Overview
The curriculum in general pediatrics fulfills the requirements specified by the American Board of Pediatrics. For an overview of this curriculum, please see the rotation and conference descriptions below. Our goal is to provide the highest quality education in general pediatrics to allow residents to be successful leaders in all fields of pediatrics.
The Chair of the Curriculum Committee works closely with a team of Education Managers who run each rotation. These Education Managers are Duke faculty members who have been specially trained in graduate medical education. The Education Managers are supported by the Curriculum Committee in developing meaningful goals, objectives, instructional strategies, and evaluation strategies to promote resident learning. The pediatric residency curriculum is available as the Curriculum Online for Resident Education (CORE). Educational materials for every rotation are available at all times to our residents electronically and may be accessed by computer or mobile device.
Our Rotation Schedule
In July 2025, our residency program transitioned to an X (inpatient) +Y (continuity clinic/outpatient) curriculum to allow for a more consistent and focused learning experience across inpatient and outpatient settings. “X” rotations are typically hospital-based, clinic-free blocks that allow residents to focus fully on inpatient care (PGY-1s do not rotate in the PICU). “Y” rotations incorporate continuity clinic and are generally centered on outpatient electives, with protected weekends without clinical responsibilities. This structure not only supports work-life balance but also optimizes learning by allowing residents to be fully present in each clinical environment.
Sample Block Schedule
A representative three-year path through the categorical pediatrics residency. Individual schedules vary — this shows the typical distribution of required rotations across training.
Rotations
PGY-1 rotations include continuity clinic, full-term nursery, neonatal intensive care unit (NICU), inpatient general pediatrics at Duke as well as at a community hospital, inpatient hematology-oncology, community and advocacy rotation, acute care clinic, and subspecialty experiences. The PGY-1 has primary responsibility for the care of inpatient and outpatient infants and children. PGY-1s work as part of an interdisciplinary team that includes senior residents, faculty, students, and other personnel.
The PGY-2 year includes supervisory rotations on the wards, both at Duke and at a community hospital. During supervisory rotations, PGY-2s oversee PGY-1s and medical students. Additionally, PGY-2s have rotations in adolescent medicine, behavior and development, mental and behavioral health, the emergency department, NICU, pediatric intensive care unit (PICU), and subspecialty experiences. PGY-2s may rotate at Lincoln Community Health Center--a community health center dedicated to the care of a large medically underserved urban pediatric population.
PGY-3s serve as the senior supervisory resident on the general inpatient services and mental and behavior health clinic. PGY-3s also have rotations in the emergency department and PICU. They will also work 1:1 with a hospitalist for 2 weeks on the inpatient complex care service. This is the year that interested residents have the opportunity to engage in global health rotations if they elect to. Finally, the program includes many individualized subspecialty rotations during the PGY-3 year to add breadth and depth to each resident’s experience, while also allowing the resident to tailor his or her education to his or her personal and career goals.
Hands-On, Team-Based Training
Our three-year residency curriculum is designed to prepare residents to become outstanding pediatricians, no matter where their careers take them. Residents develop a strong foundation in general pediatrics while building the clinical skills, judgment, and independence needed to pursue the careers that are right for them.
Residents train at Duke Children’s Hospital, ranked #1 in North Carolina and tied for #1 in the Southeast by U.S. News & World Report. The breadth and depth of care at Duke means residents learn to care for children across the full spectrum of pediatrics, from common childhood illnesses to the rarest and most medically complex conditions. Our residents work with experts across every pediatric subspecialty and have access to the resources of a major academic medical center, including pediatric critical care, emergency medicine, surgery, imaging, transplantation, and other highly specialized services.
Caring for children is a team effort, and we believe residents should learn medicine the same way. Throughout their training, residents work alongside faculty, nurses, advanced practice providers, pharmacists, therapists, social workers, and many other members of the healthcare team. As residents progress through the program, they take on increasing responsibility for patient care and leadership of these teams while receiving the supervision and support they need to grow into confident, independent pediatricians.
A strong foundation in general pediatrics and longitudinal care remains central to the residency experience. During Y blocks, residents return to their continuity clinic, where they build lasting relationships with patients and families and experience the rewards and challenges of caring for children over time. These experiences complement training in inpatient, emergency, critical care, newborn, and subspecialty settings and help residents understand the full continuum of pediatric care.
Our curriculum continues to evolve alongside our residents. Residents provide ongoing feedback about their clinical and educational experiences and meet regularly with program leadership to identify opportunities to make the program better. We encourage residents to bring forward new ideas and support them in developing new rotations, curricula, and educational experiences. In doing so, our residents help shape not only their own education, but the training experience for those who follow them.
Continuity Clinics
Continuity clinic is a cornerstone of pediatric residency training, offering residents the unique opportunity to develop lasting relationships with patients and their families. At Duke Pediatrics, each resident is assigned to either the North Durham or South Durham clinic at the start of training and remains at that site for all three years. Interns inherit a panel of patients from graduating residents, steadily adding to their panel through experiences in the full-term nursery, NICU, acute care clinic, emergency department, and inpatient wards. By graduation, many residents find it hard to say goodbye to the families they have come to know so well—and those families feel the same. Our clinics function as true primary care medical homes, supported by an exceptional multidisciplinary team that includes dedicated faculty preceptors, skilled Spanish interpreters, lactation consultants, mental health professionals, nurse clinicians, and social workers. Together, we care for the majority of Durham’s Medicaid population as well as children from surrounding counties, making our continuity clinic both a deeply rewarding and impactful part of residency.
Electives
Below is a list of our current elective offerings. We are excited to continue expanding these opportunities as we implement recent ACGME changes that place greater emphasis on individualized curricula. In response to resident interest, and with resident input and partnership, we have already added electives in Legislative Advocacy, the Pediatric Intensive Care Unit (PICU), and the Neonatal Intensive Care Unit (NICU). Our Curriculum Committee, which includes program leadership and faculty educational leaders, helps develop and support high-quality electives that reflect residents' interests and evolving training needs.
A one-month ambulatory elective covering the major diagnostic and treatment principles for allergy, immune system disorders, and respiratory disease. Residents participate in food challenges and skin testing, and attend the division's weekly patient rounds, topic conference with fellow-led journal club, and didactic lectures. Schedules are individualized in advance around each resident's particular interests.
Residents learn the continuum of pediatric sedation and anesthesia, including preoperative evaluation, cardiopulmonary monitoring, airway management, and the indications and adverse effects of commonly used sedatives. Hands-on opportunities may include peripheral IV placement, along with observation of interventional pain procedures such as nerve blocks and epidural placement when available.
Residents join the pediatric blood and marrow transplant fellow team and carry their own assigned patients with close fellow supervision. Residents round every weekday morning and transition to the outpatient BMT clinic during the second phase of the elective. Two divisional clinical conferences each week round out the experience.
Prerequisite: PGY-2 or above and completion of inpatient Hematology-Oncology.
Residents follow and perform echocardiograms with sonographers in clinic and participate actively in daily read-out sessions with cardiac imaging attendings. Schedules or a focused project are arranged with the imaging faculty ahead of the block.
Prerequisite: Completion of Outpatient Cardiology and Inpatient Cardiology.
Residents take the day senior role on the inpatient pediatric cardiology service, carrying the service pager and running work rounds before joining full cardiology rounds with the attending. Fellow-led teaching happens daily, and the weekly cardiology surgical conference and Tuesday grand rounds are built into the schedule. Residents on this elective are excused from continuity clinic, and weekend coverage is handled by the cardiology APP team.
The core of this rotation is outpatient pediatric cardiology clinic, seeing and managing patients alongside faculty. Residents also get exposure across the full cardiac enterprise — the echo lab, cath lab, electrophysiology lab, pediatric cardiac MRI, and the CT surgery OR — with optional time in electrophysiology and cardiovascular genetics, transplant/heart failure, and fetal cardiology clinics. A robust weekly conference schedule accompanies the clinical work.
Residents join the Child Abuse and Neglect Medical Evaluation Clinic (CANMEC) team, working with child abuse pediatricians, nurse practitioners, social workers, and a trained child interviewer. The experience spans clinic evaluations, the 24/7 child abuse consult service, and the Foster Care Clinic, giving residents direct exposure to how suspected maltreatment is recognized, documented, and managed.
Based primarily on the inpatient child and adolescent psychiatry consult service, with opportunities to add outpatient child psychiatry clinics and emergency department evaluations. Residents are encouraged to reach out well ahead of the block so the rotation can be built around their specific goals and preferred settings.
A distinctive elective built around jury duty: residents summoned to serve in Durham County can use the experience to view the criminal justice system from the inside. Paired readings and structured reflection connect that vantage point to how social and criminal policy shape child health and health disparities.
Residents attend pediatric dermatology clinic and work directly with faculty on a broad range of dermatologic diagnoses. The rotation is structured to maximize teaching, with documentation and workflow guidance provided in advance so that clinic time can focus on learning dermatology.
Residents gain broad exposure to pediatric endocrinology through a weekday clinical elective with a schedule tailored to their learning goals. Diabetes care is an important component of the rotation, with focused education in diabetes management and transitions from DKA care supported by dedicated endocrine learning resources.
A 2–4 week elective giving residents comprehensive exposure to pediatric GI and hepatology in both inpatient and outpatient settings, typically structured as a week of general gastroenterology followed by a week of hepatology. Days combine inpatient work in the morning with clinic, endoscopy, or inpatient consults in the afternoon. Residents review the GI core curriculum before starting.
Residents attend genetics and metabolism clinics four days a week and join the inpatient consult service, seeing new consults and following active ones with the attending. Weekly fellows conference and clinical case conference are part of the block, and each resident researches one disorder in depth — usually drawn from a case they saw — and presents on it.
A focused elective in Duke's Healthy Lifestyles clinic centered on the assessment and treatment of children and adolescents with obesity. Residents learn to recognize and manage obesity-related comorbidities and use evidence-based treatments, including intensive behavioral interventions.
Prerequisite: Advance approval from the Healthy Lifestyles clinic team; space is limited.
Residents spend the block in the pediatric hematology-oncology clinic at the Children's Health Center, seeing patients Monday through Friday. The rotation is tailored to each resident's learning goals, with the schedule developed in advance to emphasize areas of particular interest.
A scholarly elective for residents pursuing a history of medicine project connected to their career interests. Residents learn to identify and evaluate historical literature relevant to a pediatric topic and to deliver a succinct, engaging lecture or paper on it.
Prerequisite: Faculty approval of a written project proposal before the elective can be scheduled.
A two-week elective that provides an inside look at hospital operations, including patient placement, dispositions, and the Duke transfer center. Residents practice giving remote recommendations to outside providers, balancing health system capacity with patient and family concerns, and navigating challenging decisions around transfers and admissions.
Prerequisite: PGY-3 or PGY-4.
Residents join the general pediatric ID consult team (with a separate transplant ID service also active), pre-rounding each morning and rounding with the attending in the afternoon. The week is built around a strong conference culture — HIV conference, case conference with ID faculty and microbiology, and journal club — and each resident presents at least one case of their own.
Built to close a well-documented gap in physician training, this elective pairs residents with lactation consultants to assess and support breastfeeding mother-infant dyads. Residents finish able to critically evaluate a dyad, troubleshoot common breastfeeding and lactation problems, and connect families to additional resources. Time with occupational or speech therapy can be arranged with the rotation director's approval.
An elective aimed at producing physicians who can drive system-level change for children through the legislative process. Residents learn how a bill becomes law, develop policy communication tools such as a "leave behind," and partner with organizations including the AAP state chapter and the Office of Government Relations to advocate for priority child health policies.
A primary care elective at Lincoln Community Health Center, Durham's federally qualified health center, serving a diverse and often medically vulnerable patient population. Residents practice high-value, cost-conscious preventive and primary care in a resource-limited setting while building a working understanding of health inequities, social determinants, and population health. The stated aim is that trainees come away with an appreciation for both the challenges and the rewards of caring for underserved communities.
A blended inpatient, outpatient, and procedural elective in pediatric nephrology. Residents are paired with on-call and clinic attendings and have opportunities to observe kidney biopsies and dialysis. The rotation director builds a preliminary schedule around each resident's stated interests and goals before the block starts.
Residents divide their time between outpatient clinics and the inpatient neurology service, with the balance tailored to their interests whenever possible. Clinical teaching occurs throughout the rotation through close work with the pediatric neurology team and faculty.
Residents join a multidisciplinary pediatric palliative care team of physicians, a nurse practitioner, and chaplains focused on quality of life and comfort for children with life-threatening illness and their families. The rotation places particular emphasis on patient- and family-centered communication and developing the skills needed to navigate complex conversations.
This one- to four-week elective in Duke's pediatric cardiac ICU begins with an orientation day, after which residents carry one or two patients from the fellow team under close fellow and attending supervision and present them on morning rounds. Residents read ahead on the week's posted surgical schedule, attend the PICU/PCICU case conference and CT surgery conference, and may scrub into OR or catheterization cases or take overnight call if desired.
Prerequisite: PGY-2 or PGY-3 and completion of at least one month of PICU.
Designed for residents heading toward critical care fellowship or hospital medicine, this elective emphasizes leadership and ICU-level decision-making beyond a standard PICU block. Residents respond to Rapid Response Team activations during their hours, assess alongside the fellow, develop and present a plan with graduated autonomy, and evaluate PICU consults from inpatient teams, the emergency department, and outside hospital transfers. Dedicated weekly afternoons pair residents with the PICU pharmacist, respiratory therapist, dietitian, and vascular access team, and each resident delivers at least one formal teaching session per week. The elective is two to four weeks, with a swing-shift option covering peak admission hours.
Prerequisite: PGY-3 Pediatrics or PGY-3/PGY-4 Medicine-Pediatrics.
Residents round daily with the PICU multidisciplinary team as active contributors to medication therapy decisions, typically following three to five patients each day. Under pharmacist preceptorship, residents identify and address adverse drug events and drug interactions and interpret biochemical, toxicologic, and microbiologic data to guide medication therapy.
A targeted POCUS curriculum for residents heading toward critical care or emergency medicine, with no clinical care responsibilities in the Peds ED during the block. Residents learn to recognize indications, acquire and interpret images, and fold POCUS findings into clinical decision-making, while critically appraising the modality's evidence base and limits. Each resident builds a portfolio of normal and abnormal studies and participates in POCUS quality review.
An elective designed around each resident's career goals, discussed with the educational manager roughly a month ahead, and built to maximize continuity clinic time. Residents present pre-clinic conference two to three times a week and complete a project in primary care or newborn/nursery care — a scholarly poster or case report, a pre-clinic conference, or new patient education material.
A dedicated block for building competence in the pediatric procedures ACGME expects graduating pediatricians to know. Residents develop proficiency in peripheral IV placement and venipuncture, and learn the indications, contraindications, and complications of arterial line placement, arterial puncture, chest tube placement, circumcision, intubation of non-neonates, and thoracentesis.
Residents work across ambulatory and inpatient settings on the evaluation and management of acute and chronic, congenital and acquired respiratory and sleep disorders. The rotation includes observing bronchoscopies and becoming comfortable with the physiologic concepts underlying pulmonary function and procedures.
Residents spend their days in the pediatric radiology reading room, reviewing PACS cases each morning and sitting in on attending–resident read-outs. The rotation carries a concrete exposure checklist — renal, appendix, intussusception, head, spine, pelvic, and hip ultrasound; MRI including sedated MRI; CT with contrast and CT angiography; and fluoroscopic upper GI and contrast enema studies.
Residents may receive elective credit for up to one block of protected research time. The time is intended for intensive stretches of a longer project, such as background literature review, data collection, or analysis.
Prerequisite: Available during PGY-2 and PGY-3; a research proposal must be submitted and approved in the preceding spring, and residents attend a required seminar.
Residents devote a meaningful portion of residency to teaching, and this elective provides focused training in the fundamentals of clinical teaching. Residents develop practical strategies for becoming more effective teachers while strengthening their own communication skills and knowledge.
Residents attend rheumatology clinics, cover consults and rounds with the on-call team between clinics, and join joint injection clinic twice a month. The rotation builds a specific skill set: performing a complete joint exam, constructing a differential for joint pain, and using laboratory and radiographic evaluation appropriately across juvenile idiopathic arthritis subtypes and connective tissue diseases.
Residents work in the Children's Procedural Sedation Unit alongside the hospitalist or pediatric emergency medicine attending covering the unit. Residents also work with a Child Life Specialist to learn non-pharmacologic pain and procedure management and age-appropriate ways to explain procedures to children. Continuity clinic and core conferences continue during the block.
Prerequisite: PGY-2 or above.
Duke's Special Infant Care Clinic is a NICU follow-up program that serves as a medical home for medically complex infants through their first two to three years, addressing medical and developmental needs together. Residents default to the outpatient experience but can arrange an inpatient block or a combination, with the schedule built around their educational goals.
A one- or two-week elective working with orthopedic attendings, physician assistants, and an orthopedic technician on team-based musculoskeletal care. The goal is focused on general pediatrics: recognize common orthopedic conditions of childhood, from developmental dysplasia of the hip onward, and know what can be managed non-operatively versus what needs urgent referral.
A PGY-2/PGY-3 elective in a large community level IV NICU designed for residents seeking substantial responsibility in neonatal care, particularly those considering neonatal-perinatal medicine. Residents manage extremely low birth weight infants, mechanical ventilation, and preoperative, postoperative, and convalescent care; perform neonatal procedures; and participate in delivery and resuscitation. The rotation also engages residents in ethical questions surrounding the limits of viability and limitation of care.
Residents serve as the primary caretakers for PICU patients at WakeMed, sharing responsibility with the attending for medical decision-making, orders, documentation, and family communication. Family-centered interdisciplinary rounds anchor the morning, followed by dedicated resident teaching. Co-management of surgical and trauma patients provides additional experience with a patient population that differs from many traditional pediatric ICU rotations.