Residency Training Program in General Pediatrics

The Training Experience

The aim of the residency program at SUNY Downstate Medical Center is to provide every resident with a broad and deep foundation in and understanding of general pediatrics, thereby preparing the resident for primary care practice or entry into any pediatric subspecialty. Our residency training program at the SUNY Downstate is structured so that residents acquire greater degrees of responsibility as their competence, knowledge and ability in pediatrics increases. Our goal is for all residents to become fully competent pediatricians and develop a very solid and broad foundation in pediatrics so that they are well prepared with the knowledge, understanding, clinical experience and skills for careers in pediatric practice, subspecialties or academic medicine. The basis for the educational experience is the extensive clinical interaction with diverse patient populations, direct patient care and management of many common and not so common disease states encountered at our hospitals. under the supervision of dedicated faculty. Residents diagnose and directly manage a tremendous breadth of pathologic conditions. Clinical learning occurs at the bedside and during rounds with attending faculty, consultants and other healthcare providers. It is supplemented with a structured educational program including a series of didactic conferences as well as subspecialty consultations with readily available experts in the many areas of pediatric care. Emphasis is given to the humanistic, psychosocial and ethical aspects of pediatric care, 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 residents on the various inpatient, outpatient, newborn and the intensive care services. We strongly encourage and foster intellectual curiosity, inquiry, and research for those interested and motivated. The academic year consists of thirteen 4 week block rotations. Elective extramural, research and global health electives can be arranged.

Program Description

The pediatric residency program at SUNY Downstate has 94 pediatric residents, 4 chief residents, and 25 subspecialty fellows. The UHB-Children's Hospital at Downstate and the pediatric services of Kings County Hospital Center (KCHC) constitute our integrated facilities and are closely affiliated with Coney Island Hospital and MSKCC. Our pediatric residents staff each pediatric unit at all 4 facilities. The institutions together have nearly 300 pediatric beds and newborn bassinets for about 5000 pediatric medicine admissions per year and approximately 4600 newborn deliveries with over 1300 NICU admissions. Between the major integrated sites, there are over 200,000 pediatric outpatient visits annually (approximately 60,000 emergency and acute care, nearly 20,000 resident continuity practice, over 70,000 various subspecialty clinic visits, and over 40,000 additional general pediatric visits) and over 100 attending physicians on active staff. The academic year consists of 13 one-block rotations. The program has been continuously accredited since 1956 and is currently fully accredited with commendation. It is in full compliance with the New York State Health Code Section 405 and ACGME work hour limitation regulations. The training stipend is highly competitive and the benefits package is very comprehensive.

Many of the subspecialties accredited by the ACGME are represented in the Department with subspecialty training programs. The faculty, therefore, displays considerable depth with respect to expertise. In addition to clinical concerns particular attention is given to the humanistic, social, and ethical aspects of the practice of pediatrics, as well as the acquisition of academic knowledge, scholarship and response to the intellectual challenges of pediatrics. The faculty members take pride in their didactic responsibilities enjoying an informal, open door, inquisitive environment.  Giving our residents and fellows a quality pediatric education while they deliver the highest level of medical care to their patients is our primary obligation.

Training Description

Sample PL-1 Year

During the first year of the residency (PL1), a basic foundation of knowledge in pediatrics is acquired. Under supervision by senior residents, chief residents and faculty, residents have direct and primary responsibility for the care of patients, including the history and physical, progress notes, procedures, diagnostic information, medical orders, and communication with parents, consultation services and other healthcare professionals.  Residents learn about normal growth, development, nutrition, health maintenance, preventive care, anticipatory guidance as well as variations of normal. With a broad experience in inpatient and outpatient pediatrics and neonatology, residents 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 their inpatient rotation.

1 block- Ambulatory Pediatrics - OPD
1 block- Pediatric Emergency Care
1 - 2 blocks- Neonatal ICU
3 - 4 blocks-Pediatric inpatient (incl. 4 weeks of night float)
1 block-Behavioral & Developmental Pediatrics
0.5 - 1.5 blocks-Sub-specialty Elective
0.5 block – Child Psychiatry
1 - 2 blocks- Term Newborn Nursery
1 block- Vacation

Sample PL-2 Year

During the second year of training (PL2), residents have greater exposure to pediatric subspecialties, acute and critical care experiences. They learn the pathophysiology and management of the more complex conditions encountered in pediatrics. In addition, residents learn to how to manage multiple system disease and more serious, life-threatening conditions. PL2 residents rotate for one block at Memorial Sloan-Kettering Cancer Center. With this advancement in knowledge and demonstrated clinical competence, residents are given greater supervisory responsibilities as seniors over interns, caring for the critically ill patients, and serving as a supervising night resident.

2 blocks- Pediatric Emergency Care
1 - 2 blocks- Junior resident in the Pediatric ICU
2 - 3 blocks- Senior resident in the Neonatal ICU
2 blocks- Senior resident on Inpatient Pediatrics (including up to 1 block as night float senior)
0 -1 block- Adolescent Medicine
2 - 3 blocks- Subspecialty electives
1 block- Memorial Sloan-Kettering Cancer Center
1 block vacation

Sample PL-3 Year

The third year of training (PL3) is one in which the pediatric experience is rounded out. Third year residents rotate in additional subspecialty services. During this year residents continue to improve and refine their clinical skills and judgment. Third year residents assume a greater supervisory role. With their greater fund of knowledge they are expected to supervise and educate more junior residents and medical students. Having formed a very solid foundation in general pediatrics, third year residents can now pursue their postgraduate careers with the assistance and advice of the chairman, program director and faculty mentors who provide them with guidance and advice as they choose their postgraduate placement. A small group of outstanding senior residents are competitively selected and invited to remain with the program for a fourth year as Chief Residents.

3 blocks- Senior resident on inpatient units (including 1 as the supervising night house senior)
1 blocks- Pediatric Emergency Care
0 -1 block- Adolescent Medicine (if not taken in the PL2 year)
1 block- Senior resident in the Pediatric ICU
4 - 5 blocks- Subspecialty and other electives (including research, extramural, and self-defined)
1 block- Memorial Sloan-Kettering Cancer Center
1 block vacation

PL-4 Year (Chief Resident)

4 Chief Residents covering the Kings County Hospital Center and Downstate Medical Center (UHB)
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, professionalism, commitment  and leadership traits. Residents who are offered this opportunity and elect to stay the additional year assume the role of supervisors, liaisons, administrators and especially educators for all the house staff and medical students.

Resident Responsibilities

At KCHC, UHB and CIH residents on inpatient services during the day time sign-out to a night float resident who covers the unit until the morning. The night shift system functions from Sunday night through Friday morning. On Fridays and Saturdays, there is no float coverage and calls are overnight or 24 hours. Throughout each training year, every resident will have one to two 2 week block(s) of night float.

The Nurseries are primarily covered by PL1 residents. There is a short call system from 4pm - 8 pm on the weekdays, after which time the on call resident signs out to the night float team.  On the weekends there is an on call resident from 7 am - 8 pm, after which time the on call resident signs out to the night float team.

The NICU is primarily covered by PL1 and PL2 residents. Depending on the NICU being covered, PL1 and PL2 residents are assigned either 12 hr day or night shifts or 24 hour overnight calls. There are also advanced care providers working alongside residents and residents rotating from other specialties.

The PICU is primarily covered by PL2 and PL3 residents. The PL2 in PICU has 24 hr calls every third to fourth night, depending on external rotators. The senior resident has night float coverage as described above.

Residents on pediatric emergency department rotation are generally assigned 16 to 18, 12 hour shifts per four week block (occasionally shifts are 10 hours) with a minimum of 12 hours off between each shift. Approximately 7 to 8 shifts are overnight.

Night Float 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. Night float residents are required to participate in Senior and Junior Morning Report where admissions on the inpatient units are discussed.

Residents must be provided with protected time off without clinical responsibilities (minimum 10 hours between shifts and a minimum of one 24 hour block per week). As a result, all residents receive at least one day (24 hours), usually a weekend day, 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. Most residents have 1 or 2 weekends off per month.

Residents log duty hours weekly in order for the program and institution to monitor compliance with hours limitations, supervision and time off requirements. In addition, New York State conducts legislatively mandated yearly off-site surveys and unannounced on-site visits to assure compliance.

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 mid-block evaluation from the supervising attending.The formal evaluation process consists of a written summative evaluation form entered on New Innovations (on-line web based program) which is completed by the supervising attending at the conclusion of every block rotation. The evaluations are competency based and allow the evaluator to identify the methods used for evaluating each of the six core competencies. Residents are asked to anonymously evaluate the faculty, the rotations, the program and their peers using this system as well. Residents are expected to review all evaluations in their file.

The House Staff Affairs Committee conducts monthly meetings to review resident performance is reviewed and discussed in a forum consisting of attending faculty, chief residents, the program director and/or chairman.

Supervising physicians perform evaluation of procedural skills. The supervising physician (attending, chief resident, senior resident or subspecialty fellow who has previously been privileged in the procedure) complete the privileging form if the procedure is performed successfully and satisfactorily. The assessment includes discussing risks and benefits, record documentation and manual skills.

The program director or associate program director conduct semi-annual meetings with each resident to review and discuss the resident's evaluations, in-training exam results, evaluation of procedural skills, individualized curriculum plan, scholarly and research interests, individualized learning plan, and career planning.