Second and Third Years of Residency

The second and third residency years consist of 13 four-week block rotations each.

Second Year

  • Ward Seniorship - 1 block
  • Vacation - 1 block
  • Free Elective No Call - 1 block
  • Elective with Back-up Call - 1 block
  • Elective with Q4 Call - 1 block
  • Community Pediatrics II: Development - 1 block
  • Cardiology - 0.5 block
  • Neonatal Intensive Care Unit, CHLA - 1 block
  • Pediatric Intensive Care Unit - 1 block
  • Oncology - 1 block
  • Emergency Department - 1.5 blocks
  • Night Shift - 2 blocks

Third Year

  • Ward Seniorship - 1-2 blocks
  • Vacation - 1 block
  • Free Elective No Call - 2.5 blocks
  • Elective with Back-up Call - 1 block
  • Community Pediatrics III: Advocacy - 1 block
  • Neonatal Intensive Care Unit at Hollywood Presbyterian Medical Center or CHLA - 1 block
  • Pediatric Intensive Care Unit - 1 block
  • Oncology - 0-1 block
  • Emergency Department - 1.5 blocks
  • Team 7 - 1 block
  • Night Shift - 0-2 blocks
    *Adolescent medicine is a one block-long rotation that is done during any of the elective blocks during the second or third year, based on resident request.

Rotations

  • Continuity Clinic
  • Ward Seniorship
  • Night Shift Rotation
  • Emergency Department Rotation
  • Oncology
  • Pediatric Intensive Care Unit Rotation
  • Neonatal Intensive Care Unit Rotation
  • Cardiology
  • Team 7
  • Community Pediatrics II and III: Development and Advocacy
  • Elective Rotations

Resident continuity clinic is an opportunity for our trainees to build and follow a panel of patients for general ambulatory pediatric care. Resident continuity clinics are housed at CHLA AltaMed (on campus) and AltaMed Westlake.

AltaMed Health Services can trace its history of service and patient advocacy to 1969 with the founding of El Barrio Free Clinic. Since then, it has grown to one of the largest independent Federally Qualified Health Centers in the country. It currently serves over 300,000 patients in L.A. and Orange County, providing integrated access to primary care, pharmacy, mental health, dental, PACE and HIV/ AIDS services.

The AltaMed General Pediatric Outpatient Clinic was established in 2005 and grew out of a collaboration between AltaMed and CHLA with a focus on providing clinical, educational, advocacy and research services in primary care pediatrics. Open seven days a week, it now serves over 32,000 pediatric patients from birth until 21 years of age. Sixteen percent of our patients are children with special health care needs, and over 90% of the patients are covered by public insurance.  

The Westlake satellite clinic moved to its current location at 3rd and Alvarado in August of 2018 and has served as our secondary continuity clinic site. Staffed by the same providers as the main CHLA clinic, it is the home to many of our sub-specialty clinics and provides quality pediatrics in a community setting.

In these settings, residents learn the skills to provide comprehensive well child care for healthy children and those with special health care needs. Residents also have the opportunity to see patients with common acute ambulatory issues and complaints.

Teaching in continuity clinic is provided by general pediatric and developmental-behavioral faculty and occurs through both individual patient case discussions and formal didactics. Residents and faculty lead teaching on a variety of ambulatory topics based on the Yale curriculum during the continuity clinic educational series.

The clinics are 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, social workers, a child psychologist, dietitians, a lactation consultant and Spanish language interpreters. With these resources, residents learn to apply a multidisciplinary team approach to patient care.

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

As ward senior, residents lead an inpatient ward team consisting of three first-year residents and one to two medical students. Here, our residents have the opportunity to work on leadership and teaching skills in addition to growing their patient care and clinical decision-making abilities. This is a daytime-only rotation, without call.

During these rotations, two residents on each of the wards alternate consecutive nights of call. The other days/nights are free of clinical responsibilities other than occasional continuity clinics. Night shift residents supervise interns on the general wards or cover Oncology patients during these rotations.

Our ED is a Level 1 Trauma Center with high volumes (over 100,000 visits per year). Here our second- and third-year residents attend to a number of urgent and emergent pediatric concerns and are able to further hone their procedure skills—particularly lumbar punctures, incision and drainage of abscesses, suturing, reduction of nursemaid’s elbows, splinting and intubation.

You can find more information about our ED here.

This rotation consists of inpatient management of oncology patients. Each resident provides three weeks of daytime coverage and one week of nighttime coverage. The acuity of patients on this service is typically higher than that of patients on the general wards, which allows residents to build their skills at managing acutely ill children.

You can find out more about CHLA’s Oncology Section here.

During the Pediatric Intensive Care Unit rotation, residents care for critically ill infants and children with both medical and surgical conditions in our 24-bed PICU. Residents are on call every fifth night with a PICU fellow and attending in house. Residents may also rotate in our 24-bed CTICU if they choose to do so on an elective.

You can find more information about our PICU here.

Residents rotate through the CHLA and Hollywood Presbyterian (HPMC) NICUs. With about 3,500 deliveries annually, the NICU at HPMC provides many opportunities to strengthen neonatal resuscitation skills and manage common neonatal medical problems. The NICU at CHLA is a Level IV referral center with 58 beds. Residents learn to manage more complex neonatal disorders under the supervision of in-house fellows and attendings. Residents are on call every fourth night on this rotation.

You can find more information about our NICU here.

Two weeks of the second year are spent in our Cardiovascular Acute Unit, a 21-bed cardiac step-down unit, learning about the medical and surgical management of patients with cardiac diseases. Rounds are supervised by cardiologists and pediatric hospitalists, as well as the cardiovascular surgeons when applicable. Both weeks are call-free and without weekend responsibilities.

Team 7 is a general pediatrics team staffed by two senior residents and a hospitalist attending. There are also one to two medical students on the team. This is an opportunity for residents to take a more autonomous approach in the care of general inpatient pediatric care. There is no overnight call on this rotation.

Our residents participate in an integrated, longitudinal curriculum across their three years touching on a variety of community pediatrics topics including outpatient care, developmental and behavioral pediatrics, population health and political advocacy.

The second year experience is focused primarily on developmental and behavioral pediatrics with time spent in our clinics focused on the long term care of premature infants, autism, ADHD, mental health issues, youth in the Child Protective Services system and children with complex medical needs. Our residents also work with CHLA’s Injury Prevention Team to conduct home safety visits for one of their clinic patients under the age of 2. In this experience, residents provide free home safety products and use the opportunity to provide families with anticipatory guidance on a wide range of topics including safe sleep, drowning avoidance, earthquake and fire preparedness, and car seats. Residents also use their time completing a community mapping project, in which they identify food sources, air quality and water quality in a specific community to think more broadly about the social and environmental factors that impact their patients’ health beyond the individual home.

The third year is focused on policy and advocacy. Topics include health care financing, media training and vaccine hesitancy. During this rotation, residents create root cause analyses of health topics to look more broadly at the historical and social factors that may contribute to disease. They also write letters to their representatives about proposed bills or opinion/editorial pieces about health topics of their choosing. Additionally, residents engage in discussions reflecting on the practice of medicine, including how their personal experiences and biases shape their encounters with patients and their families.

The PGY-2 and PGY-3 elective experiences allow residents to explore subspecialty interests, research opportunities and/or community-based experiences. All medical and surgical subspecialties are available electives. Residents may also choose to do elective rotations at offsite hospitals or clinics.