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 into separate rotations to develop you as a pediatric expert.
Intern Year Block Rotations
- Inpatient Wards: 7 blocks
- Emergency Room (CHLA): 1 block
- Newborn Nursery and NICU (at HPMC): 1 block
- Newborn Nursery (at Kaiser Permanente): 1/2 block
- Cardiology (CHLA): 1/2 block
- Outpatient/Advocacy Pediatrics: 1/2 block
- Free Elective: 1 block
- Selective: 1/2 block
- Vacation: 4 weeks
Inpatient Ward Rotations
On the wards, each of the six teams will consist of:
- An attending physician
- A ward senior (PL-2 or PL-3 resident)
- Three Children's Hospital Los Angeles interns
- 1-2 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 Accreditation Council for Graduate Medical Education duty hour guidelines. Overnight call is every 6th night. The patient load varies from 3 to 5 patients.
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
- Intern Rounds
- 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 in an organized and thoughtful manner (at times at the bedside). Senior residents also present patient-related teaching topics during work 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 six general ward teams in attendance.
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.
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 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. There are also conferences that occur three nights per week.
- 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 both pediatric advocacy and developmental-behavioral pediatrics. Interns have all weekends off without assigned call during this rotation, with the exception of two weeks of jeopardy sick call.
During this rotation, 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, Foster HUB, Lactation clinic, and Alliance for Child Rights. Interns also teach injury prevention at local elementary schools, and teach healthy lifestyle and nutrition in obesity clinics. The pediatric behavior and development sites allow interns to spend time with our specialists learning how to administer and interpret developmental screening tools. They also participate in specialty clinics (e.g., autism clinic) and spend time at a variety of community sites which serve children with developmental disabilities, including Regional Center, and a CCS Medical Therapy Unit.
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 Track, Global Health Track and Quality Improvement Track. Interns who choose the IMPACT Project 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. Project 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, they 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 Rotavius vaccine in Peru and U.S, Cyber-trafficking of children in the Philippines, Opportunistic immunization of adolescent patients, Food Insecurity, Hand sanitation at an orphanage in rural Malawi, Mindfulness/wilderness program to reduce stress in high-risk youth, Increasing use of long-acting reversible contraceptives, 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. 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.
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 call-free and without weekend responsibilities (although you may be on jeopardy call).
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.
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 of Newborn Nursery experience occurs at Kaiser Permanente Medical Center. There is no overnight call at Hollywood Presbyterian or 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 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.
The intern 4-week 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. Interns also have a two-week selective rotation, where they may rotate through an outpatient subspecialty clinic such as Pulmonology, Gastroenterology, Neurology, Medical Genetics, Neurology, etc. Both these experiences are call- and weekend-free rotations.