Summary of Ongoing Program Development

I hope this overview demonstrates our commitment to providing the most comprehensive training possible.  Though you may not have experienced all of these changes, your input helped make them possible.  The feedback provided by residents and alumni remains an integral part of ongoing program improvements. 

Sincerely,
John S. Andrews M.D., Director, Pediatric Residency Program

Quote from the survey:
“I think our residency was a great one.  I’ve compared to my other friends/med school classmates/colleagues, and I find that my knowledge base is at LEAST equal, and usually superior to theirs.  And many of them come from “top” programs, such as Northwestern, Mayo, Cincinnati, UCSF, and Stanford.”

Subspecialty Experience

• Subspecialty rotations were restructured so as to assure consistent and protected time in outpatient specialty clinic, providing an improved balance of clinical experience.  With this model senior resident subspecialty rotations are structured to spend half of the month on inpatient service and the other half in outpatient clinic.

• Residents have 4 specialty months using this model.  One month occurs in the 2nd year (Endocrine) and three months occur in the 3rd year.

• The outpatient half of the month is without call so as to assure maximal experience in the outpatient setting by avoiding post-call days.

• The Endocrine rotation was further changed last year.  The previous rotation was a combination of Genetics/Endocrine/Metabolism.  Resident and faculty feedback indicated difficulty in mastering all three areas.  By changing this to an Endocrine only rotation residents’ clinical skills in pediatric endocrinology have increased significantly.  Genetics/Metabolism is now offered as an elective frequently selected by residents.

Acute Care/Emergency Medicine Experience:

• A second Emergency Medicine rotation block was added to the schedule for all residents.

• All residents are scheduled for one month of Emergency Medicine at HCMC and a second month at either Children’s-St. Paul or Children’s-Minneapolis

• The added Emergency Medicine month allowed us to remove coverage of the ER when residents are on call during the inpatient rotations at Children’s – Minneapolis and Hennepin County Medical Center.

• This 2nd month was added in place of an inpatient ward rotation.

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Procedural Experience

• To assure opportunities for basic procedural experience several of the 1st year ER shifts have been designated “orientation and procedural shifts” to provide experience early in residency.

• The Benchmark Procedural Skill Lab for interns was restructured to create a pediatric focused procedural lab.

Musculoskeletal Curriculum

• Addition of the Sports Medicine Workshop Series, with 4 afternoon workshop sessions each year covering sports medicine topics and learning the musculoskeletal exam.

• Addition of a one-day Pediatric Orthopedic Workshop for all first year residents.  The workshop covers splinting/casting, knee exam, scoliosis, arthritis, toe walking, limp, and hip dysplasia.  The workshop is conducted with both didactic sessions and hands-on workshops.

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Changes to assure compliance with work hour requirements

• The neonatology experience at Children’s-St. Paul was changed from Q 3 night call to Q 4 call and now includes a cap on the number of patients covered by each resident.

• Patients identified as extended stay patients at Children’s-St. Paul will no longer be followed by the resident teams starting May 2004.

• Weekend moonlighters will be utilized during winter months from 8 am - 1 pm to assist post call teams at Children's St. Paul and Children's Minneapolis.

Elective Opportunities

• An additional elective block was added to the 2nd year schedule providing the flexibility of 6 elective months during residency

• 3rd year electives were changed from back-up call to call free

Addition of other Curriculum and Opportunities

• Dental, recognizing the significant health impact of poor dental care

• Sleep Medicine, recognizing that sleep disorders such as sleep apnea are significantly under recognized in the pediatric population

• Public Policy and Child Advocacy, an opportunity to meet with Representatives of the State Legislature and to understand the opportunity we have to be a voice for the needs of children

• Commitment to Academic Opportunities, including supporting residents interested in the Integrated Research Pathway, mentoring residents in academic career opportunities, and assuring protected time for residents interested in participating in a project during residency

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Graduate Survey Summary

Outlined is a summary of the results of the survey sent to residents graduating 1998 – 2003. 

• The program overall provides comprehensive training
  

• Many faculty serve as strong role models
  

• The most frequent issue identified is the need for more training in mental health disorders of childhood and adolescence

Areas identified as being adequately to well prepared to manage following residency:

• Development
  

• Infectious Disease
  

• Pulmonary
  

• Gastroenterology
  

• Endocrinology (was borderline, anticipate greater improvement)
  

• Hematology/Oncology
  

• Nephrology
  

• Acute Care/Emergency Medicine
  

• Critical Care
  

• Cardiology
  

• Neonatology
  

• Normal Newborn
  

• Adolescent Medicine
  

• Child Abuse and Neglect
  

• Inpatient Pediatrics
  

• Patients with Complex Needs
  

Areas that individuals identified as being least prepared to manage following residency:

• Psychiatry
  

• Neurology
  

• Genetics/Metabolism
  

• Gynecology
  

• Orthopedics
  

• Collagen Vascular Disorders
  

• Musculoskeletal/Sports Medicine
  

• Behavioral Pediatrics
  

• Outpatient Pediatrics
  

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Current changes and additions to the program that helped address areas of need identified in the previous survey:

• Sports Medicine Workshops – 4 workshops offered to all senior residents each year
  

• 2nd block month of pediatric emergency medicine – to assure more acute care pediatric experience, including common injuries
  

• Orthopedics Workshop for interns plus curriculum added to the developmental disabilities rotation
  

• Outpatient clinic time on subspecialty rotations
  

• GEM (genetics/endocrine/metabolism) changed to Endocrine only rotation
  

Goals:

• Addition of a required neurology rotation for all residents, to include outpatient clinics, consults, and exposure to neuropsych testing
  

• Review Adolescent rotation to assure adequate experience in adolescent gynecology and adolescent mental health disorders
  

• Review Behavioral rotation to assure adequate experience in ADHD
  

• Increase overall curriculum in Pediatric Psychiatry
  

• Review survey with residents to help guide elective selection (Neurology, Psychiatry, Genetics/Metabolism, Rheumatology, Orthopedics, Sport Medicine, circumcisions)
  

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