The med-peds program currently accepts 14 intern candidates into each year's class. One half of each class begins their training in medicine, the other half in pediatrics, with each group switching between departments every about every four months. Residents in the combined medicine/pediatrics program spend 16 blocks as interns, each block lasting 4 weeks. During this time, they are introduced to rotations on inpatient services at our five major hospitals, interspersed with ambulatory and elective assignments to provide a solid, well-rounded foundation in clinical decision-making. Interns' experiences are sufficiently broad and complete to provide them the confidence to transition to a supervisory role at block 17. The Med-Peds residents switch between departments every four blocks, allowing for exposure to illnesses with seasonal variation in both adult and pediatric patients. During the remaining 36 blocks, the resident performs as a team leader (corresponding to a second or third year categorical resident) expanding his/her role as both clinician and teacher. The supervisory responsibilities blend inpatient and outpatient services to prepare the resident for a variety of future career options. Elective choices are tailored to individual career needs.
Our training exposes the resident to an extensive range of adult and childhood illnesses. Designed to meet the combined guidelines established by the American Boards of Internal Medicine and Pediatrics, the curriculum undergoes continual evaluation and development in response to feedback from residents and faculty. The rotations encompass neonatology to geriatrics, ambulatory, inpatient, emergency and intensive care in public, private and managed care settings. With a focus on competency-based training we have adopted several other important program experiences, which include a quality improvement project, evidence-based medicine learning, professionalism portfolios and clinic passports.
Didactics are integrated into both departments' activities, including Grand Rounds, morning reports and noon conference series. Each resident is scheduled to present one grand rounds style conference in the PGY3 or the PGY4 year, utilizing skills in literature review, case presentation and/or research. In addition, residents make presentations on the ambulatory block rotation, on geriatrics, on the pediatric community rotation, and for Med-Peds journal club. Conference series are designed to allow residents in the combined program exposure to each department's lecture curriculum over their four years.
Inpatient team size varies from 2 to 6 residents. The number of patients per intern usually averages from 6 to 10. Determinants of team size include educational goals and patient volume and acuity on the individual services. Third and fourth year medical students are frequently participants in ward teams. Faculty and, on certain services, fellows are readily accessible at all times for assistance and guidance.
All blocks last four weeks. Call during the internship year occurs as a 'short call' until 9 pm every four to six days. The structure of this short call varies depending on the hospital and the service. Each intern will also have one block of night float -- one each on the medicine and pediatric services -- when she or he will gain experience in typical overnight call activities. During the 36 blocks as a senior resident, night call varies from every fourth to sixth night, averaging every fifth night. House staff have a minimum of four days free of duties each block while on an inpatient service. There are a number of ambulatory and call free elective blocks. Residents are encouraged to develop their individual skills via independent scholarly or leadership projects. They also have the opportunity to demonstrate citizenship through participation in residency and institutional committees. Our program strictly adheres to current residency training guidelines.