Ideally, you spend most of your training on the cusp of your learning curve (read: the learning to work ratio should be favorable). Another analogy: the treadmill of training should be quite challenging, but comfortably so.
What are unique features of our curriculum?
Probably the most important is that our residents stay together on the same discipline for the first two years of training. All residents start together in internal medicine and rotate together every four months for the first two years of residency.
Why is this so important? For many reasons, not the least of which is the close bonds each class is able to forge with each other. It also makes switches easier (especially the first one from medicine to pediatrics), and less stressful (you are never alone). You start with the rigorousness of internal medicine during intern year, and then rotate to pediatrics in November. Once our residents hit their third year have grown their clinical confidence, we allow them to rotate on a more frequent basis as the schedule allows.
In fact, we believe that having every class stay together during those critical first two years is a very important part of why we have such a low drop-out rate and high residency satisfaction.
- Four month switches. We switch every four months during the first two years of residency. We refer to this as the “Goldie Locks” approach. Why Goldie Locks? Because the four month switchers are "not too long, and not too short".
You can relax the fourth month and enjoy a sense of mastery (unfortunately a bit difficult in this ambitious discipline!), but you don’t have to start from scratch with every switch. Indeed, how many times do you want to memorize the dose for amoxicillin?
We have found the four months blocks are optimal for learning during those foundational years of residency. It keeps the treadmill at a reasonable speed. It evens out your lecture series attendance in internal medicine and pediatrics, who always have a series of early conferences for the incoming residents.
It also provides seasonal variation in pediatrics, which is a key element in pediatric training. After all, managing RSV disease is important to learn, but not four winters in a row.
- The residents always start in internal medicine. This cements the rigorous approach to differential diagnosis and independent decision making. The switch to pediatrics in November is easier than the reverse would be. You still start team leading in both internal medicine and pediatrics in the second year, easily keeping pace with your categorical counterparts.
- Ambulatory experiences. We have 6.5 months of ambulatory block time built into the curriculum. There are six weeks primary in the first year and two divided in the third and fourth years.
These rotations include a range of experiences including: dermatology, orthopedics, ophthalmology, women’s health, geriatrics, end-of-life care, managed care, rural medicine, high risk clinic, lead clinic, home visits with nurses, sports medicine, transitional medicine, headache clinic, homeless van, evidence based medicine and more!
There is one month of child development, a month of outpatient adolescent medicine and two weeks of private med-peds office experience.
There is also lots of ED at CCHMC, which addresses Frank Biro’s graduate survey from the 1980’s, in which the most universal complaint about training was that there was too little pediatric ED experience.
Our pediatric ED is fully staffed by board certified ED Attendings and there is a wide range of patients and acuity. You work in many different levels of acuity, from being part of the trauma team to treating common ailments. It is also one of the world’s busiest pediatric EDs and a fabulous educational experience.
- Maintain parity with the categorical residents in team leading, supervisory experiences, and ICU time. Our residents are never “supervised” by categorical residents at the same training year during residency. We are able to structure the schedule so that rotations early in the second year are “second year only” rotations and our residents are team leading with their peers by mid second year. As a result, there are only a few months of call in the third and fourth years. This is due to the “front loaded” design of our curriculum, in order to keep you up to speed with the categorical residents.
- Maximize learning in the ICU setting, not time spent there. There is no second PICU month because of similarities with the MICU, where you spend two months. There are only 2 months total of NICU.
What can this curriculum accomplish for you?
Your training will provide you with a foundation to pursue any subsequent career goal you have!