Curriculum | Pediatric Residency

The MaineHealth Maine Medical Center (MH-MMC) pediatric residency program has 24 Pediatric Residents (8 per PGY), and a pediatric chief resident. In addition, our combined internal medicine/pediatric residency program has 4 residents per year.

Each academic year is comprised of 26 two-week blocks. We utilize a modified X+ Y scheduling system wherein Continuity clinics are spread out over most outpatient experiences but don’t occur during inpatient blocks such as IPU or PICU. Continuity clinic days will include well child checks and follow up with patients that you see longitudinally. The program curriculum is as follows:

Inpatient Pediatrics (IPU Days, IPU Nights, and Clinical and Admitting Support Role)

Those working in the inpatient pediatric unit (IPU) care for a variety of patients referred from the Greater Portland region, as well as the entire state of Maine and parts of southern and eastern New Hampshire. More than 3,000 patients per year are cared for on the IPU of the MaineHealth Barbara Bush Children’s Hospital (MHBBCH). Our patients present with everything from bread and butter diagnoses to complex medical conditions.

The attending faculty include a 24/7 pediatric hospitalist service with fully dedicated inpatient physicians and a full range of sub-specialists involved in medical and surgical subspecialty care. Residents rotating on our IPU will work on one of 2 teaching services. Team 1 consists primarily of Pediatric Hospital Medicine and Hematology/Oncology patients. Team 2 consists of primary Pediatric Hospital Medicine and Gastroenterology patients. The patients attended by other subspecialists, such as Neurology, Nephrology, Pulmonology, and Cardiology, are spread across both teams. We have embraced iPACE rounds, which incorporates the entire multidisciplinary team with bedside, family-centered rounds scheduled into appointments. As part of this system, in addition to teaching at the bedside, we have dedicated time for interprofessional sessions where we learn not only from our attendings, but from our nursing, child-life, PT/OT, and pharmacy colleagues as well.

Senior residents participate in responding to admitting pager calls coming from emergency departments and primary doctors, enhancing their triage and coordination of care skills. On IPU Days, seniors are identified as team leaders responsible for organizing patient care and supporting the junior learners on the team. Senior residents on IPU nights hold a unique role that oversees patients in the Pediatric Intensive Care Unit, IPU, and Newborn Nursery. Senior residents are on IPU Days or IPU Nights for 2 weeks at a time. In our program, our senior residents also elected to cover the weekend day shifts while on their IPU Day rotations. This enables most non-inpatient months to be “call free” during the day. Only Friday and Saturday nights are covered by senior residents not on an inpatient rotation.

Interns take part in 3 different shift types: Day shifts, Night shifts, and Swing shifts. Interns are on IPU Nights or Swing shifts for 1 week at a time. Swing shifts are a dedicated shift that goes from 1pm to 9pm when interns get the opportunity to focus on admitting new patients to help them develop their initial diagnosis/management skills while also helping to provide coverage during the change of shifts between days and nights.

The X + Y (4 weeks/2weeks) scheduling model means that when you are on the inpatient service, you won’t attend your continuity clinics, thus fostering the ability to be wholly present whether on an inpatient or ambulatory experience.

Ambulatory General Pediatric Rotations

Ambulatory general pediatric rotation experiences span the three years of residency training, and take place in many locations. The rotations that make up this learning experience are Acute Care Pediatrics, Continuity Clinic, Rural Pediatrics, and Community Pediatrics. In the course of your general pediatrics ambulatory training, you will master the diagnoses and treatment of a wide variety of problems from those that are very common to the very rare. You will have the opportunity to do this in multiple primary care settings.

Acute Care Pediatrics (“Peds Clinic”) is spent in the MHBBCH on-site Pediatric Clinic where there are over 7,500 patient visits per year. The patient population is composed of many generational Portland residents and a large proportion of refugees or immigrants. Portland is a refugee resettlement city, and we have developed an International Health Service at MHMMC to help transition refugees and asylees into our health care system. This provides a unique opportunity to learn how to address a multi-cultural and diverse population of patients.

Once/month dermatology clinic, twice/month child psychiatry, Monthly Autism Diagnostic clinic, monthly Silver Diamine Fluoride dental clinic and a weekly international clinic are additional experiences residents participate in during this block. During each Acute Care Pediatrics block, residents rotate 1 week onto the Newborn Nursery Teaching Service under the supervision of dedicated newborn hospitalist faculty. Here you will participate in a longitudinal experience in newborn care over all three years of your training. The Newborn Nursery Teaching Service covers over just under 1,000 newborns a year in the Coloumbe Family Tower at MHMMC. The newborns include level one and level two patients from the diverse population at the pediatric clinic, babies born to mothers on the high-risk OB service, and the local community. This rotation provides numerous opportunities for residents to recruit new patients into their continuity clinic practice, care for well and ‘level 2” infants, and learn procedures such as circumcisions!

The Continuity Clinic experience for residents takes place at the MHBBCH Pediatric Clinic. Residents spend time in most outpatient blocks going to continuity clinics. We emphasize the “continuity aspect” of resident education and work hard to ensure residents see “their “ patients as much as possible for routine well care, sick visits and complex care follow up visits. We also provide the opportunity for other experiences related to primary care (patient registry reviews, in-basket management time). Continuity clinics are supervised by our board certified ambulatory pediatric staff.

The Continuity Clinic experience includes a structured Quality Improvement longitudinal curriculum that enables residents to manage their patient panels for primary care quality metrics. The Pediatric Clinic operates under a Patient Centered Medical Home model, and employs behavioral health therapists, nurses, medical assistants, care managers, a nurse practitioner and a long-standing dedicated staff who love working with the patient population and the residents. In addition, residents in our acute care experiences benefit from our Pediatrics/Child Psychiatry Fellow Buddy System in the continuity clinic. This unique program pairs each pediatric resident with a child psychiatry fellow with the goal of promoting relationships and collaboration in managing the multitude of mental health issues facing children today. This collaboration has become the model for other programs in the country.

The Community Pediatrics rotation in the second year takes place in a local pediatric practice or a rural setting; your choice! In addition to seeing patients of the practice, residents also work with office management staff to learn the operation of the practice and the components of managed care that are involved in pediatric practice today.

During this rotation, time is also spent at MaineHealth Weight Management South Portland and in the MaineHealth Behavioral Health at Spring Harbor developmental disorders unit so residents get a glimpse into these important resources for pediatric providers.

ACQUIRE: Our Longitudinal Scholarship Curriculum

The ACQUIRE (Advocacy, Community, Quality Improvement, Research, Education) rotation provides an opportunity to gain introductory skills in the various forms of scholarly activity and guides residents in the choice of a longer-term scholarly activity project for the remaining time in residency. This longitudinal curriculum takes place over 6 weeks (divided into 2 week increments during all years of residency). The rotation includes faculty-led learning sessions on foundational skills in research, quality improvement, advocacy and teaching, opportunities to network with residents and faculty on scholarly projects, and time for independent work. Additionally, residents will be introduced to the available departmental supports for scholarly work, including the MaineHealth Barbara Bush Children’s Scholars Academy and the Faculty-Resident Scholarship Program.

• The research and QI curriculum provides education, structure, and mentorship to allow residents to explore different types of scholarly work and access institutional scholarship supports. Residents are trained in various QI methodologies, including completing White Belt training and using the IHI Model for Improvement framework.
• The advocacy curriculum includes skills-building workshops around advocacy project planning, legislative advocacy, and community partnership building. Residents attend the Northern New England Advocacy Collaborative Summit as part of their PGY1 ACQUIRE rotation, which is a 2-day conference between MHMMC, University of Vermont, and Dartmouth. The Summit champions resident advocacy work, provides opportunities to network with local and national advocacy leaders, and highlights shared advocacy issues and community stories.
• The medical education curriculum focuses on building clinician educator skills, including sessions on learning climate, feedback, clinical reasoning, and presentation skills. During the PGY3 ACQUIRE, residents demonstrate their ability to teach junior learners, through individualized clinical teaching opportunities, integration into our simulation teaching team, and opportunities for small and large group teaching.

Advocacy - Child and Community

Our residents have a dedicated four-week Advocacy rotation. Residents are encouraged to develop an individualized advocacy project. Examples of recent advocacy projects include the creation of a community cooking program to highlight healthy ways to utilize food bank resources and a project to improve screening for and mitigation of period poverty in the Resident Continuity Clinic utilizing community partnership to enhance resources. Residents use this rotation to engage in legislative advocacy opportunities with our MaineHealth Government Affairs team or the Maine AAP. They also have the opportunity during this time to plan individualized community experiences, which can include volunteering or shadowing with local community partners. Residents also present a teaching session for their co-residents on an advocacy topic, focusing on improving health equity for our patient population.

Other advocacy opportunities within our program include:

• We have an annual Resident Advocacy Day, where residents meet at the State House in Augusta, ME, network with legislators and/or community partners, and learn about the legislative process.
• Serving as a resident member of the Maine AAP board (which has 2 voting resident members), a Maine AAP subcommittee, or the Section on Pediatric Trainees (affiliated with the national AAP)

Behavior/Developmental Pediatrics

Behavioral and Developmental Pediatrics occurs in the intern year where residents work with our four board certified developmental pediatricians and four psychologists caring for children with behavior issues, autism spectrum disorders, ADHD, and learning disabilities. The residents are also able to attend the multidisciplinary NICU follow up clinic. The bulk of this rotation occurs in the outpatient developmental-behavioral pediatric clinic with some community visits to diagnostic and therapeutic settings such as special purpose preschools and Child Development Services.

Adolescent Medicine

Adolescent Medicine training includes a block in the second year where residents work side by side with faculty in school based health clinics, pediatric specialty care clinic, eating disorders clinic, adolescent psychiatry clinic, sports medicine clinic, STD clinic, and other venues where care is directed toward teens. This experience also includes the weekly "Teen Clinic" and sessions spent in primary care offices where adolescents make up the bulk of the patient population. Our two board-certified adolescent medicine specialists work directly with residents in their practice setting as well during this rotation.

During the adolescent medicine rotation, residents get another opportunity to work in child psychiatry medication management clinic with their “Child Psychiatry Fellow Buddy” as part of the Pediatrics/Child Psychiatry Buddy System Program and spent time at the MaineHealth Behavioral Health at Spring Harbor adolescent inpatient psychiatry unit.

Child/Adolescent Mental Health Rotation

Mental health and behavioral issues are central to pediatric practice. This rotation gives residents more experience with the diagnosis and treatment of common mental and behavioral disorders such as ADHD, anxiety, depression, Substance Use Disorder and PTSD along with exposure to more complicated psychiatric issues.

Residents will spend time with our staff Child Psychiatrists and fellows at various Maine Health sites, both inpatient and outpatient, including Gender clinic, Family Therapy, Fellow Medication clinic, Consult clinic and outpatient practices.

Neonatal Intensive Care

The neonatal intensive care unit experience includes the 30 bed level 4 NICU and 20 bed Step Down unit; our Labor and Delivery suite; as well as our mother-baby unit and newborn nursery. The NICU has over 950 admissions per year of which approximately 270 are transports from outlying hospitals. Residents are supervised by a team of full time, board certified neonatologists with a wealth of experience caring for premature infants as well as the education of residents. Residents gain valuable delivery room experience, manage premature infants with complex needs, and learn assessment skills to quickly triage those infants requiring intensive care from the delivery room. Experienced neonatal nurse practitioners complement the neonatology service and are involved in the day to day care for patients, and hands on training of residents in our NICU.

Pediatric Intensive Care

Our pediatric intensive care unit clinical rotation occurs in two 4 week blocks during the second year. During this time, the residents are the primary caregivers for critically ill children in our 10-bed PICU directly adjacent to our pediatric inpatient unit. Here, residents work closely with our PICU staff, pediatric subspecialists, and surgical and cardiovascular subspecialties.

The patient population in the PICU is varied, so residents care for children with the myriad of diagnoses that require critical care, including status epilepticus, respiratory failure, diabetic ketoacidosis, sepsis, and the pre and post-operative care of patients with critical congenital heart disease.

Residents are also members of the Pediatric Critical Care Transport Program. This ground-based system transports critically ill children from Maine and southern New Hampshire hospitals to MHBBCH. This experience provides residents with autonomy, the opportunity to perform many pediatric procedures, and independently make acute management decisions, all under the direction of our pediatric intensivist staff who value patient care, and resident teaching.

Emergency Pediatrics

Residents spend 8 weeks of their training at the MHMMC Pediatric Emergency Department, 4 weeks in the intern year and a supervisory 4 week rotation in year 3. Pediatric Emergency Care is provided on the MaineHealth Portland campus and at MaineHealth Urgent Care Plus Brighton Ave Portland. The MHMMC Portland ED serves as the only ACS verified Level-1 Trauma Center in Maine and serves almost 15,000 pediatric patients per year. Due to its proximity to MaineHealth Urgent Care Plus Brighton Ave Portland, pediatric patient acuity is relatively high.

An additional 6,000 pediatric visits occur at MaineHealth Urgent Care Plus Brighton Ave Portland annually consisting predominately of sprains, strains, fractures, lacerations and upper respiratory infections. Pediatric residents are scheduled preferentially on the pediatric wing of the department, to maximize their experience with children.

Adults with pediatric applicable issues are also seen on this rotation (young adult women who need pelvic exams, adults that need laceration repairs, splinting, reduction of dislocations, etc.). In addition, residents spend time at MaineHealth Urgent Care Plus Brighton Ave Portland. Emergency pediatrics is supervised by attending emergency medicine staff under the direction of three board-certified pediatric emergency medicine physicians.

In the third year, pediatric residents supervise the learning of pediatric and emergency medicine interns in the care of pediatric patients in the ED. Residents also spend time at the Northern England Poison Control Center as part of the embedded toxicology curriculum during these months.

Subspecialty Experiences

18 weeks of time during the training program are dedicated to subspecialty experiences. All of the major subspecialty areas are represented in our program. Your program director and individual faculty advisor will help you chose your subspecialty rotations, designed to meet your needs by taking into account your future career interests. Options for these experiences include the following:

• Allergy/Immunology
• Cardiology
• Child Abuse
• Endocrinology
• Gastroenterology
• Genetics
• Hematology/Oncology
• Infectious Diseases
• Nephrology
• Neurology
• Pulmonology

PRiSM (Pediatric Rotation in Subspecialty Medicine)

During their intern year, residents will participate in a four-week PRiSM rotation that offers exposure to a variety of pediatric subspecialties. Throughout this period, residents will attend outpatient clinics with pediatric subspecialists, as well as engage in multidisciplinary clinics, such as the aerodigestive clinic, and participate in relevant procedures.

Dedicated half-day sessions for independent learning will provide opportunities for residents to pursue specific interests and explore additional learning experiences. This rotation is designed to introduce residents to pediatric subspecialties early in their training, supporting the exploration of career paths and the development of individualized educational plans.

Additionally, residents will review the referral and consultation processes to enhance their skills in making appropriate referrals throughout their career.

Individualized Curricular Experiences (ICES)

In addition to your subspecialty time, 32 weeks of training is set aside to provide for an individualized curriculum designed by each resident, Program Leadership, and Faculty Advisors. The goal of this requirement is to personalize the education of each resident so that they receive the experiences that will best prepare them for their individual career choices.

As part of this individualized curriculum program, residents can chose to spend additional experiences in any of our community, rural, inpatient, acute care, or subspecialty rotations. Secondly, many residents design unique experiences that best prepare them for their post-residency plans. And finally, additional rotations listed below are available for residents specifically geared to prepare them for the career path they decide to focus on after their residency.

• Child Psychiatry
• Chronic Care Management
• Continuing Care - Level 2 Nursery
• Discipline and Parenting Reading Elective
• Global Health – International
• Global Health – Local
• Integrative Medicine
• Neonatology Hospitalist
• Pediatric Hospitalist
• Pediatric Simulation
• Pediatric Surgery
• Research Block Month
• Rheumatology
• Sports Medicine

We can tell you much more about these experiences during your interview. Our curriculum will provide you with ample opportunity for general and subspecialty exposure so that you can make the best decisions regarding your future plans. We can then work with you to tailor your curriculum based on these future career goals. We look forward to hearing from you!