A Message from the Program Director

Michelle Arandes, MD

Michelle Arandes, MD, FAAP

Associate Professor of Pediatrics
Vice Chair of Pediatrics
Program Director
UT Pediatric Residency Program
Department of Pediatrics

Hello and welcome to UT Health San Antonio Department of Pediatrics website!

My name is Michelle Arandes and I am the Residency Director for the Department of Pediatrics. The program in San Antonio is a mid-sized, general pediatric oriented program with a family feel and strong ties to the community. We have the distinction of being the longest standing Pediatric training program in South Texas and are proud to be part of the UT Health San Antonio Long School of Medicine. We pride ourselves on our passion for innovation in education, being one of the first programs in the nation with a required curriculum in Quality Improvement, a nationally recognized international elective Community for Children on the Texas-Mexico border and a robust longitudinal advocacy program. Our Department and program value our trainees as an integral part of our mission to provide excellent clinical care, generate new knowledge in the form of clinical research and educate future generations. To that end we highly prioritize all aspects of the well-being of our residents time with us. We have a robust Wellness Initiative and Curriculum that is resident driven and responsive including number of events and activities to build resilience and camaraderie. We also understand the challenges of integrating and balancing your clinical education with preparation for the next step in your careers. We incorporate a number of level specific workshops and every trainee receives a full set of Med Study Board Prep® Curricular materials including access to a Board Review Course. Our residents have the opportunity to work with a diverse population, are exposed to a broad range of pathology in patients ranging from neonates to adolescents. Our residents are also primary care providers, offering continuity of care to our patients in their own continuity clinics. We have a legacy of training Pediatricians for practice in our regional community and beyond. San Antonio is located in heart of one of the fastest growing areas for children less than 5 years of age and between 5 and 13 years of age in the nation, providing an excellent and diverse patient care experience.

You may have seen some of the dynamic changes happening in San Antonio over recent years! The University of Texas Health Science Center has transitioned its branding to UT Health San Antonio and with that recommitted to our promise to educate and serve our community, our patients and our profession! The Department of Pediatrics has collaborated with our primary hospital partner for over 50 years, the University Health System, to develop a comprehensive pediatric care model for San Antonio, Central and South Texas. The University Health System 900 million dollar capital campaign supported the construction of two new facilities: one in the South Texas Medical Center and the other in downtown San Antonio. Both locations are served by a network of over 20 community and school based clinics located across San Antonio and the surrounding area. Our Pediatric Outpatient and Subspecialty practices and new afterhours Express Med clinic for children are located in the state of the art outpatient facility on the Robert B. Green campus in downtown San Antonio. In April 2014, University Health System opened its new 10-story, one million square foot, patient tower in the South Texas Medical Center. LEED Gold Certified, this facility brings our total inpatient beds to over 100 including Pediatric Emergency Department, Inpatient Pediatrics, Medical and Trauma ICU and separate Comprehensive Care Cardiac Unit. A 65-bed Neonatal Intensive Care Unit and Level 2 nursery along with our extensive term nursery bring us close to 200 inpatient beds. These new facilities have been the first in San Antonio to bring all levels of general and subspecialty pediatric, pediatric surgical and mother-baby care under one roof, including outstanding regional trauma and burn care, solid organ transplant, extracorporeal membrane oxygenation and cardiothoracic surgery. Both our inpatient and outpatient services operate with fully integrated electronic health record (EHR) system. In addition we are anticipating continued expansion of the Women and Children's facilities at UHS- an exciting new plan for the future! As one of the largest Departments at UT Health SA we have over 150 engaged faculty across the range of general pediatrics and broad subspecialty areas. In addition we have 5 fellowships including Neonatology, Critical Care, Endocrinology, Hematology Oncology and Child Abuse Pediatrics as well as access to Pediatric Palliative Care and Academic General Pediatrics fellowship training.

The Department of Pediatrics will be interviewing for a class of 13 categorical positions.  If you would like to learn more about our residency program and the transformative changes happening in health care for our city, please do not hesitate to call or email me.  You can reach me at my office number 210-562-5324 or through my email directly Arandes@uthscsa.edu. I look forward to talking with you soon, and I am very excited for what lies ahead for our program and for the care we deliver to our community of children.

Sincerely,

 

Michelle Arandes, MD, FAAP
Vice Chair Department of Pediatrics
Associate Professor of Pediatrics
Pediatric Hospitalist
Residency Training Director Pediatrics
Ph: (210) 562-5324
Email: Arandes@uthscsa.edu

Education

The mission of the School of Medicine at the UT Health Science Center at San Antonio is to serve the needs of the citizens of Texas by providing medical education and training to medical students and physicians at all career levels. We strive to create an environment of life-long learning that is flexible and emphasizes professionalism. Our commitment to preparation of physicians in both the art and science of medical practice includes training and experience in conducting biomedical and other translational research, delivery of exemplary evidence driven health care, and providing a responsive resource in health –related affairs for the nation and the state, with particular emphasis on South Texas.

The goal of the residency program is to train physicians to become competent general pediatricians with sufficient background in the subspecialties and critical care to manage a broad mix of general pediatric and subspecialty problems and poised to succeed in pursuing primary care careers or subspecialty training.

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A major focus of the program is care of the child and adolescent in the outpatient setting. In addition to the Continuity Clinic experience, there are 28 weeks of general ambulatory care and emergency room experience during the three-year residency. There is a four-week-long rotation in Child Development and Behavior in the first year and an Adolescent Medicine rotation of four weeks occurs in the second year.  The management of the acutely ill child, minor musculoskeletal trauma, and suturing technique is the focus of the rotations in the Emergency Center.

Separate rotations on Neonatal Intensive Care and on the Term Nursery Service allow the attention of the resident to be focused on the problems of the acutely ill neonate at one time and on the more common problems of the normal newborn at another. The pathophysiologic basis for the management of neonatal problems is the focus of faculty attending neonatologists and resuscitation of the newborn is particularly emphasized. In addition to daily rounds and faculty lectures, there is a weekly discharge planning conference and a Perinatal Mortality Conference is held monthly.

Required subspecialty rotations over the three years include Gastroenterology, Pulmonology, Cardiology, Endocrinology, Nephrology, and Neurology, each preparing the resident to individually manage common subspecialty problems and prepare him or her to participate as a member of a multidisciplinary team in the care of complex subspecialty patients. Subspecialty rotations cover both inpatient admissions and outpatient patient visits.

The Ambulatory Care rotations operates out of the Robert B. Green facility, our new 6-story state of the art clinic building providing the resident with an opportunity to experience general and subspecialty outpatient pediatric care with on-site, readily available, full-time faculty for consultation/teaching. The resident's Continuity Clinic also at the Robert B. Green facility provides the core of this rotation. Each resident has the opportunity to follow patients that he/she has recruited from the Term Nursery, other rotations and the Walk-In Clinic, to provide ongoing well-child care, care for children with chronic illness or recurring problems, and care for children with acute illness. The resident attends his/her Continuity Clinic in this one facility, one-half day a week throughout the three-year residency, allowing the opportunity to observe each child through a two- or three-year period of growth and development.

There are over 20 weeks of elective time, in the PL-2 and PL-3 years. These elective rotations are part of the resident’s Individualized Resident Track and are based upon the resident’s interest in general outpatient, hospitalist or subspecialty practice and include opportunities for off-campus or individually crafted electives as well as core options to prepare residents for their next career step.

Call varies by rotation but averages one call every fifth night at most with some rotations having night float call no more frequent than 5 nights in a row (interns) or 4 nights in a row (upper levels). The residency program is fully compliance with all ACGME Resident Duty Hour Regulations.

Responsibility for patient care and teaching is increased from year to year. Instruction of medical students is considered a part of the resident’s responsibilities at all levels. The PL-1 is the patient's primary physician. The senior residents supervise the care provided by PL-1s. Residents are provided a variety of development opportunities to acquire and enhance teaching skills particularly at transitions in roles.

Regularly scheduled didactic conferences emphasizing active learning are central to the residency experience. On inpatient services the workday begins with morning report during which the previous night's admissions are discussed with faculty and house staff. A protected block of didactics is offered every Friday to cover core curriculum of relevant general and subspecialty topics as they relate to the acute or hospital based care of patients. In addition, a twice weekly led curriculum based on nationally vetted lectures is provided to those residents on night float to ensure they are exposed to content. There are separate faculty lecture series for the critical care units and small group seminars during each subspecialty month. Department wide grand rounds is held weekly.  On the inpatient ward services and Hospital Hematology-Oncology rotation at the University Hospital, formal daily faculty attending rounds emphasize teaching of the residents.

The Division of General Pediatrics presents a comprehensive general pediatric curriculum as part of the resident's Continuity Clinic experience. This curriculum, 108 seminar hours, covers the entire range of general pediatric and acute care management issues.  In addition residents cover the Bright Futures curriculum and do many of the on-line Johns Hopkins cases. Specialized curriculum in substance abuse preventions strategies is also taught. An interactive advocacy curriculum also spans all three years and includes site visits to a number of community based locations that serve our most vulnerable patients.

Reliance on evidence based medicine is emphasized throughout the residency including longitudinal curriculum in addition to robust interactive PGY 3 lead Journal Clubs happening monthly. 

The program encourages residents to develop their clinical skills and professional interests to the greatest extent possible. We provide active support for individuals entering general pediatric practice and those seeking subspecialty fellowship training. Over the past fifteen years, upon completion of training, 60% of the graduates of the program have entered Primary Care General Pediatrics, securing positions throughout the country.  The remaining 40% have secured fellowship training across the country in a variety of disciplines including: Adolescent Medicine, Allergy and Immunology, Anesthesia, Child Development, Cardiology, Critical Care, Dermatology, Endocrinology, General Academic Pediatrics, Hematology/Oncology, Infectious Disease, Neonatology, Neurology, Pulmonology, Rheumatology, and Sports Medicine.

Highly Qualified, Nationally Recognized Teaching Faculty

One-on-one guidance from your faculty advisor

Individualized Residency Tracks

24 weeks of elective time

Protected Weekly Didactic Conferences

Scheduled didactic conferences are central to the residency experience

New State-Of-The-Art Outpatient & Inpatient University Health System Facilities

Full EMR and physician order entry

Technologically-Advanced Residency Program

Fully integrated electronic medical records system

On-line access (resident portals, EMR) 24/7

Sensible Limits on Workload

Strict adherence to work hour limits

San Antonio is Awesome

Semitropical climate with year-round outdoor activities

University Hospital Neonatal Critical Care Unit

The only Level IV Neonatal Intensive Care Unit in South Central Texas and you get to work here. At University Hospital’s Level IV Neonatal Intensive Care Unit (NICU), infants are cared for by a compassionate staff committed to achieving the best outcome for each premature and critically ill baby. The NICU treats 600 infants each year inside the 58-bed facility, offering the highest level of care led by on-site neonatologists.

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Patient Population

Our trainees see a broad patient population ensuring a diverse and inclusive experience. For example, the patient population seen in the Continuity Clinic is 90 percent Mexican-American with approximately 70 percent of patients covered by Medicaid. Patients seen at the clinics held in the clinical facilities of the Uniformed Services Pediatric Residency Program are military dependents and represent all diverse backgrounds.

Every patient receives the highest level of patient family centered, evidence based and quality care available.

Because of the proximity to the U.S./Mexico border, residents will likely treat children with illnesses such as dengue fever that they would not have the opportunity to see in other parts of the country. They also manage diseases that have become increasingly common in children such as Type 2 diabetes. It was through patient contacts and ensuing research, that the Pediatric Endocrinology faculty helped sound the alarm concerning this phenomenon.

Whatever the rotation, residents encounter a variety of diverse and complex cases that assure an outstanding learning experience.