The Department of Pediatrics at Newton-Wellesley Hospital is comprised of a group of approximately 80 community primary care pediatricians including family practitioners and approximately 50 pediatric subspecialists which includes those primarily based in the Newton-Wellesley community and those who are based at Mass General Hospital but have clinical responsibilities at Newton-Wellesley Hospital. A diverse group of patients is admitted to the pediatric inpatient unit including a wide array of pediatrics and pediatric subspecialty patients including gastroenterology, cardiology, pulmonary and pediatric surgery. The average daily census on the in-patient unit is 13 – 7 on 6 West and 6 in the SCN. In-house pediatric staff include; Dr. Joel Bass, Chairman of the Department of Pediatrics, Dr. Brinda Gupta, Pediatric Inpatient Director, Dr. Carol Moore, Director of Medical Student Education, Dr. Mary-Jean Fanelli and Dr. Tina Gartley. The Department of Pediatrics includes a Level II Special Care Nursery providing care for approximately 225 high-risk neonates per year. Neonatologists Dr. Richard Wilker and Dr. Elisa Abdulhayoglu staff the Special Care Nursery. In addition, the Newborn Nursery cares for approximately 3200 newborns per year. The Emergency Department at Newton-Wellesley Hospital sees approximately 9500 visits per year for patients less than age 20. Ambulatory services for pediatric patients at Newton-Wellesley Hospital include many subspecialty clinics staffed by subspecialists from Mass General Hospital, including cardiology, surgery, gastroenterology, allergy, pulmonary, nephrology, neurosurgery, rheumatology and genetics.

In September 2000, Mass General Hospital began sending a PL2 level pediatric resident to rotate through Newton-Wellesley Hospital each month on the inpatient pediatric unit. In July of 2001, this resident participation will increase to also include a PL3 level resident as a teaching resident and a PL1 level resident effective January 2002. A second PL2 resident on elective will participate in the system. The anticipated educational experiences of each resident will be described further in this letter. In addition to the MGH pediatric residents three (3) third year medical students from Tufts University School of Medicine are assigned to the pediatric department for their third year pediatric clerkship during each clerkship block. During some rotations, there may be a fourth year medical student from Tufts participating in a subinternship rotation. The MGH pediatric residents along with the in-house attending physicians directly supervise these third year medical students.

The MGH PL2 resident is assigned as the Pediatric Inpatient Resident at Newton-Wellesley Hospital. During this month, the resident operates under the supervision of the patients attending physician for patient care and also is supervised by the in-house attending staff who also orient to the program, round daily on all patients with the housestaff, organize teaching sessions for the housestaff and provide ongoing feedback to the residents. The PL 2 resident is responsible for supervising the PL1 resident and the Tufts medical students on the inpatient service. The PL2 inpatient resident is also responsible for leading morning rounds with the team on the pediatric ward. One or more members of in-house attending staff also attend these rounds. The PL2 resident is responsible for an examination and note on all overnight and short stay medical admissions to the pediatric unit. They also follow and round on the pediatric surgical patients.

The PL2 inpatient resident is responsible for coordinating medical care for the patients on the pediatric unit in conjunction with the patient’s attending physician. The attending physician discusses all incoming admissions with the resident and will communicate with them daily regarding their patient’s care. The PL2 resident also reviews the written work ups of medical students and countersigns medical student write ups and progress notes. They take an active role in teaching on morning rounds and help medical students and interns to develop their clinical skills. The PL2 residents also participates in all teaching conferences which include a weekly pediatric radiology conference, weekly pediatric grand rounds, weekly visit rounds with the community attendings, weekly housestaff rounds with in-house attendings and scheduled subspecialty rounds with pediatric subspecialists. Other activities the PL2 inpatient resident may participate in include attending MGH subspecialty clinics when time permits, providing care to children in the emergency department when requested and assisting the neonatologist in emergency situations when requested. The PL2 resident is on call one in four nights including weekends. One of the in-house pediatric attending staff is always on administrative and service call and available to the pediatric resident. The PL2 inpatient resident meets weekly with the in-house attending staff to discuss the rotation and receive and provide feedback.

Effective July 2001, one PL3 level resident from MGH will be assigned to pediatrics at Newton-Wellesley Hospital as a teaching resident. Their teaching responsibilities include to prepare and present a case review conference during their month at Newton-Wellesley Hospital for the pediatric team and to prepare a weekly medical student conference. Teaching responsibilities will also include rounding in the Special Care Nursery with medical students and neonatolgists and precepting medical students as they follow selected babies in the Special Care Nursery. The teaching resident will also precept medical students in doing newborn exams and write ups in the Newborn Nursery. In addition, the PL3 teaching resident will also participate in the routinely scheduled rounds and conferences as outlined for the PL2 resident. The PL3 teaching resident participates in pediatric subspecialty clinics as assigned which may include cardiology surgery, gastroenterology, allergy, pulmonary, nephrology, otolaryngology, neurosurgery, rheumatology and genetics. The PL3 teaching resident covers the inpatient pediatric unit when on call every fourth night and weekends. They also cover the inpatient pediatric unit one afternoon per week when the inpatient PL2 resident is at their continuity clinic. They may also assist the inpatient resident in covering the pediatric unit during times of high census. Other activities include assisting the neonatologist in emergency situations when requested and providing care to children in the emergency department when requested. This PL3 teaching resident will also meet weekly with the in-house attending staff to discuss the rotation and receive and provide feedback.

Effective January 2002, one PL1 level resident from MGH will be assigned to the Newton-Wellesley Hospital inpatient pediatric unit each month. Their responsibilities include an examination and note on all overnight and short stay admissions to the pediatric unit daily progress notes on all medical patients on the pediatric unit, and a preop or postop note on pediatric surgical patients. The PL1 resident will be responsible for coordinating medical care for their patients under the supervision of the pediatric resident and attending. The PL1 resident will also participate in all rounds and conferences as outlined for the pediatric inpatient resident. The PL1 level resident will work closely with the Tufts third year medical students in helping to supervise them and develop their clinical skills. The PL1 resident prepares one presentation during the month for the housestaff group on a topic of their choice. Other activities that the PL1 resident may participate in include attending MGH pediatric subspecialty clinics when time permits. The PL1 resident helps to provide care in the emergency department when requested under the supervision of the pediatric or emergency room attending. They may also elect to attend high-risk deliveries with the neonatolgists and attend scheduled time in the operating room with anesthesia coverage. The PL1 resident is on call one in four nights including weekends and is assigned to be on call with the PL3 MGH resident.

Since the initiation of the MGH resident rotation at Newton-Wellesley Hospital in September 2000, the transition of MGH residents into the functioning of the pediatric unit has been smooth. The presence of MGH residents has met with overwhelming positive responses from both the nursing staff and the attending staff. With the establishment of a large number of subspecialty clinics here at Newton-Wellesley Hospital staffed by MGH subspecialists and also with the establishment of the pediatric emergency room program it is anticipated that there will be an even wider variety and number of patients on the pediatric inpatient unit and ambulatory experiences for these residents to participate in.