A major focus of the program is care of the child and adolescent in the outpatient setting. In addition to the Continuity Clinic experience, there are 28 weeks of general ambulatory care and emergency room experience during the three-year residency. There is a four-week-long rotation in Endocrinology in the first year and an Adolescent Medicine rotation of four weeks occurs in the second year. The management of the acutely ill child, minor musculoskeletal trauma, and suturing technique is the focus of the rotations in the Emergency Center.
Separate rotations on Neonatal Intensive Care and on the Term Nursery Service allow the attention of the resident to be focused on the problems of the acutely ill neonate at one time and on the more common problems of the normal newborn at another. The pathophysiologic basis for the management of neonatal problems is the focus of faculty attending neonatologists and resuscitation of the newborn is particularly emphasized. In addition to daily rounds and faculty lectures, there is a weekly discharge planning conference and a Perinatal Mortality Conference is held monthly.
Required subspecialty rotations over the three years include Gastroenterology, Pulmonology, Cardiology, Endocrinology, Nephrology, and Neurology, each preparing the resident to individually manage common subspecialty problems and prepare him or her to participate as a member of a multidisciplinary team in the care of complex subspecialty patients. Subspecialty rotations cover both inpatient admissions and outpatient patient visits.
The Ambulatory Care rotations operates out of the Robert B. Green facility, our new 6-story state of the art clinic building providing the resident with an opportunity to experience general and subspecialty outpatient pediatric care with on-site, readily available, full-time faculty for consultation/teaching. The resident's Continuity Clinic also at the Robert B. Green facility provides the core of this rotation. Each resident has the opportunity to follow patients that he/she has recruited from the Term Nursery, other rotations and the Walk-In Clinic, to provide ongoing well-child care, care for children with chronic illness or recurring problems, and care for children with acute illness. The resident attends his/her Continuity Clinic in this one facility, one-half day a week throughout the three-year residency, allowing the opportunity to observe each child through a two- or three-year period of growth and development.
There are over 20 weeks of elective time, in the PL-2 and PL-3 years. These elective rotations are part of the resident’s Individualized Resident Track and are based upon the resident’s interest in general outpatient, hospitalist or subspecialty practice and include opportunities for off-campus or individually crafted electives as well as core options to prepare residents for their next career step.
Call varies by rotation but averages one call every fifth night at most with some rotations having night float call no more frequent than 5 nights in a row (interns) or 4 nights in a row (upper levels). The residency program is fully compliance with all ACGME Resident Duty Hour Regulations.
Responsibility for patient care and teaching is increased from year to year. Instruction of medical students is considered a part of the resident’s responsibilities at all levels. The PL-1 is the patient's primary physician. The senior residents supervise the care provided by PL-1s. Residents are provided a variety of development opportunities to acquire and enhance teaching skills particularly at transitions in roles.
Regularly scheduled didactic conferences emphasizing active learning are central to the residency experience. On inpatient services the workday begins with morning report during which the previous night's admissions are discussed with faculty and house staff. A protected block of didactics is offered every Friday to cover core curriculum of relevant general and subspecialty topics as they relate to the acute or hospital based care of patients. In addition, a twice weekly led curriculum based on nationally vetted lectures is provided to those residents on night float to ensure they are exposed to content. There are separate faculty lecture series for the critical care units and small group seminars during each subspecialty month. Department wide grand rounds is held weekly. On the inpatient ward services and Hospital Hematology-Oncology rotation at the University Hospital, formal daily faculty attending rounds emphasize teaching of the residents.
The Division of General Pediatrics presents a comprehensive general pediatric curriculum as part of the resident's Continuity Clinic experience. This curriculum, 108 seminar hours, covers the entire range of general pediatric and acute care management issues. In addition residents cover the Bright Futures curriculum and do many of the on-line Johns Hopkins cases. Specialized curriculum in substance abuse preventions strategies is also taught. An interactive advocacy curriculum also spans all three years and includes site visits to a number of community based locations that serve our most vulnerable patients.
Reliance on evidence based medicine is emphasized throughout the residency including longitudinal curriculum in addition to robust interactive PGY 3 lead Journal Clubs happening monthly.
The program encourages residents to develop their clinical skills and professional interests to the greatest extent possible. We provide active support for individuals entering general pediatric practice and those seeking subspecialty fellowship training. Over the past fifteen years, upon completion of training, 60% of the graduates of the program have entered Primary Care General Pediatrics, securing positions throughout the country. The remaining 40% have secured fellowship training across the country in a variety of disciplines including: Adolescent Medicine, Allergy and Immunology, Anesthesia, Child Development, Cardiology, Critical Care, Dermatology, Endocrinology, General Academic Pediatrics, Hematology/Oncology, Infectious Disease, Neonatology, Neurology, Pulmonology, Rheumatology, and Sports Medicine.