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Training Summary In a three-year program, we aim to provide every resident with a broad and deep foundation in general pediatrics, thereby preparing him or her for independent primary care practice or entry into any pediatric subspecialty they choose. The residency training program at the SUNY Downstate is structured so that residents acquire greater degrees of responsibility as their knowledge and ability in pediatrics increases. Our goal is to provide all residents with a very solid and broad foundation in pediatrics so that they have the information, understanding, clinical experience and skills to pursue careers in pediatric practice, pediatric subspecialties, or academic pediatrics. The basis for the educational experience is in the extensive clinical experience with diverse patient populations, direct patient contact and management of many common and not so common disease states encountered at our facilities. Residents see, diagnose and directly manage a tremendous breadth of pathologic conditions. Clinical learning occurs during bedside teaching and is supplemented with a series of didactic conferences, rounds and both formal and informal consultations with readily available experts in the many areas of pediatric care. Extensive and particular attention is given to the humanistic, social and ethical aspects of pediatric practice, as well as to the acquisition of academic knowledge, the intellectual challenges of pediatrics and to an understanding of the medico-legal and practical aspects of medical practice. Residents are given a progressively increasing level of responsibility for managing their patients and supervising more junior staff on the various inpatient, outpatient, newborn and intensive care services. The increase in responsibility is commensurate with their increase in knowledge and demonstrated performance. We strongly encourage intellectual curiosity, inquiry, and research for those interested and motivated. The academic year consists of twelve one month rotations. Elective extramural, research and overseas experiences can be arranged. Residents receive four weeks annual vacation leave. Training Description The PL-1 Year — 1-2 months of ambulatory pediatrics - OPD or ER — 1-2 months of neonatal ICU — 5-6 months junior resident - pediatrics inpatient (incl. 1 month overnight coverage) — 1 month of behavioral/developmental pediatrics — 0-1 month selective subspecialty — 1-2 months term baby nursery — 1 month vacation During the first year of the residency (PLI), a basic foundation of knowledge in pediatrics is acquired. Under supervision, house staff have direct responsibility for the care patients, including the initial history and physical, progress notes, all procedures, diagnostic information, all orders and communication with parents. Residents learn the characteristics of normal growth, development, health maintenance, anticipatory guidance as well as variations of normal. With a broad experience in inpatient and outpatient pediatrics and neonatology, house staff learn the characteristics and management of the more common illnesses encountered in neonates, infants, children and adolescents. In addition, first year residents directly supervise third year medical students assigned to them. During this year's experiences residents will realize many of the joys and challenges of contemporary pediatrics. The PL-2 Year — 2 months of ambulatory pediatrics - OPD or ER — 1-2 months junior resident in pediatric ICU — 1-2 months senior resident in neonatal ICU — 2-3 months supervising senior resident inpatient units (including up to 1 month as overnight senior) — 2-3 months of selective subspecialties or electives — 1 month at Memorial Sloan-Kettering Cancer Institute — 1 month vacation During the second year of training, residents have greater exposure to pediatric subspecialties. They learn the pathophysiology and management of the more complex conditions encountered in pediatrics. In addition, residents learn to understand and manage multiple system disease and more serious, life-threatening conditions. With this advancement in knowledge and demonstrated clinical competence, residents are given greater supervisory responsibilities as seniors over first year residents, function as admitting resident in the E.R., and rotate as night float. The PL-3 year — 2 months of ambulatory pediatrics - OPD or ER — 2-3 months supervising senior resident on inpatient units (including 1 as overnight senior) — 1 month of adolescent medicine — 0-1 month senior resident in pediatric ICU — 0-1 month of neonatal ICU — 4-5 months of selective subspecialties — 0-1 month elective (research, extramural, self-defined) — 1 month vacation The third year of training is one in which the pediatric experience is rounded out. Third year residents rotate with additional subspecialty services and expound on subjects briefly considered before. During this year residents improve and refine their clinical skills and judgment. Third year residents assume a still greater supervisory role. With their greater fund of knowledge they are expected to be educators of other residents, medical students, and ancillary personnel. Having formed a very solid foundation in general pediatrics, residents can now pursue their postgraduate plans with the assistance and advise of the chairman, program director and faculty mentors. The PL-4 Year (Chief Residency) (4 Chief Residents at the Downstate campus + 1 at Staten Island and 1 at Lenox Hill full time) — 3 months KCHC Inpatient — 3 months UHB Inpatient and Outpatient — 3 months KCHC Critical Care (and ER) — 3 months Residency Administration — 1 month vacation Fourth year positions as chief resident are offered to select members of the senior house staff who have demonstrated the greatest clinical competence, teaching skills, knowledge, and leadership potential. Residents who are offered this opportunity and elect to stay the additional year assume the role of supervisors, administrators and especially educators for all the house staff and medical students. Evaluation Evaluation of residents is multifaceted. The attending staff and chief residents are expected to give prompt oral formative feedback to the residents. In addition, midway through each rotation, the resident is expected to receive an informal oral appraisal of his/her performance from the supervising attending. The formal evaluation process consists of a written summative evaluation form completed by the supervising attending at the conclusion of every monthly rotation. These evaluations are discussed with the resident by the attending. The program director reviews the evaluations and discusses them with the residents semiannually. In addition, residents are expected to review all evaluations in their record and acknowledge their review by initialing the evaluations. Monthly meetings of the House Staff Affairs Committee are used to review resident performance in a forum consisting of attending faculty, chief residents, the program director and/or chairman. Residents are required to take an annual in-training examination in pediatrics. The exam is distributed and administered by the ABP. The in-training exam is a resident self-assessment tool to assess progress over the course of the program. Supervising physicians perform evaluation of procedural skills. The supervising physician (attending or senior resident of subspecialty fellow who has previously been privileged in the procedure) only complete the privileging form is the procedure is performed successfully and satisfactorily. The assessment includes discussing risks and benefits, record documentation and manual skills. Informal evaluations occur spontaneously as needed. Formal written evaluations and House Staff Affairs Committee meetings occur monthly. The in-training exam is given annually in early July. Evaluations and in-training exam results are reviewed with residents by the program director, associate program director, or vice-chairman semiannually in the Fall and in the Spring of each year. The Pediatrics Residency program will be transitioning from a paper based evaluation system to a web-based evaluation tool utilization the WebEspRIT residency management system. The new evaluations are competency based and will allow the evaluator to identify the methods used for evaluating each of the six core competencies. Automated email reminders will notify faculty of delinquent evaluations. Misdirected evaluations will be easily redirected to appropriate evaluators. Faculty will complete the evaluations and residents will be able to review evaluations on-line via the web. The training program is evaluated at faculty meetings, CEPI meetings, through the CQI process and written evaluation by resident staff. The anonymous written evaluation forms assess the rotation experience, location and supervising attending faculty. There are quarterly meetings held separately for first year residents and for second and third year residents with selected faculty to discuss issues regarding resident’s experiences and concerns. A written report of these meetings is distributed to the chairman, program director and directors of service. Residents are organized with 3-4 representatives from each training year forming a Resident’s Action Group. The purpose of this group is to identify problems in a timely manner and recommend solutions to the Program Director in order to optimize the educational training environment and enhance resident-faculty-administration communication. Also, during the residents’ semiannual evaluation meetings, residents are asked to provide a oral evaluation of the program, its training effectiveness and how well the trainee is meeting his/her personal learning objectives. A resident mentoring program exists. It is expected that residents will feel comfortable with their mentors and give honest feedback to them about the training program and the faculty. Teaching effectiveness of the staff is evaluated by senior faculty and by residents’ written evaluation. Discussions with chief residents, who act as the liaisons for the resident staff, also provide feedback on faculty performance. The annual in-training examination and board certification examination reports provide a summary of subject areas and resident performance in those disciplines and is used to assess faculty teaching effectiveness. Finally, departmental faculty retreats are held every 2 to 3 years. These retreats serve to focus attention on the department’s role and methods in advancing education, research and clinical practice. Periodically, the department holds pediatric and medicine/pediatrics resident’s retreat. The purpose of this retreat is for the residents to independently assess the program with regard to education, training, socialization, development, administration, etc.. The residents identify their own issues and recommend necessary solutions. On Call Schedules and Responsibilities All residents on all rotations are assigned on-call responsibilities. The on-call schedule for all residents conforms to the New York State Health Code - Section 405 hours limitation regulations. At KCHC and UHB residents on inpatient services have short calls, approximately every 4th day, only until 10:00 p.m. and then sign-out to a night shift resident who covers the unit until the morning. The night shift system functions from Sunday through Thursday night. On Fridays and Saturdays, there is no float coverage and calls are overnight. Each PLI and PLIII resident spends one month each year as a night shift resident, and PLII residents generally serve no more than 2 weeks as night shift. Infrequently, second and third year residents who function as junior residents or those rotating at SIUH have call every fourth night, overnight. Residents in the NICU do 12 hour and 24 hours shifts. Residents on pediatric emergency department rotations are generally assigned 15 to17 12 hour shifts per month (occassionally shifts are 10 hours) with a minimum of 12 hours off separating each shift. Approximately 7 to 8 shifts are overnight with the rest being daytime or afternoon to evening. Residents assigned to Urgent Care coverage are on call until only 8 or 10 p.m. On elective rotations, resident call schedules are often very light with very short calls in Urgent Care or only a few PICU calls or inpatient calls. When residents are assigned rotations on night shift they are not a night float. The residents’ experiences during night shift are meant to remain identical to those experienced by day time residents. Night shift residents are supervised in the same manner as residents on inpatient units during daytime. Attending faculty provide general supervision – they are immediately available by phone and in person within 20-30 minutes. Pediatricians (in the ER) and neonatologists (in NICU) are available in the hospital as needed 24 hours a day 7 days a week. In addition, a PL4 chief resident is always available either in hospital, immediately by phone or in-person within 15-20 minutes. A PL3 resident is always present as a senior supervising resident in hospital. Residents on night shift rotations participate in daily work rounds, scheduled conferences (Resident Education Conference, Grand Rounds, Patient Management Conference, Radiology Conference, Morbidity and Mortality Conference, Journal Club), daily morning report, daily attending rounds. Night shift residents are also asked to see their continuity clinic patients during an abbreviated early session. Residents must be provided with protected time off without clinical responsibilities (minimum 8 hours between shifts and a minimum of one 24 hour block per week). As a result all residents receive at least one weekend day (24 hours) off duty every week. On occasion, usually at the request of the resident or in order to comply with 405 requirements, a weekday may be substituted for a weekend day off if it will not interfere with educational and continuity clinic activities. Quarterly surveys of resident’s hours serve to monitor compliance with hours limitations, supervision and time off requirements.
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