Overview

The goal of the residency program is to train physicians to become competent general pediatricians with sufficient background in the subspecialties and critical care to manage the broad mix of general pediatric and subspecialty problems. A major focus of the program is care of the child and adolescent in the outpatient setting. In addition to the Continuity Clinic experience, there are 38 weeks of general ambulatory care and emergency room experience during the three-year residency. There is a four-week-long rotation in Child Development and Behavior in the first year. An Adolescent Medicine rotation of four weeks occurs in the second year. The management of the acutely ill child, minor musculoskeletal trauma, and suturing technique is the focus of the rotations in the Christus Santa Rosa Children's Hospital Emergency Center. First-year residents spend 22 weeks on inpatient services including 6 weeks on the Christus Santa Rosa Children's Hematology/Oncology inpatient service. Senior residents will spend a total of 28 weeks on inpatient services over the 2 years including 8 weeks in the Christus Santa Rosa Children's Hospital Pediatric Intensive Care Unit and 4 weeks on the Hematology/Oncology inpatient service. Third year residents have a four week night float rotation at the Children's Hospital.

Separate rotations on Neonatal Intensive Care and on the Term Nursery Service allow the attention of the resident to be focused on the problems of the acutely ill neonate at one time and on the more common problems of the normal newborn at another. The pathophysiologic basis for the management of neonatal problems is the focus of faculty attending neonatologists during the rotations in the newborn nurseries. Resuscitation of the newborn is particularly emphasized. In addition to daily rounds and faculty lectures, there is a weekly discharge planning conference and a Perinatal Mortality Conference is held monthly.

The two required subspecialty rotations in Cardiology, Endocrinology or Nephrology, in addition to the time spent in Hematology/Oncology, prepare the resident to individually manage common subspecialty problems and prepare him or her to participate as a member of a multidisciplinary team in the care of complex subspecialty patients.

The Ambulatory Care rotation provides the resident with an opportunity to experience general and subspecialty outpatient pediatric care with on-site, readily available, full-time faculty for consultation/teaching. The resident's Continuity Clinic provides the core of this rotation. Each resident has the opportunity to follow patients that he/she has recruited from other rotations and the Walk-In Clinic, to provide ongoing well-child care, care for children with chronic illness or recurring problems, and care for children with acute illness. The resident attends his/her Continuity Clinic one-half day a week throughout the three-year residency, allowing the opportunity to observe each child through a two- or three-year period of growth and development.

There are 24 weeks of elective time, 8 weeks in the PL-2 year and 16 weeks in the PL-3 year. Sixteen weeks of the elective time are call-free providing the potential for off-campus electives. Interns and residents assigned to the NICU take night call four times during each four week rotation. The nights not covered by housestaff are covered by neonatal nurse practitioners and moonlighting physicians. Interns and residents assigned to the University Hospital Ward service take call every fifth night.

Interns assigned to the Children's Hospital Ward services have call every sixth night. Residents assigned to these services have two or three call nights per month. Resident level coverage for the wards the remaining nights is provided by the night float resident.

Residents assigned to the Children's Hospital PICU take night call four times during each four week rotation. Interns and residents are assigned to outpatient rotations and residents assigned to electives with call or subspecialty rotations average 3 or 4 nights of call per month, either on the University Hospital Ward or, as residents, in the Children's Hospital PICU.

The residency program is committed to complete compliance with the July 2003 ACGME Resident Duty Hour Regulations.

Management of problems to the extent of the house officer's capability is encouraged. Fellows and sub-specialists are available to support rather than usurp the house officer's management of patients. Responsibility for patient care and teaching is increased from year to year. Instruction of medical students is considered a part of the house officer's responsibilities at all levels. The PL-1 is the patient's primary physician. The senior residents supervise the care provided by PL-1s. Regularly scheduled didactic conferences which emphasize active learning are central to the residency experience. At the Children's Hospital the work day begins with morning report during which the previous night's admissions are discussed with the program director, assistant program director, ward attending staff and housestaff. Scheduled daily noon conferences at the Children's Hospital present an array of faculty lectures covering both general and sub-specialty topics. There are separate faculty lecture series for the critical care units and small group seminars during the required subspecialty months. Grand Rounds is held weekly. On the inpatient ward services at the Children's Hospital and University Hospital formal daily faculty attending rounds emphasize teaching of the residents; instruction of medical students is a shared responsibility.

The Division of General Pediatrics presents a comprehensive general pediatric curriculum as part of the resident's Continuity Clinic experience. This curriculum, 108 seminar hours, covers the entire range of general pediatric and acute care management issues. The curriculum begins with a comprehensive overview of health supervision issues including well child visits, immunizations and safety issues and progresses to comprehensive coverage of behavioral/developmental topics, normal growth and neuromaturation, nutrition, and normal and abnormal psychological and behavioral development. Separate seminar topics include social and cultural factors in healthcare, ethics, and practice management. The gamut of general pediatric acute care management issues ranging from asthma to acne and menstrual disorders to musculoskeletal injuries is covered.

Reliance on evidence based medicine is emphasized throughout the residency. Interns attend two one-day seminars which introduce them to the fundamentals of evidence based medicine including informatics in literature searches and study design. A two monthlong board review course is held for the third-year residents each spring in the context of noon conference.

Completion of Training The program encourages residents to develop their clinical skills and professional interests to the greatest extent possible. We provide active support for individuals entering general pediatric practice and those seeking subspecialty fellowship training. Over the past five years, upon completion of training, three-quarters of the graduates of the program have entered Primary Care General Pediatrics. They secured practice positions across the country including the following states: California, Colorado, Florida, Missouri, Oregon, Minnesota, Texas, Virginia, and Washington. The remaining quarter secured fellowship training across the country in a variety of disciplines including: Adolescent Medicine, Child Development, Cardiology, Critical Care, Endocrinology, General Academic Pediatrics, Hematology/Oncology, Neonatology, Pulmonology and Sports Medicine.