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Rotational highlights
Inpatient service
The Children’s Medical Center at the VCU Medical Center has two primary inpatient pediatric wards as well as a step-down unit for a total of 43 regular pediatric beds, plus seven step-down beds.
Two housestaff teams provide coverage for all ages of pediatric inpatients on the wards and in the step-down unit. These teams care for general patients, as well as subspecialty patients. Subspecialties include: hematology and oncology, neurology, cardiology, infectious diseases, pulmonology, gastroenterology, allergy and immunology, rheumatology and endocrinology. Residents are supervised by academic faculty members who are dedicated to educating residents and students in evidence-based patient care.
Each team consists of one PGY-3, one PGY-2 and three to four 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 as the junior house officer and shares duties with the PGY-3. 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 caregivers 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
Community Pediatric Experience
Research Experience
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 PICU admission. All patients with primarily non-surgical problems are covered by one of the two housestaff 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-bed to 14-bed unit providing intensive care to critically ill patients and is the only Level 1 PICU in central Virginia. The PICU provides care for children with conditions such as acute respiratory failure, status asthmaticus, circulatory shock, major trauma, head injury, intracranial hypertension, status epilepticus, diabetic ketoacidosis, renal failure and chemical intoxication.
The PICU also provides postoperative care for a broad range of surgical subspecialties such as neurosurgery, cardiac surgery, general surgery, transplant surgery, orthopedics, urology, plastic and ear-nose-and-throat surgery. Averaging 950 admissions a year, the PICU not only receives admissions from the emergency room, pediatric floors and operating rooms, but is a referral site for hospitals in the Richmond area and regional hospitals. The PICU has treated more than 18,000 children since 1978 and is proud of its team approach to care.
The three (PGY-2 or PGY-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 PGY-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.
PGY-1 residents are primarily responsible for intensive patients. PGY-2 residents are primarily responsible for intermediate patients, as well as shared supervision of the PGY-1 residents. The PGY-2 and PGY-3 residents are responsible for calls to the delivery room throughout the day and when they are on call. PGY-3 residents are responsible for the supervision and teaching of PGY-1 and PGY-2 residents. PGY-2 and PGY-3 residents provide coverage at night with a PGY-1or neonatal nurse practitioner. Neonatal nurse practitioners, fellows and attendings also staff the service.
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Newborn Nursery
The Newborn Nursery is staffed by one to two PGY-1s and a PGY-2. 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. There is no overnight call of the Newborn Nursery residents. The PGY-2 resident on night float provides nursery coverage for acute issues.
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Pediatric Emergency Department
The Pediatric ED is the only Level 1 emergency department in central Virginia and 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 12-hour shifts. There is 24-hour coverage of the Pediatric ED. An active transport unit, including MedFlight helicopter, is maintained by the ED attendings. In addition, the ED houses an active child protection program staffed by attendings and nurse practitioners who are experts in child protection and who serve as teachers for pediatric residents.
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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 and sick care to these patients. Residents also spend at least one block per year in the resident clinic.
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, PGY-1 residents see four patients per half-day session; PGY-2 residents see six patients per half-day session; and PGY-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.
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Community Pediatric Experience
PGY-2 and PGY-3 residents also have the option to 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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Research Experience
The pediatric research curriculum was established to give PGY-2 and PGY-3 pediatric residents the opportunity to gain research experience. This includes any work that could be defined as a scholarly project and ranges from bench top studies, to clinical studies, to literature review. Research time is given as one half-day per week during outpatient rotations, which constitutes roughly 26 weeks per year. Residents also have the option to spend four weeks on research electives to enhance the research experience.
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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 Case Conferences on Wednesday mornings. In addition, residents are directly responsible for the day-to-day teaching of medical students on the various services. With faculty guidance, PGY-2s learn to critically appraise an article of their choosing to then present at the monthly residency journal club.
A curriculum of general and subspecialty topics has been developed so that residents have the opportunity to hear a variety of topics during their tenure here.
A pediatric library, which contains a variety of general and subspecialty texts and journals, is located on the floor. There are Internet-connected computers in all areas where housestaff work. All residents have e-mail accounts, as the majority of housestaff 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. Most journals are available online through the VCU Libraries Web site.
American Board of Pediatrics Exam passage is important and the department has developed several ways to assist residents in passing. Recent revisions in the inpatient team structure have resulted in more time available for bedside teaching. The pediatric faculty actively participate 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 resident Web 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 American Board of Pediatrics 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.
The Core Curriculum Review (CCR) program is designed to reflect and complement the core curriculum lecture series. Each month, August-May, a CCR Quiz is given that covers the core sections reviewed that month.
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