In July 2019, our program initiated an exciting change in our resident scheduling model as part of an ACGME-approved pilot study. Instead of the typical 4-week blocks with a half-day of continuity clinic interspersed each week, we re-designed our schedule so that our residents typically complete 3-week rotations followed by a full week of clinic. This 3+1 schedule allows our residents to more fully focus on the rotation in which they are participating, whether inpatient or outpatient.
The clinic weeks are spaced to allow our residents to more easily see their continuity patients for their regular well visits every 2-3 months in the first two years. During each clinic week, we have built in additional ambulatory experiences including two half-days each week at each resident’s community REACH site, dedicated time to work on research and quality improvement projects, and a curriculum in systems-based practice.
15 weeks – Pediatric Inpatient Ward
3 weeks – Pediatric Ward Nights
4 weeks – Well Baby Nursery
4 weeks – NICU
2 weeks – PICU
10 weeks – General Ambulatory clinic
3 weeks – Adolescent Medicine
3 weeks – Development
4 weeks – Elective
8 weeks – Pediatrics Inpatient Ward
4 weeks – Pediatric Ward Nights
4 weeks – PICU
4 weeks – NICU
2 weeks – Advanced NICU/Delivery Team Nights
4 weeks – ER
9 weeks – General Ambulatory Clinic
2 weeks – Senior Teaching Elective
11 weeks – Electives
5 weeks – Pediatric Inpatient Ward
5 weeks – Pediatric Ward Nights
1 week – Advanced NICU/Delivery Team Nights
3 weeks – ER
3 weeks – PICU
3 weeks – NICU
10 weeks – General Ambulatory Clinic (1 longitudinal week at the end of each 3-week block)
4 weeks – Outpatient Urgent Care
14 weeks – Electives
Our inpatient training is focused at Kaiser Oakland Medical Center on a busy 35-bed pediatric ward. The pediatric ward has an excellent mix of general pediatrics, subspecialty pediatrics including hematology-oncology, and general and subspecialty pediatric surgery. The residents manage the patients on the ward under the guidance of a pediatric hospital-based attending, who is available in-house 24 hours a day. Resident autonomy is developed through senior resident leadership of day and night team activities and family-centered rounds. Our residents also work closely with the various pediatric subspecialists, serving as the first point of communication for all subspecialty consults, and act as a consult service for pediatric cases in the emergency room.
Residents have continuity clinics based at one of our Kaiser East Bay campuses in Oakland, Richmond, Pinole, or San Leandro. Each resident carries their own panel of patients, and many serve as providers for newborn patients from their well-baby nursery and NICU experiences and follow them for the entire length of training. Senior residents have concentrated experiences in serving as junior preceptors as well as a senior level rotation at Kaiser Richmond, in which they act as junior staff pediatricians. Our residents care for each other’s patients when unavailable and participate in practice and population management through quality improvement initiatives and small group meetings. Residents also learn to communicate with their patients through telephone, secure email messaging, and video-based encounters, reflecting practical training for the next generation of pediatric practitioners.
Our NICU is a 24-bed level III NICU. Kaiser Oakland is a high-risk obstetric referral center with a large volume of deliveries and referrals of critically ill neonates throughout the region, providing residents with the opportunity to develop excellent skills in neonatal resuscitation and critical care. Residents have primary responsibility for the care of premature and critically ill babies as well as opportunities to perform a variety of procedures in this intensive care setting. Direct daytime and night team teaching and guidance from our team of Neonatology and Neonatal Hospitalist faculty afford our trainees excellent skill building for virtually any career venue.
The well baby rotation is an opportunity for residents to care for a large number of healthy newborns from a diverse patient population, born at the Oakland Medical Center campus. Residents on this team attend routine and high-risk deliveries, gaining skills in neonatal resuscitation. Residents also gain skills in performing circumcisions, providing breastfeeding counseling and support, and participating in home-visits and after-care follow up.
Our PICU is a 12-bed unit with a superb mix of medical and surgical patients, including post-cardiac surgeries. It provides training focused on critical thinking at the bedside, supervised in a one-on-one fashion with our PICU faculty. Residents are trained in this high acuity educational setting with the support of 24 hour in-house intensivist coverage, with opportunities for procedures and transport under their supervision.
Emergency room longitudinal experiences continue throughout residency, beginning in the PGY-1 year, as our ward residents consult on pediatric patients in our Kaiser Oakland emergency room. During the PGY-2 year, residents rotate at the Children’s Hospital Oakland Emergency Room, offering an excellent community based pediatric ER experience that includes trauma and general pediatric care. Finally, the PGY-3 educational experience continues with a focused rotation at the Kaiser Oakland and Richmond Emergency Departments. In this setting, residents have the opportunity to do a large number and variety of procedures in the minor injury clinics, function as consulting providers for acute and emergent care in the ED setting, and work individually with emergency medicine faculty.
Our residents have terrific opportunities for elective rotation experiences over their three years of training in a breadth of subspecialties and interest areas. See below for a list of our subspecialty faculty and elective opportunities. In addition, residents also choose to do electives in advocacy, research, quality improvement, lactation, antibiotic stewardship, transport/sedation, medical journalism, rural pediatrics, border health, and global health.