2008-2009
PEDIATRIC RESIDENCY ROTATIONS
GOALS ANDOBJECTIVES
TABLE OF CONTENTS
Overall Goals and Objectives…………………………………………………………...…...3
Adolescent Medicine………………………………………………………………………...10
Allergy & Immunology…………………………………………………………………….…13
Cardiology Elective……………………………………………………………………….....15
Child Neurology Elective……………………………………………………………………18
Continuity Clinics……………………………………………………………………………..21
Dermatology Electives……………………………………………………………………….24
Developmental & Behavioral Pediatrics……………………………………………………27
Emergency Department………………………………………………………………….…..30
Endocrinology Elective………………………………………………………….……………33
Gastroenterology Elective……………………………………………………………..…….36
Genetics………………………………………………………………………………….……39
Hematology/Oncology Service – Inpatient………………………………………….……..41
Infectious Disease Elective……………………………………………………….…………43
MCJCHV Inpatient Ward……………………………………………………………..……..45
Neonatal Intensive Care Unit……………………………………………………………….50
Nephrology Elective………………………………………………………………..………..52
Newborn Nursery………………………………………………………………….…………55
Pediatric Inpatient Rotations………………………………………………………..………58
Pediatric Intensive Care Unit……………………………………………………………….64
Pulmonary Elective………………………………………………………………………….67
Sports Medicine Elective………………………………………………………………..….70
Pediatric Acute Care Clinic………………………………………………………… ……..73
Vanderbilt University Department of Pediatrics Residency Program Training Goals
We have created an educational environment the goal of which is to allow residents to gain the fundamental knowledge and expertise to become the best pediatricians possible, and from there to pursue their individual giftedness. We challenge residents to become leaders and agents of change in their individual career paths and become true child advocates.
Departmental philosophy: broad-based training with exposure to a wide variety of general and subspecialty problems in children stressing the importance of “patient involvement and ownership” prepares housestaff to be the best pediatricians possible. As a result, housestaff can then pursue careers in both general and subspecialty fields. We recognize that 3 years is an arbitrary time limit and that and is not the end of pediatric education, rather only the beginning. Thus, we want housestaff to know how to learn as preparation for continuing education throughout their medical careers.
Summary of the Training Program
Because the basics of pediatric medicine are learned best through direct patient contact, with guidance from experienced role models, the training program centers on the PLl as the patient's primary physician, especially on ward, NICU and PAC clinic rotations. The PLl therefore plays a central role in making decisions regarding his or her patients. Orders are written by the PL1 only. Leadership experience begins early in the PL2 year, when the resident is placed in supervisory positions on the Vanderbilt wards and in the NICU. Residents assume a large part of the responsibility for teaching the medical students. In the PL3 year, an additional supervisory opportunity is available as chief resident of the PAC clinic. Residents filling this role are encouraged to plan a variety of teaching opportunities, including conferences, informal discussions of clinic patients, and mock codes. Two chief residents in pediatrics function at the PL4 level. These individuals are responsible for resident scheduling in addition to planning and leading many of the teaching conferences.
Conferences and Resources
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In addition to frequent spontaneous teaching, many formal teaching settings are available, including weekly Grand Rounds, the Chief Residents' Conference, subspecialty conferences, weekly case management conferences, morning report, and other regularly scheduled lectures. The full schedule of medical and basic science conferences conducted throughout the MedicalCenter is available to residents as well. Residents keep abreast of current literature in a number of ways. Journal Club meets monthly in for discussion of current journal articles. A collection of textbooks, as well as easy computer access, is maintained on the ward for immediate access at all hours. Additional resources are found in the physician workrooms of the general pediatric clinics. Residents have 24hour access to MEDLINE literature searches.
Rotations
The program is broad enough to provide training for whatever pediatric interest a resident chooses to pursue. A typical schedule for the three years of training is shown below. Each rotation schedule is explained in further detail below.
PL-1
Vanderbilt Wards5 months
NICU2 months
ChildDevelopmentCenter 0-I month
Acute Care Clinic2 months
Newborn Nursery1 month
Elective0-1 month
Emergency Room1 month
PL-2
Vanderbilt Wards2 months
Heme-Onc1 month
Adolescent medicine1 month
NICU1 month
PICU1 month
Emergency medicine1 month
Acute Care Clinic1 month
Electives 4 months
PL3
Vanderbilt Wards1 month
Heme-Onc1 month
PICUI month
Acute Care Clinic ChiefI month
Emergency medicine1 month
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NICU1 month
Nashville GeneralHospital1 month
Electives5 months
Night call is every fourth night for the first year and averages every fourth to sixth nightfor the subsequent two years.
INPATIENT SERVICES
Vanderbilt Wards
Vanderbilt ward teams are composed of a fulltime faculty attending physician (may be a hospitalist, General Pediatrician or subspecialist), a volunteer attending physician from the surrounding community, two PL3s or PL2s, four PL-1s, and externs (fourth year medical students). Thirdyear medical students are also an integral part of the service. Each team has a targeted maximumcensus of 24 patients. Call is every fourth night. Faculty members rotate as ward attending physicians for 2-4 week periods. Rounds with Vanderbilt faculty and/or private attending physicians occur daily. These teaching sessions provide an excellent opportunity for the resident to interact with a Vanderbilt subspecialist or general pediatrician and to gain perspective on how various pediatric illnesses might be managed in the private practice setting. The ward rotations provide a cross section of pediatric experience, with approximately half of all admissions to general pediatrics and half to subspecialty services. Thirty percent of patients are admitted by practicing community pediatricians.
Pediatric Critical Care Unit
The Pediatric Intensive Care Unit is a 36-bed unit where approximately 12001400 children are admitted yearly, 60 percent of which are medical admissions. The pediatric service follows all patients, medical and surgical, who are admitted to the unit. The PICU team consists of two attending physician, two fellows and four PL3s or PL2s. Half of the team covers the medical side of the unit for 2 weeks, with the other half covering the surgical side (roles are switched after 2 weeks to allow for a complete experience). Call is every fourth night. Teaching rounds and radiology rounds occur daily.
Neonatal Intensive Care Unit
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The Neonatal Intensive Care Unit is a 62bed unit where approximately 900 newborns are admitted annually. 40 to 50 percent of admissions are transfers from other facilities. The NICU is staffed by attending neonatologists, neonatology fellows, four PL2 or PL-3 residents, four PL1 residents, and neonatal nurse practitioners. Call is every fourth night. Attending rounds and radiology rounds are held daily. PL-2 residents spend time in the Stahlman NICU attending deliveries and providing care for the acutely ill, inborn neonates. The nursery provides experience in managing all types of neonatal problems, from intensive care illnesses and acute delivery room management to mother/infant relationships. Vanderbilt also provides extra corporeal membrane oxygenation (ECMO) for the region. A second 12 bed satellite NICU is located in VanderbiltUniversityHospital near the delivery suite and obstetrical unit. This unit is covered by Neonatology attendings, fellows, nurse practitioners and PL-2s from the main NICU rotation. At night, PL-1s from the Newborn Nursery rotation cover call in this unit.
Newborn Nursery
Two PL-1’s, assisted by a general pediatric attending physician, are responsible for the newborn nursery, including all admissions and discharges. In addition to providing normal newborn care and performing circumcisions, the rotation involves education and instruction to all families of babies on the newborn nursery service. In addition, PL-1s on the rotation take night call every 4th night in the delivery suite to evaluate and stabilize babies with perinatal problems.
Outpatient Services
Pediatric Acute Care Clinic
The PAC clinic provides the foundation for the resident's experience in outpatient general pediatric management. The resident rotating through the PAC clinic performs wellchild checkups, treats many routine childhood diseases, and evaluates patients with more unusual problems who are referred by other physicians. In addition, since a proportion of the patients served by the PAC clinic are from Nashville's indigent population, the rotation provides important exposure to many of the social and human problems of pediatrics. Approximately 12,000 children are seen in the PAC clinic each year. The PAC clinic is staffed by a team consisting of two PL3’s, two PL2’s, three or four PL1s, and two general pediatric attending physicians. Variable numbers of third or fourthyear medical students are also available. The PL3 residents are designated as the PAC chiefs and, with the help of the attending physician, arranges teaching in the form of talks on topics pertinent to general pediatrics. Night and weekend call consists of emergency room shifts for the PL-1’s. In addition, each intern spends at least one week in the "Our Kids Clinic", a specialized evaluation center for child sexual abuse.
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Pediatric Subspecialties
Pediatric subspecialty rotations occur in the second and third years of training (although one elective can be done in the intern year). These may be taken in almost any area of interest and include adolescent medicine, allergy, cardiology, child and adolescent psychology, community medicine, endocrinology, gastroenterology/nutrition, genetics, hematology/oncology, immunology/rheumatology, infectious diseases, nephrology, neurology, orthopedics, ophthalmology, otolaryngology, pediatric surgery, pulmonology, radiology, urology, rehabilitation and sports medicine, and clinical and laboratory research. Further, there are multidisciplinary clinics in spina bifida, cerebral palsy, cystic fibrosis, adolescent gynecology/endocrinology, Down’s syndrome, international adoption, and hemophilia. Residents are encouraged to be creative in arranging rotations that will best prepare them for their future pediatric careers. Elective time often provides exposure to subspecialists who may have an influence upon a resident's ultimate career goals.
Pediatric Primary Care Practice
The Primary Care Practice (also known as Continuity Clinic) provides residents with longitudinal responsibility for ambulatory patient care, allowing them to learn concepts of normal child development as well as longterm management of children with chronic and subacute illness. Interns and residents accumulate a variable number of their own private patients for whom they provide ongoing care during the three years of training. These may be patients encountered while on the ward service, nursery (normal or intensive care) service, subspecialty service, or in the outpatient clinic. Primary care teams consist of six residents who share a half day each week of regular appointments. Each primary care clinic is staffed by a general pediatric attending physician. Teaching conferences that cover a wide variety of general pediatric topics are held at the beginning of each clinic session. There are approximately 10,000 Pediatric Primary Care Practice visits each year.
Pediatric Emergency Department
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Pediatric Emergency services are available twentyfour hours a day. More than 40,000children with urgent medical needs are seen annually in the Pediatric Emergency Department. MCJCHV is a Level 1 trauma center and transports patients from throughout the region on LifeFlight, Vanderbilt's transport helicopter. The Pediatric ED is staffed at by pediatric residents from PAC and elective rotations. In addition, residents at each PGY level have one month block rotations in the ED and, along with residents in Emergency Medicine, staff daytime shifts. Pediatric emergency medicine faculty are available on site to the pediatric housestaff at all times. A weekly resident conference provides a forum for discussion of interesting cases by the faculty in general pediatrics and the emergency department.
General Pediatrics Electives
Residents may choose from several general pediatric elective experiences. They may spend one month in a private practice setting with a clinical faculty member. This rotation offers exposure to patient care away from the university or public health setting. Residents choose a preceptor in the community and work closely together in the office and on nursery and hospital rounds. A community continuity clinic program, begun in 1994, allows residents to elect a second halfday per week in a private practice setting during the PL-2 and PL-3 years. This opportunity has become very popular especially, but not exclusively, among residents with future interests in private practice. Clinical faculty are very enthusiastic about this program.
Center for ChildDevelopment
A highly trained group staffs the CCD, including Child Development pediatric faculty members and specialists in speech and language, psychology, social work, and education. A rotation through the CCD is required for all residents in the P1 or 2 year.
Adolescent Medicine
Residents on the adolescent medicine service learn to manage routine adolescent illnesses as well as more complex psychosocial issues such as teenage sexuality, substance abuse, eating disorders and dysfunctional family relationships. A rotation in adolescent medicine is required for all residents in the PL2 or PL3 year.
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LEARNING OBJECTIVES FOR PL-1 YEAR
1. Learn how to recognize the acutely ill patient and correctly distinguish from those with lesser illnesses.
2. Learn the details of direct patient management in the inpatient and outpatient settings.
3. Learn proficiency with common pediatric procedures.
4. Develop initial acquaintance and working relationship with full time and private pediatric attendings.
5. Hone presentation and physical examination skills.
LEARNING OBJECTIVES FOR PL-2 YEAR
1. Acquire skills needed to organize, oversee and run a patient care team.
2. Begin to identify specific career paths and begin to make preparations for post-residency positions.
3. Begin to assume a major teaching role for medical students and PL-1s.
4. Increase depth of knowledge regarding disorders of specific organ systems (subspecialty experience).
LEARNING OBJECTIVES FOR PL-3 YEAR
1. Further increase knowledge base with regard to diseases managed by general pediatricians and those managed by subspecialists.
2. Gain additional leadership responsibilities as PAC Chief.
3. Gain experience with researching a topic and formal presentation of this topic at a Pediatric Grand Rounds, Chief’s Conference or other scholarly project.
4. Further hone general leadership and supervisory skills through leadership on ward teams, Morning Report and consult services.
5. Make preparations for post-residency positions.
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ADOLESCENT MEDICINE
Residents will spend a one month block in Adolescent Medicine during the second or third
year of training. This is an ambulatory rotation with the resident continuing to
maintain his/her continuity clinic.
Goals, Objectives and Resident Responsibilities of the Adolescent Medicine Experience:
Patient Care: Residents are expected to provide patient care that is compassionate, appropriate
and effective for the promotion of health, prevention of illness, and the treatment of disease in the
adolescent population. The resident should
Gather accurate, essential information from all sources, including medical interviews,
physical examinations, medical records and diagnostic/therapeutic procedures
Make informed recommendations about preventive, diagnostic and therapeutic options and
interventions that are based on clinical judgment, scientific evidence, and patient
preference
Develop, negotiate and implement effective patient management plans and integration of
adolescent care.
Medical Knowledge: Residents are expected to demonstrate knowledge of established and
evolving biomedical, clinical and social sciences in adolescent medicine, and the application of
their knowledge to patient care and the education of their patients and patients’ families. The
resident will apply an open-minded, analytical approach to acquiring new knowledge, access and
critically evaluate current medical information and scientific evidence and apply this knowledge to
clinical problem-solving, clinical decision-making, and critical thinking. Specifically, the resident will
Learn to recognize normal and abnormal growth and development in adolescent patients
Learn to differentiate normal and abnormal pubertal growth and development and the
accompanying physiologic and psychologic changes
Understand common adolescent health problems including chronic illnesses, sportsrelated
issues and the effects of environmental violence.
The resident should be prepared to discuss the following topics in the adolescent patient:
Abdominal pain
Acne
Contraceptive methods
Eating disorders and obesity
Headaches
Menstrual disorder
Sexually-transmitted abuse
Sports injuries
Substance abuse
Violence
Practice-Based Learning and Improvement: Residents are expected to be able to use scientific
evidence and methods to investigate, evaluate, and improve patient care practices, and
Identify areas for improvement and implement strategies to enhance knowledge, skills,
attitudes and processes of care
Analyze and evaluate practice experiences and implement strategies to continually
improve the quality of patient practice
Develop and maintain a willingness to learn from errors and use errors to improve the
system or processes of care
Use information technology or other available methodologies to access and manage
information, support patient care decisions and enhance both patient and physician
education.
Interpersonal and Communication Skills: Residents are expected to demonstrate interpersonal
and communication skills that enable them to establish and maintain professional relationships with
patients, families, and other members of health care teams, and
Learn to provide effective and professional consultation to other physicians and health
care professionals and sustain therapeutic and ethically sound professional relationships
with patients, their families, and colleagues
Use effective listening, nonverbal, questioning, and narrative skills to communicate with
patients and families
Maintain comprehensive, timely, and legible medical records
Complete evaluations of the attending staff and the rotation
Learn to give age-appropriate anticipatory guidance including discussions of health
promotion and disease prevention
Develop an effective approach to help adolescents discuss issues relating to male and
female reproductive health including sexuality, pregnancy, contraception and sexuallytransmitted
diseases.
Professionalism: Residents are expected to demonstrate behaviors that reflect a commitment to
continuous professional development, ethical practice, an understanding and sensitivity to diversity
and a responsible attitude toward their patients, their profession and society, and