June 13, 2013
Going back to the basics, Saint Agnes molds future leaders and teachers in pediatric medicine.
Second-year pediatric resident Jessica Knight-Perry, right, consults with hospitalists Eric Balighian and Sheila Hofert on the pediatric ward at Saint Agnes.
The Johns Hopkins pediatric residency program is not for want of reputation. Former residents cite robust clinical experiences and increasing levels of independence in what they describe as one of the most prestigious, sought after programs in the country. But housed in the brand new Charlotte R. Bloomberg Children’s Center, what the program is not is hands-on pediatric medicine in a community hospital setting.
So, how do these residents face the lesschronic, less-complex conditions they’re likely to encounter more often in community practice? Where do they accumulate early leadership experiences and opportunities to work closely with community pediatricians? The answer is their rotation at Saint Agnes Hospital, perched on a hill less than 10 miles south of the Johns Hopkins campus.
“The idea was to compliment the resident’s experience at a tertiary hospital with what happens in a community hospital,” says Saint Agnes Pediatrics Chairman Michael Burke. “Here they focus on more bread-and-butter inpatient pediatrics.”
Since 1992, explains Burke, the 20- bed pediatric inpatient unit at Saint Agnes has been home to Hopkins pediatric residents for 3 ½ months of their 3-year residency. A recent rejuvenation of the Saint Agnes campus, including a plush patient tower, lends a modern look to a hospital with origins in the 1860s. But the pediatric ward—with the traditional central nursing station and children’s art lining the hallways—has retained a comforting, community hospital feel.
Here Hopkins interns treat generally healthy kids who are admitted for a day or two due to conditions like an asthma attack or a urinary tract infection, though diagnostic challenges do occur. They also do procedures, like laceration repairs and blood draws, that other services perform at Hopkins. These interns are supervised by 2nd year residents, and the following year they become those 2nd year leaders.
“It’s one of the few rotations where 2nd year residents get to act as supervisors,” notes Hopkins Pediatrics Residency Director Janet Serwint. “But geographically separated from Hopkins, they have to learn how to think more independently and decide when a patient needs a more tertiary care placement because they don’t have ready access to our specialists.”
Saint Agnes hospitalist Eric Balighian, who went through the rotation four years ago, agrees, noting that greater autonomy encourages greater effort.
“If the onus is on you to make the treatment decision, it’s more challenging and you feel that pressure, that responsibility,” says Balighian. “You think harder, you research harder, and you ask more questions because you want to make the right decisions.”
Saint Agnes Hospitalist Sheila Hofert, another veteran of the pediatric residency rotation, also cites this independence as a hallmark of the program. She notes that while at Hopkins many new inpatients come with a plan of action from the subspecialist, at Saint Agnes the residents take initial ownership of the plan.
“The residents have the first say and make an assessment plan of what they think is going on and what they want to do,” says Hofert. “That’s the neat thing about being here and being able to run the show, although they still run their plans by the supervising attending.”
Hopkins pediatric interns also spend one month in the well-baby nursery attending deliveries, seeing newborns, counseling new mothers and working side-by-side with community pediatricians who serve as attendings for about half of the newborns. Residents in the inpatient pediatric unit connect with community pediatricians, too.
“You’re constantly getting ahold of the community pediatricians about their patients because they own the patients and have more of a role in their hospital care. At Hopkins a lot of the patients are owned by the subspecialists,” says Balighian. “Here residents see the conditions community pediatricians treat, the difficulties they face.”
During the rotation, these young leaders are taught to be teachers, too.
“Instead of answering questions, you’re turning it around and asking ‘What do you think? What would you like to do?’” says Hofert. “As a second year you’re inclined to give the answers, but here you have to learn the skill of making the learner come up with the answers. It’s the first step in becoming a good teacher.”
Another step, says Burke, is for residents to look at their role models for teaching.
“I always looked up to the teachers I had here at Saint Agnes, who were very dedicated in going back to the basics, including asking more questions in history, doing a better job in physical exam and relying less on lab data and imaging,” says Hofert. “That really resonated with me as something I’d like to pass on to the interns and residents here.”
The rotating residents teach the more experienced staff, too.
“I learn a lot from the residents just by working with them, by hearing their questions and having to respond to their questions,” says Burke. “I like watching them mature from internship through second year. It’s neat to see how they evolve.”