The PGY-1 year is designed to give our Med-Peds residents a broad exposure to the basic inpatient and ambulatory experiences they will be building on during their residencies. Our academic year is broken into 13 four-week blocks. The PGY-1 curriculum contains 4 ambulatory months, which is a welcome change of pace from many Med-Peds programs with 10 or 11 inpatient ward months during the first year.
On the pediatric side, our rotations include the neonatal intensive care unit, newborn nursery, 2 months of pediatric wards, 1 month of pediatric oncology, 1 month of ambulatory pediatrics, and pediatric emergency medicine.
NICU: In the NICU, residents take q4 overnight call. Interns attend all of the high-risk deliveries while on call and accept new admissions. Interns generally carry 6-8 patients each and are supervised directly by the NICU attendings.
Newborn Nursery: Our newborn nursery gives good exposure to the normal newborn exam and management of common newborn problems such as jaundice and some less common problems such as unrecognized congenital heart disease. Interns are also responsible for any circumcisions that need to be done prior to infant discharge. Usually, there are 2-3 residents in the NBN each month caring for an average of 25 patients per day. There is no overnight call while in the nursery, but interns do take short call until 10 pm approximately 7 times during the rotation. On short call, they cover the nursery as well as triage phone calls from our ambulatory clinic.
Pediatric Wards: While on pediatric wards, interns generally care for up to 10 patients with an upper level resident. Each resident-intern team takes overnight call 7 times during the rotation and has 2 full weekends off. After 10pm, the intern is responsible for taking triage phone calls from our ambulatory clinic. While on wards, they care for a wide variety of pediatric illnesses, so that they have experience with both the most common pediatric cases as well as the more rare diseases and presentations.
Pediatric Oncology: Our residents work directly with our pediatric oncology attending physicians to care for our inpatient service, consults, and also will see patients in the pediatric oncology clinic.
Ambulatory Clinic: On our clinic rotation, interns work at the Center for Pediatric Medicine, where they see children for both well-child care and for acute illnesses. An intern will see 10-15 patients each day (our clinic sees approximately 30,000 visits each year). In addition, they will also take short call until 10 pm approximately 7 times during the rotation.
Pediatric ER: Half of the med-peds interns complete the peds ER rotation during their first year and half during the beginning of their second year. While working in our very busy peds ER, they have the opportunity to care for a wide range of pediatric acute care illnesses and participate in the acute stabilization of pediatric patients who are brought to our trauma bay. During our 17 12-hour shifts, they are also able to perform a wide variety of procedures including lumbar punctures, intubations, and suturing.
On the internal medicine side, our rotations include pulmonary teaching service, 2 months of medicine teaching service, ambulatory medicine, emergency medicine, geriatrics, and outpatient cardiology.
Pulmonary Teaching Service (PTS): While on PTS, interns care for inpatients, focusing primarily on their pulmonary problems and basic vent management. During the day, 4 PTS interns are supervised by 1 upper level resident. Each intern takes q4 overnight call, supervised by the critical care upper level resident. While on call as interns, they not only have the opportunity to care for pulmonary patients, but they also are able to gain experience in the intensive care unit with the critical care upper level resident.
Medicine Teaching Service (MTS): Our 4 MTS teams each consist of 2 interns and 1 senior resident, with each team taking q4 overnight call. Each intern is generally responsible for 5-10 general medicine patients, including both floor patients and non-ventilated intensive care unit patients. The MTS teams care for not only our own medicine clinic patients, but also for other hospitalized patients who are interesting learning cases. The intern is also responsible for taking triage phone calls from our ambulatory clinic over night.
Ambulatory Medicine: Interns on our ambulatory medicine rotation work primarily at our Internal Medicine Clinic seeing patients who need to be evaluated for acute problems. They will also rotate through other offices including sports medicine, ENT, ophthalmology, and mental health. Furthermore, the interns will also work at our subspecialty clinics, where they see our own clinic patients for more specialized problems. There, they are supervised by physicians from multiple specialties, including cardiology, dermatology, nephrology, and pulmonology to name a few.
ER: During our emergency medicine rotation, interns work primarily in the adult critical care emergency room, where they have the opportunity to be the first to evaluate and stabilize a wide variety of patients. They are also able to gain experience performing a wide variety of procedures, including intubations and the placement of central lines.
Geriatrics: While on our geriatric rotation, interns are able to participate in the care of a wide variety of geriatric patients. They spend part of their time at the geriatrics outpatient center where they participate in the comprehensive geriatric assessment of many new patients. They also spend one day per week at a local nursing home, caring for both short-term rehab and long-term care patients. In addition, they spend time doing geriatric consults on the inpatient setting. Unique to this rotation, they will also have the opportunity to participate in home visits of hospice patients.
Outpatient Cardiology: During the outpatient cardiology rotation, interns spend most of their time at a local cardiology office. There, they are able to participate in stress tests, observe echocardiograms, evaluate new cardiology patients, and see follow-up cardiology patients. In addition, they spend one day per week in our internal medicine subspecialty clinic, seeing patients in the CHF and general cardiology clinics. While half of the med-peds interns complete this rotation in the first year, the other half does this during the beginning of their second year.
Click here to see a sample PGY-1 curriculum.