Neonatal Intensive Care Unit (NICU)
Residents in our NICU gain excellent experiences in neonatal resuscitation and neonatal critical care as Women’s and Children’s Hospital cares for many high-risk pregnancies. Additionally, our neonatal critical care transport team transfers preterm infants by ground and air to the hospital each day from all over the state of Missouri. As such, more than 500 infants are admitted to the NICU each year.
The NICU teaching service includes an attending neonatologist, one or two senior residents and one or two interns. As the NICU is a favorite rotation for medical students, there is often a fourth-year medical student on service. All residents work six days per week. We also have a non-teaching service for level II newborns that is staffed by attending neonatologists and neonatal nurse practitioners.
The Pediatric rotation involves the inpatient care of general pediatric and specialty care patients on our pediatric and adolescent floors. There are two inpatient teaching teams, each of which includes an attending pediatric hospitalist, a senior resident and one or two interns. Additionally, there are usually one or two fourth-year medical students and several third-year medical students on each service.
We strive for a multidisciplinary, family-centered approach to patient care, so there is very close interaction with Child Life specialists, social workers, nursing staff, therapy services, dietician, and speech pathologists on daily rounds. We conduct rounds at the bedside allowing for interaction with patients and their families.
The call schedule is divided into a day and night shift system. One of the two day teams is on call from 6 a.m. to 5 p.m. each day. The night team, consisting of a senior resident and an intern, cover all overnight admissions. All residents on the pediatric floors will have four days off per month. The ward schedule is created so that senior residents have their days clustered into two “golden” off weekends during their rotation.
Pediatric Intensive Care Unit (PICU)
The PICU is dedicated to the care of critically ill children. The unit is staffed by an attending pediatric intensivist, senior resident and usually one intern. Residents in the PICU will learn the intricacies of caring for pediatric medical, surgical and trauma patients. There is very close interaction with the pediatric medical and surgical specialists.
Residents in the PICU will work six days per week, with duties ending at 5 p.m., when the overnight senior resident comes on service.
Term Newborn Rotation
The term newborn nursery rotation provides an excellent opportunity to become proficient in basic newborn care, newborn physical examination, circumcision, breastfeeding education and routine neonatal resuscitation. The nursery service is staffed by an attending pediatrician and two or three residents who may be senior residents or interns. The newborn observation unit and physician work area is located proximate to the labor and delivery unit, allowing for close collaboration with obstetricians and the labor and delivery nursing staff.
Duty hours are 7 a.m. to 5 p.m. for six days each week. The overnight shift is covered by the NICU team.
Harry S. Truman VA Hospital
The VA rotation allows for the provision of general medicine and cardiac care to veterans. Accordingly, this rotation is an excellent time to gain experience managing a wide variety of common and not-so-common medical conditions as well as to gain exposure to numerous internal medicine bedside procedures. There are three inpatient teams each made up of an attending hospitalist physician, senior resident and two interns. Additionally, there are often multiple third- and fourth-year medical students on each care team. Each team can carry up to 20 patients with each intern covering no more than 10 patients.
Daytime call at the VA is from 7 a.m. to 6 p.m. every third day. Overnight call is covered with a night float system composed of a senior resident and an intern.
Inpatient Cardiology (CICU)
The inpatient cardiology service at University Hospital includes the management of cardiac conditions in the cardiac intensive care unit, progressive care (step-down) unit and the general cardiology inpatient ward. This rotation allows residents to gain experience managing acute coronary syndrome, congestive heart failure, cardiac arrhythmias and other cardiology problems. The rotation is often a favorite of our residents because of the excellent teaching by both attending cardiologists and fellows, as well as exposure to multiple cardiac conditions.
The cardiology inpatient team includes an attending cardiologist, cardiology fellow, four or five resident physicians, a case manager, social worker and a cardiology nurse practitioner. The call schedule is split equally among the residents on the service and is from 7 a.m. to 7 p.m. each day. Overnight call is covered by a senior resident. Days off are arranged by the residents; however, all residents will have at least one day off each week.
MU Health Care Inpatient
The inpatient medicine rotation provides an opportunity to learn the skills necessary to manage hospitalized adult patients who are admitted from our emergency department or accepted as transfers from referring hospitals from across the state of Missouri. Inpatients are accepted on to one of four general inpatient teaching services and one non-teaching service.
The four general teaching services are staffed by an attending hospitalist physician, senior resident and two interns. Each of these teams can carry up to 18 patients with no more than nine patients per intern. Each teaching service takes call every fourth day from 7 a.m. to 7 p.m. Many of the early morning admissions are accepted to the non-teaching service which includes an attending physician and physician assistants, allowing the teaching inpatient teams adequate time for rounding and resident education. Overnight admissions are handled by a night float system that includes a senior resident and two interns. An attending physician is often present in-house overnight to staff admissions and to supervise all procedures.
All inpatient medicine teams have an assigned social worker, care coordinator and pharmacist as is consistent with our multidisciplinary approach to patient care.
The medical intensive care unit rotation is a favorite rotation of our residents because of the excellent teaching provided on-service as well as exposure to multiple procedures including endotracheal intubation, central venous and arterial line placement, thoracentesis, paracentesis and lumbar punctures. This hands-on rotation allows for excellent bedside teaching by attending physicians and pulmonary/critical care fellows. Residents will become proficient in the management of critically ill adults, including procedures and ventilator management.
Patients admitted to the intensive care units are distributed between two attending physicians. There are two teams, and each includes a pulmonary/critical care fellow, senior residents and interns. Each resident will work six days per week. Overnight admissions are covered by a night float system that consists of two senior residents who take call every other night.