Educational Pathways (General Pediatrics Program)

• Primary Care Pathway
• Critical Care Pathway
• Physician Scientist Pathway
• Special Alternative Pathway (SAP)
• Integrated Research Pathway
• Global Health Scholars Program

Rotations (Applicable to all residents)

• Adolescent Medicine
• Behavior, Development and Disabilities
• Continuity Clinic
• Physician in Society
• Subspecialty Rotations
• Transport
• Overall Rotation Schedule

Other Features (Applicable to all Residents)

• Teaching Skills
• Advising and Mentorship
• Career Development

There are a number of optional educational pathways in the General Pediatrics Program for those residents with identified special interests, allowing incoming PL-1s to select a residency experience that is more tailored to needs. Residents in the various pathways share a common core curriculum of general and subspecialty pediatrics in inpatient, intensive care and ambulatory settings; all pathways lead to eligibility for Board Certification in Pediatrics and poise each resident for entry into any competitive postgraduate fellowship or practice opportunity. Pathways are selected after the match, but before starting the residency program so as to create an appropriately focused schedule (including the selection of the Continuity Clinic site).

For more than 30 years, UCSF has offered applicants the opportunity to participate in an intensified primary care experience. The Primary Care Pathway, a track within the Categorical Pediatrics Program offers expanded training in community and practice-based primary care pediatrics.

All primary care residents are based at Mount Zion Pediatrics for their continuity clinic training site. Residents have time set aside for a second half day of continuity clinic per week during outpatient months. In addition, residents are allocated “primary care days” throughout the year. These “primary care days” are an opportunity for the residents to explore interests related to local community health, visit community sites, explore new longitudinal outreach experiences, collaborate with community organizations, develop clinic-based quality improvement or medical education projects or pursue research interests. Special primary care seminars and regular primary care meetings are also integrated into the curriculum.

In their third year of residency, Primary Care Pathway residents apply their skills learned in community medicine, primary care quality improvement or medical education to collaborate with other residents on a primary care project. Graduating residents present their projects at an annual poster session held each June.

Recent projects include:

•  Assessing Barriers to Nutrition and Fitness in the Western Addition (Received AAP CATCH grant)
•  The Western Addition Beacon After-School Running Program
•  Urban Garden Project at KIPP Middle School and Gateway High School
•  Community Safety and Violence Prevention in the Mount Zion Neighborhood
•  Clinic-Based Quality Improvement in the Approach to Child Obesity
•  Hilltop High School Teen Mother Educational Program
•  African Immigrants and Refugees Health Project
•  Primary Care Curriculum Needs Assessment
•  Compilation of Mt. Zion Community Resources

Ultimately, UCSF Pediatric Primary Care Pathway residents are uniquely and specially trained in clinic and community-based approaches in improving child health.

Within the General Pediatrics Program, a Critical Care Pathway is available and offered to up to four residents each year. The pathway is designed for residents identified as highly interested in careers such as neonatology, critical care, and cardiology. These residents rotate in the PICU during their first year of training (usually a second year rotation) and have the ability to schedule an appropriately focused critical care specialty elective early in their second year, thus allowing them to explore their interests and make a decision regarding fellowship applications earlier in their residency.

As a center of excellence in biomedical research, UCSF has many outstanding resources available to residents interested in academic pediatrics. This evolving pathway seeks to create opportunities to optimize the training environment for residents interested in becoming physician-scientists. One core activity of this group is a monthly journal club, led by residents in conjunction with a faculty mentor. A proactive faculty advisor program has been developed to help interested residents prepare fellowship applications, identify optimal postgraduate training environments at UCSF and other institutions, and to develop curriculum in the second and third year tailored to residents' academic interests.

Some residents in the Physician Scientist Pathway may choose to take advantage of a unique opportunity at UCSF known as the Molecular Medicine Training Program (MMTP). The MMTP offers post-residency research training positions for physicians committed to a career in basic biomedical or translational research. MMTP fellowship positions are available at different stages of clinical training: either in conjunction with Residency training, or post-clinical fellowship. At the time of acceptance into the program, MMTP fellows are guaranteed access to training positions in laboratories of Molecular Medicine or other appropriate faculty either in the affiliated Program in Biological Sciences (PIBS) or the Biomedical Sciences Program (BMS). Participating MMTP faculty are members of interdisciplinary programs including Biochemistry & Molecular Biology, Immunology, Microbiology, Cell Biology, Developmental Biology, Genetics, Pathology, and Neuroscience.

Please visit the MMTP website directly for full details about the program.

IMPORTANT INFORMATION (for potential MMTP applicants only)

• Tuesday 12/11/07
• Tuesday 12/18/07
• Thursday 1/10/08

Invitation for an interview in the Pediatric Residency Training Program does not guarantee an interview for the MMTP. However, should an applicant be denied an interview for or selection by the MMTP, the strength of candidacy for the Pediatric Residency Program is entirely independent of those decisions made by the MMTP.

Fellowship applicants:
Generally, an application is made either at the time of clinical fellowship application or during the fall of the first clinical year of fellowship at UCSF.

The American Board of Pediatrics (ABP) recognizes that occasionally an exceptional candidate should be given special consideration to begin pediatric subspecialty or related training after the completion of the PL-2 year of general comprehensive pediatrics. Before the start of the PL-2 year, the program director may petition the ABP that a resident be considered for the (SAP), indicating that the candidate has superior overall competence. The subspecialty program director must also provide a letter outlining the clinical and research training proposed, including special requirements to be met during the PL-2 and PL-3 years. In addition, such candidates will be required to take a screening examination. The application material and the score on the screening examination will be reviewed by the SAP Credentials Committee.

A SAP trainee may apply for the certifying examination in general pediatrics in the fifth year of training provided that he or she has successfully completed the required two years of general pediatrics residency and at least 12 months of clinical rotations in the pediatric subspecialty.

The Integrated Research Pathway (IRP) is designed to accommodate MD/PhD graduates who would benefit by having the ability to continue ongoing research during their pediatric residency. During the 3 years of general pediatric residency, a maximum of 11 months may be spent in research, with at least 5 months in the PL-3 year and no more than 1 month in the PL-1 year. Individuals may apply to the American Board of Pediatrics for this program either before entering the pediatric residency program or during the first 9 months of the PL-1 year. The curricular components of the minimum of 22 months of core clinical pediatric residency must be fulfilled.

A supervisory/review committee will be established by the residency program and the research mentors to ensure that each trainee is meeting the requirements of training and is successfully completing each experience to be continued in the pathway. The program directors will provide careful evaluation of clinical training to determine whether the resident is attaining the knowledge and experience necessary to provide independent care of children. A research mentor will oversee the research experiences to ensure that the trainee is accomplishing pathway goals. To meet the eligibility requirements for certification in general pediatrics, the resident must satisfactorily complete 36 months in the IRP. An additional 12 months of pediatric clinical experience in an accredited specialty residency or fellowship must be successfully completed to be eligible to apply for the certifying examination in general pediatrics.

Global Health Scholars Program

In 2005, the UCSF Departments of Pediatrics and Medicine collaborated to develop an Global Health Scholars Program jointly with UCSF Global Health Sciences. This program is designed to give tailored mentorship and educational experiences to residents with a specific commitment to global health. Currently there 4 residents from Pediatrics in this program. They are among 16 total scholars from 7 different residency programs, including surgery, psychiatry, family practice, ob/gyn, orthopedics, and medicine.

Participants in the GHS program receive:

1. An intensive September course covering basic topics in global health
   
2. Mentored Project and Immersion experience at an international site, either in a Clinical Research Pathway or a Policy/Program/Education Pathway
   
3. Participation in a local global health project
   
4. Rotation at select clinics that address international or global health issues
   
5. Regular meetings to provide contact with like-minded trainees and faculty to discuss issues, review articles, and discuss career paths
   
6. Opportunities to participate in future Global Health curricular development
   

Residents apply to this program during the PGY-1 year. Upon completion of the program, participants will obtain a Recognition of Distinction in Global Health from UCSF Global Health Sciences.

The GHS program is complemented by the Pediatric International Health Interest Group which includes faculty, fellows, residents, and medical students. The group has monthly meetings which include a potluck dinner and a presentation by a member or guest.

ROTATIONS (Applicable to all residents)

A structured one-month introduction to this discipline is provided in the PL-1 year, with focused clinical experiences and teaching continuing throughout the remaining years of training. The Adolescent Medicine Unit is staffed by an interdisciplinary team, including pediatricians, obstetrician-gynecologists, child psychiatrists, psychologists, social workers, nurses and nutritionists, providing comprehensive care to ambulatory and hospitalized adolescents. There are ample opportunities for community interface and extensive outreach, as this unit supports health services at many local institutions, including schools, storefront clinics, and residential programs for high-risk youth and teenage mothers. The option exists for residents to select a school-based clinic for continuity clinic.

An extensive educational program and clinical experience in behavior and development is provided as a dedicated month-long rotation in the PL-2 year. This outpatient experience is academically challenging and clinically stimulating. The focused teaching on this rotation is applicable to all other educational and service settings, and thus plays an important role throughout the pediatric training program. Housestaff training is based at multiple sites in the community, including experiences as diverse as participation in the evaluation and therapy of children with behavioral disorders and multiple physical disabilities, on-site observation of preschools and elementary schools, and site visits to community programs and state institutions. The involvement of pediatricians, occupational and physical therapists, child psychiatrists, psychologists, social workers, speech and language specialists, and special education teachers serve to ensure a truly multidisciplinary experience.

Each resident participates in regular continuity clinics at one of the five program sites throughout the three years of training. These continuity clinics are organized as group practices, meeting on a fixed day of the week, and are composed of several residents and a faculty preceptor. In addition to the opportunity to develop and experience a personal "practice," a formal curriculum is offered. This features small-group, interactive discussions that cover general ambulatory pediatric topics, particularly pediatric health surveillance, psychosocial, and behavioral issues.

This rotation utilizes resources in the community and within UCSF to provide residents with a structured learning experience which includes issues of domestic violence, political advocacy and health policy, and cultural competence. It has in the past been awarded the Honorable Mention Teaching Award by the Ambulatory Pediatric Association. Resources include leadership from local and state advocacy organizations, faculty from UCSF's Institute for Health Policy Studies, and field placement in a variety of schools, shelters and community-based service providers for children and families. For residents in the Primary Care Pathway, this rotation provides a timely foundation for developing the community project in the third year. Examples of recent community projects include: the development of a clinic-based literacy project; a peer education program on tobacco-related health risks; a state legislative advocacy project; and a culturally sensitive asthma education program for Latino patients.

Rotations through selected subspecialties are part of each resident's experience, ensuring exposure to such areas as cardiology, neurology, infectious diseases, gastroenterology, nephrology, endocrinology, pulmonology, immunology, rheumatology, genetics, bone marrow transplantation, hematology, and oncology. These are either in-depth, singular service elective rotations, designed to provide experience across the full range of clinical care in one subspecialty, or a block rotation on the newly created, combined in- and outpatient services for certain selected subspecialties.

This elective third year rotation is a structured opportunity for residents to integrate and utilize technical skills learned during the previous years, providing experience in evaluating, stabilizing and managing infants and children before they reach the Medical Center. Residents transport infants and children to UCSF by ambulance and/or small plane from locations throughout Northern California and Nevada.

The overall rotation schedule of all residents reflects their individual curricular goals. No two residents have exactly the same rotation schedule. The residents' schedules are influenced by personal choices developed with the help of faculty advisors, as well as by either the General Pediatric or PLUS program they are in, the location of their continuity clinic, educational pathway and/or flexible schedule options.

First year residents have at least three months in general pediatrics acute care clinics and emergency room experiences; an adolescent medicine and newborn rotation; 4 months of inpatient general pediatric and subspecialty services, and 2 months of critical care services (PICU/ICN).

Second year residents have increasing responsibility for more complex patient problems, and increasing clinical decision making ability with less direct supervision from senior level residents. There are 2.5-3.5 months of general pediatric clinics and ER, a 1.5 month rotation in pediatric behavior/development/disabilities, a 1.5 month rotation on the hematology/oncology/BMT service, the Physician in Society month, 1-2 months of supervisory inpatient general pediatrics, 1-2 months of critical care services (PICU or ICN), and 1-2 months of electives. PLUS residents have a special PLUS rotation in community advocacy and leadership.

Third year residents have the greatest opportunity for supervisory experiences and to individualize their curriculum. There are 1-2 months of general pediatric clinics, 1-2 months each of inpatient pediatrics and intensive care nursery, and 2-3 months of electives. One month is spent on the "jeopardy" rotation, our program's method to cover other residents on short term absences. Most residents have a month of pediatric intensive care (depending on the educational pathway), and may also rotate on our pediatric transport service. Primary Care Pathway have a designated month to complete their community based project, and PLUS residents have up to 2 months of PLUS-specific curriculum.

OTHER FEATURES

The pediatric faculty and residents at UCSF have developed seminars fostering growth of teaching skills and team leadership in residents. These are offered in small group settings to all pediatric house officers. These skills are utilized regularly, as house officers share both formal and informal teaching responsibilities amongst themselves and as they supervise medical students rotating through the pediatric services. We have developed additional curricula to enhance professional skills and attitudes for working successfully with the tremendous diversity of our patients.

All residents are assigned a "transitional" faculty advisor in their first year, and then select a "career" advisor to help guide them through their final years in the program. The faculty advisors serve as advocates for the residents, as well as provide individual mentoring. The advising system assists residents with identifying pediatric career opportunities and job placement.

Residents are encouraged to participate in the annual "Life After Residency" day-long conference (workshops and panel discussions on relevant topics) sponsored by the Northern California Chapter of the American Academy of Pediatrics. Recent UCSF graduates in community practices and postgraduate training programs are readily available by phone or email to share personal experiences of career decisions, and meet with groups of residents, often annually.