First Year of Residency

Each year of our Pediatric Residency consists of thirteen four-week block rotations. The typical year is organized as follows:

Block Rotations

Inpatient Wards - 6 blocks
Emergency Department - 1 block
Newborn Nursery and NICU (at Hollywood Presbyterian Medical Center) - 1 block
Newborn Nursery (at Kaiser Permanente) - 0.5 block
Community Pediatrics I: Ambulatory - 1 block
Focused Clinic Experience – 0.5 block
Mental Health Rotation – 0.5 block
Free Elective - 1 block
Selective – 0.5 block
Vacation - 1 block + 1 week (totals 5 weeks)

Rotations

Inpatient Wards

Our inpatient ward experiences provide residents with longitudinal exposure to both general pediatric and subspecialty patients throughout their residency. PGY-1 residents rotate through each of our inpatient ward teams, which are structured as follows:

Team 1: General Pediatrics and Hematology
Team 2: General Pediatrics, Pulmonology, and Allergy/Immunology
Team 3: General Pediatrics, Endocrinology, and Rheumatology
Team 4: General Pediatrics and Neurology
Team 5: General Pediatrics and Nephrology
Team 6: General Pediatrics and Gastroenterology

Ward teams consist of three PGY-1 residents, one senior resident (a PGY-2 or PGY-3 resident), a general pediatrics attending, and subspecialty attendings. There are also one to two medical students on each team.

Continuity Clinic

In our resident continuity clinic, trainees build and follow a panel of patients for general ambulatory pediatric care. Resident continuity clinics are housed at CHLA AltaMed (on campus) and AltaMed Westlake.

AltaMed Health Services traces its history of service and patient advocacy to 1969 with the founding of El Barrio Free Clinic. Since then, it has grown to one of the largest independent Federally Qualified Health Centers in the country. It currently serves over 300,000 patients in L.A. and Orange County, providing integrated access to primary care, pharmacy, mental health, dental, PACE and HIV/ AIDS services.

The AltaMed General Pediatric Outpatient Clinic was established in 2005 and grew out of a collaboration between AltaMed and CHLA with a focus on providing clinical, educational, advocacy and research services in primary care pediatrics. Open seven days a week, it now serves over 32,000 pediatric patients from birth until 21 years of age. Sixteen percent of our patients are children with special health care needs, and over 90% of the patients are covered by public insurance.

The Westlake satellite clinic moved to its current location at 3rd and Alvarado in August 2018 and has served as our secondary continuity clinic site. Staffed by the same providers as the main CHLA clinic, it is home to many of our sub-specialty clinics and provides quality pediatrics in a community setting.

In these settings, residents learn the skills to provide comprehensive well child care for healthy children and those with special health care needs. Residents also have the opportunity to see patients with common acute ambulatory issues and complaints.

Teaching in continuity clinic is provided by general pediatric and developmental-behavioral faculty and occurs through both individual patient case discussions and formal didactics. Residents and faculty lead teaching on a variety of ambulatory topics based on the Yale curriculum during the continuity clinic educational series.

The clinics are staffed by a full complement of personnel who work together to ensure family-centered care. In addition to the half-day clinic experiences spread throughout the year, our interns participate in a two-week focused experience where they spend each morning seeing patients and the afternoons learning systems-based practice through work with our ancillary staff, such as clerical support staff, nursing staff, nursing case managers, social workers, a child psychologist, dietitians, a lactation consultant and Spanish language interpreters. With these resources, residents learn to apply a multidisciplinary team approach to patient care.

Community Pediatrics I: Ambulatory

Our residents participate in an integrated, longitudinal curriculum across their three years touching on a variety of community pediatrics topics including outpatient care, developmental and behavioral pediatrics, population health and political advocacy.

In the first year, our residents learn foundational skills of community pediatrics, including general health topics such as vaccines, screening tools, and asthma and obesity management. They also receive lectures on the history of pediatrics, normal child development including literacy promotion and toilet training, and public health topics such as social determinants of health and adverse childhood experiences. Our residents begin work on their quality improvement projects and learn how to use the EMR for data mining and analysis. Residents are paired with a clinic coach who will spend time with them and help them grow as outpatient general pediatricians.

Emergency Department Rotation

One block of the first year is spent in the Emergency Department. Our ED is a designated Level I Trauma Center and Pediatric Critical Care Center. It is also an incredibly high-volume ED, with over 100,000 visits per year. Here, our residents address a variety of acute medical concerns and perform procedures including lumbar punctures, incision and drainage of abscesses, suturing, reduction of nursemaid’s elbows, splinting and intubation.

Newborn Nursery and Neonatal Intensive Care Unit Rotation

Every first-year resident spends four weeks in the Newborn Nursery and NICU at Hollywood Presbyterian Medical Center, a community hospital next door to CHLA. At this hospital, which delivers about 3,500 babies annually, residents learn to resuscitate newborns, perform well newborn exams, screenings and anticipatory guidance, and treat common neonatal illnesses requiring ICU care. Two additional weeks of normal newborn experience are provided at Kaiser Permanente Medical Center, another community hospital located about a block away from CHLA.

Electives and Selectives

The PGY-1 elective experiences allow residents to explore subspecialty interests, research opportunities and/or community-based experiences. All medical and surgical subspecialties are available electives. Residents may also choose to do elective rotations at hospitals or clinics offsite.

PGY-1 residents also have two two-week selective rotations during which they rotate through outpatient subspecialty clinics of their choosing.

These are generally call- and weekend-free rotations except for two weeks of the year when PGY-1 residents serve as back-up call.