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Welcome Note

Welcome to the PICU!  We are excited that you will be rotating with us and will be looking for you on Monday.  Below are some general tidbits about the rotation.


Rounds start at 0745 in the PICU during the week and 0800 on Sat/Sun.  On your first day, you may want to get there a few minutes early (0715) just to get settled in and meet the group. Following this, students should arrive by 6am for signout from the overnight resident.  The resident space is in the middle of the unit: desks outside 2c10 and 2c11 in front of ‘the board’-a large TV screen in the middle of the unit with patient names and room numbers.  You will work out your night shift schedule with the other student and/or residents when you arrive.  You are expected to take 4 overnight 12 hour shifts. Don’t take night call the first night and don’t take night call with another student.  You do not need to come to work on weekends. Also, you are NOT expected to post call round.  The fellow and attending call schedule is posted on the resident reference cabinet, above their work computers.  You can add your night schedule here so that everyone knows when to expect you.


You should receive a copy of the power point of the student orientation.  As MS4s you should not carry more than 2-3 patients at any one time and you should refrain from carrying any one patient for more than a week (at the most).  These limitations are suggested for two reasons.  1) Your primary goal should be exposure to as many disease processes as possible, this is why we suggest not following patients for more than 1 week at a time.  2) If you carry too many patients you will be too focused on ‘getting work done’ and you won’t have as much time for learning.

You will be following patients in cooperation with a resident.  You should pre-round, examine (please do not skip the pre-rounding exam- it’s important) and sift through labs and vitals and develop plans on your patients. Each patient you are following should also be discussed with the resident.  You can also feel free to discuss the plan or labs with the fellow or attending if a resident is unavailable.


Students can now write notes that can be incorporated into the medical record.  We have a standard PICU note template in EPIC that you will need to use.   Please ask the residents or fellows to share the template with you so that you can access it.  Then you will share your notes with the resident that is following the patient.  The resident will then edit the note and route to the attending for co-signature.

Other items

The main objectives of this rotation are for exposure to critically ill pediatric patients, developing an understanding of the complex pathophysiology impacting pediatric patients, and learning how they are managed.  Come in with a good attitude, a willingness to ‘get your hands dirty’ and demonstrate that you know the ins and outs of your patients, and you will be fine.  One of the most important ways that we can get an assessment of your understanding of the patient and pathophysiology is by assessing your presentations so, please ask for feedback early and often on this!  It will serve you well.

Best of luck and, again, welcome to the PICU we are glad to have you as part of the team.  Please, if there are questions, don’t hesitate to ask the attending or fellow on service or send me an email.



Melissa Smith, MD
Assistant Professor, Department of Pediatrics
Division of Critical Care Medicine
The University of North Carolina at Chapel Hill
417 MacNider Hall, CB #7221
Chapel Hill, NC 27599-7221
Phone: (919) 966-7495
Pager: (919) 216-4761

Select Educational Resources

  1. Helfaer, M.A. and D.G. Nichols, Rogers’ Handbook of Pediatric Intensive Care. 2008: Lippincott Williams & Wilkins.
  2. Fuhrman, B.P. and J.J. Zimmerman, Pediatric critical care. 2006: Mosby-Elsevier.
  3. Jones, M.B., Klugman D., Fitzgerald, R.K., et al, Pediatric Cardiac Intensive Care Handbook. 2018: Pediatric Cardiac Intensive Care Books.
  4. Marino, P.L. and K.M. Sutin, The ICU book. 2007: Lippincott Williams & Wilkins.

UNC Children’s Clinical Care Portal:

  • This site has many flowsheets and protocols that are useful throughout the month