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 2012, the program added Procedural and Poverty & Social Justice electives in response to resident feedback requesting more education in these areas.
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. Residents rotate through a county youth correctional facility, a hospital-based Pediatric and Adolescent Gynecology Clinic, a residential treatment facility for abused teenage girls, an Adolescent Psychiatry Clinic, and the University of Louisville Pediatric Rheumatology Clnic. In addition, residents complete the Ryan Residency Training Program in Family Planning, visit a local Planned Parenthood Clinic, and women’s surgical center. The goal of this rotation is to provide residents with broad exposure to the care of adolescent patients with an emphasis on the unique threats to health that exist within at-risk adolescent populations. This rotation provides an intimate and practical experience that provides our residents the foundation they need to be knowledgeable, compassionate, and understanding practitioners for adolescent patients and their families.
Theis 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.
Beginning in 2013, community experiences will be integrated into the Ambulatory rotation. The goal of this experience is to expose the resident to various community services and community settings that care for children. Residents will have a variety of experiences during the rotation and can choose some experiences based on their Individualized Curriculum pathway. The list includes (but is not limited to):
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 health care needs
Family Scholar House, an organization that provides housing, financial assistance for child care and transportation, and academic advising, among many other services for single parents earning a four-year college degree
UofL Dental Clinic, providing a full range of general and specialty dental services to the public
Children and Youth Project Home Health services
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.
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.
The Division of Pediatric Emergency Medicine is responsible for the evaluation and management of 69,000 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 work a longer shift every fourth day, admitting all new patients between the hours of 3pm and 8pm. While admitting patients on their long day, residents have significant autonomy while managing new admissions and cross-cover issues. Residents rotate on the general inpatient ward day team for seven months during their pediatric residency -- 3 months during intern year and 2 months in a supervisory role during each of the 2nd and 3rd years of residency. Residents also rotate on the general inpatient ward night team for two months during their pediatric residency – 1 month during their intern year, two weeks during their second year and two weeks during their third year.
The Division of Pediatric Hematology/Oncology consists of 10 faculty members and follows approximately 650 children in the clinic with approximately 6,500 outpatient visits per year. The inpatient Hematology/Oncology service has an average census of 14-16 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, Hemophilia, bleeding disorders and others 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 multiple areas including bone marrow transplantation and neuro-oncology.
The Division of Neonatal Medicine cares for approximately 1,500 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 20 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.
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.
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.
This required intern elective provides residents with a conceptual and experiential foundation in pediatric procedural medicine. The two-week elective consists of three days of didactic and simulation sessions followed by 1.5 weeks of "on call" time as the first resident paged to perform procedures. Residents are getting an average of 71 procedures during this time from peripheral and central lines, to lacerations, transport, splinting and bladder and NG catheter placements.