Pediatrics

Resident Curriculum

In 2018, our program began participating in a scheduling model known as 3+1.  Instead of 4-week rotations (inpatient pediatrics, PICU, NICU…) with a half-day of continuity clinic incorporated into each week, the 3+1 schedule consists of 3-week rotations followed by a full week of continuity clinic.  During a resident’s continuity clinic week, they see patients just as before, but also have dedicated time for longitudinal curricula including mental health, community advocacy, and clinic administration education. Senior residents also have dedicated time to pursue research as well as supervise junior residents.

We have found the new scheduling model to allow for more focused education as well as a decreased number of patient hand-offs.  This limits the amount of cross coverage required, in turn lowering the potential for hand off errors and ultimately, improved patient safety.  The 3+1 model has also improved continuity, giving patients more dates and times within a given week to schedule appointments with their resident physician.

We believe this new scheduling model enhances the resident educational experience, not only by allowing them to focus on their core rotations during 3-week blocks, but also by immersing them in the outpatient setting for a week at a time.  As an added benefit, the 3+1 schedule also provides for a less demanding schedule every 4th week which has helped improve work-life balance.  Even residents deserve a break every now and then!

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Sections: Highlights | PL-1 Year | PL-2 Year | PL-3 Year | Academic Conferences | Scholarly Project

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Highlights

X+Y Scheduling

In traditional residency scheduling, residents spend one half day each week in continuity clinic, which decreases continuity of care in clinic and on the inpatient services by forcing residents to stop caring for one group of patients, travel to care for another group of patients, only to return to their rotation after clinic. All of this leads to work compression, disjointed patient care, more patient handoffs and cognitive fatigue for residents.

An X+Y scheduling system, a common system used in internal medicine residencies, addresses these concerns. In our program, we schedule on a 3+1-week staggered block schedule.  Core rotations, such as floor, ICU, ER and subspecialties are 3 weeks in length followed by an Ambulatory Week which includes multiple continuity clinic sessions as well as longitudinal rotations. Not being pulled from rotations for a weekly half-day clinic allows residents to focus on their rotation. It also frees the inpatient teams from the stress of residents leaving each day.

During Ambulatory Week, residents have several half-day sessions of continuity clinic as well as longitudinal curricular elements, such as advocacy and mental and behavioral health. Second- and third-year residents have one half day set aside for career exploration in primary care or subspecialties. All residents also are assigned a half day of administrative time to catch up on work and self-care.

The every-4th-week pattern allows for continuity with well-baby care and recurring chronic care appointments.  Residents also can follow patients with acute issues that may need to be seen more than once in the same week. The lighter clinic hours allow a chance to recoup from the longer hours spent on rotations such as inpatient, ICU and ER.

The University of Toledo Pediatric Residency Program is one of only a handful of pediatric programs in the country approved by the ACGME for a true X+Y schedule.  We are studying the new schedule as part of an ACGME pilot project. Our program is paving the way to change, and we are excited about that!

Academic Half Days

Our Pediatric Residency Program has been utilizing academic half-days for many years. Rather than have a single lecture every day, our residents are excused from rotations and patient care every Tuesday afternoon from 12:30-4:30pm. Most Tuesday afternoons consist of Noon Report (like Morning Report but at 12:30pm), three one-hour lecture sessions and one half-hour lecture session.

One half-day per month is set aside for simulation at The University of Toledo Interdisciplinary Immersive Simulation Center (IISC) on UT’s Health Science Campus.

Academic half-days foster resident comradery and consistency in educational programming 

Multidisciplinary/Simulation Training

The Pediatric Residency Program is partnering with The University of Toledo College of Nursing and The University of Toledo respiratory therapy program to capitalize on interdisciplinary learning opportunities. Five afternoons per year are set aside for simulation with learners from all three groups at The University of Toledo Interdisciplinary Immersive Simulation Center (IISC) on UT’s Health Science Campus. Multidisciplinary teams work through neonatal, infant and child cases in real time. Debriefing is done by faculty in each discipline. As a result of this curriculum, our Pediatric residents are more comfortable with and have been more likely to participate in emergency care situations that arise on the inpatient services.

Dedicated Continuity Clinic Curriculum

During their clinic week, our residents participate in a Continuity Clinic Curriculum consisting of topics from the Yale Continuity Clinic Curriculum. The curriculum is facilitated by a general pediatrician with interactive resident involvement.

Each group of clinic residents is also scheduled to discuss adolescent patient care and topics once a quarter with our Adolescent Medicine physician.

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Academic Conferences

A variety of scholarly forums occur throughout the year including:

• Grand Rounds - every other week Wednesday morning conferences with many guest speakers on cutting edge pediatric issues.
• Interesting Case Conference - first Friday of each month from 7:30-8:30 AM at Toledo Children's Hospital. 
• Core Curriculum Conferences - Didactics are held every Tuesday from 1-4:30 p.m.   
• Afternoon Report - occurs on Tuesday from 12:30–1 p.m. Resident-faculty interactive conference aimed at discussing practical and state of the art diagnosis and management.
• Journal Club - once a month a senior resident chooses a pediatric article for residents and attendings to critique. 
• Morbidity and Mortality Conference - once each month a complicated pediatric case is presented and discussed.
• Pediatric Radiology Conference - One Friday per month from 7:30-8:30 a.m. our pediatric radiologist Dr. Dessner presents interesting radiologic cases.

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Guidelines for Resident Scholarly Project

The University of Toledo Pediatrics Residency Program expects that all residents will be involved in scholarly activity. To conduct any scholarly activity requires some basic skills. These skills will be introduced during residency training. These skills include: (1) Formulating a search using keywords; (2) Searching MEDLINE/multiple informational databases; (3) Accessing journals online; (4) Searching the Web – Finding information and assessing its quality/usefulness; (5) Learning presentation skills, including PowerPoint; (6) Learning how to adequately critique the literature/practice guidelines.

In addition, all residents will complete and present in a scholarly forum a project to be selected from the list below. All residents must have a pediatric faculty member as a mentor on their project. This project will need to be completed prior to graduating and receiving a certificate for completion of residency. Progress and ultimate approval of the Scholarly Project will be assessed at biannual Evaluation and Promotion Committee Meetings. Failure to keep deadlines relating to the Scholarly Project will result in failure to be promoted.

The Research Elective will now be reserved for ONLY those residents who plan to conduct a full research project as listed below in Activity #8. Those residents considering fellowship training are highly encouraged to select Activity #8 below.

RESIDENT SCHOLARLY PROJECT OPTIONS

ACTIVITY	OUTCOME GOAL	COMMENTS
1) Case Report	Needs to be submitted for publication to receive credit.	Must be done in collaboration with a faculty member. Does not need IRB approval.
2) Case Series	Needs to be submitted for publication to receive credit.	Must be done in collaboration with a faculty member. Needs IRB approval.
3) Chart Audit/Quality Assurance Project	Submit an internal report: Evaluation of the audit to be presented to faculty.	Needs a faculty member's involvement and approval. Needs IRB approval.
4) Patient/Community Education	Testing and actual implementation of educational material with evidence of outcomes.	Needs a faculty member's involvement and approval. Needs IRB approval for outcomes research.
5) Book Chapter or Review Article	Assist faculty member(s) who was invited to submit a book chapter or review article for known publication.	May only select this option if the faculty member already has an invitation from an editor to submit such work. Does not need IRB approval.
6) Instructional Design	Evidence of progress in developing specific curriculum with evidence of outcomes.	Assist faculty member. To be done in consultation with experts in education. Needs IRB approval for outcomes research.
7) Community/Health Policy Project	Submit an internal outline/document + evidence of implementation in community with evidence of outcomes.	Needs a faculty member's involvement and approval. Needs IRB approval for outcomes research.
8) Research	1. Submission of abstract for presentation at local, regional or national meeting, or 2. Submission of small grant proposal.	Collaboration with a faculty member(s) is required. Needs IRB approval.

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