The junior year is when residents get their most concentrated exposure to subspecialty and acute care pediatrics, accompanied by an increase in decision-making autonomy and responsibility for high-acuity often critically ill patients. The junior year also introduces supervisory roles and affords more opportunities for leadership and teaching.
Increased acuity, increased autonomy: Juniors are the only residents on the following BCH subspecialty inpatient services: GI, Cardiology, Complex Care and Oncology. Breadth of subspecialty experiences is maintained by building in protected ambulatory experiences into each of these primarily inpatient subspecialty units.
Juniors also work with increased autonomy caring for acutely ill patients in the EDs at BMC and BCH, serve as the main responders to all deliveries requiring a pediatrician at BWH, and cover one of the three main teams in the Medical-Surgical Intensive Care Unit (MSICU). These rotations require juniors to build on the clinical skills and knowledge gained during the intern year, become more nuanced in their evaluations and differential diagnoses, and more independent and efficient in patient management.
Supervisory experiences: Juniors supervise interns in the BMC Ward and NICU, in the BCH Intermediate Care Program, on two geographic subspecialty teams (a Hematology and End-Stage Renal Disease teamand an Endocrine, Adolescent, and subspecialty Pulmonary team), and on the General Pediatrics Teams (which also contain a small number of subspecialty patients in Toxicology, Rheumatology, Allergy/Immunology, and Nephrology). They are also frequently role models and sources of support for interns in the ED’s at BCH and BMC. Many of our residents love to teach and lead, and these experiences are highly valued by juniors as opportunities to participate in shaping the culture of the BCRP.
Resident as Teacher Curriculum: Juniors have a two week TEACH rotation focused on developing residents’ supervisory and teaching skills. It includes scheduled activities such as delivering a chalk talk, practicing feedback, and precepting medical students, as well as provides individualized time tailored to each resident’s career goals.
Individualized Curriculum: The junior year includes 6-10 weeks elective time, of which 2 weeks are call-free. Juniors use this time to personalize their training experience by pursuing further exposure to pediatric subspecialties, dedicating time to research or teaching, engaging in global health experiences, and a myriad of other options. Some are structured by the residency program and others are individual and unique.
Expanded UHAT opportunities: UHAT residents have a half-day every month when they can choose between a second continuity clinic and a project in urban health, advocacy, global health or public policy.
PL-2 Rotation Schedule
|Service||Units 1U=4 wk||Night/Weekend Call|
|Supervisory Experience (GPB, GPC, BMC Ward, CCS, ICP, 6Subs, 7Subs||1-2||BCH Gen Peds/BMC Ward/7Subs: 2 Friday calls, 2 Sunday day shifts
CCS:Every 4th night (supervising pulmonary intern)
ICP: Night float
6E/6Subs: No call on outpt. On 2 wknds, off 2 wknds
|Inpatient Wards (GI, CCS, Cardiology)||2-3.5||CCS: Every 4th night
GI and Cardiology: 2 wks of day shifts, 1 wk night shifts, 1 wk outpt
|Medical-Surgical Intensive Care Unit (BCH MSICU)||1-2||2 wks day shifts, 1 wk night shifts,
1 wk outpt
|BWH Delivery Room (DR-1)||0.5-1||Every 4th night|
|Oncology||1||2 wks day shifts, 1 wk night shifts,
1 wk outpt
|Stem Cell Transplantation Unit||0-0.5||Day shifts 6 days/wk|
|Emergency Medicine||1-2||Overnight shifts in 2 week blocks (5 nights on, 2 nights off)|
|TEACH||0.5||2 weeks call-free|
|Admit||0-0.5||5 evenings on, 2 off/wk|
|Primary Care||0.5||No night/weekend call|
|Elective||2-3.5||8 wks every 4th night call or Saturday call (2 weeks call-free)|
|Vacations||Two 2-wk breaks||—|
|Continuity Clinic||1 afternoon/wk on average||Increased frequency of clinic during outpatient “Y” weeks|