Rotation, Calls & Electives

X+Y System

Our residency program is unique in that our clinical time is structured in a “X+Y” scheduling system rather than the traditional month long rotations.

UH Rainbow Babies & Children’s “X+Y” system is a 6+2 schedule. During the “X”, resident experiences may include 2 or 4 week inpatient rotations, electives, or other individualized curriculum. During the “Y”, residents have their outpatient continuity clinic coupled with other outpatient based curriculum such as Adolescent Medicine and Developmental and Behavioral Pediatrics. Our “Y” schedule allows residents to mix across class years so that you get the opportunity to work with all of your colleagues. Our ambulatory blocks occur with the same cohort of residents, who are grouped into one of four “Flights”, which allows you the opportunity to have academic half days together as well as create longitudinal group experiences.

This system has been embraced by our residents since the change was made 3 years ago. There are many advantages of this system, some of which are listed below.

  • Residents are on ambulatory for 2 weeks out of every 8 weeks. This helps to break up long stretches of inpatient pediatrics.
  • Residents generally have weekends off during ambulatory. This allows for more golden weekends during the 3 year residency experience.
  • Residents no longer start on inpatient in the morning and then “shift gears” to continuity in the afternoon. Separating these allows residents to better focus on outpatient pediatrics when on their ambulatory blocks and on their hospitalized patients when on inpatient services. It also allows for the inpatient teams to stay whole throughout the day and offers additional opportunities for inpatient didactics.
  • Residents are on ambulatory every 2 months, which allows for continuity with their patients. This is particularly true for infants who are seen for well visits at 0, 2, 4, and 6 months of age as well as offering the ability to maintain continuity with patients who need short-term follow-up (1 – 2 days).



Each year is divided into 13 four-week blocks to maximize the clinical experiences and available elective time.

  • Each year, all residents have one two-week block of vacation, two one-week blocks of vacation, and additional time off during the winter holidays.
  • Additionally, first year residents have a one-week vacation at the end of their internship year.
Rotation PL-1 PL-2 PL-3
Inpatient ward/Senior Night Team 5.5 1 (supervisor) 3 (supervisor)
Junior Hospitalist 1
Heme/Onc/BMT Team .5 1
NICU/Neonatal Step Down Unit 1 1 1
Emergency Medicine .5 2.5 1
Newborn Nursery .75 .25 .75
QI-Advocacy 1
Developmental Behavioral Peds .5 .5
Adolescent Medicine .5 .5
Outpatient Based Resident Experience (OBRE) 1
Subspecialty/Elective/Individualized Curriculum .5 2.5 6.5
Vacation 1 1 1


Inpatient Ward Teams

University Hospitals Rainbow Babies & Children’s Hospital’s inpatient wards are covered by six resident teams. The six teams (Orange, Red, Green, Silver, Purple and Yellow) are staffed by 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 their team. Each color team comprises the following services:

  • Orange Team: Pulmonology (asthma, cystic fibrosis, interstitial lung disease) and Endocrinology (Type 1 diabetes, thyrotoxicosis, pan-hypopituitarism)
  • Purple Team: Neurology (seizures, Guillain-Barré, Pseudotumor Cerebri), Epilepsy, and Cardiology (complex congenital heart disease, postoperative care of the cardiac patient, congestive heart failure)
  • Green Team: Gastroenterology (Crohn’s disease, ulcerative colitis, autoimmune hepatitis) and Nephrology (acute kidney injury, nephrotic syndrome)
  • Red Team: Hematology (sickle cell anemia, hemophilia, thalassemia) and Oncology (leukemia, lymphoma, solid organ tumors, brain tumors, and BMT)
  • Yellow and Silver Team: General pediatrics. There is a diverse group of patient disease processes on our general pediatric service including gastroenteritis and dehydration, bronchiolitis, Kawasaki’s disease, and medically complex children. Patients on the Metabolism service (urea cycle disorders, glycogen storage diseases) are also cared for by Yellow team.
  • Junior Hospitalist (Silver Team): This four-week rotation provides junior residents with a unique opportunity to develop their independent patient management skills under the mentorship of a member of the Division of Pediatric Hospital Medicine. The team consists exclusively of five junior residents who work in close collaboration with the pediatric hospitalist on service.

Day/Night Coverage

The inpatient ward teams utilize a day team/night team system. Over the course of the year, interns typically work a total of 14 weeks on day teams and six weeks on night teams, allowing for maximum continuity and education.


UH Rainbow Babies & Children’s Hospital’s Neonatal Intensive Care Unit has long been a leader in the field of neonatology. Our beautifully redesigned unit provides each family a private room. The unit comprises of two hybrid resident/NP teams, each with a neonatology fellow and attending. The Junior and Senior residents follow a day/night system, whereas the interns only do days. Residents care for everything from meconium aspiration to congenital diaphragmatic hernia requiring maximal support with ECMO. The NICU has its own didactic curriculum, with neonatology lectures given by our esteemed attendings and fellows.


The 20-bed Pediatric Intensive Care Unit is staffed by five residents from pediatrics in addition to critical care fellows and attending physicians. Call is every 5-6 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, 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. Residents in the PICU also get to enjoy small critical-care noon conferences given by our fellows and attendings.

Emergency Department

The Pediatric Emergency Department at UH Rainbow Babies & Children’s Hospital is the only pediatric emergency department and an American College of Surgeons designated Level 1 Pediatric Trauma Center in Cleveland. 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, evaluate and treat pediatric patients with acute medical and surgical conditions. Residents are directly supervised by board-certified pediatric emergency medicine physicians 24 hours a day. During their ED rotation, residents also attend interactive weekly didactic sessions that are led by our emergency medicine faculty.

Newborn Nursery

Residents rotate in the Newborn Nursery for three weeks their intern year (days), one week during their junior year (nights), and three weeks during their senior year (two weeks of days and one 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 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 rotation is split between the first and third years of residency. The intern experience is an introduction to developmental pediatrics including clinics in general developmental, fetal alcohol syndrome, ADHD, and autism. This is supplemented with didactic teaching sessions designed to educate the resident on a wide variety of topics in developmental and behavioral pediatrics. In the third year, the residents take on additional responsibilities, now with a much deeper appreciation of the system based practices needed to care for patients with developmental and behavioral problems.

Adolescent Medicine

This rotation is split between the first and third years of residency. Taking place at our new UH Rainbow Center for Women & Children, residents learn about the unique medical and social needs of adolescents during this rotation. The rotation is led by our adolescent medicine specialists and psychologists. This rotation also includes a variety of off-site visits to our community partners who specialize in providing medical, social, and psychiatric care to adolescents.

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, 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. 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
  • Business of Medicine
  • Cardiology
  • Child Protection & Advocacy
  • Comprehensive Care (Children with Complex Medical Needs)
  • Community Hospitalist
  • Dermatology
  • 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
  • PICU Pre-fellow
  • Psychiatry
  • Pulmonology
  • Radiology
  • Research
  • Respiratory Therapy
  • Rheumatology
  • Sedation Unit
  • Sports Medicine
  • Subspecialty Pre-fellow
  • Teaching Skills
  • Transport