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An innovative internship approach during COVID-19

A year ago, Jenae Vancura joined an elite group of college and high school students for a unique and innovative summer internship program at CHOC Children’s. The interns shadowed physicians, joined doctors on their rounds and attended meetings with a wide range of professionals in the medical field.

The days were long. The work was challenging.

And Jenae, a 21-year-old biology major from UC Santa Barbara, is back again this year, now serving as a lead intern for the Sharon Disney Lund Medical Intelligence and Innovation Institute  (MI3) summer internship program. She now helps guide a new group of students through the rigorous program.

“But this year is a little different,” Jenae says.

Now in its eighth year, the internship has been effectively reimagined as a virtual program, a pivot quickly executed at the onset of the global coronavirus pandemic.

virtual MI3 internship meeting
Jenae participates in a virtual meeting as part of the MI3 internship.

The COVID-19 crisis emerged just as CHOC leaders and physicians were gearing up for this year’s internship program. That meant that the 63 participating students would not be able to work directly with hospital staff or go on rounds to interact with patients as in years past.

Cancelling not an option

While many internship programs have been halted worldwide due to COVID-19, canceling the MI3 internship was simply not an option, organizers say. The experience was much too valuable and too many young had worked too hard to get this far.

“Many of our interns look to our program to affirm and motivate their decision to apply to medical school,” says Debra Beauregard, director of MI3. “Nearly all of the interns aspire to become physicians.”

So, with just weeks to go, the decision was made to recalibrate the program and put the whole curriculum online.

“The easy thing would have been to postpone or cancel,” says Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer who launched the program eight years ago. “We wanted to give the students the same level of opportunity. To their credit, the team stepped up and made the internship rotation on par with previous years.”

Dr. Chang started the internship because he wanted to give young people an in-depth experience of the medical field.

“I felt like no one was really doing something like this,” he says. “The students were staying with one mentor doing one assignment. That sounds like a research assignment, not an internship. I wanted to give them access to something that gave them access to a hundred mentors.”

A rigorous pace remains

Even though the pandemic has restricted access to the hospital, it hasn’t slowed the  interns’ pace. Their work schedule starts early and, with a few breaks between, doesn’t end until the evening.

“We set up a lot of Zoom meetings,” Debra says. “Our interns have a full schedule. They participated in rounds and shadowed our physicians virtually. They were even able to remotely view multiple surgeries. This was a challenge, but everyone pulled together to provide what turned out to be a great summer program.”

a virtual session as part of the MI3 internship program
MI3 interns participate in a Zoom meeting as part of their virtual internship.

Dr. Chang says that while the interns are receiving the same level of instruction, what’s missing are some of the personal interactions that come with face-to-face contact.

“Not having one-on-one time in person and not having more intimate moments in small groups is difficult for us,” he says. “For instance, in past years they’ve had one-day retreats where they come to my house for breakfast and lunch. I wasn’t able to do that this year.”

But that doesn’t mean there isn’t room for a little fun.

“Our directors and lead interns made sure that all interns felt connected,” Debra says. “We included team-building exercises, interactive small group sessions, and even a virtual graduation ceremony. The leads even organized a virtual talent show and Zoomie Awards, in addition to a competitive team competition. Our leads have gone above and beyond to ensure that our interns had a meaningful and memorable experience.“

Dr. Sharief Taraman, internship co-director and pediatric neurologist at CHOC, has been part of the program almost since it started. He’s confident that this year’s group is better off than students anywhere else.

“They’re way ahead of their peers in terms of experience and what they can get out of the summer,” he says. “We have a lot of moving parts, so we had to pivot very quickly.”

And to ensure the interns get all the experience they can, they are being invited back next year when they are hopefully able to receive hands-on work.

“We have offered guaranteed spots for our interns next year, so they can have an in-person experience,” Debra says. “We are confident that most will be coming back.”

Student gratitude abounds

The interns themselves are grateful for the chance to continue their internships during these difficult times.

“When I thought it wouldn’t happen, I got very upset,” says 20-year-old Julia Keating from the Massachusetts College of Pharmacy and Health Sciences University. “It’s such a competitive internship.”

For Jessica Octavio, a 20-year old San Diego State student majoring in microbiology, going online was positive experience.

‘’We’re lucky,” she says. “They’ve been more than flexible. The biggest thing was learning this online interface, but as far as programming goes, it’s almost advantageous for us.”

While working on site would have been ideal, Luke Arnold says he appreciates all the work the health system staff have put into making this year’s program a success.

“It’s not ideal and obviously we’d like to have this in person,” says the 21-year-old biology major from Chapman University. “But being in quarantine has given us opportunities to work in group settings. We’re all in this together.”

For intern Nicole Fraga, working from home has had some surprising benefits.

“It can be a very rigorous process,” says the 22-year-old recent graduate from Brown University. “But ironically, I think they’re getting closer to the interns online because we are meeting in small groups. We are able to communicate on Slack and share memes. We have a smaller community.”

Dr. Chang calls the internship a “circular experience.” The health system staff, he says, learn as much from the students as the students do from the physicians.

“We’re grateful that the interns are even more inspired to go into medicine despite the pandemic,” he says. “It’s very heartwarming to hear. The future of medicine is in good hands. I see the interns push back against the temptation to give up. They have the idealism and no fear of failure.”

Learn more about CHOC's MI3 internship

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Augustina’s heroic battle with COVID-19

When Augustina, then age 13, visited her doctor in early June because she wasn’t feeling well, she had no idea she’d be rushed to CHOC Children’s Hospital and spend the next two months fighting for her life.

“My doctor told my dad that we needed to get to CHOC right away,” Augustina says. “I don’t remember much right after that.”

Originally admitted to CHOC with respiratory distress, Augustina was soon diagnosed with COVID-19. She was initially on high flow nasal canula for supplemental oxygen. Eventually that was escalated to a BiPAP machine — bi-level positive airway pressure — a machine that pushes much-needed oxygen into a patient’s airway. Her condition continued to worsen, and she was put on a ventilator to increase her oxygen levels. She was medically sedated for most of her stay in order to tolerate the ventilator.

“She was in critical condition for a long time,” says Dr. Jason Knight, medical director of the Josie Y.S. Lee Pediatric Intensive Care Unit (PICU) at CHOC Children’s Hospital. “There were two different nights during her hospitalization when we thought we might lose her.”

Dr. Jason Knight
Dr. Jason Knight, medical director of the Josie Y.S. Lee Pediatric Intensive Care Unit (PICU) at CHOC Children’s Hospital

During this extended hospitalization, Augustina’s father Jose visited her every day. Although his daughter was sedated, he spoke messages of support and encouragement to her.

“‘Mama, just relax. Everything is going to be OK’ is what I would tell her,” Jose says. “Even though she was asleep, I knew she could hear me.”

Indeed, when Augustina finally woke up from sedation, she thanked her dad – and her nurses, who had shared similar messages in her ear – for that encouragement.

“I couldn’t  talk, but I could still hear them,” Augustina says.

At one point, her condition improved thanks to proning and nitric oxide.

Eventually, Augustina underwent a tracheostomy, where a surgeon created an opening in her neck to place a tube into her trachea, allowing oxygen to enter the lungs. Once her tracheotomy was in place, she was more awake and the team was able to wean her ventilator support.

Once she was off her ventilator, the next step was rehabilitation, in partnership with CHOC’s physical therapists. The first milestone was sitting up in bed, then standing next to her bed, then walking around a little bit at a time. That process took several weeks.

Working through physical challenges and coming to terms with all she had been through was an emotional experience for Augustina.

Dr. Knight recalls one particularly anxious day for Augustina. Doctors wanted to perform a small procedure and because she was now coherent, she felt anxious – even though the procedure was relatively small.

Dr. Knight shares how that anxiety lead to a pep talk and bonding moment for the physician and his patient.

Dr. Knight: Why are you so sad?

Augustina: I’m sick and I have a trach and I’m not going to get better.

 Dr. Knight: Are you kidding me?

 Augustina: What do you mean?

 Dr. Knight: Augustina, you beat COVID! You were near death twice. One of those nights, I was on call and I thought we were going to lose you. COVID has killed hundreds of thousands of people and you were going to be one of them and you said no. It’s OK to be upset that you have a trach, but you also have to know that there’s a lot of people who weren’t always sure you were going to make it.

 From then on, Augustina’s entire outlook changed for good.

Augustina leaving the pediatric intensive care unit
Augustina leaving CHOC’s PICU.

Send-off celebration

After 57 days in CHOC’s PICU, Augustina was ready to be discharged to a local rehabilitation facility as a step toward going home. Wanting to make sure Augustina felt celebrated in her journey and give her the hero’s send-off she deserved, child life specialists from the Cherese Mari Laulhere child life department sprang into action. They created signs, organized gifts and planned a cheer tunnel filled with her favorite staff members holding streamers. The celebration brought tears to Augustina’s eyes.

Finally home

After spending a few weeks – and celebrating her 14th birthday – at the rehabilitation facility, Augustina finally went home.

These days, Augustina is back in school – albeit virtually for now – and happy to be surrounded by family, whom she missed during her hospitalization.

Augustina leaving CHOC's PICU
Augustina leaving CHOC’s PICU, pictured with her physical therapists and child life specialists.

The impact she made on CHOC’s PICU team remains strong.

“It’s important for people in the PICU to have victories like Augustina,” Dr. Knight says. “We don’t get victories all the time. There can be sadness and disappointment in the PICU. Everybody in the PICU knew Augustina and took care of her. Everyone knew how serious her case was. Our PICU team put a lot of time and effort and love into Augustina. It’s safe to say the entire PICU team is celebrating her success.”

Get more information on Coronavirus (COVID-19)

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What to expect from your child’s COVID-19 test at CHOC’s Outpatient Evaluation Center

CHOC Children’s outpatient evaluation center offers COVID-19 testing for children who have been exposed to COVID-19 or are experiencing symptoms associated with COVID-19, as well as children who require a test before an upcoming procedure.

We understand that having a child undergo a COVID-19 test can be stressful for parents, so we’ve prepared this guide on what to expect.

What to know before your appointment:

  • You will be notified in advance by phone of your appointment time at the outpatient evaluation center. Children with possible exposure or those experiencing symptoms will first have a telehealth visit.
  • The outpatient evaluation center is an outdoor area with large tents.
  • Wait in your car until a CHOC employee comes to check you in. Please ensure all vehicle passengers wear a mask.
  • Your child should stay seated in the car and wearing a seatbelt.
  • A nurse or respiratory therapist will ask you a few questions and take your child’s temperature before beginning the test.
  • They will wear yellow or white gowns, gloves, masks and face shields.

What to expect from your child’s COVID-19 test:

The COVID-19 test is done using a nasal swab. This might sound scary, but if your child can relax, the test takes just 5 seconds.

There are some things you can do to make the process easier:

  • Bring a small comfort item for your child to hold.
  • You can try sitting next to your child and holding their wrists, if necessary.
  • Parents may sit younger children in their laps and wrap their arms around them.
  • The provider can also help hold your child steady, if necessary.
  • After counting to 5, the provider will insert the swab into the back of the child’s nose, twist it and then pull it out. Inserting the swab this far into the nose is necessary to ensure the provider gets a proper specimen.
  • The test feels funny. It may feel similar to when water gets in your nose at the pool or beach. Your child might sneeze, and their eyes may water.

Waiting for your child’s COVID-19 test results:

Awaiting testing results can be worrying, and we want to clarify the process and what parents can expect.

If your child underwent a COVID-19 test before a scheduled procedure — and the test is positive, you will receive a telephone call by the end of the day or, in some cases, early the next morning. Any scheduled procedure will be canceled. If the test is negative, you will not be contacted.

If their test was negative, you should come for the procedure as scheduled. After the test, your son or daughter should stay at home until their procedure the next day to prevent COVID-19 exposure. Parents will not be tested for COVID-19. Instead, they must pass a health screening at the hospital upon arrival for their child’s procedure the next day. They must also wear a mask.

If your child underwent a COVID-19 test due to COVID-10 exposure or symptoms — you will receive a phone call with your child’s test results, which may take up to 14 days.

Even if the test is negative, the child should isolate at home for 14 days after contact with someone who has COVID-19. If the child has shown COVID-19 symptoms, they should isolate at home for 10 days after symptoms began and for at least 24 hours after a fever has resolved.

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CHOC patients meet with legislators for advocacy week

CHOC Children’s patients Zachary and Jennifer, along with their families, recently participated in virtual meetings with legislators as part of ongoing advocacy efforts.

“Each family met virtually with their members of U.S. Congress to discuss the importance of prioritizing children’s healthcare,” says Rachel Rolnicki, CHOC’s director of government affairs. “Especially now, both families felt it was critical to raise awareness about the ongoing and essential care provided by children’s hospitals, such as CHOC.”

More than 50 patient families from children’s hospitals across the country participated in Children’s Hospital Association’s Speak Now for Kids Advocacy Week. The annual effort is intended to raise further awareness about important issues that affect children’s healthcare.

Zachary and Jennifer shared their personal stories of receiving care at a children’s hospital, in order to help educate lawmakers about the essential role of children’s hospitals and the Medicaid program during an uncertain and challenging economic time brought about by the COVID-19 pandemic.

One in three children in the U.S. receive health coverage and benefits under Medicaid. Many patients and their families depend on timely access to doctors trained to care especially for them and their unique needs. The Children’s Hospital Graduate Medical Education (CHGME) program is a vital source of funds that help train future physicians. Children’s hospitals in the CHGME program receive half the funding that adult hospitals receive for similar training programs. One element of these virtual meetings was a request that Congress increase funding for CHGME.

“Supporting children’s hospitals is a short- and long-term investment in children’s health we’re asking Congress to make,” Rachel says. “Particularly now, in this public health emergency, millions of families — like Jennifer’s and Zachary’s — are counting on children’s hospitals to provide medical care and behavioral health services to help their children reach their full health potential. Together, we can ensure our nation’s children lead the most healthy and productive lives possible.”

Learn more about Zachary:

Zachary was diagnosed with spina bifida in utero at 16 weeks. At just 7 years old, Zachary has had over 20 surgeries at multiple hospitals and has seen providers from more than a dozen specialties including urology, neurology, neurosurgery, pulmonology, ophthalmology, orthopedics, gastroenterology, pediatric surgery, radiology and plastic surgery.

Zachary and his family
Zachary and his family

He continues to see neurosurgeons and urologists at CHOC Children’s Hospital for his healthcare needs. In 2019, Zachary needed a full VP shunt replacement. A ventriculoperitoneal (VP) shunt is a device that relieves pressure on the brain caused by fluid buildup. Using leading-edge technology and equipment, CHOC clinicians were able to alleviate the pressure on Zachary’s brain by replacing his shunt with a new programmable one. They also replaced an older value with a newer one that will help prevent shunt failure in the future.

Zachary and his family participate in a virtual meeting with legislators
Zachary and his family participate in a virtual meeting with legislators from CHOC’s Seacrest Studios

Currently, Zachary is doing well and thriving academically and socially. He likes to hang out with his family, his twin sister, Lily, and his service dog, Tiki. He enjoys playing video games with his friends and loves adaptive sled hockey and basketball. Zachary wants to be a radiologist one day and has an interest in the human body and bones.

Learn more about Jennifer:

When Jennifer was 10 years old, her life was fairly typical. She liked school, hanging out with her friends and cheerleading. One day she noticed the fingers on her left hand were becoming misshapen. The family doctor did not seem concerned and told her to simply exercise them.

After a few months, Jennifer was experiencing weakness in her foot and right hand. She was referred to the CHOC Children’s Neuroscience Institute where she underwent testing to determine what was happening.

Jennifer began to have seizures and started taking anti-seizure medication. She also started seeing clinicians for physical and occupational therapy, as well as psychology. Doctors diagnosed her with Rasmussen syndrome — a rare, progressive, chronic encephalitis or swelling of the brain. Jennifer had brain surgery in December 2016.

“The hospital staff at CHOC took excellent care of my daughter,” says Jennifer’s mom, Josepha. “They have always motivated her and made her feel special. “They even organized a special 15th birthday celebration, a quinceañera, in the hospital days before her brain surgery. As parents, we are deeply grateful for all the support they have always given our family.”

Jennifer and her family at her quinceañera at CHOC
Jennifer and her family at her quinceañera at CHOC

Jennifer continues to recover from surgery and is improving. She likes arts and crafts, painting, coloring, going shopping and playing with her dog.

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Respuestas a las preguntas más frecuentes sobre la telemedicina

En esta época de grandes desafíos, aquí en CHOC Children’s nuestra meta es brindar tranquilidad a los padres de familia cuando se trata del cuidado de la salud y del bienestar de sus hijos. La atención médica a los niños, ya sean exámenes físicos, vacunas o acceso a especialistas, es fundamental. Por esa razón, nuestras clínicas permanecen abiertas empleando medidas preventivas adicionales y ofreciendo citas con el uso de telemedicina, cuando resulte adecuado, para que tenga disponibilidad de nuestros expertos desde su hogar.

Comprendemos que la telemedicina es algo nuevo para muchos padres y sus familias, así que hemos preparado una guía que contiene las preguntas más frecuentes sobre esta tecnología para responder a cualquier duda que tengan y ayudarlos a prepararse para la primera cita de su hijo/a por videollamada.

¿Qué es la telemedicina?

Las citas mediante el uso de la telemedicina son consultas por video con un profesional de la salud de CHOC a través del empleo de un teléfono inteligente, tableta o computadora. Usted y su hijo/a pueden participar en ellas desde su propia casa o de cualquier otro lugar que cuente con acceso a internet y donde usted se sienta cómodo. Durante su cita, podrá ver y escuchar a su médico o especialista de siempre. También podrá interactuar con él o ella, hacerle preguntas y responder a las que le hagan.

¿Todas las citas pueden llevarse a cabo mediante la telemedicina?

Su doctor/a de cabecera o su especialista pueden proporcionar atención médica sin problemas y adecuadamente para muchos tipos de afecciones a través del uso de tecnologías como la telemedicina. Algunos tipos de consultas necesariamente deben ser en persona. Su profesional del cuidado de la salud determinará si una cita por videollamada es lo ideal para usted.

¿Es segura y confiable la tecnología que usa CHOC para la práctica de la telemedicina?

CHOC utiliza una versión especial de Zoom, un programa especial para videoconferencias, que cuenta con niveles de seguridad adicionales para garantizar la protección de nuestros pacientes y de la información sobre su salud. Nuestra plataforma de telemedicina siempre ha sido y continuará siendo segura.

¿Qué sucede una vez que mi cita por telemedicina ha sido programada?

Una vez que se apruebe su cita virtual, recibirá un mensaje por correo electrónico con instrucciones, sugerencias para resolver las dificultades que surjan y un enlace de acceso para su videollamada. Siga las indicaciones. Primero verá una “sala de espera” virtual en donde se le pedirá que espere a que el médico de su hijo/a le dé ingreso a la consulta. No se salga de esta pantalla. Cuando sea admitido, verá y escuchará a su prestador de atención a la salud y le podrán ver y escuchar a usted.  Asegúrese de que su hijo/a esté presente para que sea evaluado adecuadamente.

Vea este video en preparación para su primera cita virtual y obtenga sugerencias para que sea exitosa.

¿Quién debe estar presente?

Por favor, asegúrese de que él/la paciente esté presente para todas sus citas por telemedicina para que su profesional de servicios médicos lo/la evalúe debidamente.

¿Con quién será la cita de mi hijo/a por videollamada?

Su cita será con su médico de cabecera o su especialista.

¿De qué hablaremos durante la consulta por telemedicina?

Usted y su hijo/a pueden hablar con su profesional de la salud de todo lo que hablan durante sus citas en persona: síntomas, el plan de cuidado médico y cualquier pregunta o inquietud que tengan. Si es necesario, su doctor/a les informará sobre los resultados de sus análisis de laboratorio o de radiografías que se le hayan realizado, tal como lo hace cuando la consulta es en persona. Quizás también le pida, por ejemplo, que le tome la temperatura a su hijo/a o que le muestre el sarpullido que le brotó.

¿Cuál es el costo de una cita a través de la telemedicina?

Las consultas por videollamada se facturan de la misma manera que las cita en persona.  Se le cobrará lo mismo que usted paga por una visita médica convencional. Contará con la participación de su doctor de cabecera o de su especialista y obtendrá la misma atención de alta calidad que recibe en cualquier otra cita en CHOC.

Mi cita, ¿debe ser por videollamada?

Aunque la telemedicina puede parecer extraña o incómoda, su doctor quizás la prefiera porque podrá atenderlo/a más pronto que lo que podría hacerlo en persona. Si usted desea una cita en persona, pídala cuando llame a la oficina de su pediatra o al Centro de Acceso al Paciente (PAC); su prestador de servicios para la atención a la salud determinará si es conveniente esperar a que haya una disponible.

Llame a su médico de cabecera para hacer su cita o al 1-888-770-2462 para consultas con su especialista.

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