Transformational Change to X+Y Rotation Schedule

The BCRP is making the most transformative changes in the history of the residency program. We have made fundamental changes to the schedule of rotations by introducing an X+Y schedule format using the scheduling pattern of 4 weeks inpatient time paired with 2 weeks of ambulatory time, including Electives, Primary Care, Behavioral and Mental Health and Teach Rotations. In addition, we have increased the size of our intern class, prompted in part with the inclusion of PGY2 and PGY3 residents from Tufts who will do rotations at Boston Children’s Hospital and Boston Medical Center to fulfill their training requirements.

We believe that the changes we have implemented for the current Academic Year will significantly improve the clinical learning environment for our residents. Specifically, we have increased staffing on the Pediatric Hospital Medicine (PHM) Teams on weekends and created an additional combined Subspecialty Team and a 3rd Night Team, thereby easing the workload across the inpatient teams at Boston Children’s Hospital. At the same time, we have implemented a series of changes that we believe will enhance the clinical learning environment with the elimination of extended shifts (no more 24-hour calls), a larger Admit Team, the elimination of post-call rounding and a larger Flex Pool (to accommodate illness, family emergencies, etc.). In transforming the schedule to an X+Y format, we believe that an immediate benefit will be the “pacing” that is afforded to residents directly attributable to the nature of the schedule – no longer will residents have long stretches of inpatient rotations, which by their very nature are more fatiguing than ambulatory rotations or electives.

Medical Team Associate Program

We have introduced a new program of Medical Team Associates (MTA) on the Pediatric Hospital Medicine (PHM) Teams to further enhance the clinical learning environment: MTA’s serve the inpatient teams to offload tasks from residents, such as arranging for tests and procedures, obtaining medical records, scheduling interpreters, arranging for durable medical equipment for discharge, scheduling follow-up visits and the like. Other programs who have similar staff have found that it makes a huge difference for residents by allowing for more time to be at the bedside or to participate in self-directed learning activities. We believe that this new program will have a positive impact on workload and wellness.

Inpatient Pediatrics Services

In the 2022-2023 Academic Year, we have reorganized inpatient pediatrics services at Boston Children’s Hospital to provide better staffing, reduce workload and provide a more optimal clinical learning environment in our new X+Y rotation format. Here is the lineup of inpatient pediatrics rotations:

Pediatric Hospital Medicine Teams

Pediatrics Hospital Medicine (PHM) Teams A, B and C consist of a supervising resident and two interns with approximately 12 patients per team. There is a fourth team, PHM D, which is a non-teaching service staffed by a PHM attending physician and a Nurse Practitioner. PHM Teams (A, B, C) provide inpatient care to patients with a variety common inpatient general pediatric conditions and also provide care for patients with behavioral and mental health conditions who require inpatient hospitalization. PHM D provides inpatient care with a unique focus on patients with behavioral and mental health conditions. Every Thursday, PHM faculty will provide a Morning Report Case Conference from 7:45 – 8:15 am in the Housestaff Lounge. Each Friday will be an Intern Report from 7:45 – 8:15 in the Housestaff Lounge.

Combined Subspecialty Teams

• 6 Subs:  The 6 Subs Team consists of one supervising resident and one intern and covers patients on the following services: Hematology, End Stage Renal Disease and Toxicology/Environmental Medicine. Overnight, there is a separate Night Team (one supervisor and one intern) that covers 6 Subs and 9 Subs patients.
• 7 Subs:  The 7 Subs Team consists of one supervising resident and one intern and covers patents on the following services: Adolescent Medicine and Endocrinology. Overnight and on weekends, the 7 Subs Team also covers patients from the BRIDGES service, young adult patients with chronic medical conditions who are transitioning their care to adult providers at Brigham and Women’s Hospital. Night coverage is by a Night Team (one supervisor and one intern) that covers PHM C, 7 Subs and the BRIDGES services.
• 9 Subs:  The 9 Subs Team consists of one supervising resident and one intern and covers patients on the following services: Pulmonary, Allergy/Immunology/Rheumatology and General Nephrology. Overnight, there is a separate Night Team (one supervisor and one intern) that covers 6 Subs and 9 Subs.
• Admit Team:  The Admit Team consists of one supervisor and two interns and is present Monday through Friday from 1 pm to 10 pm to admit patients to the PHM and Combined Subspecialty Teams, thereby protecting the time (5 pm) of the Afternoon Handoff. Because this is the inaugural year for this new team, it is possible that the Admit Team may also provide service to other inpatient teams for admissions or that residents may be redeployed to other inpatient services depending for unique staffing or acuity needs. We believe that the addition of this team will optimize the clinical learning environment across the inpatient services at Boston Children’s Hospital.