Mission

We support the readiness needs of the US Armed forces by training military pediatricians to provide exemplary, family-centered care with compassion for children and youth with special healthcare, neurodevelopmental and behavioral needs, through leadership, advocacy, scholarly inquiry, and knowledge mastery.

Vision

Through provision of high-quality education experiences, we will ensure care excellency for military children with special neurodevelopmental and behavioral health care needs. Fellows will graduate with the experience and skills needed to lead, educate, guide and coach military pediatricians in the care of children who present with early
developmental concerns. Military Developmental-Behavioral pediatricians will contribute to accessible and equitable care for all military connected children and promote the importance of Developmental medicine in supporting the mission of the U.S. Armed Forces.

Aims

• Train Tri-Service Developmental Behavioral Pediatricians as the subject matter experts for caring for children with neurodevelopmental, behavioral, and related special health care needs with additional focus on caring for the unique needs of military children.
• Contribute to the greater body of literature for military children with special health care needs through scholarly activities (SA).
• Train military Developmental Pediatricians to be advanced clinicians, competent faculty, policy advocates for military children and peer leaders.
• Promote well-being of fellows and faculty through emphasis on family wellness, resilience, self-development, and physical and mental fitness.

• Each academic year starts with the Fellow Foundations Boot Camp, a combined multidisciplinary teaching series which focuses on the foundational knowledge and skills needed for success during fellowship. Fellow Foundations is combined with the University of Washington, DBP Fellowship program, increasing the breadth and diversity of teaching and further eliciting the spirit of collaboration between our two programs.
• All fellows and staff participate in weekly formal didactics with a focus on clinical education, systems-based practice and board eligible content. Didactics include formal lectures from faculty/staff, invited experts, local collaborators, and fellow-led talks. Fellow-led board review is offered weekly and paired with didactics.
• Multidisciplinary Fellow Continuity Clinic Rounds are held weekly at the end of didactics and allow fellows/staff the opportunity to discuss high profile, high yield and complex cases. Rounds are attended by DBP fellows/staff, Genetics, Physical Therapy, Occupational Therapy, Behavioral Analysts, Social Work and Psychology.
• Combined Pediatric Psychiatry Rounds are held monthly and allow fellows the opportunity to discuss complex medication management cased with Child and Adolescent Psychiatry, DBP, Psychology and Social Work.
• Neuroradiology Rounds are held weekly to review complex neuroimaging.
• Research Rendezvous provides biweekly didactics and support for scholarly activity.
• Research Rendezvous Flex time is scheduled time biweekly for fellows to collaborate one-on-one with their research team.
• Additional Didactic Opportunities: Fellowship Book Club, Journal Club with the Child and Adolescent Psychiatry team from the Child Study & Treatment Center, Department PI/QI and M&M activities, Department Morning Report and DevoDay (formal educational conference led by the Chief Fellows each academic year).

• All rotations are longitudinal. Madigan rotations span all three years, but fellow responsibilities and autonomy increase in time. Madigan DBP Teaching Clinics are scheduled through the week and fellows are assigned on a rotating schedule, integrated with their offsite rotations, and protected time for scholarly work.
• Madigan Clinical rotations are built around interdisciplinary clinics:
  • Autism Diagnosis and Care (Autism Referral Clinic, Autism Spectrum Diagnosis Clinic, Primary Care Medical Home STAT Clinic, JBLM CARES Clinics, DBFRC Clinics)
  • High Risk Infant and Toddlers (Infant and Toddler Clinic, NICU follow up Clinic)
  • Behavioral Health (Complex Behavior Clinic, School Behavioral Health Liaison program, DBP Consultations)
  • Neuromuscular Disorders (Neuromuscular Clinic, DBP Consultations)
  • Chronic and Complex Care for Children with Neurodevelopmental Needs (Fellow Continuity Clinic, Combined Congenital Cardiac Clinic, FAITH Transition Clinic)
  • Itinerant Care (multifocal evaluation/management of military children in remote locations includes virtual medicine, CAMP camp, asynchronous consultations and travel to provide developmental medicine with a faculty member in a military location with reduced resource availability)
• Offsite rotations supplement diversity of patient presentations, pathology, and differing approaches to medical management:
  • University of Washington, Institute on Human Development and Disability, Seattle Washington (advocacy, high risk infant evaluations)
  • Seattle Children’s Hospital, Neurodevelopmental Clinic and Craniofacial Clinic, Seattle Washington (various neurodevelopmental and behavioral evaluations)
  • Child Study & Treatment Center, Lakewood Washington (Residential care for children and adolescents with psychiatric and behavioral health conditions)
  • During all offsite rotations, fellows spend 1 day/week at the offsite and the remaining 4 days/week are at Madigan. Fellows are given “Scholarly Activity Weeks” with decreased clinical load and increased time for focused scholarly work 2 weeks out of every clinical rotation month and for three weeks during dedicated scholarly activity/elective months. There is a Home-Based Curriculum Elective (up to 4 weeks per trainee) for fellows who require prolonged absence from face to face clinical duties due to medical or family leave.

  1st Year	2nd Year	3rd Year
  Boot Camp/Scholarly Activity - 2 months Scholarly Activity - 3 months LEND- Institute on Human Development & Disability - 4 months LEND- Infant Assessment Training Program - 3 months	Scholarly Activity/Elective - 3 months Developmental Behavioral Clinic - 3 months Seattle Children's Neuro-development - 3 months Child Study and Treatment Center - 3 months	Scholarly Activity/Elective - 3 months Seattle Children's Craniofacial Clinic - 3 months Chief Fellow - 4 months Chief Fellow/Junior Staff - 2 months

Fellows participate in longitudinal rotations to ensure a broad base of experience across developmental and behavioral medicine. Elective opportunities include Faculty Development, Physical Medicine and Rehabilitation, Genetics, and specific opportunities to focus on advocacy within the Military Health System. Interested fellows are supported in completing the Uniformed Services University Faculty Development Certificate Program during their training.

Madigan Army Medical Center is home to the only Developmental Behavioral Pediatrics fellowship within the Department of Defense; there is rich history of training Tri-service fellows and caring for families from all branches of the DOD. JBLM is the Army’s only power-projection platform west of the Rockies, and home to one of the largest populations of military children with special health care needs. Fellow education is enriched by the additional focus of military life and culture on the family unit, on the child and the military specific resources available to families.

Caring for military families requires a unique understanding of the interplay between child and family healthcare and readiness of the service member. Fellows gain experience in collaborating with service members and advocating to units/command teams. Fellows learn about EFMP, EDIS, DBRFC, DODEA and other military unique programs. Fellows also become experts in the specialized needs of military children and families, gaining a deep understanding of the impact on parental deployment, family moves, family separation and military unique stressors. Through this greater understanding, fellows can then serve as a professional advocate for military children with special health care needs.

Transitional Year didactic meetings cover a range of educational topics such as simulation exercises, military unique topics, patient safety, medical ethics, and professional development. 

• All fellows must complete the Leadership in Education and Neurodevelopmental Disabilities (LEND) Program through the University of Washington. Fellows are scheduled for LEND activities throughout their first two years, culminating in presentation of their LEND Advocacy Project at the end of their second year.
• All fellows must participate in at least two formal Faculty Development Seminars at Madigan during their training. Seminars occur twice per year.
• Fellows complete the required Madigan Graduate Medical Education Central Curriculum.

The Developmental-Behavioral Pediatrics clinic at Madigan includes a state-of-the-art observation room offering real-time audio-visual direct observation during fellow led patient care. Fellows are observed throughout their training during a variety of consultative and multidisciplinary clinics. Direct and interactive observation is preferred over simulated patients. Simulation is utilized informally to teach developmental testing protocols and to enhance comfort with discussing difficult diagnoses with parents.

Fellows participate in the University of Washington Leadership Education in Neurodevelopmental Disabilities Training Program (LEND). This is a graduate level interdisciplinary training program (>300 hours), preparing trainees for leadership roles in healthcare and related services for children and families affected by neurodevelopmental disabilities. This program is funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.

Fellows are asked to participate in a hospital level committee of their choice and are assigned as the lead clinical liaison to a local School Behavioral Health Program. These are opportunities for fellows to practice leadership in action. Military unique Leader Professional Development, Leadership Book Club and Arbinger training are other available opportunities.

• Fellows are required to participate in Scholarly Activity in accordance with requirements set by the American Board of Pediatrics. Fellows are given > 1 year of scholarly activity time to ensure adequate opportunity for meaningful research.
• Research (scholarly activity) curriculum includes introductory material on use of military medical data repositories, available research courses, available statistical support and an introduction to the standard timeline expected for research completion. Research Rendezvous provides biweekly didactics and support for scholarly activity. Research Rendezvous Flex time is scheduled time biweekly for fellows to collaborate one-on-one with their research team.
• Fellows receive one on one mentorship for a scholarly project in their area of interest. A Scholarly Oversight Committee (SOC) is assigned and meets with the fellows regularly throughout their training to ensure project success. The SOC ultimately determines if the fellow project meets ABP criteria for graduation.
• Fellows are expected to submit a manuscript to a peer reviewed journal by the end of their fellowship (acceptance and publication are not required). Fellows are expected to present their scholarly work at Madigan Research Day; they are encouraged to submit for presentation at academic conferences (up to two funded conferences per year).
• There are additional opportunities to collaborate with colleagues from University of Washington, Seattle Children’s Hospital and Uniformed Services University. Fellows are expected to lead a formal PI/QI project (including curriculum projects) and present their findings to the Department.

Fellows are required to demonstrate meaningful participation in formal process improvement/quality improvement projects and present their findings at Pediatric Department meetings prior to graduation. Fellows receive formal instruction and informal coaching on project development and are encouraged to partner with residents and multidisciplinary staff.

Projects can be tailored to the fellow’s unique area of interest, to include curriculum development, and are not confined to the Pediatrics Department. Recent examples include the creation of a new hospital-wide virtual curriculum on Disability Care, creation of a resident teaching clinic focusing on autism diagnosis clinic in the primary care medical home, initiation of automated vision screening in the pediatric specialty clinic and roll out of ACES screening in the Pediatric medical home.

• Professional development is highly valued, and fellows are supported in applying for faculty appointments at Uniformed Services University of the Health Sciences. Faculty Development is an integral part of our training and fellows can opt to complete the full USUHS Faculty Development Certificate program.
• In keeping with military readiness principles, fellows are credentialed as General Pediatricians, and are given opportunity to maintain their skillset by volunteering as a staff physician in the Pediatric medical home, inpatient ward and nursery. Fellows are given time to maintain medical certifications such as PALS, ACLS, ATLS, NRP, STABLE, etc.
• Fellows receive funding to complete a Developmental Behavioral Pediatrics Board Review Course during fellowship, the Birth to Three annual meeting, and local Early Intervention collaboration meetings.
• Fellows are also encouraged to take advantage of military leadership courses and Arbinger training as desired.

• Madigan Army Medical Center: Department of Pediatrics, Tacoma, Washington
• University of Washington Center on Human Development and Disability: Seattle, Washington
• Seattle Children’s Hospital: Neurodevelopmental Clinic and Craniofacial Clinic, Seattle, Washington
• Child Study & Treatment Center: Lakewood, Washington
• Additional itinerant Care Opportunities: includes trips with McChord Developmental Behavioral Family Readiness Center, Fort Wainwright Alaska Joint Base Elmendorf Richardson Alaska, Fort Bucannon Puerto Rico and Children’s Association for Maximum Potential Camp in CenterPoint Texas

• In addition to virtual interviews, candidates are welcome to consider a formal rotation or face to face visit with our program. Residents from the Madigan Pediatrics Residency Program complete their required Developmental Behavioral Pediatrics rotation within our program. Applicants from another military residency are welcome to rotate with us as long as it is coordinated, approved and funded by their residency program.
• Less formal and shorter program visits offer an opportunity to meet the team and sample the educational/clinical environment without the rigor of a formal rotation; visits are not funded by the fellowship.
• There may be opportunities for candidates to house with a current faculty or fellow during a rotation/visit, but this cannot be guaranteed.

• Candidates will be interviewed virtually. Interviews will begin in August of each academic year. All applicants are offered a formal interview with program leadership and an informal two-part interview with additional faculty and current fellows. The goal of the formal interview is to assess a candidate’s likelihood of success in the fellowship program based on their passion, skills, attributes, success in prior GME, military/leadership experiences and scholarly activity. The informal two-part interview offers candidates an opportunity for faculty/fellows to assess goodness of fit for the program via a semi-structured group interview, followed by a “low threat” opportunity for the candidate to speak freely with fellows (no faculty/leadership involvement) about the program, culture, educational experience and quality of life.
• Candidates should provide a copy of their Curriculum Vitae when virtual interviews are scheduled. CVs will be shared with all faculty/fellows who participate in the program’s individual order of merit board leading up to the official joint selection board. Any candidates who are onsite for a rotation or visit will be offered the option to interview virtually or in-person. In-person interviews are not required.

Program graduates take the American Board of Pediatrics, Developmental-Behavioral Pediatrics Board. This exam is offered every other year. To become fully board certified, applicants are eligible to take board certification exam after completion of training. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Pediatrics prior to enrolling for the initial certifying examination.

American Board of Pediatrics pre-requisites include:

• Current board certification (maintenance of certification) in General Pediatrics.
• Submission of the fellow’s Scholarly Work product to the ABP with approval by the Scholarly Oversight Committee.
• Successful graduation from an accredited three-year fellowship program (boards are not taken until after completion of training).
• The candidate must possess a valid, unrestricted medical license.
• Specialty Pediatrics boards must be taken/passed within seven years of graduation from fellowship.

The program places a high priority on developing fellows as educators. Principles of adult learning are utilized and fellows are exposed to a broad range of faculty development topics. Fellows participate in a variety of experiences alongside staff to include precepting Introduction to Clinical Reasoning cases through USUHS, facilitating simulated cases with residents on sharing difficult news, directly teaching residents and department pediatricians how to perform initial autism assessments in the primary care setting. Procedures (developmental testing tools) are generally taught by senior fellows to junior fellows with staff support.

Fellows assist in running the resident rotation in DBP and serve as the first line preceptor/educator for residents in DBP teaching clinics. Fellows also participate in teaching junior fellows from the University of Washington DBP program when they rotate at Madigan for autism specific training.

Fellows participate regularly in formal Faculty Development seminars, USUHS Focus Faculty Development lectures and quarterly Dept Faculty Development opportunities.

Senior fellows rotate as Chief Fellow, during which time they are the primary consultant for DBP. The Chief is responsible for the didactic schedule. Fellows are supported in preparing and presenting didactic lectures/Grand Rounds annually. Fellows provide formal resident lectures throughout the academic year.

Fellows run the virtual Autism Extender Training courses through the fellowship. This is a half day virtual course which trains primary care physicians to recognize, diagnose and initiate first line interventions for toddlers with autism spectrum disorders. Fellows are credentialed as General Pediatricians and have ample opportunity to precept residents in the primary care clinics, on the inpatient ward and in the nursery.

In addition to Board Certified Developmental-Behavioral Pediatricians, our diverse faculty include specialists in Genetics, Pediatric Psychology, License Clinical Social Work, Pediatric Physical Therapy and Occupational Therapy.

Offsite and remote faculty members from University of Washington, Seattle Children’s Hospital and Nellis Air Force Base enhance educational opportunities. The fellowship is housed within a large tertiary care medical center which boasts a broad range of disciplines available to fellows, including: Adolescent Medicine, Pediatric Neurology, Neonatology, Clinical Pharmacy, Nutrition, Pediatric Subspecialists, Pediatric Surgical Specialties, Exceptional Family Member Program and Behavioral Health.

Fellows collaborate regularly with the JBLM Center for Autism, Resources and Education (CARES). The CARES team includes a Developmental Behavioral Pediatrician, Board Certified Behavioral Analysts, Speech and Language Pathologists, Occupational Therapists, Nurse Case Manager and an Exceptional Family Member Program (EFMP) Systems Navigator.

Education is further enhanced through our community and military partnerships with Child and Adolescent Psychiatry, School Behavioral Health Programs, Child and Youth Services, Developmental Behavioral Family Readiness Centers and itinerant care programs.

As a military GME training platform, the fellowship values mentorship to support fellows in developing their careers in medicine, education, scholarly work, and as a military leader. Fellows meet with program leadership two-four times per year with a focus on holistic growth and progression in training. A rotating Chief Fellow is designated as the first line peer mentor for junior fellows.

Fellows have ample opportunities to connect with Developmental Behavioral Pediatricians across the MHS and to receive service specific mentoring on military promotion, military professional education, and military unique opportunities. Fellows who meet eligibility requirements are frequently nominated for military specific courses such as AMEDD Junior Leadership Course, Iron Majors and the Female Physicians Leadership Course.

Fellows are supported in identifying a faculty mentor for their scholarly activity and quality improvement/process improvement projects. In addition, fellows are paired with a Scholarly Oversight Committee to provide research specific mentorship and support throughout their training.

Fellows are encouraged to consider opportunities to mentor Pediatric Residents and medical students.

Wellness is a high priority for our fellowship. We recognize that to best care for our patients and families and to maintain success and productivity, we must ensure wellness in ourselves. Fellows have protected education time, and a family friendly culture to support growth with flexibility in scheduling. No overnight call is required during the three-year fellowship and typical hours of work are during the duty day. Many fellow and staff led family friendly gatherings are hosted throughout the year. We host a biannual Retreat (Fall/Spring), often pairing formal programmatic agendas with teambuilding and wellness activities. The DBP division hosts a Winter Wellness Day.

Wellness check ins are done formally with biannual (quarterly by exception) counseling sessions and informally through the year. Fellows are provided time for group/individual wellness/physical fitness two afternoons per week (Wellness Time). Fellows are encouraged to utilize any work environment in which they most thrive, with the program allowing for scholarly activity to be completed from home, in the office or at an alternate work site if the fellow (and their productivity) is accounted for; this has been a highly valued aspect of the program supporting wellness. Fellows and staff have been recent recipients of the Madigan Wergeland Wellness Award.