First Year Residency

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 time is spent on the inpatient services: there are two general medicine teams with a mix of patient ages and conditions. The attending staff are members of the general pediatrics faculty group practice, with several hospitalists providing leadership. The attendings are available seven days a week. Patient care rounds are Family-Centered Rounds four days per week; formal attending teaching rounds are also held three times per week. The first-year resident is responsible for the initial workup of 25 to 40 new patients each month; interns take the history and perform the physical examination, make clinical decisions, write orders, and communicate with parents. All interns participate in the teaching of medical students.

In addition to the ambulatory and adolescent medicine block rotations described above, the interns have a block rotation in the well-baby nursery that emphasizes common newborn problems, delivery room skills, and the counseling of mothers of healthy newborns. All interns also spend six weeks in the Pediatric Emergency Department caring for children with everything from common colds to life-threatening emergencies. Our Pediatric Emergency Department is staffed by pediatric emergency room attending faculty 24 hours a day and is one of the busiest of all voluntary hospitals in New York City, providing an exposure to a rich variety of medical and surgical disorders.

The Neonatal Intensive Care Unit is staffed by interns and second-year residents, house physicians, nurse practitioners, fellows, and attendings. The level of acuity and complexity is among the highest in the country. Working in this environment is stimulating, educational, and rewarding. Interns spend one four-week block rotation there, during which they are well supported by their colleagues and other providers.

Interns spend one month on the inpatient cardiology service. There is a nurse practitioner and a cardiology hospitalist who manage the service and provide support for the interns. In addition, the Director of the Inpatient Cardiology Service provides clinical support and decision making, and has regular teaching rounds for the residents. Patients on this service have a full range of clinical problems--both simple to complex cardiac lesions, heart transplant recipients, hypertension, rhythm disturbances, etc.

The oncology service, as a blended team with interns and nurse practitioners, provides the interns with exposure to the full range of oncologic conditions in childhood during this block rotation.

Night call is an average of every fourth night during the ward, oncology, and cardiology months. The program is in full compliance with the guidelines of the New York State Bell Commission Law and federal work-hour regulations. Residents are excused promptly from clinical responsibilities the morning following a call night. The on-call schedule and coverage system is designed so that interns can practice in an environment that supports and encourages personal accountability and responsibility.

Second Year Residency

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, for example 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 highlights of the second year is the development of diagnostic and management skills by learning how to quickly assess and to stabilize patients who present to the emergency room.

Second year residents spend one block rotation in the Pediatric Intensive Care Unit. Our PICU has a 41-bed capacity, and is comprised of 2 medical-surgical PICU's and one Cardiac ICU. Second year residents work with third year residents, house physicians, and nurse practitioners, and 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.

Second year residents have two block rotations in the Neonatal ICU, with increased responsibility and the opportunity to help supervise and act as resources to the interns.

The ambulatory experience in the second year consists of continuity clinic at the same site and with the same preceptor, and another ambulatory block rotation. Residents find their experience tremendously satisfying, with the establishment and maintenance of enduring relationships with children and their families. The breadth of their knowledge and skills in ambulatory care is significantly augmented by the block rotation in Behavioral-Developmental pediatrics. On this and the neurology service rotation in this year, second year residents have dual roles as trainees and consultants.

Three blocks of elective time are provided in the second year of training. Residents have the opportunity to develop 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.

Third Year Residency

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, subinterns, 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 Pediatric ICU 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 a leadership role in the small group discussions in their practices, helping the faculty discuss educational and patient counseling topics.

Senior residents have ample opportunity to practice teaching skills. They review the literature pertinent to the patients' problems and present at Intake Rounds to other housestaff and students. Access to computerized literature search programs is available to all residents throughout the hospital. The seniors teach during patient care rounds on the inpatient services. In addition, every senior resident is required to present a formal Chief of Service for the Department. In their mentoring role, 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. Senior residents have at least four months of elective time.