Curriculum | Pediatric Residency

The MaineHealth Maine Medical Center (MHMMC) pediatric residency program has 20 pediatric residents (8 PGY-1, 6 PGY-2, 6 PGY-3), and a pediatric chief resident. Our program recently expanded and will be recruiting 8 residents per year going forward. In addition, our combined internal medicine/pediatric residency program has four residents per year.

Each academic year is comprised of 26 two-week blocks. During X blocks rotations, you will not have continuity clinic. During Y blocks rotations, you will have additional continuity clinics embedded in the two weeks. Continuity clinic days will include well child checks and follow up with patients that you see longitudinally. The program curriculum is as follows:

Individualized Curricular experiences are chosen based on future career goals and include:

• Subspecialty Rotations
• Subspecialty “non-core” Rotations
• Additional Community, Acute Care, or Inpatient Rotations
• Chronic Care Management/Medical Home
• Neonatal Continuing Care Nursery (Level II)
• Pediatric Surgery
• Global Medicine Local Immersion
• Global Medicine International Opportunities
• Research Block(s)
• Resident Self-Designed curricular or procedural month

Inpatient Pediatrics (IPU Days/Night Team and IPU Days)

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 2,000 patients per year are cared for on the inpatient unit of the MaineHealth Barbara Bush Children’s Hospital (MHBBCH). Diagnoses range from the common respiratory and gastrointestinal disorders to congenital heart disorders, metabolic disorders, and childhood cancers to name a few.

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. We have have embraced iPACE rounds, which incorporates the entire multidisciplinary team with bedside, family-centered rounds scheduled into appointments. As part of this new 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 spend 2 weeks on the night team and 2 weeks on the day team. The inpatient seniors trade off covering the weekends in order to allow non-inpatient months to be mostly “call free” during the day. Only Friday nights and Saturday nights are covered by senior residents not on an inpatient rotation. Interns take part in 3 different shift types. They have 1 week of nights, 2 weeks of days, and 1 week of “swing shift”. This is a dedicated shift that goes from 1 pm to 9 pm where interns get the opportunity to just work 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 and 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. Here, many of the patients are 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, 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 all their “Y” blocks going to continuity clinics. Most “Y” blocks have 2-3 days of continuity clinic per week, as well as 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 Rural Pediatrics block in the first year is also a unique immersion experience where residents have the opportunity to explore general pediatrics in a small town or rural setting. The resident is matched with a faculty rural pediatric practice in one of many small communities throughout Maine. This is a wonderful opportunity to provide medical care away from the specialty environment of the children's hospital, live in the local community, and work directly with a rural based pediatric practice within a 2 hour radius of Portland. Most residents live in provided housing during this block. Opportunities for additional rural rotations are available in the second and third year for interested residents!

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 Scholarly Activity

The ACQUIRE (Advocacy, Community, Quality Improvement, Research, Education) rotation provides residents 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. The rotation occurs as two weeks during the fall of the PGY1 year and two weeks early in the PGY2 year. 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.

Advocacy- Child and Community

Our advocacy curriculum is an exciting and unique longitudinal learning experience. During the first year, residents are provided the opportunity to learn introductory skills in how to engage in advocacy and community work through the first two weeks of the ACQUIRE rotation. As part of the ACQUIRE rotation, residents will attend the Northern New England Advocacy Collaborative Conference, which is an annual advocacy conference jointly facilitated by the pediatric residency programs of MHMMC, University of Vermont, and Dartmouth along with each of their respective state AAP chapters. The conference includes advocacy skills training, opportunities to highlight resident advocacy work, and regional advocacy networking opportunities.

During the second year, residents gain more advanced advocacy skills during the second two weeks of ACQUIRE, including workshops on how to create an advocacy project plan, Maine legislative advocacy, and community partnership and coalition building. This sets the stage for residents to complete their dedicated Advocacy rotation, which is four weeks of independent time to work on an advocacy project and partner with the Maine AAP on legislative advocacy and other initiatives. Residents also present a teaching session for their co-residents on a health equity topic during their Advocacy rotation, aimed at improving learner’s understanding of implicit bias and structural discrimination. Examples of recent advocacy projects include the creation of “Ask-a-Doc” sessions with various adolescent community programs and improvement in the equity of obesity care for children by availability of educational documents in various languages, as well as integration of cultural food considerations.

Other advocacy opportunities within our program include:

• We will start to integrate a Resident Advocacy Day during the 2024 Maine Legislative Session, where residents will have the opportunity to meet at the State House in Augusta, ME, practice legislative advocacy skills, and network with legislators and/or community partners
• 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.

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.

Senior Teaching Rotation

Our teaching rotation is in the third year of training and allows our residents the opportunity to demonstrate their ability to facilitate the learning of inpatient unit learners, including medical students, interns, co-senior residents and other health care professionals. Through experiential and self-directed learning, the Teaching Senior targets preparation of teaching materials, teaching in large and small groups, bedside teaching, one-on-one teaching based on direct observation, and using feedback and evaluation all in an effort to improve their teaching ability. Self-directed learning provides residents the opportunity to focus on different learning styles, adult learning theory, bias, and reflection with self-assessment to strengthen the resident’s educator toolkit and prepare them for diverse learners and learning environments.

Subspecialty Core Experiences

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

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

Individualized Curricular Experiences (ICES)

In addition to your subspecialty time, 28 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 in the second and third years of training so that each receives 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 core 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.

Academic Advanced Pediatric Primary Care Elective

This block rotation is available to senior residents in the program. The elective is spent in the MHBBCH pediatric clinic with the emphasis on Teaching/Precepting junior learners; Improving skills in Quality Improvement; Honing skills around billing and coding, and developing scholarly work on primary care topics. During this elective, senior learners will precept medical students or interns with attending supervision to solidify skills around teaching and giving feedback. 

Work on quality improvement can be the development of a new project or work on an ongoing Continuity clinic project. Non-patient care activities include attendance at Preceptor and Division director level meetings and individual time with Billing Coders. Scholarly activities will include supervision of 2 Medical Student case reports, 2 brief lectures in Pediatric Clinic on primary care topics, an evidence-based Primary Care morning report, and a scholarly project ( abstract, article, QI project, EPIC workflows). This elective is valuable for residents contemplating a primary care career (especially where there are teaching options) the rising chief, or hospitalists who may cover in outpatient clinics.

Pediatric Surgery

Pediatric surgery experience is available as an individualized curricular option. Here, under the direct supervision of four board-certified pediatric surgeons, residents gain knowledge of common pediatric surgical conditions including the evaluation of the acute abdomen, hernias, trauma, burn management, vascular access needs, pyloric stenosis, intussusception and others. 

Residents spend about half their time on this rotation seeing patients with the surgeons in the office setting, and about half the time following inpatients, NICU or PICU patients with surgical issues. The opportunity for dedicated mornings with pediatric anesthesia is an option during this month as well. 

A valuable competency of this rotation is to gain an understanding of the pre- and post-operative management of children undergoing surgery. This experience is extremely valuable to any resident looking to practice primary care pediatrics in a rural or urban setting, as well as those residents looking to pursue fellowship training in a pediatric subspecialty that works with pediatric surgeons (NICU, PICU, and gastroenterology, among others).

Chronic Care Management

The chronic care management (CCM) rotation is another experience available as part of the individualized curriculum. This primarily outpatient based rotation has an overarching goal of gaining increased exposure to the care of children with chronic health care needs. Time is spent in a variety of settings. Residents will have time to review the current literature regarding the Pediatric Medical Home concept, spend time in extended sessions with some of their own continuity clinic patients observing in a school setting, participate in an Individualized Educational Plan (IEP) meeting, or doing a home visit to better understand the needs of their own patients with chronic health care issues. 

Thirdly, residents will spend time in a variety of specialty clinics based on resident interest that will expose them to patients with multidisciplinary health needs. Clinics available for this experience include Oncology Wellness Clinic, Cleft Palate Clinic, Metabolism Clinic, NICU follow-up clinic, Pediatric Dentistry, and Muscular Dystrophy Clinic to name a few. This experience is extremely valuable to any resident looking to practice primary care pediatrics in a rural or urban setting, residents looking for a career as a pediatric hospitalist, as well as those residents looking to pursue fellowship training in a pediatric subspecialty that cares for kids with chronic health care needs.

Continuing Care Level 2 Nursery (CCNSY)

This block rotation in the Continuing Care Nursery is one of our experiences available as part of the individualized curriculum. This experience has the following goals: to provide resident education and experience in the delivery room attendance of the late pre- term and term infants, to gain expertise in the initial management and evaluation of the transitional infant from the delivery room, and to provide care of the NICU graduate including discharge planning with appropriate medical and social follow-up. This rotation is a valuable opportunity for those residents looking to practice as either general pediatricians in settings without a level 3 NICU nearby, or as hospitalists who will be managing this population. In addition, residents who will be practicing and providing consultation services to family physicians may find this experience valuable. 

Global Health Overseas or Local Immersion Experience

All of our residents receive education throughout the training program on how to practice pediatrics effectively in a global community. This is accomplished via didactics, time spent in our international clinic, and during opportunities to visit local organizations that serve our immigrant population. Residents can participate in a "Global Health Local Immersion" rotation as well as international global health opportunities.

For those residents looking to spend time in international settings, our program strongly encourages them to explore these interests during training. We have sent many residents to a number of international destinations including the Dominican Republic, Haiti, India, Swaziland, Lesotho, Cambodia, Guatemala, and Ecuador over the years. A number of our residents have gone on to pursue international positions post-training with the Baylor AIDS Program, among others. We've even had one resident hired to lead a residency training program in Eritrea after working overseas post-training.

Non-Core Elective Experiences

In addition to the subspecialty and individualized curricular experiences above, a number of other elective experiences are available to residents as follows. These opportunities are available as 2 or 4 week experiences, and can be split up over the course of residency. Goals of each of these rotations would be to provide the education needed for a resident based on his/her career plans. No "one size fits all" here! You will work with your advisor and program leadership to help plan these experiences. Below is a list of some of these opportunities:

• Child Psychiatry
• Discipline and Parenting Reading Elective
• Integrative Medicine
• Neonatology Hospitalist
• Pediatric Hospitalist
• Pediatric Simulation
• Research Block Month
• Rheumatology
• Sports Medicine

We can tell you much more about these experiences during your interview. Our curriculum will provide you 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!