Intern Year PGY-1
In the first year of residency the house officer has a stimulating educational experience that is centered on providing patient care to all levels of acuity, ranging from ambulatory care to the neonatal intensive care unit (NICU). First-year residents are responsible for admission histories, physical examinations, clinical decision making, inputting orders, and communicating with a multidisciplinary team of care providers. The development of these skills is done within the context of a supervising senior resident who serves as the primary manager of the wards team alongside hospitalists.
Interns spend one month on the inpatient cardiology service with patients that have a full range of clinical problems including but not limited to: simple to complex cardiac lesions, heart transplant recipients, hypertension, and rhythm disturbances. In addition, first year residents also rotate for on month on the inpatient oncology service that provides interns with exposure to the full range of oncologic conditions. First exposure to ICU level care is provided through a one-month rotation in the NICU, whose acuity level is among the highest in the country. Overall, the first year provides a strong foundation for patient care and leadership and prepares the intern for progression to the second year of residency.
The second year of pediatric residency provides the resident with the opportunity to consolidate his or her learning and to assume a greater role as supervisor and teacher of the interns and medical students. One of the highlights of the second year is the development of diagnostic and management skills through learning how to quickly assess and to stabilize patients who present to the emergency room and clinically deteriorating patients on the pediatric wards units. PGY-2 Residents gain further autonomy during this year in their roles as admitting residents, managing transfers from the pediatric intensive care unit (PICU) to the wards, direct admissions, and emergency department admissions.
Second-year residents spend one block rotation in the PICU. Our PICU has a 41-bed capacity and residents are supervised by pediatric critical care fellows and attendings. This rotation provides an extraordinary opportunity to manage a wide range of critically ill children and to learn with an emphasis on the pathophysiology of specific disease processes and management. Residents also further expand their NICU exposure with two month-long rotations during the second year.
By the third year, senior residents take a leadership role as supervisors and teachers. As supervisors, the senior residents refine their leadership as well as medical skills and have primary responsibility for the daily management of the patients on the wards, in the emergency department, and in the intensive care units.
As team leaders on the inpatient services, senior residents conduct daily patient care rounds with interns, sub-interns, and medical students. Each senior resident spends two to three months on inpatient ward rotations and is the primary decision-maker for patients on the service with appropriate attending supervision. Senior residents also rotate in the PICU and the pediatric emergency department; they serve as mentors and have a supervisory role for more junior trainees in both of these settings. Night call for senior residents varies from only weekend call to an average of every fourth night on call, depending on the rotation.
Residents consolidate their ambulatory training experience during their senior year. They have ongoing involvement in their ambulatory practices; they have the skills to pursue complicated patient problems and use the time to refine diagnostic and therapeutic interventions. They also assume leadership roles in the small group discussions in their practices, helping the faculty discuss educational and patient counseling topics.