Collaborating for the Children

Research, teaching, and patient care converge in GW’s longstanding relationship with Children’s National Medical Center.

By Kathleen Kocks

This year, Children’s National Medical Center in Washington, D.C., is increasing its research laboratory space by 25 percent, creating a 100,000-square-foot facility that will host hundreds of projects to benefit children’s health. When the expanded lab opens, The George Washington University will have yet another reason to appreciate its 35-year collaboration with Children’s.

One of America’s top pediatric hospitals, Children’s is an independent hospital that was established in 1870. The 283-bed facility is the country’s third oldest freestanding pediatric hospital and cares annually for more than 360,000 patients. Children’s also conducts clinical, translational, and community health research through its Children’s Research Institute.

Children’s collaboration with GW derives from its relationship with The George Washington University Medical Center. The Medical Center comprises the School of Medicine and Health Sciences (founded in 1825 and the 11th oldest medical school in the nation), the School of Public Health and Health Services, the 371-bed George Washington University Hospital, the GW Medical Faculty Associates clinical group practice, and several specialized medical institutes.

Since 1973 Children’s has served as the Department of Pediatrics for GW’s School of Medicine and Health Sciences. This relationship produces numerous benefits to medical students and opportunities for medical research, says Dr. Mark Batshaw, who is the chief liaison between Children’s and GW.

Dr. Batshaw is Children’s chief academic officer and director of CRI. He also is professor and chair of GW medical school’s Department of Pediatrics and associate dean for academic affairs.

Explaining Children’s role in educating the University's medical students, Dr. Batshaw says, “While GW Medical Center has its own hospital, the only pediatric services offered are within a clinical neonatology group. Through our affiliation with GW, all pediatric training of GW medical students occurs at Children’s. Having a top-10 pediatrics hospital as your medical school’s pediatrics department obviously is a great asset to the school and its students.”

The doctors at Children’s are full-time employees of the hospital who also hold academic positions in pediatrics and surgery within GW’s medical school and teach all of its pediatrics courses, Dr. Batshaw says. “GW’s medical school has around 853 full-time faculty members and about 350 of them are sited at Children’s,” he says. “Some of them have medical specialties other than pediatrics.”

Student training includes pediatric rotations or clerkships for third- and fourth-year medical students, Dr. Batshaw adds. The rotations can last from one to three months full time. Students choosing to specialize in pediatrics then take a sequence of electives at Children’s to complete their undergraduate medical education, he explains.

Clerkships at Children’s are not limited to medical students who want to become pediatricians. As part of their core education, all GW medical students must complete a pediatrics clerkship, as well as clerkships in other disciplines, to obtain a well-rounded medical education.

“Additionally, about one third of all GW medical students do an elective during their senior year at Children’s,” Dr. Batshaw says. “We also have a number of GW medical school graduates enrolled in our three-year pediatric residency program.”

The GW/Children’s relationship also benefits students enrolled in other GW medical programs—such as the physician assistant nursing programs. And the relationship facilitates collaborative research between Children’s and the University.

Multimillion Dollar Research

(Left) Dr. Mark Batshaw, the chief liaison between Children’s and GW, is chief academic officer and director of GW’s Children’s Research Institute. Dr. Batshaw also is a professor and chair of GW’s Department of Pediatrics as well as associate dean for academic affairs. (Right) Dr. Mary Ottolini, professor of pediatrics, is one of two pediatrics liaisons within GW’s Department of Pediatrics and is in charge of third- and fourth-year medical students. She also is director of medical student education and chief of the Hospitalist Division at Children’s. Thom Kohout /GWMCCM

Research at Children’s is housed within CRI. The institute also undertakes all educational and academic activities for the hospital and for GW’s Department of Pediatrics.

Research at Children’s began in 1947 with $2,500. According to the 2007 CRI annual report, CRI's current grant/contract portfolio totals $75 million, with nearly 64 percent coming from federal agencies, particularly NIH. Children’s ranks ninth in NIH funding for pediatric departments and sixth in NIH funding for children’s hospitals in the nation.

CRI has more than 300 scientists, trainees, and staff members, plus a 100,000-square-foot laboratory and associated state-of-the-art equipment. Research projects are organized into four centers, covering cancer and immunology; clinical and community; genetic medicine; and neuroscience. With the new lab space, Children’s is expanding all of its centers.

Dr. Batshaw says two key strengths of CRI’s research are its multidisciplinary approach and the capability to transition lifesaving developments in the lab to the clinical setting. Some of the research underway at CRI was displayed during Children’s Eighth Annual Research Day in May, showcasing nearly 200 projects by graduate students/trainees, postdoctoral fellows, and hospital faculty and staff members.

“The collaboration between GW and Children’s definitely benefits medical research,” Dr. Batshaw says. “Children’s has very strong programs that complement those at GW and really expand our opportunities. For example, Children’s has strong research on child disorders, while GW’s medical school has strong research on adult disorders. Our collaboration here enables GW to take a lifespan approach.

“On another level, GW has strength in basic and translational lab research, while we bring in strength in translational and clinical research. Working together gives both institutions the full spectrum from discovering a disorder’s most basic factors to developing cures, to delivering them to patients and to the community,” Dr. Batshaw explains.

Dr. Batshaw believes opportunities exist to further cooperate with GW Hospital. He points to chronic diseases of children that used to be fatal but now are survivable into adulthood. This opens the door to use Children’s pediatric experience to develop joint programs using GW Hospital’s adult experience.

Much of the GW/Children’s collaborative research involves the science of medicine—such as one project between Children’s and GW Medical Center’s Department of Microbiology Immunology & Tropical Medicine. The project focuses on the activation and regulation of T-cells. Another joint project, funded by the Keck Foundation, studies the structure and function of the neuromuscular junction.

Other shared projects tackle problems surrounding health care issues and community education. One example is the D.C. Initiative, which involves an NIH grant to improve the outcomes of children born to poverty. This research includes the Neonatology Group at GW Hospital, GW’s School of Public Health and Health Services, and Children’s.

“We’ve worked for several years on this project, and it would be the best example of how our collaborative work has produced results in this area. This program led to a decrease in adolescent pregnancy and helped improve the outcome of premature infants,” Dr. Batshaw adds.

GW’s medical school and Children’s also are collaborating in pursuing NIH Clinical and Translational Science Awards. This initiative seeks to transform how clinical and translational research is conducted at academic health centers, with one goal to deliver new treatments more efficiently to patients.

The NIH program ultimately will involve a national consortium of 60 academic health centers that will train the next generation of clinical and translational researchers. The centers will be linked to share resources throughout the consortium.

The benefits of the GW/Children’s affiliation also include nuts-and-bolts advantages through mutual sharing of highly specialized equipment. Dr. Batshaw mentions GW’s confocal laser-scanning microscope core and Children’s Matrix Assisted Laser Desorption/Ionization-Time Of Flight mass spectrometer as two examples.

Multiple Disciplines Involved

Children’s research with GW spans multiple disciplines, Dr. Batshaw says. “We have a number of joint grants with other GW groups that allow us to complement or expand the work we are doing. For example, we are working on health care issues with the Department of Health Policy within GW’s School of Public Health and Health Services, which is nationally renowned in the area of healthcare policy.”

Children’s also teamed with GW’s Graduate School of Education and Human Development to develop the Master Teacher Program, a certificate program that improves the teaching skills of medical faculty members. The effort addresses traditional and new medical concepts, such as managed care and evidence-based medicine. Children’s then worked with GW’s School of Medicine and Health Sciences to jointly offer the program, Dr. Batshaw adds.

Looking at future opportunities, Dr. Batshaw foresees joint projects between Children’s and several GW departments, such as biology and computer science, working on bioinformatics, which uses computational and mathematical tools to discover properties of DNA, RNA, proteins, etc. This research would complement and expand Children’s work in geonomics and proteomics.

“Another upcoming area for joint research is systems biology, a new discipline that researches how individual cells work together to function,” Dr. Batshaw says. “We have strength in this discipline and are considering bringing our experience to GW.”

Dr. Batshaw adds that Children’s faculty members also work with GW students on various projects. One example involves graduate students at GW’s Institute for Biomedical Sciences, which consists of three partners: Children’s, GW Medical Center, and GW’s Columbian College of Arts and Sciences. Some of the institute’s graduate students come to Children’s for rotations or thesis work. Another opportunity is provided through GW’s Gill Scholarship Program, which awards medical students a summer stipend for conducting medical research with faculty members.

With the science of medicine increasingly turning to new tools from other disciplines, the 35-year affiliation between GW and Children’s has proved beneficial and appears poised to expand further.

More Than Medicine

Thanks to people like Dr. Mary Ottolini, the affiliation between Children’s National Medical Center and GW’s School of Medicine and Health Sciences is producing a more humanistic breed of doctors.

Dr. Ottolini is a professor of pediatrics and one of two pediatrics liaisons within GW’s Department of Pediatrics in charge of third- and fourth-year medical students. She helps prepare their curriculum, plans individual clerkships, teaches them, and seeks areas for collaboration on projects. Dr. Ottolini also is director of medical student education and chief of the Hospitalist Division at Children’s. As such, she observes every day the interaction among patients, parents, medical students, residents, and doctors.

All this, plus a master’s degree in public health, gives Dr. Ottolini insight into the challenges of patient-doctor relationships that involve children. One challenge is communication; another is the need for a higher level of empathy as doctors treat their vulnerable, young patients. Dr. Ottolini strives to resolve these challenges and pass lessons learned to her GW medical students.

One of her approaches involves the use of standardized patient exercises to train students to perform physical exams on infants or small children. These exercises require students to assess the patient’s condition then explain their findings to the parents. Students are observed and critiqued by faculty members.

Such exercises ideally involved volunteer patients and parents, but it is difficult to use real infants or young children. Through a project with faculty members at GW Hospital, Dr. Ottolini helped develop multimedia computer simulations of pediatric patient scenarios for standardized exercises. This introduced control over the scenario and better facilitated teaching.

“We also used the GW Simulation Center to train Hospitalist faculty members to lead ‘family centered’ bedside rounds—to ensure faculty members are effectively leading the team of students and residents to teach correct physical exam assessment, clinical reasoning, and communication with patients and families. Medical students helped me create the simulated bedside scenarios,” Dr. Ottolini says.

“Students also played the role of standardized students and residents in the scenarios along with standardized patients and family members providing feedback to faculty members on their performance. Turning the tables on faculty members during the exercise produced worthwhile feedback comments from the students.”

Additional communication lessons include teaching students how to present the clinically relevant information in an organized way that patients and families can understand by having them participate in Children’s family-centered rounds. During these rounds, family members are included when the medical team discusses a patient’s condition, learning firsthand of any developments and being able to ask questions. Students attending these rounds thus learn how to better communicate with parents.

Dr. Ottolini also works with assistant pediatrics professor Dr. Terry Kind and Dr. Linda Raphael, adjunct professor of English, using a grant from the Arnold P. Gold Foundation to promote humanism in medicine.

According to the Gold Foundation, humanism in medicine uses innovative medical education to promote caring doctors who embrace humanistic attributes. These include integrity, excellence, compassion, altruism, respect, empathy, and service.

“We are working with students in different clerkships to help them understand what emotional interactions they bring to the doctor-patient relationship. Often students are so busy acquiring medical knowledge and skills that they lose sight of this. We are trying to increase their awareness and help them find ways to better connect with their patients,” Dr. Ottolini explains.

“One part of the program uses reflective essays. Students read a short story by pediatrician and poet William Carlos Williams, and Dr. Raphael helps them to relate the author’s story to a real-life experience they’ve had. In another segment of the program interns share their stories about being able to connect or not connect with pediatric patients and families, modeling reflective practice.

“We then ask students to reflect on their experiences and verbalize why they feel a strong connection or aversion to the patient or parents. In the future, when the students might find themselves discounting what the patient is telling them or distancing themselves from the patient, they can reflect on lessons from this program and resolve obstacles.”

In October 2007, Dr. Ottolini and Dr. Kind collaborated with Dr. Julia Frank, the psychiatry clerkship director, to conduct a workshop at GW to teach other faculty how to incorporate similar experiences within their clinical courses.

A Physician Assistant’s Experience

For Kerri Thorn, the collaboration between GW Medical Center and Children’s National Medical Center landed her the job of her dreams. She is a physician assistant in the neurosurgical department at Children’s, employing skills learned at GW’s physician assistant master’s program.

“I earned my bachelor’s degree then decided to become a PA because I felt it would be a fulfilling career,” Thorn says. “I chose the GW program because it ranked as one of the highest and was the only program offering dual master’s degrees in both health sciences and public health. I received an excellent education. We were integrated with GW med students, and the professors were hands on in their teaching.”

Thorn’s education involved 42 weeks of academic courses, followed by a clinical phase requiring nine hospital rotations and a seven-week final preceptorship. She also conducted a community-based project to complete her Master of Public Health degree. The project involved helping low-income pregnant women and young mothers use community and health resources available to them.

“I did an elective rotation at Walter Reed Army Medical Center in pediatrics that led me to pursue a career in pediatrics,” Thorn says. “With guidance from Dr. Howard Straker, I did my final preceptorship at Children’s in the pediatric intensive care unit. I saw how much the hospital offered to children and their families. The faculty was very receptive to teaching and I learned a lot of pediatric medicine. I found it to be a very rewarding experience.”

During her preceptorship, Thorn met Dr. Robert Keating, Children’s chief of neurosurgery, while taking care of his post-operative neurosurgical patients in the PICU . He offered her an internship after her graduation in 2004, and this led to her current job.

Thorn works 10-hour days, five days a week, with an additional 24-hour call once a week and a 72-hour call one weekend a month. She works with three neurosurgeons in the department, overseeing patient care. On a daily basis, Thorn evaluates and makes clinical decisions for patients with neurosurgical issues in the emergency room, inpatient floor, intensive care unit, and outpatient clinic. Other tasks include first assisting in the operating room and with emergent/nonemergent procedures, radiographic and laboratory interpretation, and inpatient rounds.

She also gives an annual lecture on common neurosurgical issues to pediatric residents and helps others working toward medical careers. In addition, Thorn helped another GW PA student do her preceptorship in the PICU and was instrumental in the recent hiring of a GW PA to join the neurosurgical staff.

This past year, the Children’s Board of Visitors awarded Thorn a grant to implement an educational-based project on chiari 1 malformations, which involve structural defects of the cerebellum, the part of the brain that controls balance. This project involved creating a database of all patients treated and seen at Children’s with this diagnosis. The information generated from the database is being used to develop an educational brochure to distributew to local pediatricians. She also is using the information from the database for a research project she will be presenting at an upcoming annual neurosurgical conference.

“I love working with children and really enjoy the families. That’s why I’m here,” Thorn says.

Areas of Research at Children’s National Medical Center Adherence in Juvenile Diabetes Asthma & Lung Disease Autism Brain & Spinal Cord Trauma Brain Tumors Cancers of Childhood Cigarette Smoking Crib Death (SIDS) Depression in Childhood Diabetes Down Syndrome Epilepsy Health Care Quality and Assessment HIV/AIDS Inborn Errors of Metabolism Leukodystrophy Macular Degeneration Medical Errors Muscular Dystrophy Neuro-oncology/Neurofibromatosis Obesity & Metabolic Syndrome Provider Patient Communication Sickle Cell Diseases Transgender Issues Violence Exposure Among Young Mothers White Matter Disease

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© 2008 The George Washington University
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