Core Rotation Information

Inpatient Pediatric Floor

The pediatric wards at CMHH consist of 68 floor and 24 IMU beds for infants, children, and adolescents aged 0-18 years. General pediatric patients are cared for by four inpatient teams, which consist of two interns and two upper level residents (usually one third year and one second year) working under the supervision of a full-time faculty attending. There are two teams on call and admitting patients every other day with upper levels alternating every other call day. Teams also include third year medical students as well as fourth year students completing acting internships from UT Houston McGovern Medical School.  We occasionally have Physician Assistant and Nurse Practitioner students joining us for their clinical pediatric rotation.  The pediatric floor team follows all medical and some surgical patients (Urology, ENT).  Often times, the pediatric team is consulted by the surgical teams (Orthopedic Surgery, Pediatric Surgery, and Neurosurgery) for assistance with the medical management of their patients.

Well Baby Nursery

This rotation provides clinical experiences and teaching to enables interns to develop competence in the care of normal newborns.  An understanding of maternal history, recognition of important factors in maternal history and the delivery process that can affect the newborn and how to manage them, principles of infant feeding, common newborn problems, parent education in routine newborn care, and issues important to discharge planning are stressed.  Both Memorial Hermann Hospital and Lyndon B. Johnson Hospital are considered as baby-friendly hospitals and all babies’ room with their mothers, unless sent to the high-risk nursery or NICU. Residents have the opportunity to visit with the Lactation Foundation and are required to strengthen their knowledge about breastfeeding through online modules.

Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) rotation exposes residents to the evaluation and management of critically ill neonates with medical and surgical conditions.  There are ~600 admissions per year at LBJ and ~1,000 admissions per year at CMHH.

LBJ consists of a 12-bed level III NICU and a 24-bed level II high-risk nursery step down unit. The team at LBJ consists of 2-3 interns, 1-2 second year residents, and a third year resident.  Residents rotate through a shift system consisting of long or short days as well as a block of nights.  CMHH consists of an 80-bed level IV NICU and 38-bed level II/III step down unit.  The team at CMHH consists of 2-4 second year residents and a 1-2 third year residents.  Residents rotate through a night shift schedule.

All teams have a Neonatology fellow and a full-time faculty Neonatology attending in house 24-hrs per day. Residents are required to attend high-risk deliveries and are given the opportunity to resuscitate the term/preterm infants under the guidance of a fellow, NICU nurse practitioner, or faculty member.  Admissions to the NICU are augmented by transports from the greater Houston area as well as transfers from surrounding Houston hospitals for need of tertiary level care.

Pediatric Intensive Care Unit

The Pediatric Intensive Care Unit (PICU) rotation exposes residents to the evaluation and management of critically ill pediatric patients with a variety of medical and surgical conditions.  There are over 850 admissions per year to the combined CMHH PICU and Children’s Heart Center Intensive Care Unit (CHC-ICU) and approximately 125 congenital heart surgeries performed each year. It is a level I unit that recently expanded to 32-beds. The resident is an integral member of the ICU team, which consists of 2-3 second year residents, 2-3 third year residents, 1-2 ER residents, a critical care fellow, and a full time faculty member from the Division of Pediatric Critical Care.  Residents rotate through a night shift schedule most months. Residents have the opportunity to rotate through the CHC-ICU service allowing for exposure to care for the critically ill cardiac patients.

Pediatric Emergency Department

The Pediatric Emergency Department rotation allows residents to evaluate and treat acutely ill infants, children, and adolescents.  This rotation occurs only at CMHH, a level I trauma center for the greater Houston area. Residents rotate during their second or third year of residency and work closely with housestaff from the Department of Emergency Medicine as well as Pediatric ED faculty.  Both medical and surgical patients are seen in the Pediatric ED, stabilized, and admitted to the pediatric wards or ICU.

Subspecialty Services

A unique aspect of our pediatric residency program is the opportunity to rotate through a variety of subspecialty services outside of elective time.  These subspecialties include Infectious Disease, Nephrology, Neurology, Gastroenterology, Genetics, Chronic Care, Endocrinology, Cardiology, and Pulmonology.  Each of the rotations with subspecialty services includes a combination of both inpatient and ambulatory experiences exposing residents to a wide variety of conditions.

Pediatric Oncology Floor at MD Anderson Cancer Center

The U.S. News & World Report has ranked MD Anderson as one of the top two cancer centers in the nation. Each year, thousands of patients from around the world come to the institution for their care and residents have the opportunity to work with children and families from all over the world. The Pediatric inpatient unit consists of 35-beds.  Residents are exposed to a wide variety of oncological (both solid and liquid) cases, chemotherapy treatment, as well as the management of oncological emergencies.  The monthly team consists of three interns and two upper level residents working under the supervision of a Hem/Onc fellow and a full-time faculty attending.  During the rotation, residents have the opportunity to perform bone marrow aspirations as well as lumbar punctures.

Sick Doc

The sick doctor rotation is a 1 month rotation taken during PGY-2 and PGY-3 years.  Residents usually do a full day clinics at either of the following clinic sites: UT Kids Place, CEO Pediatric and Adolescent Center, or NAM clinic. This month is an opportunity for residents to see and care for patients coming to clinic for a variety of reasons whether it is for a well child check, newborn follow up, hospital follow up visit, or a sick patient that walks into clinic.  Residents work closely with medical students during this rotation and have the opportunity to act as a supervisory and teaching role when seeing patients.  This month allows residents to develop the competency to determine the acuity level of a sick patient to delineate whether a patient will need close follow up or be sent to the emergency center or hospital for admission in an outpatient setting.

Development and Behavior

This rotation consists of predominantly ambulatory experiences at several different sites including ADHD clinic, Spina Bifida comprehensive clinic, and Duncan Children’s Neurodevelopmental clinic.  Residents also have the opportunity to go out in the community to gain further hands on exposure to neurodevelopmental and behavioral issues in the educational setting by visiting The Parish School and Carruth Center, The Monarch School, Headstart program, and early childhood intervention.  Residents are also required to visit the UT Health Science Center Daycare where they have exposure to children in their normal developmental stages.  The goal of the rotation is learn about both normal and abnormal behavior and development.

Adolescent Medicine

The adolescent medicine rotation consists of predominantly ambulatory experiences at several different sites including a college student health service, the Harris County Juvenile Detention facility, and several clinics in the greater Houston area. Residents will occasionally see inpatient consults.

Night Float

PGY-2 residents cover the LBJ well-baby and LBJ floor teams overnight during their night float month. PGY-3 Senior residents cover the pediatric floor teams not on call and subspecialty primary patients on their night float month. This system helps to reduce fatigue for both the daytime and nighttime senior residents on the pediatric floor service.