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PL-1 Rotations

As a Primary Care Track (PCT) resident, your rotations are similar to the Categorical and LAUnCH Tracks. You will have monthly rotations with a mix of inpatient and outpatient months. We offer two unique curricular adaptations during your intern year: 

1. Providing an Early Foundation: PCT Residents rotate through two core outpatient experiences in their intern year, giving them a solid foundation for their consolidated outpatient time in the 2nd and 3rd years. 

2. Close Mentorship: All three tracks get one month in their main outpatient clinic site. In the PCT, you are paired with one primary 3rd year preceptor who will be dedicated to supervising and teaching you for that one month. This learning dyad (pair) is a powerful way to get you started with primary care pediatrics.

PL-2 and PL-3 Rotations

Residents spend two immersive five-month blocks at the Children’s National Pediatricians and Associates (CNPA), Foggy Bottom clinic: one in the 2nd year and one in the 3rd year. In traditional residency curricula, it is difficult to maintain continuity due to monthly switches to other rotations. Our unique curricular enhancement boosts continuity of care – allowing you to develop relationships with patients of all ages (birth to 21 years). You will see these patients in every aspect of outpatient primary care pediatrics: from well child care, acute care, chronic disease management, and evaluation and treatment of common mental health concerns. Working side by side with attending physicians, your experience will give you a full view of how an outpatient primary care medical home functions including: referrals to specialists, coding and billing and the business aspects of primary care.

Your educational experiences during the PL2 and PL3 year include:

  • 8 a.m. - 5 p.m. Clinic Schedule:  During regular patient sessions, you will see up to eight patients per session as a PL-2 and up to 10 patients per session as a PL-3. We blend supervision with preceptors with increasing autonomy as you advance in your training. 
    Continuity Clinic:
    Continuity clinic is a constant “home” during your three years in the primary care track, even during your outpatient block. Each continuity clinic starts with a 30-minute learning event tailored to common well child care guidelines and outpatient diagnoses. 
  • Elective (REACH): One and a half days is given each week in your second year and one full day in your third year to structure as you choose to pursue advocacy, policy, global health, research projects or subspecialty clinic work. It can be part of a REACH project or simply elective time. You have the flexibility and independence to meet any individualized curriculum or pathway you choose from the Primary Care Track.
  • Development/Behavior/Mental Health Curriculum: Primary Care Pediatrics is filled with concerns that span a continuum from early childhood development delay to mental health concerns in adolescence. We have designed an integrated curriculum that includes: 
    • Developmental Pediatrics: Combined with early rotation in Development your intern year, several key conferences address approaches to evaluation of developmental delay. Our well child supervision visits include evidence based screening tools to detect developmental concerns early. 
    • Behavior Seminar: These seminars are included in the Wednesday morning didactic curriculum and are led by a local leader in childhood behavior. After completing these seminars, you can confidently discuss common concerns related to sleep, toilet training, discipline and temperament. 
      Child Psychiatry/Mental Health: Through a HRSA (Health Resources & Services Administration) Grant, we have designed a sub-curriculum aimed at training primary care providers to provide front line care for the three most common mental health conditions in pediatrics: ADHD, Depression and Anxiety. These conferences are led by Children’s Child Psychiatry fellowship director.
    • Reserved Clinical Application: During your 2nd and 3rd year blocks, you have one hour per week that you can refer patients for follow up for extended consults to discuss concerns related to development/behavior/mental health. This reserved time allows you to apply all you have learned in the curriculum to patient care. 
  • Conferences: Primary Care Conference, Development, Behavior and Mental Health Conference and Adolescent Conference
    • Primary Care Conference is held from 9:00 a.m. to 10:30 a.m. every Wednesday and covers basic topics in primary care, often in our “journal club” format. Residents are often assigned to read the latest literature on an aspect of the topic, such as UTIs and serve as “experts” on that aspect as cases are discussed. Each resident presents one of his/her own conferences during this time. These conferences can be based on cases they have seen in the Pediatric Intensive Care Unit or inpatient wards that hold particular relevance or lessons learned for the primary care setting. Resident conferences can also review or update a primary care case. We also use Wednesday mornings for field trips to the AAP legislative office, schools and Toys R Us (to examine baby equipment, safety equipment, etc).
    • Development, Behavior and Mental Health Conference follows from 10:30 a.m. to 11:30 a.m., where we discuss cases and common topics encountered in infant development, behavior and child psychiatry.
    • Adolescent Conference, held after lunch on Wednesday, reviews topics such as interviewing and confidentiality, sexuality, contraception and sexually transmitted disease.
  • Adolescent Medicine Patients: The Wednesday afternoon clinic session is mentored by our adolescent medicine specialist, Judy Ratner, M.D., who runs the earlier conference and provides clinical supervision.
  • Community Health Experience: During the PL2 year, you can choose to dedicate one clinical session per week to a community health experience. This will provide you with a broader understanding of the healthcare of children in an under-resourced population. Below are examples of current sites:
    • Upper Cardozo Clinic: This practice provides residents with an experience working in the system of care that serves the under-resourced population of the Columbia Heights neighborhood of DC. While the CNPA practice serves a very diverse population, 25 percent of whom are insured through Medicaid and SCHIP, the Upper Cardozo Clinic sees patients who may not have insurance and for whom access to care is more challenging. This experience is only available if a resident has working proficiency in medical Spanish.
    • DC Early Intervention: You visit Early Intervention intake center in Washington, DC, and tour the facility where children from 3-5 years of age go to receive assessments. You will observe actual assessments of children for developmental delays and develop a deeper understanding of the concept of early intervention and the policies that influence how services are delivered to these children.
    • Child and Adolescent Protection Center: Residents will have the opportunity to participate in the evaluation of various forms of child maltreatment for both inpatients and outpatients, and to learn what a child and family may experience when a report of abuse is made. In addition, residents will learn how a multidisciplinary team works together to meet the needs of vulnerable children. This experience fosters an understanding of why history and physical exam findings are important to elicit, identify and document cases of abused children and understanding how the local legal system works in relation to abuse cases.
    • Population Health Initiatives/Quality Improvement: Children’s National Hospital boasts one of the largest repositories of population health data in pediatrics in the country. Residents with interest in population health and related quality improvement measures can join numerous ongoing initiatives or develop their own with the help of our health informatics team.
  • Mentor Meeting: Once a week, each resident meets with one of our faculty to review cases, discuss career plans and do literature searches on clinical questions that arise from patients seen in the practice.