Residency Program

PROGRAM DESCRIPTION

The pediatrics program at New-York Presbyterian Hospital/Weill Cornell Medical Center is a three-year program designed to provide the trainee with the basic tools for the practice of general pediatrics, with increasing levels or autonomy and responsibility as one progresses through the years. Each year is broken into 17 three-week rotations, including four weeks of paid vacation.

FIRST YEAR: THE BASICS

The internship year is designed to provide experience and education pertaining to all aspects of general care of the hospitalized and ambulatory pediatric patient. Rotations through the Greenberg Pediatric Pavilion allow comprehensive care of the diverse Komansky Center for Children's Health inpatient population, while ambulatory experience is gained through time spent at the outpatient clinics.

First Year Rotation Schedule:

4-5 blocks are spent in the general pediatrics inpatient unit, where interns are exposed to a wide cross section of inpatient issues.
3 blocks are spent in the pediatric emergency room, giving interns a feel for the important bridge between inpatient and outpatient care, and providing valuable experience with simple pediatric procedures.
2 rotations through the general pediatric oncology service at Memorial Sloan-Kettering Cancer Center (MSKCC) provide an in depth education regarding the care of oncology patients.
2-3 rotations at New York Hospital Queens (NYHQ) provide interns with experiences in community hospital based pediatrics.
1 rotation in the well-baby nursery provides necessary experience in the care of newborns and their families.
1 rotation in the 55+ bed Level III neonatal ICU provides the initial foundation in neonatology which is further expanded during the 2nd and 3rd years.
Ambulatory rotations in pediatric cardiology and pediatric neurology provide sub-specialty experience while emphasizing those skills required by the general pediatrician.
1 block is devoted entirely to primary care, at one of our three outpatient continuity clinic sites.

THE SECOND YEAR: INTENSITY AND LEADERSHIP

The second year resident spends much of the year in an increasingly supervisory role in multiple settings.

Second Year Rotation Schedule:

2 blocks are spent on the general pediatrics inpatient service as one of two team leaders.
1 rotation in the pediatric ER allows for further refinement of diagnostic and procedural skills learned during the previous year.
2 blocks are spent in the neonatal ICU, allowing for further expansion of knowledge base and experience with neonatal procedures.
2 rotations through the Pediatric ICU introduce the resident to the management of complex, critically ill children. Residents gain familiarity with the management of post-operative cardiology, oncology, neurosurgery, and orthopedic patients, as well as many other common and uncommon conditions requiring acute monitored care.
One rotation on the bone marrow transplant service at MSKCC further enhances the resident's ability to diagnose and treat clinical problems that are typically encountered in the complex patient.
2-3 rotations are spent at New York Hospital Queens, where residents work with a faculty mentor to design and implement a year-long community advocacy project.
1 block is spent on an Anesthesia selective, which allows residents to further gain experience in sedation, airway management, and intubation in a controlled setting working closely with pediatric anesthesiologists.
1 ambulatory rotation in child development improves the PGY-2's proficiency in developmental evaluations.
2 blocks are devoted entirely to primary care, at one of our three outpatient continuity clinic sites.
1 block at Hospital for Special Surgery, where residents focus on musculoskeletal diseases, i.e. orthopedics, rheumatology, and sports medicine in both the inpatient and outpatient setting.
Ambulatory based selectives gastroenterology, hematology/oncology, endocrinology, allow the resident a broader sub-specialty experience.
Elective time may be spent on a clinical or academic pursuit in consultation with the pediatric program director.

THE THIRD YEAR: INDEPENDENCE AND TRAINING

The senior resident is allowed an increased level of responsibility and independence in both patient care and in teaching the other house officers and medical students.

Third Year Rotation Schedule:

1 block is spent in the general inpatient unit, where the senior resident is given the opportunity to exercise his/her independence as an educator and supervisor.
1 block is spent at New York Hospital Queens, where the senior resident is ultimately responsible for the care of every child admitted to this community-based pediatric inpatient service.
1 block is devoted entirely to teaching; emphasis is placed on precepting medical students in the outpatient clinic, working with the students on the inpatient unit on written and oral case presentations, and as resource for students' evidence-based medicine presentations. The resident also focuses on teaching in larger groups, i.e. journal club, morning report.
2 rotations are spent in the pediatric ER, where senior residents demonstrate their decision-making skills and ability to act independently. Teaching skills are further honed.
2 blocks are spent in the PICU as a PGY-3, where they are encouraged to think and act with increasing independence. During this rotation, the focus is on pre-operative and post-operative cardiac care.
1 block is devoted to the William Randolph Hearst Burn Center, where the resident works with the surgical service as a pediatric consultant for every child admitted to the unit.
1 block is spent in the well-baby nursery, where the third year works closely with the well baby intern.
1 ambulatory rotation in adolescent medicine solidifies the PGY-3's proficiency in caring for the teenage patient.
1 block of elective time can be used by each resident to round out his or her education on an individual basis.
1 call-free elective block is provided for each senior resident to allow for experiences at outside institutions and remote locations. Senior residents are encouraged to take advantage of our partnership with Bugando Medical School and Hospital in Tanzania, Africa, to experience pediatrics in the developing world.
1-2 blocks are devoted entirely to primary care, at one of our three outpatient continuity clinic sites.
2-3 blocks are also devoted to further experience in outpatient subspecialty rotations, e.g allergy/pulmonology and nephrology.

THE RESIDENT GROUP PRACTICE: CONTINUITY OF CARE

All house officers spend one half day per week participating in the Resident Group Practice where they follow a cohort of patients longitudinally through all aspects of sick and well patient care. In addition, residents spend block time in each year at their continuity site. There are three sites for continuity clinic; the main site is adjacent to the Hospital in the Helmsley Medical Tower, and there are satellite practices at New York Hospital Queens and the Long Island City Community Practice.

Every effort is made to ensure that patients see their own resident doctor at each visit, in order to forge strong physician-patient relationships. Residents in a group model see those same continuity patients for episodic illness and telephone triage. Residents often find their continuity clinic to be one of the most rewarding parts of their training.

CALL SCHEDULE

The call schedule of the Pediatric Residency Program has been designed to comply with the New York State and ACGME restrictions on residents' working hours. The residency program supports the philosophy that cross coverage of inpatient units can be deleterious to patient care and resident education. For most inpatient services, nights are covered for one week at a time via a night float system by two members of the team from that unit. Cross coverage is kept to a minimum with an emphasis on continuity of care. The call schedule for NYHQ and MSKCC is Q3-Q4. Thus, ambulatory selective and elective experiences can be carried out with no in house call during the week, and occasional weekend calls.

CONFERENCES

In addition to weekly Grand Rounds and Professors Rounds there is a daily morning report, and noon conference. Morning report is attended by all residents on the pediatric inpatient service and those residents on ambulatory rotation as well as faculty, the program director, and the department chairman. It includes discussion of interesting cases in the inpatient and outpatient fields. Once per week for the first third of the year there is an intern morning report to focus on skills and topics specific for new interns. Noon conference is a daily one-hour didactic teaching session given by attending physicians and is designed to provide a comprehensive pediatric curriculum for residents. There are resident-led lectures on general pediatrics topics given prior to each session of the Resident Group Practice Clinics. In addition, as part of a major medical center that includes Memorial Sloan-Kettering Cancer Center, Rockefeller University, and the Hospital for Special Surgery, there are numerous day and evening lecture opportunities covering a broad range of medical topics at which all residents are welcome.