General Pediatrics

The Division of General Pediatrics has a longstanding history of innovative leadership in graduate and undergraduate medical education. The Division Faculty are the core teachers for 60 pediatric housestaff and the medical students during their pediatric clerkship. The training is carried out in neighborhood based programs.

Residency

In the late 1990’s the residency program at Children’s Hospital of New York was restructured to give new emphasis to primary care and community pediatrics. Residents have a weekly full-day of continuity clinic at the community based practices and an entire month of primary care in each year. During the ambulatory and community pediatrics blocks, resident have direct involvement in community based experiences with neighborhood organizations. Residents make home visits to their patients with faculty from the Division. These visits have proven to be a terrific laboratory for teaching residents about the role of physicians, understanding the doctor-patient relationship, and exploring the psychosocial component of illness and recovery.

Community pediatrics is a perspective that enlarges the focus of care from one child to all children in the community. The traditional approach of caring for individual children in the medical practice setting does not adequately address many of the major threats to our children's health. Problems such as infant mortality, obesity, domestic violence, intentional and unintentional injuries are better addressed by a community pediatrics approach. Children and their health needs are best understood and attended to within the interlinking contexts of biology, family, and the community.

Over the last ten years, CHONY has realized the importance of working collaboratively with agencies and stakeholders in the Washington Heights Inwood community to address health issues in the community. By developing partnerships, both the Hospital and the community can benefit from each other’s strengths and abilities in order to optimize child health outcomes, and services delivered are more closely aligned with the community’s self-perceived needs. Forming truly reciprocal partnerships, based on mutual trust and respect, is not an easy or quick process; rather it requires patience, continual honest communication and a high level of dedication to achieving mutually agreed-on goals. Once such a partnership is established, it can provide the foundation for building effective programs that result in the improvement in the health and well-being of the community’s children.

Community Pediatrics is now embedded in the culture of the training program and informs the development of all community based programs. Residents provide meaningful resources to community based organizations and gain knowledge and experience about community based work and the context in which their patients live and provide leadership for community health projects within the institution.

In partnership with Harlem Hospital Center, the Division has a Health Resources Services Administration funded fellowship program in Urban Community Health. The Primary Care Clinician Research Fellowship in Urban Community Health entails: 1) advanced training in the clinical practice and teaching of primary care in an urban, underserved, community in New York City; 2) pursuit of an advanced degree in public health, either a Masters in Public Health or a Master in Science in Epidemiology or comparable field at the Mailman School of Public Health; and 3) the completion of a research project and a publishable manuscript on urban community health. Fellows have the option of setting up a clinical practice at Harlem Hospital Center or Children’s Hospital of New York Presbyterian.

Families of children with chronic illness are well known to the staff of a medical center. Life outside the hospital for these families is often complex. The pediatric residency training program at CHONY recognizes the importance of a continuum of care from the hospital to the home fro these families. Project DOCC is a training program to enrich the educational experience of pediatric residents. If we achieve our best in residency training, residents learn not only the latest advancements in medical care but they also gain a perspective about a holistic understanding of the role of the family in the life of a child with chronic illness. Parents of children with chronic illness teach pediatric residents about family life outside the hospital. Residents make home visits and have in-depth interviews with parents. When parents take on the role of articulate teachers and advocates, the relationship between physician and the parent changes profoundly, and facilitates the development of trust and a therapeutic partnership.

The Web Based Curriculum of Children’s Hospital was designed to eliminate many of the obstacles to learning which are associated with residency programs: availability of mentors, time, passive teaching techniques and delayed feedback. Sections of the website are devoted to enhance resident satisfaction including discussion boards and accessibility to difficult medical order templates. We sought to create a forum where both teachers and students could appreciate the great resources they could be for each other. The greatest strength of this medium is that the residents are the creators of the content. As studies and experience have shown educators, “To teach is to learn twice.”