*Each year is divided into thirteen four-week blocks to maximize the clinical experiences and available elective time. 
*Residents have two 2-week blocks of vacation each year plus an additional five days off during the December holiday season. 
*First year residents also have one-week of vacation at the end of their internship year. 
*Each year, one elective block is free from call responsibilities; in addition, one to five blocks of electives include only Jeopardy call – sick call with no scheduled in-house call.
* Telephone triage is limited to 2 weeks as a junior resident (usually during developmental pediatrics), and is limited to Monday-Friday from 5pm-1030pm. During the remainder of the week, calls are handled by our triage center.

Call System/Schedule
Call ranges from every 4th night to every 5th night during the inpatient ward, PICU, NICU, and Junior Hospitalist blocks. Newborn nursery call is every 5th to every 6th night. Other rotations are either jeopardy call or no-call (as described above). 
At night on call, there is one Intern (or PGY-2 for the Junior Hospitalist service) on for each team and two upper level residents to supervise the wards.  There is an additional upper level resident on-site beginning at 4:30pm to assist the floor teams with admitting patients, performing procedures, and ensuring that the off-call residents leaving on time.

REQUIRED ROTATIONS

Inpatient Ward Teams

Rainbow Babies and Children’s Hospital’s inpatient wards are covered by four resident teams.  Each team is comprised of two junior or senior resident ward supervisors, four interns, and two or three third year medical students.  Each team includes patients with a variety of subspecialty and general pediatric medical conditions.  Attending physicians participate in team rounds daily.

Red Team: 
This team covers our Hematology service (sickle cell disease, hemophilia, coagulation disorders), Oncology (leukemia, lymphoma, solid tumors), and BMT patients; Rheumatology (JIA, scleroderma) also admits patients to this team.

Blue Team:  
This team cares for General Pediatric patients (gastroenteritis, asthma, pneumonia), Gastroenterology patients (Crohn’s disease, ulcerative colitis, autoimmune hepatitis), and Nephrology patients (acute kidney injury, nephrotic syndrome, kidney transplantation).

Green Team:
Patients include General Pediatrics (including a small subset of community pediatricians with admitting privileges), Cardiology (congenital heart disease, arrhythmias, post-cardiac surgery), Neurology (epilepsy, Guillain-Barré, pseudotumor cerebri) and Infectious Disease.

Orange Team:
Patients on this team are from Endocrinology (Type 1 diabetes, thyrotoxicosis, panhypopituitarism), Pulmonary (asthma, cystic fibrosis, interstitial lung disease); Metabolism (urea cycle disorders, glycogen storage diseases), and General Pediatrics.

Silver Team:
This General Pediatrics team was created in response to resident feedback about the need for increased staffing during busy winter months.

Junior Hospitalist:
This 2 week rotation was also developed in response to resident feedback.  The team consists of four junior residents under direct supervision of an attending.  This allows the residents to focus on developing their independent patient management skills under the mentorship of a member of the General Academic Pediatrics inpatient service.  This team takes the place of Silver Team during three of the five busiest months of the year.

Intensive Care Units

NICU:
Rainbow Babies and Children’s Neonatal Intensive Care Unit has long been a leader in the field and was ranked #2 by US News and World Report in 2009. The unit is comprised of two teams, each of which includes an intern, junior resident, senior resident, nurse practitioners, a neonatology fellow and an attending physician.  Call averages every 4th to 5th night and residents are supported on-call by the in-house neonatology fellow.  Residents do not cover deliveries while on their NICU rotations.

PICU:
The recently renovated 20 bed Pediatric Intensive Care Unit is staffed by four or five junior residents, critical care fellows and an attending physician.  Call is every 4th to 5th night with in-house critical care fellows on-call to assist in patient care decisions and management.  During this rotation, residents have the opportunity to care for critically ill children with the benefits of a large support infrastructure and all modern medical technologies, including ECMO and oscillatory ventilation.  Clinical conditions you’ll see include respiratory failure, ingestions, heart failure, liver failure, major trauma, organ transplantation and life-threatening infections.  Residents do not write daily progress notes in the PICU while still caring for every patient admitted. This allows for greater time devoted to procedures and management of the PICU’s acutely ill patients.

Emergency Department:
The Pediatric Emergency Department (PED) at Rainbow Babies and Children’s Hospital is the only Pediatric Emergency Department in the city of Cleveland and an American College of Surgeons designated Level 1 Pediatric Trauma Center. 
We receive patients of all acuity levels from the local emergency medical services, the Hospital’s Critical Care Transport and MedEvac Services as well as by private vehicle. 
Here, residents learn how to assess, resuscitate, evaluate and treat pediatric patients with acute medical and surgical conditions.  The residents are directly supervised by Board-certified Pediatric Emergency Medicine physicians and Board-certified pediatricians 24 hours a day.  Interns rotate through the PED during their Ambulatory/Surgical block rotation, junior and senior residents spend an additional five months in the PED over the course of their residency. 
Education is provided through teaching about actual patients and a 25-topic on-line curriculum that covers everything from splinting and suturing to toxicology and trauma. 
A separate Rapid Care area, staffed by community pediatricians, helps manage the patient flow during the busy afternoon and evening hours.  A brand new Emergency Medicine Center is under construction.

Newborn Nursery:
Residents rotate in the Newborn Nursery for two weeks during each year. The team covers the newborn nursery at MacDonald Women’s Hospital, which is physically connected to Rainbow.  Under the supervision of a Neonatology Attending, the residents take care of all healthy newborns and attend all deliveries where a pediatrician is needed.

Developmental Pediatrics:
This is a four week long rotation usually done during the junior year.  This rotation includes didactic teaching sessions and clinical experiences designed to educate the resident on a wide variety of topics in Developmental and Behavioral Pediatrics. 

Adolescent Medicine:
Residents learn about the special needs of adolescents during this four-week rotation.  The rotation is led by our Adolescent Medicine specialists and includes time at the nearby Free Clinic as well as the Adolescent Clinic at Rainbow.

Ambulatory Surgical Subspecialites/ER:
This four-week rotation gives interns experience in the Pediatric Emergency Department at Rainbow and in several of the surgical subspecialty clinics. This allows for learning the pathophysiology and management of patients traditionally only cared for by the pediatric surgeons and subspecialty surgeons.  In addition, this rotation includes visits to a community home for children with developmental disabilities, and to a pediatric hospice provider.

Pediatric Surgery:
This two-week rotation as a senior resident allows for collaboration with our pediatric surgeons with inpatient management of surgical patients. Time is divided between assisting with surgical consultations and managing workflow on the floors.  Time in the operating room is optional.

ELECTIVES

During each of the three years, residents have several elective blocks to explore the breadth of pediatric subspecialties, from Cardiology to Radiology, Ethics, and International Health. There is no scheduled in-house call during these months, though the resident is often on Jeopardy call (back-up call in case of illness or emergency).  A list of available electives at RB&C is below; however residents may also design their own electives, with the help of a faculty mentor and program directors.

• Allergy-Immunology
• Anesthesia
• Cardiology
• Cardiothoracic Surgery/CICU
• Child Protection
• Child Psychiatry
• Critical Care (Intensive Care)
• Dermatology
• Development of the Premature Infant
• Endocrinology
• Ethics
• Genetics
• Gastroenterology
• Hematology-Oncology
• Infectious Disease
• International Health
• Metabolism
• Nephrology
• Neurology
• OBRE (outpatient private practice pediatrics)
• Ophthalmology
• Orthopedic Surgery
• Otolaryngology (ENT)
• Pharmacology/Toxicology
• Pulmonology
• Radiology
• Research
• Rheumatology
• Sedation Unit
• Sports Medicine
• Teaching Senior