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.

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.

A look at the virtual model of the Medical Innovation and Intelligence Institute summer internship program.

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 small group session during the 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.”

Interns will be invited back for the 2021 session in hopes of a hands-on experience.

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 the Medical Innovation and Intelligence Institute summer internship program.

MI 1&2 meeting and journal club

CHOC Children’s MI 1&2 Meeting and Journal Club goes virtual this month to discuss the latest advances in artificial intelligence and innovation.

This two-part lecture will be held Sept. 14 from 4 to 5:30 p.m. and will focus on innovative solutions to problems in pediatric healthcare. This month’s session will feature presentations from several industry partners, including:

  • Casey Clay, director of the escalating behavior program, Thompson Autism Center at CHOC Children’s
  • Adam Blum, VPO/CEO and co-founder of Auger AI
  • Paul Auffermann, chief customer officer of Closed Loop AI
  • Zack Muqtadir, founder of ZL Technovation

The MI1 portion of the meeting will take place from 4 to 4:45 p.m. and discuss medical intelligence, including monitoring model accuracy in medical machine learning and artificial intelligence for healthcare.

The MI2 portion discusses medical innovation and will begin at 4:45 p.m. It will include presentations on the impact of artificial intelligence on healthcare and the future, as well as immersive virtual reality training for caregivers of children with Autism Spectrum Disorder.

You can register to join the MI 1&2 meeting here. Journal Club will take place beforehand, from 3-3:45 p.m., and is accessible by Zoom Meeting ID 811 5578 7821.


Virtual Mini-Hack to address problems amplified by COVID-19

Pediatric nurses, caregivers, data scientists and more are invited to join an upcoming virtual “Mini Hack” to solve problems magnified by the COVID-19 crisis.

Co-hosted by CHOC Children’s and UC Irvine, the Aug. 3 CHOC-ZOT!-ZOOM COVID-19 Mini-Hack Virtual Event gathers these groups, along with business leaders, computer science and nursing students, entrepreneurs and industry leaders to solve real-world conundrums.

The day of collaboration is designed to help solve problems falling into many categories including school reintegration; work reintegration/remote work; pediatric mental health; telenursing/telemedicine/remote care; ensuring families feel safe to seek care; and ensuring healthcare workers feel safe to provide care.

Participants will work in teams to devise answers, develop prototypes and pitch solutions to their problem. In doing so, they will learn how to solve real-life problems through design-thinking concepts, while interacting with innovation leaders and mentors to get hands-on experience with pitching ideas.

Further, the event provides potential opportunities for commercialization, including the potential sharing of net profits.

Register here.

Journey to a rare diagnosis: Colten’s story

Christine Schweer knew early on that her son, Colten, faced some health complications.

Christine, a pediatric intensive care nurse living in the Midwest with her husband, Todd, and then 3-year-old daughter, Chloe, recalls feeling different during her pregnancy with Colten. Once Colten was born, little things started popping up, she says.

Over the next few months, Colten developed several symptoms: cold hands and feet, a sleepy demeanor, strange breathing and chronic, involuntary eye movements – a condition called nystagmus.

At this point, Colten had already gone through several emergency department visits, including an admission to the hospital for respiratory syncytial virus (RSV) and eventually unexplained heart failure. But after genetic testing and screening for cystic fibrosis, cancer and blood clots all came back negative, Colten and his parents and doctors were left confused.

Searching for an answer

Colten was 6 months old when two new symptoms arose. An occupational therapist thought Colten’s vision and hearing were waning, and an ophthalmologist confirmed the therapist’s suspicion.

Then, around 9 months old, Colten’s weight mysteriously began to skyrocket.

Meanwhile, the Schweers decided to relocate to California to be near family. Christine, who now works in the PICU at CHOC Children’s at Mission Hospital, transferred all of Colten’s records to CHOC. She began to schedule visits to a team of CHOC providers, including pediatrician Dr. Lauren Dwinell and pediatric cardiologist Dr. Anthony Chang.

Armed with her signature beach bag full of Colten’s records, Christine continued the search for a diagnosis with Colten’s new care team, led by Dr. Chang.

“We hit it off right away,” Christine says of Dr. Chang. “He admired me for my dedication and advocacy for Colten, and I respected him for his thoroughness, for trusting my parental instincts and for his commitment to innovative treatment. We developed a good rapport and a lot of trust. He would listen to me and recommend next steps for us both; then we would meet and compare results.”

But the Schweers and Dr. Chang were still puzzled by Colten’s symptoms, and Colten was now 2 years old.

“Nothing was adding up,” Christine says. Colten’s heart function would worsen if off his medication, and his weight continued to climb. “He was eating healthy and walking, swimming and exercising a lot, but his weight was not budging.”

A few years passed while they continued to search for an answer.

An answer at last

Dr. Chang suggested they revisit genetic testing, despite Colten having received genetic testing a few years prior.

“We trusted Dr. Chang’s instinct,” Christine says. “He pointed out that tests can change even in a short time, and he wanted to be sure we covered our bases.”

He sent them to Dr. Neda Zadeh, a CHOC pediatric geneticist and Associate Director of the Molecular Diagnostic Laboratory.

A thorough walkthrough of Colten’s history and several questions later, Dr. Zadeh had an idea. Recalling a case she encountered during her fellowship at Stanford University, she brought up a rare condition called Alström Syndrome and suggested they test for it.

While they waited, Christine got to work researching Alström Syndrome symptoms and immediately knew they had figured it out.

“Alström checked all the boxes: heart failure, flat and wide feet, nystagmus, obesity and delayed developmental milestones – it completely fit,” Christine says.

Six months later, a genetic sequencing test paid for by the foundation Alström Syndrome International confirmed what Christine and Dr. Zadeh suspected – Colten had Alström Syndrome. He was the 972nd person in the world to receive the rare diagnosis. By this point, he was 8 years old.

The Schweers were immediately welcomed into the Alström family, Christine says. They got involved with the foundation that covered Colten’s genetic testing, and families around the country and globe reached out to them. Colten even met one of his current best friends, a boy with Alström from Canada.

Despite the relief of a diagnosis after years of searching, Alström came with some difficulties. The diagnosis meant that Colten’s vision was weak and that his hearing would decline, too. The disease also affects his lungs, kidneys, liver and weight.

“It of course felt horrible at first to me and my husband to learn that Colten has a rare disease, but it was also a relief to know that we had an answer now; there wouldn’t be so many surprises anymore,” Christine recalls.

The Schweers continued to work with Colten’s specialists, finally certain they knew the cause of his symptoms.

Collaboration is key

Christine reflects on the years of searching for answers and, despite the difficult moments, feels thankful for their collaborative care team at CHOC.

“If it weren’t for Dr. Chang suggesting more genetic testing, if he hadn’t advised we see Dr. Zadeh and if it weren’t for the Alström case Dr. Zadeh remembered from years before, we probably wouldn’t have figured it out,” she says.

Christine thanks Dr. Chang for always keeping innovation in mind.

“It would be easy to think inside the box and rely on past test results,” Christine says, “but Dr. Chang always stayed up-to-date with tests and looked at things creatively. It’s a multidisciplinary team approach at CHOC.”

Most importantly, Christine admires the way Colten’s care team relates with him.

“Doctors at CHOC are very personal with Colten,” she says. “They get on his level and take time to get to know him and what he’s been up to. Colten trusts them and wants to make them happy, so it’s always a positive experience for him to see them.”

The approach has resulted in a fruitful partnership between Colten, his parents and his providers.

“We’re all such a good team now. We feel confident we’re doing everything we can possibly be doing for Colten.”

Learning about rare disease at Peds2040

The experience getting Colten’s diagnosis sparked in Christine a connection to the rare disease community. She heard about a rare disease panel planned for the Pediatrics 2040 Conference, an annual conference on innovation in pediatrics spearheaded by Dr. Chang, who had since been appointed CHOC’s Chief Innovation Officer and head of CHOC’s Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3). Christine expressed interest in attending right away, so MI3 sponsored her to attend. The experience was invaluable.

“It was a great learning opportunity,” Christine says. “I had lunch with a speaker whose son had a rare cancer, spoke with other families and shared Colten’s story with providers, interns and residents.”

She also learned about CHOC’s partnership with Rady Children’s Hospital to offer microarray testing – a more thorough chromosomal test that can detect rare genetic conditions in kids like Colten during infancy.

Thinking back to Colten’s journey to a diagnosis, Christine felt grateful they had MI3 and Dr. Chang on their side. Peds2040 highlights the importance of medical innovation to those with rare diseases.

Colten visits with Dr. Anthony Chang at the Pediatrics 2040 Conference.

One of the most memorable moments of the conference for Christine was Colten arriving toward the end of the day, when he was able to catch up with Dr. Chang.

Colten today

Today, Colten is a loving, strong-willed, intelligent 13-year-old with a deep love of cars and an amazing memory. These days, he and his family are grateful to be able to go several months between specialist appointments.

Even so, Christine notes, he faces some difficulties.

He is short for his age, so they’re seeing endocrinologist Dr. Himala Kashmiri to monitor his hormone levels. Additionally, like his vision, Colten’s hearing has waned and will continue to weaken during his teenage years. But, Christine reports, he has learned braille and thriving at it. And, because Alström can affect multiple organs, they continue to watch his heart, liver and kidney function with the help of medication and several specialists.

Colten continues to see Drs. Dwinell and Chang, along with nephrologist Dr. Shoba Narayan, pulmonologist Dr. Chana Chin, gastroenterologist Ellen Schoenfield, NP, registered dietitian Vanessa Chrisman, audiologist Dr. Kristi Panek and a pediatric ophthalmologist.

Nevertheless, the Schweers ensure Colten is empowered to do what he wants.

“We’ve never held him back from doing something,” Christine says. “If he wants to do something, we’re going to make it happen.”

Colten joined a Challenger baseball team for kids with special needs, now one of his favorite activities.

And, despite vision loss, his love of cars is as strong as ever.

“Before, he could instantly tell you what a car was when he saw it” Christine says. “Now, he can identify them by sound.”

Some of Colten’s favorite memories so far include joining his baseball team, going horseback riding and ziplining, and he has plenty more adventures planned.

“Despite his challenges, he’s very determined and has a don’t-baby-me, I-can-do-this attitude that impresses me – and makes me a nervous wreck,” Christine adds.

“When Colten was little, his doctors said he might not be able to talk. Now we joke that we have to beg him for five minutes of quiet. He doesn’t stop talking when he’s around his loved ones.”

Advice for other families

Christine looks back at the difficult road to a diagnosis and is now grateful for the community that Alström has brought her family.

“Let yourself grieve after a difficult diagnosis,” she says, “but also try to recognize you’re part of a new family. You’re not alone in this. Know that there are other parents out there who know what this feels like, so don’t try to take it on all by yourself. Despite how it can feel at first, every day is not going to be a bad day.”

Learn more about Medical Intelligence and Innovation at CHOC

CHOC Appoints Chief Intelligence and Innovation Officer

Anthony Chang, MD, MBA, MPH, Chief Intelligence and Innovation Officer, Sharon Disney Lund Medical and Innovation Institute at CHOC
Anthony Chang, MD, MBA, MPH,
Chief Intelligence and Innovation Officer,
Sharon Disney Lund
Medical and Innovation Institute at CHOC

Dr. Anthony Chang, who helped establish the Sharon Disney Lund Medical and Innovation Institute at CHOC, has been appointed chief intelligence and innovation officer for the pediatric healthcare system.

Innovation has been a long-held organizational value at CHOC and now, with Dr. Chang’s leadership, vision and focus, along with the generous support of the Sharon Disney Lund Foundation, innovation will drive creative solutions that improve pediatric medicine in Orange County and abroad today and in the years ahead. We recently sat down with Dr. Chang to discuss the ways in which innovation is part of the hospital’s culture and to learn more about his vision for the future.

1) Innovation is becoming a trend at hospitals, such as Boston Children’s. What is CHOC doing different?

Innovation is simply solving problems with creativity and execution.

I do not feel that any children’s hospital should be competing with another in this culture of innovation, which promotes inter-institutional collaboration. What is truly inspiring is that we are already working very closely with a group of about 35 children’s hospitals in an innovation coalition (preliminarily called the international Society for Pediatric Innovation, or iSPI). This effort was a direct result of our Pediatrics2040: Trends and Innovations in the Next 25 Years meeting October 2013 here in Orange County.

2) What is CHOC doing to support a culture of innovation?

CHOC has embraced innovation in the past two years with the formation of the Medical Intelligence and Innovation Institute (MI3) with its monthly meetings and summer internship program. In addition, with the support for a chief intelligence and innovation officer, CHOC is investing in its future in both data analytics/ artificial intelligence as well as innovation in pediatric medicine. Throughout the next year or so, there will be group efforts to bring about a transformational change at CHOC to understand innovation and embed this in our institutional DNA.

3) What innovations are currently underway at CHOC to improve pediatric care?

We are very early in the process of innovation projects, but a few CHOC physicians and employees are being considered for MI3 innovation grants to provide time for creative solutions to problems. A few of the earliest innovations that are being explored at CHOC include: a new heart medication for babies; a new way to look at hospital patient data; a new way to predict heart failure in children with cancer who had chemotherapy; and a few devices in pediatric surgery. We are also organizing a quarterly CHOC Innovation Forum to engage all of our employees who like being creative!

4) What is your vision for the future?

I’d like to see an intellectual venue where all the pediatric stakeholders (doctors, nurses, allied professionals, parents, industry, etc) can come together to share and exchange innovations as well as growing iSPI, encouraging all the children’s hospitals to meet on a regular basis to discuss and practice pediatric innovation.

5) How can doctors and others interested in innovation outside of CHOC support this effort?

We welcome physicians and other pediatric stakeholders to support innovations in pediatric medicine by joining iSPI or attending our monthly MI3 meetings. Collaboration across multiple organizations and communities can lead to greater solutions to problems, positively impacting children here and across the globe.

Monthly MI3 Meetings

Meetings are held the third Monday of the month and feature updates on genomic medicine, regenerative medicine, nanotechnology, medical devices, artificial intelligence and robotics. For more information, contact Dr. Chang.