Rotations & Experiences
Our program is designed to improve your skills and increase your confidence as you progress through the three years of training. One of the strengths of our program is that all residents rotate through all of the core subspecialties of pediatrics. This allows the elective months to be truly tailored to your interests and career goals. In addition, we have developed a comprehensive web-based curriculum that provides rotation-specific orientation, goals and objectives, clinical cases, readings, and self-assessment tools. Goals for each year of training are:
- PL1 year – Emphasis is on the care of inpatients, while providing exposure to the newborn nursery, ambulatory clinics, and emergency medicine.
- PL2 year – Residents rotate through all pediatric subspecialties, ensuring a broad-based exposure to common and complex pediatric problems. This is a unique opportunity that residents truly value.
- PL3 year – Designed to enhance leadership and teaching skills as the team leader in a number of settings.
Residents have the option to choose from a wide variety of elective opportunities. Some of the electives we currently offer include:
Additional Clinical Opportunities
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 a half-day every other Friday afternoon for all 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
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 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 and 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. Standing room only is the norm at this conference!
- Grand Rounds – Grand Rounds provides 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.
We also have several conferences designed to enhance resident skills and knowledge in a number of areas. These include:
- Ethics – This monthly conference is led by Dr. Norm Fost, Director of the UW Program of Medical Ethics and internationally-recognized expert in medical ethics. Cases and questions are posted in advance, and the conference provides time for in-depth discussion of relevant ethical principles.
- Evidence-Based Medicine – The EBM series is led by Dr. Frohna, our program director, whose passion is 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.
- Injury Prevention – Dr. Gwen McIntosh, one of our general pediatricians, directs this series of talks which focus on preventing injury in pediatrics. Advocacy issues are often included.
- Professionalism – This series of conferences includes small group discussions about a variety of topics related to professionalism and leadership. Using videos and vignette discussion, the goal is to build a common culture of professionalism within the Department of Pediatrics.
- Quality Improvement – During the adolescent month, residents will work with the University Health Services physicians to assess an aspect of practice and explore ways that the care provided can be improved. The residents present their results to their colleagues during a noon conference.
- Resident as Teacher – This monthly series prepares residents for their important teaching roles.
In our program, you will have the opportunity to care for a wide range of patients. You will care for patients with lots of general pediatrics problems such as new-onset diabetes, asthma, and dehydration, and you will also care for children with complex medical conditions who are referred from hospitals around the state and region. Our patient population is also socio-economically and ethnically diverse.
On the inpatient units, you will see children with the full range of pediatric illnesses, from bread-and-butter conditions to rare and complex diseases seen in tertiary care hospitals like ours. 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 free-standing American Family Children’s Hospital (AFCH), which opened in 2007. This 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 a six-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. AFCH also includes a bone marrow transplant unit and has the capability of administering novel therapies such as MIBG for patients with neuroblastoma.
In the past year, we have also expanded our hospitalist program and we now have many outstanding teachers leading the inpatient teams. 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.
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.
During the subspecialty rotations, a majority of your time will be spent in the outpatient setting. Our subspecialty outpatient clinics are 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, metabolism, 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, you will see children with all types of acute and emergent problems. The University of Wisconsin is a Level 1 pediatric trauma center. You will gain skills in the initial assessment and triage of sick children and also learn the essentials of wound repair and other core pediatric procedural skills. During your 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. You may refer the sicker of these patients to your peers in the Emergency Department, who will continue their care under the guidance of our pediatric Emergency Medicine attendings. As an intern, you will also learn the basics of phone call triage.
We are deeply committed to your success. Toward this end, we provide you with ongoing career development and personal support.
Our 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. Our residents have a strong track record of securing positions in competitive fellowship programs and attractive general pediatric positions.
Meetings with the Program Directors
The program directors meet with each resident twice per year. This time is set aside to review residents’ evaluations, 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 get feedback and discuss their personal and professional goals and achievements.
The program directors and chief residents hold bi-annual retreats for each class. These retreats allow residents time to get together as a class and discuss issues of importance. The retreats also include a social activity for residents and their families/significant others. Topics for the retreats center around the following areas:
- PL1 – Adjustment to internship, stress management, working in teams
- PL2 – Managing conflict, career planning, and leadership
- PL3 – Finding a job, negotiating a contract
There is also a program-wide annual retreat that is typically held in the spring of each year. Residents, families, and faculty members are invited. This has covered many topics, ranging from personal wellness to more program-related improvements including: increased flexibility in residents' rotations, identifying strategies to enhance the unique subspecialty experience during second year. In 2010, the retreat was held in the Wisconsin Dells at a hotel with an indoor waterpark. Residents were excused from their clinical duties on Friday afternoon and participated in activities regarding personal wellness. They then stayed overnight and reported back to work on Saturday afternoon.
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. We have a biweekly Resident Meeting which allows the program directors and chief resident to keep up with issues that are important to the residents, keeps our residents informed and involved in the issues that affect them, and provides a forum for a discussion of stressors that are common to any residency program. This is often the place where new initiatives are first discussed.
Issues are then taken up by the Resident Council, which consists of multiple representatives of each class. The Resident Council meets biweekly 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.