The R1 year is designed for residents to acquire the skills necessary to recognize children with manifestations of acute and chronic illness. We do not do any 24-hour shifts as interns. All our inpatient months have 3 weeks of day shifts and 1 week of night shifts. Typical rotations include: 

• Wards (3-4 months) 
• UW NICU and Newborn (2 months) 
• ED (2 months) 
• Development (1 month) 
• Electives (1-2 months) 
• Adolescent Medicine (1 month)
• Community Practice (1 month; Call Free)

During the Community Practice month, interns spend most days in their designated continuity clinic and have dedicated training and time to learn about community resources, including WIC, local dental offices, early intervention facilities, family court, car seat safety training, and the Promoting First Relationships program. This month is “Call Free,” meaning residents have all weekends off with no cross coverage. 

The R2 and R3 years promote leadership, teaching, and clinical decision-making skills.  Typical rotations include: 

• Wards Senior (2-3 months per year): As soon as their first month of R2 year, residents can senior a wards team. This can include time on a senior-only service for general pediatric patients, which is a fantastic opportunity to build autonomy. These months are typically 3 weeks of day shifts and 1 week of night shifts with on average 1-2 24-hour shifts.  
• PICU (1 month per year): Residents spent one month in the Seattle Children’s PICU as an R2 and again as an R3. There are no 24-hour shifts on this rotation (day-night float system).
• SCH-NICU (1 month in R2 year): R2s spend one month in the Seattle Children’s NICU. This is primarily a day-night float system with residents sometimes doing 1-2 24-hour shifts during the block. Residents interested in NICU can spend more time there as an R3.  
• HMC (1 month per year): Harborview Medical Center (or HMC) is the region’s level 1 trauma and burn center. Residents spend time in the PICU, wards, and ED during their time at Harborview. This is primarily a day-night float system with residents sometimes doing 1-2 24-hour shifts during the block. 
• Professional Development (1 month in R2 year): All R2 residents build a rotation to work towards personal and professional goals. Areas of focus often include research, advocacy, meeting with mentors and advisors, and personal wellness. 
• WWAMI (2 months in R2 year): A highlight of R2 year is spending two months practicing rural primary care through the WWAMI rotation. Learn more about WWAMI here.  
• Inpatient Hematology-Oncology (1 month in R2 year): Previously an intern rotation, we are transitioning to making this a senior-only rotation. Seniors manage inpatient hematology (e.g. complications of sickle cell disease, aplastic anemia) and oncology (e.g. diagnosis/induction for solid and liquid tumors, febrile neutropenia, complications of chemotherapy). 
• Electives (3-4 months per year): Residents have many electives to choose from and ample time to explore areas of interest (see more below). 

In addition to the typical subspecialty electives, our program offers numerous other electives for residents. Favorites include Wilderness Medicine (where residents spend time backpacking and applying their medical skills in the field) and Clinics Rotation (where residents create their own schedule visiting various pediatrics clinic sites to see the various sides of primary care). 

Other popular electives include Advocacy, Bioethics, Procedures, Complementary & Alternative Medicine, Palliative Care, Hospitalist Medicine, Indian Health Service, Global Health, and Transplant Medicine. Residents also regularly set up Away Rotations based on personal interests and career goals.  

• Noon Conference: Daily teaching (except Thursdays) from 12:00-100pm in a variety of formats including case-based presentations given by residents, boards prep interactive questions and discussions, and teaching presented by general pediatric and subspecialty attendings focusing on a core curriculum of ambulatory and inpatient topics. Executive residents hold phones and pagers during conference to allow for protected time for learning. Lunch is also provided on most days. A sample of a prior noon conference can be found here (Passcode: Noonconference4all!). 
• Morning Report: Every Wednesday morning, residents, fellows, and attendings meet to discuss patient cases. These sessions are co-led by a resident and/or executive resident, and are wonderful opportunities for community building, discussing various medical topics, and developing clinical decision-making.
• SCH Provider Grand Rounds: Every Thursday morning from 8:00-9:00am, residents, hospital staff, and community physicians attend this lecture series of varied topics, ranging from advances in molecular research to legislative issues affecting children. This forum brings international experts in pediatric medicine, research, and policy as it relates to their expertise to our local population. See the schedule for Grand Rounds here. 

• INclusion, Cultural humiLity, Diversity, Equity (INCLUDE)
• Health Equity Rounds
• Climate Change Curriculum: Started by residents in 2021, this curriculum is the first of its kind in the country. Residents learn about how climate change impacts the health of our children, how to have discussions about this with families, and actions residents can take to improve the health of our climate.
• Residents As Teachers and Leaders (RATL): The RATL Curriculum is a monthly longitudinal curriculum that is designed to empower resident teaching and encourage leadership development. Topics include developing chalk talks and giving effective feedback. Sessions are interactive and case based.
• Advocacy Curriculum: The advocacy curriculum teaches residents tangible skills that can be used to advocate for the health of children at the individual and community level, including at the local, state, and federal level.
• Journal Club: This curriculum occurs once a month and offers residents the opportunity to critically review study designs and outcomes in recently published journal articles.

We also have several longitudinal curricula which are incorporated throughout the year to enhance resident understanding of all aspects of patient care.

• Ethics Rounds: Faculty members host sessions for residents to reflect on and process difficult situations that arise, particularly with caring for children with medical complexity. 
• Topic of the Week (TOW): We have a multi-year TOW curriculum that covers a variety of primary care topics. At continuity clinic, preceptors take time during lunch to discuss the weekly topic with their residents and work through example cases together.
• Morbidity and Mortality Conference: Every month, Executive Residents and the Medical Director of Patient Safety Event Review help guide residents through patient cases to learn about the process of reviewing patient safety events for quality improvement. These conferences are often resident-led and provide a safe space for residents to discuss and learn from emotionally challenging cases. Not all cases have bad outcomes, and many themes discussed include ethics, racial bias, diagnostic closure, and communication breakdown.
• Procedure Bootcamp: All R3s participate in a Procedure Bootcamp; where they can practice procedural skills including placing IVs, running codes, intubating, splinting, and doing lumbar punctures. A similar bootcamp is also run during the intern to senior transition seminar. 
• Mock Code: Twice a month, a faculty member or fellow from the ED or ICU, in conjunction with an Executive Resident, will help facilitate mock codes for residents, APP Fellows, and medical students working on the wards. These codes are run in real patient rooms in the hospital and provide learners the opportunity to learn about various roles within a simulated code situation.

Interns have academic half days every other month, where they have dedicated and protected time to learn about various interdisciplinary topics important to a career in pediatrics. Recent topics include cardiology, pulmonology, palliative care, adolescent medicine, and microaggressions. Sessions are interactive with opportunities for hands-on learning in small group settings.   

6:00 or 6:30am: Sign-out 

The day team receives sign-out from the overnight paired team (e.g. Team 1/2). Sign–out times are staggered “early” and “late” between the individual day teams.

7:00am: Pre-rounding 

Team members gather data, speak to nursing, and examine their patients in preparation for rounds. 

8:30-11:30am: Family-Centered Rounds 

Each team rounds with general pediatric and subspecialty attendings. Patients and their families, nurses, pharmacists, and dieticians join the medical team to discuss that day’s plan of care. The team care coordinators help with administrative duties such as ordering DME and scheduling appointments. A resource resident helps with admissions and transfers to minimize interruptions during rounds.  

12:00-1:00pm: Noon Conference 

Daily protected time for resident learning. Formats include case-based presentations given by residents, boards prep interactive questions and discussions, and teaching presented by general pediatric and subspecialty attendings focusing on a core curriculum of ambulatory and inpatient topics. And lunch is provided most days! 

1:00-5:00pm: Patient Care 

The team continues patient care and follows up on labs, imaging, and conversations with patients and their families.  R1s meet and admit new patients with supervision from the senior resident. In addition to bedside teaching on rounds, there is dedicated time in the afternoon for team attendings to teach on topics relevant to the team’s current patients. An hour prior to and during evening sign–out, a resource resident helps with admissions and transfers to allow the team to complete the day’s tasks prior to sign–out and minimize interruptions during sign–out. 

5:00 or 5:30pm: Sign-out

Care is transitioned back to the night team.  We use the IPASS system to ensure patient safety.