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Rotations & Experiences

Our program is designed to create confident and highly-skilled pediatricians who are prepared to enter independent practice or further post-graduate training at the end of three years. Our program is unique in that all of our residents rotate through each core subspecialty of pediatrics. This allows the elective months to be truly tailored to your interests and career goals.

PL1 Year

Emphasis is on the care of inpatients, while providing exposure to the newborn nursery, ambulatory clinics, and emergency medicine.


Inpatient Wards

As a tertiary care referral center, AFCH admits many medically complex kids. However, we have a great balance between these children and children admitted for common pediatric problems.

Each PL1 spends two blocks on the Red ward team and two on the White ward team. Each team consists of a senior resident, two pediatric interns, and third-year medical students. Call consists of “long-call” from 5-7pm during the week and day call 6a-6p on Saturday and Sunday.


Neonatal Intensive Care Unit (NICU)

The NICU team consists of a senior resident and one pediatric intern. The NICU is located at Meriter Hospital.

This rotation consists of one four-week block during your first year. You will manage preemies requiring critical care, “feeders and growers,” and term children with medical problems such as gastroschisis and esophageal atresia. Your neonatal resuscitation skills will be refined as you attend deliveries and C-sections of both term and premature newborns. PL1s are considered first in line to perform intubations, central lines, blood draws, and circumcisions.


Newborn Nursery

During this rotation you will attend deliveries and care for healthy newborns on the University Newborn Service at Meriter Hospital. You will hone skills in neonatal resuscitation, newborn exams, and counseling new parents. You will also learn to recognize and manage common newborn disorders, perform circumcisions, and counsel mothers on breastfeeding through spending time with lactation consultants.


Community Pediatrics & Advocacy Experience

This rotation is very different from most other months in residency in that the majority of your time will be spent outside of the hospital and traditional clinic settings. While much of your training is aimed at improving child health in the context of medical care, the overwhelming majority of children not only spend much of their lives in other settings (home, school, etc.), there are many other ways in which they and their families’ health are influenced. This month is intended to give you that exposure to “reality-based medicine.”


Hematology Oncology

You will participate in the diagnosis and management of heme-onc inpatients, learn management of cancer-related complications, and care for children admitted with a wide range of hematologic abnormalities, from ITP to aplastic anemia. This team consists of a PL2 resident, a pediatric intern, and a psychiatry intern along with the heme-onc staff, and fellows.


Emergency Medicine

During this rotation, you will work shifts in the Emergency Department, seeing patients under the supervision of our Pediatric Emergency Medicine attendings. The busy ED setting allows residents to see a wide range and volume of cases and provides the opportunity to manage sedations and perform procedures.


Intern Night Float

You will spend one four-week block as the “mole” (night float) at AFCH, covering the wards and the heme-onc unit under the supervision of a PL3. The hours of this rotation are Monday through Friday night, 5 pm to 7 am.


General Pediatrics

On this rotation, you will work with General Pediatric faculty in the evening after-hours clinic and then go over to Meriter hospital to provide care for the newborns and attend deliveries. You also gain experience with taking phone calls from the general pediatric patients. It is designed to simulate what you would do in general pediatric practice.


Pulmonary & Allergy

During this rotation you will spend time in multiple outpatient disciplines including allergy, immunology, and pulmonology.


Electives

Our electives are truly elective! Residents have a long list of options to choose from and are also allowed to design their own electives to meet their personal interests or career goals.

Each resident has six blocks of time that are tailored toward his/her career development needs. This can include a variety of elective opportunities. Some of the electives we currently offer include:

  • Advanced Subspecialty
  • Anesthesiology
  • Child Abuse
  • Child Psychiatry
  • Dermatology
  • Ethics
  • Global Health
  • Heme-Onc Clinics
  • Integrative Medicine
  • Musculoskeletal Medicine
  • Obesity
  • Pathology
  • Perinatal Medicine
  • Primary Care Pediatrics
  • Public Health
  • Radiology
  • Research
  • Rural Pediatrics
  • Sedation

Additional Clinical Opportunities

  • Diabetes Camp
  • Camp Medicine
  • St. Croix Indian Reservation
  • Salvation Army Free Clinic
  • High School Football Physician
  • Other sporting events (high school state tournaments)

PL2 Year

Focus is on subspecialty and critical care rotations, ensuring a broad-based exposure to common and complex pediatric problems.


Pediatric Intensive Care Unit (PICU)

The PICU day team consists of two PL2 residents, a rotating resident from EM and/or anesthesia, and medical students. There is a night-float system in place made up of two senior residents who share the nighttime coverage each month. During this rotation, you will learn about the management of critically ill children and have opportunities to perform procedures such as central line placement and intubation.


Hematology Oncology

The second-year resident is the “senior” on the heme-onc service and provides appropriate supervision and oversight of the interns.


Behavior & Development

This PL2 spends time in both behavior and developmental clinics as well as one-on-one didactic time with our developmental pediatricians reviewing cases and readings. The clinics cover topics such as autism, ADHD, NICU graduates and kids with a wide range of developmental disabilities.


Subspecialty

All of our residents rotate through all six subspecialties listed below. Call responsibilities during these months vary from weekend ward coverage to sick call.

Cardiology

Endocrinology

Gastroenterology & Rheumatology

Infectious Disease

Nephrology

Neurology & Genetics


Neonatal Intensive Care Unit (NICU)

The NICU team consists of a senior resident and one pediatric intern. The NICU is located at Meriter Hospital.

The senior residents each work two weeks on days and two weeks on nights. The day senior provides orientation, guidance, and supervision to the intern. In addition, they carry a subset of their own set of patients.


Pediatric Intensive Care Unit (PICU) FLEX

For approximately half of each block, time is spent covering the nights in the PICU with no more than 6 consecutive shifts. The rest of the month is spent on “Flex” time where the resident identifies clinics or experiences that they feel will benefit them in their careers.


Adolescent Medicine

This PL2 rotation provides a comprehensive overview of caring for the adolescent patient. The resident spends time in the Teenage Clinics, the UW University Health Services clinics, and the university-based walk-in STI clinic. Additional activities during this rotation focus on alcohol and drug screening and treatment.


Emergency Medicine

During this rotation, you will work shifts in the Emergency Department, seeing patients under the supervision of our Pediatric Emergency Medicine attendings. The busy ED setting allows residents to see a wide range and volume of cases and provides the opportunity to manage sedations and perform procedures.


Electives

Our electives are truly elective! Residents have a long list of options to choose from and are also allowed to design their own electives to meet their personal interests or career goals.

Each resident has six blocks of time that are tailored toward his/her career development needs. This can include a variety of elective opportunities. Some of the electives we currently offer include:

  • Advanced Subspecialty
  • Anesthesiology
  • Child Abuse
  • Child Psychiatry
  • Dermatology
  • Ethics
  • Global Health
  • Heme-Onc Clinics
  • Integrative Medicine
  • Musculoskeletal Medicine
  • Obesity
  • Pathology
  • Perinatal Medicine
  • Primary Care Pediatrics
  • Public Health
  • Radiology
  • Research
  • Rural Pediatrics
  • Sedation

Additional Clinical Opportunities

  • Diabetes Camp
  • Camp Medicine
  • St. Croix Indian Reservation
  • Salvation Army Free Clinic
  • High School Football Physician
  • Other sporting events (high school state tournaments)

PL3 Year

Designed to enhance leadership and teaching skills as the team leader in a number of settings. With increased experience comes increased autonomy as residents prepare for their post-residency careers.


Inpatient Wards

As a tertiary care referral center, AFCH admits many medically complex kids. However, we have a great balance between these children and children admitted for common pediatric problems.

Each PL3 has two blocks as the “leader” of the inpatient ward teams and oversees the care of the patients with appropriate attending supervision. Call is daytime coverage (4x a month) Saturday & Sundays.


Urgent Care

Our Urgent Care is at University Station, one of the GPAM clinic sites a few hundred yards from AFCH. The team consists of a senior PL3 resident and a medical student.

The PL3 “staffs” the clinic (with faculty consultation and assistance readily available as needed). This rotation gives the resident experience in ambulatory supervision of medical students, as well as autonomy in patient management.


Pediatric Intensive Care Unit (PICU) FLEX

For approximately half of each block, time is spent covering the nights in the PICU with no more than 6 consecutive shifts. The rest of the month is spent on “Flex” time where the resident identifies clinics or experiences that they feel will benefit them in their careers.


Senior Night Float

This rotation consists of one four-week block as the “mole” (night float) at AFCH. You will supervise a PL1, covering the wards and the heme-onc unit. The hours of this rotation are Monday through Friday night, 5 pm to 7 am.


Neonatal Intensive Care Unit (NICU)

The NICU team consists of a senior resident and one pediatric intern. The NICU is located at Meriter Hospital.

The senior residents each work two weeks on days and two weeks on nights. The day senior provides orientation, guidance, and supervision to the intern. In addition, they carry a subset of their own set of patients.


Emergency Medicine

During this rotation, you will work shifts in the Emergency Department, seeing patients under the supervision of our Pediatric Emergency Medicine attendings. The busy ED setting allows residents to see a wide range and volume of cases and provides the opportunity to manage sedations and perform procedures.


Subspecialty

All of our residents rotate through all six subspecialties listed below. Call responsibilities during these months vary from weekend ward coverage to sick call.

Cardiology

Endocrinology

Gastroenterology & Rheumatology

Infectious Disease

Nephrology

Neurology & Genetics


Electives

Our electives are truly elective! Residents have a long list of options to choose from and are also allowed to design their own electives to meet their personal interests or career goals.

Each resident has six blocks of time that are tailored toward his/her career development needs. This can include a variety of elective opportunities. Some of the electives we currently offer include:

  • Advanced Subspecialty
  • Anesthesiology
  • Child Abuse
  • Child Psychiatry
  • Dermatology
  • Ethics
  • Global Health
  • Heme-Onc Clinics
  • Integrative Medicine
  • Musculoskeletal Medicine
  • Obesity
  • Pathology
  • Perinatal Medicine
  • Primary Care Pediatrics
  • Public Health
  • Radiology
  • Research
  • Rural Pediatrics
  • Sedation

Additional Clinical Opportunities

  • Diabetes Camp
  • Camp Medicine
  • St. Croix Indian Reservation
  • Salvation Army Free Clinic
  • High School Football Physician
  • Other sporting events (high school state tournaments)

Pediatric Education and Active Resident Learning (PEARL) Conferences

In 2010, we launched an innovative educational conference, Friday PEARLs, to replace the prior noon conferences. We have protected Friday afternoons for residents to attend interactive, case-based conferences. During this time, residents come together for their education, their pagers are all signed out, and the faculty provide coverage for the hospital. Our goal was to move away from the traditional didactic lectures and put together a series of sessions that focus on the general pediatric approach to a problem. The guiding principles for these conferences are:

  • Teaching philosophies based on adult learning principles
  • Varying education modalities to foster an active learning environment
  • Problem-centered approach that emphasizes the knowledge and skills needed by the general pediatrician and prepares residents for their Pediatric Boards
Pediatric Education and Active Resident Learning (PEARL)

For each PEARL, faculty members from two disciplines come together to develop cases that deal with a spectrum of illness. Each session also includes a resident “scholar,” whose job it is to help develop meaningful learning objectives and content. As an example, we have a session on the “Approach to Cough in the Young Infant.” Our otolaryngology and pediatric hospitalist faculty members meet with the resident “scholar” to plan the session, which includes case discussions on bronchiolitis, pneumonia, foreign bodies, and reflux. We use an audience response system to engage residents in the content, which is designed to be applied to the daily care of patients.

Our residents also participate in a regular series of conferences to supplement their clinical experiences:

  • Morning Report – This conference, held 2-3 days per week, focuses on the problem-oriented approach to undifferentiated inpatient and outpatient cases of interest. During this dynamic, resident-driven conference, residents present interesting cases, and the discussion is facilitated by the chief residents.
  • Problem Conference – This popular, chief-led conference is held weekly and emphasizes in-depth, critical thinking in the development of differential diagnosis, evidence-based evaluation, and treatment of an interesting case. The learning environment is active, with much time spent on discussion of the case as it unfolds.
  • Grand Rounds – Grand Rounds are held weekly and provide a balance of local and national speakers discussing state-of-the-art research, clinical, and health care delivery practices, and reviews of other important pediatric topics. In addition to UW faculty and residents, attendees include community pediatricians, research faculty, nursing staff, and medical students.
Resident Conference

We also have several conferences designed to enhance resident skills and knowledge in a number of areas. These include:

  • Evidence-Based Medicine – The EBM series is led by Dr. Veesenmeyer, our clerkship director, who has a passion for evidence-based medicine. In addition to didactic and small group sessions designed to build skills in accessing and assessing the evidence, we have an EBM journal club approximately once a month.
  • Mortality and Morbidity – This monthly conference is presented by a PL3 resident, based on a case of their choosing. Each conference focuses on opportunities for improving care for patients at AFCH.
  • Advocacy – Each PL1 presents their advocacy project from their Community Pediatrics rotation.

Clinical Experiences

The pediatric population we serve includes both medically complex children and those with general pediatric problems. The catchment area of our hospital includes the entire state of Wisconsin as well as much of northern Illinois, leading to a diverse patient population, both in terms of ethnicity and socioeconomic status.

Inpatient Pediatrics

On the inpatient units, we care for children with the full range of pediatric illnesses, from bread-and-butter conditions to rare and complex diseases. The inpatient beds in our children’s hospital and NICU total 94, not including the newborn nursery. Overall, we operate close to our target 80% capacity.

We are very proud of our American Family Children’s Hospital (AFCH), which opened in 2007, and continues to expand. This free-standing facility was designed to provide state-of–the-art care for patients and families and is a child-friendly place to work. We have an electronic medical record system, Healthlink, which helps enhance the quality and safety of the care that we provide.

AFCH is an eight-story facility that supports the full integration of clinical care, academic programs, and research initiatives to produce a state-of-the-art enterprise not found elsewhere in the region. The 22-bed Pediatric Intensive Care Unit (PICU) is the major regional referral center for outlying communities and local hospitals. Many seriously ill or injured patients are transported to the PICU from around the state via UW Hospital's Med Flight helicopter, or C.H.E.T.A., our very own Children’s Hospital Emergency Transport Ambulance. We also provide post-op cardiac care in the PICU. AFCH also includes a bone marrow transplant unit and has the capability of administering novel therapies such as MIBG for patients with neuroblastoma.

We are expanding our family-centered rounds initiative and pursuing novel ways to improve resident education, including the use of simulation.

The UW’s women and infant program is based at Meriter Hospital, our community partner hospital. The state-of-the-art NICU was completely redesigned in the spring of 2007. Our Level 3 NICU provides care for over 450 neonates per year.

Outpatient Pediatrics

General Pediatrics Experiences

Our general pediatrics services extend across Dane County, including 9 primary care clinic sites. Residents have their weekly continuity clinic in these settings and benefit from working with excellent clinicians and role models and seeing a diverse range of patients from all walks of life.

Residents in our program also have an opportunity to provide care for the underserved in Madison at Access Community Health Center's (ACHC) South Side Clinic. The ACHC is home to a medical clinic, WIC program, Planned Parenthood, dental services, Community Health library, and more. Several residents (particularly those fluent in Spanish) have their continuity clinic at this facility. The MEDIC Clinic, which is one of several Salvation Army clinics for the homeless in Madison, also provides care for women and children. Some of our residents and students volunteer at this clinic.

Rural Pediatrics Experiences

Second- and third-year residents have the opportunity to spend two rotations working with community pediatricians in small towns within commuting distance of Madison. This immersion experience offers the opportunity to understand the unique challenges faced by rural pediatricians as well as gain further experience in general pediatrics in a community setting.

Subspecialty Experiences

During the subspecialty rotations, a majority of your time will be spent in the outpatient setting primarily based at AFCH. Some unique experiences that we offer outside our AFCH subspecialty clinics include:

  • Sports Medicine - The Sports Medicine Clinic at Research Park combines an expert team of sports medicine professionals and a state-of-the-art facility. We have outstanding pediatric sports medicine faculty and a highly competitive sports medicine fellowship. Residents on the musculoskeletal elective work closely with our pediatric sports medicine faculty, athletic trainers, physical therapists, exercise physiologists, nutritionists, and massage therapists. Interested residents can also serve as a “team physician” for local high schools, and provide physicals for UW athletes.
  • Behavior/Development – We are pleased that residents have the opportunity to work at the Waisman Center, one of only nine University Centers for Excellence nationally in Developmental Disabilities, where our genetics, metabolic disorders, and developmental clinics are housed. This facility also includes research centers that study normal development, developmental disabilities, and mental retardation.

Acute Care Experiences

In our program, residents see children with all types of acute and emergent problems. The University of Wisconsin is a Level 1 pediatric trauma center. During your emergency medicine rotations, you will gain and practice skills in the initial assessment and triage of sick and injured children, while learning the essentials of wound repair and other core pediatric procedural skills. During the Urgent Care rotation, you will work at University Station, one of our pediatric clinics located next to AFCH, seeing general patients presenting with acute complaints. We refer the most ill patients to your peers in the Emergency Department, who will continue their care under the guidance of our pediatric Emergency Medicine faculty. Interns also learn the basics of phone call triage, working with general pediatrics faculty.

Professional Development

We are deeply committed to our residents' success. Toward this end, we provide all of our residents with ongoing career development and personal support.

Mentoring

Meeting with the MentorsOur program has a strong commitment to establishing and fostering meaningful mentoring relationships between faculty and residents. To facilitate this, structured, semi-annual lunch meetings between mentors and mentees are scheduled during all three years of training. Faculty mentors are hand-paired with residents, not just on shared professional interests, but also on family and lifestyle concerns. Topics for discussion at mentor/mentee meetings include how to balance work and home life, how to keep up with the medical literature, dealing with physical and emotional fatigue, and what the life of a practicing physician is really like. We believe that, with the foundation our mentoring program provides, our residents will be successful in any of their career choices.

Along with having a faculty mentor, interns are also assigned to resident mentors soon after matching to our program. Having assigned upper-level resident mentors provides leadership and guidance during the transition to residency and Madison as well as throughout residency.

In addition to these formal mentors, many residents develop mentoring relationships with other faculty, such as their scholarly project advisors, continuity clinic preceptors, subspecialty faculty in their chosen field, or just someone with whom they “click.”

Meetings with the Program Directors

The program directors meet with each resident twice per year. This time is set aside to reflect on past performance and develop meaningful goals for the next six months. The time is also used to discuss future plans and address any issues or concerns on a one-on-one basis. These personalized sessions are a great way for residents to give and receive feedback and discuss their personal and professional goals and achievements.

Retreats

Resident Retreats

The program directors and chief residents hold bi-annual professional development sessions for each class. These sessions allow residents time to get together as a class and discuss issues of importance. Topics for the sessions center on the following areas:

  • PL1 – Adjustment to internship, stress management, working in teams
  • PL2 – Managing conflict, career planning, and leadership
  • PL3 –Teaching skills, finding a job, negotiating a contract

There is also a program-wide annual retreat that is typically held in the Fall of each year. For the past couple years, retreat has featured a Resident Olympics, including a pumpkin toss, relay races, and other class competitions.

Resident Input into the Program

We take pride in our ability to respond quickly and effectively to resident suggestions and comments so that the program can be continuously improved. Residents in our program are very active in shaping the direction of our program.

Issues are then brought to the Resident Council, which consists of multiple resident representatives from each class. The Resident Council meets monthly to develop initiatives brought up by the residents and to formulate the resident response to proposals raised by the faculty.

Residents also participate in our Residency Advisory Committee (RAC). The RAC is composed of faculty directors for each rotation, the program directors and chief residents, along with residents from each class. The committee reviews the curriculum and addresses other important issues in the residency program.


Last updated: 03/12/2014
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