Rotations, Calls & Electives

Curriculum

Overall Year

Each year is divided into thirteen four-week blocks to maximize the clinical experiences and available elective time.

  • Each year, all residents have one 2-week block of vacation, one 1-week block of vacation, 7 flexible vacation days that can be used during ambulatory rotations, and additional time off during the winter holidays.
  • Additionally, first year residents have a 1-week vacation at the end of their internship year!
  • Each year, one ambulatory block is free from jeopardy responsibilities.
Rotation PL-1 PL-2 PL-3
Inpatient ward 5.5 1 (supervisor) 2 (supervisor)
Junior Hospitalist 1
Senior Night Team 1
Heme/Onc/BMT Team 1 1
NICU/Neonatal Step Down Unit 1 1 1
PICU 2
Emergency Medicine 0.5 2.5 1
Newborn Nursery 0.75 0.25 0.75
QI-Advocacy 1
Developmental Behavioral Peds 1
Adolescent Medicine 1
Outpatient Based Resident Experience (OBRE) 1
Subspecialty/Elective/Individualized Curriculum 0.5 2.5 6.5
Vacation 0.75 + 7 “Flex” days 0.75 + 7 “Flex” days 0.75 + 7 “Flex” days

Required Rotations

Inpatient Ward Teams

UH Rainbow Babies and Children’s Hospital’s inpatient wards are covered by five resident teams. The five teams (Orange, Blue, Green, Silver and Yellow) are comprised of one junior or senior resident supervisor, three interns, one acting intern (depending on the time of year), and one or two third year medical students. Silver Team changes to an all junior team during the winter blocks. Attending physicians and fellows (where applicable), participate in daily multidisciplinary rounds with each team.

  • Blue Team: Patients on this team are from Neurology (epilepsy, Guillain-Barré, pseudotumor cerebri), Cardiology (congenital heart disease, arrhythmias, post-cardiac surgery), and patients on the Video Epilepsy monitoring unit.
  • Green Team: Patients on this team are from Gastroenterology (Crohn’s disease, ulcerative colitis, autoimmune hepatitis), Metabolism (urea cycle disorders, glyco gen storage diseases), and Endocrinology (Type 1 diabetes, thyrotoxicosis, panhypopituitarism).
  • Orange Team: Patients on this team are from the Nephrology (acute kidney injury, nephrotic syndrome, kidney transplantation) and Pulmonary (asthma, cystic fibrosis, interstitial lung disease).
  • Yellow and Silver Team: Patients on this team are General Pediatrics patients (gastroenteritis, asthma, pneumonia). There is a varied combination of routine pediatric inpatient cases and more complicated patients better served on a general pediatric team with consultant input when appropriate.
  • Junior Hospitalist (Silver Team): This four-week rotation was developed in response to resident feedback. The team consists of five junior residents under direct supervision of an attending. This allows the residents to focus on developing their independent patient management skills under the mentorship of a member of the General Pediatric and Adolescent Medicine Division. This team is added during the five busiest blocks of the year.

Night Coverage

The inpatient ward teams utilize a day team/night team system. Interns do four to six nights per block while on an inpatient ward to allow for maximum continuity and education. Seniors do two weeks of nights at a time as part of a separate rotation. Some juniors will do 1 block of nights instead of 1 block of inpatient ward senior. There is an additional senior level resident on site beginning at 5PM to assist the teams with admissions and procedures during sign-out to ensure that the day team leaves on time.

Hematology and Oncology/Bone Marrow Transplantation (Red Team)

This team covers our Hematology service (sickle cell disease, hemophilia, coagulation disorders), Oncology (leukemia, lymphoma, solid tumors), and BMT patients. This team is covered by 1 intern and 2 junior residents.

NICU

UH Rainbow Babies and Children’s Hospital’s Neonatal Intensive Care Unit has long been a leader in the field of neonatology. Our beautifully redesigned unit was opened in May 2009 and provides each family a private room. The unit is comprised of three teams- one solely resident team, one resident and neonatal nurse practitioner team and one solely NP team. The teams round with their own neonatology fellow and attending physician. The Junior and Senior residents follow an every 4th day call system, while the Interns only do days. Residents care for everything from meconium aspiration to congenital diaphragmatic hernia requiring maximal support with ECMO. In addition, interns spend 2 weeks of their block caring for patients on the neonatal step down unit. The intern works directly with a neonatal attending, fellow, and/or certified nurse practitioner caring for premature babies nearing the end of their hospitalization. Residents learn about special considerations for the NICU graduate including feeding, respiratory issues, and growth and development.

PICU

The 20 bed Pediatric Intensive Care Unit is staffed by five residents from pediatrics and emergency medicine in addition to critical care fellows and attending physicians. Call is every 5th night with an in-house critical care fellow to assist in patient care decisions and management. Residents have the opportunity to care for critically ill children with the benefits of a large support infrastructure and all modern medical technologies, including ECMO and oscillatory ventilation. Clinical conditions seen include respiratory failure, ingestions, heart failure, liver failure, major trauma, organ transplantation, and life-threatening infections. Residents do not write daily progress notes in the PICU while still caring for every patient admitted, which allows for greater time devoted to procedures and management of the PICU’s acutely ill patients.

Emergency Department

The Pediatric Emergency Department at UH Rainbow Babies and Children’s Hospital is the only Pediatric Emergency Department in the city of Cleveland and an American College of Surgeons designated Level 1 Pediatric Trauma Center. We receive patients of all acuity levels from the local emergency medical services, the Hospital’s Critical Care Transport, MedEvac Services, as well as by private vehicle. Residents learn how to assess, resuscitate, evaluate, and treat pediatric patients with acute medical and surgical conditions. Residents are directly supervised by Board-certified Pediatric Emergency Medicine physicians and Board-certified Pediatricians 24 hours a day. Education is provided through bedside teaching and a 25 topic online curriculum that covers everything from splinting and suturing to toxicology and trauma. A separate Rapid Care area, staffed by community pediatricians, helps to manage patient volume during the busy evening hours.

Newborn Nursery

Residents rotate in the Newborn Nursery for three weeks their intern year (days), 1 week during their junior year (nights), and three weeks during their senior year (2 weeks of days and 1 week of nights). The team covers the newborn nursery at University Hospitals MacDonald Women’s Hospital, which is connected to UH Rainbow Babies & Children’s Hospital. Rounds are supervised and led by a general pediatrician. Deliveries are attended by the residents in the Newborn Nursery. A Code Pink resuscitation team as well as a Neonatology Attending or in-house neonatology fellow responds alongside the residents to all deliveries where a pediatrician is needed.

QI-Advocacy

This four week rotation provides first-year residents with an introduction to core principles of both Quality Improvement and Community Health/Child Health Advocacy. During this rotation, residents will develop the basic skills needed to design, implement and evaluate the outcomes of quality improvement initiatives. During the Community Health/Child Health Advocacy portion of the rotation, residents will have the opportunity to spend time working with various agencies that support the well-being of children and families in the Cleveland area. In addition, residents will develop a better understanding of core concepts related to social determinants of health, injury prevention, child health policy, and legislative advocacy. Rotation components include experiential learning within the hospital and local community, small group didactic sessions with faculty and other local experts, as well as completion of individual advocacy and QI “mini-projects.”

Developmental-Behavioral Pediatrics

This is a four-week rotation usually done during the intern year. This rotation includes didactic teaching sessions and clinical experiences designed to educate the resident on a wide variety of topics in Developmental and Behavioral Pediatrics including, but not limited to fetal alcohol syndrome, ADHD, and autism.

Adolescent Medicine

Residents learn about the special needs of adolescents during this four-week rotation. The rotation is led by our Adolescent Medicine specialists working in conjunction with the fellows. It includes time at Adolescent Clinic at UH Rainbow Babies & Children's Hospital as well as the nearby Free Clinic.

OBRE (Outpatient Based Residency Experience)

This block is completed in your PL-2 year, but many of the PL-3 residents interested in primary care request it again as a part of their individualized curriculum. This popular rotation provides an immersion experience in a community setting. Residents work with one of our outstanding providers in the Rainbow Care Network to learn about topics such as ambulatory pediatric care provision, billing and coding, telephone triage, practice management, and basics of health insurance. Residents are able to compare their experiences in the community with those in their own continuity clinic and see how medicine is practiced in different settings and with different patient populations. PL-3 residents can also elect to have their longitudinal continuity clinic experience to be in an OBRE clinic in place of or in combination with continuity clinic at Rainbow’s main campus.

Subspecialty Rotations (Electives and Individualized Curriculum)

During each of the three years, residents have several blocks to explore pediatric subspecialties of their choosing. Residents are often on jeopardy call (back-up call in case of illness or emergency) during these blocks. All residents have one 4 week block of no jeopardy call each year. A list of available electives at UH Rainbow Babies & Children’s Hospital is below; however residents may also design their own electives, with the help of a faculty mentor and program directors.

  • Allergy-Immunology
  • Anesthesia
  • Breastfeeding
  • Cardiology
  • Child Protection & Advocacy
  • Comprehensive Care (Children with Complex Medical Needs)
  • Community Hospitalist
  • Endocrinology
  • Ethics
  • Gastroenterology
  • Genetics
  • Hematology and Oncology
  • Infectious Disease
  • International Health
  • Metabolism
  • Nephrology
  • Neurology
  • Nutrition
  • OBRE (Outpatient Private Practice Pediatrics)
  • Ophthalmology
  • Orthopedic Surgery
  • Otolaryngology (ENT)
  • Pain Medicine
  • Palliative Care
  • Psychiatry
  • Pulmonology
  • Radiology
  • Research
  • Respiratory Therapy
  • Rheumatology
  • Sedation Unit
  • Sports Medicine
  • Subspecialty Prefellow
  • Teaching Skills
  • Transport

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