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Curriculum

The MMC Pediatric Residency Program at BBCH has 18 pediatric residents (6 PGY-1, 6 PGY-2, 6 PGY-3), and a pediatric chief resident. In addition, our combined internal medicine/pediatric residency program has 3 residents per year. The program curriculum is as follows:

Pediatric Residency Schedule

PGY1 PGY2 PGY3
Inpatient Unit (IPU) - Days/Night Team 3 1 2
Inpatient Unit (IPU) - Days   1 1
Primary Care Continuity Clinic
1/2 day per week each year
Acute Care Pediatrics and Newborn Nursery 2 2 2
Rural Pediatrics 1    
Advocacy - Child and Community   1  
Community Pediatrics   1  
Behavior/Development 1    
Adolescent Medicine   1  
Neonatal Intensive Care Nursery 2   1
Pediatric Intensive Care   2  
Emergency Medicine 1   1
Subspecialty Experiences 2 2
Individualized Curricular Experiences (ICEs)   3 3

Options based on future career goals include:
                              Subspecialty Rotations
                              Subspecialty “non-core” Rotations
                              Additional Community, Acute Care, or Inpatient Rotations
                              Chronic Care Management/Medical Home
                              Neonatal Continuing Care Nursery (Level II)
                              Pediatric Surgery
                              Global Medicine Local Immersion
                              Global Medicine International Opportunities
                              Research Block(s)
                              Resident Self-Designed curricular month


Inpatient Pediatrics (IPU Days/Night Team and IPU Days)

Those working in the inpatient pediatric unit care for a variety of patients referred from the Greater Portland community, as well as the entire state of Maine, and parts of southern and eastern New Hampshire. More than 2000 patients per year are cared for on the inpatient unit of BBCH. Diagnoses range from the common respiratory and gastrointestinal disorders to congenital heart disorders, metabolic disorders, and end-stage renal disease to name a few. The attending faculty include a 24/7 pediatric hospitalist service with fully dedicated inpatient physicians, a full range of sub-specialists involved in medical and surgical subspecialties, and community pediatricians. Teaching occurs regularly and is integrated into the daily work schedule.

Interns will spend 1 week on the night team during each month, and 3 weeks on the day service. Senior residents spend half the month on the night team, and half on the day team.  Residents on "Inpatient Days" have no night team coverage during the week but are part of the weekend call pool.

Ambulatory General Pediatric Rotations

Ambulatory general pediatric rotation experiences span the three years of residency training, and take place in many locations. The rotations that make up this learning experience are Acute Care Pediatrics, Continuity Clinic, Rural Pediatrics, and Community Pediatrics. In the course of your general pediatrics ambulatory training, you will master the diagnosis and treatment of a wide variety of problems from those that are very common to the very rare. You will have the opportunity to do this in multiple primary care settings.

Acute Care Pediatrics (“Peds Clinic”) is spent in the BBCH on-site Pediatric Clinic where there are over 7,500 patient visits per year. Here, many of the patients are refugees or immigrants. Portland is a refugee resettlement city, and we have developed an International Health Service within the Clinics at MMC to help transition refugees into our healthcare system. This provides a unique opportunity to learn how to address a multi-cultural and diverse population of patients.

During each Acute Care Pediatrics block months, residents rotate 1 week onto the Newborn Nursery Teaching Service under the supervision of dedicated newborn hospitalist faculty. Here you will participate in a longitudinal experience in newborn care over all three years of your training. The Newborn Nursery Teaching Service covers over 700 newborns a year in the Woman and Infants East Tower at Maine Medical Center. The newborns include level one and level two patients from the diverse population at the pediatric clinic, babies born to mothers on the high-risk OB service, and the local community. This rotation provides numerous opportunities for residents to recruit new patients into their continuity clinic practice, care for well and ‘level 2” infants, and learn procedures such as IVs and circumcisions.  Residents also spend dedicated time in our multi-disciplinary “Countdown Clinic” specifically designed to promote the interdisciplinary management of children at risk for overweight, and children with obesity.

The Continuity Clinic experience for residents takes place at the BBCH Pediatric Clinic and selected community based Maine Medical Parntners (MMP) pediatric practices. Residents spend one half day per week throughout their training in their continuity clinic under the supervision of our board certified ambulatory pediatric staff. The Continuity Clinic experience includes a structured Quality Improvement longitudinal curriculum that enables residents to manage their patient panels for Best Practice. The Pediatric Clinic operates under a Patient Centered Medical Home model, and employs social workers, nurses, medical assistants, care managers, a nurse practitioner and a long-standing dedicated staff who love working with the patient population and the residents.

In addition, residents in our acute care experiences benefit from our Pediatrics/Child Psychiatry Fellow Buddy System in the continuity clinic. This unique program pairs each pediatric resident with a child psychiatry fellow with the goal of promoting relationships and collaboration in managing the multitude of mental health issues facing children today. This collaboration now in its 4th year has become the model for other programs in the country.

The Rural Pediatrics month in the first year is also a unique immersion experience where residents have the opportunity to explore general pediatrics in a small town or rural setting. The resident is matched with a faculty rural pediatric practice in one of many small communities throughout Maine. This is a wonderful opportunity to provide medical care away from the specialty environment of the children's hospital, live in the local community, and work directly with a rural based pediatric practice within a 2 hour radius of Portland. Most residents live in provided housing during this month. Others commute from Portland.

The Community Pediatrics month in the second year takes place in a local pediatrician's private office or a rural setting; your choice! In addition to seeing patients of the practice, residents also work with office management staff to learn the operation of the practice and the components of managed care that are involved in pediatric practice today. Time is also spent in the Countdown Clinic during this month as well as Spring Harbor Hospital's Developmental Disorders Unit so that residents get a glimpse into these resources important and available to our community pediatric care-givers.

Advocacy- Child and Community

Our Advocacy Rotation in the second year is an exciting and unique rotation. This month-long experience is supervised by Dr. Larry Ricci, one of the few board-certified child abuse pediatricians in the country. Through this experience, residents have the opportunity to learn about child advocacy by meeting with experts in community organizations that provide services to children. Residents meet with State AAP representatives and leadership of the Maine Health system, participate in legislative sessions at the Maine State House in Augusta, and have the opportunity to explore a topic of their interest, interview key stakeholders in the area, visit clinics, schools and families and present their work to others. This may be done by writing an opinion editorial piece for the paper, developing a poster presentation for a local, state, or national meeting, or leading a presentation for other residents and faculty. Some examples of recent projects have included the development of resources for physicians and patients dealing with Inflammatory Bowel Disease; developing a middle-school curriculum on sun safety and the risks of tanning, working toward promoting safe sleep for newborns, exploring Early Childhood Education in Maine and developing a policy paper to address shortfalls in this system, and promoting awareness of synthetic marijuana and its risk to teens, to name a few. These examples highlight the diversity of projects chosen by our residents during this experience. Many of our residents end up continuing work on their projects during the remainder of their residency.

We value the opportunity to have residents participate in longitudinal projects of their interests with faculty advisors as mentors and have found creative ways to see projects through to completion throughout the training program.

Behavior/Developmental Pediatrics

Behavioral and Developmental Pediatrics occurs in the intern year where residents work with our three board certified developmental pediatricians and two neuropsychologists caring for children with behavior issues, autism spectrum disorders, ADHD, and learning disabilities. The bulk of this rotation occurs in the outpatient developmental-behavioral pediatric clinic. Time is also spent in pediatric neurology clinic, spina bifida clinic, child abuse clinic, and developmental team clinic. This rotation involves interactions with the diversity of experts in child development, learning disabilities, neurology, and child psychiatry.

Adolescent Medicine

Adolescent Medicine training includes a month block in the second year where residents work side by side with faculty in school based health clinics, eating disorders clinic, adolescent psychiatry clinic, sports medicine clinic, gynecology clinic, STD clinic, and other venues where care is directed toward teens. This experience also includes the weekly "Teen Clinic" and sessions spent in primary care offices where adolescents make up the bulk of the patient population.

During the adolescent medicine rotation, residents get another opportunity to work in child psychiatry medication management clinic with their “Child Psychiatry Fellow Buddy” as part of the Pediatrics/Child Psychiatry Buddy System Program and spent time at the Spring Harbor Hospital adolescent inpatient psychiatry unit.

Neonatal Intensive Care

The Neonatal Intensive Care unit experience occurs in our Women and Infants East Tower, and includes the 50 bed NICU and Step Down unit our Labor and Delivery suite, as well as our mother baby unit and newborn nursery. The NICU has over 700 admissions per year of which 150 are transports from outlying hospitals. Residents are supervised by a team of full time, board certified neonatologists with a wealth of experience caring for premature infants as well as the education of residents. Residents gain valuable delivery room experience, manage premature infants with complex needs, and learn assessment skills to quickly triage those infants requiring intensive care from the delivery room. Experienced neonatal nurse practitioners complement the neonatology service and are involved in the day to day care for patients, and hands on training of residents in our NICU.

Pediatric Intensive Care

Our Pediatric Intensive Care unit clinical rotation occurs in two 1-month blocks during the second year. During this time, the residents are the primary caregivers for critically ill children in our 10-bed PICU directly adjacent to our pediatric inpatient unit.  Here, residents work closely with our PICU staff, pediatric subspecialists, and surgical subspecialties. The patient population in the PICU is varied, so residents care for children with the myriad of diagnoses that require critical care, including status epilepticus, respiratory failure, diabetic ketoacidosis, sepsis, and the pre and post-operative care of patients with critical congenital heart disease. Residents are also members of the Pediatric Critical Care Transport Program. This ground-based system transports critically ill children from Maine and southern New Hampshire hospitals to The Barbara Bush Children's Hospital. This experience provides residents with autonomy, the opportunity to perform many pediatric procedures, and independently make acute management decisions, all under the direction of our pediatric intensivist staff who value patient care, and resident teaching.

Emergency Pediatrics

Residents spend two months of acute care pediatrics at the MMC Pediatric Emergency Department, one in the intern year and a supervisory rotation in year 3. The MMC ED is a level one trauma center and sees over 21,000 pediatric patients each year.  Our emergency department underwent dramatic expansion in 2009, and now has 10 dedicated pediatric beds geographically distinct from the rest of the department. Residents care for children who present to the ED including those with major or minor trauma, orthopedic injuries, poisonings, ingestions, and lacerations. Pediatric residents are scheduled preferentially on the pediatric wing of the department, to maximize their experience with children. Adults with pediatric applicable issues are also seen on this rotation (young adult women who need pelvic exams,  adults that need laceration repairs, splinting, reduction of dislocations, etc.). In addition, residents spend time at Brighton First Care, our urgent care center 10 minutes from MMC.   Emergency Pediatrics  is supervised by attending emergency medicine staff under the direction of three Board Certified Pediatric Emergency Medicine physicians. In the third year, pediatric residents supervise the learning of pediatric and emergency medicine interns in the care of pediatric patients in the ED. Residents also spend time at the Northern England Poison Control Center as part of the embedded toxicology curriculum during these months.

Subspecialty Core Experiences

Four months of time during the training program is dedicated to subspecialty elective experiences.  All of the major subspecialty areas are represented in our program. Your program director and individual faculty advisor will help you chose your core subspecialty rotations, designed to meet your needs by taking into account your future career interests. Options for these experiences include the following core opportunities:

  • Allergy/Immunology
  • Cardiology
  • Child Abuse
  • Endocrinology
  • Gastroenterology
  • Genetics
  • Hematology/Oncology
  • Infectious Diseases
  • Nephrology
  • Neurology
  • Pulmonology

Individualized Curricular Experiences (ICES)

In addition to your elective time, six months of training is set aside to provide for an individualized curriculum designed by each resident, Program Leadership, and Faculty Advisors. The goal of this requirement is to personalize the education of each resident in the second and third years of training so that each receives the experiences that will best prepare them for their individual career choices.

As part of this individualized curriculum program, residents can chose to spend additional experiences in any of our community, rural, inpatient, acute care, or core subspecialty rotations.  Secondly, many residents design unique experiences that best prepare them for their post-residency plans. Some recent examples include rotations in Neonatal Neurology, NICU Hospitalist, and a simulation-focused experiential month. And finally, additional rotations listed below are available for residents specifically geared to prepare them for the career path they decide to focus on after their residency.

Academic Advanced Pediatric Primary Care Elective

This month long rotation is available to senior residents in the program. The elective is spent in the BBCH Pediatric Clinic with the emphasis on Teaching/Precepting junior learners; Improving skills in Quality Improvement; Honing skills around billing and coding, and developing scholarly work on primary care topics.  During this elective, senior learners will precept medical students or interns with attending supervision to solidify skills around teaching and giving feedback. Work on quality improvement can be the development of a new project or work on an ongoing Continuity clinic project. Non- patient care activities include attendance at Preceptor and Division director level meetings and individual time with Billing Coders. Scholarly activities will include supervision of  2 Medical Student case reports, 2 brief lectures in Pediatric Clinic on primary care topics, an evidence-based Primary Care morning report, and a scholarly project ( abstract, article, QI project, EPIC workflows). This elective is valuable for residents contemplating a primary care career (especially where there are teaching options) the rising chief, or hospitalists who may cover in outpatient clinics.

Pediatric Surgery

Pediatric Surgery is one of our experiences available as an individualized curricular option. Here, under the direct supervision of four board certified pediatric surgeons, residents gain knowledge of common pediatric surgical conditions including the evaluation of the acute abdomen, hernias, trauma, burn management, vascular access needs, pyloric stenosis, intussusception and others. Residents spend about half their time on this rotation seeing patients with the surgeons in the office setting, and about half the time following inpatients, NICU or PICU patients with surgical issues. The opportunity for dedicated mornings with pediatric anesthesia is an option during this month as well. A valuable competency of this rotation is to gain an understanding of the pre- and post-operative management of children undergoing surgery. This experience is extremely valuable to any resident looking to practice primary care pediatrics in a rural or urban setting, as well as those residents looking to pursue fellowship training in a pediatric subspecialty that works with pediatric surgeons (NICU, PICU, and Gastroenterology, among others).

Chronic Care Management/ Medical Home

The Chronic Care Management/Medical Home (CCM) rotation is another experience available as part of the individualized curriculum.  This primarily outpatient based rotation has an overarching goal of gaining increased exposure to the care of children with Chronic Health Care needs. Time is spent in a variety of settings.  Residents will have time to review current literature, presentations, and websites dedicated to the Pediatric Medical Home concept; they will then spend time in extended sessions with some of their own continuity clinic patients observing in a school setting, participating in  an Individualized Educational Plan (IEP) meeting, or doing a home visit to better understand the needs of their own patients with chronic health care issues.  Thirdly, residents will spend time in a variety of specialty clinics based on resident interest that will expose them to patients with multidisciplinary health needs. Clinics available for this experience include Oncology Wellness Clinic, Cleft Palate Clinic, Metabolism Clinic, NICU follow-up clinic, Pediatric Dentistry, and Muscular Dystrophy Clinic to name a few.  This experience is extremely valuable to any resident looking to practice primary care pediatrics in a rural or urban setting, residents looking for a career as a pediatric hospitalist, as well as those residents looking to pursue fellowship training in a pediatric subspecialty that cares for kids with chronic health care needs.

Continuing Care Level 2 Nursery (CCNSY)

This month long rotation in the Continuing Care Nursery is one of our experiences available as part of the individualized curriculum.  This experience has the following goals: to provide resident education and experience in the delivery room attendance of the late pre- term and term infants, to gain expertise in the initial management and evaluation of the transitional infant from the delivery room, and to provide care of the NICU graduate including discharge planning with appropriate medical and social follow-up. This rotation is a valuable opportunity for those residents looking to practice as either general pediatricians in settings without a level 3 NICU nearby, or as hospitalists who will be managing this population. In addition, residents who will be practicing and providing consultation services to family physicians may find this experience valuable.

Newborn Neurology Elective

The Newborn Neurology rotation is an experience available as part of the individualized curriculum as either a month-long rotation or an intensive two-week focused experience. The Newborn Neurology elective is a combined experience of inpatient and outpatient newborn neurology focused on common neurological issues of the preterm and term neonate such as neonatal encephalopathy and therapeutic hypothermia, interventricular hemorrhage and periventricular leukomalacia. Residents will develop the skills to perform an excellent neurological exam in both preterm and term infants and have exposure to imaging modalities including cranial ultrasound and MRI of the brain. Residents will also learn basic interpretation of neuro-diagnostics such as aEEG and conventional EEG. In addition to inpatient consultations, residents will participate in two weekly half-day outpatient clinics where the sequela of these above-mentioned acute neurological issues such as seizures, developmental delay and spasticity/cerebral palsy will be assessed. During afternoons if there are no clinical obligations, residents will be expected to work on a clinical project that either has a clinical research or quality improvement theme. This experience is extremely valuable to any resident looking to practice primary care pediatrics in a rural or urban setting where attending deliveries and recognizing neonatal encephalopathy will be required. In addition, residents considering a career in neonatology or child neurology will benefit from this early exposure to the fast-growing field of neonatal neurology.

Global Health Overseas or Local Immersion Experience

All of our residents receive education throughout the training program on how to practice pediatrics effectively in a global community. This is accomplished via didactics, time spent in our international clinic, and during opportunities to visit local organizations that serve our immigrant population. Residents can participate in an "On Site Global Health" rotation as well as international global health opportunities.

For those residents looking to spend time in international settings, our program strongly encourages them to explore these interests during training. We have sent many residents to a number of international destinations including the Dominican Republic, Haiti, India, Swaziland, Lesotho, Cambodia, Guatemala, and Ecuador over the years. A number of our residents have gone on to pursue international positions post-training with the Baylor AIDS Program, among others. We've even had one resident hired to lead a residency training program in Eritrea after working overseas post-training.

Non-Core Elective Experiences

In addition to the subspecialty and individualized curricular experiences above, a number of other elective experiences are available to residents as follows. These opportunities are available as full one-month experiences, or split up into smaller blocks of two weeks each.  Goals of each of these rotations would be to provide the education needed for a resident based on his/her career plans. No "one size fits all" here!  One resident may need 1 or even 2 or more months of one of these experiences, others, just a few weeks. You will work with your advisor and program leadership to help plan these experiences. Below is a list of some of these opportunities:

 •Child Psychiatry

 •Countdown Clinic

 •Discipline and Parenting Reading Elective

 •Integrative Medicine

 •Neonatology Hospitalist

 •Pediatric Hospitalist

 •Pediatric Simulation

 •Research Block Month

 •Rheumatology

 •Sports Medicine

We can tell you much more about these experiences during your interview.  Come see for yourself the unique training experience our Pediatric Residency Program can offer. Our curriculum will provide you ample opportunity for general and subspecialty exposure so that you can make the best decisions regarding your future plans. We can then work with you to tailor your curriculum based on these future career goals.  We look forward to your visit!

 

 

 

 

 

 

 

 

Maine Medical Center is a member of the MaineHealth System