Pediatric Training Level 1
The first year of pediatric training is designed to provide a comprehensive overview of inpatient and outpatient pediatrics and to develop the basic clinical and technical skills involving the diagnosis and management of medical problems presented by children. The intern, or PL-1, is the primary physician for pediatric medical patients and acts under the supervision of senior residents and faculty. As such, he performs the initial complete history and physical examination and, after discussion with a senior resident and/or faculty member, writes the appropriate orders, performs the various procedures, and conveys information to the patient's parents. The intern is expected to actively participate in the teaching of medical students who serve as clinical clerks on the ward and in the clinics.
The PL-1 year is divided in the following fashion: two months on the pediatric ward, two months in general pediatric clinic, two months in the neonatal intensive care unit (NICU) and transitional nursery, one month in the newborn nursery, one month in the Emergency Department, one month on cardiology, one month on genetics-dysmorphology, one month on surgery and one month on adolescent medicine.
During the pediatric ward rotations, the intern works as a member of one of two teams; each team is composed of two interns and one or two senior residents. Usually 10-20 patients are on each team, including a variety of general pediatric and subspecialty patients.
In the NICU, the PL-1 usually works with two other interns, one or two senior residents and a neonatology fellow in providing care for 15-20 infants requiring critical care and 25-30 infants in the transitional nursery.
During the clinic rotation, in addition to caring for patients in the general pediatric clinic, patients are seen at night and on weekends in the UK Twilight Clinic. During UK Twilight Clinic, which is held from 5 - 9 p.m. weekdays and Noon - 5 p.m. weekends, an intern may be assigned to work with a senior resident and general pediatric attending in caring for children with acute illnesses and minor injuries.
The genetics-dysmorphology rotation is designed to foster development of the intern's history taking and physical examination skills.
During the cardiology rotation, the intern has the opportunity to attend the local and regional cardiology outpatient clinics, perform consults in the inpatient units, learn to read EKGs and learn the indications for echocardiography and cardiac catheterization.
The goals of the surgery rotation are to familiarize the resident with the indications for and timing of elective operative intervention, the preoperative evaluation and postoperative care of children with acute surgical problemsand to have exposure to common problems seen in children by the surgical subspecialist. Residents participate in the care of inpatients and outpatients on the pediatric surgery service and take night call (from home) with the pediatric surgery intern. Residents on the rotation also spend time in pediatric ophthalmology, orthopedics and otolaryngology clinics.
During the adolescent medicine rotation, residents learn the techniques of interviewing adolescents and become familiar with the scope of problems affecting this patient population. Residents spend time in the adolescent medicine clinics and in the Young Parents Clinic (teen mothers and their infants), evaluate patients with suspected sexual abuse and obtain exposure to the field of sports medicine. We are in the process of expanding residents' exposure to patients with substance abuse and eating disorders.
At the start of the PL-1 year, and continuing throughout all years of training, each resident attends a continuity clinic one-half day each week where he learns to manage a variety of patient problems over an extended period of time. There is a preceptor for each half day whose sole responsibility is supervision of the continuity clinic. By the end of the PL-1 year, the resident will have approximately 50 continuity patients; this will increase to approximately 100 patients by the end of the training program. Our continuity clinic has several unique features. Residents receive business cards to distribute to patients. They also have their own examining room marked by a magnetic name plate. To ensure our residents are receiving a well rounded general pediatric knowledge base, we have a curriculum that is covered at weekly conferences before each resident's clinic. Residents have the opportunity to serve on the Continuity Clinic Advisory Board which makes decisions concerning the clinic. Finally, the director of the continuity clinic is nationally involved in the Ambulatory Pediatric Association's Continuity Clinic Special Interest Group and is the editor of a national continuity clinic newsletter.
A retreat is held for all new house officers each fall. This retreat, lasting two days, provides an opportunity for the residents to get to know each other and the faculty in a casual, beautiful setting. In addition to social and recreational activities, discussions are held on various topics, such as dealing with stress, conflict resolution and balancing professional and personal obligations.
Night call for PL-1's is usually every fourth to fifth night throughout the year.
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