Neill and Zinkham Inpatient Teams
The two resident inpatient teams are named for eminent pediatricians who have been prominent in the history of the Harriet Lane Service during the latter part of the 20th century. Catherine Neill was a pediatric cardiologist whose care for patients and enthusiasm for teaching house officers are legendary. William Zinkham was a pediatric hematologist revered by residents for his diagnostic acumen, his ability to solve problems and his wizardry with the microscope.
Each of the two inpatient teams consists of two interns and two PL-3s who cover patients on the three general inpatient floors. Pediatric residents co-follow surgical patients less than two years old, but primary responsibility for all surgical patients on these floors is assumed by surgical house staff. Patients with common pediatric medical illnesses and a wide variety of subspecialty diagnostic and therapeutic problems are seen.
Medical patients represent a variety of chronic and acute disorders ranging from pneumonia, diarrhea and dehydration, and failure to thrive to complex congenital cardiac defects, renal transplants, and a variety of metabolic disorders.
There are six subspecialty resident teams assigned to work with faculty on each of the following services:
The residents assigned to each team have primary responsibility for the patients admitted to that team's service. Residents also see patients in the appropriate subspecialty clinic and participate in conferences along with the faculty and fellows. If home care is necessary for a patient upon discharge, the residents on the team participate in planning that care.
The teams are responsible for the management of their hospitalized patients, and are assisted in the details of patient management by the following:
- Intravenous therapy and phlebotomy teams available 24 hours a day, 7 days a week
- Nurse Case Managers who ensure that referrals, consultations, laboratory tests, and radiographic studies are arranged
- A Resident Assistant who facilitates inpatient and outpatient plans
Hospitalized patients who are not on the service of any of the specific patient care teams are cared for by the Neill and Zinkham Team residents.
Each resident will be assigned to a subspecialty team for approximately two months of the PL-1 year and for approximately two months of the PL-3 year, except for Hematology and Oncology, which are PL-2 rotations.
Pediatric house staff cover a 14-bed unit for pediatric oncology patients on CMSC 8 East. The pediatric house staff assume responsibility for the diagnosis and therapy of patients with malignant diseases, under the supervision of fellows and faculty. Physician assistants and oncology fellows have primary care responsibilities for certain oncology patients. Pediatric house staff also treat the general pediatric problems of oncology patients. Each resident cares for an average of three to six oncology patients and has an opportunity to attend the pediatric oncology clinic.
The Neonatal Intensive Care Unit is a separate 45-isolette unit on CMSC 2. The NICU is next to the labor and delivery area, near the antepartum and postpartum units. Infants at high risk because of immaturity, intrauterine growth disturbances, respiratory distress syndrome, presumed sepsis, congenital anomalies, and other problems are cared for in the NICU. The Department of Obstetrics High-Risk Maternal Service and the Maryland Regional Neonatal Program refer neonates to this unit. The house staff team consists of two PL-3s, two PL-2s and four PL-1s. Their experience on a NICU rotation is one of graded responsibility from the PL-1 through the PL-3 level. House staff gain experience in treating a wide variety of critically ill patients using sophisticated monitoring and cardiorespiratory support equipment.
The 26 bed unit, Pediatric Intensive Care Unit, treats both medical and surgical patients. In addition to patients admitted via the Pediatric Emergency Department, the PICU admits critically ill medical and surgical patients referred from throughout the state. During the month-long rotation, house staff have on-call responsibility only for the PICU.
As the Maryland State Regional Shock Trauma Center for Children, the Johns Hopkins Children's Center admits a large number of patients with severe trauma involving several organ systems. The Johns Hopkins PICU is also Maryland's only facility providing extracorporeal membrane oxygenation (ECMO) for infants and children with severe respiratory failure. Full-time faculty trained in anesthesiology, cardiology, pediatrics, and pediatric intensive care, as well as fellows currently training in pediatric intensive care, supervise house staff and make daily rounds in the PICU.
Special emphasis is placed upon teaching pediatric residents the principles of airway management and ventilation, cardiac and pulmonary physiology, pharmacology, monitoring techniques, and the management of head trauma and other conditions in which elevated intracranial pressure may occur. While the rotation emphasizes clinical care responsibility, house staff are encouraged to initiate or become involved in clinical and/or experimental intensive care research projects.
This facility provides acute care for neighborhood families, subspecialty patients, and patients from the greater Baltimore area, and is a vital part of the pediatric residency training program. Located on the first floor of the Edwards A. Park Building, the emergency department is staffed by house officers (at all three levels of training) who manage all emergencies, urgent admission evaluations, and acute walk-in patients. House staff also work with surgical assistants in a minor trauma area, providing care to children with lacerations, fractures, and other injuries. The emergency room is supervised by full-time pediatric faculty members and fellows. There are about 30,000 patient visits per year.
General Pediatric Surgery
One PL-3 rotates on the pediatric surgery service each month, acting as a consultant. The resident attends morning rounds, offering general pediatric knowledge/advice in the care of surgical patients. More specifically, the resident cofollows all surgical patients less than two years old. In addition, the resident participates in pediatric trauma cases in the ED and attends pediatric surgery clinics.
Newborn Nursery - St. Agnes Hospital
House staff provide newborn assessment and care, as well as family education and counseling in the St. Agnes term nursery. They work directly with attending neonatologists, pediatric nurse practitioners and staff nurses from the nursery. They communicate with the Obstetrical Service and attend high-risk deliveries. Neonatology and anesthesiology attending staff provide resuscitation experience. Approximately 3,000 infants are delivered each year at St. Agnes.
St. Agnes Ward (Heldrich Service)
Johns Hopkins pediatric residents spend approximately three to four months at St. Agnes Hospital during their three years of training. Eight pediatric residents are assigned to St. Agnes each month, either to the pediatric inpatient service, the full-term nursery, or they may choose an elective month participating in a variety of community experiences coordinated by St. Agnes Faculty.
Kennedy Krieger Institute
Each PL-2 spends one month on the Kennedy Krieger Institute Inpatient Service and Outpatient Clinics learning about many aspects of childhood development. Activities include rounds with attending physicians and conferences with audiologists, speech pathologists, physical and occupational therapists, educators, and psychologists.
Harriet Lane Clinic for Children and Adolescents/Continuity Experience
House staff identify and follow a panel of patients ranging from newborns to adolescents for well-child, acute and chronic care during their three years of training. The program provides the setting and staff to facilitate continuity. Faculty, fellows, pediatric nurse practitioners, nurses and social workers teach and assist house officers.
During the one-month block rotation in the Harriet Lane Clinic, house officers provide continuing care for their patients and are exposed to the developmental, behavioral, sociological, and psychological aspects of caring for pediatric patients.
The outpatient adolescent clinic offers wide-ranging programs. Residents learn to provide comprehensive health care to adolescents, including birth-control counseling, evaluation of gynecologic problems, sports medicine, and evaluation of adolescents with psychosocial problems. During the adolescent rotation, residents also attend a high school clinic and the Johns Hopkins University Student Health Service clinic.
About two-thirds of the residents see their continuity patients in the Harriet Lane Clinic, but the remaining one-third are assigned to Johns Hopkins Bayview Medical Center. A continuity clinic curriculum has been developed by the full-time faculty in the Division of General Pediatrics, of which the physicians at Bayview also are members. So residents assigned to Bayview are taught the same material at the same rate as the residents who see their patients in the Harriet Lane Clinic. A large percentage of patients at the Bayview site are Spanish speaking, so for those residents who want to speak Spanish, this is a popular assignment.
Pediatric Subspecialty Clinics
The subspecialty clinics listed below meet regularly in the Outpatient Center. Faculty members supervise care in all clinics.
All residents also complete a block rotation in Community Advocacy and Child Mental Health. During this rotation, residents learn about the many resources available in the community for children with a variety of chronic healthcare needs, such as Downs' syndrome, spina bifida, developmental challenges associated with premature birth, in addition to learning about the pediatricians role in helping parents with behavioral issues.
Residents also spend time learning about child abuse evaluations, visit the Maryland Poison Center and provide medical care to children in the local Hispanic community through an outreach van.
For two weeks during this rotation, residents learn to conduct mental health evaluations from a mental health care worker at the Harriet Lane Clinic and work with residents in the Child Psychiatry program at the Johns Hopkins Community Mental Health Clinics.