Clinical Rotations

Resident Clinic at the Children’s Health Center: Continuity and Acute Care Clinics (CHC/AC Clinics)

Welcome from our General Pediatrics Faculty 

Mission of the Resident Clinic (CHC/AC) Experience:

• Provide excellent, high quality, evidenced-based care to the children and families we serve
• Provide a top-notch training experience in general pediatrics for our residents and students
• Provide a supportive working and learning environment for all staff, faculty and trainees

A major focus our residency program is the care children and adolescents in the outpatient setting.  Residents rotate through the clinic in 1-week blocks during the Y portion of our X+Y curriculum.  These weeks occur approximately every 6-weeks with a total of 9 scheduled in each of the PGY-1,2,3 years.  The CHC/AC clinics are the primary site for general pediatric education during residency.  In a given Y-CHC week, the residents will spend approximately 2 full days in the Continuity Clinic and 2 full days in the Acute Care Clinic. The remaining day, Friday, is divided between a mix of clinic education, clinic administrative time, and limited AC Clinic on Friday mornings  and protected residency didactics every Friday Afternoon.

During the Continuity Clinic (CHC) days, residents see patients scheduled on their own dedicated template.  This allows residents to develop continuity and follow patients over time that they have recruited from clinic, the nursery, or other rotations. In CHC, residents see a mix of well-child and follow-up visits.  In the AC clinic, residents work together on a multi-level team that includes PGY-1,2,3 residents as well as MS3 and MS4 students to see up to 30 patients per day and see a mix of newborns, follow-up, sports medicine, and acute illness visits. In each setting, residents are supervised by dedicated faculty in a ration of 2-4 residents per faculty member who practice principles of gradual release of responsibility/graduated autonomy to appropriately supervise residents at each level.

The CHC/AC clinics combined provide a resident-driven medical home to children in our local community, aged 0-18 years. The clinics are located together, adjacent to several of the pediatric subspecialty clinics, on the 6th floor of the University Health System Robert B. Green (RBG) Facility.  This state-of-the-art clinic building includes onsite laboratory and radiology services as well as an affiliated after-hours Pediatric Urgent Care on the 1st floor, which residents can rotate through as an elective. The RBG building is located in the heart of downtown San Antonio, approximately a 10-15 minute drive from the medical center campus.  The resident clinic serves a diverse range of families with the full spectrum of medical and social issues that provided a rich learning environment in which residents can make a real impact in the community.

University Hospital Women & Children’s Hospital is our state-of-the art children’s hospital where our residents rotate through ALL of their inpatient, ICU, and ED rotations.

All of our inpatient rotations emphasize thorough assessment and critical decision-making. Management and treatment plan development is fostered through supported autonomy, a growth mindset, and regular feedback. Our culture of family-centered care and inter-professional collaboration creates an environment where clinical learning and advocacy for evidence based, patient safety-oriented care are the shared mission.

General Pediatric Hospital Medicine Service (Wards)

Our general pediatric inpatient services are made up of two teams: “Missions” and “Spurs” (everyone needs that San Antonio flair!). Both teams include residents, medical students, outside rotators from the military and family medicine, and occasionally a PHM fellow in addition to PHM faculty.

These teams care for general pediatric patients admitted from the ED, direct admissions from clinics, transfers from other hospitals, and downgrades for the PICU.  They may also co-manage with Pediatric Trauma, Pediatric PM&R, and subspecialty surgical services to ensure comprehensive, patient-centered care is maintained. The teams care for both acute care unit and intermediate care unit patients.

The training goals for interns on the general ward services include developing a robust and efficient approach to the diagnosis and management of common medical problems, refining clinical reasoning skills, maintaining a respectful communication style with the interdisciplinary team, and developing and refining caring, humanistic patient relationships.

Inpatient Services Admitting Ward Senior/Night Float (UH3)

Residents cover night shifts in the hospital with a small team (typically 1 PGY3 and 2 PGY1s) during the week and 2 upper level residents on weekends. Senior residents gain experience supervising, teaching, and developing increasing autonomy. Residents will see new admissions and manage patients on the different floors.

A wonderful culmination of autonomy in clinical decision-making, this service is supported by phone supervision by Pediatric Hospitalists on-call as well as in-house Critical Care faculty available for any urgent bedside assessments and all rapid response or code situations.

Hematology/Oncology and AYA Inpatient Service

The Hematology/Oncology and AYA service is an inpatient and consult rotation where residents have the opportunity to learn diagnosis/staging and treatment options for common pediatric malignancies and hematologic disorders, master the fundamentals of chemotherapy administration (including the prevention and/or management of common side effects), treatment of neutropenic fever, and management of other oncologic and hematologic emergencies.

Our unique exposure as the South Texas Sickle Cell and Hemophilia Treatment Centers afford our trainees exposure to the common complications of these disorders. Opportunities for diagnostic procedures such as lumbar punctures and bone marrow aspiration abound. Additionally, we have the only adolescent and young adult combined full service unit in the city allowing residents to understand the unique and seamless transition of care of childhood diseases into young adulthood.

Newborn/Couplet Care Nursery

Residents provide care to late preterm and term newborns. They attend deliveries and provide neonatal assessment and resuscitation where indicated, evaluate every infant born within the first 12 hours of life, and daily during their hospital stay.

The Women’s and Children’s Hospital is recognized as a Level IV NICU and Level IV Maternity Center, providing excellent support for mothers and babies. University Hospital is recognized as a Baby-Friendly facility which demonstrates the institution’s commitment to babies, mothers, and families. Hospitalists work as part of an interdisciplinary team to promote evidence-based best practices and help babies and families thrive.

Neonatal Intensive Care Unit

Residents work on a multidisciplinary NICU team which includes faculty, fellows, pharmacists, and NNPs. With a dedicated NICU rotation, residents have the opportunity to learn from the tiniest patients and will participate in procedures, deliveries/resuscitation, ventilator management, and daily rounds. The University Hospital NICU has been designated as a Level IV neonatal intensive care unit by the Texas Department of State Health Services, signifying the highest level of care available for premature and sick babies.

The NICU has a wonderful fellowship program which offers great opportunities for residents to participate in research and quality improvement initiatives.

Pediatric Intensive Care Unit and Pediatric Congenital Cardiac Unit

Residents in their PGY2 and PGY3 years will rotate through the PICU and work with a multidisciplinary team. University Hospital is the only Level I Pediatric Trauma Center in South Texas, and children with severe injuries admitted to the PICU are co-managed with surgical teams. University Hospital is also home to a robust Advanced Technologies Program providing Extra Corporeal Membrane Oxygenation (ECMO) and Continuous Renal Replacement Therapy (CRRT) to serve the sickest patients.  Residents have the opportunity to perform procedures including central line placement, arterial line placement, and endotracheal intubations. The PICU fellowship provides great opportunities for resident research and QI involvement to support anyone interested in pursuing a career in critical care.

Residents rotate through the Pediatric Emergency Room at University Health System Women’s and Children’s Hospital. During the EM weeks, residents work with Pediatric Emergency Medicine board certified physicians as well as adult EM physicians and have the opportunity to care for children with a variety of needs. The Pedi ED at UH sees a broad range of pediatric emergencies, and residents will gain experience:

• Managing common pediatric emergencies (respiratory distress, seizure activity, abdominal pain, etc.)
• Performing moderate sedation for painful or prolonged procedures
• Performing common procedures (laceration repair, lumbar punctures, fracture reduction, etc.)
• Exercising judicious use of laboratory and radiology resources
• Consulting medical and surgical specialists
• Determining admission criteria vs outpatient management in the context of patient-specific needs

Residents are exposed to a variety of pediatric subspecialties throughout their time in residency. UT San Antonio and University Health System provide access to a broad spectrum of specialists – our relationships with the adult hospital and community hospitals (like the San Antonio Military Medical Center) give unique access to incredibly specific skillsets thanks to our adult colleagues! Specialties include (but are certainly not limited to):

• Adolescent Medicine
• Behavior & Development
• Cardiology
• Endocrinology
• ENT
• Gastroenterology/Hepatology
• Immunology
• Infectious Disease
• Nephrology
• Neurology
• Ophthalmology
• Pulmonology
• Urology

In addition to some required rotations, residents are encouraged to select subspecialty rotations as electives. Residents who are interested in non-pediatric rotations (Trauma Surgery, Urology, Ophthalmology) can work with the program director to develop rotations.

Children’s Association for Maximum Potential (CAMP)

Children’s Association for Maximum Potential (CAMP) provides a wide range of recreational, respite, rehabilitative, and training services for children with disabilities and their families in a camp-like setting. Medical support is central to the program, ensuring all children regardless of their medical needs can participate in all programs and activities. Residents rotating on the Child Behavior/Development service during June, July, and August participate in Camp CAMP. CAMP residents are members of an interdisciplinary team with 20-25 campers with disabilities assigned to each resident within the context of that team. The residents provide ongoing chronic medical care and treat acute illnesses or the injuries associated with participation in a recreational program.

Center for Miracles

A collaborative clinic that serves the needs of neglected and abused or at-risk children in our community. It houses the UT San Antonio Pediatric Department Child Abuse Pediatrics faculty and a fellowship in Child Abuse Pediatrics.

Migrant and International Health Pathway

Designed for pediatric residents who are interested in improving their understanding of care for underserved children at home and abroad, this pathway trains pediatricians to understand the consequences of socioeconomic conditions on migrant children and families. Residents will recognize the impact on children’s health and become advocates for change.

GME Resident/Fellow Distinction Opportunities

UT San Antonio offers multiple GME Resident/Fellow tracks (available for PGY2s and above) for those interested in unique learning opportunities to enhance their skills. Current tracks offered include Health Systems Science Distinction Track, Clinical Educator Track, and Leadership Track. These tracks include mentorship, modules, and completion of a project with the support of faculty.