Neill and Zinkham Inpatient Teams

The two resident inpatient teams are named for eminent pediatricians were prominent in the history of the Harriet Lane Service during the latter part of the 20th century. Catherine Neill was a pediatric cardiologist whose care for patients and enthusiasm for teaching house officers are legendary. William Zinkham was a pediatric hematologist revered by residents for his diagnostic acumen, his ability to solve problems and his wizardry with the microscope.

Each of the two inpatient teams consists of two interns and two PL-3s who cover patients on the two general inpatient services. Patients with common pediatric medical illnesses and a wide variety of subspecialty diagnostic and therapeutic problems are seen.

Medical patients represent a variety of chronic and acute disorders ranging from pneumonia, diarrhea and dehydration, and failure to thrive to complex congenital cardiac defects, renal transplants and a variety of metabolic disorders.

Subspecialty Teams

There are six subspecialty resident teams assigned to work with faculty on each of the following services:

• Pediatric Cardiology
• Pediatric Gastroenterology
• Pediatric Hematology
• Pediatric Nephrology
• Pediatric Pulmonary Medicine
• Pediatric Oncology

The residents assigned to each team have primary responsibility for the patients admitted to that team’s service. Residents also see patients in the appropriate subspecialty clinic and participate in conferences along with the faculty and fellows. If home care is necessary for a patient upon discharge, the residents on the team participate in planning that care.

The teams are responsible for the management of their hospitalized patients and are assisted in the details of patient management by the following:

• Intravenous therapy and phlebotomy teams available 24 hours a day, 7 days a week
• Nurse case managers who ensure that referrals, consultations, laboratory tests and radiographic studies are arranged
• A nurse practitioner who assists in discharge planning

Each resident will be assigned to a subspecialty team for approximately two months of the PL-1 year and for approximately two months of the PL-3 year, except for Hematology and Oncology, which are PL-2 rotations.

NICU

The 45-bed Neonatal Intensive Care Unit is next to the labor and delivery area, near the antepartum and postpartum units. Infants at high risk because of immaturity, intrauterine growth disturbances, respiratory distress syndrome, presumed sepsis, congenital anomalies and other problems are cared for in the NICU. The Department of Obstetrics High-Risk Maternal Service and the Maryland Regional Neonatal Program refer neonates to this unit. The house staff team consists of two PL-3s, one PL-2 and four PL-1s. House staff gain experience in treating a wide variety of critically ill patients using sophisticated monitoring and cardiorespiratory support equipment.

PICU

The 40-bed Pediatric Intensive Care Unit treats both medical and surgical patients. In addition to patients admitted via the Pediatric Emergency Department, the PICU admits critically ill medical and surgical patients referred from facilities throughout the state. During the month-long rotation, house staff have on-call responsibility only for the PICU.

As the Maryland State Regional Shock Trauma Center for Children, the Johns Hopkins Children’s Center admits a large number of patients with severe trauma involving several organ systems. Full-time faculty trained in anesthesiology, cardiology, pediatrics and pediatric intensive care, as well as fellows currently training in pediatric intensive care, supervise house staff and make daily rounds in the PICU.

Special emphasis is placed upon teaching pediatric residents the principles of airway management and ventilation, cardiac and pulmonary physiology, pharmacology, monitoring techniques and the management of head trauma and other conditions in which elevated intracranial pressure may occur. While the rotation emphasizes clinical care responsibility, house staff are encouraged to initiate or become involved in clinical and/or experimental intensive care research projects.

Emergency Department

The Pediatric Emergency Department is a state-of-the-art 32-bed facility that provides acute care for neighborhood families, subspecialty patients and patients from the greater Baltimore area. It is a vital part of the pediatric residency training program. The emergency department is staffed by house officers at all three levels of training who manage all emergencies, urgent admission evaluations and acute walk-in patients. Residents have the opportunity to manage Level I traumas and critically ill patients. House staff also work in a minor trauma area, providing care to children with lacerations, fractures and other injuries. The emergency department is supervised by full-time pediatric emergency medicine faculty members, clinical associates and pediatric emergency fellows. There are approximately 35,000 patient visits per year.

For more information, visit the pediatric emergency department.

Hospital Consult Medicine

One PL-3 rotates on the Hospital Consult Medicine service each month, acting as a consultant. This opportunity increases residents’ exposure to hospitalist medicine by conducting consults and working closely with pediatric hospitalists in the medical management of surgical patients and other patients in the Children’s Center.

Newborn Nursery — St. Agnes Hospital

House staff provide newborn assessment and care, as well as family education and counseling in the St. Agnes term nursery. They work directly with attending neonatologists, pediatric nurse practitioners and staff nurses from the nursery. They communicate with the Obstetrical Service and attend high-risk deliveries. Neonatology and anesthesiology attending staff provide resuscitation experience. Approximately 3,000 infants are delivered each year at St. Agnes.

St. Agnes Ward (Heldrich Service)

Johns Hopkins pediatric residents spend approximately two-and-a-half to three months at St. Agnes Hospital during their three years of training. Eight pediatric residents are assigned to St. Agnes each month, either to the pediatric inpatient service or the full-term nursery, or they may choose an elective month by participating in a variety of community experiences coordinated by St. Agnes Faculty.

Kennedy Krieger Institute

Each PL-2 spends one month on the Kennedy Krieger Institute Inpatient Service and Outpatient Clinics learning about many aspects of childhood development. Activities include rounds with attending physicians and conferences with audiologists, speech pathologists, physical and occupational therapists, educators, and psychologists.

Harriet Lane Clinic for Children and Adolescents

House staff identify and follow a panel of patients ranging from newborns to adolescents for well-child visits and acute and chronic care during their three years of training. The program provides the setting and staff to facilitate continuity. Faculty, fellows, pediatric nurse practitioners, nurses and social workers teach and assist house officers.

During the one-month block rotation in the Harriet Lane Clinic, house officers provide continuing care for their patients and are exposed to the developmental, behavioral, sociological and psychological aspects of caring for pediatric patients.

The outpatient adolescent clinic offers wide-ranging programs. Residents learn to provide comprehensive health care to adolescents, including birth-control counseling, evaluation of gynecologic problems, sports medicine and evaluation of adolescents with psychosocial problems. During the adolescent rotation, residents also attend a high school clinic and the Johns Hopkins University Student Health Service clinic.

Intern Selectives

During the PL-1 year, residents participate in a Selective where they choose either a general pediatrics or subspecialty selective. This provides residents with more ambulatory experiences during the PL-1 year and exposes them to potential career options earlier in their training.

For the general pediatrics selective, residents will spend:

• One week at a community pediatric practice
• Three days at the Rales Center, a school-based clinic
• Two days working with nursing staff at Peds at Home

For the subspecialty selective, residents will spend:

• One week in Genetics clinics
• One week in an outpatient subspecialty clinic of their choosing:
  • Cardiology
  • Endocrinology
  • Gastroenterology
  • Nephrology
  • Oncology
  • Pulmonology

Electives

Five to six months of elective time are provided during the training program. Residents often use the elective months to devote additional time to certain subspecialty clinical activities or to take advantage of additional clinical training. Residents may also choose to develop a special elective research program with any of the pediatric faculty or with many other individuals at the Johns Hopkins Medical Institutions.

Indian Health Service Elective

Each year, many residents have the opportunity to spend a month at the Indian Health Service in Tuba City, Arizona, or in Shiprock, New Mexico. The Johns Hopkins residents who participate in the elective help care for patients in the pediatric clinic, emergency room and in the 10-bed inpatient service.

Global Health Elective

A clinical elective for two or four weeks in Guyana, Kenya, Nigeria, India, Philippines, South Africa, and Lesotho. Open to three to six pediatric residents in their second and/or third year of residency. Not only are residents exposed to tropical diseases but also to the difficulties of practicing medicine in regions of the world that experience extreme poverty and limited resources. A pediatric faculty member travels with the residents.

Taking Surgery to the Tropics

Over the past decade, pediatric emergency medicine physician Karen Schneider has already treated thousands of children in remote areas of the world through her tropical medicine elective. She and her team of pediatric residents, surgeons and nurses have set up clinics in remote places in developing countries like Guyana and Nigeria for weeks at a time, treating medical conditions ranging from dehydration to malnourishment.

Learn more about Taking Surgery to the Tropics.

Pediatric Subspecialty Clinics

The subspecialty clinics listed below meet regularly in the Outpatient Center. Faculty members supervise care in all clinics.

Behavioral and Mental Health

The Behavioral and Mental Health (BMH) Rotation is 2-4 weeks in length and is typically completed in the intern year in order to expose residents early on to behavioral and mental health assessment and management strategies they may encounter in their primary care practices in continuity clinic. The Division of Child & Adolescent Psychiatry provides on-site mental health services to patients and families in the Harriet Lane Primary Care Clinic (HLC) as well as on our dedicated inpatient child psychiatry ward and on inpatient general pediatrics through a consult liaison service, in which residents on the BMH rotation participate. The curriculum includes didactic, small group and one-on-one teaching with participating faculty and staff, as well as time spent in behavioral psychology clinics. The goal of the rotation is for residents to better understand the components of comprehensive mental health evaluations for children and their families, and to become familiar with different strategies for assessing mental health issues in children, adolescents and their parents. The rotation faculty strive to ensure that all residents recognize the impact of psychiatric dysfunction and distress on youth and families, and that they become familiar with clinic and community-based resources for children and families with mental health problems in order to integrate this into their own practice as general pediatricians.

Residency Duty Hour

Night and weekend coverage for most rotations is provided by a night team of residents working from 7 p.m. to 7 a.m. Residents are assigned to night teams for periods of one to two weeks at a time, and the total assignment to night teams is five to six weeks per year.

ACGME guidelines regarding duty hours are strictly maintained.

Continuity Clinic

Every resident participates in a longitudinal continuity experience in which he or she functions as the primary care provider for a panel of patients. Patient diversity ranges from healthy children aged birth to 21 years, to patients with special health care needs. The Harriet Lane Clinic, Johns Hopkins Community Physicians at White Marsh and Remington locations, and the East Baltimore Medical Center serve a diverse population of urban patients. A second continuity site, Johns Hopkins Bayview Medical Center, offers an opportunity to provide care to a larger proportion of Hispanic patients.

At all sites, residents are paired with a preceptor who works with them over the course of the year, and ideally for their three years of residency. Residents practice in a group practice model so they learn how to care for each other’s patients and ensure communication exchange. During this experience residents learn how to coordinate care, work with multiple disciplines, and experience and understand concepts within the family and medical home.