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Other Recent Changes in the Program |
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Other Recent Changes in the Program |
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Starting in the 2011-2012 residency year, the BCRP will introduce changes in the program to align with new duty hour standards. However, we were able to accomplish this alignment without altering the fundamental schedule of clinical rotations. The Intern Year is foundational with an emphasis on inpatient pediatrics, child development and behavior, adolescent medicine, emergency medicine, term newborn nursery, neonatal intensive care and cardiology.
The Junior Year focuses on pediatric subspecialty experiences, intensive care medicine and supervisory experiences with exposures to acutely ill patients on the pediatric subspecialties such as oncology, stem cell transplant, neurology, genetics, allergy/immunology/ rheum-atology, pulmonary medicine, endocrinology, hematology, and infectious diseases, and opportunities for electives in the pediatric subspecialties and related specialty fields. Intensive care medicine occurs in the pediatric critical care units, in the Brigham Delivery Room and the BMC NICU. Supervisory experiences occur at CHB and BMC where team leadership, teaching skills, patient management and more independent decision-making become ingrained in our developing houseofficers. Additional opportunities for emergency medicine experience and expanded time for elective opportunities round out an exceptional Junior Year.
The Senior Year features a three-month block of Academic Development in which houseofficers are expected to produce a substantial piece of scholarly work, culminating in an abstract for a national meeting, a manuscript, a research protocol with IRB approval, a new review article, a new curricular element, an advocacy project or a global health protocol or project. Additional experiences include supervisory experiences, elective time, more intensive care time (NICU and PICU), and the opportunity to experience great case-based teaching sessions, Senior Rounds.
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The leadership, faculty, and residents of the BCRP created a new team structure for July 2008 on the inpatient wards of Children's Hospital Boston - the geographic system of inpatient ward teams. Over the past several decades, inpatient resident teams had evolved to single or multiple specialty-based teams often on several different units and floors of the hospital. This structure impacted efficiency, communication, and teamwork.
In order to improve patient care, optimize communication, and enhance efficiency of team function, the BCRP created four geographic (unit-based) ward teams on 9 South, 9 East, and 7 West and 6 East. The first three of these are staffed by four interns and a senior resident. The 6 East team contains an intern and a supervising junior resident. We continue to study the effects of the geographic system and have these objectives in mind as we continually improve the systems of care:
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- More time for patient interactions and teaching at bedside
- More opportunity for family-centered rounds
- Better care coordination and communication with nursing staff
- Continued focused subspecialty education for our housestaff
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In February of 2010, we implemented family-centered rounds on our general pediatrics teams at CHB and BMC. In order to facilitate this change in rounds format, we split our traditional four-intern teams (with one Senior and an Associate Senior) into two teams, each with its own Senior. The aim of this change was to increase time at the bedside, to empower interns with greater ownership of their patients and direct communication with patients and families on rounds, and to create a more efficient team structure. It has been a successful project thus far.
In addition, we piloted a new approach to the sign-out process using a "Bundle" of interventions for improving sign-out and decreasing medical errors. We used our Fall Retreat to teach TeamSTEPPS, a team training program for healthcare professionals developed by the Department of Defense. We employed standard language for our verbal sign-outs, using a mnemonic, SIGN-OUT?, to guide the discussion at evening sign-out. Using our EMR, we developed an electronic sign-out tool that imports medical information automatically and interns update the fields within the electronic sign-out tool to provide timely information about clinical status, contingency planning, and task lists for incoming residents on-call. This pilot study demonstrated a 40% reduction in medical errors, a decrease of time at the computer (roughly 45 minutes per day), and increased time at the bedside (more than an hour per day). On the basis of these results, we are launching the I-PASS handoff bundle across our program to spread the results throughout our institutions.
We continue to refine our approach to improving duty hours within the BCRP and will monitor closely the impacts to education, patient care and continuity, resident work flow, patient safety, and work-life balance in the new inpatient team models. At the BCRP we pride ourselves in the rigorous approach we take to educational innovations and systems improvements.
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The BCRP has expanded the number of subspecialty rotation options and enhanced the rotations to better reflect the breadth of subspecialties by including outpatient clinical experiences and diagnostic and consultative services, with an emphasis on the common problems referred to pediatric subspecialists from general pediatricians. The wide range of subspecialty opportunities at CHB and BMC will compliment the exposure on the inpatient services at both institutions.
In the PL2 year trainees are exposed to Gastroenterology, Hematology, Oncology, Pulmonary Medicine and Stem Cell Transplantation. During Elective time, residents may continue to experience pediatric subspecialties or explore other specialty fields such as Anesthesia, Dermatology, Pediatric Surgery, Radiology and the Surgical Subspecialties.
In the PL3 year, residents customize their elective time and select a variety of subspecialty training experiences to enhance and individualize their training. Many choose to do research and other varied educational experiences, including global health rotations.
These opportunities allow our houseofficers to take full advantage of the faculty and clinical services at Children's Hospital and Boston Medical Center. They provide a broad and deep exposure to subspecialty pediatrics, which assists our trainees in selecting a career path.
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The BCRP features an intensive orientation process with the specific intention of better preparing interns for the first day of internship. Besides the traditional information sessions, we have developed simulations to enhance the function of interns in their inpatient rotations, and provided modules and clear guidelines about written documentation, oral presentations, procedures, the I-PASS handoff curriculum, and on-call expectations. We also orient new interns to the information systems and have them gain competence in order-writing, viewing medical information, laboratory results, and images.
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There are two residency-wide retreats held in the fall and late winter in which we address a variety of topics that are part of the basic culture or values of the residency program. In the past, we addressed themes such as teaching, leadership, feedback, work-life balance, patient-centered care, communication skills, the I-PASS handoff curriculum, and skills training. It is an opportunity for all residents to spend a day together to reflect on the topics and have a welcome break from the day-to-day grind of residency. In the late spring, we host class-wide orientation for Rising Juniors and Rising Seniors, in which we focus on new aspects of the curriculum, leadership skills, and personal development.
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