Rotation, Calls & Electives

Improving Resident Wellness and Continuity of Care: the X+Y System

Traditionally, pediatric residencies are structured so that residents would rotate on weeks-long inpatient rotations with a half-day of afternoon clinic each week.  At Rainbow, we were proud to be one of the first pediatric residency programs to embrace the “X+Y” scheduling model to improve our resident wellness and continuity of care.  We follow a “6+2” model, in which residents spend six weeks on inpatient, elective, or individualized curricular rotations followed by 2 weeks of ambulatory experiences:

The “6”:  Inpatient, Individualized Curricula

During your non-ambulatory blocks, you will rotate on two- or four-week inpatient blocks, participate in structured electives of your choosing, and/or participate in individualized curriculum tailored to your specific interests as a clinician, educator, or researcher.

The “2”:  Ambulatory Rotations and Longitudinal Curricula

All residents are scheduled for two consecutive weeks of ambulatory rotations.  Your ambulatory experience will include clinics at our multi-disciplinary medical home where we provide primary care to a medically underserved patient population.  Additionally, Rainbow’s Adolescent Medicine and Developmental/Behavioral Pediatrics departments integrate our residents into their clinical work during ambulatory rotations, and a longitudinal outpatient-based advocacy curriculum allows you to identify a passion project in improving the lives of Cleveland’s children.

Why X+Y?

The transition to X+Y has been happily and enthusiastically embraced by our residents. The advantages of this model include:

• Ensuring that residents are on ambulatory 2 weeks out of every 8, helping to break up long stretches of inpatient work.
• More frequent “golden” (two-day) weekends, as residents do not routinely have scheduled clinical duties on ambulatory rotation weekends.
• Less frequent resident sign-outs, as residents no longer leave their inpatient rotations to do a half-day of clinic. This has the added benefit of more equitable distribution of work on busy inpatient services.
• Creation of cohorts – called “flights” – of residents spanning all years of training who will always be in clinic and ambulatory didactics together.
• Opportunities for patient continuity, as residents will know the dates of their ambulatory blocks and can encourage families to see them for both short and long term follow up.

Curriculum

July 2025 Changes

Nationally, pediatrics residencies are making adjustments to their scheduling to align with bold new changes from the ACGME. Rainbow Babies and Children’s is eager to institute these new and exciting changes, and believes the new curriculum will offer an excellent education opportunity for residents.

As the final adjustments to the format for the year are solidified, we will discuss more specifics during your interview day. Below are some outlines of the experiences:

OVERALL YEAR

Each year is divided into 13 four-week blocks:

Vacation

• Each year, all residents have one two-week block of vacation and two one-week blocks of vacation totaling four weeks.
• An additional full week is typically scheduled over the winter holidays, but can easily be tailored to your preferred days of celebration.
• First year residents have an additional one-week vacation at the end of their internship year.

REQUIRED ROTATIONS

Inpatient Ward Teams

The inpatient experience is moving toward a general hospitalist team centered model, with close cooperation with our various subspecialty teams.

UH Rainbow Babies & Children’s host a full roster of core subspecialty teams who are active in patient management and resident education on the inpatient floors.

Residents will work very closely with fellows and attendings from various subspecialties, including but not limited to gastroenterology, nephrology, pulmonology, endocrinology, cardiology, neurology, epilepsy, adolescent medicine, hematology-oncology, genetics / metabolism, infectious disease, and more. Close connection to the larger University Hospitals systems enables and encourages cooperation with the various surgical subspecialties, dermatology, allergy and immunology, palliative, psychiatry, and more.

Inpatient rounds extends beyond just subspecialty teams, with multidisciplinary rounds that include pharmacists, dieticians, social workers, case coordinators, child life, and more.

Day/Night Coverage

The inpatient ward teams utilize a day team/night team system. Residents on their core inpatient teams do not do 24-hour call.

NICU

UH Rainbow Babies & Children’s Hospital’s Neonatal Intensive Care Unit has long been a leader in the field of neonatology. The unit comprises two hybrid resident/NP teams, each with a neonatology fellow and attending. The Junior and Senior residents follow a day/night system, whereas the interns only do days. Residents care for everything from meconium aspiration to congenital diaphragmatic hernia requiring maximal support with ECMO. The NICU has its own didactic curriculum, with neonatology lectures given by our esteemed attendings and fellows.

PICU

The 20-bed Pediatric Intensive Care Unit is staffed by pediatric residents from pediatrics in addition to critical care fellows and attending physicians. 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 seen include respiratory failure, ingestions, heart failure, liver failure, major trauma, and life-threatening infections. Residents in the PICU also participate in critical-care noon didactics given by our fellows and attendings.

Emergency Department

The emergency department at UH Rainbow Babies & Children’s Hospital is the only emergency center dedicated to pediatric care and level 1 pediatric trauma care in Cleveland. We receive patients of all acuity levels from local emergency medical services, community hospitals, the hospital’s Critical Care Transport & MedEvac Services, as well as by private vehicle. Residents learn how to assess, evaluate and treat pediatric patients with acute medical and surgical conditions. Residents are directly supervised by board-certified pediatric emergency medicine physicians 24 hours a day. During their ED rotation, residents also attend interactive weekly didactic sessions that are led by our emergency medicine faculty and fellows.

Newborn Nursery

Residents rotate in the Newborn Nursery, including both daytime and, when a junior/senior, nighttime coverage. The team covers the newborn nursery at UH MacDonald Women’s Hospital, which is connected to UH Rainbow Babies & Children’s Hospital. Residents in the Newborn Nursery attend deliveries requiring resuscitation in the same-building women’s hospital. A Code Pink resuscitation team as well as a neonatology attending or in-house neonatology fellow responds alongside the residents to all deliveries where a pediatrician is needed.

Advocacy

Residents participate in a longitudinal Community Health and Child Health Advocacy experience. Experiences are vast, including time working with various agencies that support the well-being of children and families in the Cleveland area. In addition, residents will develop a better understanding of core concepts related to social determinants of health, injury prevention, child health policy, and legislative advocacy. Rotation components include experiential learning within the hospital and local community, small group didactic sessions with faculty and other local experts, as well as the completion of individual advocacy projects.

Developmental-Behavioral Pediatrics

Residents gain immersive experience within the Developmental and Behavioral Pediatrics clinics, with experience in general developmental, fetal alcohol syndrome, ADHD, and autism. This is supplemented with didactic teaching sessions designed to educate the resident on a wide variety of topics in developmental and behavioral pediatrics.

Adolescent Medicine

Residents rotate in a dedicated adolescent medicine clinic, under the supervision and guidance of board certified adolescent medicine attending physicians. Residents have additional experiences with off-site, community locations that specialize in providing medical, social, and psychiatric care to adolescents.

OBRE (Outpatient Based Residency Experience)

This popular rotation provides an immersion experience in outpatient primary care pediatrics in a community setting. Residents work with one of our providers in the Rainbow Care Network to learn about topics such as ambulatory pediatric care, billing and coding, telephone triage, practice management, and the basics of health insurance. Residents are able to compare their experiences in the community with those in their own continuity clinic and see how medicine is practiced in different settings and with different patient populations.

Subspecialty Rotations (Electives and Individualized Curriculum)

During each of the three years, residents have many blocks to explore pediatric subspecialties of their choosing, and tailor their educational experience toward their individual career goals. A list of available electives at UH Rainbow Babies & Children’s Hospital is below; however, residents may also design their own electives, with the help of a faculty mentor and program directors.

• Allergy-Immunology
• Anesthesia
• Breastfeeding
• Business of Medicine
• Cardiology
• Child Protection & Advocacy
• Comprehensive Care (Children with Complex Medical Needs)
• Community Hospitalist
• Dermatology
• Medical Education
• Endocrinology
• Ethics
• Gastroenterology
• Genetics
• Hematology and Oncology
• Infectious Disease
• International Health
• Metabolism
• Nephrology
• Neurology
• Nutrition
• OBRE (Outpatient Private Practice Pediatrics)
• Ophthalmology
• Orthopedic Surgery
• Otolaryngology (ENT)
• Parenting in Pediatrics
• Pain Medicine
• Palliative Care
• PICU Pre-fellow
• Psychiatry
• Pulmonology
• Radiology
• Research
• Respiratory Therapy
• Rheumatology
• Sedation Unit
• Sports Medicine
• Subspecialty Pre-fellow
• Teaching Skills
• Transport
• Urology