Welcome! We are delighted that you are interested in our program and hope you will be able to use this day to become acquainted with the strengths of the Pediatric Residency Program at Morgan Stanley Children's Hospital. There will be a lot of information offered and because the time is limited we are providing this overview. Important elements to focus on include our housestaff, our patient population, the attending staff, and the depth in both primary and tertiary care at this hospital.

Housestaff. The housestaff is the foundation of this program. Our housestaff consist of individuals of diverse backgrounds and have broad future interests. We recruit housestaff from New York City and from as far as Germany. The concerns of the housestaff are solicited and taken seriously. The residents rely on one another completely, and therefore form a bond that extends beyond the walls of the hospital.

Patient population. The community surrounding the Columbia-Presbyterian Center campus is largely composed of recent immigrants of Dominican descent. Because of a relative paucity of other health care resources, the parents form very close relationships with the housestaff for medical care for both their healthy and sick children. Housestaff are given the privilege of caring for chronically ill children with complicated medical problems; this opportunity for primary care responsibility for such patients does not exist in all practice settings/residency programs.

Faculty. We are fortunate to have members who are highly dedicated to the housestaff and housestaff teaching. Faculty support is strong with academically focused general pediatricians and subspecialty pediatricians who are interested in helping housestaff manage ill patients.

The Department of Pediatrics is organized into thirty-five sections and divisions. All are actively engaged in research and dedicated to excellence in patient care and teaching. There are over 175 faculty members at Children's Hospital who are closely involved with the teaching program. Research productivity continues to expand. The Department of Pediatrics continues among the top ten pediatric departments in attracting research funds from federal agencies. In addition, there is constant funding from private foundations. The faculty produces over 200 papers per year.

Primary care. The Morgan Stanley Children's Hospital is extremely fortunate to have a large pediatric group practice that actively sees patients and participates in both inpatient and outpatient resident education. The group practice provides the focus for our very solid primary care training program.

Every resident attends a continuity clinic run by a single faculty member whose afternoon is dedicated to the clinic. The faculty member provides a didactic conference at the onset of the afternoon as well as providing the opportunity to discuss each patient individually with the resident. On an alternate week basis, a developmental pediatric specialist also attends the clinic, providing insights into normal and abnormal child development on an individual and group basis. A close working relationship with the Child Psychiatry Liaison Service promotes an appreciation of the interrelationships of somatic disease and its psychosocial and ethical consequences.

Emergency room. Our ER is staffed by attending physicians from the emergency department staff and the pediatric group practice 24 hours a day. There are 35,000 visits each year to the emergency room, and 52,000 visits to our ambulatory clinics.

Subspecialty services. The Children's Hospital provides the best of two worlds: a children's hospital in an academic health center with the complete range of pediatric services in significant depth including a full range of pediatric surgery and radiology services. There is close affiliation with New York Presbyterian Hospital providing outstanding consultations for conditions uncommon in the pediatric population, but more familiar to the internists. Children's Hospital has outstanding subspecialty services in pediatric cardiology, gastroenterology, neurology, and the neonatal services.

We realize that today may provide too brief an exposure to the many aspects of our program. If you would like to spend more time informally with us, we encourage you to return for a second visit. You may either speak with Ms. Deborah Goins at the time of your departure today, or call at a later date, at (212) 305-8504.

Elizabeth A. Wedemeyer, M.D.
Director, Pediatrics Residency Program
Medical Director 4 Tower/5 South

First Year

Interns are selected through the National Resident Matching Program (NRMP). In the first year of residency the house officer experiences intense clinical exposure and is directly responsible for his or her own patients. The majority of the time is spent on the inpatient services: There are two teams with a mix of patient ages and conditions. The attending staff on the wards are members of the faculty group practice, community pediatricians, and subspecialty staff. Attending on the inpatient service is considered an honor, and the attendings are dedicated to education and the highest quality of patient care. The attendings are available seven days a week; formal attending teaching rounds are held four to five days a week. The first-year resident is responsible for the initial workup of 25 to 40 new patients each month; interns perform the history and physical examination, make clinical decisions, write orders, and communicate with parents. There are also rotations through the well-baby nursery, cardiology, and ambulatory pediatrics. All interns participate in the teaching of medical students.

All first-year residents have four weeks of an ambulatory pediatrics block rotation. The first-year residents have a continuity session one afternoon each week. Attendance is mandatory, and other residents cover the inpatient responsibilities of the intern during this time. The afternoon sessions begin with didactic intakes by the clinic attending, followed by patient care. The interns develop a panel of patients for whom they are the primary health care providers throughout three years of residency. In addition, the interns have a block rotation of ambulatory adolescent medicine and a well-baby rotation that emphasizes common newborn problems, delivery room skills, and the counseling of mothers of healthy newborns.

Interns spend one or two block rotations in the Neonatal Intensive Care Unit.

Night call is every fourth night, except during the ambulatory and emergency room rotations. The program is designed to be in compliance with the guidelines of the New York State Bell Commission Law, so residents are excused from clinical responsibilities the morning following a call night. The on-call schedule and the availability of residents, subspecialty fellows, and attending physicians enable the first-year resident to continue to meet the goals of the program in a milieu that provides both accountability and responsibility.

Second Year Current

 

The second year of pediatric residency provides the resident the opportunity to consolidate his or her learning and to assume a greater role as supervisor and teacher of the interns and medical students. In this year, there is more time to pursue the academic aspects of pediatrics, through participation in morning Intake Rounds geared directly to the junior and senior residents. Each second-year resident spends one month as the teaching resident on the ward services; the second-year resident also takes night call as the supervising resident. One of the strong points of the second year is that residents develop their diagnostic and management skills by learning how to quickly assess and to stabilize patients who present to the emergency room. The Pediatric Emergency Room at The Children's Hospital of New York is one of the busiest of all volunteer hospitals in New York City, providing an exposure to a rich variety of medical and surgical disorders.

Exposure to subspecialty areas of child development, neurology and pediatric intensive care occurs during the second year. On these services, the residents have dual roles as trainees and consultants. In addition, two blocks of elective time are provided. Residents are afforded the chance to formulate clinical research projects, and to participate as consulting residents for the subspecialty services. Elective time provides an opportunity to read in areas of special interest and to prepare for the increased teaching and supervisory responsibility of the senior year.

Continuity sessions are full days during the second year, in addition to an ambulatory block rotation. The ambulatory experience during this year is tremendously satisfying with the establishment of strong relationships with children and their families. In the second year, residents participate in a formal rotation in community health that is expanded to a four-week rotation the following year.

Third Year

 

By the third year, the senior residents are major resources as supervisors and teachers in the training program. As supervisors, the senior residents refine leadership as well as medical skills and have primary responsibility for the daily management of the patients on the wards, in the emergency room, and in the intensive care units.

As teachers, the senior residents conduct daily rounds in patient care for interns, subinterns and medical students. The senior residents also review the literature pertinent for the patients' problems and presents at Intake Rounds and to other house officers and students. Access to a computerized biographical search program is available to all residents at computer terminals throughout the hospital. The senior residents are expected to be sensitive to the problems and pressures facing the residents on their service and to provide support and guidance whenever appropriate.

Two senior residents, or one junior and one senior resident, are assigned to each ward service each month. One resident is designated as the Supervising Resident, the other is the Teaching Resident. The two residents complement each other and ensure the smooth functioning of the ward service. Each senior resident spends two or three months on ward rotations.

Other rotations during the third year include supervisory roles in the Pediatric Intensive Care Unit and the the Emergency Room. There are four months of electives in the senior year. Night call varies from every fourth to every sixth night. (Every fourth night in the pediatric intensive care unit and on the ward services; weekend emergency room call or every fifth night PICU call while on elective.)

Residents consolidate their ambulatory training experience during their senior year. They have ongoing involvement in their ambulatory practices with full-day weekly continuity sessions; they have the skills to pursue complicated patient problems and use the time to refine diagnostic and therapeutic interventions. They also assume a leadership role in the small group discussions in their practices, helping the faculty discuss educational and patient counseling topics.

Basic and clinical research on diseases of children are a critical part of the overall mission of the Department of Pediatrics and Babies & Children's Hospital. The Department is ranked 8th in overall research funding among pediatric departments in the country; the training of future investigators who will pursue academic careers in clinical or basic research on pediatric diseases also has a very high priority. There are several programs and activities that are relevant. Resident applicants who are interested in pursuing an academic career should identify themselves during the application process. For such individuals, we will arrange special meetings with relevant faculty on the interview day.

Residents are afforded the opportunity to pursue basic science research and clinical investigation at Babies & Children's Hospital. These experiences are designed to allow residents to explore their interest in investigative careers and to select among the many available possibilities in basic and clinical research. Options for research experiences range from intensive, structured elective experiences to flexibility in the residency training schedule to permit early incorporation of research activities into the resident's training program. The elective experiences include exposure to ongoing clinical or basic research projects combined with relevant didactic experiences and work with a faculty mentor. One new elective combines specific educational sessions focusing on statistical and epidemiologic methods with members of the medical school's General Clinical Research Center and development of a research project. (This elective is sponsored by two faculty from the Neonatal and the Infectious Disease Divisions). The residency director should be contacted for additional information.

Residents are also encouraged, their responsibilities permitting, to attend lectures and seminars in the University and especially to participate in the Junior Faculty Research Seminar organized by the Child Health Research Center. They are also welcome to attend the Journal Club/Laboratory Meetings in specific laboratories in any department they choose.

In addition, the ability to pursue the Special Alternative Pathway through the American Board of Pediatrics is supported and encouraged by the Department of Pediatrics. Individuals who have experience in laboratory investigation (particularly, but not limited to, M.D., Ph.D. students) and those who plan academic careers in one of the subspecialties with a major emphasis on laboratory research may shorten their residency training time in a flexible, integrated program that combines both clinical and research work while fulfilling the requirements for eligibility for the Pediatric and subspecialty boards. Residents interested in this pathway, and any resident with a MD, Ph.D., or clear interest in a research career in academic pediatrics, should contact Dr. Robert Winchester, the director of the Child Health Research Center, or Dr. John Driscoll, Jr., the principal investigator, for additional information and advice.

Another opportunity for qualified pediatric residents is the Pediatric Scientist Development Program of the Association of Medical School Pediatric Department Chairpersons (AMSPDC). The program provides research training and career development for pediatric residents in academic medicine. It offers an intense, full time experience in basic science research in eminent research laboratories. Two to three years of research training is funded by the Program. At the moment we have one trainee enrolled in the program working in the laboratory of Dr. Rudy Leibel. Information is available through the Chairman's office.

Perhaps the major opportunity for research career development in the Department is the Child Health Research Center (CHRC). The CHRC is aimed at fostering the research careers of residents, fellows and junior faculty in the study of diseases of children. It seeks to equip an individual with the necessary research skills to allow them to successfully compete for faculty positions in academic pediatrics. The CHRC at Columbia University has been established with a grant from the National Institutes of Health to foster development of the young physician scientist in a multidisciplinary program of excellence in pediatric research using all the resources at Columbia. The CHRC at Columbia University has several career guidance activities focused on residents. In addition, the Center provides salary support for one or more years of research training after the clinical portion of fellowship training. As part of this effort, over 40 faculty members from departments throughout the medical center, all with demonstrated ability in research ability and track records as mentors, have been identified to act as potential mentors. The mentors are organized into four main groups according to research themes: Genetics: The identification of susceptibility to develop a disease with a particular alternative gene form. Regulation of gene expression and identification of signal transduction pathways involved in cellular growth, proliferation and differentiation. Organogenesis and development, reflecting the action of these antecedent properties of expression. Mechanisms of tissue response to injury including inflammation and specific immunity. Collectively, the program faculty have the research experience and fundamental technologies that can address a wide range of pediatric diseases and their therapy at basic and/or clinical levels. These diseases include: growth and mental retardation and related disorders, genetic and metabolic disorders, autoimmune and other inflammatory disorders, diseases resulting from environmental factors such as toxic substances, infections and nutrition. The CHCR also assists applicants in applying for various other career developing fellowships and awards available from the National Institutes of Health that permit a person interested in a research-based career to obtain all of the necessary support through acquisition of junior faculty status.