Regardless of career direction, each graduating resident must be well-grounded in both ambulatory and inpatient pediatrics. Ambulatory pediatrics includes longitudinal experiences in the resident’s own primary care practice, behavioral/developmental pediatrics, adolescent medicine, the normal newborn nursery, community-based pediatric rotations, and a variety of other primary care related rotations.
Primary Care Continuity
Pediatric residents have their longitudinal primary care pediatric experience (“continuity clinic”) at one of several community-based sites. Health Centers are located in Ann Arbor and surrounding communities including rural, urban, underserved, and suburban locations. By decentralizing our continuity training away from the hospital setting, our program aims to provide trainees with a more realistic primary care training experience that more closely approximates community-based practice and that is more reflective of our diverse local patient population, including variations in ethnicity, socioeconomic status, and disease prevalence.
In the second and third years of training residents add a second half-day of continuity clinic per week during most rotations. Most residents do this second half-day at their primary care sites. However, because we recognize that many residents will go on to subspecialty and other careers, we offer other options that might better support each resident's individual career interests and learning objectives. Residents can choose to spend their second half-day of continuity clinic at a different primary care site, in a subspecialty outpatient clinic, or can use this additional clinic time to pursue a long-term advocacy or research project.
Pediatric Community Health
All of our residents participate in a Pediatric Community Health rotation. The overall goal of this rotation is to provide residents with the experience and skills necessary for organizing and delivering health care for children within the larger context of their communities. During each of this block rotation, residents complete a multimedia, web-based didactic curriculum and a community-based child advocacy project, where core principles of health care organization (including managed care and related concepts), environmental health, advocacy, violence and injury prevention, and care of the medically underserved, are reviewed and discussed. Residents provide direct patient care and/or visit community based organizations to gain experience applying their knowledge and learning how to build partnerships with other child advocates in their communities. Some of these partner sites include a non-profit organization providing care to teen parents and their children, a middle school-based health center, a clinic providing care only for those without insurance, a migrant health clinic, and a domestic violence shelter. Through these experiences and relationships, residents learn not only how to be better advocates for children in our community, but also for those children in any community they find themselves providing care after training. The community health rotation is supplemented by our case conference curriculum which includes presentations related to health advocacy child abuse, health service delivery, and other related topics.
During the one-month Developmental and Behavioral Pediatrics rotation, learning and clinical experiences emphasize normal developmental and behavioral progression; behavioral challenges associated with predictable transitions; developmental variations and disorders; developmental screening; adaptation to acute and chronic health conditions; psychosocial and environmental stressors; and the management of common medical-behavioral problems in infants and children. Clinical experiences and patient-based learning with three board-certified subspecialty faculty members provide the core individualized instruction, supplemented with readings and evidence-based presentations. Residents also participate in multidisciplinary clinics that interface with pediatric neurology and psychology (Multispecialty Evaluation of Development; Neonatology Follow-up; and Pediatric Sleep Medicine). Seven pediatric psychologists provide didactic teaching during the month and interface with residents in other subspecialty clinic settings and on inpatient units. Resident education in this area continues throughout training, as an integral component of the Primary Care and Community Pediatrics rotations.
All residents receive a comprehensive adolescent medicine experience supervised by two adolescent medicine specialists. The goal is to equip residents with the skills to manage the broad needs of teenage and young adult patients. The rotation provides specific training in growth and development, reproductive health and adolescent gynecology, care of chronically ill adolescents, management of eating disorders, adolescent mental health, sports medicine, and other problems common to adolescents. Residents will see patients in the university-based subspecialty clinic, school-based teen centers, and also at The Corner Health Center, a community-based teen health center that provides access to care to uninsured teens or for teens seeking confidential services. Additional training in adolescent medicine — both didactic and clinical—is provided longitudinally throughout all years of training.
Normal Newborn Nursery
Each resident rotates through the normal newborn service, where the goal is to learn about care of the normal newborn in the context of his/her family. The faculty supervisors are practicing primary care physicians and pediatric hospitalists. These faculty members bring a “real world” perspective to the rotation and are able to share with the resident their own approach to normal newborn care. There is a specialized curriculum that covers all aspects of newborn care.