Pediatric Residency Program Overall Goals and Objectives

The following is the overall program goals for the University of Toledo Pediatric Residency Program. The program operates under the ACGME six core competencies: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism, Practice Based Learning and Improvement and Systems Based Practice.

The overall goals are based on PGY level, to emphasize the ongoing acquisition of skills, knowledge and attitudes, development of progressive autonomy and provision of appropriate levels of supervision.

Sections: Goal | Objectives | Goals and Objectives based on PGY Level

Goal

To maintain and achieve further excellence in the education and training of pediatric physicians in patient care and the conduct of research. Additionally, the goal of the residency program in Pediatrics is to "provide educational experiences in the diversified field of Pediatrics in an intellectual environment conducive to learning the exemplary practice of Pediatrics". This is accomplished by providing an organized, progressive educational experience with increasing patient care responsibilities over a three year period in a setting which has a diverse patient population and a teaching staff with professional ability, enthusiasm and a commitment to teaching.

Objectives

I. PATIENT CARE

Achieve competency in patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents must be able to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for the treatment of health problems and the promotion of health.

Patient care is the cornerstone of pediatric residency training. It should take precedence over all other responsibilities of the pediatric resident. Under the supervision of the Chairman of Pediatrics, the program directors, and attending physicians, the resident assumes responsibilities for safe, effective and compassionate care of patients, consistent with the resident's level of education and experience. The resident is expected to adhere to the established policies, procedures, and practices of the department, hospital and it's affiliated institutions.

Elements May Include:

Gathering essential and accurate information about the patient using the following clinical skills:
- Medical interviewing
- Physical examination
- Diagnostic studies
- Developmental assessment
Making informed diagnostic and therapeutic decisions based on patient information, current scientific evidence, and clinical judgment:
- Use effective and appropriate clinical problem-solving skills
- Understand the limits of one's knowledge and expertise
- Use consultants and referrals appropriately
Developing and carrying out patient care management plans.
Prescribing and performing competently all medical procedures considered essential for the scope of practice.
Counseling patients and families:
- To take measures needed to enhance or maintain health and function and prevent disease and injury
- By encouraging them to participate actively in their care by providing information necessary to understand illness and treatment, share decisions, and obtain informed consent
- By providing comfort and allaying fear
Providing effective health care services and anticipatory guidance.
Using information technology to optimize patient care.

II. MEDICAL KNOWLEDGE

Competence in medical knowledge and the application of this knowledge in patient care : Residents must demonstrate knowledge about established and evolving biomedical, clinical, epidemiological and social-behavioral science, and the application of this knowledge to patient care.

Each resident is expected to participate fully in the educational and scholarly activities of the residency program and, as required, assume responsibility for teaching and supervising other residents and medical students. The resident will:

Be responsible for reading and following the goals and expectations of each rotation, which will be provided and discussed with the resident at the beginning of the rotation.
Seek feedback from faculty particularly at the midpoint of a rotation and at the end of a rotation.
Participate in self-assessment.
Be expected to develop and participate in a personal program of self-study and professional growth with guidance from the teaching staff.
Be expected to participate in institutional programs, committees, councils, and activities involving the medical college or medical staff of the hospital as assigned by the program director.
Attend all educational conferences, lectures, and Grand Rounds unless the resident is on vacation or has another compelling reason. All unexcused absences will result in the loss of vacation time.
Continuity clinic is one of the most important educational experiences in a pediatric residency. The Residency Review Committee requires that continuity clinics take precedence over all other responsibilities and only allows for absences for illness or planned vacations. Residents are expected to arrive promptly participate fully in their continuity clinics under the guidance of their preceptor.
Pediatricians are expected to be proficient in certain procedures. This proficiency can only be achieved through proper training and supervision. Documentation of such training and supervision is needed for each resident's file. The Department of Pediatrics has established a list of procedures and the number of each that have to be completed by the end of residency training by each resident.

III. INTERPERSONAL AND COMMUNICATION SKILLS

Competency in interpersonal and communication skills, which results in effective information exchange working with patients, their families, and other health professionals. Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates.

Elements May Include:

Residents will be evaluated using a variety of tools to evaluate their interpersonal and communication skills. These include patient satisfaction surveys, peer evaluations, evaluations by ancillary staff, direct observation of patient interactions.
Communicating effectively in a developmentally appropriate manner with patients and families to create and sustain a professional and therapeutic relationship across a broad range of socioeconomic and cultural backgrounds.
Communicating effectively with physicians, other health professionals, and health related agencies.
Working effectively as a member or leader of a health care team or organization.
Being able to act in a consultative role to other physicians and health professionals.
Maintaining comprehensive, timely and legible medical records.
Medical Record Expectations: It is essential that medical records be kept up to date.

IV. PRACTICE BASED LEARNING AND IMPROVEMENT

Residents must demonstrate competence in the use scientific methods and evidence to investigate, evaluate, and improve their patient care practices.

Elements May Include:

All residents will participate in the research and journal club curriculum.
All interns must develop an Individualized Education Plan, or ILP. This will be done by using the website, www.pedialink.org.
The Department of Pediatrics has established a research curriculum for the residency program in order to foster critical thinking, develop skills in reading the scientific literature, and gain knowledge about the research process. Residents are expected to choose a Scholarly project during their PL-1 year and will be required to present the results at a formal presentation prior to graduation.
Taking primary responsibility for lifelong learning to improve knowledge, skills, and practice performance.
Analyzing one's practice experience to recognize one's strengths, deficiencies, and limits in knowledge and expertise.
Using evaluations of performance provided by peers, patients, superiors, and subordinates to improve practice.
Locating, appraising, and assimilating evidence from scientific studies related to health problems of patients.
Using information technology to optimize lifelong learning.
Actively participating in the education of patients, families, students, residents, and other health professionals.

V. PROFESSIONALISM

Residents must demonstrate a commitment to carrying our professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

Elements May Include:

Demonstrating respect for responsiveness to the needs of patients and society by:
- Accepting responsibility for patient care including continuity of care
- Demonstrating integrity, honesty, compassion empathy in one's role as a physician
- Respecting the patient's privacy and autonomy and maintaining appropriate professional boundaries
- Demonstrating accountability and commitment
- Demonstrating a responsiveness to the needs of patients and society that supersedes self-interest
Residents' professionalism will be evaluated using a variety of tools.
Demonstrating high standards of ethical behavior.
Demonstrating sensitivity and responsiveness to patients' and colleagues' gender, age, culture, disabilities, ethnicity, and sexual orientation.

VI. SYSTEM BASED PRACTICE

Residents must demonstrate competence in and practice quality health care and advocate for patients in the health care system.

Elements May Include:

Knowing how types of medical practice and delivery systems differ from one another, such as in methods of controlling health care costs, assuring quality, and allocating resources.
Practicing cost-effective health care and resource allocation that does not compromise quality of care.
Develop and demonstrate basic understanding of the various health care delivery models, payment structures and insurance issues.
Advocating for quality patient care and assisting patients in dealing with system complexities.
Knowing how to work with health care managers and health care providers to assess, coordinate, and improve patient care.
Knowing how to advocate for the promotion of health and the prevention of disease and injury in populations.
Acknowledging medical errors and developing systems to prevent them.
Completion of the Institutional GME Curriculum (online modules).
Satisfactory completion of community advocacy rotation.

VII. Resident as Teacher (RAT)

Residents must develop the skills and attitudes necessary to function as a life-long teacher of self, peers, patients/families and the community. Residents must demonstrate competence in this area.

Elements may include:

Develop and demonstrate competence in understanding basic theory in adult learning techniques
Demonstrate the ability to precept medical students and junior residents, including effective teaching and delivery of meaningful formative feedback, including:
- "One-Minute" precepting
- Group teaching such as on inpatient rotations
- Review of student documentation/order writing
- Development of a core conference topic that is both didactic and evidence based
- Giving specific feedback on positives as well as areas of improvement
- Serving as a role model in demonstrating self-education and acceptance of feedback
- Completion of GME and department specific RAT curriculum
Residents will be evaluated via medical student evaluations (semi-annual basis) and monthly attending evaluations.

Goals and Objectives Based on PGY Level

PGY-1

Competency in medical knowledge and patient management of common inpatient and outpatient pediatric diseases and conditions.
See intern expectations for details.
Competency in principles of preventative health care for children and adolescents.
Competency in intravenous lines, lumbar punctures, and common office procedures.
See procedure log.
Learn to recognize seriously ill patients from those who are less acutely ill.
Refine history taking and physical examination skills.
Become proficient with directing and planning the workup and treatment of common pediatric disease.
Develop and refine basic teaching skills as pertains to patients, families and medical students.
Develop basic skills in designing a scholarly project.

PGY-2

Achievement of PL1 competencies plus:

Competency in facilitating the learning of others.
See goals and objectives of teaching rotation.
Competency in the knowledge, interpersonal skills, and patient care of acutely ill children in the pediatric intensive care unit as evidenced by satisfactory completion of PICU rotation and satisfactory performance of on-call duties in PICU.
Competency in knowledge, interpersonal skills, and patient care of children with complex health conditions such as diabetes, congenital heart disease, and developmental disabilities.
Competency in knowledge, interpersonal skills, and patient care of preventive and acute care for adolescents.
Competency in procedures required for PL2.
Begin planning post-residency career.
Develop and display more in-depth understanding of organ specific conditions, particularly in the realm of the subspecialties.
Assume a major role as a teacher of patients, families, peers and students.
Develop and demonstrate basic team supervisory skills.

PGY-3

Achievement of PL1 and PL2 competencies plus:

Competency in leadership of inpatient ward service - See Senior resident expectations.
Competency in leadership of NICU service - See Senior resident expectations.
Competency in Community Advocacy.
Competency in procedures required for PL3's.
Completion of all graduation requirements.
Demonstration of scholarly presentation skills.
Demonstrate competency and commitment to education of patients, families, peers and students at the level of a competent general pediatrician.

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