Rotations and Electives

Below are summaries of the mandatory rotations each resident will serve during their three-year tenure in our program. In addition to our mandatory rotations, the training program also offers elective rotations in all subspecialty divisions, including an International Rotation.

In 2011, we added a new Behavioral Health elective and a Palliative Care elective in response to resident feedback requesting more education in these areas.

Adolescent Medicine

The Division of Adolescent Medicine's prime focus is directed toward the outpatient care of teenagers. An understanding of normative growth and development and how various psychobiologic variations or diseases affect the overall health of the individual are the goals for our residents. These are accomplished by patient contact with youth identified as "troubled" or "delinquent." Residents rotate through a county facility, a hospital-based Pediatric and Adolescent Gynecology Clinic and in outpatient settings that are part of the department’s outpatient practices, which provide both primary care and/or consultative services. In addition, consultation and supervision of hospitalized adolescents with either acute illnesses or exacerbations of chronic diseases are integral parts of our focus. Kosair Children's Hospital usually maintains a census of 12-25 young people between 11 and 18 years of age on its inpatient services. We maintain a liaison with the Department of Psychiatry for consultation and/or collaboration, and with the department of Obstetrics and Gynecology.

Ambulatory

The Division of General Pediatrics is proud of its home at 706 South Floyd Street. With 18 exam rooms, 2 waiting rooms, business area, office and conference room, this facility places much greater emphasis on the ambulatory experience. UofL Pediatrics, the practice arm of the Pediatric Department, provides opportunities for resident training in all aspects of pediatric practice. A priority experience of the ambulatory program is the resident's personal continuity practice. Each resident is expected to provide comprehensive preventive health care as well as management of acute and chronic illnesses for a heterogeneous panel of patients. The goal of the continuity practice is to offer the house officer an opportunity to develop technical and interpersonal skills in a supervised outpatient setting. In addition to experiencing the "normal" developing infant and child in his or her family, the intangible advantages and rewards of close physician-patient-family associations can be fostered. Our ambulatory electives include subspecialty rotations, Children and Youth Project, and the Child Evaluation Center.

Weisskopf Child Evaluation Center (Behavior and Development)

The Weisskopf Child Evaluation Center (WCEC) offers comprehensive multidisciplinary evaluations for children with developmental disabilities throughout the state in order to clarify diagnoses and provide direction for families and schools regarding treatment options. There are several units in the WCEC, including the Diagnostic and Evaluation Clinic, the Clinical Genetics and Dysmorphology Unit, the Cytogenetic Laboratory, and the Community Developmental Outreach and Genetic Outreach Programs. While WCEC is primarily a diagnostic facility, treatment services are available through STAR (Systematic Treatment of Autism and Related Disorders) and the Feeding Evaluation Team. Many children are also followed for medication management purposes. WCEC provides training programs for professionals in various disciplines involved in the treatment and management of mental retardation, autism, ADHD, learning disorders, birth defects and other developmental disabilities.

Community Experience

This is a half-month rotation that is completed in the PGY-3/4 year of residency. The goal of this rotation is to expose the resident to various community services and community settings that care for children. Residents spend time at the following sites and programs:

1. Home of the Innocents, an emergency shelter for children in crisis as well as a long-term care facility for medically fragile children with chronic healthcare needs. 
2. The Louisville Metro Health Department
3. The Kosair Children's Hospital Hearts and Hands Program, which provides medical, emotional, and community support for hospitalized children with chronic and/or life-threatening conditions
4. Norton Lactation Consultants

Continuity Clinic

All residents are assigned to one of our three continuity clinics at the beginning of their intern year, providing residents with experience in general outpatient medicine through comprehensive longitudinal patient care. During this experience, residents will receive guidance and training from faculty members who have established a learning environment that fosters inquiring and critical assessment of pediatric practice.

Learn more about the Continuity Clinic rotation.

Emergency Medicine

The Division of Pediatric Emergency Medicine is responsible for the evaluation and management of over 45,000 patients per year seen in the Emergency Department at Kosair Children's Hospital. Supervision and education of house staff while providing high quality care is the main focus of the division. Didactic lectures, small group conferences and bedside teaching in the Emergency Department provide the house staff with knowledge of the initial management and recognition of critically ill and injured patients. Residents participate in all levels of care including minor surgical procedures, splinting and the resuscitation of acutely ill/injured children.

General Inpatient Medicine (Wards)

On the general inpatient medicine rotation, the residents are responsible for the inpatient management of all the general medical patients admitted to Kosair Children's Hospital. They will manage common pediatric illnesses such as bronchiolitis, status asthmaticus, gastroenteritis and dehydration, and cellulitis as well as patients with more complicated medical problems and subspeciatly patients. We practice family-centered care that is managed by four different teams of residents.

On this rotation, residents take new admissions every fourth day, their “admitting team” day.  While on the admitting team, residents have significant autonomy while managing new admissions and cross-cover issues. The residents rotate on the general inpatient ward day team over 7 months during their pediatric residency -- 3 months during intern year and 2 months in a supervisory role during both the 2nd and 3rd years of residency. Residents also rotate on the general inpatient ward night team over 2 months during their pediatric residency – 1 month during their intern year and 1 month during their second year.

Hematology/Oncology (Inpatient)

The Division of Pediatric Hematology/Oncology follows approximately 550 children in the clinic with approximately 6,500 outpatient visits per year. The inpatient Hematology/Oncology service has an average census of 10-12 patients. During the training period, the resident cares for the most common hematology/oncology problems seen in pediatrics as well as some of the rarer ones. The rotation includes didactic training and practical experience in the examination of bone marrow preparations and peripheral smears along with other laboratory skills. Comprehensive centers for Sickle Cell Disease and Hemophilia are conducted in our clinic.

The division is an active member of Children's Oncology Group. A pediatric hematology/oncology seminar is held weekly, and current research is being conducted in bone marrow cryopreservation and platelet function.

Neonatology/Perinatology (NICU)

The Division of Neonatal Medicine cares for approximately 1,000 critically ill neonates each year in the intensive care nurseries of University of Louisville Hospital and Kosair Children's Hospital. Patients are referred to the units from primary and intermediate care facilities throughout western Kentucky and southern Indiana.

The division is staffed by 14 full-time neonatologists and 7 neonatal fellows. Residents rotate for periods of four weeks through both nurseries and the intensive care unit at Kosair Children’s Hospital. During these rotations, residents learn about both the normal and sick neonate and develop the skills to resuscitate, stabilize and manage the high-risk newborn. Other components of the division include neonatal research laboratories (investigating the areas of nutrition, infection and cardiopulmonary disease), a high risk infant follow-up program, a neonatal pulmonary function/sleep apnea program, a neonatal extracorporeal membrane oxygenation (ECMO) and a nitric oxide programs, and a transport program. The latter is an extremely sophisticated system equipped to handle both ground and air transports from any hospital in our referral area.

Newborn Nursery

All residents complete a one month rotation where they care for healthy newborns. In the morning, residents see newborns at University of Louisville Hospital Newborn Nursery. In the afternoons, residents see newborns in our university-affiliated clinics at their first newborn outpatient visits. Residents become competent in the normal newborn exam as well as in the daily communication with the parents of these infants. They also learn about common newborn conditions including hyperbilirubinemia, hypoglycemia, perinatal infections and also complete a breastfeeding curriculum.

Pediatric Intensive Care (PICU)

The Division of Pediatric Critical Care offers house staff didactic conferences in critical care and provides direct involvement in the management of critically ill and injured children. House staff rotate through Kosair Children's Hospital (“Just for Kids” Critical Care Center) during their second and third years of residency. The Critical Care Center is a combined medical and surgical unit that cares for patients ranging from infancy to seventeen years of age. A variety of illnesses are encountered, e.g. acute respiratory failure from multiple etiologies, septic or cardiogenic shock, meningitis, multiple-trauma victims including patients with severe head injuries, post-operative cardiology patients and scoliosis patients. During the course of their rotation in Critical Care Medicine, residents work with the Critical Care staff to learn techniques of airway management, ventilator support and vascular access. This clinical experience coupled with didactic instruction enables residents to acquire confidence in their clinical skills as well as an understanding of pathophysiologic mechanisms and appropriate pharmacologic and surgical management.

Private Practice

All residents complete one month in which they see and care for patients in a private practice setting in the community. During this rotation, the residents are exposed to patient care outside of the academic setting and also learn about the business aspects of medicine such as billing and scheduling.