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Residency program

Rotational highlights

Inpatient service

Children’s Hospital of Richmond’s downtown campus has two primary inpatient pediatric wards as well as a step-down unit located on the seventh floor of the main hospital, for a total of 41 acute pediatric beds plus seven step-down beds.

Two house staff teams provide coverage for pediatric inpatients of all ages on the wards and in the step-down unit. These teams care for general patients as well as subspecialty patients. Subspecialties include: neurology, cardiology, infectious diseases, pulmonology, gastroenterology, allergy and immunology, rheumatology, nephrology and endocrinology. Hematology and oncology patients are admitted to their own team. Residents are supervised by academic faculty members who are dedicated to educating residents and students in evidence-based patient care.

Each team consists of one PGY-3, one PGY-2 and one to three PGY-1 residents, as well as four to six medical students. The PGY-3 serves as the senior house officer and provides direct oversight and education for interns. The PGY-3 conducts daily work rounds, facilitates attending rounds and coordinates all non-ICU inpatient admissions. The PGY-2 serves as the junior house officer and shares duties with the PGY-3. He/she also is the designated teaching resident, with responsibility for leading teaching sessions for medical students and performing literature searches on clinical questions that arise during rounds. Each PGY-1 acts as the primary physician for a subset of patients on the team, from admission to discharge. House staff are primary caregivers for patients regardless of their designation as general or subspecialty admissions. At all levels, they provide education and mentorship to M-3 and M-4 students. The two primary inpatient house staff teams provide coverage for pediatric inpatients on the wards and in the step-down unit, including infants, toddlers, school-aged children, adolescents and young adults.

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Inpatient hematology/oncology team

All inpatient hematology/oncology patients are cared for by the inpatient hem/onc team. The team consists of a pediatric hem/onc nurse practitioner and two PGY-2s. The team works closely with hem/onc fellows and attendings. There is no overnight call on this service and the average census ranges from eight to 20 patients.

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Pediatric progressive care unit

The PPCU is a seven-bed step-down unit for pediatric patients with medical and surgical problems that require close monitoring above the level of care provided on the wards, but that do not require PICU admission. All patients with primarily non-surgical problems are covered by house staff teams under the supervision of the attending for either general pediatrics or the appropriate subspecialty.

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Pediatric intensive care unit

Our 14-bed PICU includes state-of-the-art equipment and large private rooms for the families providing intensive care to critically ill patients. Children’s Hospital of Richmond’s PICU is the only Level 1 PICU in Central Virginia.

The PICU provides care for children with conditions such as acute respiratory failure, status asthmaticus, circulatory shock, major trauma, head injury, intracranial hypertension, status epilepticus, diabetic ketoacidosis, renal failure and chemical intoxication.

The PICU also provides postoperative care for a broad range of surgical subspecialties such as neurosurgery, cardiac surgery, general surgery, transplant surgery, orthopaedics, urology, plastic and ear-nose-and-throat surgery. Averaging 950 admissions a year, the PICU not only receives admissions from the emergency room, pediatric floors and operating rooms, but is a referral site for hospitals in the Richmond area and regions beyond. The PICU has treated more than 18,000 children since 1978 and is proud of its team approach to care.

The three or four residents (PGY-2 or PGY-3) and nurse practitioners who staff the PICU are the primary caregivers to all patients admitted. Supervision is by a PICU fellow and attending. Residents take overnight call for one week of their four weeks while in the PICU. Residents have direct hands-on experience with issues such as ventilator management, sepsis, respiratory failure, trauma and multisystem dysfunction. Interdisciplinary rounds include nurses, dieticians, social workers, child-life specialists and pharmacists.

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Neonatal intensive care unit

The NICU is a 40-bed capacity unit that is currently divided into an intensive care unit and an intermediate care unit. The average census is 20 to 30 patients, with half being in the intensive care unit.

PGY-1 residents are responsible for both intermediate and intensive patients. PGY-2 residents are also responsible for coverage of the unit during night shifts alongside a neonatal nurse practitioner, fellow or attending. The PGY-3 resident is responsible for calls to the delivery room throughout the day, as well as supervisions and teaching of the PGY-1 residents.

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Newborn nursery

The newborn nursery is staffed by one to two PGY-1s and one pediatric nurse practitioner. All residents provide primary and direct care to term infants born at VCU Medical Center under the direction of general pediatrics faculty. The average daily census is 15 to 30 infants. There is no overnight call of the newborn nursery residents. The PGY-2 resident on night shift provides nursery coverage for acute issues.

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Pediatric Emergency Department

The pediatric ED is the only Level 1 emergency department in Central Virginia. Residents from the departments of Pediatrics (including medicine-pediatrics), Family Medicine and Emergency Medicine provide direct patient care in 12-hour shifts. There is 24-hour coverage of the pediatric ED. An active transport unit, including MedFlight helicopter, is maintained by the ED attendings. In addition, the ED houses an active child protection program staffed by attendings and nurse practitioners who are experts in child protection and who serve as teachers for pediatric residents.

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Pediatric group practice

The pediatric group practice, located in the Children’s Pavilion, serves as the resident continuity clinic. Residents have continuity clinic on an assigned day (with rare exceptions) based on other clinical rotation requirements. Residents have continuity clinic only during non-inpatient blocks. Morning or afternoon assignments are based on clinic needs. During continuity clinic, residents provide well-child and sick care to a panel of their own patients, as well as other resident’s patients. Residents also spend additional time in the resident clinic throughout the third year of residency.

Faculty-to-resident ratio is 1:3 to 1:5. Residents see a gradually increasing number of patients per session based on academic advancement. On average, PGY-1 residents see four patients per half-day session; PGY-2 residents see six patients per half-day session; and PGY-3 residents see eight patients per half-day session. Residents will also care for acute illnesses as the “urgent doctor” while on their clinic rotation.

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Outpatient elective rotations

During the three-year residency, residents have several block outpatient rotations. While on these rotations, residents are exposed to the evaluation of pediatric patients in the outpatient setting. Residents rotate on outpatient surgical subspecialties, outpatient pediatric subspecialties, behavioral and developmental pediatrics, and adolescent medicine and also have time for direct learning or supervising in areas such as genetics, child abuse or HIV clinics.

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Community pediatric experience

PGY-1 residents will spend two weeks at the office of one of the community pediatrics faculty members, or will spend an additional two weeks in the outpatient hematology/oncology clinic. Also, PGY-2 and PGY-3 that choose the primary care longitudinal track have the option to spend one-half day per week in a community clinic during non-inpatient blocks. Here, they can experience outpatient pediatrics in various settings, develop an understanding of the differences between academic and community practice, and see diversity of disease processes. Often the residents have used these experiences to develop ties to the community and, ultimately, generate employment opportunities.

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Research experience

The pediatric research curriculum was established to give PGY-2 and PGY-3 pediatric residents the opportunity to gain research experience. This experience includes any work that could be defined as a scholarly project and ranges from bench-top studies to clinical studies to literature review. Research time is given as one half-day per week during outpatient rotations, which constitutes roughly 26 weeks per year. Residents also have the option to spend four weeks on research electives to enhance the research experience.

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Education

Residents are involved extensively in the educational program. Senior residents present new admissions and important follow-up of patients at the twice-weekly morning report conferences. Interesting patient cases are presented at case conferences on Wednesday mornings. In addition, residents are directly responsible for the day-to-day teaching of medical students on the various services. With faculty guidance, PGY-2s learn to critically appraise an article of their choosing to then present at the monthly residency journal club.

A curriculum of general and subspecialty topics has been developed so that residents have the opportunity to hear a variety of topics during their tenure.

A pediatric library, which contains a variety of general and subspecialty texts and journals, is located on the floor. There are Internet-connected computers in all areas where house staff work as well as free access to UpToDate (electronic clinical resource tool for physicians). All residents have email accounts, as the majority of house staff communication occurs via email. Additionally, the medical school library (Tompkins-McCaw Library for the Health Sciences) is located one block from the hospital and houses a vast array of journals, books and other educational resources. Most journals are available online through the VCU Libraries website.

The American Board of Pediatrics Exam passage is important and the department has developed several ways to assist residents. Recent revisions in the inpatient team structure have resulted in more time available for bedside teaching. The pediatric faculty actively participate in resident teaching in the clinic, the inpatient services and the newborn nursery. Each rotation has written goals and objectives that are published on the resident website. During the past four years, additional subspecialists have been recruited to the divisions of General Pediatrics, Pulmonology, Endocrinology, Gastroenterology, Neonatal and Perinatal Medicine, Critical Care Medicine, Hematology/Oncology, Nephrology and Adolescent Medicine.

Each resident is expected to take the annual American Board of Pediatrics In-training Exam. Results of this exam are shared with the residents and they are individually advised about study techniques in order to improve their future performance.

The Department of Pediatrics also pays for each resident’s membership in the Med-Challenger board preparation program. This is a computer-based program with nearly 5,000 board-style questions to help you prepare for your General Pediatrics Boards. Users of Med-Challenger PEDS report a 98% pass-rate on the ABP board exam.

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