Curriculum Overview

Program

PL-1 Year

The first year resident will spend extensive time with patients and their families.  Under the supervision of upper level residents and attending physicians, the intern will become proficient in the organization of complete patient care, from taking a history to creating and carrying out a treatment plan.

The first year of residency emphasizes developing information gathering techniques, honing diagnostic skills, assessing clinical situations, formulating differential diagnoses, and creating care plans under the guidance of the attending physician.  The intern functions within a medical team comprised of other residents, students, fellows, and attending physicians.  The faculty and other house staff are all readily accessible for consultation, teaching, and support.

Please see below for example of PL-1 schedule.

The second year emphasizes both a more supervisory role, and experience in subspecialty electives.  Assuming increased responsibility for patient care, the junior resident will be involved with supervising interns and medical students as the resident team leader of both the Subspecialty Inpatient Team, and Metrowest Hospital inpatient services.  There are several months set aside for elective rotations, and these provide opportunities to learn about general or subspecialty pediatrics.  The year also provides experience in adolescent medicine, normal newborn care, and emergency transport of the critically ill.  The PL-2 resident also works in the neonatal and pediatric intensive care units, where both leadership and independence are further developed.

Please see below for example of PL-2 schedule.

The final year of residency provides the maximum opportunity for patient care and education of residents and medical students under the supervision of Floating attending physicians.  The senior resident leads the unit teams, and a supervisory role is emphasized throughout the year.  Senior residents also have several months of electives.  These are used differently by each resident, to prepare for individual medical careers, hone clinical judgment and increase knowledge of pediatric subspecialties.  Senior residents work in the pediatric intensive care unit and emergency room and a variety of primary care settings. The resident who completes the program will be competent o practice general pediatrics in the community, or to go on to fellowship training.

Please see below for example of PL-3 schedule.

Resident Rotations and Descriptions

PL-1 Block 1: Newborn Nursery Block 2: Medical Ward Block 3: Heme/Onc Ward Block 4: Medical Ward Block 5: ER/Vacation Block 6: Medical Ward Block 7: Behav. & Develop. Block 8: Elective Block 9: Outpatient Clinic Block 10: NICU Block 11: Academic/Vacation Block 12: Heme/Onc Ward Block 13: Comm. Hospitalist

PL-2 Mental Health/Adolescent Heme/Onc Ward Supervisor Elective - No Call ED at Boston Med. Ctr. NICU Cardiology NICU Night team and ER Hospitalist Supervisor  Academic/Adolescent ER and Ward Nights  PICU NICU NICU Night Team/Vacation

PL-3 Academic/Vacation  Elective ER Neurology Inpatient Ward Senior Teaching Resident Elective - No Call Nursery/Clinic Preceptor Elective  PICU Elective - No Call Advocacy Elective

Rotation Descriptions

Newborn Nursery:  Residents cover the well-baby nursery and attend all delivery pager coverage, including hi-risk with the backup of neonatology attending and fellows. 

Medicine Ward:  General pediatrics inpatient service under the direction of the hospitalist program.  Residents will also admit patients to the GI, Rheumatology, and Neurology services.

Heme/Onc:  Resident admits to the inpatient hematology and oncology service covering hematologic and oncological emergencies including bone marrow transplants as well as staffing inpatient consults.

ER:  Level 1 trauma center, central admitting point for many patients. 

Behavior/Development:  Focus on outpatient developmental pediatrics.  Rotation includes experiential opportunities for learning, including field trips as well as opportunity to observe different kinds of diagnostic testing and therapy.

Outpatient Clinic:  Residents responsible for sick patient visits in the Tufts Floating General Pediatrics clinic, with continuity during the month maintained for follow-up as needed.

NICU:  Level 3 neonatal intensive care unit, managing newborns from 24+ weeks upward.  Residents work side by side with nurse practitioners and fellows to manage a 42-plus bed unit.

Academic:  Interspersed throughout three years of residency, provides residents with the opportunity to identify a research or academic interest that can be explored throughout three years.

Lowell:  Community general pediatrics in Lowell, MA near the New Hampshire border with 24-hour hospitalist backup coverage to cover a 10-20 bed community unit.

Mental Health:  Residents participate in mental health intake interviews, therapy interviews, didactic sessions, and field trips to explore how development, family, and psychosocial as well as organic stressors can precipitate mental health pathology in children and adolescents.

Adolescent:  Residents see patients in the outpatient adolescent clinic including coverage of adolescent physicals and sick visits at Tufts Floating.

BMC ER:  At Boston Medical Center, an active urban emergency room in the South End about 10 minutes south of Tufts Floating.  Residents work with staff at BMC, BCH, family residents and emergency medicine residents.

Cardiology:  Primarily outpatient cardiology both at Tufts as well as satellite community sites in the referral area, with inpatient consults as they arise. 

MetroWest:  Supervisory role in the second year in a community general pediatrics ward, running a team with family practice and transitional year interns. 

PICU:  10 bed pediatric intensive care unit.  There is no fellow coverage.  Residents work autonomously under the direction of an attending physician.

Neuro:  Outpatient neurology clinic staffing sick visit neuro patients, as well as follow inpatient admissions and consults.

Teaching Resident:  Education and teaching development with dedicated preparation time for conferences to residents, medical students, as well as opportunity to explore different teaching techniques and theories.

Nursery/Clinic Preceptor:  As a senior resident, will run the newborn nursery team as well as precept in the general pediatrics clinic, and staff weekend clinics under the guidance of an attending.

Advocacy:  Time for community advocacy projects, working with the AAP, conferences, etc.

Elective:  Residents participate in research, GI, pulmonology, hospitalist, anesthesia, general pediatrics … these are also opportunities for away electives, or more creative projects subject to program approval.

Current Call Summary

Note:
All shifts in the intern year are 12 hours.
All rotations have at least 1 weekend off per month.
4 weeks of vacation per year.

PL-1

Newborn Nursery - 2 months, each with 2 weeks of NICU night team

Medical Ward - 1 week of night team and 2-3 weekend shifts, 2 weekends off/month

Heme/Onc Ward - No weekday or night call, 2 weekends with day shifts

ER/Vacation - 6-8 ER shifts and 2 weeks of vacation

Behavior & Development - No weekday call, 3-4 weekend shifts in NICU

Elective - No weekday call, 1-2 weekend shifts in NICU, 1 week of vacation

Outpatient Clinic - No weekday call, 1-2 ward weekend shift

NICU -  No weekday or night call, 3-4 weekend day shifts

Academic/Vacation - 1 week of night team and 1 week of vacation

Community Hospitalist-Lowell - No weekday call, 2 weekend shifts in NICU

PL-2

Mental Health/Adolescent - 2-3 weekend shifts in NICU

Heme/Onc Ward Supervisor - No weekday or night call, 2 weekend day shifts

Elective - No Call

BMC ED - 10-12 shifts with 1 week of vacation

NICU Jr - No weekday call, 3-4 weekend shifts

Cardiology - 1 week PICU night team and 2 weekend shifts

NICU Night Team and ER - 2 weeks NICU night team and 6-8 ER shifts

Hospitalist Supervisor–MetroWest - No weekday call and 2-3 weekend NICU shift

Academic/Adolescent - 2nd sick call (Not called in unless 2 people sick)

ER - 14-16 Pediatric ED shifts

PICU - 1 week of PICU night team and 2-3 weekend shifts

ER and Ward Nights - 6-8 Pediatric ED shifts, 1 week of vacation and 1 week of Heme-Onc night team

NICU Night Team/Vacation - 2 weeks of NICU night team and 2 weeks vacation

PL-3 Academic/Vacation - 1 week of ward night team and 1 week of vacation

Elective No Call - No Calls

ER - 14-16 ER Shifts

Neurology – No weekday call, 2-3 weekend shifts

Inpatient Ward Senior - No weekday call, 2-3 weekend shifts

Teaching Resident - 1 week ward night team and 3 weekend shifts

Nursery/Clinic Preceptor - No weekday or night call, 2 weekends of nursery call

Elective - 1 week of sick call(Only on call if 1 person sick)

PICU - 1 week of PICU  night team and 2-3 weekend shifts

Advocacy - 1 week of ward night team, 2 weeks sick call and 1 week of vacation

Elective WN - 1 week of call in Heme/Onc unit

Continuity Clinics

An integral part of residency education occurs in the Continuity Clinic.  Here the housestaff gains extensive experience in long-term primary care.  Clinic sites include the General Pediatrics Clinic at Floating Hospital, neighborhood health centers in diverse communities in Boston, and private practices within the greater metropolitan area.  Each resident attends his or her clinic weekly throughout the three years of residency.

Each clinic is precepted by attending physicians who arrange weekly primary care conferences.  Speakers include faculty, guests, and residents themselves.  House officers see their patients with direct backup from preceptors and other clinic staff.  Preceptors are fully available to discuss such aspects of patient care as healthcare, and psychological issues.

Incoming interns are asked to state their preference for continuity site placement, and every effort is made to give interns the site of their choice.

Global Health Education Experience

A significant proportion of our pediatric residents come into residency with strong interests in international health, often having had prior international work or elective experiences. Our residents have been participating in International Health Electives for many years.  Residents have traveled all over the world including Haiti, Italy, Romania, Vietnam, and Germany. 

We are currently developing a Global Health and Social Medicine curriculum aiming  to support residents in their pursuit of global health opportunities abroad while concurrently formalizing domestic global health and social medicine learning opportunities here at the Floating.  The curriculum will draw parallels between global health clinical and epidemiological issues in low and middle income countries with similar issues and clinical practice opportunities encountered during clinical practice in Boston and surrounding communities. 

We have many faculty who participate in global clinical experiences including Paraguay, Tanzania, Rwanda, Lebanon, Guatemala and the Dominican Republic.  The faculty are eager to have residents join them as well as participate in didactics and journal clubs.

The Tufts University School of Medicine is also a wonderful resource for Global Health Experiences.