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Here at MGHfC, we take pride in hearing our residents’ voices and adapting our curricula to meet the needs of our residents, both on an individual and at a programmatic level.
We are truly a resident-driven program, and most of the programs we describe below are initiatives that were either led by or done in partnership with our residents. We feel that the programs listed below are unique to MGHfC and allow our residents to have the most robust education tailored to their needs:
The longitudinal curriculum focuses on ambulatory topics in pediatrics and individualized physician wellness and reflective practice and is taught over academic half days for our interns and juniors. Interns meet on Thursday mornings and juniors on Tuesday mornings for truly protected time in which to step aside from busy clinical obligations to engage in a unique workshop-based curriculum which has grown and changed based on resident feedback. Our intern curriculum includes yearlong group thought experiment projects in Community Oriented Primary Care, topics in ambulatory pediatrics, and our Personal and Professional Development curriculum in which the interns come together to learn how to reflect on their experiences as physicians. Our junior curriculum includes topics in ambulatory pediatrics (including sessions with patients and families and their physicians), workshops run by juniors on topics of their choice, and, by popular demand, a continuation of the Personal and Professional Development curriculum started in the intern year. Residents participate in longitudinal Quality Improvement and Evidence-Based Medicine curriculum during this time, giving them the skill set to be involved in systems leadership and analysis as graduates. We readjust our curriculum each year based on the feedback and needs of the residents.
We strive to provide a three year training program which grants our residents graduated autonomy and responsibility, challenging them to push the edges of their comfort while supporting them in their growth and development. In the intern year, in addition to our traditional experiences on the wards in the NICU and in the ED, interns work in the Cambridge Hospital Emergency Room where they are the sole pediatric provider supported by a general ED physician. They learn to triage and work-up patients (with the supervision of the emergency room attendings) while performing necessary procedures and learning to determine “sick” from “not sick” children independently. In the second year, juniors lead inpatient ward teams at Newton Wellesley Hospital and North Shore Children’s Hospital. As juniors, they run rounds, teach the interns and medical students, and make independent management decisions (supported by their attendings), including when to transfer patients into Boston to our PICU. They work with medical students from BU and Tufts, PA students from Tufts and interns from the Carney Hospital Family Medicine Residency. Junior residents also supervise one inpatient team at MGH at night, with an in-house senior resident to support them. As seniors, the residents lead the ward and NICU teams at MGH where they run rounds, teach the interns and Harvard medical students, and make management decisions in conjunction with the hospitalists and specialists. In this way, the residents progress through their training with increased autonomy and responsibility in each year of residency.
Unlike many training programs, we offer a variety of continuity clinic sites. After match day, we reach out to each intern to learn about what is important to each of them when it comes to their continuity clinic, a site at which they will work weekly throughout their training. We have hospital-based sites, community health centers, and private practices. In placing residents, we take into account languages spoken and future plans to allow for an optimal experience for each resident according to individual goals. Every site uses an ambulatory evidence-based, case-based curriculum which is taught at every site each week.
We provide mentorship to our residents in a variety of ways because we believe that each individual needs a village of mentors to be successful. Over the summer of intern year, each intern meets with the chief residents to discuss individual interests and what each seeks in a mentor. The program director also runs a mentorship workshop and helps the interns to formulate mentorship goals during a longitudinal curriculum session early in the intern year. The information garnered from both sources is used to pair each intern with a mentor who will be with them for the entirety of their residency based on mutual interests. These mentor/resident pairs meet several times a year and discuss resident goals and ways to reach them as well as helping give the residents access to resources and additional individuals who will help them in their career development. Additionally, we have group mentoring sessions during the longitudinal curriculum session in which residents work together to help each individual plan their electives for the next year, taking into account the individual’s goals in the short and long term. Twice a year, each resident also meets with the program director or one of the associate programs directors to discuss goals and future plans. In this way, we ensure that each resident is mentored throughout their residency journey and no one falls through the cracks.
With the change in the ACGME requirements requiring increased time for residents to prepare for their future careers, we developed PICs, blocks of time in which residents can do traditional electives, travel on global health electives both domestically (IHS) and internationally, do research, or create an elective which meets their individual learning needs. Residents, for example, have done rotations at Shriner’s, the nearby burn hospital, learned to do procedural sedation, conducted simulation training in Kenya, done dedicated clinical research in pediatric epilepsy and visited multiple primary care sites to learn about different models of primary care. We encourage residents to share the PICs they have created for others to use and welcome new PIC additions!
We believe it is our responsibility to teach our residents to be medical educators and have many programs in place to help residents in their development in this area. In addition to teaching sessions that all team leaders are expected to hold with their teams, we also have opportunities for residents to have mentored teaching experiences. In the junior year, residents lead journal clubs at the community sites and get feedback on their teaching from the chief residents. Also in the junior year, residents lead a longitudinal curriculum session on a topic of their choice, designing a workshop for their peers while being mentored by a faculty member. In the senior year, all residents have a Ward Teach rotation in which they are paired with a faculty member handpicked for their expertise in teaching. Prior to the rotation, the faculty/resident pair meets to discuss the resident’s goals for the rotation. Over the course of two weeks, the faculty member observes the resident leading morning case conferences and one noon conference, then gives the resident immediate in-person feedback on her teaching styles, reviewing aspects of adult learning theory based on the resident’s interests. Also in the senior year, each resident presents at Grand Rounds an interesting case of their choice, then receives feedback on their talk from the residency administrative team. Residents also have the choice to do a medical education PIC in which they can have even more observed teaching time with faculty. Our residents have also formed a group, PRIME: Pediatric Residents Interested in Medical Education, which compiles a list of opportunities for residents to teach each other and medical students and supports residents in doing this work.
We believe that simulation is an excellent opportunity for residents to try out and perfect their clinical reasoning in a safe environment. Our residents participate in simulation in several settings. They have team-based mock code in-situ simulations on the pediatric wards and in the PICU. Interns and juniors also take part in a longitudinal level-specific simulation curriculum in which they progress through six cases, in pairs, over the course of each year. These cases are not mock codes but rather scenarios that are similar to those that our residents would be expected to manage at their level of training, and are meant to ensure that all of our residents have been exposed to a set of core scenarios while being observed and getting feedback on their performance. This program is paired with an end of the year simulation day in which each resident progresses through six cases independently and is evaluated on their performance as an end-of-year evaluation. We will be expanding this program to the senior residents in future years.
We are proud of our residents’ significant interest in advocacy for children. Our residents lead a Residency Advocacy Group which hosts guests speakers throughout the year and hosts our annual Residents and Fellows Day at the State House (RFDASH), a day in which all pediatric residents and fellows in Massachusetts are invited to learn how to lobby for pediatric issues, then spend the afternoon speaking to their State Representatives about issues before the Massachusetts Legislature relating to children. RFDASH is sponsored by MGHfC in collaboration with the Massachusetts Chapter of the American Academy of Pediatrics..
The Designing Residency Innovation, Vision, and Educational goals, or DRIVE, Committee is the committee which is the driving force behind all of the major changes in the program. It is made up of residents, faculty who lead clinical rotations, and the program administrative team. DRIVE meets at the beginning of each academic year to set the program’s priorities for the year, based on requirements from the ACGME and feedback from the residents and faculty from our annual end-of-year survey. Once our priorities are set, the DRIVE committee forms working groups to address the areas on which we want to improve and meets several times over the course of the year to chart our progress towards those goals. This is the committee which redesigned our rotations in the setting of work hour changes, set the groundwork for the longitudinal curriculum and is currently working on updating and improving our evaluations.
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