Children with a wide variety of conditions are seen in our 26 private-bed inpatient unit at Ascension St. John Children's Hospital. As pediatric residents progress, they have increasing responsibility in the management of these children. The first –year resident has primary responsibility for initial assessment and daily care for the patient on the pediatric floor. This care is provided under the close supervision of the senior pediatric resident and full-time teaching staff. The second and third-year residents have greater responsibility for supervision of other residents and medical students, including facilitation of learning experiences for junior residents and medical students. Work and teaching rounds are conducted daily by members of the full-time teaching staff.
The diversified interests of the full-time staff enhance the resident’s learning experience. A wide variety of pediatric surgical problems are also seen. The pediatric resident assumes co-responsibility with the surgical resident for evaluation and follow-up of patients with surgical problems.
Considerable emphasis is placed on pediatric outpatient medicine. Over one-half of the resident’s experience is set in one of the ambulatory venues. Full-time pediatric generalists directly supervise the pediatric residents in the clinic. The hospital clinic includes continuity clinics, both well and sick general clinics, plus subspecialty clinics such as hematology/oncology, dermatology, allergy, cardiology, neurology, child development, endocrinology and gastroenterology. Each individual clinic is supervised by board certified staff in the specific subspecialty. One month in the third year is spent in ambulatory surgeries, ophthalmology, urology, nephrology and otolaryngology.
Pediatric Emergency Medicine
Ascension St. John Hospital and Medical Center is a Level I Trauma center. Visits average approximately 95,000 per year, 22,000 of which are pediatric patients. The pediatric resident spends two month-long block rotations in the pediatric module of the ER. During the third-year block experience, they are the sole senior resident in the pediatric unity during their assigned hours of coverage.
Neonatal Intensive Care
Our newly renovated, 35 bed, Level III Neonatal Intensive Care Unit at Ascension St. John Children's Hospital is one of the busiest in the state and one of the major referral centers for critically ill newborns in southeast Michigan. A large portion of the approximately 5,000 deliveries per year at Ascension St. John Hospital are maternal transfers. This allows the pediatric resident to be involved with critically ill newborns from the moment of birth until discharge from the hospital. The NICU is staffed by six board certified neonatologists as well as a team of experienced Neonatal Nurse Practitioners. Pediatric residents are given increasing autonomy in the handling of critically ill newborns as they progress through the program. Skills such as umbilical artery and vein catheterization, intubation and management of mechanical ventilation are just a few of the techniques learned during rotation through this unit.
Pediatric Intensive Care Unit
Our newly renovated, 8 bed PICU is dedicated to the care of critically ill children of all ages. The unit is staffed by three, dually-board certified Pediatric Intensivists and offers residents the opportunity to gain competency in numerous procedural skills, including endotracheal intubations, lumbar punctures, and central line placement, as well as the experience of caring for complex medical issues with a multidisciplinary approach. Residents are responsible for managing surgical, trauma, and critically ill children in conjunction with the pediatric surgery team, trauma team, and other subspecialty groups under the supervision of the Pediatric Intensivists.
A wide variety of subspecialty electives are available to pediatric residents. Subspecialty choices are made by the resident to tailor the residency experience to meet his/her needs. All subspecialty rotations are supervised by board-certified subspecialists interested in teaching.
Our recently built high-tech simulation lab allows residents to participate in life-like scenarios to gain confidence and competence in both routine and potentially lifesaving procedures and practices. Supervised by Pediatric staff physicians and intensivists, a SIM lab curriculum is incorporated into NICU and PICU rotations.
*All lectures are considered protected time for residents and students to allow for optimal attendance during didactics. Only during instances of medically urgent scenarios are residents called away from lectures.
Held two mornings per week, this conference is directed by the senior residents and attended by full-time faculty along with residents and medical students. The focus is based on recently admitted cases. The presentations are case-based and focus on recent and/or interesting cases encountered on the Pediatric Inpatient Unit or clinic primarily.
Tuesday Morning Pediatric Conferences
Weekly conferences are held each Tuesday morning. The first Tuesday of each month is a guest lecture by a visiting professor. On the second Tuesday of each month, there is a formal departmental meeting conducted by the Chief of the Department. At this meeting, topics relating to hospital planning, departmental changes, economic questions, etc., are discussed. These meetings are of value to the residents in preparing them for office, hospital and community responsibilities. The third Tuesday is reserved for a pediatric radiology conference. Current or recent patients with interesting imaging studies are used as a teaching point for hour-long formal instruction. Pediatric Grand Rounds occur on the fourth Tuesday of each month. Full-time and private staff discuss patients with interesting or unusual diseases. Finally, when there is a fifth Tuesday, Pediatric Tumor Board is held.
Pediatric Journal Club
We hold two types of Journal Club each month; evidence based and critical appraisal. During our Evidence Based Journal Club, the resident addresses a clinical question, in recently published literature and presents the evidence from a medical and clinically applicable standpoint. During the Critical Appraisal Journal Club, the residents learn how to properly read and evaluate journal articles.
Clinical-Pathology Conference (CPC)
During the CPC, residents discuss the differential diagnosis, work-up, findings and final diagnosis of a case assigned to them by one of our faculty members, Dr. Karen Alton. Each resident is assigned two CPCs during the 3-year residency, with the complexity corresponding to the resident’s year of training.
Teaching and Work Rounds
Work and Teaching Rounds occur daily on the infant and child units, child and adolescent units, nursery and neonatal units, and pediatric critical care units.
Noon conferences occur 4 days per week. Lecture topics cover the entire core curriculum and are presented by the teaching faculty.