GEISINGER PEDIATRIC RESIDENCY PROGRAM ROTATIONS
Geisinger's Pediatric Residency Program offers residents a wide array of rotation opportunities on our medical campus in Danville. All ACGME approved electives as well as required elements of study are available locally so there is no need to travel to remote facilities to complete any part of resident training.
Listed below are the formal clinical rotations offered by the program as well as a sample schedule to give you an idea of what a typical residency curriculum looks like. In addition, residents are welcome to work with the program to develop unique learning opportunities that satisfy their personal educational needs.
Our program utilizes a modified 6+2 (X+Y) educational model. during a typical 8 week period, 2 weeks are devoted to our Outpatient Core Curriculum. The Core Curriculum includes time for residents to gain experience in Continuity Clinc, Urgent Care Clinic, Child Advocacy, Adolescent Health, and Neurodevelopmental Pediatrics. Additionally, time is also reserved for wellness and administrative duties that may need to be completed to ensure that residents remain on track. Utilizing this strategy promotes improved resident wellness and a more focused framework of study. This model reduces resident stress by preventing the inherent issues associated with time management during inpatient rotations. Our schedule has been developed to ensure that resident continuity clinic still occurs throughout the entirety of the academic year. The schedule improves resident availability for Continuity Clinic which enhances the clinic experience and allows for a high level of patient ownership.
ADOLESCENT MEDICINE
Adolescent Medicine is an ACGME required rotation. Although residents participate regularly in the care of adolescents throughout their three years, residents obtain specialty specific education in adolescent medicine during a longitudinal curriculum that is incorporated into their Outpatient Core Curriculum during their PGY2 year. In addition to the routine health care of adolescents, residents learn by caring for patients with unique growth and developmental conditions, eating disorders and other behavioral health issues, sexually transmitted illnesses, sexuality and reproductive concerns, and sports related injuries.
ALLERGY AND IMMUNOLOGY
The Allergy and Immunology rotation is a completely outpatient elective. Residents learn from our faculty at the Foss Clinic located on the main campus in Danville. Patients seen include those with common allergic disorders and asthma as well as congenital and acquired immune disturbances. Residents can accompany our faculty to several outreach clinics if they wish during the block.
AMBULATORY PEDIATRIC ELECTIVE
Many of our residents plan to practice primary care. Although our Continuity Clinic experiences provide an excellent preparation for this type of practice, some of our residents wish to have a primary care experience in a smaller practice away from the medical center. Geisinger has a number of outstanding pediatric sites within the Health System, most within a short drive from Danville. Residents may elect to spend a month working in one of these locations with our outpatient staff, many of whom are actually our former residents.
ANESTHESIA/SEDATION
The Anesthesia/Sedation block is an elective month frequently selected by residents planning on careers as critical care and emergency medicine specialists as well as hospitalists. The rotation combines time spent with our Pediatric Anesthesia staff in the operating rooms as well as with our Pediatric Sedation Service providers. The sedation service is managed by both PICU and Hospitalist staff and provides deep sedation to over 1500 children each year. This month of study can also be applied as a surgical elective for osteopathic physicians wishing to achieve a Proposition 46 waiver upon graduation.
CARDIOLOGY
The Janet Weis Children's Hospital is home to the first Kiwanis Heart Center in the country. Our cardiologists offer all aspects of cardiac care including general and diagnostic cardiology care, cardiac imaging services (ECHO and MRI), interventional procedures such as device closures and invasive monitoring, and electrophysiology studies and ablation services. Additionally, Geisinger performs palliative and corrective cardiac surgery on newborns and children with congenital and acquired heart disease. Our residents have the opportunity to work in all aspects of our cardiology program as they complete their general pediatrics residency training.
CONTINUITY CLINIC
All residents maintain a panel of patients at the Geisinger Woodbine Clinic which is located in Danville just a short drive from the main hospital campus. The clinic provides primary care to about 14,000 children, most of whom are enrolled in our resident's clinics. Resident Continuity Clinc is scheduled during the Outpatient Core Curriculum blocks every 6 weeks as well as occasionally during subspecialty outpatient rotations. Our residents enjoy close relationships with their continuity families. The clinic is a new state of the art facility that was designed to optimize care. Most resident clinics located in large, university-based, urban centers have patient no-show rates that exceed 35%. We are fortunate that our parents truly respect our efforts to care for their children, which is reflected in our uniquely low 9% rate of no-shows. Our Continuity Clinic is one of the highlights of our program and a favorite of our residents.
DERMATOLOGY
The Dermatology rotation is a four-week elective that is mostly outpatient, with exception of the occasional inpatient consult. Residents work with our Pediatric Dermatology staff at the Woodbine Clinic. Given that general pediatric practice includes a fair amount of dermatology, many residents interested in primary care request an opportunity to complete this rotation. The clinic manages a number of patients with common conditions such as acne, eczema, and nevi, but also less frequently encountered pediatric conditions such as epidermolysis bullosa and ichthyosis.
EMERGENCY MEDICINE
Emergency Medicine is an ACGME required field of study. Coupled with a strong urgent care experience, residents become quite competent in managing acute illnesses in our program. Residents have two dedicated block months of Emergency Medicine during their last two years of training. Our residents care for patients in our main campus Emergency Department which is home to our Pediatric facility, as well as in the Geisinger Shamokin ED and Geisinger Bloomsburg ED, each located just a short drive from Danville. Geisinger employs a unique rural telemedicine program that permits our resident learners at the satellite locations to remain connected to pediatric specific providers at the main campus. In addition to these dedicated blocks of study, our residents have additional opportunities to engage in emergency care on our main campus as part of the Pediatric Trauma Team during their PICU blocks as well as providing consult services to assist our ED providers during off-hours of operation.
ENDOCRINOLOGY
Our Endocrinology Clinic is located on Foss Clinic 6. We are the only center managing pediatric diabetics or children with other endocrine disorders in the region. The program manages about 1200 diabetic patients, and residents get a solid grasp on insulin management and proper diet in this population of children. The physician staff is complemented by a team of diabetic nurse practitioners and dietitians who all love to teach resident learners. Residents on the diabetes rotation during the summer months are encouraged to attend one of the three diabetes camps supported by Geisinger's Children's Miracle Network in the area to get a greater appreciation of what it is like to live with this life impacting medical condition.
GASTROENTEROLOGY
Pediatric Gastroenterology is our department's largest division. Our specialists manage the full spectrum of children with gastrointestinal disorders. Residents spend the most time in the outpatient setting, seeing outpatient consults and participating in endoscopic procedures and other imaging studies. Additionally, residents perform inpatient consults, however, the daily care of GI patients is the responsibility of the inpatient subspecialty team. This is a highly developed rotation and our broad faculty has assisted many residents in launching research and even careers as a pediatric gastroenterologist.
GENETICS
Geisinger is home to the largest genome bank in the country as well as the region's newborn screening clearinghouse. Our geneticists participate in the MyCode initiative, performing whole genome sequencing on thousands of people every year. Many genetic causes for pediatric disease, including breakthroughs in epilepsy, developmental delays, and even orthopedic conditions have resulted from the work of our geneticists partnered with our pediatric subspecialists. Residents have the opportunity to spend a block month working with our staff of pediatric geneticists and genetic counselors. Experiences include both outpatient and inpatient consults for suspected genetic and metabolic disorders as well as opportunities to learn about genetic research and newborn screening.
HEMATOLOGY/ONCOLOGY
The Hematology/Oncology Clinic is located in Foss Clinic 3. Our staff cares for children with all pediatric cancers and is a research participant in the Children's Oncology Group as well as other national and international oncology workgroups. Our clinic sees about 40-50 new cancer diagnoses each year, offering ample opportunity for residents to explore their interests in the field. With no fellows to compete with, residents have the opportunity to perform sedated lumbar punctures and bone marrow biopsies while on the rotation. Residents also assist with inpatient consults, although the inpatient Heme/Onc team is responsible for the daily care of admitted oncology patients.
INFECTIOUS DISEASE
The Infectious Disease rotation is largely a consultative rotation. Although some patients are seen in the Foss 6 Clinic, most patient encounters are as consults in the NICU, PICU, floor and newborn nursery. The ID team also manages a cohort of HIV patients, and residents have the opportunity to travel with the providers to our outreach clinic in Scranton. Residents have daily lectures offered by our specialists and are challenged to really understand important aspects of infection control, antibiotic stewardship and infection prevention.
INPATIENT WARD ROTATIONS
Residents spend a fair amount of their residency working on the inpatient wards. The rotations are designed to promote an increasing level of responsibility as learners progress from one level to another. The inpatient team is divided in to three services: two hospitalist teams, One heme/onc team and one general subspecialty team. Evening coverage is provided by a night float team that in incorporated into the resident floor assignment. PGY1 residents typically manage five to six patients per day and cap at eight. This ensures adequate opportunity for patient care opportunities while still allowing time to get to lectures and other learning activities. Time is spent every morning in lecture for an hour discussing the prior day's admissions as well as other important aspects of inpatient care.
NEONATOLOGY (NICU)
The NICU is a busy place, providing tertiary and quaternary care for newborns with a wide array of medical conditions. Our perinatology group is the only high-risk OB practice in all of northern Pennsylvania, and is responsible for a large number of our over 1,000 admission annually. Residents are supported by a team of neonatal nurse practitioners in caring for these little patients. Residents typically carry about six patients and cap at ten. With no fellows with whom to compete for procedures, our residents regularly have the opportunity to perform intubations, place umbilical lines, and even chest tubes when the opportunity arises. Neonatal resuscitation of high-risk babies is performed by our NICU team, including our residents who once properly trained are give the opportunity to take the lead. Resuscitation of otherwise low-risk infants is usually taught during the newborn nursery blocks.
NEPHROLOGY
Our Nephrology Clinic is located on Foss Clinc 6. This four-week block is mostly outpatient, however, residents will also have the opportunity to perform inpatient consults in the NICU, PICU and floors. The clinic manages a large number of children with chronic renal issues, including transplant recipients and children receiving peritoneal and hemodialysis. Residents on the service during Block #2 may enjoy spending time at Kamp Kydnie, a camp for children with chronic renal conditions held at Camp Victory every year.
NERODEVELOPMENTAL PEDIATRICS
Neurodevelopment is an ACGME mandated block of study. We are fortunate that Geisinger has one of the most respected Neurodevelopmental Pediatrics departments in the country. Our providers are nationally recognized and are chosen each year to contribute to the AAP guidelines pertaining to the diagnosis and management of autism. Our clinic is located in Lewisburg at the Autism and Developmental Medicine Institute, a joint venture between Geisinger and Bucknell University. This program takes full advantage of Geisinger's genomics infrastructure and is the recipient of a number of prestigious national grants every year. Although residents gain considerable experience in child development throughout their entire residency, specialty specific education in neurodevelopment occurs during the PGY3 Outpatient Core Curriculum. This longitudinal experience permits residents to have a broader experience in the field as well as a greater opportunity for continuity with children who have developmental needs.
NEUROLOGY
Child Neurology is a four-week block. Residents engage in the care of patients both in the hospital as well as outpatient clinic located on Dickey 2. The child neurologists specialize in a number of areas within the field including epilepsy, brain mapping and sleep, offering residents a well-rounded experience. Residents perform inpatient consults on the floors, PICU, NICU and newborn nursery. The care of admitted patients to the Neurology Service is the responsibility of the inpatient subspecialty team.
NEWBORN NURSERY
Being a hospital within a larger medical center sometimes has its advantages. One of them is having a newborn nursery immediately available for resident education rather than making residents drive to a community hospital to learn about newborn care. Our nursery is rather busy, caring for about 1,800 infants annually. Our residents learn newborn resuscitation as well as all aspects of the newborn exam and accepted protocols for care. Residents have one formal nursery rotation in the PGY1 year as well as one block in the PGY3 year but cover the nursery intermittently at night throughout their entire residency. Although at times families travel considerable distances to deliver a baby at Geisinger, many of our families live live locally, making our nursery a great source for recruiting babies to Continuity Clinic. Our nursery manages both well newborns as well as more complicated babies such as those born with congenital syndromes requiring palliative care, infants of diabetic mothers and children who develop neonatal abstinence syndrome. Unlike some programs, pediatric residents perform all circumcisions in our nursery.
OPHTHALMOLOGY
Ophthalmology can be taken as a two or four-week block. Patients are seen in the outpatient clinic located on the Woodbine campus. Additionally, residents are welcome to follow our faculty to the operating room to watch ROP laser treatments, strabismus surgery, and other pediatric eye procedures. Our ophthalmologists stress the importance of screening for ocular misalignment, acuity issues, lens abnormalities and leukocoria. Additionally, residents learn when to consult an ophthalmologist for both acute issues as well as how to safely follow common developmental issues that may not always require ophthalmologic intervention.
ORTHOPAEDICS
Geisinger's Pediatric Orthopaedics Department cares for children with all orthopaedic concerns from acute injuries to congenital malformations. Residents see patients at the Woodbine Clinic as well as in the operating room if desired. Residents spend time with a number of providers including general pediatric orthopedists, sports specialists and spine surgeons. Residents are incorporated into the team at cast clinic, learning how to apply splints and casts as well as tips for parents on how to care for a child with a cast. Time is also spent learning about the specialized equipment frequently used to promote mobility and support for children with common orthopaedic abnormalaities.
OTOLARYNGOLOGY (ENT)
Pedaitricians work closely with ENT specialists. Pediatricians need to know how to properly assess for infections of the head and neck as well as understand the indications for surgery and when to refer to an ENT specialist. Our ENT rotation offers residents the chance to work one on one with several ENT specialists as well as audiologists to learn how to diagnose and manage ear and throat infections as well as care for children with hearing deficits. Additionally, residents learn to manage children requiring cochlear implants, airway surgery, swallowing and speech abnormalities and cleft lip and palate correction.
PEDIATRIC CRITICAL CARE (PICU)
All of our residents are scheduled for two full block rotations in pediatric critical care, one during the PGY2 year and the other during the PGY3 year. Our ICU is the only regional pediatric intensive care unit in the entirety of northeastern and central Pennsylvania. As such, the unit is capable of managing children with highly complex medical issues. In addition to patients with medical disease, residents also contribute to the care of children with surgical problems, trauma victims and complex congenital heart disease. With no fellows in our PICU, residents have the opportunity to perform a number of procedures including orotracheal intubation, line placement, and chest tubes. The PICU staff provides regular didactic sessions to residents during the block. Our residents find this to be a highly educational, influential month, leading many to consider further training in critical care.
PEDIATRIC SURGERY
Residents have the option of engaging in a two or four week block in general pediatric surgery. The rotation is primarily spent in outpatient clinic learning about conditions that should be referred to a pediatric surgeon. Additionally, residents are permitted to spend time in the operating room participating in the operations of common pediatric procedures such as appendectomies, hernia repairs, gastrostomy tube and central line placement and abscess drainage. Although not required, residents are welcome to assist in the inpatient management of children, especially those admitted to the trauma service for child physical abuse. This block of training will fulfill the osteopathic requirements for states mandating Proposition 46 activities for licensure.
PULMONOLOGY
Nearly all residents select an elective in Pediatric Pulmonology at some time during their training. This four week block is held in our Foss 6 Clinic and is mostly an outpatient activity. Residents care for children with a wide range of illnesses from common things such as asthma to less frequently encountered diagnoses such as ciliary dyskinesia. Our clinic is the only cystic fibrosis center in northern Pennsylvania and is a contributor to national studies and quality data for this population. In addition to our typical clinic, residents do perform inpatient consults, but residents assigned to the Hospitalist Service are responsible for the daily care needs of children admitted to the general wards.
RADIOLOGY
Geisnger's Pediatric Radiology staff is always excited to host our pediatric residents. Residents work with our radiologists reviewing plain films, CT and MRI images and nuclear studies. Additionally, residents have a chance to assist with fluoroscopy studies such as GI studies, voiding cystourethrograms, and vascular imaging. Radiology can be either a two-week or full four-week block experience.
RHEUMATOLOGY
This is a four-week elective block that is mostly outpatient with the occasional inpatient consult. Children admitted for rheumatologic conditions are managed by residents scheduled on the Hospitalist service. Residents have the chance to work with our rheumatologists at the Foss 6 Clinic seeing children with a wide variety of conditions. Learning to ask a very detailed history and perform a very complete exam looking for evidence of inflammation is a key part of this rotation.
SPORTS MEDICINE
Geisinger has a very advanced Sports Medicine program including a fellowship in Pediatric Sports Medicine that is supported by our residency program. The Pediatric Sports Medicine Clinic is housed at the Woodbine campus, adjacent to our Continuity Clinic site. Residents on Sports Medicine hone skills on performing joint exams, splinting and casting, and concussion screening. Additionally, residents are offered in depth discussion of common orthopedic sports injuries, overuse syndromes and pre-participation issues. Residents are welcome to attend a number of high school sporting events with our faculty and fellows as part of this rotation.
URGENT CARE CLINIC
Rotations at our Urgent Care Clinic is a regular component of our training program. Residents are scheduled for two block each year of training at our Urgent Care Clinic on the Woodbine campus. The clinic ares for both the pediatric patients seen in Continuity Clinic as well as children seen by other local providers as an alternative to utilizing our emergency department. The clinic accepts just about everything with the exception of major trauma and life threatening conditions. Learning how to manage acute illness is an important part of being a great pediatrician, and learning these skills directly from general pediatricians is a must in resident education.
SAMPLE SCHEDULE
One of the advantages in choosing a medium-sized program is the amount of flexibility available in making your schedule. There are some general rules for required rotations, but the timing these rotations and your selection of elective rotations can be tailored around your personal needs and individualized learning plan. Just to give you a sense of what a typical three-year residency schedule looks like, we have included a sample schedule below.
The schedule is designed to offer residents not only opportunities to maximize their education, but also to ensure that they have adequate time to manage the other important aspects of their lives. Overnight call is consolidated as much as possible to provide a generous amount of call-free time. During the PGY1 year, overnight in-house call is limited to just four weeks of inpatient night float. Additionally, a home-call model for supervision of the newborn nursery occurs during one month. Interns are included in this call schedule and are responsible for about ten nights during their month of nursery. If a resident feels that a child needs more support than can be offered by phone, other members of the healthcare team are already on-call in the hospital to assist, making it unnecessary to travel into the hospital at night when covering the nursery. Upper-level call is spread between both the PGY2 and PGY3 class, creating a schedule with minimal off-service call requirements.
A sample of our overall educational program is depicted below:
The Outpatient Blocks are designed to optimize availability in Continuity Clinic and promote resident ownership of the children and families they manage. During each Outpatient Block, residents also experience patient care in our Woodbine Urgent Care Clinic. This clinic manages acute care visits for children who are usually cared for at the Woodbine Clinic, but also for children needing referral from their primary doctor who do not need emergency level care. During each year of training, an additional area of concentration is also included in these blocks. In the PGY1 year, interns complete their training in Child Advocacy. PGY2 residents manage patients in our Adolescent Medicine clinic, and PGY3 residents focus on Neurodevelopment. Finally, in each block, dedicated time is scheduled to allow for personal wellness activities and to complete administrative work.
A sample of the Outpatient Block schedule is offered below:
