The Intern Year
Each year of our Pediatric Residency, including the intern year, consists of thirteen four-week block rotations. The lists below demonstrate how the typical year is divided:
Intern Year Block Rotations
- Inpatient Wards: 7 blocks
- Emergency Room: 1 block
- Newborn Nursery and NICU (at HPMC): 1 block
- Newborn Nursery (at Kaiser Permanente): 1/2 block
- Cardiology (CHLA & Community-Based): 1/2 block
- Advocacy/Outpatient Pediatrics: 1/2 block
- Free Elective: 1 block
- Selective: 1/2 block
- Vacation: 5 weeks
Inpatient Ward Rotations
Teams 1-6 consist of:
- An attending physician
- A senior resident (PL-2 or PL-3 resident)
- 3 interns
- 1-2 medical students
Team 7 consists of:
- An attending physician
- 2-3 interns
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 optimize interactions with attendings, continuity of patient care and our educational mission, while maintaining compliance with the Accreditation Council for Graduate Medical Education clinical hour guidelines. Overnight call on Teams 1-6 is every 6th night. Team 7 is a call-free rotation. The patient load typically varies from 3 to 5 patients per intern.
Click here to view a PDF of the Intern Year Rounding Schedule. Each of the rounds is described below.
- Work Rounds
- Attending Rounds
- Morning Report
- Case Conference
- Noon Conference
- Sample Daytime Conference Schedule
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 with the senior residents who provide patient related teaching during work rounds.
Attending rounds are conducted in a variety of formats. On Monday mornings, each ward team has its own subspecialty teaching rounds, which may include case-based or bedside teaching or a formal lecture on a topic of the team’s choosing. On select Tuesday mornings, attending rounds are led by the General Pediatric and Hospital Medicine ward attendings.
Morning report is a forum for discussing interesting patients that have been recently admitted to Children's Hospital Los Angeles. 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 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.
The noon conference series is based on the American Board of Pediatrics content specifications. In addition to general and subspecialty pediatric topics, the curriculum includes In Training Exam reviews, health care management, quality improvement sessions, and resident as teacher sessions. Journal Clubs are scheduled on a monthly basis during the noon conference hour. The program also has a night time curriculum which takes place Saturdays and Sundays.
- Community Pediatrics & Advocacy Rotation
- Emergency Department Rotation (Children's Hospital Los Angeles)
- Newborn Nursery Rotation and Neonatal & Infant Critical Care Rotation
- Outpatient / Community Pediatric Service (Children's Hospital Los Angeles)
- Free Elective Rotation & Selective Rotations
The community pediatrics and advocacy rotation comprises two weeks of the year during which interns are introduced to community health topics and pediatric advocacy. Interns have the weekends off without assigned call during this rotation.
During this rotation, interns spend time at community sites learning about a variety of child health resources, care delivery models, and the roles of pediatricians in community health. Some of the sites include Women Infants & Children, Foster HUB, Lactation clinic, and Alliance for Child Rights. Interns also spend time at community sites that serve children with developmental disabilities, such as the Regional Center and a CCS Medical Therapy Unit. At the end of each rotation, interns write a newspaper editorial or letter to a legislator on a topic of their choosing (e.g. youth sports participation, texting while driving, vaccinations, reproductive health access, childhood obesity or healthcare access for vulnerable populations)
In the spring, all interns 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 familiarize themselves with local elected officials. The groups then prepare letters and policy briefs or fact sheets, and present them to legislative aides during visits to local legislators' offices.
IMPACT (Improving Medicine: Pediatricians and Communities Together) Track is designed for those pediatric residents who wish to have a more in-depth experience in pediatric advocacy. Pediatric residents participating in IMPACT track can choose from one of 3 areas of emphasis: Community Pediatrics, Global Health or Quality Improvement. Interns who choose the IMPACT track will spend 2-3 weeks during their intern year working on the planning and development of a project, with the use of up to 2-4 additional weeks during their free elective time during first year. During this time they work closely with advocacy directors and mentors to perform 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. IMPACT track residents are required to spend some elective time in the second and third year to complete their projects, and are expected to present at a regional or national meeting and at Grand Rounds. Global Health track residents are also required to spend at least one rotation abroad. Lastly, as third years, IMPACT track residents participate in legislative advocacy and leadership trainings and activities in Sacramento. Some examples of past and current projects include: “Impact of infant oral and gut microbiome on response to Rotavirus vaccine in Peru” and “U.S, Cyber-trafficking of children in the Philippines”, “Opportunistic immunization of adolescent patients”, “Food Insecurity screening”, “Hand sanitation at an orphanage in rural Malawi”, “Mindfulness program to reduce stress in high-risk youth”, “Increasing use of long-acting reversible contraceptives”, and “Improving triage of children with acute respiratory illness in Haiti”.
For more detailed information regarding our tracks, please visit chla.org/Impact
All residents will participate in a home safety visit for one of their continuity clinic patients during their second year through the Home Safe Home project. Residents, along with a faculty mentor, visit the home of a patient who is less than two years old and perform an environmental and safety assessment . We provide positive reinforcement for the amazing care our parents provide for their children, and offer suggestions of ways they can make their homes even safer. Wherever possible, we give families home safety items such as outlet covers or cabinet locks. Members of our Injury Prevention team also inspect car seats to ensure they are safely installed for our rear-facing riders.
Interns have two weeks of dedicated cardiology experience. One week is spent in outpatient Cardiology clinics at CHLA, the other week in Private Cardiologists' offices learning pathophysiology and medical management of pediatric cardiac conditions. Both weeks are free of scheduled call, although you may be on jeopardy call.
One block of the intern year 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. It is divided into an acute/trauma care area 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. The ED fellows and attendings provide a series of lectures during the month. ED shifts are 10 hours long and there are 8 days off during the rotation. There is also the opportunity to go out on transports during the ED block.
Every intern spends four weeks in the Newborn Nursery & NICU at the Hollywood Presbyterian Medical Center examining healthy newborns and treating common problems in the neonate, as well as learning how to resuscitate newborns and treat common neonatal illnesses requiring ICU care. Two additional weeks occur at Kaiser Permanente Medical Center. There is no overnight call at Hollywood Presbyterian nor at Kaiser Permanente as an intern.
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 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 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, social workers, a child psychologist, dieticians, a lactation consultant, and Spanish language interpreters. Residents learn to apply a multidisciplinary team approach to patient care.
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 coach for their three years of training here at Children's Hospital. Coaches serve as resources for the residents, and are also responsible for reviewing feedback on the residents' performance in the ambulatory setting. Coaches and residents are expected to meet at least twice per year to review progress in continuity clinic and set goals for continued improvement.
The intern 4-week elective block is a call-free rotation which allows housestaff to explore subspecialty interests, research opportunities, and/or community based experiences. All medical and surgical subspecialties are available electives for interns. Housestaff may also choose to do elective rotations at an offsite hospital or office. Interns also have a two-week selective rotation during which they may rotate through an outpatient subspecialty clinic. Both are call and weekend free rotations.