Pediatric Residency Program Curriculum

Required Pediatric Rotations

Akron Children’s required pediatric rotations offer a comprehensive curriculum designed to equip residents with essential skills and knowledge that will last the length of the pediatric residency.

• Ten blocks: Inpatient Medicine
• Two weeks: Inpatient Hematology-Oncology
• Two blocks: PICU
• Six weeks: NICU
• One block: Newborn Nursery
• Three blocks: Ambulatory
  • Includes one block Community Advocacy
• One block: Ambulatory Adolescent
• One block: Ambulatory Developmental Behavioral Pediatrics
• Three blocks: Emergency Medicine
• One block: Subspecialty Outpatient Ambulatory Electives
  • Two each of two-week electives
• Five blocks: Individualized Curriculum Subspecialty Elective
• Six blocks: Individualized Curriculum Elective
  • Divided into eight electives
• Total vacation: 12 total weeks: PL 1 – three weeks; PL 2 – four weeks; PL 3 – five weeks

PL 1 Year Residents

• Two blocks: Inpatient Hospital Medicine
• Two blocks: Inpatient Subspecialty
• One block: Inpatient not specified
• One block: Two weeks NICU (day shifts only), one week Developmental Behavioral Pediatrics (ambulatory), one week vacation
• One block: Emergency Medicine
• One block: Three weeks Community Advocacy (ambulatory), one week vacation
• One block: Adolescent Medicine
• One block: Newborn Nursery at Summa Health
• Two blocks: Individualized Curriculum Subspecialty (elective)
• One block: Three weeks Individualized Curriculum Subspecialty (elective), one week vacation

PL 2 Year Residents

• Two blocks: Inpatient Hospital Medicine: Supervisor
• One block: Inpatient Subspecialty: Supervisor
• One block: NICU at Summa Health
• One block: PICU
• One block: Emergency Medicine
• One block: Ambulatory
• One block: Development Behavioral Pediatrics (ambulatory)
• One block: Two weeks Subspecialty Outpatient (elective), one week Individualized Curriculum Subspecialty (elective), one week vacation
• One block: Three weeks Individualized Curriculum Subspecialty (elective), one week vacation
• Two blocks: Three weeks Individualized Curriculum Elective, one week vacation
• One block: Two weeks Inpatient Subspecialty (Hematology-Oncology), two weeks Subspecialty Outpatient Hematology Oncology

PL 3 Year Residents

1. Two blocks: Inpatient Hospital Medicine: Supervisor
2. One block: PICU • One block: Emergency Medicine
3. One block: Ambulatory • One block: Mental Health (ambulatory)
4. Two blocks: Individualized Curriculum Subspecialty (elective)
5. Five Blocks: Three weeks Individualized Curriculum Elective, one week vacation

Ambulatory Care Residency 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 Health – St. Elizabeth Boardman Hospital: PL 3
• NICU: Introduction to NICU: PL 1
• PICU: Advanced: PL 3
• PICU: Introduction to PICU: PL 1

Hospital Medicine Electives

• Hospital Medicine, Akron Children’s Hospital, main Akron campus
• Hospital Medicine, Community-Based at Akron Children’s Beeghly or at Wooster Community Hospital

Pediatric Surgery Residency Program Electives

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

Other Pediatric Rotation Electives

• Administrative Leadership
• Bioethics
• Domestic: Away rotation in the U.S.
• Global Health: International
• Informatics
• Lactation
• Parenting
• Procedures
• Professional Development
• Quality Improvement
• Research
• Teaching

The goal of the community health clinical rotation is to provide a rich, community-based experience in which the pediatric 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

Community Advocacy 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 Ministry Medical Clinic with Akron Children’s pediatricians
• Independent scheduling – virtual
  • WIC
  • Help Me Grow/Early Intervention

Advanced Community Advocacy Elective

• 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 emails to educate residents in the program about advocacy.
• Highly recommended: Select an advocacy issue to work on as your required residency QI project.

Clinical Requirements for the Advanced Community Advocacy Elective

• The pediatric resident must choose and attend six 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 and Mortality Conferences
  • Emphasis on mitigating biases, including implicit biases
• Resident Conversation Circles 
  • Six 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 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 Foodbank at Akron Children’s
• Annual Have a Heart Do Your Part Radiothon
• Harvest for Hunger Program
• Annual Kids are #1 Run

 Pediatric Global Health Residency: 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 treats 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 or Mexico.
• Community health in remote settings
  • Work with health program teams to improve healthcare in poor, disadvantaged and remote communities in India, Nepal and 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 Rotation

• Akron Children’s NICU, main Akron campus: Level 4 NICU
  • Faculty: Akron Children’s Neonatologists
  • No on-site deliveries
  • 75 beds
• Akron Children’s NICU at Summa Health, Akron: Level 3 NICU
  •  5 miles from Akron Children’s Hospital, main Akron campus
  • Faculty: Akron Children’s Neonatologists
  • On-site deliveries
  • 22 beds
• Akron Children’s NICU at St. Elizabeth, Boardman: Level 3 NICU
  • One hour away from Akron Children’s Hospital, main Akron campus
  • Faculty: Akron Children’s Neonatologists
  • On-site deliveries
  • Elective site for those residents interested in becoming neonatologists 
  • 25 beds

Intern NICU Residency Program Required PL 1 Rotation

• Two-week PL 1 rotation (one week at Akron campus; one week at Summa Health)
  • Work 6 a.m.-4 p.m. M-F and two weekend mornings per month
  • There is no overnight coverage required

PL 2 NICU Residency Program Required Rotation July 2024-2025

•  PL 2s will rotate at Akron Children’s NICU at Summa Health, Akron.
  • Two weeks: Total of six shifts; 12-hour day shifts for rounds and deliveries 
  • Two weeks: Total of six 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

Delivery Experience

• Pediatric Residents who are interested in NICU can do:
  • Introduction to NICU: PL 1
  • Summa NICU Delivery Experience: PL 2
  • Advanced NICU
  • Community NICU
  • Community-Based Hospital Medicine Rotation: Wooster

Goal of the Quality Improvement Training for Health Care Professionals

• Residents will be able to discuss QI methodology by actively participating in group QI projects.
  • Quality improvement projects for residents expose them to multidisciplinary work groups, hospital logistics and presentation skills, along with QI methodology.

QI Project 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 one 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.
  • Three didactic Noon Conference sessions/year (one for interns only and two for all residents)
  • Two 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 two or three 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 Akron Children’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 the 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 Hand

This is a longitudinal 18-month residents-as-teachers 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 six foundational lectures on medical education topics from faculty and the chief residents.
• Each resident in the track is required to give four 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.
• Pediatric 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 June 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 Inpatient Floor Team”
    • DEI Panel Discussion
  • Skills
    • LPs
    • BVM
    • Auscultation of Murmurs

Longitudinal Simulation Curriculum – TN/PEM

Participants

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

Schedule during the four-week block

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

Each four-hour session is on Friday afternoons

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

NICU Simulation Curriculum

Participants

• Interns and PL 2 residents on their NICU rotations

Schedule

• Four Fridays during the block

Sessions

• Three one-hour: Low-fidelity NRP (delivery) simulations
• One four-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

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