Pediatrics Electives and Selectives

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. Time off for residency interviews must be requested at least 4 weeks in advance. Absences must be pre-approved and made up before the last Friday of the rotation. The rotation includes one week of night shifts.

Location: CRMH and IP Pediatric Wards

Available: July – June

Duration: 4 weeks

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview:  This Acting Internship in General Pediatrics provides advanced clinical training in outpatient pediatric care, preparing students for the responsibilities of a pediatric residency. Students will independently employ preventative care guidelines, evaluate patients, formulate differential diagnoses, and develop evidence-based management plans for common outpatient pediatric conditions under the supervision of attending pediatricians. The rotation emphasizes communication skills with patients, families, and healthcare team members while fostering professionalism and ethical decision-making. Clinical experiences will occur primarily at the Botetourt and Tanglewood outpatient pediatric offices, offering exposure to diverse patient populations and a variety of conditions commonly encountered in community pediatrics. In addition to these outpatient settings, participants will also have the opportunity to gain exposure to the resident clinic, further enhancing their understanding of pediatric residency training. Students will gain experience documenting encounters using the electronic medical record system and reflecting on the continuum of pediatric healthcare.

Learning Objectives Having successfully completed this course, the student will be able to:

1 Formulate differential diagnoses by integrating patient history, physical exam, and diagnostic results.

2 Apply clinical guidelines, in an outpatient setting, to develop personalized pediatric management plans.

3 Employ preventative care guidelines.

4 Create personalized care plans that integrate diagnostic information, family dynamics, and social determinants of health to optimize patient outcomes.  

5 Evaluate pediatric patients for behavioral and emotional health concerns.

6 Apply triage skills in the outpatient setting to differentiate between cases requiring emergency care and those suitable for outpatient management.

7 Design a quality improvement project in pediatric outpatient care, grounded in the latest medical literature, to enhance clinical practices and patient outcomes.

8 Modify care delivery and communication to address social determinants of health and the diverse cultural backgrounds of pediatric patients and families, ensuring equitable and patient-centered outcomes.

Attendance:  Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location:  CRMH/Roanoke locations

Available:  July – June

Duration:   2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation:  1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The student will work in the community, spending several days each week doing the community activities indicated on the month’s schedule and teaching in a school or community setting or participating in a community-based advocacy activity related to their specific topic of interest. Students will attend activities along with a pediatric resident. More experiences will be included in the 4-week rotation than in the 2-week rotation. 
 
The student will become progressively proficient and knowledgeable in the following:

1. Utilizing knowledge of child development in interacting with students at various grade levels
2. Developing teaching skills
3. Demonstrating ability to interact with children of various ethnic and socioeconomic backgrounds
4. Demonstrate the ability to identify, contact and participate with community groups working on advocacy efforts similar to the trainee’s area of interest
5. Locating and participating in community advocacy activities related to the student’s area of interest by contacting, networking and/or collaborating with at least three people or agencies with similar focus

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: CRMH

Available: July – June

Duration: 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion
• Documentation of having spent time in a newborn nursery prior

Overview: This elective will give the student a broad understanding of the medical problems afflicting infants during the first month of life and convey generally applicable principles in the NICU setting.

Suggested preparatory reading: Care of the High-Risk Neonate (ISBN-10: 0721637094)

The student will become progressively proficient and knowledgeable in the following:

1. Performing neonatal resuscitation procedures
2. Accurately obtaining a history of pregnancy and perinatal events relevant to the newborn and using the unique aspects of the physical examination of the premature and newly born full-term infant, including gestational age assessment (PC, MK, ICS)
3. Describing the broad medical, social and economic consequences of prematurity, including factors related to or influencing its incidence and disorders unique to premature infants (e.g., lungs, brain and eyes) (PC, MK, ICS)
4. Analyzing height-, weight- and gestational age-related neonatal morbidity and mortality statistics and comparisons of perinatal, neonatal and infant mortality rates, regionally, nationally and internationally (PC, MK, ICS,SBP)
5. Conducting assessment and management of the infant in the delivery room with a background knowledge of transitional physiology (cardiopulmonary, metabolic and temperature changes) (PC, MK, ICS, SBP)
6. Recognizing the clinical presentation and providing appropriate management of emergencies presenting in the first month of life, including respiratory distress and cyanosis, shock, bleeding, inborn errors of metabolism or life-threatening neurologic abnormalities (PC, MK, ICS, PBLI)
7. Analyzing the physiology, pathphysiology, diagnosis and treatment of acute and chronic respiratory disorders in the premature and full-term infant, including hyaline membrane disease, apnea, meconium aspiration, persistent pulmonary hypertension, trasient tachynea, pneumonia, pneumothorax, PIE, diaphragmatic hernia, pleural effusions, congenital pulmonary disorders and bronchopulmonary dysplasia (PC, MK, ICS)
8. Determining clinical and laboratory diagnosis, pathophysiology and treatment of disorders of premature and full-term infants
9. Applying the systematic approach to a newborn infant with a congenital malformation(s) (PC, MK, ICS, SBP)
10. Analyzing the nutritional needs and management of infants of different gestation and postnatal ages and birth weights, including knowledge of intrauterine and postnatal growth rates. Determine parental nutritional and fluid needs of the low-birth-weight and critically ill infant, and the choice and timing of enteral feedings, including the role of breast milk and breast feeding. (PC, MK, ICS, SBP)
11. Identifying family and parental psychological aspects associated with an abnormal infant against the backdrop of a normal birth and the process of maternal-infant bonding (PC, MK, ICS, P)
12. Applying a broad understanding of the role of obstetric and perinatal medicine in assessing high risk pregnancies and fetal well-being
13. Mastering techniques involved in endotracheal intubation, umbilical artery and vein cannulation, suprapubic bladder tap, chest tube placement and arterial puncture

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: CRMH and Pediatric Cardiology

Available: July – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: This elective will provide in-depth experience in the field of non-invasive Pediatric Cardiology with an emphasis on outpatient management of children with heart disease. Students will participate in non-invasive testing for heart disease, including electrocardiography, echocardiography, fetal echocardiography and stress testing. The student will become familiar with the workup and management of pediatric patients with murmurs, chest pain, palpitations and syncope. Students will evaluate patients with suspected cardiovascular abnormalities, with special emphasis on the longitudinal management of patients with congenital heart disease. The student will develop clinical skills in cardiac auscultation and interpretation of pediatric ECGs. Learning environments include the Roanoke pediatric cardiology clinic as well as multiple outlying clinics and inpatient consultation. The students will attend teaching and patient care conferences.

The student will become progressively proficient and knowledgeable in the following:

1. Interpreting blood pressure, chest pain, syncope, auscultation of murmurs and EKGs in pediatric patients
2. Diagnosing and managing congestive heart failure, congenital heart disease, cardiogenic shock and cyanotic and acyanotic disease
3. Diagnosing and managing infectious and postinfectious disease, such as infective endocarditis, rheumatic fever, myocarditis, pericarditis and Kawasaki disease
4. Identifying and analyzing rate and rhythm disorders
5. Naming and discussing systemic diseases affecting the heart

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: CRMH and Pediatric Endocrinology

Available: July – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The elective will be primarily an outpatient experience, evaluating patients presenting for consultation or follow-up to the pediatric endocrinology clinic. The student will see a diverse population with a wide variety of endocrine diseases and will further develop knowledge of endocrine diseases while becoming competent and confident in the diagnosis and management of these diseases. Students may also participate in inpatient consultations when they are available and educationally relevant. Common problems encountered will include type 1 and type 2 diabetes; obesity and metabolic syndrome; disorders of the thyroid, pituitary and adrenal glands; and disorders of growth, puberty and bone/calcium.

The student will become progressively proficient and knowledgeable in the following:

1. Obtaining thorough and accurate medical histories on pediatric endocrine patients
2. Explaining the endocrine components of the physical exam, including the thyroid, Tanner pubertal staging, and evaluation for acanthosis nigricans
3. Accurately plotting height, weight, BMI/weight for height, mid-parental height and growth velocity (if appropriate) and determining percentiles on every clinic patient encountered
4. Effectively communicating history and physical exam findings to the attending physician through both oral and written presentations
5. Identifying common and important growth patterns including normal growth, failure to thrive, endogenous obesity, constitutional delay of growth and puberty, precocious puberty, growth hormone deficiency, Turner syndrome and hypothyroidism, by interpreting the growth pattern of every patient with the attending
6. Explaining how bone age is determined and how bone age relates to growth and prediction of final adult height
7. Listing causes of delayed and advanced bone age
8. Using knowledge gained during evaluation to diagnose and manage common pediatric endocrine diseases, including age-appropriate symptom presentation, interpretation of diagnostic tests, treatment plan and coordination of health care team to accomplish treatment goals
9. Searching for and critically appraising relevant information regarding diagnosis and treatment options
10. Explaining the pathophysiology of type 1 and type 2 diabetes
11. Comparing the onset and duration of short-, intermediate- and long-acting insulins and describing how they are used for diabetes with subcutaneous injections and an insulin pump
12. Performing basic diabetes care, including checking blood glucose, keeping a blood glucose log, counting carbohydrates and calculating insulin doses as part of a diabetes simulation
13. Listing co-morbid conditions that should be routinely screened for in patients with type 1 and type 2 diabetes

Attendance:  Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location:  CRMH and Pediatric Gastroenterolgy

Available:  July – June

Duration:   2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation:  1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The elective rotation is intended to develop the medical student’s clinical skills and enhance his/her fund of knowledge in the evaluation and management of inpatient and outpatient GI, hepatology and nutrition disorders. Students will rotate in the inpatient ward and the outpatient clinics, experience the Endoscopy Lab, and round with the physicians in these areas. In some instances, students will examine patients, perform physical examinations and come up with a differential diagnosis and a proposed workup and treatment plan in both an inpatient and outpatient setting.  
 
The student will become progressively proficient and knowledgeable in the following:

1. Recognizing and initiating a diagnostic treatment plan for common GI, hepatology and nutrition disorders
2. Explaining referral criteria for patients with GI, hepatology and nutrition disorders
3. Recognizing symptoms of reflux and treating gastrointestinal reflux disease in infants, toddlers and older children
4. Describing the indications for management for constipation
5. Formulating a differential diagnosis for children and infants who have failure to thrive, describing the nutritional parameters to assess and follow, ordering appropriate screening tests and conducting a thorough physical examination
6. Formulating a differential diagnosis for children and infants with chronic diarrhea, describing the nutritional parameters to assess and follow, ordering appropriate screening tests and conducting a thorough physical examination
7. Discussing the anatomy and physiology of patients with short bowel syndrome and intestinal failure guidelines
8. Identifying inflammatory bowel disease and discussing diagnosis and ongoing follow up in consideration of important factors in patient history, initial laboratory evaluation and physical exam findings
9. Identifying eosinophilic gastrointestinal disorders and determining the basic treatment of these disorders
10. Describing the workup for cholestasis presenting at any age and the criteria for referral to a pediatric GI specialist and inpatient admission
11. Reviewing relevant articles from NASGPHAN and ESPGHAN clinical guidelines

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: Pediatric Hematology/Oncology

Available: July – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The elective consists of consulting on patients with hematological and oncological conditions. The medical student will do the patient’s chart review, history taking and physical examination. From this information, the medical student will develop a differential diagnosis, plan the diagnostic evaluation and design the management of the patient. The student may observe lumbar punctures and bone marrow tests as scheduled during their rotation. On the 4-week rotation, students will give a 15-minute talk on a topic agreed upon by the attending physician.

The student will become progressively proficient and knowledgeable in the following:

1. Obtaining accurate medical histories on pediatric heme/onc patients
2. Performing age-appropriate physical examination related to the chief complaint, including interpretation of vital signs
3. Effectively communicating history and physical exam findings to the attending physician through both oral and written presentations
4. Outlining a diagnostic plan based on a differential diagnosis and justifying the diagnostic tests and procedures, taking into account the test’s sensitivity, specificity and predictive value as well as its invasiveness, risks, benefits, limitations and costs
5. Interpreting the results of diagnostic tests or procedures, using age-appropriate values for commonly used laboratory tests
6. Formulating a therapeutic plan appropriate to the working diagnosis
7. Formulating a communication plan to inform the health care team and the family of working diagnosis, diagnostic workup and decisions, eliciting and incorporating family and health team response and feedback
8. Searching for relevant information and critically appraise this information to make evidence-based decisions
9. Describing the influence of chronic condition on child, family and societal function

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: CRMH and IP Pediatric Wards

Available: July – June

Duration: 2 or 4 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The students will work in the ICU and see a wide range of illnesses from multiple organ systems. The student will be expected to develop skills in interacting with critically ill children and their parents.

The student will become progressively proficient and knowledgeable in the following:

1. Recognizing the need for, stating proper indications for, discussing potential complications of and demonstrating appropriate initial stabilization of patients requiring airway management, cardiopulmonary resuscitation, transport, invasive procedures or shock
2. Explaining indications for and managing advanced life support technologies (under close senior fellow and attending supervision)
3. Analyzing and interpreting data from common ICU monitoring modalities
4. Explaining basic pathophysiologic and pharmacologic principles underlying patient management
5. Interpreting laboratory and physiologic data, synthesizing it to recognize patient deterioration or improvement, and making fundamentally sound decisions regarding patient support

 

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. See the attendance policy for more details.

Location: CRMH and Pediatric Pulmonology and Allergy

Available: July – June

Duration: 2 weeks, starting any Monday and ending Friday

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: The student will rotate in the inpatient ward, PICU, NICU, the outpatient clinics and experience the bronchoscopy lab and PFT lab. Rotations will include rounding with the physicians in these areas. In some instances, students will examine patients, perform physical examinations and come up with differential diagnosis and a proposed workup and treatment plan in both an inpatient and outpatient setting. Goals and curriculum components for this elective will be similar to those of the pediatric residency program.

The student will become progressively proficient and knowledgeable in the following:

1. Recognizing and initiating a diagnostic treatment plan for common inpatient and outpatient pulmonary, allergic and immunologic disorders, to include: allergic rhinitis, asthma, atopic dermatitis, food allergy, urticaria, evaluation of recurrent infections and possible immunodeficiency, care of the child with a tracheotomy, chronic lung disease of prematurity, cystic fibrosis and chronic cough/stridor
2. Implementing referral criteria for patients with pulmonary, allergic and immunologic disorders
3. Applying the concepts of respiratory physiology as they pertain to measures of lung function, including spirometry, lung volumes and gas exchange
4. Applying with the NAEPP guidelines for the diagnosis and treatment of asthma in children

Attendance: Students may not take time off on the start date but must attend check-in and system orientation with Visiting Student Affairs. Time off for residency interviews must be requested at least 4 weeks in advance. Absences must be pre-approved and made up before the last Friday of the rotation. The rotation includes one week of night shifts.

Location: CRMH and Carilion Children's (Tanglewood)

Available: July – June

Duration: 2 or 4 weeks

Number of students per rotation: 1

Prerequisites: 

• Letter of Intent from Peds chair/advisor validating applicant’s intent to pursue residency in Peds at Carilion
• Personal Statement must include reasons why applicant is interested in Pediatric Residency at Carilion

Overview: This elective will consist of consulting on patients with the pediatric neurologists. The medical student will do the patient’s chart review, history taking and physical examination. From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation and design the management of the patient. The student will make a presentation to the preceptor if doing the four-week rotation. The locations are the outpatient clinic at Tanglewood and Carilion Roanoke Memorial Hospital.