Program requirements
Curriculum
Conferences
PL-year summaries
Rotational highlights
Subspecialties
Documentation
Rotational highlights
Inpatient service
The Children’s Medical Center at VCU Health System has two primary inpatient pediatric wards as well as a step-down unit located on the seventh floor of main hospital, for a total of 43 regular pediatric beds plus seven step-down beds.
Two Housestaff teams provide coverage for pediatric inpatients on the wards and in the step-down unit, including infants, toddlers, school-aged children, adolescents and young adults. Team 1 includes patients having diseases within the subspecialties of hematology and oncology, neurology, cardiology, and infectious diseases, as well as general pediatric patients. Team 2 includes patients having diseases within the subspecialties of pulmonology, gastroenterology, allergy and immunology, rheumatology, and endocrinology, as well as general pediatrics patients. Each team has an assigned primary-care physician as the general attending who participates in the education of the residents and medical students. In addition, subspecialty attendings associated with each team hold regularly scheduled rounds with the team.
Each team consists of one PGY-3, one PGY-2 and three PGY-1 residents, as well as five to six medical students. The PGY-3 serves as the senior house officer and provides direct oversight and education for interns. The PGY-3 conducts daily work rounds, facilitates attending rounds and coordinates all non-ICU inpatient admissions. The PGY-2 serves the junior house officer and is responsible for a limited panel of scheduled admissions. He/she also is the designated teaching resident, with responsibility for leading teaching sessions for medical students and performing literature searches on clinical questions that arise during rounds. Each PGY-1 acts as the primary physician for a subset of patients on the team, from admission to discharge. Housestaff are primary care givers for patients regardless of their designation as general or subspecialty admissions. At all levels, they provide education and mentorship to M-3 and M-4 students.
Pediatric Progressive Care Unit
Pediatric Intensive Care Unit
Neonatal Intensive Care Unit
Newborn Nursery
Pediatric Emergency Department
Pediatric Group Practice
Outpatient Rotations
Education
Pediatric Progressive Care Unit (PPCU)
The PPCU is a seven-bed step-down unit for pediatric patients with medical and surgical problems that require close monitoring above the level of care provided on the wards, but that do not require intensive care necessitating PICU admission. All patients with primarily non-surgical problems are covered by one of the two house staff teams, under the supervision of the attending for either general pediatrics or the appropriate subspecialty.
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Pediatric Intensive Care Unit (PICU)
The PICU is a 12-plus bed unit providing intensive care to critically ill patients. It includes acute care and ventilator management, as well as care of postoperative cardiac surgery patients. The three (PL-2 or PL-3) residents who staff the PICU are the primary caregivers to all patients admitted. Supervision is by a PICU fellow and attending. Resident call is every fourth night with cross coverage provided by PL-2 residents. Residents have direct hands-on experience with issues such as ventilator management, sepsis, respiratory failure, trauma and multi-system dysfunction. Recently the PICU underwent a multimillion-dollar renovation with new state-of-the-art equipment and large private rooms for the families.
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Neonatal Intensive Care Unit (NICU)
The NICU is a 40-bed capacity unit that is currently divided into an intensive care unit and an intermediate care unit. The average census is 20 to 30 patients, with half being in the intensive care unit. PL-1 and PL-2 residents are primarily responsible for the direct care of these babies with a graduated increase in responsibility over the two years. PL-3 residents are responsible for the supervision and teaching of PL-1 and PL-2 residents. PL-2 and PL-3 residents provide coverage at night with a PL-1 and are responsible for calls to the delivery room at night. Neonatal nurse practitioners, fellows and attendings also staff the service. Additionally, neonatal nurse practitioners and fellows take calls with the residents.
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Newborn Nursery
The Newborn Nursery is staffed by two interns and a PL2. All residents provide primary and direct care to term infants born at VCU Medical Center under the direction of general pediatrics faculty. The average daily census is 15 to 20 infants. Either interns on the pediatric inpatient service or those assigned to the newborn service provide nighttime coverage. There is no overnight call of the Newborn Nursery residents. The PL2 resident from the inpatient ward teams provides nursery coverage for acute issues.
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Pediatric Emergency Department
The Pediatric ED is a distinct unit contained within the Emergency Department. The Pediatric ED is staffed by Pediatric-ED-trained faculty. Residents from the departments of Pediatrics, Medicine-Pediatrics, Family Medicine and Emergency Medicine provide direct patient care in eight- to 12-hour shifts. There is 24-hour coverage of the pediatric unit. An active transport unit, including MedFlight helicopter, is maintained by the ED attendings. In addition, there is an active child abuse program run out of the ED, staffed by trained professionals who serve as teachers for pediatric residents. Senior residents on ED rotations are responsible for child abuse evaluations at night.
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Pediatric Group Practice
The Pediatric Group Practice, located in the Children’s Pavilion, serves as the resident continuity clinic. Residents have continuity clinic on an assigned day (with rare exceptions) based on other clinical rotation requirements. Morning or afternoon assignments are based on rotational requirements, call schedule and clinic needs. During continuity clinic residents build a patient panel and provide well-child care to these patients. During outpatient rotations, residents cover sick visits in addition to well-child care.
Faculty to resident ratio is 1:3 to 1:4. Residents see a gradually increasing number of patients per session based on academic advancement. On average, PL-1 residents see four patients per half-day session; PL-2 residents see six patients per half-day session; and PL-3 residents see eight patients per half-day session.
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Outpatient Rotations
During the three-year residency, residents have several block outpatient rotations. While on these rotations, residents are exposed to the evaluation of pediatric patients in the outpatient setting. Residents rotate on outpatient surgical subspecialties, outpatient pediatric subspecialties, behavioral and developmental pediatrics, adolescent medicine, and also have time for direct learning or supervising in areas such as child abuse or HIV clinics.
PL-3 and PL-2 residents also spend one half-day session per week during their outpatient and subspecialty electives at the office of one of the community pediatrics faculty members. Here they can experience outpatient pediatrics in various settings, develop an understanding of the differences between academic and community practice and see diversity of disease processes. Often the residents have used these experiences to develop ties to the community and, ultimately, generate employment opportunities.
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Education
Residents are involved extensively in the educational program. Senior residents present new admissions and important follow-up of patients at the twice-weekly morning report conference. Interesting patient cases are presented at Chairman’s Case Conferences on Wednesday mornings. In addition, residents are directly responsible for the day-to-day teaching of medical students on the various services.
A curriculum of general and subspecialty topics has been developed and is conducted on a rotational basis so that residents have the opportunity to hear a variety of topics during their tenure here. Mini-didactic and interactive topics also are covered daily at the beginning of each continuity clinic session on primary care topics and competencies. Journal club is held once a month at noon conference.
A pediatric library, which contains a variety of general and subspecialty texts and journals, is located on Main – 7. There are Internet-connected computers in all major areas where house staff are working. All residents have e-mail accounts, as the majority of house staff communication occurs via e-mail. Additionally, the medical school library (Tompkins-McCaw Library) is located one block from the hospital and houses a vast array of journals, books and other educational resources.
American Board of Pediatrics Exam passage is an important issue and therefore the department has developed several ways to assist residents in this. Recent revisions in the inpatient team structure have resulted in more time available for bedside teaching. The primary-care faculty actively participates in resident teaching in the clinic, the inpatient services and the newborn nursery. Each rotation has written goals and objectives that are published on the residency online management database site. During the past three years, additional subspecialists have been recruited to the Divisions of Pulmonary, Gastroenterology, Endocrinology, NICU, and PICU.
Each resident is expected to take the annual in-training exam. Results of this exam are shared with the residents, and they are individually advised about study techniques in order to improve their future performance on that exam, as well as the ABP exam.
The Core Curriculum Review (CCR) program is designed to reflect and complement the core curriculum lecture series. Each month August-May there will be a CCR given that will cover the one to three core sections reviewed that month.
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