INPATIENT WARDS – YELLOW TEAM (PULMONOLOGY)
Rotation Contacts and Scheduling Details
Rotation Director:
John Mark, M.D. jmark@stanford.edu
office: 770 Welch Rd, Ste 350
Administrator:
Linda Zarate
phone: 723-8325
office: lzarate@stanford.edu
Introduction
Inpatient pediatrics ward rotations are at the core of general pediatrics training. At LPCH, the focus is on the care of
acutely and chronically ill children with a high degree of complexity and acuity. On the Yellow Team, you will
manage a variety of inpatients followed by the Pulmonology subspecialty service. At times, Yellow Team may
include other consult services (e.g. Endocrine) and the format below may need to be modified.
Expanded educational clinical opportunities are being offered this year during the Yellow Team rotation. The
schedule below and rotation details represent the anticipated structure of the rotation but are subject to review and
change during the year. If you have any questions about the plan for the week or expectations, please discuss with
the service attending.
Time
0700-0800
0800-0830
0830-0900
0900-1000
Monday
Pre-round
Morning Report
Pulm Txp Rounds
Pulmonology
Rounds
Teaching Session*
Tuesday
Pre-round
Morning Report
Pulm Txp Rounds
Pulmonology
Rounds
Teaching Session*
Wednesday
Pre-round
Morning Report
Pulm Txp Rounds
Pulmonology
Rounds
Teaching Session*
Thursday
Pre-round
Morning Report
Pulm Txp Rounds
Pulmonology
Rounds
Teaching Session*
Friday
Pre-round
0800-0900
Grand Rounds
Pulm Txp
Rnds
Pulm Rounds
Patient Care
Patient Care
Patient Care
Patient Care
Conference
Patient Care
Sign-out (interns)
Conference
Patient Care
Sign-out (interns)
Conference
Patient Care
Sign-out (interns)
Patient Care
Chairman’s Rds
Conference
Patient Care
Sign-out (interns)
Sign-out (seniors)
1730*Attending/Fellow to arrange
Sign-out (seniors)
Sign-out (seniors)
Sign-out (seniors)
1000-1030
1030-1200
1100-1200
1200-1300
1300-1800
1700-
Conference
Patient Care
1630
Sign-out
Rotation Specifics
Orientation
Residents should receive sign-out before beginning the rotation so they are well versed with the patients on the first
day. Interns are expected to arrive at the hospital with enough time to pre-round on their patients before Morning
Report. Your supervisor will arrive by 6:45am on Intern Switch Day to help orient you to the service. The Senior
Resident on the Team should hold a brief session on the first day of intern block to discuss how rounds will be
conducted and review the expectations for presentations, pre-rounding, notes and interaction with medical students
and attendings.
Caps
The intern patient cap is 10. When the census is greater than 10, the senior will pre-round on up to 4 patients. When
the census is 12 on a given team at 5pm, the outpatient intern will come in at 6am the following morning to help preround and do work. Additionally, the outpatient intern will take part in intern sign-out. The outpatient intern will
pass of her/his notes to the supervising resident (if the outpatient intern has no morning responsibilities s/he will take
part in ward rounds). This is not optional and is a policy to ensure manageable patient loads to inpatient interns and
supervising time for seniors. In addition, when the census is overwhelming despite these measures, doing
“discovery rounds” is an option.
Rounds
The Senior Resident runs rounds. The team is expected to walk round to see patients and discuss the plan with the
family and the nursing staff. Communication with the family and the outside pediatrician is very important to the
care of our patients. Rounds should be “work rounds” and daily orders should be written as rounds progress. Daily
Updated 6/1810
discharges after rounds should be given priority. Teaching sessions will be held in the mornings with a variable
format including didactic, case based, bedside and experiential. The teaching sessions will be determined by the
Attending/Fellow each week.
Pagers
The Yellow Team will have a team text pager to facilitate communication. Interns will be the primary team member
to carry the pager, except when in Continuity Clinic or after signing out to the Blue/Yellow night float resident.
Yellow Team Call Schedule
Fridays
 Interns on the outpatient services will come to sign-out on weeks 1 and 3 to be aware of the services they will
pre-round for and then cover on Sunday from 6A-5P.
 Interns on the primary inpatient service will take overnight call with help from one of the 2 Senior NF
supervisors who has been covering in an every-other-night fashion all week with her counterpart, and so
therefore knows the children well.
 Interns on call on Friday night will pre-round on their primary week-day service early on Saturday morning,
with support from the NF supervisor, who is not needed for rounds on Saturday morning.
Saturdays
 Post-call interns complete their work with the help of the NF supervisor who was on-call with them the prior
night. This supervisor facilitates any necessary hand-offs to the on-call team, and gives the intern’s notes to the
day-time supervisor for Yellow Team rounds. The post-call interns leave within 27 hours of their arrival the
prior day, likely without actually attending rounds.
 Rounds are run by the day-time supervisors, who are also the seniors on the teams during the week. One senior
will round with Blue/Yellow, and one senior will round with Red/Green. The on-call interns for these services
will be present with each senior, but the senior will report the data (and ideally examine on rounds) the children
seen by the post-call intern who should be gone by rounds.
 The NF supervisor is able to stay to join rounds on the children who were examined by the post-call intern, and
ideally has some sense of their course and their exam findings as well. The NF supervisor does not need to be
back in the hospital until 5PM on Monday night, so duty hours restrictions are not as big of a concern with this
person.
Sundays
 During Intern Week 1, the outpatient Yellow and outpatient Green interns will come in for a day shift until
5pm. They will do the pre-rounding, rounding, and patient care. They should have some sense of the patients
since they came to sign-out on Friday night, and they have the supervision of senior residents who are on the
regular day-time teams. At 5pm, the Night Float interns come to take over.
 During Intern Week 2, the 2nd and last week of Night Float for the Night Float Interns, the Night Float Interns
come in on Sunday for a 24-hour call. This ensures a golden weekend for the color-team residents, while also
granting the Night Float interns only one 24-hour Sunday without the need for reversal back to night-time hours
on Monday as the rotation is then over.
 Rounds will again be run by two separate day-time seniors who are on the primary, week-day teams:
Blue/Yellow will be run by one senior (either the week-day Blue or Yellow senior) and Red/Green rounds will
be run by the other day-time senior (either the week-day Red or Green senior).
Sign-out
Sign-out should take place as follows:
 Prior to 5 pm, supervisors determine order of team sign-out and update LINKS
 On the first day of the rotation, the day senior will sign out to the night intern and night senior while the day
intern observes
 On following days, the day intern will sign out to the night intern then the day senior will sign out to the night
senior (day seniors should observe intern sign-out and day interns should observe supervisor sign-out as time
allows. In such cases the day senior listens carefully adding any missed details, teaches intern about sign-out
strategies, and answers pages as needed).
Updated 6/1810



Sign-out consists of a brief one-liner about the patient, significant PMHx, reason for admission, and current
status. Then either problem-based or systems-based sign-out should include current exam, tasks to be done
overnight for that system or problem, contingency planning (what could go wrong and what the team should do
about it), and “what worked” (highlight of problems that have arisen and what worked to solve them)
As the rotation progresses, Night Teams will know the service better. Therefore, sign-out should be relatively
quick and concise—focusing on new admissions and new developments for existing patients.
Sign-out will not include pulmonary consult patients even if resident supervisor or intern participate in the
evaluation of the pulmonary consult patient.
During their weekday calls, the Night Team is only responsible for pre-rounding on and writing notes for the new
patients who they admitted during the previous night (progress notes needed on all admissions prior to midnight).
Between 6:45 and 7:00 each morning (Monday through Friday) supervisors from each team will meet with the Night
Team supervisor to sign out new patients and important overnight events (the night team must be out of the hospital
by 7:30. If the day team arrives too late, this on time departure cannot happen). Interns should provide written signout to the daytime teams and give verbal sign out to the daytime interns about new admissions and significant
overnight events. In addition, the Night Team will communicate any questions regarding their management
overnight and the day team will provide feedback on those issues the following night.
Evening Report (when working overnight shift)
As part of our educational curriculum, there is an Evening Report held each night in the Housestaff Lounge. These
reports, led by overnight pediatric hospitalists, focus on acute ‘on call’ issues. The sessions will be very flexible and
will include bedside teaching, practical skills, and physical exam rounds. It is the responsibility of the night float
supervisor to contact the hospitalist to arrange the most convenient times for these educational sessions.
Resident Roles and Responsibilities
Intern:
• Performs the primary patient care role
• Pre-rounds on patients and writes daily progress notes and orders
• Presents patients on rounds and takes care of daily work associated with patient care
• Performs dictated history and physicals on new patients
• Plans discharges and does paperwork.
• Takes call on weekends
• Supervises medical students caring for your patients.
Supervising Resident:
• Supervises interns and medical students
• Starts day at 6:45-7:00 am
• Examines new and sick patients, check labs and films – prior to Morning Rounds
• Discusses overnight events with the Night Team and receives sign-out
• Runs rounds and makes management decisions with the input of the team and attendings
• Follows-up on daily patient work to ensure the plan is carried out appropriately
• Contacts the private pediatricians with an update on their patient
• Takes responsibility for the care of all patients on the team
• Conducts efficient walk/work rounds
• Helps organize/facilitate morning teaching sessions with the Attending/Fellow
Evaluation and Feedback
The methods of evaluation for the Yellow Team Ward Rotation will consist of:
 MedHub Resident Evaluations, Faculty Evaluations, Rotation Evaluations
Feedback should be provided by the supervisor to intern on a regular basis, but at least weekly. The supervisor
should also request feedback from the intern. This is a professional expectation. The focus of feedback will be on
competency-based goals and objectives. Feedback to the supervisor should be provided by the service attendings on
a weekly basis focusing on competency-based goals and objectives and leadership of a patient care team. It is the
responsibility of the resident to solicit attending feedback.
At the end of the rotation an end-of-rotation feedback session will be conducted by the supervising resident and subspecialty attending.
Updated 6/1810
ACGME Competency-based Goals and Objectives
Goal 1. Demonstrate competency in caring for patients with complicated pneumonia
Resident Objectives
Instructional Strategies
Assessment of Competence
1. Select appropriate imaging modalities  Patient care
 MedHub evaluation (done by
to clarify diagnosis
 Teaching on rounds
pulmonary service attending)
 Teaching Module:
 Active observation by service
 X-ray
“Complicated Pneumonia”
attending of patient care
 CT
 Review and discussion with
 US
resident imaging results
 Laryngoscopy
 Bronchoscopy
(PGY 1, 3)
2. Selected appropriate antibiotic
 Patient care
 MedHub evaluation (done by
coverage when indicated
 Teaching on rounds
pulmonary group)
(PGY 1, 3)
Teaching Module:
 Active observation by service
“Complicated Pneumonia”
attending of patient encounter
3. Recognize when acceleration or
 Patient care
 MedHub evaluation (done by
alteration of care indicated for
 Teaching on rounds
pulmonary group)
inadequate response to therapy and
Teaching Module:
 Active observation by service
initiate consultation or additional care
“Complicated Pneumonia”
attending of patient encounter
 IR
 Chest tube
 VATS
(PGY 3)
ACGME Competency Goals
MK—Demonstrate knowledge evolving sciences and
apply this knowledge to patient care
PC—Provide effective health care services
SBP - Incorporate considerations of cost awareness and
risk-benefit analysis in patient and or population-based
care as appropriate
MK—Demonstrate knowledge evolving sciences and
apply this knowledge to patient care
PC—Provide effective health care services
MK—Demonstrate knowledge evolving sciences and
apply this knowledge to patient care
PC—Provide effective health care services
ICS—(a)Communicate effectively with physicians, other
health professionals, and health related agencies;
(b)Work effectively as a member or leader of a health
care team
SBP - Work in inter-professional teams to enhance
patient safety and improve patient care
Goal 2. Demonstrate competency in caring for patients with neuromuscular disorders with pulmonary compromise
Resident Objectives
1. Identify the physical examination
findings that reflect pulmonary
compromise in setting of neuromuscular
weakness syndromes
(PGY 1, 3)
2. Discuss and demonstrate participation
in the multi-disciplinary approach to the
care of a patient with neuromuscular
disease
 Nutrition services
 Respiratory therapy
 Social services
Updated 6/1810
Instructional Strategies
 Patient care
 Teaching on rounds


Patient care
Teaching on rounds
Assessment of Competence
Active observation by service
attending of physical examination
or repeat of exam
ACGME Competency Goals
PC—Provide effective health care
Services
MK—Demonstrate knowledge evolving sciences and
apply this knowledge to patient care

MK—Demonstrate knowledge evolving sciences and
apply this knowledge to patient care
PC—Provide effective health care services
SBP—(a )Know how to work with other health
professionals and health related agencies (b) Assist
patients in dealing with system complexities
ICS – Work effectively with others as a member or leader

Patient-centered discussion with
faculty
 Faculty observation during patient
care conferences
of a health care team or other professional group
 Nursing
(PGY 1, 3)
Goal 3. Demonstrate competency in caring for patients with exacerbation of cystic fibrosis requiring hospitalization
Resident Objectives:
Instructional Strategies
Assessment of Competence
ACGME Competency Goals
1. List the signs and symptoms of cystic
 Reading materials
 Patient-centered discussion with
MK—Demonstrate knowledge evolving sciences and
fibrosis exacerbation warranting
 Clinical encounters
faculty
apply this knowledge to patient care
hospitalization
PC—Provide effective health care services
(PGY 1, 3)
2. Initiate care for patient with cystic
 Reading materials
 Patient-centered discussion with
MK—Demonstrate knowledge evolving sciences and
fibrosis exacerbation
 Clinical encounters
faculty
apply this knowledge to patient care
 Review of orders by attending
PC—Provide effective health care services
 Selection of appropriate antibiotics
 Selection of appropriate airway
clearance techniques
 Selection of appropriate nutritional
support
 Initiate appropriate infection control
measures
(PGY 1, 3)
3. Discuss and demonstrate participation  Patient care
 Patient-centered discussion with
MK—Demonstrate knowledge evolving sciences and
in the multi-disciplinary approach to the
 Teaching on rounds
faculty
apply this knowledge to patient care
care of a patient with cystic fibrosis
 Faculty observation during patient
PC—Provide effective health care services
care conferences
SBP—(a )Know how to work with other health
 Nutrition services
professionals and health related agencies (b) Assist
 Respiratory therapy
patients in dealing with system complexities
 Social services
ICS – Work effectively with others as a member or leader
 Nursing
of a health care team or other professional group
(PGY 1, 3)
4. Describe the roles of commonly used
 Reading materials
 Patient-centered discussion with
MK—Demonstrate knowledge evolving sciences and
medications in the management of a CF
 Clinical encounters
faculty
apply this knowledge to patient care
exacerbation
 Review of orders by attending
PC—Provide effective health care services
 Anti-inflammatories (e.g.,
azithromycin)
 Mucolytics (e.g., dornase alpha, Nactyl cysteine, hypertonic saline)
 Bronchodilators (e.g., albuterol)
 Pancreatic enzymes
(PGY 3)
Updated 6/1810
5. Reflect in rounds presentations
 Reading materials
 Patient-centered discussion with
MK—Demonstrate knowledge evolving sciences and
(including care plan) consideration of
 Clinical encounters
faculty
apply this knowledge to patient care
extrapulmonary manifestations of cystic
 MedHub evaluation
PC—Provide effective health care services
fibrosis
ICS—(a)Communicate effectively with physicians, other
health professionals, and health related agencies;
 Pancreatic insufficiency (fat
(b)Work effectively as a member or leader of a health
malabsorption, insulin intolerance)
care team
 Hepatic dysfunction
 Nutritional deficiencies
(PGY 1, 3)
Goal 4: Demonstrate understanding of the care of a child with pulmonary disease in the setting of an immunocompromised state
Resident Objectives:
Instructional Strategies
Assessment of Competence
ACGME Competency Goals
1. Recognize signs and symptoms of
 Patient care
 Discussions around patient care
PC—Provide effective health care services
rejection versus infection in an
 Reading materials
MK—Demonstrate knowledge evolving sciences and
immunocompromised patient (e.g., s/p
apply this knowledge to patient care
lung transplant)
(PGY 3)
Goal 5. Demonstrate proficiency in use and titration of various devices for respiratory support
Resident Objectives:
Instructional Strategies
Assessment of Competence
ACGME Competency Goals
1. Experiment with and differentiate
 Respiratory therapy
 Direct input from respiratory
MK—Demonstrate knowledge evolving sciences and
between various respiratory support
collaboration
therapist
apply this knowledge to patient care
devices
 Independent reading
PC—Provide effective health care services
ICS—(a)Communicate effectively with physicians, other
 Oxygen delivery modalities (e.g.,
health professionals, and health related agencies;
nasal cannula, various face masks)
(b)Work effectively as a member or leader of a health
 CPAP/BiPAP
care team
(PGY 1, 3)
2. Experiment with and differentiate
 Respiratory therapy
 Direct input from respiratory
MK—Demonstrate knowledge evolving sciences and
between various airway clearance
collaboration
therapist
apply this knowledge to patient care
devices
 Independent reading
PC—Provide effective health care services
ICS—(a)Communicate effectively with physicians, other
 VEST
health professionals, and health related agencies;
 IPV
(b)Work effectively as a member or leader of a health
 Cough assist
care team
 Acapella/Flutter device (+ pressure)
(PGY 1, 3)
PBLI = practice based learning and improvement
ICS = interpersonal and communication skills
P = professionalism
MK = medical knowledge
PC = patient care
SBP = systems based practice
Updated 6/1810