Education is the core focus of the Kaiser East Bay Pediatric Residency Training program. Didactic and group education occurs via Chief Resident-guided twice weekly morning report sessions and Resident guided twice weekly morning topic based conferences. Daily lunch conferences spanning the breadth of pediatrics, weekly radiology rounds, weekly departmental grand rounds, monthly mock codes and mock deliveries, and a monthly EBM exercise, allow for a diverse and broad platform for interactive education. Clinical Case Conferences, regional pediatric subspecialty web-based and video conferences, and M&M sessions are offered as well. In the clinical environment there are also frequent opportunities for patient-centered talks delivered by team members. Pathology and Pediatric Surgical case conferences as well as special local and regional seminars/training (EBM, Biostatistics, Cultural Competency, Research, Mentorship, Physician Wellness, Quality Improvement, Communication as Teachers, Leadership/Business of Medicine, Global Health “Brown Bag” webinars) occur on an ongoing basis. The residents have an opportunity to teach 3rd year medical students from UCSF School of Medicine and 4th year students from across the country rotating on the inpatient ward, in the outpatient clinic, in the NICU/PICU, and subspecialty disciplines. The focus of our teaching at Kaiser is on patient-centered, evidence-based, quality and outcome driven, clinically useful information. Clinical experiences are divided in the following areas:

 

Inpatient Training

Our inpatient training is focused at the new Kaiser Oakland Medical Center on a busy 35-bed pediatric ward. The pediatric ward has an excellent mix of general pediatrics, subspecialty pediatrics, hematology-oncology, general pediatric surgery, and pediatric surgical subspecialty. The range of pathology seen in this setting is outstanding, providing a high level of acuity and complexity that prepares each trainee in the scope of caring for “bread and butter” general pediatric patients as well as tertiary care medical and surgical patients referred with multi-specialty based issues. The pediatric residents have primary responsibility for the care of all of the general and subspecialty pediatric patients, as well as team-based responsibilities for our surgical patients. Residents and faculty engage in family centered rounds and our curriculum is also applied to night team experiences.

The residents manage the patients on the ward under the guidance of a pediatric inpatient hospital based faculty attending, and resident autonomy is developed through critical thinking skills and clinical problem solving. Residents also work closely with the various pediatric subspecialists, including pulmonary, hematology/oncology, neurology, gastroenterology, endocrinology, nephrology, infectious diseases, and cardiology, among others. The ward residents also act as a consult service for pediatric cases in the emergency room. Pediatric inpatient faculty support is available in-house 24 hours a day, for day and night team trainees.

Outpatient Training

The outpatient clinic experience is a major strength of the training program and affords longitudinal experiences and relationships with patients, families, and the populations we serve.

Residents have continuity clinics based at the Kaiser Oakland campus, each with their own panel of patients drawn from the large, diverse Northern California Kaiser population. Many residents serve as providers for newborn patients from their well-baby nursery and NICU experiences and follow them for the entire length of training. With a faculty preceptor in the clinic steering residents through quality based and evidence driven clinical education, residents are guided through their training and afforded progressively increased independence and responsibility for their own patients. Residents care for each other’s patients when unavailable and participate in clinic practice and population management through quality improvement initiatives and small group meetings.

To best prepare trainees for future career environments, senior residents have concentrated experiences in serving as junior preceptors as well as a senior level rotation at Kaiser Richmond, in which third year residents act as junior staff pediatrician. During these months, residents see a terrific blend of urgent care and well-child care visits, and sharpen their skills in ambulatory teaching and leadership. Along with participating in direct advocacy and communication with their patients through telephone, secure email messaging, and video based encounters, these experiences reflect practical training for the next generation of pediatric practitioners.

Community Pediatrics

As a nonprofit integrated health care delivery system, Kaiser Permanente has a long tradition of sponsoring preventative and volunteer efforts in our communities. There are multiple opportunities for residents to volunteer for health fairs and other health seminars. In addition, residents have the opportunity to spend time in the community outside of Kaiser during their residency training. Senior educational experiences allow for the opportunity to work in community-based clinics serving underserved and under-accessed population and to participate in community-based projects and spend time learning more about community resources including WIC, The Regional Center of the East Bay, hospice centers, and the Alameda County Lead Prevention Program.

In addition, residents spend time in outside clinics and community centers during their adolescent and developmental/behavioral pediatric rotations, as well as on several of their electives. As part of our diverse conferences, a variety of speakers discuss the role of the pediatrician in the community related to a wide range of issues from foster care to school based medicine to culturally competent care. Advocacy for children’s health issues is also a part of this curriculum. In 2012-2013, our residents began to integrate many of these experiences via the Kaiser Pediatric REACH program.

Neonatal Intensive Care Unit (NICU) Rotation

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.

Well Baby Rotation

The well baby rotation, affectionately known as the “First Week of Life” 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 participate in attending deliveries, managing a variety of newborn clinical issues, and gain skills in neonatal resuscitation for routine and high risk deliveries. Residents also gain skills in performing circumcisions, gain deeper experience in breastfeeding counseling and support, have opportunities to participate in home-visits and after-care follow up.

Pediatric Intensive Care Unit (PICU) Rotation

Our PICU is a 12 bed unit with a superb mix of medical and surgical patients. It is staffed by pediatric intensivists and provides PICU training that focuses on critical thinking at the bedside and supervised in a one-on-one fashion with our PICU faculty, with opportunities for procedures and transport under their supervision. Residents are trained in this high acuity educational setting with the support of 24 hour in-house intensivist coverage.

Our residents have experiences in critical care that span the continuum of graduate education. In the PGY-1 year, residents have an introductory experience in our Oakland Medical Center PICU, with an emphasis on developing foundation skills in critical care. In their second year, they are assigned to a block rotation at Children’s Hospital Oakland for a Pediatric Intensive Care rotation. The Children’s Hospital Oakland PICU is 10 minutes from Kaiser Oakland. Kaiser residents are part of a team which includes an intensivist, and an ICU fellow. In the third year, residents spend a senior level experience in the PICU at Kaiser Oakland, emphasizing problem solving and strengthening essential critical thinking skills in this setting.

Pediatric Emergency Room

Emergency room immersion and longitudinal experiences begin in the PGY-1 year at Kaiser Oakland and Richmond and continue along the educational continuum, with opportunities for consultation on pediatric patients, focusing on evaluating and treating acute ill children, and developing strong communication and effective decision making skills. 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 during daytime and nighttime inpatient experiences and also takes place during 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.

Electives and Individualized Curriculum

Our residents have terrific opportunities for elective rotation experiences over their three years of training in a breadth of subspecialties. Together with faculty mentors and program directors, residents may also steer their training to pursue more individualized curricular experiences, tailored to emphasize preparation for prospective future career paths and educational needs. Resident specialty elective opportunities on our campus include (but are not limited to): Pulmonology; Hematology/Oncology; Dermatology; Gastroenterology; Pediatric Surgery; Neurology; Nephrology; Cardiology; Endocrinology; Allergy; Genetics; Physical Medicine and Rehabilitation; Rheumatology, Neurosurgery; Sports/Medicine; Orthopedics; Ophthalmology; Pediatric Anesthesia; Pediatric Head and Neck Surgery; and Radiology. In addition residents may also choose to do clinical rotations at other Kaiser Permanente or affiliated facilities in the San Francisco Bay Area and beyond. We strongly encourage our residents to use their elective time to gain the subspecialty experience they need to become excellent general or subspecialty pediatricians, and to be able to pursue areas of particular interest to their future career goals. Individual curriculum blocks are designed to help each trainee gain more advanced training tailored to career path and/or educational goals. We offer flexibility with elective training and work with each resident to individualize the residency training experience to best suit personal and professional learning and educational goals.

Research and Scholarship Opportunities

With the terrific backdrop of our organization, Kaiser East Bay pediatric residents have rich opportunities to explore and discover through research and scholarly pursuits. Many of our residents are involved with research and scholarship projects, ranging from clinical inquiries to quality improvement to medical education. Strong support is provided for residents to engage in these pursuits and present their work in a variety of venues. Kaiser Permanente Northern California is home to our Division of Research (DOR). The DOR was founded in 1961, and today its staff of over 400 is actively involved with over 220 active research projects. The DOR and our residency programs have an established relationship, and residents who require access to patient databases, statistics, and other analytical services collaborate with resources via the DOR for assistance in project planning, data collection and processing, and vehicles for dissemination. Residents interested in research also participate in resident-based training offered by the DOR, designed to support the skills needed to navigate critical processes and sharpen their investigative skills further. More information about the DOR can be found at the Division of Research website.

Rotation Schedule

PGY 1

The first year is designed to provide a solid clinical foundation of experiences with a broad overview of general and subspecialty pediatrics needed in order to be prepared to take on a supervisory role. Emphasis is placed upon foundations of clinical competency, cultivating growth, communication skills, and entrustment. A typical PGY-1 training schedule may look like the following:

4 blocks – Pediatric Inpatient Ward
1.5 blocks – Pediatric Ward Nights
1 block – NICU
0.5 blocks PICU
2 blocks – General Pediatric Ambulatory clinic/Development
1 block – Adolescent Medicine
1 block – Well Baby Nursery and Delivery Team
1 block – Elective/Individualized Curriculum

PGY 2

The second year emphasizes synthesis of foundations of clinical competency into more problem solving and critical thinking as a leader, with growing autonomy and further entrustment of responsibilities. Emphasis is placed upon further development of competency as a clinician and supervisor. Residents participate in more subspecialty elective training and are given the opportunity to explore arena in greater depth. A typical PGY-2 training schedule may look like the following:

1.5 block – Pediatrics Inpatient Ward
1 block – Pediatric Ward Nights
1 block – PICU
1 block – NICU
0.5 blocks – Advanced NICU/Delivery Team Nights
1 block – ER
1.5 block – General Ambulatory Clinic/Development
0.5 block – Senior Teaching/Leadership
4 blocks – Electives/Individualized Curriculum

PGY 3

The third year focuses on strengthening clinical competency in preparation for independent practice or further post-residency training. Residents are afforded independence to make decisions regarding management and are responsible for organizing and leading inpatient and outpatient services under the supervision of a faculty pediatrician. Particular attention is paid to the senior resident as a teaching supervisor. Emphasis is placed on synthesis and demonstration of all six general competencies in all environs. A typical PGY-3 training schedule may look like the following:

2 blocks – Pediatric Inpatient Ward
1 block – Pediatric Ward Nights
1 block – ER
1 block – PICU
1 block – NICU
1 block – General Ambulatory Clinic/Development
1 block – Richmond Ambulatory Clinic
4 blocks – Electives/Individualized Curriculum/Development

If you have any additional questions, please feel free to contact Trixy Bulda, GME Coordinator.