The Department of Pediatrics offers a three-year fully accredited residency training program. The pediatric inpatient and outpatient services provide the resident with a wide variety of clinical problems of varied complexity and in-depth experience in primary and continuity care. Full-time academic faculty representing all of the subspecialties are actively involved in the training program, providing an ideal milieu for teaching. The residency program is organized to provide an advancing educational experience with increasing patient responsibilities over a period of three years in order to develop necessary medical judgment and demonstrated competence. The program includes a broad experience in all aspects of human growth and development from conception through the neonatal period, infancy, childhood, and adolescence.
Residents are exposed to conditions ranging from minor illnesses to life threatening conditions requiring intensive care. They experience health supervision of the well child and manage common diseases encountered in office-based pediatric practice including psychological and social problems. The strength and breadth of our many subspecialty rotations prepare the resident not only to provide primary care, but to serve as a consultant in the care of seriously ill children in the community.
Supervision of resident training is by full-time academic pediatric faculty who conducts all their professional activities in the University of Iowa Children's Hospital. This pediatric faculty takes pride in its "open- door policy" of always being available for consultation and advice whenever residents seek such guidance and assistance. We have an ongoing tradition of being recognized as a "teaching faculty," both by medical students and by residents. We constantly strive to improve and extend this recognition.
Each member of the faculty evaluates and constructively criticizes the performance of residents advancing through the three years of training. A confidential method of evaluation that assesses competence in a variety of areas has been devised. Each resident reviews his/her evaluations several times yearly in a formalized manner with a faculty preceptor and/or the director of the residency program. All residents take the American Board of Pediatrics "In-training Examination" at the beginning of each year of training. This allows each resident to identify personal strengths and weaknesses and permits the program director to identify individual needs for further intensive training. Several additional evaluative methods used to provide both formative and evaluative feedback include oral examinations and videotaped patient encounters.
Each attending faculty pediatrician rounds daily with the members of the team and discussions during these daily rounds are aimed to be of interest and value to the pediatric residents. In addition to teaching rounds at the bedside, there are other regularly scheduled teaching conferences including Pediatric Grand Rounds, Resident Case Conferences, Morbidity and Mortality Conferences, Therapeutics and Toxicology Conferences, Societal/Professional/ Ethical Issues Conferences, and pediatric x-ray conferences. Morning report is held twice weekly, during which time all residents on the inpatient and outpatient services present interesting patients for discussion of differential diagnosis and treatment. A monthly resident journal club is designed to teach the residents to critically evaluate the literature. There is an ongoing resident education core curriculum lecture series that incorporates a series of didactic presentations covering a specific planned content over an eighteen month cycle. Outstanding pediatricians from across the nation are invited throughout the year to contribute their expertise to the teaching program.
The Pediatric Library contains current texts and journals dealing with general pediatrics as well as the subspecialties and basic sciences. Videotape and computer programs provide a growing collection of self-instruction programs. Several personal computers in the library and on all the wards linked to a medical database allow the residents to conduct up-to-date literature searches. The proximity of the library to the clinical areas allows the faculty, residents, and students easy access to reference material at all times. A number of general pediatrics texts and subspecialty texts are available on the various patient units for ready access by the residents. Extensive reference material is available in the Hardin Library for the Health Sciences located across the street from the hospital.
The three-year pediatric training program has been carefully designed, each year being integrated with the training and experience of the previous year. The department continually reassesses and revises the goals and objectives of its training program by means of a departmental education committee with active resident representation. The following is a brief review of the integrated three years of residency:
PL-1 Year
The first year of training is primarily designed to emphasize the care of the sick child of all ages, allowing the resident to develop expertise in distinguishing the ill from the well child. Supervision is by a PL-2 or PL-3 on the inpatient wards and attending faculty members. In addition to inpatient ward and nursery experiences, the PL-1 spends significant time in the outpatient clinic under the supervision of the general pediatrics faculty where he/she evaluates both acute care walk-in patients many of whom represent patients seen in an emergency room setting, as well as selected diagnostic problems. Experiences in general pediatrics are further strengthened by a supervisory experience in the low-risk normal newborn nursery. A rotation in pediatric endocrinology is also built in to the PL-1 year.
During the first year, the resident begins to develop a practice panel (child health/continuity care clinic) which consists of infants and children who receive their well-child care by the resident on continuity basis. At the end of the first year, the resident is expected to include children with chronic illnesses in the continuity care clinic. For each resident, this offers an opportunity to follow and to provide appropriate pediatric services to patients for three years simulating as closely as possible the role of the private practitioner. Additionally, an elective opportunity is present even in the first year to help residents start to pursue areas of interest.
PL-2 Year
The second year provides the resident in-depth experience in a number of pediatric subspecialty areas, including cardiology, hematology-oncology, and allergy and pulmonary diseases. During these rotations, the resident is totally involved with subspecialty activities and is the first-line consultant for each of the above services for both inpatient and outpatient areas and actively participates in designing the diagnostic work-ups and therapy programs for these groups of patients. The resident participates in a variety of conferences, meetings, and seminars within the subspecialty divisions. In addition to the required subspecialty experiences, two electives will be available effective July 2006. This will allow residents to pursue areas of interest such as research or other clinical experiences as they consider future career plans.
Additional experiences in the PL-2 year are designed to prepare the resident to assume increased responsibility including two 2 week night float rotations as the senior resident in house supervising interns on call. Critical care experiences are provided in the PICU and in all NICU bays.
The PL-2 spends one month in the general pediatric clinic, and one rotation in the community and a public health clinic working in a private practice environment with pediatricians on our clinical faculty. Effective July 2006, the community rotation will be built into the PL-3 year. A rotation devoted to developmental and behavioral pediatrics occurs this year. The PL-2 also spends one month rotating in the Emergency Room at Blank Children's Hospital.
PL-3 Year
This final year of pediatric training will allow the resident to further refine his/her clinical skills and judgment in a variety of settings. The PL-3 will serve as the senior resident in charge of the neonatal ICU; the Red and Blue Teams; and general pediatrics outpatient clinic. On each of these services, the PL-3 will be the first-line consultant and supervisor for PL-1s, junior medical students, and occasionally a senior medical student extern. A second rotation in the PICU occurs in the PL-3 year. These experiences give the PL-3 an opportunity to initially manage a great variety of both common and complex pediatric problems and share in the teaching of junior house staff and students.
Experiences in general pediatrics include a rotation in Adolescent Medicine, and a rotation in the Emergency Treatment Center at UIHC. The PL-3 will continue to add to an enlarging group of patients in the child health/continuity care clinic. A rotation in orthopedics exposes the resident to common orthopedic issues involved in pediatric patients. A community rotation in a private practitioner's office in the community exposes the resident to issues of practice management and provides further experience in general pediatrics.
Given the growing need to train pediatricians in mental health issues, a rotation in child psychiatry is being built into the program effective July 2006. One additional elective rotation will be available with opportunity to pursue additional clinical or research experiences.
All residents are expected to participate in the planning of the resident curriculum. These include responsibility for planning and leading conferences and membership on the pediatric departmental education and clinical affairs committees.
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