For inpatient services, interns and residents usually begin pre-rounding around 6:30 am. Vital signs, labs, and radiology reports can be retrieved on any computer in the hospital or on the iPad supplied to each resident. All residents are expected to attend and participate in Morning Report from 7:55-8:30, Monday through Friday. Rounds with the attending usually begin around 8:30. Most teams perform family centered or walk rounds in the morning.
Rounds are designed to be led by the upper level residents with attending guidance and supervision. The attending is present every day for rounds and plays a vital role in day-to-day education. Inpatient rounds are finished by 12:00 noon so that residents are able to attend noon conference.
GENERAL INPATIENT SERVICES (GIPS)
- The General Inpatient Service is divided into 4 teams.
- Each GIPS team consists of an attending, three pediatric residents and 1-3 medical students
- Each team is also assigned a social worker, case manager, and pharmacist to assist with follow-up appointments, patient teaching, working with DHR, coordinating prescriptions, along with many other services
- Each team has a cap of 16 patients with a max of 8 patients admitted on a call day
- Patients are admitted to GIPS teams using a “drip system” in which each team can get new patients daily. Overflow patients are admitted by the hospitalist team
- A separate night float team is in house at 5 pm to perform cross-cover and admissions
- Residents present interesting patients for Stagno Morning Report 2-3 times during the month
- Ward teams participate in monthly simulation cases to enhance their learning.
The Emergency Department rotation consists of shifts ranging from 4-12 hours in duration. Like most urban children’s hospitals, the emergency department cares for a wide array of problems ranging from routine pediatric concerns to acute, life-threatening traumas and illnesses. The total number of patient visits to the Children’s of Alabama ED in 2014 was 69,158, with 395 of these being level I or II trauma patients. During the emergency department rotation, residents provide initial contact and care with supervision from fellowship trained, pediatric emergency medicine specialists. The Children’s of Alabama ED is equipped with 54 single-patient rooms, along with 4 state of the art trauma bays.
Residents spend, on average, ½ day a week in Continuity Clinic at the Primary Care Clinic. The Primary Care Clinic is located in the Park Place building, a building directly adjacent to the hospital. Residents serve as the general pediatricians for children from the surrounding community and are each assigned a patient panel of approximately 100 patients, ranging from newborns to 18 year olds, with a variety of medical problems. Residents also enjoy working with the same primary care clinic pediatrician as their attending throughout the 3 years of residency.
As part of the outpatient pediatric education, residents also rotate through various outpatient clinics including adolescent medicine, Sparks Center at UAB, sub-specialty clinics at Children’s of Alabama, Jefferson County Health Department community care clinics, along with a number of community private pediatric offices.
All residents complete a one month experience in adolescent medicine. This rotation provides the basis for evaluation and care of this special pediatric population. Training locations include the inpatient and outpatient facilities of the Children’s of Alabama as well as focused instruction in eating disorders clinic, juvenile detention centers, weight management clinics, adolescent HIV clinics, adolescent gynecology clinics, and a teen transition clinic.
BEHAVIOR AND DEVELOPMENT
An understanding of normal and abnormal behavior and development are key foundations of training in pediatrics. A one month experience in behavior and development is required for all residents. Subspecialty clinics are the backbone of this rotation. Residents participate in the following specialized clinics: autism, Down syndrome, muscular dystrophy, newborn follow up, occupational and physical therapy, and spina bifida among others. Educational modules and clinical case scenarios supplement the clinic rotations.
NEWBORN NURSERY and NEONATAL INTENSIVE CARE
One month is spent in the newborn nursery at UAB’s Women and Infant’s Center during intern year learning routine newborn care . They are taught normal and abnormal physical exam findings as well as the management and evaluation of common newborn problems such as: jaundice, possible sepsis, feeding intolerance, breastfeeding, and heart murmurs. Residents also gain expertise with circumcisions on this rotation.
A total of 4 months during residency is spent in the 120 bed, level III+ Regional Neonatal Intensive Care Unit (RNICU), also located at UAB’s Women and Infant’s Center. As one of the largest and busiest NICU’s in the nation, residents can expect to see a wide range of patients ranging from extremely low birth weight infants to critically ill full term neonates. Residents attend all high risk or otherwise complicated deliveries and thus become proficient at resuscitating newborns on this rotation. Additionally, residents have the opportunity to perform numerous procedures including intubations, umbilical line placement, and lumbar punctures. Residents are also exposed to the management and care of neonates with cardiac lesions while in the NICU. While in the NICU, overnight call for 2nd and 3rd year residents is every 4th night. Interns are on a rotating night float system with approximately one consecutive week of night shifts and three weeks of day shifts per month.
PEDIATRIC INTENSIVE CARE
Second year pediatric residents spend two months in the Pediatric Intensive Care Unit (PICU) at Children’s of Alabama. This 22 bed unit provides state-of-the art, critical care for the sickest children in the state and region. Residents gain in-depth experience in the identification and management of respiratory and cardiac failure, treatment of sepsis, management of severe trauma, post-operative complications and a wide range of other disorders. This experience provides confidence to manage sick patients for the remainder of our residents' careers. Residents also hone their procedural skills with intubations, line placement and other diagnostic procedures during these rotations. Care is supervised by Pediatric Critical Care trained faculty.
PEDIATRIC SUB-SPECIALTY ROTATIONS (CHILDREN'S OF ALABAMA AND UNIVERSITY HOSPITAL)
The UAB Pediatric residency training program offers sub-specialty exposure to the full array of pediatric experiences. Sub-specialty rotations include hematology-oncology, pulmonary, nephrology, allergy-immunology, rheumatology, endocrinology, gastroenterology, infectious disease, neurology, cardiology, and genetics. Subspecialty rotations are spread throughout the three years of training. During these months residents experience inpatient and outpatient care.