NCC Pediatrics Residency @ Walter Reed Bethesda
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Oveview of the Curriculum

Our curriculum is designed to allow the faculty to certify that our graduates can be entrusted to perform the Entrustable Professional Activities of a General Pediatrician. Our faculty and residents use a variety of teaching methods to reach every type of learning style in order to develop the knowledge, skills, and attitudes needed to independently perform these EPAs. Here are the key and unique components of our curriculum.

 

Continuity Clinic Curriculum

Residents and faculty meet for 45 minutes during the noon hour to discuss the weekly topic of the continuity clinic curriculum. The curriculum was developed by CAPT Joseph Lopreiato in 1995 and has been continually updated to provide residents and faculty with the up-to-date knowledge about primary care health-maintenance. The small group, case-based discussions cover screening, nutrition, immunizations, behavior, normal development, educational testing, and other topics useful for caring for patients in a busy primary care practice. In the spring, the curriculum covers more global practice topics such as telephone triage and cultural sensitivity and more specific topics such as primary care of premature infants.

Morning Report and Lecture Series

Our program has a dedicated 60 minute daily morning report and lecture that is attended by all residents.  The first 20 minutes is Morning Report which reviews recent admissions and highlights a case presented by an intern or junior trainee.  Morning Report is led by the senior pediatric resident.  This role for a senior resident is unique among pediatric residencies, and is aligned with the reality that our graduates practice as the local pediatric expert in remote locations where they must teach and lead medical teams who may not have much pediatric experience.

A 40 minute lecture follows morning report.  Lectures are approved for CME credit.  Topics are aligned with the American Board of Pediatrics content specifications.  The first month deals with emergency and acute care pediatric topics from all specialties including general outpatient pediatrics.  Our current academic calendar details past and upcoming lectures.  Faculty (and residents) receive training in teaching techniques, and the program’s culture of expecting critique and feedback from all levels of learners have resulted in an excellent lecture series.

Required Rotations

PL-1:  During this year, residents are given primary patient care responsibility under direct supervision of senior residents and staff.  The emphasis is on primary care of pediatric patients from newborns to adolescents. Interns spend three months on the inpatient ward (one as day shift, one as night shift and one at the local Children's Hospital), 2 months in the neonatal intensive care unit, two months on the newborn service (one as night shift) and 3 months in the general pediatric clinic.   One month rotations are completed on the adolescent medicine service,, the Walter Reed Emergency Department, and in the emergency room at Children’s National Medical Center, Washington, DC.  Navy interns complete the Walter Reed pediatric orthopedic and sports medicine service at the Naval Academy; other interns can elect to do this required selective later in training. For more information, consult our Rotation Information Page.

PL-2:  The second year is designed to introduce the resident to more sub-specialized patient care and to learn how to supervise junior residents in inpatient settings and in the nursery.  Rotations are offered in developmental medicine, community pediatrics, pediatric critical care (at a local Children's Hospital), the NICU, one month on the Pediatric Consult Service caring for WRB PICU and pediatric surgical patients, ambulatory medicine, and in 4-5 electives. For more information, consult our Rotation Information Page.

PL-3:  In the third year, residents gain skills as teaching chiefs on the inpatient services and in the clinics. Rotations in subspecialty electives and the pediatric ICU at Children's National Medical Center are offered. Two semi-independent rotations prepare graduating residents for their first duty station by approximating attending duties, responsibilities, and privileges at two high-volume sites: one outpatient ambulatory pediatrics month at Malcolm grow Medical Center at Andrews Air Force Base, and one inpatient nursery rotation at Womack Army Medical Center at Fort Bragg, NC. In 2017, a Transition to Practice Rotation in the last month before graduation will be offered. For more information, consult our Rotation Information Page.

Electives

Electives in every pediatric subspecialty are offered by on-site faculty specializing in nephrology, genetics, rheumatology, gastroenterology, endocrinology, cardiology (including specialists in electrophysiology and fetal cardiology), hematology-oncology, infectious diseases, and pulmonology. Pediatric electives are also available on-site at Walter Reed Bethesda in pediatric anesthesia, dermatology, allergy/immunology, radiology, urology and other surgical subspecialties. Rotations in Humanitarian Medicine, Research Methods, and Medical Education Theory and Development are available as well. Residents are encouraged to help develop new electives that specifically meet their individualized career plans. For more information, consult our Rotation Information Page.

Research Curriculum

The NCC Pediatrics Residency has a strong active research community in pediatric basic science, clinical studies, and educational research .  Primers on conducting pediatric research are incorporated into the morning lecture series.  A constantly updated online database of projects and mentors is available.  There are many active protocols initiated by our residents.

All residents are required to complete a scholarly project by the time of graduation.  Topics in basic research methods are offered through the morning conference schedule, and a two-year mentored research curriculum which culminates in a completed IRB-approved research project of the resident’s own design is offered.  A monthly research conference is held prior to Grand Rounds and highlights an area of active research within the Department of Pediatrics at the hospital and at the medical school.  A yearly Resident Research Conference provides a forum for residents to present their projects.  Residents also are encouraged to submit abstracts of their research to national meetings, and funds are provided by the residency for travel for research presentations.  Our residents, fellows, faculty and medical students annually submit over 50% of abstracts for the American Academy of Pediatrics Uniformed Services Pediatric Seminar Scientific Awards Competition.

Resident Involvement on the Program Evaluation Committee

Two representatives elected yearly from each resident class are voting members on the Program Evaluation Committee, formerly known as the Policy & Curriculum Committee, which meets quarterly.  The program has a strong legacy of valuing and implementing resident ideas and suggestions into residency policy and into the educational curriculum.  The intern and PL-2 resident representatives also comprise half of the interview and selection committee for the Chief Resident position for the upcoming academic year. The two senior resident representatives chair the Reverse Education Meeting which collates and provides aggregate feedback from residents to individual faculty.

The committee also commissions a faculty member from an outside institution to review one of our rotations in depth each year.  The committee reviews the report and works with the rotation faculty to implement suggestions.  Curricular improvements and refinements are derived from monthly rotation evaluations by residents, yearly evaluations of the program by faculty, ad hoc suggestions by residents and staff, ideas shared by collaborating institutions, or from changes in policy or guidance from accrediting bodies. The Program Evaluation Committee generates the Annual Program Review which outlines an action plan for programmatic improvement using alumni surveys, program and ACGME resident and faculty surveys, ABP board passage rates, aggregate inservice-training exam results, feedback from site directors, and other report.

Military Unique Curriculum

All residents receive training and exposure to operational medicine and pediatrics.  Interns attend “C4,” the Combat Casualty Care Course.  All residents take the Military Medical Humanitarian Assistance Course, where they learn the knowledge and skills to perform basic epidemiological monitoring, administer oral rehydration solution, assess nutritional status and treat infectious disease in a humanitarian disaster. Operational medical topics such as sports injuries, eye injuries, dive medicine, flight medicine and field dermatologic conditions are offered during seminars and during morning report.

Resident Retreat / Program Retreat / Class Retreats

The yearly resident retreat occurs in September.  The residents use the retreat to foster team-building and to work together to improve the program.  Faculty, staff, residents and nurses gather each year in June to re-assess the delivery of military pediatric care and pediatric resident education in the National Capital Area.

Each class has a yearly retreat experience of their own.  Interns and PGY-2’s have a day and call-free night to be able to meet together for team-building.  Senior residents together spend 4 days at an off-site course to solidify their educational experience.

Performance & Quality Improvement

In fitting with the ACGME's Core Competencies, residents take-on Problem-Based Learning & Improvement (PBLI) projects as part of their Continuity Clinics, learning the basics of PI/QI and applying them to a self-selected primary care topic.  Examples of resident PI projects can be found here.  Additionally, residents participate in the monthly Performance Improvement meeting at the morning conference.  All projects are designed to meet the requirements of MOC Part IV for the American Board of Pediatrics for both faculty and for residents.

Multidisciplinary Care Meeting

Residents participate in the weekly multidisciplinary care meetings while on the inpatient ward rotations.  These meeting involve social workers, nurses, care managers, nutritionists, case managers and physicians.  Their goal is to provide and plan for optimal care and services for our special needs patients as they transition towards discharge.

Pediatric Safety Huddle

Residents participate in the Safety Huddle each week on the Pediatric Ward. This group brings all of the disparate departments and activities involved in care for children - laboratory, nursing, physical plant, pharmacy, operating rooms, and more - to review and improve processes that involve children at our hospital.

Pediatric Medical Simulation

Our hospital boasts one of the most extensive medical simulation facilities in the United States.  Our residents use the USUHS Simulation Center to practice procedures, interview and examine mock patients and perform simulated telephone triage.  An additional facility dedicated to simulation of newborn delivery and premature infant care located at the Walter Reed National Military Medical Center is using for Breaking Bad News simulations and practice on procedural trainers. Weekly mock codes on the ward use simulation..

Advanced Life Support Courses

All interns become qualified in PALS and NRP as well as ACLS and ATLS.  Residents become NRP and PALS instructors by the time of graduation. Resident take the Pediatric Fundamentals of Critical Care Skills Course.

Evidence Based Medicine

Journal Club and discussion of evidence-based medicine topics occurs monthly. PGY2s lead the discussion based on an article of their choice. Faculty mentors help the resident prepare for the discussion. The residency was an early adopter of Massively Open Online Courses (MOOCs), and residents are strongly encouraged to take a research methods or biostatistics MOOC in the PGY2 or PGY3 year. Residents are offered the opportunity to participate in peer-review of articles given to faculty members by editors of journals. The Fresno Test is administered in the PGY1 and PGY3 years to assess EBM Skills. A Clinical Librarian is embedded into the Inpatient Ward and NICU teams.

Combat Casualty Care Course

All pediatric interns spend a week in Camp Bullis, Texas to learn the practice of combat casualty care.  They certify in Advanced Trauma Life Support at the course.

Global & Humanitarian Medicine

All residents take the Military Medical Humanitarian Assistance Course (MMHAC), a course the NCC Pediatrics Residency co-designed with the pediatrics residency at Wilford Hall in 1995. Residents have the opportunity to take the Humanitarian Medicine elective in the PGY2 and PGY3 year, in locations such as Honduras, Peru, Kenya, Nepal, Ghana or aboard the USNS Comfort. More information is available on our HA Medicine page>
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Pre-Attending Clinic & Nursery Rotations

An outpatient rotation and a nursery rotation at community hospitals occur during the PGY3 year. These rotation allow the resident to practice under indirect supervision in an environment and with a scope of practice similar to the assignments given to graduates.

Grand Rounds

The Department of Pediatrics of the Uniformed Services University of the Health Sciences sponsors Grand Rounds, a twice-monthly invited lecture given by pediatricians who are leaders in their fields.

Residents as Teachers

The residency and the Departments have a long tradition of teaching pediatric medicine to medical students, and the Departments are known for their innovation and expertise in pediatric medical education.  Residents receive formal and informal instruction on the art of educating medical students and other learners. Awards are given yearly from the medical students to acknowledge the Resident Teacher of the Year.

Clinical Competency Committee (C3)

The residency Clinical Competency Committee (C3), formerly known as the 'Education Committee,' meets monthly to review resident performance, and is responsible for forming the global assessment of residents using the ACGME Pediatric Milestones and for recommending resident promotion to the Program Director and Associate Program Directors. The C3 is comprised of the residency leadership, the department head, service directors, and resident advisors. Senior residents are not permanent members of C3 as delineated by a policy change approved by the resident and faculty members of the Program Evaluation Committee in 2011, but may be invited to submit written statements or to attend when their feedback is required.

Research Conference

Research conferences are held prior to Grand Rounds. Residents present their research to the department in June at Resident Research Day. Faculty Research Days are built into the morning conference schedule.

Child Neurology Pathway

Residents, if selected by the Army, Navy or Air Force for a pediatric neurology training slot, may enter the Child Neurology Pathway. Residents complete 22 months of general pediatrics training then enter a period of 3 years of neurology and pediatric neurology training under the NCC Child Neurology Fellowship. Residents who successfully meet the requirements of this non-standard pathway are eligible for both Pediatrics and Neurology board certification. The 22 months of general pediatric training must meet the specified requirements of the American Board of Pediatrics.

Individualized Curriculum

The program offers significant opportunity to individualize their curriculum. Residents have 11 or more block rotations in which their education is tailored to both their future as a military pediatrician and to their chosen career path. Four of the individualized blocks must be electives in core subspecialties of their choosing, and one must be an outpatient experience in pediatric orthopedics and sports medicine. The remaining 6 or more blocks are chosen by the resident based on their personal interests and goals (e.g. research, subspecialty fellowship, international health, advocacy, or others). Schedule selection is a resident collaborative experience and is run by the Chief Resident. Each resident schedule, including the individualized curriculum chosen by the resident, is reviewed by the Program Director and advisor to ensure satisfaction of ABP and ACGME requirements.

ARM Longitudinal & Individualized Curriculum

The Advocacy-Research-Military Studies program offers a longitudinal curriculum experience throughout the PGY2 and PGY3 levels. Residents in this voluntary program spend up to two 1/2 days per month participating in an individualized curricular experience. These can include participation in a subspecialty or multi-disciplinary clinic, school-based health clinics, clinics for underserved immigrant or socioeconomically disadvantaged children, clinical or bench research, teaching and educational positions or advocacy in the hospital or community. Residents apply for the ARM Program at the end of intern year with the help of an advisor.

 

 

   
   
   

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