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. You 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  rotation choices will be offered each year. 

Possible rotations include: 

• Oncology (Main supervisors:  Nicole Vincent, Ph.D. and Nadia Torres-Eaton, Psy.D.)
• Young Child (Main supervisor: Marni Switkin Nagel, Ph.D.)
• Neurosciences (Main supervisors:  Grace Mucci, Ph.D., ABPdN and Priscilla Armstrong, 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 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 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-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 can include working with those parents/families with an infant in the Neonatal Intensive Care Unit 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. 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 this 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 primarily work with the Neurology team.  The focus is on inpatient consults, which may include 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 (depending on scheduling).  In addition the intern will participate in 1 – 2 presurgical epilepsy evaluations and present the findings at multidisciplinary Epilepsy Medical Rounds. 

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;

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 immunodeficiencies.  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 psychological consultant 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.  (Supervisor:  Heather Huszti, Ph.D.)

Psychopharmacology:  In this innovative experience, you will work with our child and adolescent psychiatrist in his medication clinic once a week along with a child and adolescent psychiatry fellow.  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.  (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.   (Supervisor:  Mery Taylor, Ph.D.)