Children's Assessment Center
San Bernardino, California
Overall Educational Goals of the Child Abuse Pediatrics Fellowship at LLU
The Child Abuse Pediatrics Fellowship provides Pediatricians with the experience necessary to gain expertise in the medical and forensic evaluation of children who are suspected victims of abuse and/or neglect; in the education of medical and non-medical professionals about child maltreatment; in the design, execution, and evaluation of research; in program administration; and in community and regional advocacy. The fellowship is 3 years in length, and is designed in alignment with the ACGME program requirements for Child Abuse Pediatrics Fellowships. Clinical experience includes physical abuse, sexual abuse, all forms of neglect, and pediatric condition falsification, also known as medical child abuse. Fellows perform inpatient consults, outpatient evaluations, and expert case reviews. Fellows learn to work in and lead a multi-disciplinary medical team including pediatricians, nurse practitioners, nurses, medical social workers, mental health care providers, and child life specialists, each dedicated to this area of specialized practice. Fellows provide court testimony, as needed, regarding the cases with which they are involved. Fellows participate in the physician role within the community and in the multidisciplinary investigation of child abuse and neglect. Fellows participate in the education of medical students, residents, fellows, regional healthcare providers in terms of continuing medical education, community multidisciplinary team members, and general members of the community in a variety of venues and formats. Research opportunities include injury prevention, improving accuracy in the diagnosis of abuse, design and implementation of educational materials for medical and non-medical professionals, or any other areas of child abuse pediatrics that are of interest to the fellow. Administrative, public policy, and advocacy skills are developed through involvement in ongoing team projects and affiliated community organizations.
The skill set required to serve as a independent practitioner of Child Abuse Pediatrics is introduced and acquired over a continuum of medical education. The CAP Fellowship will seek to align learning with one of the core tenets of the ACGME graded and progressive responsibility. Under the supervision of forensic examiners and experts, fellows will receive supervision that provides value, context and meaning to their patient interactions. As fellows demonstrate growth, they will be provided with opportunities to exercise their skills with greater independence. Along this path to independence, forensic examiners graduate from direct supervision to independent supervision and oversight with faculty assessment. This structure meets the adult learners needs while guaranteeing safe and effective medical care of children.
As with most fellowship trainings, the CAP Fellowship is building on already acquired skills learned during Pediatric Residency. This includes the skills of professionalism, communication, history taking and examination, etc. The CAP Fellowship also adds a different dimension to this prior learning. The skills of communication and professionalism now apply to interactions among other systems with which Pediatricians have little exposure, such as child protection services, law enforcement and the legal arena. Medical knowledge, procedural skills and patient care has to expand into an area most Pediatricians have little exposure to in training. Complicated familial and psychosocial issues require graded exposure and increasing autonomy to learn to navigate. Three basic overall educational goals for the program emerge by year of training. These include:
Year One Fellow:
Year one fellows focus on more foundational techniques, recognition of the signs and symptoms of abuse, thorough and effective history taking, the identification of injuries, the collection of evidence, and the interpretation and meaning of these findings.
Year Two Fellow:
With the foundation in place, the overall goal of year two is to understand and maneuver within the systems of child abuse investigations. Year two fellows will learn the multifaceted role they serve as fact finder, educator and advocate. Experience now extends to the application of year one goals towards a knowledge of the juvenile and criminal court arena with the goal of patient protection and safety.
Year Three Fellow:
Year three fellows now move into year three with a goal of establishing themselves as an independent expert in child abuse investigations. The nuances of report writing and the role of sound expert testimony play a key part in the transition of a fellow to an expert. This year provides opportunities for autonomy in areas that can be anxiety provoking yet the availability of experienced forensic staff provides guidance and support. Ethics, morality, and administration now evolve as goals for a third year practitioner.
The traits of mature learners show that the progression through these years is different for every learner. Adult learners typically have increased responsibilities, self-direction and a desire to actively guide their own learning. Adult learners seek learning experiences that are useful, practical and result oriented. This increases motivation and satisfaction. The CAP Fellowship has set forth competency based goals and objectives by assignment at each educational level. Given the characteristics of the adult learner, these fairly detailed goals and objectives will serve as a guide however faculty and mentors will engage learners in setting their own overall and assignment based goals and objectives. With self assessment and individual learning plans discussed bi-annually, fellows will develop a structure that they value as their own individual roadmap to independence.