A unique pediatric residency rotation focusing on patient advocacy has resulted in a closer working relationship between the Orange County Health Care Agency's Public Health Services and pediatric residents at Children's Hospital of Orange County.

Upon beginning my duties as Orange County health officer in August 2006, I began outreach efforts to organizations, including the Orange County Chapter of the American Academy of Pediatrics. During the AAP chapter meetings, I learned that CHOC had developed an advocacy rotation for pediatric residents, and I saw a tremendous opportunity to educate residents about the programs and services provided by Public Health Services.

Working with Daphne Wong, MD, director of the advocacy rotation, and with chief residents Anthony McCanta, MD, and Matthew Coulson, MD, we were quickly able to formulate a plan to incorporate two additional days of education and experience for the 19 CHOC residents. Previously, they participated in a one-week rotation with the county's Child Abuse Services Team, where they saw firsthand the issues and challenges associated with child abuse. The additional time provided by the expanded rotation helps them gain a greater appreciation of the multitude of variables that impact the health of children and families in Southern California.

The advocacy rotation allows residents to choose from a wide variety of experiences, including participating in home visits with public health nurses, which provides the residents with a better idea of the social and socioeconomic factors that impact children. Other opportunities include delivering health education programs at schools and observing restaurant inspections with environmental health specialists, where the residents learn more about food safety and the proper conditions in which food should be prepared. Residents can even explore seeking grants for community health initiatives or the role of the media in communicating information about public health issues like obesity or communicable disease prevention.

According to Dr. McCanta, the CHOC residents are benefiting from the increased exposure to areas not included in the typical pediatric residency. "Knowing more about public health resources will help our residents provide better care for their patients, now and in the future," Dr. McCanta says. "They are seeing firsthand how the medical profession and public health interact. Already this experience has helped them refer patients for services provided by public health, like the Women, Infants and Children nutrition program. Obesity is one of the greatest issues affecting children and families, and public health's commitment to the health of children in this vital area is very important."

Residents have also been exposed to school nursing and the key role of school nurses in the health of children and the community. "We spoke to a group of school nurses and came away amazed and respectful of the job that school nurses do," Dr. McCanta says. "There are many more kids who need care than there are school nurses, and our residents now have a greater appreciation for what they do."

CHOC residents also note the value of the original advocacy rotation in which they spend a week working with the Orange County Child Abuse Services Team. Dr. McCanta describes the experience as one of the more shocking aspects of the entire residency program. At the same time, he says the residents are awed at the resiliency of children who have been victims of child abuse.

Evaluations submitted by the first group of residents to complete the advocacy rotation have been overwhelmingly positive. The residents already have the ability to expand their experience in public health through the use of electives, but consideration may be given to increasing the amount of time in the advocacy rotation. From the public health perspective, there may be value in expanding the program to include time with other county service areas, such as additional social services programs or the jails, so that residents can broaden their community experience.

In addition, we in public health believe the benefits will far exceed the small investment in time. Already we have gained much by developing improved lines of communication with Children's Hospital of Orange County through the advocacy rotation and hope that programs like this will continue to build our relationships with other community healthcare providers.

Eric G. Handler, MD, MPH, is health officer for the Orange County Health Care Agency. His previous experience includes serving as the deputy secretary for Children's Medical Services in the Florida Department of Health and as chief medical officer for the Boston Regional Office of the Centers for Medicare and Medicaid Services. Dr. Handler received his medical degree from Chicago Medical School and completed his pediatrics training at LAC+USC Medical Center. He can be reached at ehandler@ochca.com.