|
|
 |
|
|
|
|
The Program for 2011-2012 Adapts to New Duty Hour Standards |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 | ||
Home
BCRP
Program
The Program for 2011-2012 Adapts to New Duty Hour Standards
|
|
| ||
|
The Program for 2011-2012 Adapts to New Duty Hour Standards |
|
|
|
Based on the new ACGME Duty Hour Standards that go into effect for July 2011, BCRP leadership, the Residency Program Training Committee members, and residents from all three training years developed the new approach to call schedules and team structure to achieve compliance starting in July 2011.
|
|
|
|
We first developed guiding principles to inform the work process. These included the idea that we need to balance educational and service responsibilities and, at the same time, maximize the time residents spend engaged in patient care. It is important to us to prioritize the time interns spend on family-centered rounds and to continue the tradition of case-based instruction and to emphasize time at the bedside. Another important principle was that residents should continue to follow patients they admit and provide longitudinal care over time. This drove our efforts to facilitate patient ownership and responsibility. It was of the utmost importance to us to avoid creating a shift work mentality with shortened shifts and numerous handoffs. We contemplated eliminating certain rotations but decided in the end that we must maintain those unique curricular elements that are so much a part of our pediatric training. It was also a guiding principle that the models of team structure must support residents' lives outside of the workplace, so we paid careful attention to the timing of rounds, evening sign-out, lengths of day and night shifts, and the need for time off on weekends to support friendships and family life. The focus on night shifts made us re-examine our didactic curriculum and we are developing new educational sessions during night shifts. Finally, we consulted our sleep science experts here and at the Brigham to use evidence about clinical performance and patient safety and apply that evidence to our final models.
|
|
|
|
We were able to maintain the identical lineup of training experiences throughout our residency program with a few key changes at each institution in team structure and call coverage. We are very excited indeed about the new structure and look forward to the advantages afforded by these changes but we are committed to monitoring the changes and are prepared to tweak the system in rapid improvement cycles to ensure optimal education, patient care, and resident satisfaction.
|
|
|
|
We used existing personnel and merged several teams to create a day team - night team model on the general inpatient wards at Children's Hospital Boston and Boston Medical Center.
Each weekday team at CHB and BMC consists of two supervising residents and four interns that split into two smaller clinical teams to facilitate family centered rounds and efficient workflow. Theses teams cover each others' patients for continuity clinic sessions, do not take call during the work week, but provide some weekend day and night coverage.
The night team (one senior and one intern) receives sign-out from the weekday team in the late afternoon, provides ongoing care to the team's patients, and admits new patients overnight.
This day team - night team structure provides several key advantages:
Enhanced afternoon coverage
Intern presence on morning rounds
Regular attendance of continuity clinics
Consistency of intern - supervisory resident interaction days and nights
Increased attendance at didactic sessions during the work week
|
|
|
|
As is the case in the current structure, the Cardiology rotation will consist of 3-4 interns who work closely with the Cardiology faculty, nurse practitioners, and fellows on the inpatient cardiology unit. Within the rotation, each intern will have a series of daytime and nighttime shifts. On a typical month in which there are four interns, one week of four will be a series of night shifts and the remaining three weeks feature weekday shifts and weekend day and night coverage. This system provides optimal continuity of patient care during the one month block. On months when there are three residents assigned to the rotation, the Cardiology Department will assign other providers to provide patient care.
|
|
|
|
On the Brigham Neonatal Intensive Care Unit Rotation, residents will be on two pods in the current NICU. In the coming year, because of limitations in duty hours, interns will do a series of day shifts and night shifts in the NICU with gaps in coverage provided by non-resident providers, NICU hospitalists. Residents will have a mixture of day shifts and night shifts, with strings of 3-4 nights in a row in order to facilitate attendance of continuity clinic each week. The maximal number of night shifts will be 7 per block, similar to the Q4 schedule that we have now. This re-structuring will facilitate enhanced teamwork on a single pod, improved continuity of care, and maintain attendance at teaching sessions, while achieving compliance with new duty hour standards.
|
|
|
|
|
|
The BMC NICU rotation will consist of two supervisory residents (one PL-3 and one PL-2) and two interns. The supervisory residents will continue to rotate call on a Q4 schedule. The two interns will rotate on a daytime schedule with alternating long call and short call experiences. In addition to hand-on patient care, the curricular focus will include attending deliveries of term and preterm newborns, deliveries, performing NICU procedures, and attending daytime NICU teaching conferences. Although the two interns will cover day shifts on weekends, there will be no overnight call for interns during this rotation.
The BMC Nursery rotation consists of two interns from the BCRP and one intern from Family Medicine at BMC. Three interns will work with the nursery nurse practitioners to provide clinical coverage during days and evenings throughout the block. Responsibilities of the interns will include examining well newborns, drawing blood and placing IVs, and attending a daily newborn teaching conference. There is no overnight coverage on this rotation.
|
|
|
|
The ICP Rotation will consist of interns who work weekdays and provide weekend night and day coverage with juniors in supervising roles. Cross covering interns from two subspecialty rotations will provide night coverage in strings of nights on this rotation. The ICP rotation provides interns with an opportunity to take care of sicker older infants and children in an environment with an optimal blend of patient numbers and acuity, and in-house faculty 24/7 without fellows. In this new model, we have provided interns with an opportunity to learn how to cross cover patients in a well supervised and manageable environment.
|
|
|
|
The new residency rotation structures that are outlined above allowed us to create new opportunities for supervisory rotations. In the Senior year, there will be additional supervisory time and enhanced supervision of night teams. In the Junior year, we will preserve the junior supervisor position on the Short Stay Unit during the work week and we plan to add two junior supervisory experiences on the ICP rotation and on the Brigham and Women's Delivery Room rotation, where junior residents will supervise interns on the newborn nursery rotation. We believe these supervisory experiences will enhance the training program.
|
|
|
|
The adjustment of our training program to adapt to new duty hour standards was accomplished through the hard work and thoughtful efforts of our entire residency program, at the grassroots level and at the leadership level. We came together as a program, focused our efforts using our guiding principles, and arrived at solutions that are educationally sound, fully compliant with ACGME requirements, and mindful of the personal needs of our future trainees. This process illustrates what the BCRP is all about, a residency program that is constantly striving for to be better and involving residents in solutions. By the time of your interview day, we should have a good sense of how well our planned changes have worked out.
|
|
|
|
|
|
