Residency Training Program in General Pediatrics

The ambulatory experience for trainees in the Downstate program is excellent and enjoyed by all who participate. The general pediatric, acute care and specialty experiences represent a natural extension of the inpatient training, but more than that it provides the future pediatrician with a window into the realities of Pediatric practice and invaluable experience to last a lifetime.

Ambulatory Care and Services at Downstate (University Hospital and Kings County Hospital)

An incredibly broad range of outpatient services are provided by the SUNY Downstate Department of Pediatrics at the Children's Hospital at Downstate and at Kings County Hospital. These services are available to the residents as training experiences in pediatrics. Attending practice sites as well as hospital based clinics are utilized. In addition to several general pediatric practices and clinics providing both routine and acute pediatric care, outpatient services include subspecialty clinics in every major pediatric specialty and subspecialty discipline. These specialty clinics are conducted by the respective specialty divisions and are supervised by appropriate specialty attending faculty. Specialty clinics provide ongoing ambulatory care for children with chronic illnesses as well as consultative evaluations and follow-up. Many specialty diagnostic procedures are performed or arranged through the specialty clinics.

When pediatric residents in this program rotate as a member of a subspecialty service during required, selective and elective experiences, they participate in all the division's functions including all clinics, clinically oriented case conferences and research activities. In addition to specialty block rotations, two week and one month block rotations in pediatric ambulatory care afford the resident opportunities to participate in a variety of general, acute care and subspecialty clinics. Residents on block ambulatory care rotations can choose from a variety of outpatient activities occurring each weekday morning and each afternoon and thereby customize the experience to their own interests and needs.

The tremendous volume and diversity of patients using our facilities for primary care make the general pediatric outpatient services an outstanding educational resource. The experience with the pediatric subspecialty ambulatory services is exceptional because of the superb faculty role models and the wealth of clinical material referred from throughout the area as well as from other parts of the U.S. and overseas. Various subspecialty outpatient services are offered in gastroenterology and nutrition, nephrology, neonatology and developmental disorders, respiratory diseases, hematology, oncology, endocrinology, genetics, allergy and immunology, neurology, AIDS and infectious diseases, adolescent medicine, sexual abuse, dermatology and others including numerous pediatric surgical and surgical subspecialties clinics.

Ambulatory Care at Long Island College Hospital

During their LICH rotations, residents may be assigned to the LICH outpatient division. The rotation at Long Island College Hospital is supervised by the Director of Ambulatory Services and a bevy of general pediatricians who take great pride in their roles as teachers. The goal of this rotation is for residents to have experiences which help develop sklls needed by the general pediatrician in the ambulatory setting. The outpatient division provides well child and high risk infant clinics, walk-in urgent care and, based at LICH and at a number of satellite offices, subspecialty clinics such as allergy, adolescent medicine (including high school health), cardiology, dermatology, gastroenterology, hematology, nephrology, pulmonology and a variety of surgical specialties such as ENT, Ophthalmology, Ped General Surgery, and Orthopedics. Utilizing the offices of practicing pediatricians as well as hospital physician staffed practices and clinics, a wide variety of general pediatric and specialty ambulatory experiences are available. Also, residents may be assigned sessions or entire block rotations in private pediatrician practices in order to appreciate the mechanics of providing care in and managing a private pediatric practice. Throughout all these ambulatory experiences, residents remain integrally involved in the full program of didactic activities provided at LICH throughout the month.

Pediatric Ambulatory Continuity Practice Experience

One afternoon each week, residents have the exciting opportunity to establish their own mini-pediatric practice in one of several unique ambulatory care sites: University Hospital of Brooklyn, Kings County Hospital Center, Long Island College Hospital, private practices of faculty or community physicians or at public family health stations.

Each of these sites has its own special ambiance, but over three years all of them enable residents to develop a practice with their own cadre of patients. Patients are drawn from the term nurseries, acute care services and in-patient wards providing the resident with a true longitudinal continuity of care experience. Patients are also picked up as new referrals to be followed by the resident over the course of the resident's program. A record of the resident's experiences in the clinic is logged. Emphasis is placed on well child care, growth and development, nutrition, screening, anticipatory guidance, immunizations, safety and preventive care, as well as management of chronic illness. Structured Clinical Observations of the resident's performance are conducted to provide the resident feedback and document the resident's developing competence. Residents are initially closely supervised by the faculty and are given progressively greater autonomy and responsibility with demonstrated acquisition of clinical competency. The experience of being the primary care pediatrician for a well child or a child with a special medical or developmental or social problem over a period of time is essential.

Each practice site is staffed by full time board-certified pediatric attending faculty who provide supervision, guidance, consultation, and serve as role models. The attending faculty lead the residents as part of a team of providers caring for the patients. Residents are provided personal business cards that they are expected to distribute to their patients' parents so that the resident can be identified as the child's primary care provider. Ambulatory care oriented clinical conferences and journal clubs, which are either topic or case oriented, are held daily at each major clinic site and allow the resident to participate in informal group discussions and to develop presentation skills.