Rotation, Calls & Electives
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, 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.
|Inpatient ward||5.5||1 (supervisor)||2 (supervisor)|
|Senior Night Team||-||-||1|
|NICU/Neonatal Step Down Unit||1||1||1|
|Developmental Behavioral Peds||1||-||-|
|Outpatient Based Resident Experience (OBRE)||-||1||-|
|Vacation||0.75 + 7 “flex” days||0.75 + 7 “Flex” days||0.75 + 7 “Flex” days|
Inpatient Ward Teams
UH Rainbow Babies and Children’s Hospital’s inpatient wards are covered by five resident teams. The five teams (Orange, Red, 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.
- Orange Team: Patients on this team are from Neurology (Seizures, Guillain-Barré, Pseudotumor Cerebri), and Epilepsy for those patients with more complex seizure disorders, and Pulmonary (asthma, cystic fibrosis, interstitial lung disease).
- Green Team: Patients on this team are from Gastroenterology (Crohn's disease, ulcerative colitis, autoimmune hepatitis), Metabolism (urea cycle disorders, glyco gen storage diseases), Nephrology (acute kidney injury, nephrotic syndrome) and Endocrinology (Type 1 diabetes, thyrotoxicosis, panhypopituitarism).
- Red Team: Patient on this team are Hematology (Sickle Cell Anemia, DVTs) and Oncology (Leukemia, Lymphoma, solid organ tumors, brain tumors, and BMT)
- Yellow and Silver Team: Patients on this team are 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.
- 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 Division of Pediatric Hospital Medicine. This team is added during the five busiest blocks of the year.
- Cardiology: All interns spend 2 weeks on our inpatient cardiology service caring for children with complex congenital heart disease including those requiring post-operative care. This is a separate experience from those wishing to do a cardiology elective.
The inpatient specialty ward teams utilize a day team/night team system. Interns do three weeks of days and one week of nights per block while on an inpatient ward to allow for maximum continuity and education. The inpatient general pediatric ward teams utilize a call schedule. This is one call every 4-5 days. One of the goals of call is to allow residents to attend morning rounds so they can present the patients they admitted overnight and provide the rationale behind their medical decision making and thus receive real time feedback for the care they provided.
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 provides each family a private room. The unit is comprised of three teams, two resident and one 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. Residents learn about special considerations for the NICU graduate including feeding, respiratory issues, and growth and development.
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.
The Pediatric Emergency Department at UH Rainbow Babies and 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. Education is provided through bedside teaching and a 25 topic online curriculum that covers everything from splinting and suturing to toxicology and trauma.
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 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.”
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.
Taking place at our new UH Rainbow Center for Women and 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.
- Business of Medicine
- Child Protection & Advocacy
- Comprehensive Care (Children with Complex Medical Needs)
- Community Hospitalist
- Hematology and Oncology
- Infectious Disease
- International Health
- OBRE (Outpatient Private Practice Pediatrics)
- Orthopedic Surgery
- Otolaryngology (ENT)
- Pain Medicine
- Palliative Care
- PICU Pre-fellow
- Respiratory Therapy
- Sedation Unit
- Sports Medicine
- Subspecialty Pre-fellow
- Teaching Skills