Frequently Asked Questions
1. Do you accept fellows from a pediatrics background and those from an emergency medicine background?
Yes. We have experience training fellows from both backgrounds.
2. Do fellows get trained by faculty from both a pediatrics background and an emergency medicine background?
Yes. Our full-time faculty consists of 5 physicians who completed a residency in pediatrics and then a fellowship in pediatric emergency medicine and 6 faculty who completed a residency in emergency medicine and then a fellowship in pediatric emergency medicine. We also have several part-time physicians who are fellowship trained in pediatric emergency medicine with initial training in pediatrics or emergency medicine.
3. How long is your training program?
Our program lasts 3 years for graduates of pediatrics residencies and 2 years for graduates of emergency medicine residencies. This reflects the difference in requirements for sitting for the subspecialty board examination through the American Board of Pediatrics or the American Board of Emergency Medicine.
4. Do you have a lot of practice guidelines?
No. Our Division Chief's philosophy is that academic faculty need the freedom to practice clinical medicine as they see appropriate. Practice guidelines can be seen to slow innovation and impede creative, individualized care for acutely ill and injured children.
5. Without practice guidelines, isn't this confusing for new fellows and other trainees?
Sometimes. But our fellows learn a variety of approaches to common and uncommon conditions affecting acutely ill and injured children throughout their training with us. In the end, the fellow has a breadth of knowledge and experience from which to develop their own approach to pediatric emergency medicine.
6. Do you use high-fidelity simulation?
Yes. We use our Loma Linda Medical Simulation Center for procedural and immersive simulation training. Our simulation center is a state-of-the art, 8,000 square foot facility that opened in 2010. The medical director of the Simulation Center is one of our emergency physicians, Dustin Smith. Here's a YouTube video about the Loma Linda Medical Simulation Center.
7. What will my experience be like with regard to trauma?
Fellows gain extensive experience in managing blunt trauma. The vast majority of cases arrive "from the field" - meaning that the children have not been "worked up" at another hospital before coming to us. As the only level 1 pediatric trauma center serving a very large geographic area (which is the size of the entire country of Portugal), many acutely injured children are flown to us directly from the accident site by helicopter. Our fellows and faculty are expected to manage the vast majority of "traumas" prior to surgical consultation. Individuals from the pediatric intensive care unit and the department of anesthesia do not come to the emergency department to care for traumatized children. In particular, we manage the airway for all acutely injured children who present to our pediatric emergency department.
8. What about extremity trauma?
Many fracture reductions and joint dislocation reductions are performed by our pediatric emergency physicians prior to or without consultation from the department of orthopedics. Many of our faculty are licensed to perform fluoroscopy in the pediatric emergency department and we have our own fluoroscopy machine stationed in the pediatric emergency department.
9. When will I be functioning like an attending?
Graduates of pediatrics residencies serve on the medical staff and function just like our attendings do during the 3rd year of fellowship.
10. How do fellows function during the first 2 years of fellowship?
We have graded responsibilities with increasing independence as the first 2 years progress. All patients are seen by an attending physician before final disposition. Fellows get appropriate support, teaching, and supervision throughout the first 2 years.
11. Are you based in the Department of Pediatrics or the Department of Emergency Medicine?
We are based in the Department of Emergency Medicine.
12. How far away from the pediatric emergency department is the CT scanner?
There is a door between rooms 5 and 6 that leads directly to a CT scanner. In essence, a CT scanner is our room 5 1/2.
13. How old is your pediatric emergency department?
Our current physical space opened in 2002. A new hospital is currently under construction and scheduled to open in 2020, which will include a new, larger pediatric emergency department.
14. Do you use propofol and ketamine for procedural sedation?
Yes. We have extensive experience with deep and dissociative sedation including the use of propofol and ketamine. We perform our own sedations and do not defer this to others (such as anesthesiologists).
15. Do you use fluoroscopy?
Yes. Many of our faculty and fellows are licensed to perform fluoroscopy in the pediatric emergency department and we have our own fluoroscopy machine that is kept in the pediatric emergency department for our use. We primarily use fluoroscopy to perform fracture reductions in the pediatric emergency department.
16. Do you use bedside ultrasound in the Pediatric Emergency Department?
Yes. We have an ultrasound machine for dedicated use in the pediatric emergency department.
17. What electives can I do?
There are many elective options available and fellows are encouraged to be creative in designing their own elective experiences. Electives include research, dental anesthesia, pediatric intensive care, child abuse, toxicology, international emergency medicine, and a wide range of pediatric subspecialties.
18. What kind of attending coverage do you have in the Pediatric Emergency Department?
We have a fellowship trained pediatric emergency physician present in the pediatric emergency department 24 hours per day, every day. We have 2 additional "swing shifts" that add one more attending physician from noon until 2am. The vast majority of these swing shifts are covered by pediatric emergency physicians and a few of them are covered by general emergency physicians. Another way to say it is that we have 38 hours of attending coverage per day.
19. How do consultations work in the Pediatric Emergency Department?
We have a relatively unique relationship with our pediatric subspecialists. We typically speak directly to the attending physician from the pediatric subspecialties when needed. We do not have residents coming down to the pediatric emergency department to perform consultations. The exceptions to this are the surgical services. For pediatric surgery (both for trauma and non-traumatic consultations), ENT, orthopedics, pediatric neurosurgery, pediatric dentistry, hand surgery, and other surgical services, a more traditional consultation process is used that includes having the resident from that service come to the pediatric emergency department and evaluate the patient prior to talking to their supervising attending physician.
20. How many children do you see each year in the Pediatric Emergency Department?
21. What are the required rotations?
The required rotations depend on the background of the fellow. For those who graduated from a pediatrics residency, 4 months in the adult emergency department, 12 months in the pediatric emergency department, and a month of obstetrics, PICU and pediatric anesthesiology are required during the first 2 years. During the third year, the fellow functions as an attending physician in the pediatric emergency department. For those who graduated from an emergency medicine residency, one month each of pediatric intensive care, neonatal intensive care, child abuse pediatrics, pediatric anesthesiology and two months of subspecialty outpatient pediatrics are required in addition to 12 months in the pediatric emergency department.
22. Do you have an observation unit?
We admit children to "observation status" and observe them for up to 24 hours for those children who cannot be directly discharged home, but also do not clearly require an inpatient stay. Fellows will gain experience in selecting patients for admission to observation status and performing the rechecks needed during an observation stay. Fellows will also participate in the decision process for the ultimate disposition (discharge home or admission to the hospital) for children under observation status. We do not have a separate physical location that serves as an observation unit.
23. Do you have a separate fast track/urgent care?
No. High acuity patients will be a part of every shift that fellows work in the pediatric emergency department.
24. Do I learn about coding and billing?
Yes. Specific learning sessions on coding and billing are provided throughout fellowship training.
25. Can I get a Master's Degree in Public Health or a similar degree during my fellowship?
Yes. We have had one past fellow obtain a Master's Degree in Public Health as a part of their fellowship experience. It is recommended that you discuss your interest in this option with the program director early in the selection process as some early planning is needed to make arrangements for this.
26. How do you chart your medical records in the pediatric emergency department?
We use electronic charting (EPIC based referred to as LLEAP) and it is expected that fellows learn how to effectively chart using this system.
27. When are your interviews?
We typically being to review applications through ERAS in July. Interviews typically occur on Mondays in September, October, and November.
28. Where is Loma Linda?
Loma Linda is located about 1 hour east of Los Angeles just south of I-10 and east of the 215 freeway. We are about 30 minutes east of the Ontario International Airport.
Click here for a Google map of the medical center.
29. Where do most of the fellows and faculty live?
Most live in Redlands, Yucaipa, Loma Linda, and a few places a bit further away. Redlands is probably the most popular.
Click here for a Google map of the medical center. Zoom out on the map until you find Redlands to the East.
30. What is traffic like in the area?
Loma Linda is located on the eastern side of the Greater Los Angeles region. Being in southern California, it is a populated area, but less so than nearby Los Angeles proper to the west and San Diego to the south. It therefore offers access to these areas with much less daily commuter traffic. It is close to sparsely populated mountainous and desert areas in inland southern California.
31. What restaurants are there in the area?
Characteristics local restaurants include Romano's, Citrone, The State, Darby's American Cantina, Eureka Burger, Caprice Cafe, Niko Niko Sushi, and The Gourmet Pizza Shoppe, in addition to typical chain restaurants. Many of these are located in the Citrus Plaza, which is a shopping and moviegoing location in Redlands.
32. Do fellows have access to a health and fitness center?
Yes, all fellows and faculty have complimentary access to the Drayson Center, which offers a lap pool, weight room, intramural sports, fitness classes, as well as racquetball, basketball, tennis and pickleball courts.
33. What activities are there in the area?
The area has great hiking, as close as within the city of Loma Linda. Jedi Trail and Dragon's Back are fellow favorites. If you're feeling more adventurous, try the six local peaks. The San Bernardino mountain range boasts Mount San Gorgonio, the tallest peak in southern California, as well as skiing, biking and hiking at mountain resorts like Bear Mountain at Big Bear Lake, which is 41 miles from the medical center. Lake Arrowhead is even closer. Joshua Tree National Park is 75 miles east the medical center, and offers desert camping and hiking. Palm Springs is only 52 miles from the medical center. A short day trip of a bit more than an hour southwest of Loma Linda offers world famous surfing at spots like Doheny and San Onofre.
The historic downtown section of neighboring Redlands offers great local restaurants and shopping. Redlands is also well known as a great place for cyclists, hosting the annual Redlands Bicycle Classic, one of the oldest professional stage races in American bike racing. Redlands also boasts the oldest community-run circus in the US, as well as the Redlands Bowl, an outdoor concert venue that hosts the oldest free concert series in the US.
If you have kids (or don't), Disneyland is only 48 miles from the medical center. Downtown Los Angeles is 61 miles from the medical center and San Diego is 108 miles away. Give Shelly Nelson, our program coordinator, a call at (909) 558-7698 and let her know what you are interested in for more info.