Level 1 (PGY-1)
The goal of the first year of pediatric training is to provide the new resident with the experience and skills necessary to care for patients with competence and compassion. To achieve this goal, a variety of opportunities for the resident exist.
In the clinics and on the inpatient units, the PGY-1 resident works under the supervision of senior residents and pediatric faculty members to provide primary care to all pediatric patients. An extensive schedule of educational conferences and lectures is developed for each academic year. Conferences in July and August are designed to review important aspects of acute pediatric care for incoming PGY-1s. Throughout the year, daily resident case conferences and noon conferences cover a core curriculum in all aspects of pediatrics. A full schedule of departmental and subspecialty conferences maintain the foundation of instruction by providing the resident with basic problem-solving skills and introducing them to new frontiers in pediatric practice.
Each inpatient service also provides learning experiences during daily work rounds with the ward resident and during regular teaching rounds with the attending. Ancillary health team members, including nursing staff, social service personnel, chaplains, hospital teachers, occupational and physical therapists, dietitians and pharmacists, often join the medical staff during rounds. PGY-1s on inpatient services participate in teaching third-year medical students.
PGY-1s have four weeks of night shift under the supervision of upper-level residents.
Level 2 (PGY-2)
The PGY-2 program provides the resident with intensive training through manager-style clinical rotations in various pediatric subspecialties, including adolescent medicine and inpatient hematology/oncology. Each subspecialty has a core curriculum consisting of specific readings, self-teaching units, slides, lectures and discussion sessions. The resident performs consultations for hospitalized patients and works closely with the faculty in managing subspecialty clinics and evaluating private patients.
PGY-2 residents will select an individualized longitudinal experience to create flexibility in their residency curriculum and encourage them to develop overall career goals early in their residency career. These tracks include primary care or adolescent medicine, public health/global health/advocacy, procedure specialty (e.g., PICU, NICU, ED), and non-procedural specialty (e.g., endocrine, hem/onc, pulmonary, ID, cardiology, pulmonary). The longitudinal experience will include one core elective, one ancillary specialty elective, and two weeks of half-day didactics with curricula developed by a track director.
On the inpatient wards, the PGY-2 spends six weeks on the hematology/oncology specialty ward. Two PGY-2 residents are paired with hematology/oncology fellows and faculty in a manager model of care. The residents use the skills from their PGY-1 year to serve as the primary care provider while having direct support and supervision as they take on more independent roles in patient management. In addition, the PGY-2 serves as the junior house officer and shares duties with the PGY-3 on general ward rotations. During this month, he/she also is the designated teaching resident, with responsibility for leading teaching sessions for medical students and performing literature searches on clinical questions that arise during rounds.
Overnight coverage for the two inpatient ward teams is provided by a night shift system and by the team seniors. Each PGY-2 resident does four weeks of night shift over the course of the year. Night shift duties consist of supervising the PGY-1s in their clinic decisions, and managing the inpatient hematology/oncology team and newborn nursery. The PGY-3 managing the other teams is available for assistance.
On the neonatology service, the PGY-2 residents are responsible for intermediate and intensive patients. The PGY-2 residents provide coverage at night five days per week with a neonatal nurse practitioner, fellow or attending physician. The PGY-2 resident also plays a leadership role in the NICU code team, responding to high-risk deliveries.
The Pediatric Intensive Care Unit (PICU) is staffed by three or four residents (PGY-2 or PGY-3) who are the primary caregivers to all patients admitted. Supervision is by a PICU fellow and attending. PGY-2s gain experience with management of respiratory failure, sepsis, trauma and multi-organ system dysfunction. For more information, see our PICU section.
In addition to their one half-day session per week in the Pediatric Group Practice while on outpatient and elective blocks, PGY-2s spend one half-day per week while on subspecialty and outpatient rotations either in research activities or assigned to a clinic in the field that is related to their longitudinal track.
During the PGY-2 year, in-house call is every seventh night while on inpatient ward teams. In the Pediatric Intensive Care Unit, the resident will do night shifts for one week of their four weeks spent in the PICU. For the remainder of the year, call primarily consists of answering phone calls at home from continuity clinic patients and parents.
Level 3 (PGY-3)
The PGY-3 year provides the resident with extensive supervisory experience that builds on the PGY-2 foundation. The PGY-3 resident supervises one of the inpatient teams in the Children’s Hospital of Richmond at VCU and follows the progress of all patients on non-surgical services. The PGY-3 resident is responsible for organizing and conducting daily work rounds, facilitating discussion during attending rounds, providing guidance to the PGY-2 resident in their teaching role and providing direct oversight of the PGY-1s and medical students.
Like the PGY-2 resident, PGY-3 residents will continue in their individualized longitudinal experiences. The longitudinal experience during PGY-3 year will include a mix of core elective and ancillary specialty electives for a total of 12 weeks, and two weeks of half-day didactics with curricula developed by a track director. In total, each track member will have four weeks of specific track-directed didactics between the PGY-2 and PGY-3 years.
During the year, the PGY-3 resident continues to have exposure to a variety of pediatric subspecialties. There also are elective opportunities to work on other services in the medical center such as dermatology, orthopaedics, child psychiatry or radiology. PGY-3s continue to spend one half-day per week on research or a clinic in the field of their longitudinal track while on all outpatient or elective rotations, in addition to their one half-day in the resident continuity clinic during those weeks.
The PGY-3 is on call every seventh night while on the inpatient ward teams. In the Pediatric Intensive Care Unit, the resident will do night shift for one week of their four weeks spent in the PICU. Weekday overnight coverage for the two inpatient ward teams is provided by a night shift system. Night shift duties consist of supervising the PGY-1s in their critical decisions, teaching and managing of the ward teams. The PGY-3 is also available to assist the PGY-2 who manages the hematology/oncology service and newborn nursery. Each PGY-3 resident does four weeks of night shift over the course of the year. In addition, the night shift resident acts as a backup to assist both the NICU and PICU senior residents in the event of an emergency.