1
SEP
2014
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The pediatric residency program features an excellent curriculum structured to provide residents with increasing levels of responsibility for patient care and the clinical supervision of and teaching of junior residents and medical students. The curriculum is designed to help foster the development of skills and competencies set by the Accreditation Council of Graduate Medical Education (ACGME) for the training of excellent pediatricians prepared for contemporary practice. The program maintains a strong focus on primary care education while providing excellent exposure to the pediatric specialties and the care of medically complex children in a tertiary care setting. The program also provides experiences in inpatient, outpatient, and community settings that and provides excellent exposure to a highly diverse patient population. Patient safety, evidence based medicine, and continuous quality improvement are additional areas of focus. Our curriculum is developed and continually improved through an active participatory process in which the feedback of faculty and residents are highly valued.

ROTATIONS


The academic year consists of thirteen four week rotations across inpatient, outpatient, and community-based settings.



A. Inpatient Rotations:

Inpatient Pediatrics

Resident gain skills in the care of acutely ill and hospitalized pediatric patients at Arnold Palmer Hospital for Children. Arnold Palmer Hospital for Children is the largest freestanding facility of its kind in the southeast and is a major referral center for subspecialty pediatric care. Residents work alongside physician assistants, nurse practitioners, clinical pharmacists, social workers, case managers, clinical staff nurses to deliver multidisciplinary, family-centered care. The inpatient pediatric service is divided between a general pediatrics service and a subspecialty service. An intern averages five to seven patients while on service.

Residents also rotate on the Hematology/Oncology service during both their intern and second year of residency. The Center for Children’s Cancer and Blood Disorders, housed within Arnold Palmer Hospital for Children is comprised of a 20-bed inpatient unit, an outpatient clinic with a chemotherapy infusion center and a radiation oncology department. An intern averages five to eight patients and the senior resident is responsible for managing pediatric Hematology/Oncology consults and patients admitted to the PICU and PSCU.

Pediatric Special Care and Intensive Care
Residents participate in the care of critically patients in a 17 bed a state of the art Pediatric Intensive Care Unit (PICU). Board certified pediatric critical care specialists manage and oversee the care of all children admitted to the unit. The unit is staffed by dedicated nurses, respiratory therapists, pharmacists, social workers, chaplain, residents, nutritionist, child-life and physicians trained in pediatric critical care. In addition the unit fully supports a dedicated pediatric critical transport service and serves as a major referral center for critically ill pediatric patients from all over Central Florida. The PICU provides residents with valuable experience in invasive cardiovascular monitoring, complex fluid management, ventilatory assistance, critical postoperative management, and all other areas of pediatric intensive care. Senior residents average five to eight patients while on service.

The Pediatric Special Care Unit (PSCU) cares for children that require monitoring and close observation. The PSCU originally opened in 1989 with 6 beds and has grown to occupy and a newly renovated unit with the capacity to care for 26 patients and averages near 2,000 admissions a year. Residents average eight to ten patients while on service.

Newborn Nursery
Residents gain important exposure to the care for newborns and in educating parents in areas such as breastfeeding practices and preventative health care during their newborn nursery rotation at Winnie Palmer Hospital for Women & Babies. Residents average eight to ten patients while on service.

Neonatal Intensive Care
Residents are exposed to the full range of medical and surgical disorders of premature and term newborns as well as to the latest technological modalities including extracorporeal membrane oxygenation (ECMO) at the Alexander Center for Neonatology. The Alexander Center for Neonatology at Winnie Palmer Hospital for Women and Babies is one of the largest Neonatal Intensive Care Units (NICU) in the United States caring for more than 1,600 babies every year. Residents work alongside Neonatal ICU attendings, nurse practitioners, dedicated nurses, respiratory therapists, pharmacists, social workers, chaplains, nutritionist, and child-life specialists in the 112-bed inpatient unit. Residents attend high-risk deliveries daily and care for patients on a dedicated teaching service, averaging four to five patients each.

B. Outpatient Rotations:

Outpatient Pediatrics

Residents receive excellent exposure acute health conditions most encountered in the office setting and the care of acutely ill children and adolescents during their Outpatient Pediatrics rotation. Clinical experiences are supplemented with lectures and small groups group discussions. The rotation takes place at the Orlando Health Primary Care Pediatrics facility located in the downtown campus opening in August 2014. Residents are supervised by faculty from the Department of General Pediatrics.

Emergency Medicine
Opened in 2007, the Bert Martin's Champion for Children Pediatric Emergency Department & Trauma Center at Arnold Palmer Hospital, is a 33 bed 23,500-square-foot, state-of-the-art facility. The center is the only Level One Pediatric Trauma Center in Central Florida and provides care for over 20,000 patients each year. Residents do 8-12 hour shifts under the supervision of board certified pediatric emergency medicine physicians during their rotation.

Behavior and Development
During this rotation residents learn basic concepts of normal child development and screening; disorders of cognition/ language; behavior and mental health issues. Areas of focus include the assessment and management of developmental disorders and learning disabilities, such as ADHD and Autism Spectrum disorder. Residents spend time in various sites including Howard Phillips Center for Children and Families, Prescribed Pediatric Extended Care and several special needs schools. They also work with specialists in Physical Therapy, Occupational Therapy, Speech Therapy, Physical Medicine and Rehabilitation, Neurology, Neuropsychology, Genetics and Adolescent Medicine. The resident’s continuity clinics during the rotation are focused on performing full developmental screens for patients scheduled for well-child checks. This experience is facilitated by our general pediatrics out-patient faculty.

Adolescent Medicine
Residents gain experience in delivering comprehensive, developmentally appropriate care to patients 11-21 years of age during their Adolescent Medicine rotation. The rotation provides residents with diverse experiences in the areas of sports medicine, pediatric and adolescent gynecology, sexual and reproductive health, eating disorders. Residents are supervised by multidisciplinary faculty, including two board certified adolescent medicine specialists. Residents also gain exposure to school based health care through Teen Xpress, a mobile health program that delivers free medical, mental health, nutrition, and case management services to uninsured and underinsured adolescents in Orange County schools. Teen Xpress has been recognized nationally by the American Academy of Pediatrics-Adolescent Health Partnership Project-Promising Practices Award for its commitment to positive youth development and its strength-based approach to adolescent health promotion.

Advocacy
During their advocacy rotation is a four-week rotation during the PL-2 year. It includes two week experience with Child Protection Team through which residents learn more about child abuse prevention and intervention and the child protective services system in Central Florida. The Child Protection Team is a multidisciplinary team of professionals who provide assessments of child abuse and neglect to the Department of Children and Families and law enforcement. Co-located within the Orange and Osceola Children's Advocacy Centers, the Child Protection Team assesses risk factors and provides recommendations for interventions to protect children and enhance families' capacities to provide them with safer environments.

During the remainder of the advocacy rotation, residents are exposed to In the Zone Community Pediatrics program. This program gives residents a chance to leave the examining room and get out into the community where they can see first-hand the many factors that impact a child's health. To better understand the resources available to children and their families, residents also have the opportunity to spend time with local agencies that serve children and families, including the Ronald McDonald House, Second Harvest Food Bank, Coalition for the Homeless, and a nearby charter school. The program is designed to help prepare residents to act as effective leaders and agents of change within the community, with the ultimate goal of eliminating healthcare disparities for people of diverse racial, ethnic, and cultural backgrounds.

Specialty Rotations and Electives
Residents gain exposure to pediatric specialties at the Arnold Palmer Hospital for Children specialty practices. Arnold Palmer Hospital Specialty Practice provides excellent care and has been recognized by US News and World Reports Recognized Best Children’s Hospital in 8 Pediatric Specialties.



CONFERENCES
Case Report (Morning Report)

  • A Friday morning tradition. Case report series allows residents the opportunity to acquire skills in case presentation and to use critical and organized thinking in formulating differential diagnoses and management plans for hospitalized patients on the general wards and in the Pediatric Intensive Care Unit.

Grand Rounds
  • One hour CME conference weekly at 8 a.m in the Winnie Palmer Hospital Auditorium
  • Grand Rounds features interesting General Pediatrics topics, state-of-the-art updates, and a variety of special topics to round out your education. Presentations are given by our own expert faculty, visiting professors, national, and international speakers
  • The monthly schedule available by contacting the Academic Pediatrics Office at 407-649-6876 or nancy1.ramos@orlandohealth.com

Pediatric Conferences
  • Lectures on specific topics by general pediatric attendings, sub-specialists and guest speakers. The curriculum is based on the American Board of Pediatrics Content Specifications and is used as an adjunct to board preparation.
  • Lectures also cover professionalism, residents as teachers, adult learning theory, ethics in pediatrics, billing and coding, and other interesting topics.
  • Lectures structured around a carefully designed topical block schedule. Each block (4wk period) covers a specific subspecialty or organ system to help focus resident study and prepare for boards.
  • Many conferences promote resident participation using an audience response system

Prep Course/Board Review

  • Offers a condensed comprehensive review of specific pediatric topics with active participation of both the residents and faculty
  • Led by upper level residents
  • Board style test questions are used to facilitate discussions and resident learning

Journal Club (Evidence-Based Medicine)

  • Occurs monthly and utilizes the principles of evidence-based medicine (EBM)
  • Promotes a critical review of the literature and biostatistics

Professor’s Rounds
  • One of our favorite conferences. Facilitated by Dr. John Tilelli of our critical care faculty, a case is presented to a blinded general pediatrician and they work through their diagnostic thought process. Once the diagnosis is established multiple specialists from Pathology, Radiology, or special guests from the health department or medical examiner’s office present their perspectives on the case.

Behavior & Development Conference
  • Concise review of behavior and development; conference occurs monthly
  • Given by resident during the behavior and development

Colin J. Condron, MD Care of the Sick Child Conference
  • Residents are encouraged to attend this conference held annually in Orlando. Residents receive free registration to the Orlando Health Office of Continuing Medical Education sponsored conference.
  • Emphasis is placed on the day-to-day issues the pediatric provider encounters and challenging diagnostic or management dilemmas
  • Topics are based on current trends and features recognized leaders in their fields


SPECIALIZED CURRICULUM

Global Health
Pediatric residents have the opportunity to complete four week long global health electives during their PL-2 and PL-3 years. Residents also have the opportunity to serve in short term international missions with faculty. In the past 5 years we have had many residents serve in diverse locales such as Brazil, Egypt, Nigeria, Malawi, Kenya, Trinidad, and Niger.

Individualized Learning Curriculum
The Individualized Learning Curriculum (ILC) is a new requirement for pediatric training programs established by the ACGME. The goal of ILC is to allow residents the opportunity to choose or create six rotations that focus on preparing them for their identified career path post-residency. These experiences need to be unique and/or different from any other rotation that they have completed or will complete as part of their graduation requirements. Each training program will have a different methodology of fulfilling this requirement. Our program offers 5 ILC tracks: General Pediatrics (Inpatient and Outpatient Medicine) Outpatient Pediatrics, Hospitalist Medicine, Academic Medicine, and Subspecialty. Some examples of subspecialty tracks are Pediatric Emergency Medicine, GI, Adolescent Medicine, Pulmonology, ID, Heme-Onc, Cardiology, Neonatology and Critical Care. Each track’s structure was created by a faculty member (track director) in each specialty area. Our program’s ILC structure is flexible, with each resident’s experience being tailored to their specific interests and to strengthen each resident’s medical knowledge and clinical skills as a general pediatrician. ILC tracks are chosen midway through the PGY-1 year with the assistance of the intern’s advisor. ILC blocks are chosen with the assistance of the resident’s advisor, the PD and the chosen track’s director.

Pediatric Simulation Curriculum
The curriculum allows resident to gain proficiencies and skills through simulated exercises. These include:
  • Mock Codes: To improve resident response, comfort level and competency with commonly encountered scenarios in the critical care setting, residents are involved in simulated code in real time on the in-patient units. The multidisciplinary code team includes nursing, respiratory therapy, pharmacy, physician, and allied health staff members. Interns also participate in a separate Pediatric Advanced Life Support (PALS) based curriculum utilizing simulated codes and mini stations with simulators in scenarios developed by our residents and pediatric critical care specialists.
  • Communication Workshops: This curriculum developed to help residents build skills to effectively communicate with patients and families utilizes literature-based methods and standardized patients and actors enacting scenarios frequently encountered in pediatric practice. The series also includes Breaking Bad News (BBN) series that helps prepare residents to effectively engage in difficult conversations and deliver bad news to patients and families.