Description

The Child Abuse Pediatrics rotation at the Mayo Clinic Center for Safe and Healthy Children and Adolescents (MCCSHCA) prepares future physicians to provide care for victims and suspected victims of child abuse and neglect as a member of the multi-disciplinary team.  Visiting medical students will participate in case presentations, department conferences, grand rounds, case review meetings with Child Protective Services, and multi-disciplinary team meetings. They will have the opportunity to observe child forensic interviews, outpatient clinic visits, and inpatient consults for abuse or neglect as their schedule permits. During unscheduled time, they will complete a self-paced curriculum in Child Abuse Pediatrics including high-yield literature, videos, and interactive presentations.

Specific goals

1. Define the term sentinel injury as it pertains to child physical abuse
2. Construct an appropriate work-up when there is a concern for non-accidental trauma, and specifically, abusive head trauma
3. Identify bruises that are high-risk for child physical abuse
4. Assess whether the history (i.e., mechanism) provided for a fracture is consistent with the type of fracture seen on imaging
5. Complete a burn history and physical, including elements pertinent to whether or not the burn is consistent with the history provided
6. Triage a concern for child sexual abuse, including when to refer the child for forensic evidence collection
7. Name the 5 subtypes of neglect and list the criteria needed to meet the definition of medical neglect
8. Name the acts of omission and commission that can constitute psychological maltreatment
9. Define medical child abuse and outline the steps to take when medical child abuse is first suspected
10. Navigate the American Academy of Pediatrics Technical Report to determine the timing and expectations of medical visits needed by children in foster care

Activity outline

The rotation will start with an orientation including a review of elective structure and module assignments with the faculty director and a review of an introductory PowerPoint. Medical students will take the rotation pre-test during their first week and an identical post-test during their last week. Residents will have an opportunity to review the pre-test with a physician faculty member during the rotation. Medical students will be involved in any case discussions, team meetings, outpatient visits, and inpatient consults attended by the child abuse pediatricians at MCCSHCA. During unscheduled time, medical students will complete a set of module assignments consisting of relevant literature, webinars, podcasts, and interactive Kahoot modules.

Method of evaluation

Toward the end of the rotation, medical students will participate in a comprehensive case review with the faculty director. Because this rotation is otherwise primarily observational given the sensitive and medicolegal nature of the cases, this is the students’ opportunity to put their acquired knowledge and skills into action. Medical students will have the opportunity to formulate history questions, describe key physical exam findings, use evidence-based medicine to formulate a differential and plan, implement their plan by placing orders, filing a mandated report, and practice having tough conversations with families. Residents will also participate in a “feedback dice game” at the end of the rotation, in which they roll a die and the resulting number determines the topic of discussion. This is done once for a set of learning-focused prompts and once for a set of growth-focused prompts.

Per Mayo Clinic institutional policy, faculty and residents/fellows will not complete any outside evaluations. You will be provided with an electronic performance evaluation via Mayo Clinic’s MedHub portal. A final summative evaluation will be sent to you and your school official upon completion of your clerkship.