Pediatrics
The Pediatric Residency Program at Texas Tech Health Sciences Center is small (for a state the size of Texas) with a big mission. There are six pediatric residents per year of training. Texas Tech serves the Texas Panhandle, which is a rectangular area bordered by New Mexico and Oklahoma. The land area is 25,824 square miles with a population of nearly 500,000. Residents are presented with patient encounters on a primary care basis rather than seeing tertiary cases with pre-existing diagnoses. The residents have a close direct relationship with faculty. We have over 30 faculty who oversee the training of our residents in areas of patient care, medical knowledge, interpersonal skills/communication, professionalism, practice based learning and systems based practice. The education is led by Curtis Turner, MD, Program Director, Chris Todd, MD, Associate Program Director (Inpatient Services) Shannon Herrick, MD, Associate Program Director (Outpatient Services), with Zankhana Master and Rasmi Palassery as PL3 Co-Chief Residents. This team is a strong advocate for the resident well-being and resident experience. One focus is to create a team of residents who function at a very high level. TTUHSC Amarillo is the recipient of a grant award: the Affordable Care Act: Primary Care Residency Expansion. This grant is funded by the Health Resources and Services Administration (HRSA). TTUHSC Amarillo increased to a total of 6 residents per year starting July, 2011. One resident per year will be selected who expresses an interest in rural health and will have all travel and lodging expenses covered and receive an additional $15,000 per year for 2 years ($30,000) for repayment of student loans. The resident will spend 2 months per year in a rural pediatric clinic for a total of 6 months of the 3 years of training. We have four former residents who are now on the faculty roster including Shannon Herrick, MD, Tetyana Vasylyeva, MD, Johnnie Faircloth, MD, and Amanda Griffin, MD.
I. Current House staff consists of a total of 16 residents including 6 PL-1s, 5 Pl-2s, and 5 PL-3s. There is a high Esprit de Corps because of team building that starts during the internship. We conduct an annual off-site working resident retreat in which the entire resident group goes to an offsite location. Residents learn about themselves and each other and are given skills sets allowing them to work as a team to improve the resident experience resulting in resident "bonding", improved accountability for professional behavior, increased collaboration, improved interpersonal skills and communications. The end result is a high satisfaction of the residents with the program.
II. The workload is balanced with personal time, education and providing excellent patient care. Time is available to allow for entry level research including case reports, scholarly reviews and small clinical studies. Call schedule for PL-1 resident include 2 months of night shift as a PL-1 resident for 12 to 16 hours. In addition, weekend call occurs in 12 -16 hour shifts occur for PL-1 residents who are not on the night shift rotation. Senior have 1-2 night float rotations per year and a single call on the weekend per month on other rotations.
The average inpatient load for PL-1 resident is 7 patients with a range of 5-10 patients depending on the service. The level of independence begins with the interns being highly supervised and autonomy is increased over the intern year. Senior residents have a high level of independence with supervision by the attending. Adequate time to read is generally available with additional time available during the sub-specialty rotations and outpatient clinic rotations. Residents are excused from clinical service to attend educational conferences.
III. Faculty Availability Faculty are always available and serve as preceptors in Clinic, Wards, NICU, PICU, Newborn Nursery and Subspecialty rotations. Most faculty have full time teaching roles and they take every opportunity to teach.
IV. Teaching/Curriculum. Faculty are responsible for the majority of the lectures but allow residents to participate as well. Teaching conferences are organized in parallel with the American Board of Pediatrics guidelines for the certifying examination. In additional to medical knowledge, residents learn about patient care, interpersonal skills/communication, professionalism, practice based learning and systems based practice.
The curriculum for the Department of Pediatrics three-year residency training program is designed to prepare the physician to be well rounded and competent in pediatrics and child development. The graduate pediatrician is prepared for a career in primary care pediatrics or begin training in a pediatric subspecialty fellowship. The program is designed to meet the requirements of the ACGME and the pediatric residency review committee.
PGY - I ROTATIONS - The first year includes thirteen rotations in a 28-day cycle. The first month is spent as orientation through service areas including the In Patient Ward, Outpatient Clinic, Newborn Nursery, and Pediatric Intensive Care Unit for 1 week. The rotations for the remaining year which consists of Night Shift (2), Outpatient Clinic (4), Inpatient Wards (2), Emergency Medicine (1), NICU (1), and Newborn Nursery (2). In the first year, the PGY - I individual develops appropriate skills Goals and Objectives that frame the experience for each rotation and form a basis for the remaining two years of training. The first year resident rotates through the term newborn nursery twice before rotating once through the neonatal intensive care unit (NICU).
PGY - II ROTATIONS Second year residents are given progressive responsibility and rotate once in the Pediatric Intensive Care Unit (PICU) and once in the Emergency Department (ED). They have two rotations in the pediatric required subspecialty (RS) areas (e.g. cardiology, hematology/oncology, infectious disease, gastroenterology, genetics, nephrology, neurology or pulmonary) and one rotation in a subspecialty (SP) experience (e.g. pediatric surgery, radiology, dermatology or anesthesia). The residents supervise for two months in the NICU, two night floats on the general pediatric ward and one rotation as a day time supervisor on the ward. Breadth in subspecialty and supervisory responsibility also include a Developmental/Behavior rotation as well as Adolescent Medicine.The second year experience includes rotations in Adolescent Medicine (1), Behavior and Development (1), Emergency Medicine (1), Outpatient Clinic (1), Ward Supervisor (1), Night Float Supervisor (2), Sub-specialty (2), Sub-Specialty Experience (1), PICU (1), and NICU (2). This experience, with its written objectives and evaluations, allows the individual to gain experience with appropriate faculty supervision both on an inpatient and outpatient basis. The PGY - II resident develops deeper understanding, acquires new skills and cares for children with more complexity and acuity.
PGY - III ROTATIONS The PGY - III curriculum is designed to provide additional subspecialty experience and increase in the role of supervisor and teacher. The rotations of the final year of training include Outpatient Clinic (2), Emergency Medicine (1), Ward Supervisor (2) Night Ward supervisor (2) PICU (1), NICU (2), Sub-Specialty (2) Subspecialty experience (3). These rotations are designed to allow experience in the management and evaluation of many different areas within the scope of pediatrics.
V. The Medical Center in Amarillo is Northwest Texas Hospital Systems (NWTHS) and is located directed across from Texas Tech University Health Sciences Center. NWTHS is the major community based inpatient teaching hospital for over 1100 annual ward admissions to the resident service for general and subspecialty pediatric care. Additional annual in-patient admissions for the pediatric residents’ inpatient experience include approximately 900 (nursery), 300 (PICU), 430(NICU) and 18,900 pediatric ED visits. The resident to patient case ratio is adequate in volume, complexity and diversity. TTUHSC faculty supervise all inpatient admissions with the residents and education occurs with direct patient care. NWTHS provides full support for the pediatric residency program. These in-patient cases are utilized for teaching points during conferences and teaching/work rounds. Residents rotate at NWTHS for several subspecialty electives. All Ancillary Services including laboratory, venipuncture and patient transportation are provided. Subspecialty rotations include Adolescent Medicine, Behavioral & Developmental, Cardiology, Gastroenterology, Genetics, Hematology/Oncology, and Nephrology and Pediatric Surgery. Additional rotations are available in Lubbock for Infectious Disease, Neurology and Endocrinology.
VI. Annual Resident Salaries/Benefits for 2010-2011 are as follows: PGY – 1- $44,617.43; PGY - 2 - $46,073.41 and PGY - 3 -$47,528.32. Vacation Leave : 15 working days as a first and second year resident, 20 days as a third year resident. For all benefits and conditions of employment including information concerning leaves of absences and medical malpractice insurance, please visit www.ttuhsc.edu/som/gme/. Your membership dues for The American Academy of Pediatrics will be paid by the Department. Residents receive an annual stipend of $250 for books, membership dues, and CME.
VII. The Community of Amarillo. Strengths : Family friendly , safe ,very affordable , ease of access to all the main stores , wide diverse choice of apartments and houses for rent and purchase.
VIII. Summary of the Program Upon graduating from this program, residents will be prepared to sit for the board with enough experience in pediatric bread and butter and a good exposure to sub specialty training. The friendly atmosphere will make the long three years an easier more tolerable journey. If you are looking for a place where you are a respected team player, this is one of your best choices.
So how do we measure our success? The ABP certification rate over the past five years is 70%. Graduates from our program obtain excellent fellowship opportunities. Our 15 residents published 15 articles over that past three years. Below is information that will give you a snapshot of our program.
So how are we measured by external reviewers? The Accreditation Council of Graduate Medical Education (ACGME) and the Pediatric Residency Review Committee (RRC) conducted a site visit January 22, 2009. On October 25, 2009, the Committee granted the Texas Tech University Amarillo program continued accreditation with a 5-year cycle. The length of cycle is the maximum granted by the ACGME. The average length of accreditation is 3.9 years. The accreditation process is arduous in evaluating training programs.
Resident Publications
Resident Patient Experience
Resident Events Slideshow
Fellowship Placement
Eleven of twelve residents who applied for fellowship since 2004 were successful in obtaining fellowships.
2012 Zankhana Master, MD-Neonatology, at Johns Hopkins, Baltimore, MD
2012 Rasmi Palassery, MD - Hematology/Oncology, Rainbow Babies, Cleveland, OH
2011 Ladan Modallel, MD - Neonatology, at University of California in Los Angeles, CA
2010 Samer Kaylani Zaid, MD - Pediatric Hematology/Oncology at University of Alabama
2009 Anish Trehun, MD - Pediatric Intensive Care at University of Maryland
2008 Srilatha Alapati, MD - Pediatric Cardiology at University of Texas at Houston
2008 Prakruti Jambula, MD - Neonatology at Cincinnati Children's Hospital
2006 Rishita Tiwari, MD - Pediatric Endocrinology at Brown
2006 Tetyana Vasylyeva, MD - Pediatric Nephrology at Harvard
2006 Phuong Thao Hoang, MD - Pediatric Endocrinology at UCLA
2005 Carmen Ballestas, MD - Pediatric Hematology/Oncology at University of Alabama
2004 Hamza Alsayouf, MD - Neurology at Ohio State University
Resident Clinical Research/Publications
TTUHSC, as an institution, supports increased clinical research. Tom Hale PhD, Pediatrics, directs a newly created Clinical Research Unit. Dr. Hale, and Dr. Jordan (Regional Dean) have has also created an annual resident and medical student research day for poster presentations with financial incentives. In addition, scholarship awards (plaques and $250) were given each to resident who published articles. In 2008 and 2009, Pediatrics was awarded the "Most Published Department" award for the Amarillo campus.
1. Johnnie Faircloth, MD; Bonna G Benjamin, MD; and Osvaldo Regueira, MD. Subclavian Central Venous Catheter Fracture and Embolization. case reports and review of literature. Consultant for Pediatricians, Feb 2010, Vol. 9, No. 2
2. Naqvi M, Paddick J, Kulkarni A, Akangire S, Subhani M,; Prune Belly Syndrome Associated with Polyhydramnios in a Preterm Neonate; Consultant for Pediatrician, September 2009; Volume 8; p. 333 – 335.
3. Akangire G, Kulkarni A, Benjamin B, Nirgiotis J. "Late presentation of Congenital Diaphragmatic Hernia": Archives of Pediatrics and Adolescent Medicine. Jun 2009; 163: 583.
4. Linh Ha, Nirgioitis J, Johnson, A. Duodenal Diaphragm presenting with Hematemisis. Third Annual Medical Students’ and Residents Research Day, TTUHSC, Amarillo, April 2009.
5. Subhani M, Akangire G, Kulkarni A, Wilson GN. Al-Awadi/Raas-Rothschild/Schinzel (AARRS) phocomelia syndrome: case report and developmental field analysis. Am J Med Genet, 149A:1494-1498, 2009.6
6. Kulkarni, A, Turner C: A Quality Improvement Project: Improving Hospital Staff Cooperation to Foster Compliance with Pediatric Resident Procedure Requirements Texas Pediatric Society, 2009.
7. Akangire G, Kulkarni A, Benjamin B, Nirgiotis J. Late presentation of Congenital Diaphragmatic Hernia Archives of Pediatrics and Adolescent Medicine. In Press. (June 2009).
8. Stover DG, Alapati S, Regueira O, Turner C, Whitlock JA. Treatment of juvenile xanthogranuloma. Pediatr Blood Cancer. March 12, 2008.
9. Selvan V, Vasylyeva TL, Turner C, Regueira O. One Disease, Multiple Manifestations. Pediatric Annals 2008; 37(2): 92-95
10. Edmonson H, Hader Z, Setabutr D, Wiggins J, Cogburn A, Bozeman M, Chapman K, Grissom B, Akangire G, Naqvi M. Correlation of post-natal insulin- like growth factor I levels with severity of retinopathy of prematurity in preterm infants. TTUHSC School of Medicine 1st Medical student and Resident Research day, Amarillo, Texas, 2 May 2007. (abstract)
11. Phadke AP, Akangire G, Park SJ, Lira SA, Mehrad B. The role of CC chemokine receptor-6 in host defense in a mouse model of invasive pulmonary aspergillosis. Am J Respir Crit Care Med. 2007;June 1; (11):1165-72.
12. Kamnasaran D, Qian B, Hawkins C, Stanford WL, Guha A.GATA6 is an astrocytoma tumor suppressor gene identified by gene trapping of mouse glioma model. Proc Natl Acad Sci U S A. 2007; May 8;104(19):8053-8
13. Akangire G, Haq M, Chung Y, Low J, Naqvi M. Systemic inflammatory response syndrome (SIRS) and sequence of organ failure in neonates. Pediatric Academic society's Annual meeting, Toronto, Canada, 5-8 May Publication 5901.2, 2007. (abstract)
14. Vasyleva T. Novel roles of the IGF-IGFBP axis in etiopathophysiology of diabetic nephropathy. Diabetes Res Clin Pract. 2007; May;76(2):177-86
Resident Patient Experience
As a resident in our program, you will see a wide range of diagnoses. The list below is 100 consecutive patient diagnoses. Thus, even though we have a "small program" based upon the numbers of first year residency positions and we are a community-based program, when you train here you will obtain a broad exposure to patient problems.
1. Trisomy 21, Hypoxia, Upper Airway Obstruction, Tonsillar Hypertrophy;
2. Hodgkin's Lymphoma, Chemotherapy;
3. Seizures, Intraventricular Cyst, History of Prematurity, Iron Deficiency Anemia, Lymphadenopathy;
4. Acute Lymphocytic Leukemia, Pancytopenia, Penicillin Resistant Streptococcus Pneumoniae Bacteremia;
5. Pedestrian versus Auto Crash, Shock, Grade V Liver Laceration, DIC, Pneumothorax, CHI, Anemia; Perforated Appendicitis, Peritonitis (E. coli), Appendectomy;
6. Acute Lymphocytic Leukemia (T-Cell), Chemotherapy;
7. Cellulitis of Thigh;
8. Nephrotic Syndrome;
9. Cellulitis of Buttock (MRSA);
10. Status Asthmaticus, Dehydration;
11. UTI, Galactosemia;
12. Cellulitis, Abscess of Foot (MRSA), I&D;
13. Gastritis, Suspected Appendicitis, History of Prematurity ;
14. Asthma, Leukocytosis;
15. IDDM, DKA, Hypokalemia;
16. Pneumonia, Anemia;
17. Apnea, GERD;
18. Asthma;
19. Neonatal Jaundice, Dehydration ;
20. Acute Lymphocytic Leukemia, Suspected Sepsis;
21. Status Epilepticus, Respiratory Failure, History of Shaken Baby;
22. Immune Thrombocytopenia Purpura;
23. Cellulitis of Penile Shaft;
24. Cardiomyopathy, Aortic Insufficiency, Chronic Diarrhea, Hypocalcemia, Hypokalemia;
25. IDDM , Appendicitis;
26. Pneumonia (Viral );
27. FTT;
28. Bronchiolitis, Dehydration;
29. Nephrotic Syndrome, Cellulitis of Thigh;
30. Rattle Snake Bite;
31. Opitz Syndrome, Pneumonia, Spasticity, Seizures, Gastrostomy, Undescended Testicle, Renal Agenesis;
32. CLD, Pneumonia, History of Prematurity;
33. ATV accident, Temporal Lobe Hemorrhage, Respiratory Failure;
34. Urosepsis, Septic Shock, Pyelonephritis;
35. Trisomy 21, Hypoxia, Upper Airway Obstruction, Tonsillectomy;
36. Apnea, Neonatal jaundice;
37. Tetralogy of Fallot, Oxygen Dependent, RSV;
38. Pyloric Stenosis, Dehydration;
39. MVA, Ejection from Vehicle, Loss of Consciousness, Lip Laceration;
40. Salmonella Enteritis;
41. Appendicitis, Appendectomy, Bipolar Disorder, ADHD;
42. Appendicitis, Appendectomy;
43. Dehydration, S/P Tonsillectomy ;
44. Hodgkin's Lymphoma, Chemotherapy;
45. Postoperative Hemorrhage, S/P Tonsillectomy;
46. CLD, Respiratory Distress, Tracheostomy, Gastrostomy, History of Prematurity;
47. Apnea, Suspected Sepsis;
48. Pneumonia (RLL), Dehydration;
49. Acute Lymphocytic Leukemia, Bacteremia;
50. Seizures;
51. Bronchiolitis, Suspected Sepsis;
52. Neonatal Fever, Suspected Sepsis;
53. Bronchiolitis, Eczema;
54. Acute Lymphocytic Leukemia, Chemotherapy;
55. Meningitis (Viral);
56. Acute Lymphocytic Leukemia, Pancytopenia, Suspected Sepsis;
57. Appendicitis, Appendectomy;
58. CHARGE Syndrome, Chronic Aspiration Pneumonia, Tracheostomy, Gastrostomy ;
59. Appendicitis, Appendectomy;
60. Viral Infection, Dehydration;
61. Perforated Appendicitis, Peritonitis, Appendectomy;
62. Neonatal Fever, Suspected Sepsis;
63. Acute Lymphocytic Leukemia, Chemotherapy;
64. MVA, Femur Fracture, Splenic Laceration, Pulmonary Contusion;
65. Respiratory Distress, Tonsillar Hypertrophy, Hypoxia;
66. Status Asthmaticus, Dehydration, Pharyngitis;
67. Pneumonia;
68. CLD, Apnea, Bradycardia, GERD;
69. Seizures, Dehydration, Viral Infection;
70. Acute Lymphocytic Leukemia, Pancytopenia, Suspected Sepsis;
71. UTI, Leukocytosis;
72. Viral Infection, Abdominal Pain, Pharyngitis;
73. Perforated Appendicitis, Peritonitis, Appendectomy;
74. Status Asthmaticus, Atelectasis;
75. Status Asthmaticus;
76. Neonatal Fever, Leukocytosis, OM;
77. Aspiration Pneumonia;
78. Pyloric Stenosis, Dehydration;
79. Status Asthmaticus;
80. Pneumonia, Pleural Effusion, Chest Tube;
81. Status Asthmaticus, Atelectasis;
82. Stomatitis, Dehydration, Asthma;
83. Dehydration, Emesis, History of Gastroschisis;
84. A-V Canal, Congestive Heart Failure;
85. Meningismus, Viral Syndrome;
86. Hodgkin's Lymphoma, Chemotherapy;
87. UTI (E. coli), Dehydration;
88. Apnea, GERD;
89. Status Asthmaticus;
90. CLD, Respiratory Distress, History of Prematurity;
91. Asthma, Pneumonia;
92. Asthma, Atelectasis;
93. Bipolar Disorder, ADHD, AGE;
94. Asthma ;
95. Skull Fracture, Epidural Hematoma;
96. Respiratory Failure, Apnea, Pneumonia;
97. Bull Riding Accident, Liver Laceration, Pelvic Fracture;
98. Asthma, Pneumonia;
99. Hydronephrosis, UPJ Obstruction;
100. Salmonella Enteritis