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:
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.
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.
MGHfC and Global Health
In a day and age when travel to and from distant regions of the world is routine and many of the families we serve in the greater Boston area have immigrated from their home countries, MGHfC is committed to equipping residents with global health training, through didactics, with an option for a hands-on, mentored global health elective experiences. Residents will participate in interactive training sessions contextualized to prevailing global health challenges, including maternal-child health, malnutrition, tuberculosis and HIV. The MGHfC Pediatric Division of Global Health has partnered with sites in Uganda, Botswana and Mexico to allow residents to have mentored experiences either in inpatient or outpatient settings. Residents are also supported to establish global health electives at other sites, so long as the site provides for resident safety, well-being, and education/development. In planning global health electives, each resident is encouraged to tailor their elective experience to their own interests. The MGHfC Pediatric Division of Global Health faculty have ongoing research and clinical projects and partnerships throughout the world, providing the opportunity for residents to be partnered with faculty mentors to further their global health experience and scholarly activities.
PICs: Pediatric Individualized Curriculum Blocks
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!
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 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 like those that our residents would be expected to manage at their level of training and are meant to ensure that all 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 a simulation day in which each resident advances 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.
Resident as Educator/Prime
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.
PRIME: Pediatric Residents Interested in Medical Education is made up of a group of residents who are committed not only to our own education but also to improving in our role as clinical teachers for students, patients, and our fellow residents. There are several ongoing projects right now, including increasing connections to the preclinical Harvard medical students, creating resident-led teaching and simulation sessions for students and residents on the wards, and piloting observed structured teaching experiences for residents. Applicants who have more questions about medical education initiatives at MGHfC should contact our chief residents who can connect you to one of our group members by email or during your interview day.
The Designing Residency Innovation, Vision, and Educational goals, or DRIVE, Committee is the committee which is the driving force behind all 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 always working on updating and improving our evaluations, didactics, EBM curriculum, and scholarly activities.
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 consider 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.
At MGHfC we believe advocacy is central to the profession of pediatrics and we strive to prepare residents to remain life-long advocates for children and their families. Current residents participate in advocacy in a variety of ways. All residents can become involved in the MGHfC Resident Advocacy Group, which includes a program delegate to the AAP from every categorical and medicine-pediatrics class. The advocacy group hosts events and speakers year-round, the largest of which is the annual Residents’ and Fellows’ Day at the State House (RFDASH). Residents also have the opportunity to take on year-round roles with in the Massachusetts Chapter of the AAP and the Massachusetts Medical Society. MGHfC is proud of our graduates and faculty who hold remarkable community and advocacy roles and we are fortunate to have frequent conferences, longitudinal curriculum sessions and grand rounds to hear about current issues facing our community. Recent topics we have had the opportunity to learn about include: homelessness, food insecurity, human trafficking, non-accidental trauma, care of immigrant and refugee families, opioid addiction and changing healthcare payment systems. MGHfC also strives to incorporate advocacy into our clinical curriculum and residents will visit many programs serving at-risk populations in Boston and the surrounding area during Development and Ambulatory rotations. MGHfC seeks residents who are passionate about the role of pediatricians toward bettering children’s lives through advocacy and community initiatives in addition to our roles as clinicians. Applicants who have more questions about advocacy efforts at MGHfC should contact our chief residents who can connect you to one of our advocacy group members by email or during your interview day. For more information on advocacy work from our own residents, please click here.
At MGHfC we embrace utilizing evidence-based medicine in our clinical decision making. Among other initiatives, our evidence-based medicine committee hosts monthly journal clubs to facilitate resident engagement with relevant literature. “Journal Pubs,” which are resident led discussions of topics of their choosing, are opportunities for residents to both critically appraise studies and enjoy the company of their peers and expert faculty. Applicants who have more questions about evidence-based medicine initiatives at MGHfC should contact our chief residents who can connect you to one of our group members by email or during your interview day.
What makes MGHfC stand out from the rest? The people! We realize how taxing residency is and make resident (and fellow!) wellness a priority. The MGHfC wellness committee is comprised of residents, fellows, and faculty who aim to provide fun activities that span across the classes to further promote a sense of community. Along with that, we organize morning and noon conferences focused on wellness techniques to provide residents with the tools they need to not only survive residency but thrive in it.