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.
Possible rotations include:
• Oncology (Main supervisor: Nadia Torres-Eaton, Psy.D.)
• Young Child (Main supervisor: Marni Switkin Nagel, Ph.D.)
• Neurosciences (Main supervisors: Grace Mucci, Ph.D., ABPdN and Jonathan Romain, PhD, ABPP, Alexandra Rudd-Barnard, Psy.D.)
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 on the 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 the screening and assessment of infants and toddlers who are at higher risk for developmental delays due to prematurity, medical diagnoses identified at birth or shortly after, or term infants who are not achieving their developmental milestones on time, by using the Bayley Scales of Infant and Toddler Development- 3rd Edition (Bayley-III). This experience involves working with an interdisciplinary team made up of neonatologists, physical therapists, occupational therapists, speech therapists, dieticians, nurses, and social workers. Psychology's roles include provision of developmental assessment, consultation with team members regarding cognitive, behavioral, or psychosocial concerns, and provision of feedback to families. Other experiences include working with parents/families with an infant in the Neonatal Intensive Care Unit (NICU) to assist them in managing their anxiety/stress, attaching to the newborn, and adjusting to having an infant in the hospital. At times, NICU consultation may include assisting families with issues of loss and grief as needed. When providing NICU consultation, interns will have the opportunity to interact with multidisciplinary team members including physicians, residents and fellows, nurses, social workers, case managers, dieticians, developmental team members, and the chaplain. Interested interns may also participate in the CHOC Feeding team, which includes nursing, physical and occupational therapists, and physicians. This experience would include participating in interdisciplinary feeding assessments and will provide knowledge about complex feeding disorders and techniques to treat feeding difficulties. Trainees on the Young Child rotation will develop a better understanding of the relationships between prenatal, perinatal, and postnatal complications and related neurodevelopmental outcome.
Interns on the Neurosciences rotation will work with the Neurology team. The focus is on inpatient consults, which may include working with children with neurological disorders, 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, do bedside neuropsychological exams and potentially observe WADA testing (depending on scheduling). As a part of this rotation interns will learn about the evaluation process for pre-epilepsy surgery by observing faculty, attending pre-surgery rounds, and potentially testing a pre-surgery candidate.
Additional Clinical Activities
Interns will have an opportunity to participate in three minor rotation experiences, each rotation lasting 4 months. These rotations may differ somewhat from year to year, but training opportunities are comparable each year. Currently offered minor rotation experiences include;
Psychopharmacology: In this innovative experience, you will work with our child and adolescent psychiatrist in his medication clinic once a week. Tasks include participating in 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. The team includes pediatrics residents and child and adolescent psychiatry fellows. (Supervisor: Wayne Nguyen, M.D.)
Endocrinology: Interns on the Endocrinology rotation work closely with the multi-disciplinary Endocrine team, with a focus on patients with diabetes. Interns will participate in the Endocrine Clinic with a variety of health care providers, including physicians, diabetes nurse educator’s, nutritionists, and social workers. As the psychological consultant in the clinic, you triage and assess clinic attendees. Problems have included, coping with new diagnosis or treatment, adherence issues, school issues, and psychological factors affecting medical. You will also serve as a co-facilitator of a weekly group for adolescents with diabetes. (Supervisor: Mery Taylor, Ph.D.)
Evidence-Based Practice Project: While on the Evidence-Based Practice Project rotation you will have protected time to delve more deeply into evidence-based assessments and treatments. While we believe strongly in the use of evidence based treatments and assessments, we also believe it is important to have time to apply these principles to specific cases. Together with your outpatient therapy supervisor, you will select an outpatient therapy case to illustrate how to select and evaluate the effectiveness of chosen evidence-based treatments. You will examine the literature, select the best evidence-based assessment of symptoms and evidence-based treatment approaches for your patient. You will discuss the issues of treatment fidelity for this case as well as the cultural and diversity issues related to the selected case, and assessment of treatment outcomes. You will also track any modifications in treatment and reasons for modifications (Supervisors: Heather Huszti, Ph.D., Julie Moghal, Ph.D., Nicole Vincent, Ph.D.)