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Department of Pediatrics and Adolescent Medicine
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RESIDENCY PROGRAM

The rotations of residents in the Department of Pediatrics and Adolescent Medicine at AUBMC are distributed as follows:

































Children's Cancer Center of Lebanon (CCCL) Affiliated With St Jude Children's Research Hospital
The Oncology Ward is located on the tenth floor of the AUBMC building.

The team consists of a fellow and two interns. The two other fellows will be taking care of patients in the outpatient section of St Jude. The round daily starts at 7:00 am sharp. During this round, the teams will check what happened overnight with the patients and get to know the new admissions admitted during the night. At 9:30 am, the attending round will start, during which the team will discuss the cases with the assigned attending. Thereafter, the teams will go to the patients' management.

The nurse manager of this unit is Miss Nadine Ghobreel. She can be reached at pager number 0747 or at her office at extension 6307. She deals with any problem you might face with the staff or the patients in her unit.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
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Emergency Department (ED)
The ED is on the first floor of Phase I. Its entrance is directly opposite to the main lobby.

The unit team is composed of three residents (junior or senior), three interns and three Med IV students. They share the duty on the bases of 12-hour shifts (day, day / night, night / off, off).

All patients should be checked by both the junior and the senior residents. All non-urgent cases are referred either to the Outpatient Private Clinics or Outpatient Department (OPD). The ED team will take care of all patients aged 0 to 19 years, except married patients who will be directly referred to the Medicine Ward at the ED.

Pediatric and adolescent patients who are enrolled in the “Hospitalization Insurance Plan (HIP)” are to be seen by the family medicine residents; pediatricians will only be consultants. The St Jude patients are accepted in ED during working hours, only if their condition is urgent or emergent.

The ED team is not expected to leave the ED facility for any reason. For the purpose of conferences, one of the team members has to physically be in the ED, and the rest of the team will go to the lecture.

The nurse manager in this unit is Miss Rima Jabbour. She can be reached at pager number 0862 or at her office at extension 6605. She deals with any problem you might face with the staff or the patients in her unit.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
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Epilepsy Monitoring Unit (EMU)
The unit is in the south section of the sixth floor.

The EMU is a computer and electronically-assisted and based unit where longterm, extensive, video EEG recording and other testing can be performed to allow for the proper diagnosis of difficult and selected cases of epilepsy. This is very important, not only in cases resistant to therapy, but also in cases where the referring doctor suspects epilepsy. These patients may be suffering from other disorders, like syncope, migraine, staring spells, etc...

This program has automatic seizure detection that continuously goes on 24 hours a day, seven days a week. It records EEG during the patient’s seizure, in addition to the clinical manifestations, and through an alarm system that alerts the staff to those events. When enough information is collected, it is analyzed to determine the type of seizure that the patient has and its site of origin. This helps the epileptologist decide on the next management step. It also helps tremendously in deciding on the possibility of performing epilepsy surgery or on medical treatment.

For instance, if the seizure is found to be initiated from a single area of the brain which can be resected, then epilepsy surgery is advised. In most cases, certain sophisticated tests are performed to insure that the area being considered for resection is a silent area in the brain and that its removal will not cause the patient any harm or deficit. One example is the WADA test that determines the memory and speech centers' location in the brain.

Only a few epilepsy surgery candidates require additional video EEG monitoring with special electrodes placed on the surface of the brain (subdural electrodes) or with electrodes introduced into the substance of the brain (depth electrodes). Such electrodes are used in selected cases, such as those with deep foci, to determine exactly where the seizures are starting.

Few patients will be admitted for SPECT scan testing. During this procedure, the resident from the inpatient rotation will be observing the patient closely. As soon as the patient starts her/his aura or the usual seizure, the resident will inject the neurolyte dye and bring the patient down to the Nuclear Medicine Ward in the Radiology Department. This is the ictal phase of the SPECT scan. The interictal phase is also done, and the resident will accompany the patient to the Nuclear Scan Suite and back to EMU.

The EMU also provides the service of EEG under conscious sedation to non-admitted patients.

It is the responsibility of the first-year resident in the ward team to check the patient both pre and post-procedure for any contraindication for sedation or any complications prohibiting the patient form discharge home.

The goals and objectives of this rotation will be provided at the beginning of the rotation.
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Neonatal Intensive Care Unit (NICU)
The NICU is located on the seventh floor of the Medical Center building, right next to the Delivery Suite.

The round daily starts at 7:00 am sharp. During this round, the teams will check what happened overnight with the patients and get to know the new admissions admitted during the night. At 9:30 am, the attending round will start, during which the team will discuss the cases with the assigned attending. Thereafter, the teams will go to the patients' management. The team consists of a fellow, a senior resident, a junior resident and two interns. At times, an intern from the Makassed General Hospital (MGH) will join the team for a period of one month. The senior resident will attend every single delivery considered at risk by the obstetric team, along with the junior resident, until the beginning of October. After October, the junior resident will attend the delivery and will call for the senior resident only in case s/he judges the condition requiring so. The fellow will have to be informed of any high-risk, pregnancy delivery.

The term, newborn intern will be caring for the healthy newborns but will attend the rounds of the NICU as s/he shares the duties on this unit with the NICU rotating interns.

The nurse manager in this unit is Miss Saadiyeh Sidani. She can be reached at pager number 0819 or at her office at extension 5632. She deals with any problem you might face with the staff or the patients in her unit.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
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Outpatient Department (OPD), Adolescent and Developmental Behavioral Clinics
These clinics are located on the sixth floor of the AUBMC building, right next to the Private Clinics. The clinics' teams work from 7:30 am till 5:00 pm daily.

The clerk will admit the patients for screening on a first-come-first-served basis. The senior resident will be responsible for the morning screening of patients. The senior resident will decide which patient has the most urgent condition and the most teaching cases to admit. At 8:30 am, no new cases can be assigned to the students. If the condition of the patient is considered urgent as decided by the resident, the patient can be assigned to the Med IV student or the resident. The patient will be distributed to the medical students (Med III), and they will finalize the cases with one of the associate attending staff, who starts her/his clinic between 9:30 and 10:00 am. Each attending can have four new cases or any equivalent (each new case = two followup cases). Every student can have one new and one followup case or two followup cases at a maximum.

The walkin cases are checked by the resident. If the condition is not judged to be urgent, the patient will be given an appointment. If the case is urgent, then the patient will be checked by the medical student (Med IV) and finalized with the resident or seen directly by the resident. No walkin cases are accepted after 2:00 pm. No patients can be seen or ordered tests or renewal of any prescription without having this documented on their charts.

The Neurology Clinics are distributed on three different clinics per week. On Tuesday and Wednesday morning, only the followup cases are checked by the resident, and the cases are finalized with the neurologist. On Wednesday afternoon, the new cases are seen by the neurologist and referred for followup to the resident in the Neurology Followup Clinics. No new cases can be seen in the Neurology Followup Clinics.

The Adolescent Clinic and Developmental Behavioral Clinic patients will be seen according to the same rules as the OPD, but no students are assigned cases. The patients are directly seen by the resident.

Each resident is assigned a day for her/his Continuity Clinic from 1:00 till 3:00 pm. During this time, the resident will be following a group of patients varying from well baby to complex diseases requiring multiple specialists. The resident will be assigned a mentor who will accompany the resident during her/his clinic time. It is the responsibility of the resident to organize her/his clinic appointments. She/He needs to have the patient’s phone numbers, to adjust a light schedule during her/his tough rotations and to cancel her/his appointments in case s/he is out of town. Only out-of-AUB rotations are acceptable reasons to cancel Continuity Clinics.

One day of the week, on Wednesday, the resident rotating in one of these clinics will go to a community to do school health screening.

In case of disasters at the Emergency Department (ED), the outpatient residents are the first to be called for help. In case of any emergency in the Private Clinics or any procedure (LP or catheterization of bladder), the resident from the OPD will be called.

In case of emergency occurring in OPD, the Private Clinics nurses will come for help to stabilize the patient until transfer to the ED.

The nurse manager for the OPD is Mrs Marlene Gharzeddine. She can be reached at pager number 0780 or at her office at extension 6185. She deals with any problem you might face with the staff or the patients in her unit.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
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Pediatric Intensive Care Unit and Step Down Unit (PICU/SDU)
The PICU/SDU is on the sixth floor in the north section. It is the place where the most acutely sick children are admitted until stabilization. The SDU will be the area where less sick, but requiring continuous care and close followup, will be admitted.

The team in the intensive care area consists of a resident (either a first-year resident PGY2 or a fourth-year resident PGY5) and two or three interns (PGY1). The team will round at 7:00 am daily to go over the overnight problems and admissions, then the attending round will start at 8:00 am daily. After the round, usually a teaching activity is prepared by one member of the team, after which the team will go to patient management.

One of the PGY1's (the one who is post-call) will cover the St Jude outpatient till 1:00 pm. The other one will cover the PICU with the resident. During five months of the year, a first-year resident from the Makassed General Hospital (MGH) will join this team and work, along with the members, sharing the night calls with them.

The PGY1 is the first oncall to the PICU and SDU. The second oncall will be the second-year resident PGY2 or PGY4. The third oncall will be the senior resident from the floor rotation.

The nurse manager for PICU and SDU is Mrs Lili Abilamaa. She can be reached at pager number 0814 or at her office at extension 6223. She will be dealing with any problem you will face with the staff or the patients in her unit.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
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Pediatrics Ward (AUBMC)
The Pediatrics Ward is on the sixth floor of the Medical Center building.

The north section is the Private Ward where private patients are admitted. The south section is the ward part where patients are admitted after approval of the chief resident who will choose only the teaching cases to be admitted after discussion with the team. The ward is led by a team of one senior resident (PGY3), a junior resident (PGY2) and an intern (PGY1), along with a team of medical students (Med IV).

The round starts daily at 7:00 am sharp from the 6 South section. During this round, the teams will check what happened with the patients overnight and get to know the new admissions admitted during the night. At 9:30 am, the attending round will start when the team will discuss the cases with the assigned attending. Thereafter, the teams will go to the patients' management.

The nurse manager of the 6 North Unit is Mrs Katia Kozman. She can be reached at pager number 0782 or at her office at extension 6226. She deals with any problem you will face with the staff or the patients in her unit.

For the 6 South Unit, the nurse manager is Mrs Nadia Issa. She can be reached at pager number 0809 or at her office at extension 6226. She deals with any problem you will face with the staff or the patients in her unit.

It is important to emphasize that the transfer of patients from a unit to the other should never be delayed by administrative procedures. If the condition of the patient requires her/his transfer to a higher acuity service or if the patient should be transferred to release the bed for another admission, the resident is encouraged to proceed with the transfer without waiting for the official paper work. The resident will be supported by the chief resident if s/he faces any conflict with the nurses to do the above procedure.

The goals and objectives of this rotation will be handed to you at the beginning of this rotation. (pdf format)
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Pediatrics Ward (Makassed General Hospital (MGH) and Rafic Hariri University Hospital (RHUH))
There is an agreement between the three institutions for exchange of residents. The AUBMC resident rotating in any of the above mentioned institutions will work according to the rules and regulations of the host institution.

Any absenteeism during the rotation has to be reported to both chief residents of the AUBMC and host institution.

During the rotation at RHUH, the resident is supposed to rotate on the ward. The resident will attend the teaching, morning round with the assigned physician, and then, s/he will go to the management of patients. When the resident is oncall, s/he is supposed to cover both the ward and the Neonatal and Pediatric Intensive Care Units. They are the first oncall and should get a senior resident involved all the time. The residents are expected to write admission, progress and procedure notes when they are rotating at RHUH exactly according to the same rules mentioned for the Pediatric Ward at AUBMC. The teaching staff at RHUH will be giving daily didactic lectures at noon. All the residents, including those who are post-call, are expected to attend the lecture.

The goals and objectives of this rotation will be provided at the beginning of the rotation. (pdf format)
(Top)

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Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center