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Ambulatory Care Ambulatory Care and Services at Downstate An incredibly broad range of outpatient services are provided by the SUNY Downstate Department of Pediatrics at the Children’s Hospital at Downstate and at Kings County Hospital. These services are available to the residents as training experiences in pediatrics. Attending practice sites as well as hospital based clinics are utilized. In addition to several general pediatric practices and clinics providing both routine and acute pediatric care, outpatient services include subspecialty clinics in every major pediatric specialty and subspecialty discipline. These specialty clinics are conducted by the respective specialty divisions and are supervised by appropriate specialty attending faculty. Specialty clinics provide ongoing ambulatory care for children with chronic illnesses as well as consultative evaluations and follow-up. Many specialty diagnostic procedures are performed or arranged through the specialty clinics. When pediatric residents in this program rotate as a member of a subspecialty service during required, selective and elective experiences, they participate in all the division’s functions including all clinics, clinically oriented case conferences and research activities. In addition to specialty block rotations, two week and one month block rotations in pediatric ambulatory care afford the resident opportunities to participate in a variety of general, acute care and subspecialty clinics. Residents on block ambulatory care rotations can choose from a variety of outpatient activities occurring each weekday morning and each afternoon and thereby customize the experience to their own interests and needs. The tremendous volume and diversity of patients using our facilities for primary care make the general pediatric outpatient services are outstanding educational resource. The experience with the pediatric subspecialty ambulatory services is exceptional because of the superb faculty role models and the wealth of clinical material referred from throughout the area as well as from other parts of the U.S. and overseas. Various subspecialty outpatient services are offered in gastroenterology and nutrition, nephrology, neonatology and developmental disorders, respiratory diseases, hematology, oncology, endocrinology, genetics, allergy and immunology, neurology, AIDS and infectious diseases, adolescent medicine, sexual abuse, dermatology and others including numerous pediatric surgical and surgical subspecialties clinics. Ambulatory Care at Staten Island University Hospital During their SIUH rotations, residents may be assigned to the SIUH outpatient division. The rotation at Staten Island is supervised by the Director of Ambulatory Services. The outpatient division provides well and high risk infant clinics, and, based at SIUH and at a number of satellite offices, many subspecialty clinics such as allergy, adolescent medicine (including high school health), cardiology, endocrinology, gastroenterology, hematology, neurology, and pulmonology. Utilizing the offices of practicing pediatricians as well as hospital physician staffed practices and clinics, a wide variety of general pediatric and specialty ambulatory experiences are available. Also, residents may be assigned sessions or entire block rotations in private pediatrician practices in order to appreciate the mechanics of providing care in and managing a private pediatric practice. Ambulatory Care at Lenox Hill Hospital Lenox Hill Hospital provides a distinctly different ambulatory pediatrics experience utilizing their own general pediatric clinical practice as well as the practice offices of a number of pediatric specialists and pediatric surgical subspecialists. Because the patient population captured by Lenox Hill is markedly different form those at the other facilities, residents can expect a complementary experience. The outpatient services at Lenox Hill provide experiences including Sports Medicine, corrective ENT surgery, Plastics, Corrective and Cosmetic Surgery in addition to a range of the more common pediatric medical specialties. During the experience at Lenox Hill emphasis is also placed medical education, critical appraisal of the literature and an evidence based approach to medical management. Daily didactic conferences are held as well as several medical teaching workshops during the course of a month. In summary, the ambulatory experience for trainees in the Downstate program is excellent and enjoyed by all who participate. The general pediatric, acute care and specialty experiences represents a natural extension of the inpatient training, but more than that it provides the future pediatrician with a window into the realities of Pediatric practice and invaluable experience to last a lifetime. Pediatric Ambulatory Continuity Practice Experience At least one afternoon each week, residents have the exciting opportunity to establish their own mini-pediatric practice in one of several unique ambulatory care sites: University Hospital of Brooklyn, Kings County Hospital Center, private practices of faculty or community physicians, or at public family health stations. Each of these sites has its own special ambiance, but over three years all of them enable residents to develop a practice with their own cadre of patients. Patients are drawn from the term nurseries, acute care services, in-patient wards providing the resident with a true longitudinal continuity of care experience. Patients are also picked up as new referrals to be followed by the resident over the course of the residents program. A record of the resident’s experiences in the clinic is logged. Emphasis is placed on well child care, growth and development, nutrition, screening, anticipatory guidance, immunizations, safety and preventive care, as well as management of chronic illness. Residents are initially closely supervised by the faculty and are given progressively greater autonomy and responsibility with demonstrated acquisition of clinical competency. The experience of being the primary care pediatrician for a well child or a child with a special medical or developmental or social problem over a period of time is essential. Each practice site is staffed by full time board certified pediatric attending faculty who provide supervision, guidance, consultation, and serve as role models. The attending faculty lead the residents as part of a team of providers caring for the patients. Residents are provided personal business cards that they are expected to distribute to their patients’ parents so that the resident can be identified as the child’s primary care provider. Ambulatory care oriented clinical conferences and journal clubs, which are either topic or case oriented, are held daily at each major clinic site and allow the resident to participate in informal group discussions and to develop presentation skills. Acute Care Experiences Emergency and Acute Care at Kings County Hospital Center The acute care experience at Kings County Hospital's Pediatric Emergency Room is a unique highlight of the program. With about 50,000 pediatric visits per year, this site is the major trauma center and pediatric urgent care facility for a Brooklyn population of close to 1,000,000 children. Our graduates develop a great deal of hands on experience and a tremendous sense of confidence because the setting is so vibrant and rich in pathology. Residents are involved in all procedures, emergencies and resuscitations. Very few other programs rival this exposure to and experience in handling of major emergencies. The emergency area is directed by faculty dual certified in pediatrics or emergency medicine, and pediatric emergency medicine. This area is also staffed with a complement of attending pediatricians who see patients and supervise and educate housestaff. In addition to pediatric residents, in the emergency area the Pediatric Department hosts rotating residents from the Departments of Family Practice and Emergency Medicine, and in the surgery section, residents from Pediatric Surgery. Emergency and Acute Care at University Hospital of Brooklyn (Children’s Hospital at Downstate) The recently opened and subsequently expanded and renovated Acute Care Receiving Center at Downstate experienced a surge in pediatric emergency and acute care visits. The Center, now designated a 911 EMS receiving facility evaluates and treats well over 15,000 pediatric patients per year. Infants, children and adolescents are cared for in a specially unit within the ACRC. Attending staff supervising residents in the ACRC are either Pediatric Emergency Medicine physicians or Pediatricians. Many of the emergency medicine staff in the ACRC also work in the Pediatric ER at KCHC. The ACRC is however distinctly different from KCHC in at least two ways. First, the ACRC is the referral center for evaluation of thousands of patients with chronic and complex illnesses followed by the pediatric subspecialists at Downstate. Second, the ACRC is a referral center for evaluation and often for admission of many of the patients followed by private pediatricians throughout central Brooklyn. Emergency and Acute Care at Staten Island University Hospital The outpatient division includes an emergency service, well and high risk infant clinic, and, based at SIUH and at a number of satellite offices, many subspecialty clinics such as allergy, adolescent, cardiology, endocrinology, hematology, neurology, and pulmonology. For acute care experience, residents will be assigned to the SIUH emergency room and urgent care walk-in center. This affords the resident an experience in working one to one with the pediatric emergency attending. Together they evaluate acutely ill patients referred by local practicing pediatricians in addition to a range of very ill children brought in by their parents or the paramedics.
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