Pediatric Residency Program Curriculum

Ambulatory electives:

• Advanced Adolescent
• Advanced Community Advocacy
• Advanced Development
• Amish Health and Ambulatory Genetics at the New Leaf Clinic (rural rotation)
• Fast Track: PEM
• Healthy Active Living
• Locust Pediatrics (urban rotation: underserved population-including refugees and children in foster care)
• Rural rotation

Subspecialty Medical Electives

• Allergy-Immunology
• Anesthesiology/Procedural Sedation
• Cardiology
• Dermatology
• Endocrinology
• Gastroenterology
• Genetics
• Infectious Disease
• Nephrology
• Neurology
• Palliative Care
• Pharmacology/Toxicology
• Pulmonology
• Radiology
• Rehabilitation
• Rheumatology
• Sports Medicine

Other Medical Subspecialty Electives

• Advanced elective in any pediatric medical subspecialty
• Advanced Newborn
• Bone Marrow Transplantation
• Cardiac Imaging
• Hematopathology
• NICU: Advanced: PL 2
• NICU: Community based at Mercy Hospital-St. Elizabeth (Mahoning Valley): PL 3
• NICU: Introduction to NICU: PL 1
• PICU: Advanced: PL 3
• PICU: Introduction to PICU: PL 1

Hospital Medicine Electives

• Hospital Medicine, Akron Campus
• Hospital Medicine, Community-based at Akron Children's Beeghly or at Wooster Community Hospital

Pediatric Surgery Electives

• Cardiothoracic Surgery
• Dentistry
• ENT
• General Surgery
• Neurosurgery
• Ophthalmology
• Orthopedic Surgery
• Neurosurgery
• Urology

Other Electives

• Administrative Leadership
• Bioethics
• Domestic: away rotation in the US
• Global Health: international
• Informatics
• Lactation
• Parenting
• Procedures
• Professional Development
• Quality Improvement
• Research
• Teaching

The goal of this rotation is to provide a rich, community-based experience in which the resident:

• Identifies community-based organizations involved in supporting the optimal growth and development of children and families in our region.   
• Engages with community so that the resident and agencies can properly advocate for children.  
• Develops insight into the principles of the patient centered medical home.  
• Develops an understanding of the unique and complex circumstances of Children with Special Health Care Needs.  
• Develops an understanding of the social determinants of health including the effects poverty, housing, income and toxic stress have on child development and health.  
• Participates in small group discussions with faculty about diversity, racism and social determinants of health.

Rotation Overview

• Full day experiences
  • New Leaf Center: serves the Amish population
  • Locust Pediatrics: serves our refugee population
  • Dental Clinic
  • CARE center: child abuse center
  • School Health in the Akron Public Schools
  • Reach Out and Read program
• Half-day experiences
  • Bridges Out of Poverty - virtual
  • Legal Aid session with Akron Children’s legal aid lawyer
  • Lead Clinic, Locust Pediatrics
  • Family Child Learning Center
• Seasonal experience
  • Hartville migrant clinic with Akron Children’s pediatricians
• Independent scheduling - virtual
  • WIC
  • Help Me Grow/Early Intervention

Advanced Community Advocacy Elective

• Includes completing the AAP Advocacy Training Modules.
• Contacting federal legislators on a child health issue, based on your interests, through the AAP.
• Submitting a one paragraph update on two different advocacy topics of your choice.  These updates will be included in the Residency program’s Weekly Wednesday E-mails to educate residents in the program about advocacy.
• Highly recommended: Select an advocacy issue to work on as your required residency QI project.

Advanced Community Advocacy Elective: Clinical Requirements

• The resident must choose and attend 6 half-day sessions from the following areas during the rotation:
  • SDH: Healthy Weight Clinic
  • SDH: Care Center
  • SDH: Addiction Medicine
  • SDH: Lead Clinic, Locust
  • SDH: Dental Clinic
  • SDH: Mental Health: work with the LISW Social Workers in the BHU in the ED
  • DEI: Center for Gender Affirming Medicine
  • DEI/SDH: Locust Pediatrics or ACHP East: working with the underserved and refugee/immigrant population
  • Population Health: work with the Case Manager in the ED

Adolescent Medicine Rotations

• Interns get the opportunity to work in the Center for Gender Affirming Medicine for transgender and LGBTQ+ youth during this rotation.
• The Center’s team includes gender-affirming physicians, medical assistants, social workers, nurse coordinators, mental health therapists and endocrinologists.
• Residents who wish to spend more time in the Center can choose to do an Advanced Adolescent Medicine rotation.

Social Determinants of Health

• Resident Health Equity Curriculum: During Noon Conferences
  • Overview on the Social Determinants of Health and Workshop on Food Insecurity: intern session
  • Transportation Barriers: intern session
  • Health Care Treatment Costs/Cost Effective Care: sessions occur annually

Pediatric Residency’s Diversity, Equity and Inclusion (DEI) Initiatives

• Resident-led Morbidity & Mortality Conferences
  • Emphasis on mitigating biases including implicit biases.
• Resident Conversation Circles 
  • 6 sessions per year
    • Each session provides a structured format for residents to discuss a variety of topics, including race, gender identity and LGBTQ+ issues. 
• DEI Boot Camp Session at Intern Orientation
  • Session at intern boot camp where interns spend time talking with representatives from the LGBTQ+, refugee, and the Amish communities.  
  • The goals are for our interns to:
    • Learn how members of these groups experience living in Akron and interact with the health care system.
    • Discuss ways that our residents can help advocate for their well-being.

Hospital Supported Community Events and Programs

• Read to Me Day
• Akron Children’s pays your registration fee for the Akron Marathon
• Akron Canton Regional Food Bank at Akron Children's
• Annual Have a Heart do your part Radiothon
• Harvest for Hunger Program
• Annual Kids are #1 Run

Resident Opportunity in Global Health: Dominican Republic at the Oscar de la Renta Pediatric Center

• Managed in partnership with the Edward Via College of Osteopathic Medicine (VCOM), Dominican Republic Ministry of Public Health, Servicio Nacional de Salud, Akron Children's Hospital and Grupo Puntacana Foundation.
• Serves a population of more than 15,000 children living in the underserved communities in and around Veron Punta Cana. 
• Services are rendered free of charge, with a modest fee for laboratory services.
•  The facility diagnoses and treat common illnesses, offers regular checkups and immunizations, take x-rays and scans, and tracks children's growth progress.
• Residents work in an ambulatory pediatric clinic.
• Safe lodging for residents in a suburb in Punta Cana. 
• Safe transportation:
  • To and from the airport to lodging
  • To and from lodging to the clinic
  • To and from the Westin Hotel in Punta Cana which is on the beach: residents can use the hotel’s facilities

Global Health Partnership with NEOMED for Residents

• Clinical experiences and rotations
  • Work with our medical team at one of our academic partner institutions in India, Nepal, Kenya, Colombia, Mexico.
• Community health in remote settings
  • Work with health program teams to improve healthcare in poor, disadvantaged, and remote communities in India, Nepal, Kenya.
• Global research and innovation
  • Work with NEOMED and international researchers or team up with innovators at the Nepal and India innovation centers and help solve medical challenges.

NICUs Where our Pediatric Residents Rotate

• NICU at Akron Children’s (ACH) Akron campus (Main): Level 4 NICU
  • Faculty: ACH Neonatologists
  • No onsite deliveries
  • 75 beds
• Akron Children's NICU at Summa Health System - Akron Campus: Level 3 NICU
  • 5 miles from our ACH Akron campus
  • Faculty: ACH Neonatologists
  • Onsite deliveries
  • 22 beds
• Akron Children's Hospital NICU at St. Elizabeth: Level 3 NICU
  • 1 hour away from our Akron Campus
  • Faculty: ACH Neonatologists
  • Onsite deliveries
  • Elective site for those residents interested in becoming Neonatologists 
  • 25 beds

Intern NICU Required PL 1 Rotation 

• 2-week PL 1 rotation (1 week at Akron campus; 1 week at SUMMA)
  • Work 6a-4p M-F and 2 weekend mornings per month
  • There is no overnight coverage required

PL 2 Required Rotation 7/2024-2025

• PL 2s will rotate at the NICU at SUMMA 
  • 2 weeks: Total of 6 shifts; 12-hour day shifts for rounds and deliveries 
  • 2 weeks: Total of 6 shifts; 12-hour night shifts for admissions, consults, and deliveries
  • No weekends or holidays required
  • Goal of more autonomy and less "learner competition" for delivery experience

Goal of the QI Curriculum

• Residents will be able to discuss QI methodology by actively participating in group QI projects
  • Exposure to multidisciplinary work groups, hospital logistics, presentation skills along with QI methodology

Requirements

• All residents are required to be actively involved in a QI project each academic year with an aim statement, key driver diagram, collection of data and completion of at least 1 PDSA cycle per academic year.
• Residents present their QI projects each fall and spring during Noon Conference and turn in group summary and individual reflection
  • 3 didactic Noon Conference sessions/year (1 for interns only and 2 for all residents)
  • 2 Noon Conference sessions that are broken into smaller groups to share progress and learning
  • Friday Noon Conference time is available for QI group work (as requested by residents) with support from quality services to help with their QI projects during this time
• Residents complete 2 or 3 online IHI Open School modules each year (different for each academic year)

Residency QI Committee

• QI Residency Leadership Team: Dr. Samantha Gunkelman, Dr. Sladjana Courson, and a designated chief resident
• Dr. Gunkelman and the designated chief resident serve as representatives from the residency program to the Hospital Based Care QAPI.
• Assistance from ACH’s Quality Services
  • Gives didactic presentations to the residents on QI.
  • Provides support to the residents at group QI work sessions at Noon Conferences.
  • Provides feedback at small group Noon Conference sessions.
  • Provides feedback with individual group projects as needed.

QI Elective

• Elective is offered to senior residents with expectation that residents will:
  • Obtain IHI Open School Basic Certification.
  • Work on one’s QI group project with time allotted to prepare to present or publish one’s QI Project if desired.
  • Implement QI methodology in one’s QI project (pareto charts, control charts, process mapping, FMEA, etc.).
  • Participate in Quality Service activities/committees; including attending quality services morning huddle, safety rounds, and QI committee meetings.
• Much of this work during this elective can be done remotely.

Resident QI Projects from the 2022-23 Academic Year

Several resident group QI projects were focused on advocacy.

• Improving Inpatient Resident Rotations Effectiveness
• Reducing Pain with Needles
• Inpatient Asthma Improvement (Discharge Checklist/Home Health/MATH referrals)
• Improving Resident Breastfeeding Support
• Medication Reconciliation
• Firearm Safety
• Discharge Patient Instructions
• Discharge by Noon
• Improving Patient Experience for those with Autism
• Resident Efficiency
• Emergency Transfer/Situational Awareness
• Screening for Sex Trafficking
• ET Tube Code Sheet
• ED to Inpatient Handoff
• Nighttime Curriculum

This is a longitudinal 18-month curriculum track for second- and third-year residents that begins in January of every academic year.

• It is administrated by the chief residents.
• The faculty mentors are Dr. Heksch and Dr. Ramundo.
• Residents receive 6 foundational lectures on medical education topics from faculty and the chief residents.
• Each resident in the track is required to give 4 presentations on pediatric topics to M3 students during their pediatric clerkships.
• There are additional opportunities for mentoring sub-interns.
• Residents complete a curriculum project over the course of the track: can work in pairs or in a group.
• Residents are required to complete a Teaching elective in their PL 3 year and enroll in our program’s Residents as Teachers Track (RAT Tract).

Our simulation curriculum takes place at the Akron Children’s Simulation Center for Safety and Reliability, a 30,000 square foot center located in downtown Akron 1 mile from our main campus. The Simulation Center provides a fully integrated learning experience, including faculty observation areas with audio/video capability for evaluating and debriefing participants.

Purpose of the Simulation Curriculum

• Prepare interns entering our program for their clinical roles
• Enable residents to learn procedures in a safe environment
• Enable residents to work as team members and team leaders during resuscitations
• Enable residents to apply NRP principles at deliveries in order to effectively and efficiently resuscitate newborns
• Prepare residents to deliver difficult news to patients and their families
• Ensure that residents can perform LPs and effectively BVM patients who are in respiratory failure

Resident Simulation Curriculum

• Intern boot camp
• Term Newborn (TN) and PEM Simulation Curriculum
• NICU simulation curriculum
• Mastery training
• Procedures: UVC, IO, peripheral IVs, intubation, trach care and changes, OG/NG placement, bladder catheters, BVM ventilation, lumbar punctures and circumcisions
• In-situ multidisciplinary simulations

Mandatory Intern Orientation

Starts after 6/15 annually. Intern attendance is required.

• PALS and NRP courses
• EPIC training
• Intern “boot camp”
  • 2.5 days of multidisciplinary and multimodal simulation at the Simulation Center
    • Simulators
    • Standardized patients
    • Didactics
    • Procedural skills stations
  • 2022 numbers – 36 standardized patients, 39 faculty
  • Cases
    • Adolescent Abdominal Pain in the PED
    • Shared Decision-Making
    • Sick vs. Not-Sick Mini-Cases
    • Seizure Resuscitation
    • Asthma Floor Team Admission
    • Family Centered Rounding
    • Medication Reconciliation/Discharge Planning
    • Mindfulness
    • DI/SA scoring
    • “An Afternoon on the Impatient Floor Team”
    • DEI Panel Discussion
  • Skills
    • LPs
    • BVM
    • Auscultation of Murmers

Longitudinal Simulation Curriculum – TN/PEM

Participants

• PGY-1 on their TN rotation
• All residents during their PEM rotations

Schedule during the 4 week block

• 3 Friday sessions with the simulation team
• 1 Friday session with the Palliative Care team on “Breaking Bad News”

Each 4-hour session is on Friday afternoons

• Procedural skills for 2 hours
• Team-based simulation case for 2 hours

NICU Simulation Curriculum

Participants

• Interns and PL 2 residents on their NICU rotations

Schedule

• 4 Fridays during the block

Sessions

• Three 1-hour: low fidelity NRP (delivery) simulations
• One 4-hour: high fidelity simulation with procedural skills training

Cases

• PPVàCPAP, MR SOPA
• Decision to Intubate
• Decision to Start Chest Compressions
• Premature Infant Considerations

Procedures

• Warmer Set-Up: Neo-Puff
• PPV/Intubation
• Emergent UVC
• Thoracentesis

Mastery Training

• Rising PGY-2 and PGY-3s demonstrate mastery at LP and BVM prior to start of next academic year
• Combined with Just-In-Time Training

In-SITU Mock Codes

• 79 hospital mock codes were held in 2022; 49 in 2021; 79 in 2020
• Multidisciplinary Health Care Team, including residents