Inpatient/Emergency Department/Newborn Nursery/Clinic
Welcome to Pediatrics: We look forward to working with you this year. We hope this will be an enjoyable, productive, and instructive time for you as you learn to provide excellent primary care for children. We welcome any suggestions you have which will make the rotation a better one.
Duration: 2 months
Faculty: Michael A. Taylor, M.D., Chairman
Karen B. Burgess, M.D.
Elizabeth L. Cockrum, M.D.
Ashley Evans, M.D.
Beth M. Smith, CRNP
Pediatric faculty members have Inpatient Attending responsibilities for one- or two-week blocks at a time, switching over at 5:00 PM on Fridays. Night call is variable and a schedule will be provided to you. The
Inpatient Attending is always available by pager for consultation. We expect to be kept informed about any patient care issues in a timely manner.
Morning Report (Rounds): Rounds begin at 8:00 AM on weekday mornings in the 5 th Floor Classroom.
Weekend rounds begin at the discretion of the attending (usually 8 AM). The senior resident is the leader of the team and is responsible for assuring that rounds go smoothly.
1. Each patient admitted since rounds the day before is formally presented to the team. In general, a medical student should do only one presentation. The remaining admissions are to be presented by the first year resident (intern) or upper level resident that admitted the patient if available or by the on assigned to the patient.
2. Before rounds, each floor patient and well baby is to have been thoroughly evaluated by an intern.
This includes talking with the nurses, family, and patient about progress or problems, performing a physical exam, vital sign and chart review, obtaining any relevant lab and x-ray data, and preparing to present the above information at morning report. The senior resident will assign each patient to a particular intern and student for the duration of the admission, if possible.
3. A medical student (when available) will usually present each patient on rounds. However, you are to oversee the students as they prepare for rounds and collect all the information yourself.
4. Progress notes are to be written before rounds (either by yourself, or by a student under your supervision). Provide assistance to the students as necessary and review their notes prior to rounds.
5. The intern is the person primarily responsible for carrying out the treatment plans discussed during rounds. You should discuss your patient and proposed plans with the Senior Resident prior to the morning report. Be diligent in making sure your patients are cared for by “checking out” relevant information to other interns covering for you during your clinic or overnight. Take personal responsibility for your pati ents; don’t assume “someone will get around to it.”
Afternoon Report (Rounds): The Senior Resident will lead afternoon rounds with the team at 3:30 each day (or assign a different time if needed). Particular attention is to be paid to follow-up of issues from morning rounds. Occasionally, the in-house intern leads these rounds, if so directed by the Senior
Resident. If so, the intern should call the attending at about 4:30 for evening check out. The in-house intern(s) should write a brief progress note each afternoon on each patient (except well baby nursery). As stated above, you are responsible for assuring that the overnight intern covering for you knows any relevant information about your patients.
Well-Baby Nursery: The documentation required in the nursery is detailed and will be reviewed with you during your orientation session. Briefly this includes signing the admit orders, filling out the H&P form, performing and documenting the Ballard exam (gestational age assessment formerly called the Dubowitz exam), plotting the weight/height/head circumference percentiles, writing admit and progress notes, and writing orders. Every baby is to be thoroughly examined by an intern every morning! Every mother is to be talked to by an intern every morning! Anything worrisome, unusual, or unclear about a baby should be discussed with the senior resident and/or attending before mentioning it to the baby’s family. A guide for talking to new parents is included in your resident packet. CMC mothers should be given a copy of the yellow Newborn Manual (also available in Spanish).

1 st Year Resident Orientation Page 2
Admissions: The intern who admits a patient is to dictate a full history and physical examination (H&P).
Medical student H & P’s are NOT to go onto a patient’s chart. The format of the Pediatric History and
Physical will be gone over with you and is available on the CD given to you at the beginning of the rotation. The senior resident on call will write a concise admit note on each patient to be placed in the progress notes.
Emergency Department: We see our own patients, consults from the ED staff, transfers from outlying hospitals, as well as unreferred patients (Mon, Wed, Thur, and Sat) after the initial evaluation by the ED staff. We also may do the initial patient evaluation in certain circumstances (patient is sent from clinic).
The upper level resident is to have examined every patient and reviewed the treatment plan before the patient is checked out to the attending by phone. No patient is to be sent out of the ED without having been examined by the upper level resident! In the rare event that the upper level resident is not able to physically see a patient due to other responsibilities, this fact is to be made clear to the attending at the beginning of the checkout call. If a patient is to be followed up at the University Medical
Center (UMC), you must call the clinic (or voice-mail after hours) and let the clinic know to expect them.
Call the student (use their pager #) for each ED patient – this is NOT optional.
Pediatric Clinic: You will go to the Pediatric Clinic at UMC 3 half-days per week. You will be oriented to the clinic at the beginning of your first assigned session. You will see children for illness visits, follow-ups, and well-child care under the supervision of an attending. Each of your patients is to be presented to and seen by an attending before they are sent out of clinic.
Schedules: You and the senior resident will complete a clinic schedule for the month. The call schedule is completed by the residency office. You are expected to attend the Allergy & Asthma Center (Drs.
Dishuck & Helms), located at 535-C Jack Warner Pkwy, each 2 nd Wednesday morning of the month from
9 to12. A map is included in your orientation CD. In addition, you will attend the Pediatric Cardiology
Clinic (3 rd Thursday of each month (one person in the am and one in the pm)), and the Regional Sickle
Cell Clinic (3 rd Friday morning 2 out of every 3 months from 9 to 12) which are both held in the Specialty
Clinic of the University Medical Center.
Reading/Lecutres: You are to attend pediatric lectures Tuesday and Friday mornings. There is a collection of articles on the cd provided at the beginning of the rotation. Please have completed reading the articles in the “intern” section of the table of contents by the end of the rotation.
Karen B. Burgess, M.D.
12/07/2005