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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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BCRP:
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Changes in 2009-2010
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In 2009-2010, the BCRP has made fundamental changes in the overall structure of training by year. 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, 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 a preparatory two-week period for the senior Career Development Block round out an exceptional Junior Year.
The Senior Year features a three-month block of Career 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 review article, a 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 a great case-based teaching session, 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 three geographic (unit-based) ward teams on 9 South, 9 East, and 7 West. In 2009, a new geographic team on 6 East will feature 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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The next series of improvements will involve moving to eliminate/reduce extended shifts of call coverage. We are working assiduously to improve duty hours within the BCRP and eliminating/reducing extended shifts has already begun on the 9 East and 7 West inpatient teams. A key enabling factor will be the streamlining of handoffs and making certain the quality of information transferred is high quality. With the IOM resident duty hour standards as a likely reality, we will move in that direction and be prepared for further improvements in duty hours, workload, patient care and continuity, and educational quality.
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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 Endocrinology, Gastroenterology, Hematology, Infectious Diseases, Oncology, Pulmonary Medicine, and Stem Cell Transplantation. In 1.5 months of Elective time, residents may also explore other specialty fields such as Cardiology, Genetics, Nephrology, Neurology, and Allergy/Immunology/Rheumatology, and other related disciplines such as Anesthesia, Dermatology, Pediatric Surgery, Radiology, and the Surgical Subspecialties.
In the PL3 year, residents are the free to customize their elective time and undertake a variety of subspecialty training experiences to enhance and individualize their training. Many choose research and educational experiences.
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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Residents will utilize this time to design a research project, submit the project for review by the Institutional Review Board if necessary, and select a mentor. This early planning enhances productivity of senior residents during their 3-month CDB Block.
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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, sign-out, 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, 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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The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
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Copyright © Children's Hospital Boston. All rights reserved. |
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