Child Abuse

Overview



Emory University School of Medicine and Children's Healthcare of Atlanta are pleased to announce a new ACGME accredited 3 year fellowship in child abuse pediatrics. The fellowship is the latest addition to the Stephanie V. Blank Center for Safe and Healthy Children at Children's Healthcare of Atlanta, which serves families from across the state of Georgia. Approximately 1900 suspected victims of abuse and neglect are evaluated annually at Children's 3 free-standing children's hospitals in Atlanta, the Blank Center's 2 outpatient clinics, and via telemedicine throughout the state of Georgia. Fellows will not only evaluate patients when there is a concern for abuse and neglect, but will also be actively involved in educating and training medical and non-medical professionals, as well as students and residents from both Emory University and Morehouse School of Medicine.

Fellows will spend approximately 70% of their time on clinical service and in community activities, and 30% of their time on research. They will be able to collaborate with researchers at Emory School of Medicine, Georgia State University, the Centers for Disease Control and Prevention, Rollins School of Public Health and Georgia Tech. Fellows interested in more advanced clinical research instruction will be able to enroll in the formal Masters of Science in Clinical Research degree program at the Rollins School of Public Health at Emory University.

Fellows will engage in multidisciplinary collaboration on individual cases, participate on local child abuse investigation teams and child death review teams, and will be able to engage in advocacy efforts at the local and state level. Children's Healthcare of Atlanta is a recognized leader in the state in child maltreatment issues, and faculty members of the program participate on major community and state level committees and task forces.

Child abuse pediatrics fellows will rotate to the Georgia Bureau of Investigation to learn about pediatric forensic pathology, and will participat e in additional rotations in Pediatric Orthopedics, Pediatric Neuroradiology, Rehabilita tion Medicine, and Adolescent Medicine.

Children's Healthcare of Atlanta is the major pediatric provider in Georgia, serving approximately 200,000 patients per year in its 3 Emergency Departments, managing over 25,000 patient admission s to its hospitals (520 inpatient beds), and has the only Level 1 pediatric trauma center in the state. The various campuses within the hospital system will allow for the fellow to gain first-hand experience from working in an academic setting, a private-practice setting, and an urban hospital setting.

Metro Atlanta is home to more than 5.3 million people, and to 3 large universities as well as many domestic and international corporations. Twelve of the Fortune 500 headquarte rs are located here. Atlanta offers residences that are considerably less expensive than other major metro areas and its cost of living consistently ranks below the national average.There is a thriving arts and entertainment community and a vast number of eclectic restaurants featuring cuisine from every corner of the world. Atlanta is also home to 3 professional sports teams and is home to the world's busiest airport.

Faculty:
      Tamika Bryant, MD, Program Director
      Jordan Greenbaum, MD
      Stephen Messner, MD

Program Coordinator
      Cathy Jackson   Cjacks4@emory.edu

How to Apply:
To apply for a Fellowship, please complete an application through the Electronic Residency Application System (ERAS). In order to be considered, applicants must have completed an accredited three-year pediatric residency by the beginning of the Fellowship program. A completed application file will include:

Completed application form: (including J1 & H1B)
  1. Current curriculum vitae
  2. Personal statement (The personal statement should include a description of previous research and clinical experience, reason for interest in the Pediatric Fellowship, and an indication of your career goals.)
  3. Three letters of reference. One letter should be from the Director of your Residency Training Program
  4. Final Resident Evaluation / Milestone Evaluation
  5. USMLE Score Reports
  6. Official Medical School Transcript & Diploma
  7. ECFMG Report, if applicable
  8. A recent photograph

Curriculum


 Year 1

The inpatient consult service is a 3-year longitudinal rotation in which fellows are exposed to all types of cases from the beginning to the end of their training.  The fellow will begin to learn all skills immediately, rather than in a staged fashion.  As a result, many of the goals/objectives outlined below will involve a gradual progression in competencies from a very basic level (first quarter of first year) to a moderately sophisticated level (end of the first year), to a more advanced level (end of second year), to a level of clinical competence (end of third year).  Where it is possible to segregate skill acquisition into specific time frames this has been done in the goals/objectives listed below.

During the first quarter of the first year, the fellow will develop basic skills in obtaining an appropriate history, conducting an appropriate physical exam, photographing cutaneous injuries, ordering and interpreting appropriate diagnostic tests and developing a basic differential diagnosis for common manifestations of physical abuse and neglect.  The fellow will initially function primarily as an assistant to the attending physician while on the inpatient consult service.  During this period, he/she will learn how the Children’s Healthcare system works, including the electronic medical record and order entry systems, process for ordering consultations, working with physicians in related fields and with social workers, interfacing with radiology, etc.  Gradually, the fellow will assume a leading role in the initial assessment, development of a differential diagnosis, and treatment plan for his/her patients. 

By the end of the second quarter of the year, the fellow will be expanding the above skills to include more unusual cases, such as Munchausen by Proxy and extreme physical neglect.  He/she will begin relying more on current medical literature than on textbook information and classic articles published on basic topics.  As this occurs, he/she will form more sophisticated differential diagnoses and begin to understand the controversies within the field.  The fellow will be developing competence in communicating information regarding uncomplicated cases of suspected maltreatment to families and medical/non medical professionals. 

By the end of the first year, the fellow will be adept at basic clinical skills and competencies in communicating information regarding uncomplicated cases of suspected maltreatment to families and medical/non medical professionals.   The fellow will be relying on current clinical and laboratory research to build a knowledge base and inform decisions for patient care.

The supervising child abuse pediatrics attending will be expected to carefully review patient history and physical exam findings, and to be actively involved in making recommendations regarding patient care management decisions, as well as communicating with families and medical/non medical colleagues. Teaching by fellows during this rotation will primarily focus on information aimed at families and house staff, usually in a relatively informal/unstructured format.

The outpatient service is a 3-year longitudinal rotation.   Fellows will learn to identify, document, assess and manage medical and traumatic conditions commonly associated with suspected child sexual and physical abuse and neglect in children presenting in an outpatient setting.  This is a longitudinal rotation that extends through all 3 years of training and involves evaluations conducted in two outpatient clinics (Child Advocacy Centers) and three Emergency Departments, as well as via telemedicine services provided to remote locations in rural Georgia.

Year 2

During the 2nd year of the Fellowship, the fellow is expected to increasingly assume a primary role as the child abuse pediatrics consultant.  This includes becoming the primary spokesperson of the medical team during patient/family contact, leading a discussion with the referring physician team, and interfacing with nursing, social work, and other medical staff.  The supervising child abuse pediatrics attending will be expected to continue to see each patient, remain fully informed of patient progress, and provide feedback to the fellow regarding patient care management recommendations. The exact time of this progression of responsibility will depend on the individual fellow’s development of the skills listed below.  The fellow will continue to teach both families and house staff regarding increasingly complex topics.

Throughout the second year, the fellow will gradually refine their clinical skills, increase their knowledge base to a moderately advanced level, improve their communication skills and begin to discern the subtleties of clinical decision making.  Their skills in professionalism and practice-based learning will be maintained but it is expected that these skills will already be well developed.  The fellow will become a more active participant and leader in multidisciplinary meetings, family meetings and discussions of systems-based practice.  In general, the goals and objectives listed below move the fellow from the basic to the moderately advanced level.

The outpatient service will allow the fellows to develop competence in identifying, documenting, assessing and managing medical and traumatic conditions commonly associated with suspected sexual and physical abuse and neglect in children presenting in an outpatient setting.  This is a longitudinal rotation that extends through all 3 years of training and involves evaluations conducted in two outpatient clinics (Child Advocacy Centers) and three Emergency Departments, as well as via telemedicine services provided to remote locations in rural Georgia.

Year 3

During the 3rd year of training, the fellow is expected to continue his/her role as the primary child abuse pediatrics consultant.  This includes being the primary spokesperson of the medical team during patient/family contact, leading discussions with the referring physician team, and interfacing with nursing, social work, and other medical staff.  The supervising child abuse pediatrics attending will be expected to continue to see each patient, remain fully informed of patient progress, and provide feedback to the fellow regarding patient care management recommendations. The fellow will continue to teach both families and house staff regarding increasingly complex topics.

The major difference between the goals and objectives of the 2nd and 3rd years lies in the level of competence and confidence developed by the fellow over the course of the training period.   While the fellow will have moderately advanced skills and a rapidly growing knowledge base at the conclusion of the 2nd year, by the end of the third year, he/she will be proficient in clinical skills, will have developed a broad knowledge base on issues related to the multiple forms of child maltreatment, and will be proficient in communicating with children, families and professionals.  The fellow will have developed sufficient competence to enter practice without direct supervision.  His/her skills in professionalism and practice-based learning will be well developed.  The fellow will be an active participant and leader in multidisciplinary meetings, family meetings and discussions of systems-based practice.

The outpatient service will allow the fellow to demonstrate proficiency in identifying, documenting, assessing and managing medical and traumatic conditions commonly associated with suspected sexual and physical abuse and neglect in children presenting in an outpatient setting.  This is a longitudinal rotation that extends through all 3 years of training and involves evaluations conducted in two outpatient clinics (Child Advocacy Centers) and three Emergency Departments, as well as via telemedicine services provided to remote locations in rural Georgia.

Block & Conference Schedule

 FIRST YEAR BLOCK DIAGRAM

Month 1 2 3 4 5 6 7
Experience or rotations Inpt. 45% (C); Outpt. 30% (C); Orientation 25%

Sites 1-3
Inpt. 40% (C); Outpt 40% (C); Subsp. 20% (C)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Subsp. 20% (C)

Sites 1-4
Inpt. 40% (C); Outpt 60% (C);

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Month 8 9 10 11 12 13  
Experience or rotations Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
Inpt. 40% (C); Outpt 40% (C); Research 20% (R)

Sites 1-4
VAC N/A  

 

SECOND YEAR BLOCK DIAGRAM

Month 1 2 3 4 5 6 7

Experience or rotations

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Month 8 9 10 11 12 13  

Experience or rotations

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

Inpt. 40% (C);

Outpt. 30% (C);

Research 30% (R)

VAC

N/A

 

 

THIRD YEAR BLOCK DIAGRAM

Month

1 2 3 4 5 6 7

Experience or rotations

Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 20% (C); Outpt. 20% (C); Research 60% (R)

Month

8 9 10 11 12 13

Experience or rotations

Inpt. 20% (C); Outpt. 20% (C); Research 60% (R) Inpt. 10% (C); Outpt. 10% (C); Research 80% (R) Inpt. 10% (C); Outpt. 10% (C); Research 80% (R) Inpt. 10% (C); Research 90% (R) VAC N/A  

Total number of clinical months _____24/36________ 

Total number of research months _______12/36____   (total number vacation months: 3)

Conference Site Frequency R/O* Role of the Fellow

Inpatient rounds

SR Weekly R Presents cases, participates in discussion

Clinic peer review

SR/Tullie Every other week R Presents cases, participates in discussion

Telemedicine peer review

SR Monthly R Presents cases and journal articles, participates in discussions

Child Abuse Prevention meeting

SR/Tullie 4 x per year R Participate in discussion of program projects; present journal articles on evidence-based programs

Staff meetings

Tullie Monthly R Participate in discussions

Multidisciplinary team meeting for victims of Commercial Sexual Exploitation

SR Monthly R Provide case information, participate in discussions, answer questions

Multidisciplinary team meeting for child abuse investigations

Community location Monthly R Provide case information, participate in discussions, answer questions; provide medical expertise

CAP Journal club

SR Monthly R Present journal articles; lead and participate in discussions

Child Death Review Team

Community location Monthly R Provide case information, participate in discussions, answer questions; provide medical expertise

CAP Didactic conference

SR Monthly R Gives a presentation on subspecialty topic; participates in discussions

Research in progress meetings

SR 4x per year R Discusses own research, participates in discussions of other’s research

Trauma case review

SR/ECH Weekly R Participates in discussion

Pediatric Grand Rounds

ECH/Grady Weekly R (must attend at least 1/month) Participant; Presents case twice during fellowship

Trauma Grand Rounds

ECH Monthly O Participant

Teaching Symposium for Fellows in Pediatrics

Emory 3 sessions in second year R Participates in discussion, Q and A, assigned activities

Fellows introduction to Research Training (FIRsT)

Emory 5 sessions in first year R Participates in discussion, Q and A, assigned activities

Ethics Forum

Emory 6 sessions in first year R Participates in discussion, Q and A, assigned activities