Rotations, Calls and Electives

Rotations/Electives

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

• Residents have two 2-week blocks of vacation each year plus time off during the December holiday season.
• First year residents also have one-week of vacation at the end of their internship year.
• In the PL-2 and PL-3 years, one elective block is free from call responsibilities; in addition, one to five blocks of electives include only Jeopardy call – sick call with no scheduled in-house nights or call.

Night Coverage
University Hospitals Rainbow Babies & Children's Hospital residency program transitioned to an integrated shift system for interns and senior residents on the wards in 2010. With the active input of the residents, both directly and via the Resident Advisory Council leadership, interns have night shifts during their inpatient ward experience, allowing for improved continuity and education. We believe that being proactive about this change allowed us the time for the fine-tuning necessary to have a successful transition when the new rules went into effect July 2011.

REQUIRED ROTATIONS

Inpatient Ward Teams
UH Rainbow Babies and Children’s Hospital’s inpatient wards are covered by three resident teams. Each team is comprised of two junior or senior resident ward supervisors, five to six interns, one to two acting interns (depending on the time of year), and two or three third year medical students. Each team includes patients with a variety of subspecialty and general pediatric medical conditions. Attending physicians and fellows (where applicable), participate in daily multidisciplinary rounds with each team.

• Blue Team
  This team cares for General Pediatric patients (gastroenteritis, asthma, pneumonia), Endocrinology (Type 1 diabetes, thyrotoxicosis, panhypopituitarism), Neurology (epilepsy, Guillain-Barré, pseudotumor cerebri), Metabolism (urea cycle disorders, glycogen storage diseases), and Infectious Disease.
• Green Team
  This team includes General Pediatric patients, Cardiology (congenital heart disease, arrhythmias, post-cardiac surgery), and Gastroenterology patients (Crohn’s disease, ulcerative colitis, autoimmune hepatitis).
• Orange Team
  Patients on this team are from the Nephrology (acute kidney injury, nephrotic syndrome, kidney transplantation), Pulmonary (asthma, cystic fibrosis, interstitial lung disease), and General Pediatrics patients admitted by community general pediatricians.
• Junior Hospitalist (Silver Team)
  This 4 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 months of the year.

Hematology/Oncology/BMT (Red Team)
This team covers our Hematology service (sickle cell disease, hemophilia, coagulation disorders), Oncology (leukemia, lymphoma, solid tumors), and BMT patients. The team was reconfigured with the assistance of resident input for 2011-2012, and currently consists of 2 interns and 2 senior residents. In 2012 and beyond, this team will be covered by 2 interns and 2 junior residents. There is no night coverage on red team.

Intensive Care Units
NICU
UH Rainbow Babies and Children’s Hospital’s Neonatal Intensive Care Unit has long been a leader in the field and was ranked #4 by US News and World Report in 2010. Our beautifully redesigned unit opened in May of 2009 and provides each family a private space to stay alongside their baby during the hospitalization. The unit is comprised of two teams, each of which includes an intern, junior resident, senior resident, nurse practitioners, a neonatology fellow and an attending physician. Call averages every 4th to 5th night for upper level residents and residents are supported on-call by the in-house neonatology fellow. Residents do not cover deliveries while on their NICU rotations. Residents care for everything from transient tachypnea of the newborn to congenital diaphragmatic hernia requiring maximal support with ECMO.

PICU
The recently renovated 20 bed Pediatric Intensive Care Unit is staffed by five or six junior residents from pediatrics and emergency medicine, critical care fellows and an attending physician. Call is every 5th to 6th night with in-house critical care fellow’s on-call to assist in patient care decisions and management. During this rotation, 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 you’ll see 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. This allows for greater time devoted to procedures and management of the PICU’s acutely ill patients.

Emergency Department
The Pediatric Emergency Department (PED) 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 and MedEvac Services as well as by private vehicle.

Here, residents learn how to assess, resuscitate, evaluate and treat pediatric patients with acute medical and surgical conditions. The residents are directly supervised by Board-certified Pediatric Emergency Medicine physicians and Board-certified pediatricians 24 hours a day. Interns rotate through the PED during their Ambulatory/Surgical block rotation; junior and senior residents spend at least four additional months in the PED over the course of their residency.

Education is provided through teaching about actual patients and a 25 topic on-line curriculum that covers everything from splinting and suturing to toxicology and trauma.

A separate Rapid Care area, staffed by community pediatricians, helps manage the patient flow during the busy afternoon and evening hours. A brand new Emergency Medicine Center opened in July 2011.

Newborn Nursery
Residents rotate in the Newborn Nursery for two weeks during each year. The team covers the newborn nursery at University Hospitals MacDonald Women’s Hospital, which is physically connected to UH Rainbow Babies & Children’s Hospital. Rounds are supervised and led by a general pediatrician while a Neonatology Attending responds alongside residents to all deliveries where a pediatrician is needed. Call for the upper level resident is generally every 4th night and the in-house neonatology fellow along with the Code Pink resuscitation team assist the resident with any complicated deliveries.

Developmental Pediatrics
This is a four week long 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.

OBRE (Outpatient Based Residency Experience)
This block experience for PL-2 residents provides a unique immersion experience in a community setting. Residents work with one of our outstanding providers in the Rainbow Care Network throughout this experience. The educational focus of this rotation includes topics such as ambulatory pediatric care provision, billing and coding, telephone triage, practice management and basics of health insurance. Residents work with our community partners and their office staff to gain these skills. Residents complete a self-directed reflection exercise that allows them to compare their experiences in the community with those in their own continuity clinic.

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

Ambulatory Surgical Subspecialties/ER
This two-week rotation gives interns experience in the Pediatric Emergency Department at UH Rainbow Babies & Children’s Hospital and in several of the surgical subspecialty clinics. This allows for learning the pathophysiology and management of patients traditionally only cared for by the pediatric surgeons and subspecialty surgeons. In addition, this rotation includes visits to a community home for children with developmental disabilities, and to a pediatric hospice provider.

Pediatric Surgery/Anesthesia
This two-week rotation as a senior resident allows for collaboration with our pediatric surgeons with inpatient management of surgical patients. Time is divided between assisting with surgical consultations and managing workflow on the floors. This rotation also allows residents exposure to pediatric anesthesia, allowing them to hone their skills with procedures.

Subspecialty Rotations/Electives
During each of the three years, residents have several blocks to explore pediatric subspecialties of their choosing, from Cardiology to Radiology, Ethics, and International Health. There is no scheduled in-house call during these months, though the resident is often on Jeopardy call (back-up call in case of illness or emergency). 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.