News and Views

the american academy of pediatrics
SOMSRFT
News and Views
from Pediatricians in Training
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A Publication of the Section on Medical Students, Residents, and Fell
Letter from the AAP President
Over the past 14 months, as president-elect and then president of the
American Academy of Pediatrics (AAP), it has been my privilege to interact
with many medical students, residents, and fellows interested in pediatrics as
a career. I have learned that members of the Section on Medical Students,
Residents, and Fellowship Trainees (SOMSRFT) already take advantage of
many opportunities within the AAP to explore their interest in improving
children’s health. Your dedication, hard work, and fervent desire to improve
the health of children in the United States and across the globe are truly an
inspiration to me.
One of the best ways to get acquainted with AAP initiatives is to become an
active member of your local chapter. All of our chapters have committee
members working on projects, and all will welcome volunteers who are
interested in taking part. In addition, the AAP has many sections and
councils with particular interests (such as the Council on School Health
and Section on International Child Health) that are always looking for new
members. Please go to www.aap.org, review the list of chapters, sections,
and councils with the names of their executive committees, and contact those that are of interest to you.
I know that many SOMSRFT members were very active in our successful Get Out the Vote project last fall. Thank
you for all you did to increase the number of registered voters among SOMSRFT members and the general public.
Inside this Issue
2
CATCH Corner
4
Creative Learning
3
A Day in the Life of a Med-Peds Resident
6
Anne E. Dyson Child Advocacy Awards
4
NCE Wrap-Up: Jazzed!
5
Tenth Annual SOMSRFT Reception and
Poster Display
5
Insights Inside
3
Commentary
3
Point/Counterpoint
2
As I write this article in late December 2012, the tragic massacre of the students and teachers at Sandy Hook
Elementary School in Newtown, CT, weighs heavily on my mind. The AAP is committed to helping prevent
further such tragedies. This could be a very important area for contributions from SOMSRFT members.
The AAP was among several pediatric organizations that wrote to President Obama and Vice President Biden recommending that the administration and Congress pursue a 3-pronged
program in response to the Newtown tragedies. First, we have urged them to renew gun control laws, especially those banning semiautomatic rifles and large magazine clips. Second,
we have recommended a commitment to reduce children’s and adolescents’ exposure to violence in the media. Third, we have asked that they work to strengthen capabilities within our
mental health system to better identify and treat troubled adolescents and young adults. Success in achieving these goals will require a long-term coordinated effort to persuade the public,
administration, and Congress that enacting appropriate legislation and regulatory reforms is extremely important. Please consider this suggestion seriously.
Thanks so much for all that you do for children.
Thomas K. McInerny, MD, FAAP
President, American Academy of Pediatrics
From the
Chairperson’s Desk
Opportunities to Advocate for Kids
By Natalie Riedmann, MD
Spring invigorates, recharging our hopes and motivating us to work toward the change we want
to see in the world. As pediatricians, we carry this energy into our clinical practices, fueling
conversations about ways we can bring about positive change for our patients.
Our national advocacy campaign is a top priority of the American Academy of Pediatrics (AAP)
Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) each year. The 2013
campaign, “Read, Lead, Succeed,” highlights the importance of childhood literacy. If you agree
that reading together benefits children and their families, this is an excellent way to get active in
advocacy.
If you are passionate about a local child health issue, please consider designing your own
advocacy project and applying for an AAP Community Access to Child Health (CATCH) grant to
enable it. We honored several residents who used CATCH funding to implement communitybased child advocacy initiatives at the 2012 SOMSRFT Annual Assembly.
For those interested in national issues, the AAP Department of Federal Affairs Web site (www.
aap.org/en-us/about-the-aap/departmx-divisions/department-of-federal-affairs/Pages/AAPDepartment-Federal-Affairs.aspx) offers up-to-date information on child health initiatives. Please
e-mail [email protected] for information about becoming an AAP Key Contact and to receive timely
legislative updates and requests for action.
Pediatricians have a credible and powerful voice for children, and the AAP offers abundant
resources to transform ideas into concrete action that will make a difference for children. (More
information can be found on our Web site, www2.aap.org/sections/ypn/r/resident.)
As the new chairperson of the AAP SOMSRFT, my goals for the year are to promote our fantastic
“Read, Lead, Succeed” advocacy campaign; improve the technology available to residents via the
Internet and smartphones; continue to develop our mentorship
program; and expand the resources available for fellows and
medical students within our 13,000-member section. I am
optimistic that with your support, these goals will be met!
Natalie Riedmann, MD, is a chief resident at Nationwide Children’s
Hospital in Columbus, OH. Write to her at
[email protected].
Plan Now to Attend!
The 2013 National Conference & Exhibition
of the American Academy of Pediatrics
October 26–29, 2013 • Orlando, FL
As well as
The American Academy of Pediatrics
Section on Medical Students, Residents,
and Fellowship Trainees (SOMSRFT)
Annual Assembly
Saturday, October 26, 2013 • 7:30 am–5:00 pm
Please join us at 6:30 pm
Saturday evening, October 26,
for the SOMSRFT Reception and Poster Display
featuring clinical case presentations.
Learn more at www.aapexperience.org
Inside This Issue
By Captain Gayle Haischer-Rollo, MD, Secretary and Advocacy Subcommittee Chair
We mark the 21st year of the American Academy of Pediatrics (AAP) Section on Medical
Students, Residents, and Fellowship Trainees (SOMSRFT) newsletter with a new
publication title and graphic design. Resident Report has been renamed News and Views
From Pediatricians in Training, recognizing that medical students are an important
cohort within our section and emphasizing the value of pediatric fellows in our ranks.
Your executive committee coordinates content for News and Views and the SOMSRFT
Web site. We welcome your ideas! Please let me know if you have story ideas or images
(still photos or video) of SOMSRFT members engaged in advocacy for children. Any
submissions will be reviewed by the SOMSRFT Executive Committee for possible
publication in print or posting on the Web site (www2.aap.org/ypn).
Insights Inside
Just 2 days after the shootings in Newtown, CT, the Insights Inside submission from
Cheryl Bugailiskis, MD, showed up unannounced. Talk about timing.
There are protocols for institutional settings affected by violence, but Cheryl speaks to a
different kind of preparation, mostly internal. How do we learn to respond constructively
when our patients and their families experience or witness violence? What are the
elements of “patient management” in such a situation? Where do we begin?
Child abuse pediatricians are among those within our specialty best prepared to address
the effects of violence on children. Today, 264 board-certified child abuse
pediatricians practice in the United States, and
training programs coordinate 22 accredited
fellowships. We turned to our professional network
within the AAP and asked Antoinette L. Laskey, MD,
MPH, FAAP, a former chair of the Section on
Medical Students, Residents, and Fellowship
Trainees who now chairs the AAP Section on Child
Abuse and Neglect, to respond to Cheryl’s piece.
Her comments appear beside the column.
Captain Gayle (“Hava”) Haischer-Rollo, MD,
is a second-year neonatal fellow at the
San Antonio Military Medical Center, TX.
Write to her at [email protected].
Point/Counterpoint
Editor’s Note: Point/Counterpoint is a forum to share viewpoints on issues of importance to pediatrics. The column is designed to get hot topics “on the table” and encourage healthy debate. Subject
matter and authors are ordinarily identified by the Section on Medical Students, Residents, and Fellowship Trainees Executive Committee. Authors are sought to represent both sides of a topic; when
there are no volunteers to present an alternative position, someone is recruited to do so in the interest of balance and completeness. Therefore, opinions expressed in this column may not be those
of the authors and they are not necessarily those of the American Academy of Pediatrics. Medical students, residents, and fellowship trainees are welcome to submit short essays on matters of
interest.
The question at issue: Given evidence that the differences in nutritional value of organic and conventionally produced foods are not significant, should pediatricians counsel families to
select organic foods to minimize potential health risks associated with pesticide use in food production?
Background: For purposes of this debate, the term organic food refers to that grown without synthetic pesticides or fertilizers, and the term organic livestock refers to animals that are given
access to the outdoors and sunlight and whose feed is free of pesticides or animal by-products. We also stipulate that organic meat and produce is that processed without irradiation or
chemical food additives and without routine use of antibiotics or growth hormones.
Points of agreement: Nutritional counseling is an important element of anticipatory guidance. The risks and benefits of producing and consuming foods without the use of pesticides
present trade-offs, but the method of production—conventional versus organic—does not seem to have a significant effect on overall nutritional value.
Aspects in dispute: Dr Shah believes that emerging evidence of health hazards tied to consumption of pesticides suggests that families should be encouraged to choose organic. Dr Romm
feels that pediatricians should focus on encouraging families to include sufficient produce in their diets.
Choosing Organic Is About More Than Nutrition
By Anita Shah, DO, District IV Assistant Coordinator
Pediatricians Should Focus on Recommending Conventionally
Grown Produce
By Sylvia Romm, MD, MPH, District I Assistant Coordinator
The United States produces 80,000 chemicals, and the effects of most have not been thoroughly
studied in children. Children ingest more food and water than adults per body weight. They also
consume a limited diet during crucial brain and vital organ development; in the first few months
of life, their diet is limited to human milk or formula along with a select few vegetables. They are
more vulnerable to the foods that they consume.
As pediatricians, it is important for us to advocate for the safety of our patients and limit exposure
to products that may be harmful to their health. Choosing organic foods helps eliminate a portion
of the exposure. Long-term consequences of pesticide exposure are largely unknown. A
technical report from the American Academy of Pediatrics Council on Environmental Health
published in the December 2012 Pediatrics linked pesticide exposure to chronic health
complications, including asthma and malignancy.1
In September 2012, a Stanford study published in the Annals of Internal Medicine indicated that
while organic foods are no more nutritious than conventional foods, an organic diet might
reduce exposure to pesticide residues and antibiotic-resistant bacteria.2 While this study was
limited in the heterogeneity of the articles reviewed, there is good evidence that levels of urinary
pesticides decrease within 5 days of changing to an organic food diet.
Cost of organic food is an issue. For many, it may be unrealistic to choose a completely organic
diet. Pediatricians can give parents recommendations on healthy ways to limit exposure;
washing produce is one important way. Another is to choose organic alternatives when
purchasing produce such as apples and grapes that are known to be higher in pesticide levels.
The nonprofit Environmental Working Group publishes a list of produce commonly high in
pesticides at www.ewg.org/foodnews/summary.
Choosing organic food is making a statement larger than simply nutrition. It is choosing better
agricultural practices and humane treatment of livestock. It is also choosing to limit lifetime
exposure to synthetic pesticides for which effects are largely unknown. The choice should be
organic.
References
1. Roberts JR, Karr CJ, American Academy of Pediatrics Council on Environmental Health.
Pesticide exposure in children. Pediatrics. 2012;130(6):e1765–e1788.
http://pediatrics.aappublications.org/content/130/6/e1765. Accessed February 5, 2013
2. Smith-Spangler C, Brandeau ML, Hunter
GE, et al. Are organic foods safer or healthier than
conventional alternatives? A systematic review.
Ann Intern Med. 2012;157(5):348–366. http://
annals.org/article.aspx?articleid=1355685.
Accessed February 5, 2013
In the November 2012 Pediatrics, the American Academy of Pediatrics Committee on
Nutrition and Council on Environmental Health report that an analysis of current evidence finds
no significant differences in the nutritional content of organically and conventionally grown
foods.1 This news should be reassuring to any pediatrician who has struggled to recommend
more costly organic foods to populations that have already been shown to be eating insufficient
fruits and vegetables.
The trend toward organic foods has been increasing over the past 2 decades and shows no signs
of stopping. According to the Organic Trade Association, the US market ballooned from $3.5
billion in 1996 to $28.6 billion in 2010. Some organic producers claim that their products are
nutritionally superior to conventionally grown foods and may charge a markup of up to 40% on
prices for these purported benefits. This increase makes organic fruits and vegetables too
expensive for many households and may encourage consumers to buy fewer fruits and
vegetables.
Because researchers continue to report that children and adolescents are falling short of meeting
recommended guidelines from the Centers for Disease Control and Prevention (CDC) for fruits
and vegetable consumption and that produce purchases decrease as prices increase, the
nutritional benefits of organic produce would need to be well substantiated to warrant their
purchase over conventionally grown foods. This report debunks the claim that conventionally
grown food is nutritionally inferior, making the price premium indefensible for nutritional reasons.
The CDC has long cited the benefits of a diet high in
fruits and vegetables as a way to decrease lifetime risk of
many chronic diseases and some cancers. As
pediatricians, educating our patients on the nutritional
quality of conventionally grown produce and
encouraging them to buy more fruits and vegetables
overall are the healthiest recommendations we can give.
Reference
1. Forman J, Silverstein J, American Academy of
Pediatrics Committee on Nutrition and Council on
Environmental Health. Organic foods: health and
environmental advantages and disadvantages.
Pediatrics. 2012;130(5):e1406–e1415.
http://pediatrics.aappublications.org/
content/130/5/e1406. Accessed February 5, 2013
Sylvia Romm, MD, MPH, is a third-year resident in pediatrics at the Massachusetts General
Hospital for Children in Boston. Write to her at [email protected].
Anita Shah, DO, is a second-year resident in pediatrics at
Levine Children’s Hospital in Charlotte, NC. Write to her at
[email protected].
Spring 2013
Volume 23 | Number 1
Section on Medical, Student, Residents, and
Fellowship Trainees (SOMSRFT)
www.aap.org/ypn
2
Insights Inside
Readers are invited to submit brief essays describing
events in training that helped to shape their
professional gestalt. If you would like to submit an
essay or discuss a potential topic for Insights Inside,
please contact Captain Gayle Haischer-Rollo, MD,
secretary, Section on Medical Students, Residents,
and Fellowship Trainees, at [email protected].
Examining Room 19
By Cheryl Bugailiskis, MD
A 12-year-old girl sits with her shoulders slumped
forward and speaks in a barely audible whisper. She
is here for vomiting…probably gastritis. I ask what she
has been eating and her father abruptly interrupts, “You
better just tell her, she’s going to find out!”
Does she have anorexia? The girl has been barely
eating and has lost weight. I decide to get her alone
and ask her father to leave the room. He asks, “Are you
a doctor here?” I am bewildered by the question but
answer, “Yes.”
During my examination, I ask her HEADSS questions,
including if anyone is sexually abusing her? She says,
“No.” She states that she has been fighting with her
father and he punched her. The story unravels. Her
parents have been going through a divorce for a year.
To deal with this, she skipped school. Her father found
her outside the school, confronted her, and grabbed
her cell phone. She pulled back and he punched her in
the face.
The child explains to me that this is not the first time
she has been punched and she does not want me
to tell. I feel guilty that I may cause more harm by
contacting the social worker. My attending prods me,
reminding me that we are obligated to report.
In the social worker’s office, the father is defending
himself in Spanish, but he switches to English to
address me personally. “You’re young!” he says. “What
would you do? I don’t want my daughter to grow up
and become a prostitute, hanging out with hoodlums
and doing drugs!” I am startled but explain that this is
abuse.
The social worker wraps up the meeting. Although she
has made a report with the Department of Children
and Family Services (and has made the father aware of
it), she states that it’s OK for the father to go home with
his daughter. I think to myself, he is probably definitely
going to hit her when she gets home now. I decide
that I would prefer that we all meet with the daughter.
Commentary
This edition of Insights Inside brought to mind an article
published on page 6 of the Spring 2008 Resident Report
(www2.aap.org/sections/ypn/r/newsletters/Newsletter%20
pdfs/RR%20Spring%202008.pdf) after the American Board of
Pediatrics agreed to designate child abuse as the 14th
subspecialty of pediatrics. The authors, Antoinette L. Laskey,
MD, MPH, FAAP, and Tara L. Harris, MD, FAAP, provided a
bird’s-eye view of child abuse pediatrics, the path to board
certification, and its unique rewards.
I start the conversation off by saying in an unexpected,
cracked voice that I cannot prevent, “I am a human
too, I have feelings, this cannot go on! When you hit
your daughter you are telling her that you don’t love
her. You are also showing her that this is how you
communicate in relationships and that it’s acceptable
if some boy she dates one day hits her.”
I explain that his daughter has all of the signs of
depression and that she needs help dealing with the
divorce. Somewhere in the middle of the conversation,
the father asks us if we can get him anger management
therapy. The social worker almost gasps…she tells me
after the meeting that she has never had that happen
before. We wrap up the intervention with a pact that
everyone will be safe when they get home.
We asked Dr Laskey, now an associate professor of pediatrics
at the Primary Children’s Medical Center and the University of
Utah in Salt Lake City, where she is division chief and medical
director of the Center for Safe and Healthy Families, to read
and comment on Dr Bugailiskis’ experience. Her comments
follow:
•
As I head for the door, the father reaches for my hand,
almost in slow motion, and shakes it. “When I asked
you if you were a doctor here, I asked because I saw
someone last month and I asked them if she could be
depressed and they said no,” he says. “I knew when
you began asking my daughter questions that you
were going to get to the bottom of this. I want to ask
you if you can be my daughter’s doctor?”
•
My heart, which had been racing, slows.…I cannot
believe that I was so worried about reporting the
father.
This manuscript was edited for space. To obtain
the unabridged version, please e-mail the author at
[email protected].
•
Cheryl Bugailiskis,
MD, is a secondyear resident in
pediatrics at the
Children’s Hospital
University of
Illinois, a hospital
within the University
of Illinois Hospital
& Health Sciences
System, Chicago.
Write to her at
[email protected].
Dr Bugailiskis clearly has precocious communication skills,
Dr Laskey says; an intervention would not ordinarily go
this well. In such a situation, if there is a child abuse
pediatrician in your hospital, secure their help. If there is
not, ask your attending or the hospital social worker to sit
in when you talk to the family.
It is best to tell the family that you are required to make a
report to child protective services (CPS). Explain that you
are not making a judgment but abiding by the law. You are
involving CPS because you want to work with the family
to help the child be healthy and CPS has resources that
can help families in ways that you cannot. A caveat: It
would be unwise to inform the family that you are making
a report if it seems likely that doing so would put you in
danger.
If you are apprehensive about sending the child home
with the person you’ve reported, do some safety screening
and communicate that concern to CPS. Secure guidance
about navigating the system from a knowledgeable
attending, social worker, or child abuse pediatrician.
In summary, Dr Laskey says, “Child abuse is perhaps one of the
hardest ‘conditions’ we face as pediatricians. It can lead to
discomfort and doubt about our abilities to correctly diagnose
and help our patients. It can lead to very uncomfortable
conversations. However, failure to follow through on our legal
mandate to report suspected child maltreatment could mean
that our patient ends up further injured or dead. Above our
legal mandate to report is our moral mandate to ‘do no harm.’
Inaction in cases like this can be harmful.”
Creative Learning
Attention Chief
Residents!
Are you interested in joining an
online community of pediatric
chief residents to share ideas
and experiences, solicit suggestions and solutions, and interact
with colleagues from around the country? If so, please send an
e-mail to Julie Raymond, Manager, Young Physician Initiatives, at
[email protected]
with your name, position, and current training program. This (e-)
mailing list is open to pediatric chief residents, both current and
future. Messages can be received individually or as daily digests, or
read online at the Web site. Check out additional resources for chief
residents at www2.aap.org/sections/ypn/r/resident/chief_listserv.
html
International Elective Awards
The American Academy of Pediatrics (AAP) has set aside
several $1,000 awards to be given in 2013 to categorical or
combined-training pediatric residents who wish to
complete a clinical pediatric elective in the developing
world during residency. Fellowship trainee members are
also eligible to apply (the awards committee may, at its
discretion, select one fellowship trainee to receive the
award). Awards are given solely on the basis of the
application and an accompanying letter from the applicant’s
program director, faculty mentor, or global health director.
The selection committee is composed of members from
the AAP Section on International Child Health (SOICH) and
the AAP Section on Medical Students, Residents, and
Fellowship Trainees. Applicants must be members of SOICH
to apply for this award. To submit a secure application for
SOICH membership, please go to https://fs25.formsite.
com/aapmembership/SOICHResident/secure_index.html.
To learn more, please go to www2.aap.org/ypn/r and click
on “Funding & Awards.”The first cycle will be due March 15,
2013, and the second cycle will be due September 15, 2013.
Spring 2013
Volume 23 | Number 1
Environmental Exposures in Childhood
By Abby Nerlinger, MD, Liaison, American Academy of Pediatrics Council on Environmental Health
As residents, we may have knowledge of the ubiquitous environmental triggers for asthma and ideas
about community prevention of childhood obesity but may not know where to turn when asked about
headlines on arsenic in juice, low-level lead exposures, and hydraulic fracturing. The American Academy
of Pediatrics (AAP) Council on Environmental Health (COEH) studies, advocates, and provides accessible
and reliable resources on such topics.
The COEH promotes awareness of pediatric environmental health issues through timely policy
statements, legislative advocacy, and physician and community education. Its members are concerned
with everything from environmental influences in childhood obesity to the impact of childhood
radiation exposure. Policy statements and review articles developed or coauthored by the COEH and
available online address everything from “Global Climate Change and Children’s Health”1 to “Organic
Foods: Health and Environmental Advantages and Disadvantages.”2 The most recent culmination of
COEH work is the third edition of Pediatric Environmental Health (the “green book” of pediatrics), a
reference text for physicians revised and released in 2012.
Residents can take a proactive role in the prevention of pediatric disease by addressing environmental
factors in residency studies and future independent pediatric practice. Additionally, residents and fellows
now have the opportunity to join the COEH (www2.aap.org/visit/cmte16.htm) and receive various
benefits of membership, including access to a newsletter addressing current controversies and proposing
advocacy project ideas.
Residents and pediatricians with specific questions about childhood exposures in the community have
multiple resources. For example, a 2011 Pediatrics in Review article, “Addressing Environmental
Contaminants in Pediatric Practice,”3 describes how to take an environmental health history, addresses
basic environmental exposures, and presents opportunities for feasible interventions. Other resources
include the Pediatric Environmental Health Specialty Units, regional units sponsored by the US
Environmental Protection Agency that provide community outreach, e-mail, and telephone responses
to questions from the public about community exposures and potential referral to outside resources for
exposure management. The nonprofit organization Physicians for Social Responsibility also offers an
AAP-endorsed pediatric environmental health toolkit with text and visual resources for health care
professionals and patients in English and Spanish.
While environmental health is not currently a board-certified
pediatric subspecialty, the discipline relates to concerns across all
pediatric practices. As pediatricians in training and later in
practice, we seek to treat and also prevent pediatric disease.
Multiple resources are available to us. The next steps are those that
will put this learning into action!
References
A complete list of references for this article may be obtained by
writing the author at [email protected].
Abby Nerlinger, MD, is a third-year pediatrics resident at Children’s
Hospital of the King’s Daughters in Norfolk, VA. Write to her at
[email protected].
Section on Medical, Student, Residents, and
Fellowship Trainees (SOMSRFT)
www.aap.org/ypn
3
Anne E. Dyson Child Advocacy Awards
Concrete, Sustainable
Community Pediatrics Projects
The announcement of the winning child advocacy projects
submitted for the Anne E. Dyson Child Advocacy Award
competition is always a highlight of the American Academy
of Pediatrics Section on Medical Students, Residents, and
Fellowship Trainees Annual Assembly. Training program
teams honored this year took meaningful steps to address
failure to thrive among newborns and infants in emergency
housing, economic hardship as a driver of poor health
outcomes, and chronic food insecurity among families
whose children received care at a children’s hospital located
in an area where food insecurity is pervasive and acute.
Intervention for Newborns and Infants in
Emergency Housing
Win a free trip to the
2013 National Conference & Exhibition!
Applications Due July 19, 2013
Up to 3 projects will be selected to receive an Anne E. Dyson Child Advocacy Award at the 2013 Section on Medical
Students, Residents, and Fellowship Trainees (SOMSRFT) Annual Assembly, which will meet October 26, 2013, in
conjunction with the American Academy of Pediatrics (AAP) National Conference & Exhibition (NCE). The online
application will be available in May; to access it, please go to www2.aap.org/sections/ypn/r and click on “Funding &
Awards.” Benefits of selection include
•
•
•
$300 in funds to advance the winning projects’ goals
Travel and lodging expenses (2 nights) for one resident per project to attend the NCE, to be held October 26 through
29, 2013, in Orlando, FL
An opportunity to attend the SOMSRFT Reception and Poster Display on Saturday evening, October 26, 2013
Presentation of the advocacy award plaque during the SOMSRFT Annual Assembly on Saturday,
October 26, 2013
Opportunity to display and distribute project information to medical students, residents, and fellowship trainees from
across the country at the NCE
Press release and recognition in AAP News, News and Views From Pediatricians in Training, and state chapter
newsletters
The Children’s Hospital of Philadelphia (CHOP) Homeless
•
Health Initiative team piloted the Healthy Babies Program
after the December 2010 death of a young infant residing in
•
emergency housing who had suffered from severe
malnutrition. Maria Katherine Henry, MD, coordinated Healthy
•
Babies as part of her community pediatrics rotation, working
with physicians, nurses, and social workers at CHOP to
develop protocols for nurses hired to make weekly or
biweekly visits to shelters and screen for failure to thrive
among newborns and infants 0 to 4 months of age. Healthy
Babies team members provide support and education to mothers of at-risk babies and
screen for postpartum depression, a separate risk factor for poor newborn and infant
outcomes. Dr Henry reports that the program, piloted at 1 shelter over 8 weeks in 2012, is
now expanding to include 4 Philadelphia shelters. Plans for further growth in 2013 will bring
those Philadelphia shelters not yet participating in Healthy Babies under its umbrella and
enable the program to provide regular screening for all newborns and young infants in
Philadelphia emergency housing.
Financial Fitness
Clinic Creates Novel
Interdisciplinary
Partnership
2012 Anne E. Dyson award winners (left to right):
Eric Burlingame, MD; Maria Katherine Henry, MD;
and Adam David Schickedanz, MD.
In late 2010, physicians at the
University of California, San
Francisco (UCSF) pediatric clinic
and UCSF family medicine clinic
launched a partnership with
Wells Fargo and the Mission
Economic Development
Agency, a community-based
economic development group,
to create the Financial Fitness
Clinic (FFC). The FFC seeks to
remove economic barriers to health for San Francisco’s
poorest children and their
families and raise awareness of economic determinants health among patients and
clinicians. The clinic features one-on-one financial counseling and direct referral to
money-saving social services (eg, utility bill discounts, affordable child care, food stamps, tax
advice, job training). All participants leave the clinic with concrete financial action plans and
lists of economic resources tailored to their needs. Monthly clinic sessions at the primary site
(San Francisco General Hospital & Trauma Center) have been augmented by an electronic
referral portal that allows professionals from far-flung San Francisco Department of Public
Health network sites to refer families to the program. The FFC opened a second site in May
2012. More than 100 patients and families have been served by the FFC and all are regularly
contacted by clinic staff.
The Healthy Food Cart
Some ideas are so simple, they’re brilliant. Consider the Healthy Food Cart at St. Christopher’s
Hospital for Children in Philadelphia, which enables low-income patients and their families to
purchase fresh fruit and produce from a cart located in the hospital whose owner is
authorized to accept federal Supplemental Nutrition Assistance Program food stamps and
electronic benefits cards. St. Christopher’s estimates that about half the families it serves
experience hunger every year. Eric Burlingame, MD, worked with a local nonprofit to recruit
an entrepreneur to sell products on campus and organized educational programs for the
staff to facilitate effective screening for food insecurity, develop food resources, and
connect needy patients and their families to those resources. Residents also established the
Food Interest Group to sustain staff participation in these activities as well as other programs
launched by the St. Christopher Hunger-Free Hospital Initiative.
About the Dyson Foundation
The Anne E. Dyson Child Advocacy Award is supported by the Anne E. Dyson Endowment,
which celebrates and supports pediatricians in training who work in their communities to
improve child health. Anne E. Dyson, MD, FAAP, a pediatrician whose 20 years as president
and director of the Dyson Foundation reflected a strong commitment to effective child
advocacy, died of breast cancer in September 2000 at the age of 52.
Resident CATCH Corner
2014 CATCH Resident Funds (Cycle 1)
Call for Proposals: Submissions Due July 31, 2013
for Projects to Begin January 2014
Resident Grants
Grants of up to $3,000 are available for pediatric residents to work with local communities to ensure that all children, especially
underserved children, have medical homes and access to specific health care services not otherwise available.
Projects must include planning activities or demonstrate completed planning activities, and may include implementation activities.
Project activities should include developing broad-based collaborative community partnerships.
To ensure project completion, only those who are PGY-1 and PGY-2 residents on the application submission due date are eligible to
apply; PGY-3 residents may apply as co-applicants, or as primary applicants if they will be chief resident in their fourth year.
Planning Grants and Implementation Grants for Fellowship Trainees
Fellowship trainees, as well as pediatricians, are eligible to apply for up to $12,000 to carry out either a planning grant project or an
implementation grant project. Please note that, unlike the resident grants, planning projects may not include implementation
activities.
Applications will be available May 1, 2013. Proposals will be due July 31, 2013, and applicants will be notified of their status in
November.
More information is available at http://www2.aap.org/catch/funding.htm , e-mail [email protected] or call 847/434-4916.
The CATCH Planning, Implementation, and Resident Grants are administered by the AAP CATCH Program and are made possible
through the support of Pfizer and the Walmart Foundation, with additional support from individual donations through the AAP Friends of
Children Fund.
Spring 2013
Volume 23 | Number 1
www2.aap.org/ypn
Now Available from the
American Academy of Pediatrics!
Check it out!
This portal provides easy,
one-stop access to a wide array
of AAP resources to meet the
professional needs of
young pediatricians.
Section on Medical, Student, Residents, and
Fellowship Trainees (SOMSRFT)
www.aap.org/ypn
4
Tenth Annual SOMSRFT Reception and Poster Display
By Bijoy Thattaliyath, MD, District IV Coordinator
Chairperson, Clinical Case Presentations
Annual Assembly 2012: Jazzed!
By Captain Gayle Haischer-Rollo, MD, Secretary and Advocacy Subcommittee Chairperson
The American Academy of Pediatrics (AAP) Section on Medical Students, Residents, and
Fellowship Trainees (SOMSRFT) clinical case competition was launched in 2003 by
David C. Kaelber, MD, PhD, then a member of the executive committee, and it’s become
a favorite tradition. The SOMSRFT Reception and Poster Display honoring outstanding
submissions was held this year at the Mardi Gras World mansion in conjunction with the
AAP National Conference & Exhibition (NCE) in New Orleans, LA.
The American Academy of Pediatrics (AAP)
2012 National Conference & Exhibition
(NCE) was held Saturday through Tuesday,
October 20 through 23, 2012, in New
Orleans, LA. Members of the AAP Section
on Medical Students, Residents, and
Fellowship Trainees (SOMSRFT) held their
Annual Assembly on Saturday.
As I walk down the street, the soft wail of an alto sax fills my ears and the smell of jambalaya
wafts nearby. I spot a crowd of friendly faces wearing beads around their necks and pins that
declare, “I care for kids and I VOTE!” I have finally arrived in New Orleans for the 2012 AAP
NCE.
Each year, more than 7,000 general pediatricians, pediatric subspecialists, and other
professionals committed to the health and safety of children and adolescents come together
at the NCE to learn the latest and meet the greatest in pediatrics and child advocacy. Our
SOMSRFT Annual Assembly, held in conjunction with the NCE, clusters around the challenges,
concerns, and opportunities specific to us as trainees.
Janae Preece, MD, and colleagues took top honors at the 2012 Section on Medical
Students, Residents, and Fellowship Trainees clinical case competition in New Orleans, LA
for their paper, “Persistent Flank Pain and Voiding Dysfunction: A Case of Missed Anterior
Urethral Valves.” Pictured (left to right) are Joseph Zenel, Jr., MD, FAAP, editor, Pediatrics
in Review (PIR); Dr Preece; and Deepak M. Kamat, MD, PhD, FAAP, editor, PIR Index of
Suspicion column. The paper will be published in the September 2013 PIR.
A February 2012 announcement invited SOMSRFT members to submit interesting clinical
case abstracts, which generated a lot of interest among pediatric residents, fellows, and
medical students within the United States and abroad. We received 130 submissions,
the largest number so far! A panel from the SOMSRFT Executive Committee judged the
abstracts, and 10 finalists were invited to present posters at the reception.
Deepak M. Kamat, MD, PhD, FAAP, editor of the Pediatrics in Review (PIR) Index of
Suspicion column, reviewed abstracts from the 10 finalists with Lawrence F. Nazarian,
MD, FAAP, PIR editor emeritus, to select the winner.
The Winner
This year’s winning case, “Persistent Flank Pain and Voiding Dysfunction: A Case of
Missed Anterior Urethral Valves,” was submitted by Janae Preece, MD, of the University of
Maryland Medical Center. The case describes an 11-year-old boy who presented with left
flank pain and enuresis whose symptoms had begun when he was 3 years old. The final
diagnosis was made during cystoscopy, which revealed a membranous structure in the
anterior urethra.
Call for Submissions
Friday, April 12, 2013, is the deadline for online submission of abstracts for this year’s
competition. SOMSRFT members are encouraged to submit accounts of their most
interesting cases. The top 10 authors will be invited to present posters at the 2013 NCE in
Orlando, FL.
The first-place paper will be published in Pediatrics in Review as an Index of Suspicion
article in September 2013. Authors of the top paper
also receive a free 1-day NCE registration. Go to
www2.aap.org/sections/ypn/r/funding_awards/
clinical_case_pres.html for more information and a
link to submit your case.
The 2012 SOMSRFT Reception was supported by
Abbott Nutrition, a division of Abbott
Laboratories, Inc.
Bijoy Thattaliyath, MD, is a second-year fellow in
pediatric cardiology at the Duke University Health
System, Durham, NC. Write to him at
[email protected].
Take Your Best Shot
Photography Competition Announced
Do you have pictures of pediatricians caught in the act of advocating for children? Is there a
photo of your training program’s most recent hands-on community health initiative? Is your
photograph a high-resolution JPG suitable for publication? Then we have an opportunity for
you!
Any member of the Section on Medical Students, Residents, and Fellowship Trainees
(SOMSRFT) who provides a photo and caption featuring pediatricians advocating for children is
eligible to win the Take Your Best Shot competition.
Winners will be selected twice annually and their photographs will be featured in SOMSRFT
News and Views.*
First prize: Fame if not fortune.
Second, third, fourth prizes: Much the same.
You will be published!
Please e-mail your pictures (with captions) to Julie Raymond, Manager Young Physician
Initiatives, at [email protected].
*Parents of children featured in winning photos will be asked to sign a photo release, available on
the SOMSRFT Web site at www2.aap.org/ypn/r/newsletters/resident_report.asp.
Spring 2013
Volume 23 | Number 1
This year, our Annual Assembly kicked off with an update from the Section on Young
Physicians, the Home for pediatricians after residency or fellowship. Next, we heard (although
experienced was more like it) an inspirational talk by renowned clinician educator Kenneth
Roberts, MD, FAAP. Dr Roberts focused on the importance of mentoring and gave young
physicians skills to identify the potential mentors that they meet every day. The SOMSRFT is
in the process of piloting a mentorship program designed to connect section members with
AAP fellows.
National officer elections were next. Natalie Riedmann, MD, became our 2012–2013
chairperson; Faisal S. Malik, MD, stepped up to vice chairperson; and I was reelected secretary.
Natalie’s first official task was to unveil our fabulous 2012–2013 advocacy campaign: “Read,
Lead, Succeed.” From there, we hustled to the AAP NCE plenary session, where we
encountered a festive Mardi Gras parade (yes, with floats, including one carrying AAP
President Robert W. Block, MD, FAAP, who cheerfully tossed beads into the crowd). The fun
continued when cartoonist Walt Handelsman, a proud pediatrician’s son, took us through a
kaleidoscope of humorous and often poignant cartoons featuring subjects that affect the lives
of pediatricians and children. Next came a break for lunch and SOMSRFT district meetings,
where we elected new district officers and brainstormed around the best way to frame some
amazing resolutions.
From there it was on to the breakout sessions, where residents could learn cardiac
auscultation or catch up on the state of political matters affecting children. While residents
and fellows were in breakouts, medical students enjoyed a “subspecialty speed-dating
session” where they could talk one-on-one with pediatric subspecialists.
When breakouts were complete, we reconvened to whittle a plethora of amazing resolutions
down to what would be the 2013 SOMSRFT top 10 and headed over to the Mardi Gras World
mansion for a poster display that showcased cool research projects accompanied by
scrumptious food and live music.
The AAP NCE would continue into the week—engaging,
educational, and thoroughly enjoyable. Those of us who
could not stay knew that there would come a time when
our schedules would be more flexible. For now, it was
enough to know that the SOMSRFT Annual Assembly had
brought us together for a glimpse of our collective future,
viewed in—and with—the brightest of lights.
Please plan to join us next year at the 2013 NCE in sunny
Orlando, FL!
Captain Gayle (“Hava”) Haischer-Rollo, MD, is a second-year
neonatal fellow at the San Antonio Military Medical Center,
TX. Write to her at [email protected].
Visit Us on
the Web!
Looking for the latest on the Section on Medical Students,
Residents,and Fellowship Trainees? Wondering about the status
of a project you’ve heard about? Check out the YoungPeds
Network! Go directly to
www2.aap.org/ypn
or start at the AAP Web site
(www.aap.org)
Once there, hover over “About the AAP” and
“Committees, Councils & Sections,” then click on “Sections,
” then “Section Websites,” then “Medical Students, Residents, and
Fellowship Trainees.”
Section on Medical, Student, Residents, and
Fellowship Trainees (SOMSRFT)
www.aap.org/ypn
5
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News and Views
from Pediatricians in Training
u
3 | Vol
Spring 201
m
| Nu
me 23
A Day in the Life of a Med-Peds Resident
1
ber
The American Academy of Pediatrics (AAP), through its Section on Medical Students, Residents,
and Fellowship Trainees (SOMSRFT), and in cooperation with McNeil Consumer Healthcare, offers
News and Views From Pediatricians in Training to all AAP resident members and any
post-residency training members and medical students who are members of the section.
Comments, questions, and member input into future issues are welcome and should be directed to
News and Views From Pediatricians in Training
American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007
Section on Medical Students, Residents, and Fellowship Trainees
Executive Committee
Chairperson
Natalie Riedmann, MD
natalie.riedmann@nationwide
childrens.org
Vice Chairperson
Faisal S. Malik, MD
[email protected]
Secretary
Captain Gayle Haischer-Rollo, MD
[email protected]
Immediate Past Chairperson
Sarosh P. Batlivala, MD
[email protected]
District Coordinators
Yuen Lie Tjoeng, MD – I
[email protected]
Assistant District Coordinators
Sylvia Romm, MD, MPH – I
[email protected]
Marissa DiGiovine, MD – II
[email protected]
Justin Schreiber, DO – III
[email protected]
Anita Shah, DO – IV
[email protected]
Jennifer Noble, MD – V
[email protected]
Michael Colburn, MD – VI
[email protected]
Shana Godfred-Cato, DO – VII
[email protected]
Erin Kelly, MD – II
[email protected]
Wes Henricksen, MD – VIII
[email protected]
Lisa Costello, MD, MPH – III
[email protected]
Nicole Chao, MD – IX
[email protected].
edu
Bijoy Thattaliyath, MD – IV
[email protected]
Matthew Hornik, DO – V
[email protected]
Sameer Vohra, MD – VI
[email protected]
Ashley Lucke, MD – VII
[email protected]
Neha Patel, MD – VIII
[email protected]
Elizabeth Van Dyne, MD – IX
[email protected]
Tricia Pinto, MD – X
[email protected]
Managing Editor
Mariann M. Stephens
AAP Manager
Young Physician Initiatives
Julie K. Raymond, CAE
Department of Membership
[email protected]
Design
Creative Spectacles
Markus Renno, MD – X
[email protected]
Opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Copyright © 2013 American Academy of Pediatrics. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Printed in the United States of America.
Printing and distribution of News and Views is supported by
Patients 8 Days to 80 Years Old
By Lisa Costello, MD, MPH, District III Coordinator
and Medical Student Subcommittee Chairperson
Just before 7:00 am on a crisp autumn
morning, I walk across the parking lot and
into Ruby Memorial Hospital at West Virginia
University in Morgantown. I’m training in one
of the most rural states in the nation, and
ours is the busiest tertiary care center in the
state. Some of my patients will travel hours to
receive care. They make the trip because most
towns in West Virginia are without access to
any health care, let alone specialized care.
As a second-year med-peds resident, my
training involves blocks of time focused on
children and blocks of time focused on adults.
I spent the first 4 months of the year on internal medicine (IM) and am now starting
the first pediatric rotation of my second year.
The morning begins with checkout from the night-shift resident on the pediatric
inpatient wards. Over the next 5 hours, I will help to lead 1 of 2 ward teams, each
consisting of 1 attending, 2 interns, and 3 medical students.
Around 10:00 am my pager goes off. One of my IM patients has traveled 2 hours to
arrive at the hospital unannounced with an occluded peripherally inserted central
catheter (PICC) line. I make a few calls between patients; fortunately, one of our PICC
nurses is available to troubleshoot.
My focus returns to kids with pediatric health concerns: type 1 diabetes, cystic fibrosis,
congenital heart defects, asthma. Rounds finish around 11:30 am, giving me time to
arrange discharge needs.
At 1:00 pm, when the IM continuity clinic begins, my attention shifts to adults with IM
concerns: type 2 diabetes, hypertension, hyperlipidemia, depression. For the next 4
hours, I arrange appropriate screenings: mammography and colonoscopy. I see
pictures of grandchildren and hear stories from veterans. Most encounters end with a
thank-you, although there is one frustrated patient who had hoped I would prescribe
narcotic medications for chronic back pain. Between IM visits, I check on my pediatric
patients.
My last IM encounter ends around 5:00 pm and I head back to the wards. Before 7:00
pm checkout, I admit a baby with respiratory syncytial virus and catch a brief segment
of SpongeBob SquarePants with a family waiting for prescriptions that their local
pharmacy does not carry.. The parents tell me that there is no pediatrician in their
home town and thank me for my help.
At 8:00 pm, I leave the hospital, reflecting on my
med-peds day. I saw patients 8 days to 80 years
old who traveled anywhere from 4 miles to 4
hours. They know and I know that if our team
were not there, these services might not be
available to them. Outside in the mountain air
I smile, thinking about the kids and adults I saw
today and grateful for all that I have learned from
them.
Lisa Costello, MD, MPH, is a second-year resident
in internal medicine-pediatrics at West Virginia
University School of Medicine in Morgantown.
Write to her at [email protected].