Training
The educational goal and design of the program prepare a resident for a pediatric career of their choosing, whether it is as a general pediatrician or a subspecialist, in an academic or community-based setting. With its medium size and close interaction with faculty, the program provides residents with substantial subspecialty opportunities as well as a well-coordinated outpatient continuity clinic experience. This set-up provides ample oversight toward residents gaining confidence in autonomous medical decision making and allows them to participate actively in quality improvement and advocacy projects. The program incorporates an advanced wellness curriculum and promotes advisor and mentorship interactions. Educational activities throughout the week include departmental and divisional conferences that emphasize active learning skills.
Over their three years of training, our residents spend 50% of their time in ambulatory settings and 50% in inpatient settings. We believe in longitudinal exposure to both general pediatric and subspecialty medicine throughout training with increasing autonomy and supervision of more junior trainees as you progress through the curriculum. Our unique design of three-week rotations allows our residents the opportunity to rotate on more subspecialty services and enhance their learning through repetition at different stages of training. As a result of this structure, residents have six Individualized Curriculum (IC) rotations that can truly be individualized and help each resident prepare for their unique career needs. Residents attend continuity clinic once each week on most rotations as well. Our clinical exposure by year includes the following:
| PGY-1 rotations | PGY-2 rotations | PGY-3 rotations |
|---|---|---|
| Inpatient general pediatrics x 6 (days x 4, nights x 2) | Supervisory inpatient pediatrics x 2 | Supervisory inpatient pediatrics x 2 (days x 1, nights x 1) |
| Outpatient general pediatrics x 2 | Outpatient general pediatrics x 1 | Supervisory inpatient subspecialty pediatrics x 1 |
| Inpatient subspecialty pediatrics x 1 | Inpatient subspecialty pediatrics x 1 | Lead resident educator x 1 |
| Newborn nursery x 1 | Hematology/oncology inpatient x 1 | Outpatient general pediatrics x 2 |
| NICU x 1 | Hematology outpatient x 1 | PICU x 2 |
| Individualized curriculum x 1 | PICU x 1 | NICU x 1 |
| Community health/advocacy x 1 | NICU x 2 | Individualized curriculum x 3 |
| Palliative care x 1 | Individualized curriculum x 2 | Adolescent medicine x 1 |
| Child abuse and neglect x 1 | Community health/advocacy x 1 | Subspecialty care x 2 |
| Infectious disease x 1 | Subspecialty care x 4 | Emergency medicine x 1 |
| Emergency medicine x 1 | Emergency medicine x 1 | Developmental/behavioral x 1 |
| Vacation x 4 weeks | Vacation x 4 weeks | Vacation x 4 weeks |
Individualized curriculum
Residents use the six individualized curriculum rotations throughout the three years to gain additional experience in local clinical electives, international medicine rotations, or to advance quality improvement, advocacy, or research projects. Below are some choices residents can select from but have the freedom to construct their own experiences to align with their future career goals.
| Anesthesia | Allergy/immunology |
| Behavioral pediatrics | Metabolics/genetics |
| Sleep medicine | Pain management |
| Toxicology | Dermatology |
| Palliative Care | Mother-Baby Unit |
| Nutrition | Orthopedics |
| Research/Scholarship | Breastfeeding |
| ENT | Ophthalmology |
| Nutrition | Maternal/fetal medicine |
| Radiology | Critical care transport |
| Procedural elective | Global health |
Clinical sites
Inpatient and outpatient experiences for the Pediatric Residency Program include:
- Inpatient and outpatient care at Doernbecher Children's Hospital (DCH)
- Inpatient and outpatient care at Legacy Randall Children's Hospital (RCH)
- Ambulatory care at Kaiser Permanente
- Outpatient care at OHSU Bethany Village Pediatrics Clinic and Pacific Pediatrics/Yakima Valley Farm Workers Clinic
- Adolescent health at school-based health centers and Kartini Clinic
Telemedicine
The COVID-19 pandemic led to dramatic increase in telehealth medicine to meet the needs of our patients. Residents receive training in telemedicine that includes video and telephone visits. Telehealth has been incorporated into primary care as well as subspecialty care.
Academic Enrichment
Our Academic Enrichment program was started in 2021 with the goal of giving residents a longer period of time per week to focus on essential pediatric topics while having protected time away from their services. Academic Enrichment happens every other week for an individual resident, weekly alternating between interns and PGY-2/PGY-3 residents. During the summer and fall, faculty presenters cover a core curriculum of pediatric topics. During the remaining months, we cover a standard curriculum based on American Board of Pediatrics material that is presented with adult learning objectives, including hands-on learning.
Morning Report
The goal of Morning Report is to improve resident communication and clinical decision-making skills in a comfortable learning environment. Under the direction of the chief residents and in the presence of faculty, residents present timely medical cases that explore various aspects of patient care objectives, including delineation of differential diagnoses, the medical work-up, and/or management care plans. The conference also incorporates interactive tutorials from allied services of the Department of Pediatrics such as radiology and dermatology. Morning report is a half-hour conference held four days per week.
Noon Conference
Noon conferences occur approximately 1-2 times per week and address longitudinal content over a three year period. Curricula include addressing health and societal inequities, legislative advocacy, global health, quality improvement initiatives and class meetings.
Pediatric Grand Rounds
Pediatric faculty, community pediatricians, residents, and students attend this weekly session. Various pediatric topics, including research advances, translational medicine, and challenging clinical cases are presented, usually in a lecture format. Guest presentations are common, and there are several endowed lectureships throughout the year that attract acclaimed physician-scientists.
Pediatric Chair's Friday Forum
The Pediatric Chair's Friday Forum is a weekly interactive conference held October-June facilitated by faculty and residents for all department members. Friday Forum is structured around six rotating themes: clinical reasoning, evidence-based medicine, morbidity and mortality, health equity rounds, research in progress, and ethics. Its overall objectives are to instill lifelong-learning practices for participants and to further develop critical-thinking skills essential to the practice of medicine and translational science. Residents often have opportunities to present at the Friday Forum.
Pediatric-Emergency Medicine M&M
A monthly conference is held jointly with the Department of Emergency Medicine to discuss pediatric patients whose initial presentation is to the emergency department. Residents and faculty from both departments attend this conference. Patients are presented by the pediatric and emergency medicine residents. The case format allows for discussion of the differential diagnosis and treatment plan, facilitating communication between the two departments.
To supplement residents' clinical learning, we have a number of unique additional curricula. With these experiences, residents learn more than just the day-to-day of being a resident; they learn about the "real world" and develop skills that will help prepare them for the next stage of their career and life.
Community health and advocacy curriculum
Our longitudinal advocacy curriculum includes the Child and Adolescent Community Health (CACH) rotations in the first and second year, as well as our monthly scheduled advocacy special interest groups and advocacy skills training.
Anti-Discrimination and Health Equity Curriculum
Our program is committed to cultivating an equitable, inclusive, and diverse environment and to addressing inequities for our patients and families. This longitudinal curriculum includes unconscious bias training, active bystander skill development, health equity rounds, and conferences that address healthcare disparities and the role of structural racism and discrimination in healthcare.
Third Thursdays
As part of our comprehensive community health and advocacy training, we want to ensure that our residents all have the skills to address the needs of children through policy change. Our Third Thursday curriculum complements the resident experiences in CACH by having residents work through a real problem affecting Oregon children to develop a real solution. We collaborate with community-based organizations, legislators, and other public officials and families to develop the expertise and skills to effectively advocate for children. The entire experience is based on collaboration, small-group and individual work, with the goal that everyone who graduates from our program has the knowledge and skills to effect change in their communities.
Becoming an effective senior resident curriculum
During one intern Academic Enrichment in the spring, we focus on enhancing resident teaching and supervisory skills including workshops on subjects like giving feedback, assessing medical students, and facilitating bedside rounds.
Resilience and well-being
A variety of conferences and activities create space for trainees to build community, cultivate communication skills, and debrief difficult events. Intern collaborative experience is a weekly curriculum led by the chief residents and spans the first 10 weeks of the intern year. The goal is to facilitate interns building an essential skill set to include clear verbal and written communication, contingency planning, teaching skills, providing feedback, and working within teams. The sessions are interactive and hands-on, rather than lecture based, drawing from the principles of experiential education, pairing small-group activities with facilitator-guided debriefing and building on the group's development of trust over time. Facilitator-guided debriefing continues throughout residency within individual classes, and during our more emotionally and time intensive rotations, such as the intensive care units. This curriculum supplements the OHSU Resident and Faculty Wellness Program that provides individual coaching and counseling as well as educational workshops and wellness resources.
Quality improvement curriculum
This monthly curriculum is led by the director of quality for Doernbecher and the residency program director. Residents experience real-time learning about quality improvement science while working on a patient care improvement project selected by the residents.
Mock code curriculum
Serious life-threatening events occur infrequently in inpatient pediatrics. Furthermore, biennial NRP and PALS certification are insufficient to maintain critical clinical and team management skills. Through a series of “boot camps” and mock codes, residents practice managing medical emergencies and utilizing crew resource management skills in order to be well prepared when true emergencies occur.
Global health
Working alongside the OHSU Global Health Center, we have developed a longitudinal global health curriculum that draws upon the expertise of faculty at OHSU and other national and international leaders in the field. The curriculum covers both core global health subjects and enrichment curriculum. Residents have the opportunity to participate in overseas electives tailored to their career interests.
For more information or if you have any questions, please email us at: pedsres@ohsu.edu