology: In this innovative experience, you will work with our child and adolescent psychiatrist in his medication clinic once a week. Tasks include initial interviews with patients to determine what, if any, psychotropic medication might be indicated, or if currently prescribed medications require adjustment. This experience also includes education about different medications, mechanisms of action and indications for use. In essence you will take the role of a medical student/resident during your participation in this clinic.