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 of child abuse and neglect as a member of the multi-disciplinary team. Working alongside board-certified child abuse pediatricians, visiting medical students will have the opportunity to observe child forensic interviews, participate in outpatient clinic visits and inpatient consults, and attend multi-disciplinary team meetings. In addition, they will complete a self-paced, 10-module curriculum in child abuse pediatrics including high-yield literature, videos, and interactive presentations. A rotation length of two weeks is recommended, but up to four weeks can be accommodated.

Specific goals

At the conclusion of this elective, students will be able to:

1. Explain the purpose of a Children's Advocacy Center
2. Describe their role as a mandated reporter, including how to file a mandated report
3. Define the term sentinel injury as it pertains to child physical abuse
4. Construct an appropriate work-up when there is a concern for physical abuse
5. Define the TEN-4-FACES-P bruising clinical decision rule
6. Define abusive head trauma, including the constellation of injuries and most commonly reported mechanisms
7. Name the various types of fractures and categorize them as high, intermediate, and low specificity for abuse
8. Complete a burn history and physical, including elements pertinent to whether or not the burn is consistent with the history provided
9. Elicit a history of sexual abuse from a child using non-leading questions
10. Explain why 95% of genital exams in cases of child sexual abuse are normal
11. Name the 5 subtypes of neglect
12. List the criteria needed to meet the definition of medical neglect
13. Name the acts of omission and commission that can constitute psychological maltreatment
14. Define medical child abuse
15. Outline the steps to take as a pediatrician or subspecialist when medical child abuse is first suspected
16. Describe the connection between adverse childhood experiences and health outcomes in adulthood
17. Navigate the AAP Technical Report to determine the timing and expectations of medical visits needed by children in foster care

Activity outline

The hours are generally 9 a.m. - 5 p.m., except for Tuesdays, which begin at 8 a.m. with the MCCSHCA team meeting. The daily activities at MCCSHCA include, but are not limited to: child forensic interviews, medical examinations, foster care examinations, hospital consultations, curbside calls, and multi-disciplinary meetings. Students will attend any available clinical activities with the medical team. In addition, they will complete a self-paced, 10-module curriculum which includes high-yield literature, videos, and interactive presentations. Each module concludes with two completion options (students will choose one): a brief quiz or submission of three to five learning points. Students will complete a mandatory reporting script assignment and give a brief presentation on a peer-reviewed article of their choice. They will have the option to attend residency education conferences, if interested. They may have the option to observe a child protective services intake meeting as well as court proceedings or physician testimony, depending on scheduling.

Method of evaluation

Because of the sensitive nature of this medicolegal work, the rotation is primarily observational. Students will have the opportunity to participate in the history and physical examination of any consults or medical visits seen by the child abuse pediatricians, however, the volume of cases varies week to week. For any clinical encounters where students participate in the history or physical exam, direct verbal feedback including strengths and growth edges will be provided afterward by the supervising child abuse pediatrician. In addition, students will receive written feedback on all submitted assignments including the mandatory reporting script, module quizzes, and learning points.

At the conclusion of the rotation, students will participate in a “feedback dice game,” in which they roll a die and the resulting number determines the topic of discussion. All prompts are focused on learning and growth. The rotation director will complete the student’s summative evaluation in the Mayo Clinic MedHub system. 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.