Dev Priya Singhvi travelled to the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland to learn more about the patterns of disease in children's health in the USA.

What sort of work did the clinical centre undertake and what did you encounter there?

The pattern of disease in children's health at the centre was determined by the protocols conducted by investigators from 16 institutes and centres. Approximately 1500 protocols take place at NIH every year, of which 36% involve paediatric patients. 50% of the protocols are natural history studies, where they follow up patients to better understand the disease process, and the other 50% are treatment trials.

Amongst many others, I saw two patients with Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature syndrome (CANDLE), an extremely rare auto inflammatory disease that had only recently been classified. These patients were being followed up to better understand the natural history of the disease.

I also came into contact with two patients with acquired aplastic anemia who had both been enrolled in a protocol studying the efficacy of a new therapeutic drug, Eltrombopag, in addition to current immunosuppressive treatment.

What did you learn on placement?

I had the opportunity to assist with chronic and acute-on-chronic conditions affecting paediatric patients in the in-patient and out-patient setting. This included participating in ward rounds with allied institute physicians and addressing relevant paediatric questions for patients on active protocols, providing a paediatric assessment and providing a formal consult upon request.

These experiences have helped me become more confident and comfortable with seeing acutely and chronically unwell children, as well as helping me to develop a systematic approach to paediatric patients.

I enjoyed understanding the pathophysiology of diseases I observed on my rotation and correlating it with clinical manifestations. During my clinical years of medical school, I was accustomed to memorising signs and symptoms of various diseases along with their appropriate investigations and management, without fully understanding the pathogenesis to presentation of the disease. I felt that this was almost disconnected from the very essence of what attracted me to medicine in the first place.

During my elective, I was encouraged and challenged to understand the mechanism of disease with which patients would present. This led me to better appreciate the importance of genetics, biochemistry and immunology to help understand the diseases of patients I came across.

Before my elective I was interested in pursuing a career in paediatrics; my rotation with NIH has reaffirmed my interest.

I'm grateful for the opportunities I had at NIH, which included grasping the structure of the NIH and the role of the Pediatric Consult Service, and learning from patients on active protocols, many of whom had extremely rare diseases. Before my elective I was interested in pursuing a career in paediatrics; my rotation with NIH has reaffirmed my interest and I will try to remember lessons learnt into my future professional and personal life.

What were your accommodation arrangements?

I lived in the basement of a family's house in Kensington, Maryland, not too far from the hospital. I used Airbnb, which was a great way to have the freedom of living at home. It was also good to get a feel of what the local residents get up to and get some valuable local knowledge from them. It got a bit isolated at times, but I quickly made new friends and kept myself busy!

What would you advise to other students thinking of undertaking the same elective?

I would recommend it to any students wishing to experience cutting-edge research, who want to be challenged out of their comfort zone and expand their clinical and scientific knowledge.

Book accommodation early, talk to other students who have been to NIH, and it will be an experience that you will most probably remember your whole life. The Clinical Centre is situated close to Washington DC, so there are many activities at your doorstep, not to mention beautiful parks and so on.

For more on the NIH Clinical Center, visit the website.

For advice on planning your elective and getting indemnity, visit our website.

This page was correct at publication on 13/06/2017. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.