Curriculum

Mayo Clinic's three-year Pediatric and Adolescent Medicine Residency Program includes extensive clinical training, many elective opportunities, and an option for either laboratory-based or clinical research.

One third-year resident is selected each year to serve as the Pediatric and Adolescent Medicine chief resident at the PGY-4 level.

Through nominations by faculty and residents, one third-year resident is selected each year to serve as the pediatric and adolescent medicine chief resident, extending the residency to a fourth year.

Clinical Training
A typical schedule includes:

A Pediatric Advanced Life Support (PALS) certification course and a neonatal resuscitation (NRP) course will be held during orientation. You must complete the neonatal resuscitation course before taking the PL-1 rotation in the delivery service.

In addition to usual vacation time, each resident is allotted 10 days per year to present at national or international meetings, and during the course of the residency, each resident may attend one national CME meeting.

The Continuity Care Clinic serves as the backbone of the curriculum and takes place one-half day each week. Each resident serves as the primary care provider for his/her Continuity Care Clinic patients with graduated supervision by staff general pediatricians.

There are no private patients or community private attending physicians at Mayo Clinic. Each hospitalized patient is assigned to a resident physician who is responsible for that patient's care in the hospital and, when appropriate, for follow-up care in the resident's outpatient clinic.

While on a hospital team, you will receive appropriate supervision and daily teaching from a single faculty member assigned to the team. While on service, the team is that faculty member's primary responsibility, and the faculty member acts as both the attending-of-record and the teaching attending for the service. Subspecialty services also contribute to the teaching experience. During subspecialty elective rotations, residents often help provide inpatient medical consultations.

Robert Voigt, M.D., Program Director;
Chad Brands, M.D., Associate Program Director;
and Marcie Billings, M.D., Associate Program Director
Pediatric and Adolescent Medicine
Residency Program

Rotations

Community Pediatric and Adolescent Medicine Service
Mayo Clinic's community pediatric service is an office-based primary care pediatric program serving the region. You will provide comprehensive health care to the children of Rochester, Olmsted County and the surrounding region. This will include newborn care, well-child examinations, immunizations, care for children with acute and chronic illnesses, and counseling for adjustment problems. You also will gain experience in adolescent medicine and developmental and behavioral medicine.

During all three years of your residency, you will gain significant continuing outpatient experience by caring for your own panel of children in the Continuity Care Clinic, which is part of the community pediatric service.

In addition, you may become involved in various volunteer and community service projects.

Neonatal Intensive Care Unit
During the Neonatal Intensive Care Unit (NICU) rotations, you will train in a 24-bed neonatal intensive care unit and a 12-bed, step-down nursery designated as an intermediate care area. You will join a team consisting of a neonatologist and four residents. As you learn to manage sick neonates, you will perform procedures, such as endotracheal intubation, umbilical artery catheter and chest tube placement, and exchange transfusions. You also will learn respirator management under the guidance of the neonatologists and pediatric respiratory therapists. Extracorporeal membrane oxygenation (ECMO) opportunities are available in the cardiac ICU.

Newborn Nursery
You will spend two months on rotations in the newborn nursery at Rochester Methodist Hospital, part of Mayo Clinic. During these rotations you will attend high-risk deliveries and manage newborns who require special attention but do not need the intensive care provided in a level-three neonatal intensive care unit. You will be responsible for the immediate stabilization and care of all newborns needing assistance. You also will manage the normal newborn nursery, visit mothers and perform well-baby examinations.

Pediatric Critical Care Service
The Pediatric Critical Care Service provides intensive care for patients from pediatric cardiology, pediatric neurology, the general pediatric hospital service and several surgical services (e.g., pediatric surgery, neurosurgery, cardiovascular surgery, otorhinolaryngology, orthopedics, and urology). You will work with pediatric, emergency medicine and anesthesiology residents during this rotation, as you learn to care for pediatric critical care patients.

Pediatric Hospital Service
When you take rotations on the pediatric hospital service, you will be part of a team that includes four first-year residents, one third-year resident who acts as a hospital supervising resident, and one pediatric faculty consultant. Together, your team will make decisions about the diagnosis and treatment of patients on the service from the community, region, nation and around the world. You will serve as a hospitalist physician working with subspecialists and surgical teams.

As a junior pediatric and adolescent medicine resident, you will discuss diagnoses, treatment plans, psychosocial issues and general patient welfare with the patients' family members.

Emergency Medicine
There are more than 15,000 visits a year by children to the pediatric emergency corridor of the Mayo Clinic Emergency Department at Saint Marys Hospital. More than 2,000 children are admitted to Mayo Eugenio Litta Children’s Hospital from the Emergency Department each year. All children are seen initially by the pediatric emergency service.

Working directly with a pediatric emergency staff physician, you will manage common acute pediatric illnesses such as asthma and dehydration, and learn to suture lacerations, evaluate musculoskeletal injuries and perform trauma evaluations.

Hematology/Oncology Service
A PL-1 and supervising PL-2 resident work directly with the pediatric hematology/oncology consultants in evaluating and providing care for children hospitalized for hematologic problems. When not on call, post-call, or in the Continuity Care Clinic, you will spend afternoons evaluating hematology/oncology patients in the outpatient setting.

Adolescent Medicine
During this block month, you will see outpatients in the ambulatory setting. You will also have the opportunity to provide in-patient consultations. Adolescent gynecology is also a focus during this experience.

Developmental-Behavioral Pediatrics
During the block month rotation in developmental-behavioral pediatrics, PL-2 residents evaluate children and adolescents with the full spectrum of developmental and behavioral issues encountered in primary care from common behavioral concerns, learning problems, and AD/HD to mental retardation, autism, and cerebral palsy. The resident is supervised by one of three fellowship-trained developmental-behavioral pediatricians and also has an opportunity to work with child psychiatrists and psychologists, speech-language pathologists, medical social workers, and occupational and physical therapists.

Elective Rotations
The following pediatric subspecialty electives are available at Mayo Clinic:

• Pediatric Allergy and Immunology
• Pediatric Cardiology
• Pediatric Endocrinology
• Pediatric Gastroenterology
• Pediatric Genetics
• Pediatric Hematology/Oncology
• Pediatric Infectious Diseases
• Pediatric Nephrology
• Pediatric Neurology
• Pediatric Pulmonary
• Pediatric Rheumatology

A wide array of electives is available in related medical areas, including, but not limited to:

• Anesthesia
• Child Psychiatry
• Dermatology
• Ophthalmology
• Ortho/Sports Med
• ENT
• Radiology
• Surgery
• Physical Medicine and Rehabilitation
• Procedure Elective (circumcisions, cath team, IV team, respiratory therapy)

You may also choose to pursue elective rotations at Mayo Clinic in Jacksonville and Mayo Clinic Arizona during either your PL-2 or PL-3 years. Housing and an automobile are provided during these rotations at no charge. Off-site rotations are elective and not required.

You are also encouraged to consider an international elective opportunity to serve the underserved through the Mayo International Health Program.

Didactic Training
Clinical conferences, seminars, evidence-based medicine journal clubs, and one-on-one instruction are an integral part of the Pediatric and Adolescent Residency Program. You will participate in the following didactic opportunities:

Educational Programs
The residency program has a very active education conference schedule including evidence-based medicine, chief case conference, board review sessions, grand rounds, radiology conference, and mock-codes, in addition to a core curriculum that provides a didactic experience across all the ACGME core competencies.

Simulation Center Experiences
All residents participate in state-of-the art teaching and learning in Mayo’s Multidisciplinary Simulation Center. Faculty experts have implemented a pediatric case-based curriculum. Residents participate in simulation cases and debriefing without on-call responsibilities.

See also:

• Video of Mayo Clinic Simulation Center

Conferences
Educational conferences and small-group teaching sessions are offered:

• Daily: After rounds, a noontime education conference is held at 12:15 p.m.
• Mondays: During Monday noon board review sessions, board-style questions are answered anonymously utilizing an audience response system. Each question is reviewed with a staff expert. Data are compiled on group scores, identifying areas of relative strength and weakness within the training program.
• Tuesdays: An evidence-based medicine discussion is led by the department chair. This is an interactive literature review session to answer clinical questions.
• Wednesdays: Faculty present didactic lectures from the core conference series.
• Thursdays:The Baldwin Conference series provides each resident the opportunity to present on a topic of interest once yearly in a continuing medical education (CME)-approved conference.
• Fridays: Faculty present didactic lectures from the core conference series, and once per month the residents meet with program leadership in town hall meetings.

Morning Conferences
In the chief conference on Thursday, the chief (or any) resident presents a detailed case. The conference’s goal is to obtain pertinent history and physical, differential diagnosis formation, and identification of treatment strategies.

Friday is grand rounds, where the entire department assembles for a CME quality conference. Visiting clinicians and Mayo Clinic staff speak on clinical and research topics.

Ward Teaching
During inpatient assignments, the attending physicians facilitate small-group teaching sessions on various pertinent topics as part of teaching rounds.

Baldwin Conference
The Baldwin Resident Seminar Conference series is conducted weekly and sponsored by the Department of Pediatric and Adolescent Medicine. As a physician, you will be called upon to speak publicly in many forums for various audiences. This series’ primary objective is to provide a unique opportunity to practice and improve your academic presentation skills under faculty supervision and guidance.

You'll have the opportunity not only to practice presentation style and organization, but also become comfortable in preparing and making future presentations. In addition, the conferences provide continuing medical education for faculty consultants in the department and ongoing education to your resident peers.

Service
During your residency, there are ample opportunities for providing community service for area children:

• Rochester Salvation Army Free Clinic
  The Free Clinic seeks to provide short-term medical care and/or appropriate referrals at no cost to clients who meet certain eligibility guidelines. Essential services focus on assessment, evaluation and basic screening for medical problems.
• MOST Program (Mayo Outreach to Students and Teachers)
  (Mayo Outreach to Students and Teachers) This Mayo organization of physicians, medical students, residents and other health professionals works with young people to promote health and prevent disease. MOST participants speak to youth on health issues such as healthy decision-making, responsibility, chemical awareness, tobacco use, and depression. Presentations are available to classes at no cost.
• Community Service Project
  You can participate in a community needs assessment and work on a project targeted toward those needs. You will work directly with community resources, including Head Start, the public school system, child protective services, and the Olmsted County Health Department. Community projects have been a springboard into opportunities for scholarly activity.

Scholarship and Research Training
You will participate in scholarly projects during this residency. You may complete a chart review of a disease or condition or become involved in a clinical project or in laboratory research. Mayo Clinic pediatric residents typically complete several scholarly projects during their training, resulting in publications and national/international presentations. Please review our resident scholarship biography.

The Rochester Epidemiology Project is also a unique resource for resident epidemiologic research projects.

Residents are encouraged to submit papers and abstracts to scientific societies. Mayo Clinic provides 10 travel days per year, and expense reimbursement for all abstracts accepted and oral or poster presentations at national meetings. Mayo Clinic will also sponsor resident oral presentations at international meetings. Please review our resident scholarship biography to see where our current residents have presented.

Additional Training
At the conclusion of your residency training, you may wish to continue training at Mayo School of Graduate Medical Education. Fellowships are currently offered in:

• Pediatric Gastroenterology
• Pediatric Cardiology
• Medical Genetics
• Pediatric Endocrinology
• Pediatric Hematology/Oncology
• Pediatric Infectious Diseases
• Developmental-Behavioral Pediatrics
• Neonatology
• Child Neurology

During your residency, fellows are an excellent educational resource. There is no direct competition for procedures or supervisory opportunities between residents and fellows.

Evaluation
To ensure that you acquire adequate knowledge and develop technical skills, your performance will be monitored carefully during the course of the program training. You will be evaluated formally by your supervising faculty member after each clinical rotation and will meet with your faculty adviser and program leadership to review these evaluations.

In addition, you will regularly evaluate the faculty to ensure that your educational needs are being met. This program has integrated the ACGME outcome project ("Competencies") measures as a routine part of the evaluation process.

Practice Examinations
Mayo Clinic's Pediatric and Adolescent Medicine Residency Program includes annual American Board of Pediatrics in-training examinations to help you assess your progress toward board certification.

Teaching Opportunities
Residents are responsible for teaching Mayo medical students and visiting senior medical students through bedside instruction and formal didactic lectures. Senior residents receive an orientation on teaching skills during their PL-2 retreat just before beginning the PL-3 year.

Career Development
Periodic meetings with faculty members and program directors are conducted to discuss the achievement of each resident's professional goals.

Committee Assignments
You have the opportunity to gain experience in a number of administrative capacities. For example, the residents serve on the curriculum committee.

Textbooks and Journals
Each PL-1 receives the latest edition of the board review manual MedStudy and a subscription to Pediatrics. In addition, $200 per resident per year is provided as book funds.

A collection of over 40 electronic medical texts, MD Consult, can be accessed from any of the 18,000 physician workstations throughout the medical center, or from home when connected to the Mayo Clinic network. Textbook collections are available at multiple sites in the hospitals for reading and reference while on duty. The library provides access to a variety of Web-based texts and databases and access to UpToDate, PubMed, and Medline.

Conferences and Trips
The Pediatric and Adolescent Medicine Department provides one educational trip/conference during your residency. In addition, you may use up to an additional 10 days per year to present results of your research/scholarly activities at national/international meetings.

Retreats
Team-building activities and fun are provided in a beautiful outdoor setting outside of Rochester for incoming interns. In addition, for seniors, a day of instructional meetings is designed to assist in preparation for senior duties.

Resident and Fellow Appreciation Dinner
An annual formal department dinner (with staff coverage of clinical services) honors and acknowledges residents and fellows.

Call Frequency
The Community Pediatrics, Adolescent Medicine, and Developmental-Behavioral Pediatrics rotations are call free. Most electives are also call free, although rarely, certain electives incorporate home pager call. We do not utilize a night float and include very limited cross-cover during some elective months. Below are call responsibilities by rotation:

• Hospital Service (PL1) - every fourth night in-house
• Newborn Nursery - every fourth night in-house
• NICU - every fourth night in-house
• Hematology/Oncology - no in-house night call
• Community Pediatric and Adolescent Medicine - no in-house night call
• Elective - rare home call or weekend rounds on some electives; most electives are call free. Of the 12.5 elective months in our current curriculum, only 2.5 months require cross-cover every fourth night (1 month in the Newborn Nursery/Delivery Room during PL-2 year and 1.5 months in the PICU during PL-3 year)
• Emergency Department - shifts
• PICU (PL-2) - every fourth night in-house
• Adolescent (PL-3) - no call
• Development (PL-2) - no call
• Hospital Service Supervisor (PL-3) - 12-hour shifts

Mayo Clinic College of Medicine strictly follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME) regarding duty hours.

Jeopardy (Back-up) Call
A backup call system provides coverage in event of illness or family emergency.