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The experience in adolescent medicine is a 4-week block rotation for 2nd year residents taught by a multi-disciplinary staff of providers in a wide variety of settings where adolescents seek care. Settings include adolescent focused primary care practices, tertiary care center subspecialty clinics (e.g. mental health and substance abuse, sports medicine, gynecology, etc.), and community-based experiences.
Ambulatory Medicine II is a 4-week rotation for junior residents. This rotation will expose residents to the value of community health organizations and foster excitement about future collaboration. After this experience, residents should see healthcare as a partnership between the patient, their medical providers and organizations in their community. Through seeing patients in settings outside of typical healthcare environments, residents will gain new perspectives on what it means to be both a patient and a caregiver, setting higher goals for the way we deliver care. Each resident spends one week immersed in their continuity clinic and the other weeks visiting other community health centers and learning about community resources and organizations in the Boston area.
The overall goal of the second year resident BWH neonatal medicine rotation is to develop the ability of residents to evaluate, resuscitate and manage newborns in the delivery room, and immediately thereafter. At the Brigham, pediatric residents have the opportunity to lead the initial evaluation and management of neonates in the delivery room (including neonatal resuscitation as appropriate), triage and evaluate neonates with presenting with distress or illness in the first hours of life, provide appropriate care for neonates in a level 2 nursery, and appropriately counsel pregnant women and their families who are likely to have a premature baby as consultants. The rotation is based in a metropolitan referral hospital that boasts nearly 10,000 deliveries per year.
The emergency department rotation at The Cambridge Hospital offers MGH pediatric interns the opportunity to evaluate and treat a wide range of pediatric illness in the community setting. The department sees 32,000 patients per year which includes 15% of patients aged 18 years and younger. Interns work directly with on-site attending emergency physicians as the pediatric expert and primary caregiver to the pediatric patients. Rotators will have exposure to front-line community medicine including bedside procedures such as orthopedic splinting, abscess incision and drainage, and laceration repairs. The rotation provides a comprehensive community experience that will also educate interns about disposition planning and care coordination in a setting with more limited pediatric resources and sub-specialist availability than the tertiary care center, MGH, where they will also rotate.
The Developmental-Behavioral Pediatrics Rotation is a 4-week rotation during the intern year. During the rotation residents are given the opportunity to learn from a wide variety of community and clinical providers to gain a better understanding of child development and the systems in place that support children. The Lurie Center for Autism serves as the core site for the rotation where residents meet and work with a developmental-behavioral pediatrician mentor to see how to apply general development and behavioral principles into practice.
The goal of the MGH pediatric inpatient medicine rotation is to develop the ability of residents to evaluate and manage patients with a broad range of medical problems and make decisions about need for hospitalization, changes in status necessitating intensive care, and readiness for discharge. The rotation is based on a general pediatric ward in a tertiary care setting with patients aged birth to 21, and exposes residents to complex, referral-based medical problems. Learning will occur in a multidisciplinary team-based system. First year residents will be the primary caregivers for their patients, under the close supervision of third year residents, who will serve as team leaders. Residents will benefit from guidance by admitting pediatric and subspecialty attendings, as well as the service attending who will round with the team on a regular basis.
The goal of the MGH newborn rotation is to expose first year residents to the well-baby care and develop their ability to evaluate newborns and counsel new families. The rotation is based in a busy urban newborn nursery with a large referral obstetrical service. Frequent teaching sessions are provided by members of the newborn hospitalist service on topics such as rashes, circumcisions, septic risk evaluation, breastfeeding, hypoglycemia, and anticipatory guidance after leaving the hospital. In addition to caring for well newborns, interns will attend deliveries to learn the basics of neonatal resuscitation, a skill set that is further developed in our rotation at Brigham and Women’s Hospital.
The goal of the MGHfC Emergency Division rotation is to develop the ability of residents to triage, evaluate and manage children with a broad range of medical and surgical problems with varying levels of acuity. The rotation is based in an urban referral pediatric emergency department designated as a level I pediatric trauma center. Patients will include those aged birth to 19 years who live in the area, as well as those referred to this tertiary care hospital emergency department for higher levels of care. First, second and third year residents will all participate in this rotation. The residents will work closely with other team members, including other pediatric residents, emergency division attendings, subspecialists, nurses and support staff to triage and care for patients who present to the pediatric emergency room. The intern emergency medicine rotation combines shifts at both MGH, as well as shifts at Cambridge Hospital, a local community.
The goal of the MGH NICU rotation is to develop the ability of residents to evaluate and manage critically ill infants with a broad range of medical and surgical problems. The rotation is based in an 18-bed level III neonatal intensive care unit. Learning will occur in a multidisciplinary team-based system. Interns will be the primary caregivers for their patients, under the close supervision of staff neonatologists and intensive care fellows. The most important goal of the intern experience in the NICU is to develop a comprehensive knowledge of one’s patients and establish a relationship with the family as the primary physician on the NICU team. Residents return to the MGH NICU as senior residents in a supervisory role and have opportunities to teach as well as further develop their neonatal intensive care skills while covering the patient care overnight every fourth night. The NICU Senior rotation is designed to allow seniors to demonstrate the confidence and competence necessary to manage an intensive care unit for critically ill neonates.
Newton-Wellesley Hospital is a community hospital in Newton, a suburb of Boston. It has a wide service area in the western suburbs. The spectrum of pediatrics at NWH includes the Pediatric Inpatient Unit, Newborn Nurseries, SCN, Pediatric Subspecialty Clinics and the Pediatric Emergency Department. Residents rotating at NWH manage a general pediatric inpatient unit under the supervision of attending hospitalists and community pediatricians. All house-staff operate under the supervision of the patient’s attending physician. Residents provide daytime coverage at NWH; overnight coverage is provided by NWH hospitalists and moonlighters. The team consists of one PGY-2 supervisory resident and one intern, joined by medical students from Tufts University and PA students from the Massachusetts College of Pharmacy and Health Sciences. Many of our own MGH graduates join the Newton-Wellesley community after residency.
The NWH intern rotation is designed to allow interns to learn how to manage common pediatric illnesses in a community inpatient setting. Skills in working with a variable patient/family population, including those that are highly educated and knowledgeable are necessary for this rotation. There is a strong emphasis on the teaching of medical and PA students on this rotation.
The NWH Supervisory Resident rotation is designed to allow junior and senior residents to supervise a team admitting patients to an inpatient pediatric ward in a community hospital. Leadership and supervision skills are paramount for the successful resident on this rotation. Communication and the management of transition to higher level of care when necessary are critical components.
The MGH PICU is a busy 14 bed pediatric referral center. The goal of the PICU rotation is to develop the ability of junior residents to evaluate and manage critically ill children with a broad range of medical and surgical problems. Residents, acting as the primary caregiver under close attending and fellow supervision, are exposed to CPR, ECMO, invasive ICP monitoring, shock, mechanical ventilation, critically ill post op patients, sedation, and analgesia. Residents gain experience in diagnostic and therapeutic procedures such as IV placement, ABGs, bag mask ventilation, central lines, endotracheal intubation, and thoracentesis. Our PICU draws from a wide range of patient populations, providing exposure to many patients with rare or multi-organ system disease. In addition to transfers from several local community hospitals, patients from Mass Eye and Ear Infirmary are admitted to the PICU for post-op management after many complicated airway reconstruction procedures. In addition, residents assist in stabilization and management of many children admitted through our active trauma service.
The goal of the MGH pediatric surgery rotation is to develop the ability of first year residents to evaluate, stabilize and treat patients with a broad range of surgical problems of varying complexity and acuity. In addition to the operating suite, this rotation takes place in various settings within a tertiary care hospital including the pediatric emergency ward, inpatient pediatric floors, PICU and NICU. The team is led by a senior surgical resident working in conjunction with the pediatric surgical nurse practitioners under the leadership of attending pediatric surgeons. First year residents are both surgical and pediatric trainees who are the primary caregivers for the pediatric surgery patients.
We work hard to help residents tailor residency to meet their individualized educational goals. Rather than track residents into pre-defined and potentially narrow categories, we provide an opportunity for residents to explore their diverse interests and create a residency specific to their own learning and career needs, which may span several traditional “tracks.” A total of 9.5 months of residency are therefore chosen by an individual resident, with mentorship from faculty. Six and a half months of electives are within the core subspecialties listed by the ACGME and residents choose these rather than being assigned by the program to staff the GI or pulmonary service, for example. An additional three months of “individualized curriculum” can be completely self-designed and we have had residents create incredibly rich and diverse rotations such as working on a hospital-boat in Cambodia, working on comparative zoology with veterinarians, working in Kenya to create an emergency medicine curriculum and working with the Chief Quality Office of the hospital. At MGHfC, one-size does not fit all, and no two residents have the same training experience because no two residents are the same. We value resident individuality and autonomy in designing their training to meet their needs.
The Ward Teach rotation is a 2 to 4-week rotation in the PGY-3 year which combines medical student teaching with mentored large group teaching opportunities. During this rotation, the resident runs Morning Case Conference twice a week and one Wednesday noon conference every other week. Each Ward Teach resident is paired with a faculty mentor for 1:1 teaching and feedback on this large group teaching during the rotation. The conferences are designed to allow the residents to improve teaching skills while educating the residents about recent admissions to MGHfC. Residents of all three years, the hospitalist and teaching attendings, as well as medical students, attend the conferences. Additionally, the ward teach spends a significant amount of time with the medical students on their pediatric clerkship in their first clinical year. The ward teach observes medical students’ presentations on rounds, observes their initial histories and physicals when admitting new patients and reads their admission notes and gives them feedback verbally and in writing. The ward teach also leads 1-2 teaching sessions for the medical students, helps them with their physical exam skills in the newborn nursery, and leads 1-2 simulation sessions for the medical students. Additionally, the ward teach spends one evening at the Revere Crimson Care Collaborative, a pediatric student/faculty collaborative practice, assisting preclinical students in their history taking and physical exam skills. The overall goal of the senior resident ward teach rotation is to provide residents with the opportunity to teach in different settings to different levels of learner in a mentored setting in which they receive feedback through a structured “Resident as Educator” curriculum.
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