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Department of Pediatrics : Residency Programs : Categorical Pediatrics : Specialty and Subspecialty Training

MUSC

Adolescent Medicine
The pediatric residency program at MUSC includes a diverse training experience in adolescent medicine that is designed to provide a strong foundation for general adolescent care in pediatric practice. Adolescent medicine clinical services include an adolescent clinic, a school-based clinic at a nearby high school, and an active inpatient consultation service. In addition to this clinical training, didactic sessions in adolescent medicine are scheduled into the resident lecture series. The rotation also includes experience in an adolescent substance abuse treatment program and adolescent medicine didactic seminars. Other specific areas such as sports medicine, private practice adolescent medicine or eating disorder group therapy sessions can be arranged at the request of the resident.

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Pediatric Heart Program
The division of cardiology and cardiothoracic surgery work closely together to care for our infants and children with congenital heart defects. More than 350 major operations are performed annually with a 99% 30-day survival rate over the past 7 years. Critically-ill pre-operative and post-operative patients are cared for in our pediatric cardiology intensive care unit. Residents care for patients after cardiothoracic surgery procedures once they reach the ward prior to their discharge from the inpatient service. There is also an elective rotation offered for residents to gain experience in outpatient cardiology and/or inpatient consultations. Our pediatric heart program is among the top 20 in the nation.

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Child Life
Child life specialists provide diverse services to address the social, emotional and developmental needs of infants, children and adolescents. Programming includes assessment and a psychosocial care plan including therapeutic play and developmental support. Intervention strategies foster continued growth and development, minimize adverse reactions to the health care experience and reduce stress and anxiety.

Goals for children include mastery, control, opportunity for choices, self-expression and increased understanding and cooperation with medical treatments and procedures. Child life staff members manage and staff Medical Center playrooms and may be assigned to pediatric clinics, the department of emergency services and hospital units. This group also provides in-service classes and lectures within the University and throughout the community. Topics include child development and psychosocial issues concerning children and health care experiences. Consults are accepted from all services.

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Continuity Clinic
The resident's Continuity Clinic is located on the Medical University campus. Each intern begins with a panel of 75 patients, which will grow to 150 patients over three years. Residents may add newborns and patients they encounter in the hospital, emergency room or outpatient clinics. Patients are scheduled to see their own resident pediatrician for all well checks, school and behavior problems, most rechecks for acute illness, and hospital follow-ups. For those times a particular resident is not available, the clinic is divided into teams of four to maintain continuity among a smaller “practice group”. In the Continuity Clinic, residents experience the fun of following patients long enough to get to know them and their families well. They learn how to coordinate care for their patients with chronic health problems who are also under the care of specialized consultants. They see the myriad of relatively minor problems that concern parents, learn how to teach parents to recognize significant problems and encourage parents to practice good health maintenance with their children. Health problems are discussed from an outpatient perspective at a mini-conference held at the beginning of each morning clinic. Approximately 4,500 patients, an average of 35 patients a day, are seen.

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Critical Care
The critical care division coordinates the acute care of seriously ill children. The division directs patient care in the 11-bed Pediatric ICU and 10 intermediate care beds. Residents learn to take care of critically ill patients with a wide spectrum of diagnoses and are involved with critical post-operative care. Coordination of care also extends to the Children's Hospital transport team, including emergency transports via MUSC's MEDUCARE emergency transport system.

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Developmental and Behavioral Pediatrics, Child Psychiatry and Genetics
The division of developmental and behavioral pediatrics operates the Vince Moseley Developmental Evaluation Center which uses an interdisciplinary team approach in meeting the diagnostic and therapeutic needs of children with developmental disabilities. Services include developmental pediatrics, developmental psychology, occupational therapy, physical therapy, social work, speech/language pathology and schools. The team of professionals works together with children and their families through individual assessments, team staffing conferences and follow-up parent conferences to meet the specific needs of each child and his family. The types of developmental and learning problems evaluated include: learning disabilities, behavioral and emotional problems, developmental delay and mental retardation, cerebral palsy, autism, attention deficit hyperactivity disorder, spina bifida, high risk follow-up, and genetic defects, as well as a variety of other developmentally disabling neurological impairments. Fellowship training is available in this subspecialty.

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Emergency Medicine
The rotation in the pediatric emergency medicine provides a wide range of pediatric emergency experiences. A combination of direct patient care, teaching sessions, mock codes and resident directed conferences covers all aspects of pediatric emergency medicine. The development of evaluation management and technical skills is integrated with teaching the team approach needed to deal with an emergently ill or injured child. The pediatric ED has an attending in-house 24/7.

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Gastroenterology and Nutrition
The division of gastroenterology and nutrition specialize in the care of children with digestive disease and nutritional problems, including failure to thrive, malabsorption, tube feedings and parenteral nutrition. Close collaboration with the pediatric radiologists, psychologist and surgeons as well as the pathologist and pulmonologist is maintained on both the inpatient and outpatient services. Residents are welcome to elect a month rotation with the division where one-on-one didactic sessions are designed to meet the specific needs of the resident. During this rotation, residents are encouraged to participate in a full range of GI procedures.

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Hematology/Oncology
The division of hematology/oncology is responsible for the evaluation, treatment and follow-up care of all patients with hematologic disorders, coagulation defects and malignant diseases. It is also responsible, in collaboration with the adult oncology transplantation team, for pediatric patients undergoing bone marrow transplantation and it is an integral part of the university wide Hollings Cancer Center. In coordination with the attending hematology/oncology physicians, house officers assigned to this service are responsible for consultations, evaluations and treatment of both hospitalized patients and those seen in the outpatient facility. Residents are provided with support from the Department of Pathology and Laboratory Medicine, informal didactic teaching and frequent contact with all members of the division. Upon completion of a rotation on this service, the pediatric house officer will have achieved familiarity with evaluation of hematologic problems, will have the ability to recognize and manage common problems associated with pediatric malignancies and will have acquired the technical and psychological skills to perform these in practice. Fellowship training is available.

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Infectious Diseases and Clinical Immunology
The pediatric infectious diseases division provides consultation on a wide variety of infectious problems. Patients with common pediatric infections are admitted from the local population while the statewide referral population provides exposure to unusual or severe infections. The pediatric residents interact with the division through formal or informal consultations and in topic-oriented teaching sessions. The elective in pediatric infectious diseases gives the resident an opportunity to see inpatient and outpatient consultations. Participation in clinical research projects by interested residents is encouraged.

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General Pediatric Inpatient Training
The general pediatric inpatient service is a 173-bed children's hospital providing a mixture of acute and chronic diagnostic and therapeutic challenges. Patients from the local area provide residents with good exposure to common pediatric problems and a large number of tertiary care patients with rare diseases are referred from the entire state. Full-time attending physicians are integral members of the teams providing care on both the infant and the children's acute disease services. Attending hospitalists make daily teaching rounds and are closely involved in the day-to-day operation of all units. The ward service is organized into three teams, each with an upper level resident and two interns as well as medical and pharmacy students.

It is the policy of the department to delegate the primary responsibility of caring for all patients to the house staff. The inpatient service is conducted entirely within MUSC Children's Hospital; it is not necessary for house staff to rotate through affiliated hospitals for their inpatient experience.

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Nephrology
The pediatric nephrology division provides statewide tertiary diagnostic and therapeutic services for children with kidney and urinary tract diseases. A maintenance peritoneal dialysis program performs more than 500 dialyses per year. A home peritoneal dialysis training program is also provided. More than 1,500 visits are handled in the weekly pediatric nephrology clinic each year. Weekly seminars deal with renal pathology, nephrology, urology, and patient-care problems. The house officer is exposed to a variety of renal problems and participates in the care of chronic dialysis patients. The nephrology elective offers an in-depth exposure, wherein the house officer is given the chance to review the current literature and to participate in clinical research.

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Neurology
MUSC is home to a thriving pediatric neurology group whose services include ambulatory pediatric neurology, an inpatient consult service, and a video-EEG service. Experience includes basic information in pediatric neurological diseases, electroencephalography, neuroanatomy and neurophysiology. The uses and limitations of special diagnostic studies, including cerebrospinal fluid examination, video-EEG, and both CT and MRI scanning are also considered. A clinical approach stressing acquisition of knowledge and skills in neurological diagnosis in the outpatient department as well as at the bedside and clinical pathological correlation is stressed.

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Ophthalmology
The Albert Florens Storm Eye Institute has four pediatric ophthalmology faculty members who are available both for inpatient and outpatient service consultations. The staff manage a large variety of ophthalmic disorders in children and assist in the diagnosis of neurological and general systemic diseases. Lectures and seminars are available periodically throughout the year. Pediatric residents are encouraged to spend elective time on the service where they will become familiar with the in-office diagnosis and management of common pediatric ophthalmic disorders.

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Pulmonology, Allergy and Immunology
The division of pediatric pulmonology, allergy and immunology (PPAI) came into existence in July 2000. It is committed to providing effective and innovative patient care, education about common and rare pulmonary, allergic and immunologic disorders, and research. It is growing in faculty, patient numbers and research projects.

Division faculty admit their patients to the general pediatric team and make daily management/teaching rounds with members of that team. Faculty arrange case-based teaching in small groups two to four times per month. Mid- and upper-level residents who take the PPAI elective will attend the division's four main clinics: multi-disciplinary, cystic fibrosis (CF), allergy, and pulmonary. Division faculty regularly attend and contribute to morning report and provide lectures whenever requested.

The general patient groups seen in this division include asthma, apnea, BPD, CF, congenital abnormalities, lung infections, neurologic disorders, respiratory failure, restrictive lung diseases, sleep disorders and other miscellaneous conditions. The division utilizes and teaches the concept of healthcare provision by a multi-disciplinary team. Residents also learn a great deal about the indications for and information to be obtained from various types of testing, including bronchoscopy, exercise testing, pulmonary function testing and sleep studies.

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Radiology
The division of pediatric radiology in the department of radiology is staffed by three full-time pediatric radiologists who have dual appointments in pediatrics and radiology. In addition to working with the entire spectrum of pediatric radiologic investigative procedures, they are intimately involved in resident teaching and research. Daily conferences are held with the pediatric clinical subspecialists and house staff. A pediatric radiology elective is offered.

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Transport Service
The Children's Hospital has an established transport team especially designed for the neonatal and pediatric patient up to age 16. This team consists of a transport nurse and a respiratory therapist with medical control provided by the divisions of critical care and neonatology. A fully staffed medical transport service comprised of a helicopter, airplane, and mobile intensive care ground ambulance greatly enhances the Children's Hospital transport capabilities.

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