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Pediatric Residency Rotations

Neill and Zinkham Inpatient Teams

residents high five a child while rounding in a patient room

The two resident inpatient teams are named for eminent pediatricians were prominent in the history of the Harriet Lane Service during the latter part of the 20th century. Catherine Neill was a pediatric cardiologist whose care for patients and enthusiasm for teaching house officers are legendary. William Zinkham was a pediatric hematologist revered by residents for his diagnostic acumen, his ability to solve problems and his wizardry with the microscope.

Each of the two inpatient teams consists of two interns and two PL-3s who cover patients on the two general inpatient services. Pediatric residents cofollow general pediatric surgical patients less than two years old, but primary responsibility for all surgical patients on these floors is assumed by surgical house staff. Patients with common pediatric medical illnesses and a wide variety of subspecialty diagnostic and therapeutic problems are seen.

Medical patients represent a variety of chronic and acute disorders ranging from pneumonia, diarrhea and dehydration, and failure to thrive to complex congenital cardiac defects, renal transplants and a variety of metabolic disorders.

A resident assistant who assists in administrative tasks required during residents’ inpatient general pediatric rotations, including: scheduling imaging studies and procedures requiring sedation, obtaining medical records, faxing prescriptions or medical documents, and making appointments with the primary care provider and subspecialty follow up appointments at the time of discharge

Subspecialty Teams

There are six subspecialty resident teams assigned to work with faculty on each of the following services:

The residents assigned to each team have primary responsibility for the patients admitted to that team’s service. Residents also see patients in the appropriate subspecialty clinic and participate in conferences along with the faculty and fellows. If home care is necessary for a patient upon discharge, the residents on the team participate in planning that care.

The teams are responsible for the management of their hospitalized patients and are assisted in the details of patient management by the following:

  • Intravenous therapy and phlebotomy teams available 24 hours a day, 7 days a week
  • Nurse case managers who ensure that referrals, consultations, laboratory tests and radiographic studies are arranged
  • A nurse practitioner who assists in discharge planning

Each resident will be assigned to a subspecialty team for approximately two months of the PL-1 year and for approximately two months of the PL-3 year, except for Hematology and Oncology, which are PL-2 rotations.

NICU

The 45-bed Neonatal Intensive Care Unit is next to the labor and delivery area, near the antepartum and postpartum units. Infants at high risk because of immaturity, intrauterine growth disturbances, respiratory distress syndrome, presumed sepsis, congenital anomalies and other problems are cared for in the NICU. The Department of Obstetrics High-Risk Maternal Service and the Maryland Regional Neonatal Program refer neonates to this unit. The house staff team consists of two PL-3s, two PL-2s and four PL-1s. House staff gain experience in treating a wide variety of critically ill patients using sophisticated monitoring and cardiorespiratory support equipment.

PICU

The 40-bed Pediatric Intensive Care Unit treats both medical and surgical patients. In addition to patients admitted via the Pediatric Emergency Department, the PICU admits critically ill medical and surgical patients referred from facilities throughout the state. During the month-long rotation, house staff have on-call responsibility only for the PICU.

As the Maryland State Regional Shock Trauma Center for Children, the Johns Hopkins Children’s Center admits a large number of patients with severe trauma involving several organ systems. Full-time faculty trained in anesthesiology, cardiology, pediatrics and pediatric intensive care, as well as fellows currently training in pediatric intensive care, supervise house staff and make daily rounds in the PICU.

Special emphasis is placed upon teaching pediatric residents the principles of airway management and ventilation, cardiac and pulmonary physiology, pharmacology, monitoring techniques and the management of head trauma and other conditions in which elevated intracranial pressure may occur. While the rotation emphasizes clinical care responsibility, house staff are encouraged to initiate or become involved in clinical and/or experimental intensive care research projects.

Emergency Department

The Pediatric Emergency Department is a state-of-the-art 32-bed facility that provides acute care for neighborhood families, subspecialty patients and patients from the greater Baltimore area. It is a vital part of the pediatric residency training program. The emergency department is staffed by house officers at all three levels of training who manage all emergencies, urgent admission evaluations and acute walk-in patients. Residents have the opportunity to manage Level I traumas and critically ill patients. House staff also work in a minor trauma area, providing care to children with lacerations, fractures and other injuries. The emergency department is supervised by full-time pediatric emergency medicine faculty members, clinical associates and pediatric emergency fellows. There are approximately 35,000 patient visits per year.

For more information, visit the pediatric emergency department.

Hospital Consult Medicine

One PL-3 rotates on the Hospital Consult Medicine service each month, acting as a consultant. This opportunity increases residents’ exposure to hospitalist medicine by conducting consults and working closely with pediatric hospitalists in the medical management of surgical patients and other patients in the Children’s Center.

Newborn Nursery — St. Agnes Hospital

House staff provide newborn assessment and care, as well as family education and counseling in the St. Agnes term nursery. They work directly with attending neonatologists, pediatric nurse practitioners and staff nurses from the nursery. They communicate with the Obstetrical Service and attend high-risk deliveries. Neonatology and anesthesiology attending staff provide resuscitation experience. Approximately 3,000 infants are delivered each year at St. Agnes.

St. Agnes Ward (Heldrich Service)

Johns Hopkins pediatric residents spend approximately three to four months at St. Agnes Hospital during their three years of training. Eight pediatric residents are assigned to St. Agnes each month, either to the pediatric inpatient service or the full-term nursery, or they may choose an elective month by participating in a variety of community experiences coordinated by St. Agnes Faculty.

Kennedy Krieger Institute

Each PL-2 spends one month on the Kennedy Krieger Institute Inpatient Service and Outpatient Clinics learning about many aspects of childhood development. Activities include rounds with attending physicians and conferences with audiologists, speech pathologists, physical and occupational therapists, educators, and psychologists.

Harriet Lane Clinic for Children and Adolescents

House staff identify and follow a panel of patients ranging from newborns to adolescents for well-child visits and acute and chronic care during their three years of training. The program provides the setting and staff to facilitate continuity. Faculty, fellows, pediatric nurse practitioners, nurses and social workers teach and assist house officers.

During the one-month block rotation in the Harriet Lane Clinic, house officers provide continuing care for their patients and are exposed to the developmental, behavioral, sociological and psychological aspects of caring for pediatric patients.

The outpatient adolescent clinic offers wide-ranging programs. Residents learn to provide comprehensive health care to adolescents, including birth-control counseling, evaluation of gynecologic problems, sports medicine and evaluation of adolescents with psychosocial problems. During the adolescent rotation, residents also attend a high school clinic and the Johns Hopkins University Student Health Service clinic.

Intern Selectives

During the PL-1 year, residents participate in a Selective where they choose either a general pediatrics or subspecialty selective. This provides residents with more ambulatory experiences during the PL-1 year and exposes them to potential career options earlier in their training.

For the general pediatrics selective, residents will spend:

  • One week at a community pediatric practice
  • Three days at the Rales Center, a school-based clinic
  • Two days working with nursing staff at Peds at Home

For the subspecialty selective, residents will spend:

  • One week in Genetics clinics
  • One week in an outpatient subspecialty clinic of their choosing:
    • Cardiology
    • Endocrinology
    • Gastroenterology
    • Oncology
    • Pulmonology
residents sit in an office with computers talking about their patients

Pediatric Subspecialty Clinics

The subspecialty clinics listed below meet regularly in the Outpatient Center. Faculty members supervise care in all clinics.

Advocacy

All residents also complete a block rotation in Community Advocacy and Child Mental Health. During this rotation, residents learn about the many resources available in the community for children with a variety of chronic health care needs, such as Downs’ syndrome, spina bifida and developmental challenges associated with premature birth, in addition to learning about the pediatricians role in helping parents with behavioral issues.

Residents also spend time learning about child abuse evaluations, visit the Maryland Poison Center and provide medical care to children in the local Hispanic community through an outreach van.

For two weeks during this rotation, residents learn to conduct mental health evaluations from a mental health care worker at the Harriet Lane Clinic and work with residents in the Child Psychiatry program at the Johns Hopkins Community Mental Health Clinics.

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