In this Academic Year 2023-2024, we do not anticipate major changes as we just made significant changes in the past Academic Year. There are, however, two significant changes were made for the 2023-2024 Academic Year.
Enhancing Team Size on Mixed Subspecialty Teams (6-Subs and 9-Subs)
In response to a return to pre-pandemic inpatient census levels on some of the subspecialty services and with the addition of two interns from the Triple Board Residency Program that is now a partnership between Boston Children’s Hospital and Tufts Medical Center, we made adjustments to the 9-Subs rotation and the 6-Subs rotation by having 2 interns instead of 1 intern assigned to each inpatient mixed subspecialty team to provide a more optimal clinical learning environment and reduce workload.
New Coaching Program
We are starting a Coaching Program and have obtained funding for the Categorical and LEAD residents to have a Coach. We plan to launch the Coaching Program this Fall. We anticipate that there will be a strong Faculty Development component to develop the Coaches’ skill sets. We expect that each Coach will meet with their assigned residents at least 6 times per year and develop a longitudinal relationship with them over their years of training. We are discussing strategies to extend the Coaching Program to all of our combined training programs and their trainees. The Coaching Program has been a major goal of our residency in order to enhance the clinical skills and professional development of each and every trainee. In addition, we also anticipate a benefit to enhance connectedness of trainees to the leadership and active teaching faculty in such a large residency program and enhance their individual wellness.
With the anticipation of new program requirements in 2025, we do anticipate another major revision for the 2025-2026 Academic Year
Major Changes Made in the 2022-2023 Academic Year
Transformational Change to X+Y Rotation Schedule
In the 2022-2023 Academic Year, the BCRP made the most transformative changes in the history of the residency program. There were 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 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.
The changes made in the past Academic Year significantly improved the clinical learning environment for our residents. We 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 enhanced 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 provided “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 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 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 3 pm to 11 pm to admit patients to the PHM and Combined Subspecialty Teams, thereby protecting the time (5 pm) of the Afternoon Handoff. The addition of this team will optimizes the clinical learning environment across the inpatient services at Boston Children’s Hospital.