Third Year of Residency (PGY-3)

Pediatrics Residency
PGY-3 Rotations
Rotation Blocks Overnight Call
Inpatient Wards* 2 None
NICU 1 None
PICU 1 Shift Work
Wolfson Night Shift* 1 Sun-Thurs Shifts
NICU/Nursery Night Shift 1 Sun-Thurs Shifts
Adolescent Peds 1 Weekend Pool
Outpatient Mental Health 1 Weekend Pool
Electives 5 Weekend Pool
* The Wolfson Children’s Hospital day and night block are now split into 2 weeks days and 2 weeks nights between the 2 seniors on the rotation. This change was based upon feedback from the majority of the senior residents. For the other WCH inpatient ward rotation, the senior only works 5 days a week, all weekends are off.

During the PGY-3 year, there is continued emphasis on supervising junior residents and developing autonomy as residents prepare for either a fellowship or a career in general pediatrics. The PGY-3 resident oversees and assists junior residents and students on the inpatient units at Wolfson Children’s Hospital and in the intensive care units. He or she organizes and manages teams on the inpatient and outpatient services in conjunction with the faculty and is responsible for leading case discussions and patient care plans for the team.

Third-year residents prepare and present grand rounds which may be recent updates on a topic of general interest, a discussion focused around a clinical case or any scholarly work they have been involved with. They work closely with a faculty mentor in preparation. This provides an opportunity for the residents to inform and educate residents and faculty in a professional setting and to polish their public speaking skills, an essential leadership competency.

Inpatient Experience at Wolfson

PGY-3 residents complete three inpatient blocks during the third year, each providing a unique experience for the resident. The first two provide a supervisory experience by leading an inpatient general pediatrics team at Wolfson Children’s Hospital, with direct supervision and teaching of PGY-1/2 pediatric residents, medical students and physician assistant students. These two blocks are split into 2 week day/night units.

As a PGY-3 at night, residents share patient responsibilities with two additional junior residents, but function as the supervising resident for the inpatient service and admissions. The PGY-3 resident has hospitalist faculty on site until midnight. From midnight to 6 a.m. faculty are available by phone. This experience gives the residents much-needed autonomy to practice medicine in a controlled environment with indirect supervision and allows them to develop the confidence and clinical reasoning skills they need to practice once they graduate. There is a PICU faculty member in house at all times and the PICU team is available for all rapid responses and to help care for any critically ill patients when that need arises. Hospitalist faculty are available for any questions over the phone and the PICU attending is available in house for any emergencies. All noon conferences are recorded and made available online for residents to be able to review either during their call or later when they are able to do so.

The third block allows the PGY-3 resident to work one-on-one with an attending-only inpatient team, providing the resident with a unique opportunity to manage every aspect of their patients’ care. This latter experience in the third year is specifically directed at fostering independence and autonomy during the final year of training including learning concepts such as inpatient billing.

NICU Experience

During the NICU rotation, the PGY-3 resident assumes complete responsibility for the NICU team, consisting of both PGY-1 and PGY-2 residents. The third-year resident is able to help manage patient care as well as build procedural and resuscitation skills.

PICU Experience

In the PICU, the PGY-3 resident again takes on a supervisory role over PGY-2 pediatric and emergency medicine residents. This month while primarily focused on taking care of critically ill pediatric patients may also provide another opportunity to perform common procedures such as intravenous line placement, nasojujenal tube placement, bladder catheterization, intubation and lumbar puncture along with other procedures such as central line placement as and when available. The residents work closely with faculty and in addition to direct patient care, are involved in one-on-one didactics with the faculty.

NICU/Nursery Night Shift

During the NICU night shift rotation, the PGY-3 provides supervision and support to PGY-1 residents on their newborn night shift rotation, particularly when attending deliveries. They will also manage the NICU patients at night, admitting new patients, performing procedures such as intubations and central line placement (UVC) and tending to any acute concerns. During this block, they will spend the first two weeks covering the newborn nursery shifts at night.

Adolescent Medicine Experience

During the adolescent medicine rotation, residents learn about the medical and social issues affecting adolescents. Residents are exposed to a diverse population through experiences at a private preparatory school clinic, JaxHATs (adolescent transition clinic for children with special health care needs) and an adolescent inpatient mental health unit. They also spend one-half to one full day at an eating disorders clinic. We have also been able to arrange, for those interested, to learn to insert a long acting contraceptive device during two dedicated hands-on trainings per year.

Mental Health Rotation

During this outpatient mental health block, residents learn outpatient mental health screening, diagnosis and management of a variety of mental health conditions such as but not limited to ADHD, depression, anxiety, PTSD. This rotation is under the guidance of dedicated pediatric psychiatrists. An elective mental health block is also available for anyone interested during the PGY-2 year. This includes time at an addiction medicine facility once perweek.

Research and Administrative Experience

The PGY-3 residents have the option to spend a month in an administrative role. They may also use this month to do another elective if they so decide. During this month, the administrative resident assists in running noon conferences as needed and attend designated patient safety meetings. PGY-1, PGY 2 and PGY 3 residents also present a peer-reviewed, EBM article using the PICO methodology. This block also provides time for the third-year resident to work on completion of his/her scholarly and quality improvement projects as well as study for the boards. In addition, we have a 1-2 week patient safety elective which the resident can either do separately or as part of their administrative month if they choose to take this elective option.