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A Vertically Integrated Core Pediatric Education

The University of Texas Health Science Center, Houston, Texas; Department of Pediatrics, 5656 Kelley Street, Houston, TX 77026

Sharon S. Crandell, MD

Mark D. Hormann, MD

Virginia A. Moyer, MD, MPH

The University of Texas Health Science Center, Houston, Texas

The objective of this study was to implement and evaluate a vertically integrated general pediatrics rotation that includes inpatient ward, newborn nursery, and ambulatory components in a format intended to mimic real-world pediatric practice. Separate ward, well-baby nursery, and ambulatory rotations were combined into a 4-month block rotation. Two parallel teams staff the inpatient ward and newborn nursery; on alternating days, the admitting team staffs an afternoon clinic, seeing ward and nursery patients in follow-up as well as regular clinic and referral patients. Two group meetings were held during each rotation for 2 years, and questionnaires were distributed to participating residents. All 90 residents who rotated through the combined service participated in at least 1 group meeting, only 26 returned questionnaires that limited evaluation of the program. The most important positive feature of the rotation was the continuity of patient care allowed by combining the venues into 1 rotation and by the longer duration of the rotation. Concerns included the challenges of time management and fluctuations in workload across the 3 patient care venues. Upper level residents reported that the rotation confirmed career decisions for primary care. These preliminary observations suggest that a vertically integrated rotation provides improvement in perceived continuity of care and introduces residents to the time management challenges of primary care pediatrics.

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