The Intern Year

Each year of our Pediatric Residency, including the intern year, consists of thirteen four-week Block Rotations. 

The table at right demonstrates how the typical year is divided into separate rotations to develop you as a pediatric expert.  

Inpatient Ward Rotations

On the wards, your team will consist of:

• One to two attending physicians
• A ward senior (a PL-2 or PL-3 resident)
• Five Children's Hospital Los Angeles interns 
• Two to three medical students.

Interns are assigned to patients on the first day of the rotation and are responsible for all of their care.

Our schedule is designed to preserve your interactions with attendings, continuity of patient care and our educational mission, while ensuring compliance with the new Accreditation Council for Graduate Medical Education duty hour guidelines. Patient load varies from three to seven patients.

Rounding Schedule 

The daily rounding schedule during inpatient ward rotations is outlined for you below with each of the rounds described below:

 
Work Rounds

Work rounds are run by the senior resident and start at 7 a.m. By this time, interns are expected to have reviewed their patients' flow sheets and lab results, examined the patients, and developed a preliminary plan for each patient. The patients are then discussed in an organized and thoughtful manner (at times at the bedside). Senior residents also present patient-related teaching topics during work rounds.

Attending Rounds

Attending rounds are conducted in a variety of formats. On Monday mornings, each ward team has its own general/subspecialty teaching rounds, which may include discussion of newly admitted patients, bedside teaching or a formal lecture on a topic chosen by the team. On Tuesday and Thursday mornings, attending rounds are presented in a morning-report format, with all three general ward teams in attendance.

Morning Report

Morning report is a forum for discussing interesting patients that have been recently admitted to Children's Hospital. Various faculty members and the chief residents are in attendance. This is an excellent educational conference and opportunity to review the presentation, differential diagnosis and management of both common and unusual pediatric problems.

Case Conference

Case conference is a weekly, senior-resident led presentation and discussion of an interesting case. Audience participation is encouraged in generating a problem list and discussion of differential diagnoses and work-up. Pediatric faculty are in attendance to help with the discussion.

Intern Rounds

Intern rounds are held monthly and led by the chief residents and one of the program directors. The conferences focus on a variety of issues from development to health care basics.

Noon Conference

Noon conference is an hour-long lecture on various pediatric topics. Both general and subspecialty pediatric topics are discussed. In-training exam reviews, managed care issues, and other various health care topics are also presented. Journal Clubs are scheduled on a monthly basis during this hour. 

Community Pediatrics & Advocacy Rotation

The community pediatrics and advocacy rotation comprises two blocks of the intern year. During one of these blocks, interns spend two weeks on community pediatrics and two weeks on vacation. During the second block, interns spend one week on introduction to behavior  and development, one week fulfilling administrative duties, and two weeks on vacation.

During the Community Pediatrics Block, interns spend time at community sites learning about various child health resources, different care delivery models, and the role of pediatricians in community health. Some of the sites include, Women Infants & Children, the USC mobile dental van, Project NATEEN, the Department of Public Health, and Alliance for Child Rights. Interns also teach injury prevention lessons at local elementary schools, and teach healthy lifestyle and nutrition in obesity clinics.

During Introduction to Behavior and Development, interns spend time with our specialists learning how to use developmental screening tools. They also participate in specialty clinics including Autism Clinic and Rett Syndrome clinic.  During this block, they also spend time at various community sites which serve children with developmental disabilities, including Casa Colina, Regional Center, and a CCS Medical Therapy Unit.

In the spring, all interns will also participate in a legislative advocacy module. Groups of five or six interns work together with a faculty advisor to learn about current child health policy issues, develop legislative advocacy skills, and learn about local elected officials. The groups will then prepare letters and policy briefs or fact sheets, and present them to legislative aides during visits to local legislators' offices.

Interns on the IMPACT Project Track spend two of their advocacy weeks working on the development of a single project, with the use of up to four additional weeks during their free elective time during first year. During this time they work closely with advocacy directors and mentors to do a needs assessment, design and implement their study or intervention, arrange meetings with key community partners, and complete grant applications as applicable. They also learn skills to perform evaluation research on their projects, and present their findings at an academic conference. Project Track interns will complete selected elements of the community pediatrics block during the second year, and are strongly encouraged to spend elective time in the second and third year to complete their projects. Learn more about the advocacy rotation.

Project Track residents will be expected to present at a major meeting and at Pediatric Grand Rounds.  Lastly, as third years, they will participate in legislative advocacy trainings/activities in Sacramento. Some examples of past and current projects include: 

• Evaluating asthma quality of care measures at a community clinic
• Obesity prevention in an early childhood setting
• Assessing the impact of south LA hospital closures on access to pediatric services
• Improving special education resources for general pediatric clinic patients

All residents will participate in a home safety visit for one of their continuity clinic patients during their second year. During this advocacy project, Home Safe Home, residents choose a continuity clinic patient who is less than two years old, and completes a pre-visit survey with home safety and environmental health modules reviewed. A family-centered home visit is conducted with a faculty mentor, along with an environmental assessment of the child’s residence.  

Emergency Department Rotation (Children's Hospital Los Angeles)

One block of internship is spent in the Children's Hospital Emergency Department (ED). The Children's Hospital ED is a designated Level I Trauma Center and Pediatric Critical Care Center, and therefore cares for a variety of both medical and surgical pediatric problems. It is divided into two areas, which include acute/trauma care and a walk-in clinic. Interns are assigned primarily to the Acute Care area, although they are invited to participate in traumas and in the walk-in clinic as well. There is a series of lectures given by the fellows and attendings during the month. ED shifts are 10 hours long and there are eight days off during the rotation. There is also the opportunity to go out on transports during the ED block.  
 

Newborn Nursery Rotation (Los Angeles County-USC)

Every intern spends four weeks in the LAC-USC Newborn Nursery examining healthy newborns and treating common problems in the neonate. There is no overnight call during this rotation.
 

Neonatal & Infant Critical Care Rotation (Los Angeles County-USC Center)

In the LAC-USC NICU, interns are assigned to a team comprised of LAC and Children's Hospital housestaff. Interns learn how to resuscitate newborns and treat common neonatal illnesses requiring ICU care. Daily rounds are led by attendings and NICU fellows and start at 9 a.m. Lectures take place at 11 a.m. Monday through Thursday.

Outpatient / Community Pediatric Service (Children's Hospital Los Angeles)

The General Pediatric Service (GPS) houses weekly continuity clinics in which residents build and follow a panel of patients for general ambulatory pediatric care. Each resident has clinic one half day per week, typically between the hours of 1 p.m.- 5:30 p.m. New patient appointments are one hour long, and 30-40 minutes are provided for follow-up and well child care visits. Residents learn to provide comprehensive well child care for healthy children from infancy to adolescence, as well as how to care for children with special health care needs. In addition, residents see patients with common acute ambulatory issues and complaints.

Teaching in continuity clinic is provided by board certified general pediatric faculty, and occurs through both individual patient case discussions and formal didactics. Our “Topic of the Week” encourages housestaff to read independently about general pediatric topics which are then reinforced with focused teaching from the faculty. Once per month a senior resident leads a case-based discussion of an ambulatory topic of his/her choice, taken from their patient panel. The faculty and chief residents provide lectures on additional topics chosen from the general pediatric ambulatory curriculum two times per month. The clinic is staffed by a full complement of personnel who work together to ensure family centered care. In addition to the physicians, there are clerical support staff, nursing staff, nursing case managers, a social worker, a dietician, a child psychologist, and Spanish language interpreters. Residents learn to apply a multidisciplinary team approach to patient care where appropriate.

During the second and third year, residents develop their telephone triage skills by answering after-hours patient phone calls under the supervision of a faculty member.

Each resident is paired with a GPS faculty advisor for their three years of training here at Children's Hospital. Advisors serve as resources for the residents, and are also responsible for reviewing feedback on the residents' performance in the ambulatory setting. Advisors and residents are expected to meet at least twice per year to review progress in continuity clinic and set goals for continued improvement.

Sample Daily Schedule for Continuity Clinic

Sample Monthly Schedule for Continuity Clinic 

Free Elective Rotation

The intern elective block is a call-free rotation allowing housestaff to explore subspecialty interests, research opportunities, and/or general pediatric community based experiences. All medical and surgical subspecialties are represented and provide electives for interns. Housestaff can also choose to do elective rotations at a nearby hospital or office.