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Child Abuse Pediatrics Fellowship

The educational goals for the Child Abuse Pediatrics Fellowship program at IU School of Medicine are to provide physicians with the background knowledge, clinical and research experience necessary to deliver optimal care to the potentially abused child and to qualify fellows for child abuse pediatrics subspecialty board certification by the American Board of Pediatrics.

Fellows are trained to provide comprehensive medical evaluations for children who are suspected victims of abuse or neglect as well as crisis counseling services for families and professional consultation for health care providers, child protection services, law enforcement officers and other professionals. After completing this training program, Child Abuse Pediatrics fellows are qualified to provide expert testimony in legal settings; professional, parent and prevention education; and leadership in identifying and solving community issues dealing with child abuse.

The program participates in the National Resident Matching Program (NRMP) and complies with the NRMP policies and rules. One fellow is accepted into the program each year.

Program Goals and Objectives

General goals, each with specific objectives, are listed below according to the six ACGME core clinical competencies.

Fellows become clinically proficient in the evaluation, care and treatment of the child and adolescent victim of child abuse and neglect and learn to function as a cooperative partner in a multidisciplinary team.

Fellows must demonstrate broad general pediatric knowledge in addition to a comprehensive understanding of the state of the child abuse literature as it continually evolves.

Each fellow must be proficient in all their communications, written and verbal, for a wide variety of audiences, including families, health care professionals, learners, investigatory professionals and those involved in legal proceedings such as attorneys, judges and jurors. Communication skills by necessity must be accurate, respectful, timely and at an appropriate level of understanding for the audience with which they are communicating.

Fellows must be committed to acting ethically, professionally and objectively in all their professional activities.

Fellows must be able to practice effectively within the larger system serving maltreated children through care coordination, advocacy for patients and their families, efforts in prevention and dissemination of knowledge to the public.

Fellows hone a personal commitment to lifelong learning and quality improvement through self-evaluation, evaluation of the evolving body of literature, peer review and quality improvement strategies.

Curriculum

Due to the high volume of clinical consults and requests for case reviews from outside agencies, Child Abuse Pediatrics fellows typically do not spend more than two or three consecutive weeks at a time on the consult service. Elective and specialty clinic experiences are scheduled during non-consult service weeks. In addition, some specialty clinics occur only once a week or once a month (such as the metabolic bone disease / bone dysplasia clinic). Schedules are devised so that fellows are able to attend these less-frequent clinics multiple times over the course of their training.

Trainee schedules may not conform exactly to the classic month-long rotations. The following is a sample schedule for participants in this program.

Year 1
Child Protection Team Consult Service6 months
Elective1 month
Community Rotation1 month
Research3 months
Vacation1 month
Year 2
Child Protection Team Consult Service5 months
Elective1 month
Community Roation1 month
Research4 months
Vacation1 month
Year 3
Child Protection Team Consult Service4 months
Elective1 month
Community Rotation1 month
Research5 months
Vacation1 month

Elective rotations may include any pediatric specialty, though medical toxicology is recommended for all fellows and involves a rotation with the hospital based toxicology team and time in the Poison Control Center.

Community rotations include experiences in forensic interviews, the county prosecutor’s office, juvenile and criminal courts, domestic violence shelters, and the county child advocacy center, which houses Child Protective Services and the Indianapolis Metropolitan Police Department’s child abuse unit. A forensic pathology rotation based at the local county coroner’s office is recommended for all Child Abuse fellows and includes experience observing autopsies, case conferences and death scene investigations.

Other ongoing activities throughout the duration of the fellowship include:

  • Weekly half-day sexual abuse clinic
  • Home call, once per week with one weekend a month
  • Weekly Child Protection Programs case review meetings
  • Bi-monthly hospital-based multidisciplinary team case review meetings
  • Monthly county child fatality review team meetings
  • Responding to subpoenas and court appearances

Child Abuse Pediatrics Facilities and Partners

Riley Hospital for Children at IU Health (Indianapolis) is the only comprehensive children’s hospital and Level I Pediatric Trauma Center in Indiana. Fellows benefit during their training from the multi-disciplinary services offered at Riley Hospital, particularly the pediatric burn unit, a sexual assault examination room with dedicated photo-videography equipment, a high clinical volume with exposure to a wide variety of conditions (including accidental injuries, inflicted injuries and mimics), and clinical rotations available in a wide variety of specialties and subspecialties.

During the three-year fellowship, multiple opportunities exist for exposure to the medical-legal system. Fellows testify in cases in which they provided medical care, including juvenile hearings and criminal proceedings up to and including criminal trials. In addition, fellows have the opportunity to provide medical-legal consultation along with a faculty member to other attorneys seeking an expert opinion, such as U.S. attorneys, defendants’ attorneys, and county prosecuting attorneys.

Fellows have learning opportunities with diverse child abuse pediatric groups. Faculty routinely participate in teleconferences with child abuse pediatrics programs in other parts of the United States.  These conferences include journal clubs, fellow conferences and multi-center research studies.

Graduate degree opportunities are available. Fellows may combine this core course work with additional courses to allow for the completion of a master’s degree in areas such as clinical research, public health or ethics.

Research

Research months include required core graduate courses that cover clinical research methods, clinical trials and biostatistics. These rotations also allow time for fellows to develop and complete a required scholarly activity/research project.

Many research opportunities exist at IU School of Medicine. The school’s Department of Pediatrics is among the highest in National Institutes of Health research funding. The Department of Pediatrics’ Division of Children’s Health Services Research is one of the largest and most productive of its kind in the United States.

The clinical volume in the Child Protection Programs also offer ample clinical research opportunities. IU School of Medicine Child Protection Programs faculty physicians have co-authored multiple articles published in peer reviewed literature, and fellows and faculty have presented research abstracts at national meetings.