Residency Programs Strong in Peds

[dally1025]

I'm a M3 and I'm just starting to look at residency programs. I've been told on several occasions that lots of people are uncomfortable with peds when they get out of residency so I'd like to go somewhere that has a lot of peds experience. What are some residency programs that have integrated peds program rather than a block or two of peds each year? Thanks!

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[nycqqe]

If you are interested in NYC, Maimonides has a pretty strong peds experience. Due to the surrounding ethnic populations, It sees a good mount of kids with uncommon congenital problems that have chronic respiratory or cardiac issues, often on ventilators.

Pretty much all programs have similar amount of peds exposure required by its accredidation. Some programs have it in blocks, and some have it throuhgout every month. Whether people like peds or not, I think if they are required to learn peds anyways, might as well learn it well. Peds is something that takes much more time to learn, than let's say, trauma. Most of the peds patients will be like the typical coughs, fever, cuts, so at some places you have to see a lot of well kids before you encounter a sick kid. Even if you plan on working in an adult ER in the future, you don't want to be the ER doc that freezes when someone drops off an acute baby and you tell them to go elsewhere, quick.

 

[Colbert]

The the previous poster stated, most programs have a similar amount based on accreditation standards. Most programs that have a separate adult and peds ER have a similar framework where your "Peds ER" block is first year and then you work 2-4 shifts/month in the Peds ER during the rest of your emergency medicine rotations. It varies program to program, of course, but from what I remember when I was looking at programs last year is that most programs had variation of the above theme. You also have a PICU block at basically every program, but not all programs have a NICU block (some argue a NICU block isn't that high yield, but I won't get into that).

 

[Deuce Doc]

Ah yes! The holy grail.

Most programs that have a separate adult and peds ER have a similar framework where your "Peds ER" block is first year and then you work 2-4 shifts/month in the Peds ER during the rest of your emergency medicine rotations.

Agree with Colbert. That's mostly what I saw interviewing, and it would be worth asking how many shifts/month they do in peds.

Though in a place that had a mixed ED (adult and peds) you might have a little more opportunity to drive your patient collection to favor either toward peds or adults, and would have no dedicated peds shifts except for the 1 month of peds/EM at an outside institution. In this kind of circumstance it might be smart to ask on your interviews about % of patients/admits that are peds.

 

[deuist]

My program does 3 dedicated months of peds during the first year and a half, followed by ~3 peds shifts per month for the rest of residency. The result is about 6 months of total pediatrics in the ED.

 

[ORL10]

This will likely matter much less than you think, to be honest. Most residencies give you less training in peds compared to adults. You will be skilled leaving most institutions in resuscitating any adult, and you will be flying by your pants if you are resuscitating very sick children (even peds/em guys know its scary when you get a very sick child). Sure some places see more sick kids than others, but this is really not what you should be basing you decision on where to go for residency, UNLESS you want to go into peds em. Then maybe an academic program with strong pediatrics dept may be benefiical.

Anyways, you will run into much less sick kids in residency than adults. Your residency should prepare you to make decisions in the face of limited information, and in situations in which you are uncomfortable. Find a place where you will be happy, not where you "think" you will graduate with enough peds exposure.

 

[TylerDurden]

I think the best training in peds comes from programs that treat children in their main ED or have an affiliated peds ED on site. My personal bias is that you get better training in residency in these programs then when you have to go off-site to a dedicated pediatric hospital, where you are not as familiar with the staff/procedures, and are one of many trainees (peds residents, often other EM residents, and fellows) clamoring to be involved with the few high acuity, sick children that present to the ED. That being said, some programs treat children in their main ED but have a relatively low census and no attendings with specific peds training. Personally, I think it helps if they see at least ~20,000 peds visits and have a few peds EM folks on staff.

 

[KarlPilkington]

I agree that you want a place that see's kids on nearly every shift. In the real world those 1 month olds with a fever are mixed in with all the rest of the patients. Children's hospitals are great, but ideally you train somewhere where you have to see the patient, do the workup, and make decisions before calling the Peds. team. Most of us don't work at places without Children's hospitals, so any training you can get as a resident where you are having to do things on your own, and make decisions on your own, is going to help you in the long run.
Don't get hung up on big name Peds places...good luck getting your hands on a crashing 6 month old at any of the "major pediatric centers." You'll be 8th in line behind all the specialists, fellows, and senior peds folks.
I trained at a community/academic program, all my sick pedi kids were managed by me, with an ED attending in the room, no fellows, no other residents...I wouldn't trade that training for anything.

 

[DrQuinn]

I agree with ORL 10.

How many sick kids do you see in a residency shift? 0.5?

How many sick kids do I see out here in the community? 1 every other month?

Stick with the bread and butter. Don't get hung up on semantics. Every residency program will train you to handle everyhting. Will you be comfortable doing jet ventilation in an 8 month old if you did residency at X compared to Y? I doubt it.

Q

 

[Hamhock]

I agree that you want a place that see's kids on nearly every shift. In the real world those 1 month olds with a fever are mixed in with all the rest of the patients. Children's hospitals are great, but ideally you train somewhere where you have to see the patient, do the workup, and make decisions before calling the Peds. team. Most of us don't work at places without Children's hospitals, so any training you can get as a resident where you are having to do things on your own, and make decisions on your own, is going to help you in the long run.
Don't get hung up on big name Peds places...good luck getting your hands on a crashing 6 month old at any of the "major pediatric centers." You'll be 8th in line behind all the specialists, fellows, and senior peds folks.
I trained at a community/academic program, all my sick pedi kids were managed by me, with an ED attending in the room, no fellows, no other residents...I wouldn't trade that training for anything.

Agree with all of it, esp the last part.

HH