Genetics and Genomic Medicine | Residency Programs | Pediatric/Genetics Combined Residency

Description

The Pediatric/Genetics Residency Program in the Washington University School of Medicine/Barnes-Jewish Hospital/St. Louis Children’s Hospital Consortium is a comprehensive progressive educational experience that provides the formal instruction and clinical experience necessary to develop an academic career in pediatrics and medical genetics.

Our 4-year combined residency program in Pediatrics and Medical Genetics was approved by the American Board of Pediatrics and the American Board of Medical Genetics. There is an option for a 5th year of research, funded by the Department of Pediatrics. The prerequisite training/selection criteria are the same as that of the General Pediatrics residency program: medical school graduate with good clerkship grades, good USMLE exam scores, good letters of reference, personal statement describing his/her interest in clinical medical genetics and the ECFMG certification.

The goal of the program is to educate the resident in the specialties of both Pediatrics and Clinical Genetics in the 4-year period, and ensure that they meet expected standards for the ACGME's general competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Learning.

Each rotation listed in the description below has a curriculum with goals and objectives. At the conclusion of this program, the resident will be eligible to sit for both the Pediatrics board exam and the Clinical Genetics board exam to be certified.

Please see the rotation lists for this 4-year program as described below. The resident will have a total of 24 months of Pediatrics and 18 months of Clinical Genetics. In addition, the resident will have 6 blocks of elective time or individualized curriculum (IC). The resident may use these IC blocks to further his/her clinical training or to initiate and work on a research project. See Individualized Curriculum section for further details.

Each resident is assigned to a faculty mentor at SLCH to help guide them during their residency. The mentor may change if the resident becomes interested in a specific research project. The resident is also assigned to a community pediatrician outside the hospital to learn about patient continuity and practice-based offices for the first 3/12 years of the program.

The resident's supervisory and patient care responsibilities will increase each year under the supervision of the attending physicians, directors and mentors. By year 3, the resident will be supervising residents and medical students while seeing patients with limited supervision.

The resident will have a list of procedures from the ACGME to complete before completion of the program. These are logged on the ACGME website. There are didactic lectures and conferences each day for the residents to attend.

The residents are evaluated though a residency management program (New Innovations) matching each resident with each faculty member he/she works with during the program. The resident also anonymously evaluates the faculty, rotations and program. There are 360 evaluations done by all the nurses and staff working with the resident. The resident also receives feedback from patients and families.


Clinical Experience

The resident spends a total of 24 months on Pediatrics and 18 months doing Clinical Genetics, with 6 months of IC. The first 18 months of the residency focuses on a rigorous clinical education in Pediatrics. The resident will then rotate to Medical Genetics for 6 months, then back to Pediatrics. An example of a block schedule for the 4 year training program is shown below. There is some flexibility in the distribution of IC blocks, depending on the resident’s interest in research. For example, a resident may elect to have 2 months of IC time together to initiate a research project in the second year of training. He/she may elect to have several IC blocks in tandem towards the end of the 4th year to focus on the project. We will work with each resident to design a schedule that works best for their interests. All residents must meet the requirements for board eligibility for both Pediatrics and Clinical Genetics by the end of their 4 years, however.

During the Medical Genetics rotations, the residents will evaluate both children and adults in the outpatient setting and provide inpatient consultation to a wide variety of patients. In addition to clinical rotations, residents will rotate through the biochemical, cytogenetic and molecular laboratories as well as the Genome Sequencing Center to gain experience in the methodologies and interpretations of laboratory studies commonly order on genetics patients. The following summarizes the rotations.

  • Inpatient Consultation Service
  • Hereditary Cancer Clinic
  • Prenatal Genetics
  • Biochemical Genetics Laboratory
  • Cytogenetics Laboratory
  • Molecular Laboratory
  • Genome Sequencing Center
  • Electives/Subspecialty Clinics

The residents also have the opportunity to attend a variety of outpatient clinics:

  • General Genetics Clinic (both pediatric and adult patients are seen)
  • Familial Cancer Clinic (adults with breast/ovarian, colon, many other cancers undergoing initial evaluation for hereditary cancer syndromes)
  • Cancer Predisposition Clinic (follow-up for individuals requiring ongoing surveillance for malignancies)
  • Adult Marfan and Related Disorders Clinic
  • Hereditary Arrhythmia Clinic
  • Craniofacial Clinic
  • 22q Clinic
  • Down Syndrome Clinic
  • Metabolic Management Clinic
  • PKU Clinic
  • Neurofibromatosis Clinic
  • Movement Disorders Clinic
  • Neuromuscular Clinic
  • Capillary Malformations Clinic
  • Prenatal Genetics Clinic
  • Whole Exome Sequencing Clinic

Individualized Curriculum

Each resident has 6 blocks of individualized curriculum (IC), or elective time during the 4 year training program. The purpose of the individualized curriculum is to provide experiences that will help a resident be better prepared for the next step in their career after residency. The curriculum might include additional subspecialty experiences not already used to fulfill the core subspecialty requirement in Pediatrics. Additional supervisory experiences on an inpatient Pediatric service that includes care for patients with genetic and metabolic disorders are encouraged. Rotation with our metabolic dieticians to learn more about specialized formulas and dietary management of patients with metabolic disorders would be another option. Rotations that will also be helpful for a Clinical Geneticist such as Pediatric Radiology and Pediatric Neurology can be utilized.

This 6-month period could also be devoted to a research experience. The faculty in Genetics and Genomic Medicine will help the resident identify a research project and an appropriate mentor for the project. An optional fifth year (funded by the Department of Pediatrics) is available to continue this project if the resident wishes. The project could be clinically oriented, a laboratory-based project or a project related to cases in the cytogenetics, biochemical genetics, or the molecular laboratory. A computational biology project is another possibility.

Residents have the opportunity to work with researchers in any of the basic science or clinical laboratories at the Washington University School of Medicine. The Division of Genetics and Genomic Medicine currently has over 2,000 square feet of research space within the McDonnell Pediatric Research Building. These laboratories are equipped with state-of-the-art facilities for molecular, cellular, and biochemical investigation. Basic physician-scientists and researchers in the Department of Pediatrics have access to confocal, microarray, and mouse genetic cores. Furthermore, clinical research within the Department of Pediatrics is coordinated by the Patient Oriented Research Unit. Clinical studies are supported by an NIH-funded Clinical Research Center and biostatistics and epidemiology resources.


Conferences and Seminars

Pediatric Chief Resident Rounds (Mondays at 12-1PM) Year 1 for Interns
Pediatric Morning Report (Monday-Thursday at 7:30-8:30AM) All residents but Interns and during Pediatric Rotations
Pediatric Case Conference (Tuesdays at 12-12:45PM) All 5 years of the program
Pediatric All Resident Conference (Wednesdays & Thursdays at 12-1PM) First 18 months and during Pediatric Rotations
Pediatric Grand Rounds (Fridays at 9:15-10:15AM) All 5 years of the program
Genetics Case Conference (Mondays at 12-1:30PM) During the Medical Genetics Rotations
Genetics Seminar Series (Thursdays at 12-1PM) During the Medical Genetics Rotations
Genetics didactic Lecture Series (Fridays at 12-1 PM) During the Medical Genetics Rotations
Resident/Fellows Early in Research Conference (Tuesdays 4-5 PM) During the Medical Genetics Rotations


Vacation, Travel Allowance

Residents have 3 weeks of vacation time per year, and approximately 5 days off at either Christmas or New Years.

The Division of Genetics and Genomic Medicine will pay for the resident to attend one scientific meeting each time the resident in on Genetics. We also pay for the resident to attend the workshop sponsored by the National Academy of Metabolic Disorders Society for Inherited Disorders (NAMA/SIMD).


Combined Pediatrics - Medical Genetics Training - Block Diagram

Use these abbreviations for the pediatric rotations:

P-ADOL Adolescent Medicine P-RS Required Subspecialty (required by program or chosen by resident to fulfill the requirement for 4 subspecialty EUs from list 1 in RC requirements) Designate % inpatient and outpatient
P-AI Acute Illness P-SP Subspecialty Experience (subspecialty experience used to fulfill the additional 3 EUs of required subspecialty experiences from list 1 or 2.) Designate % inpatient and outpatient
P-DB Developmental/Behavioral P-TN Term Newborn
P-EM Emergency Medicine Elec/IC Experiences chosen for individualized curriculum or electives
P-IP Inpatient (no more than 1 EU in a single subspecialty) PICU Pediatric Intensive Care
NICU Neonatal Intensive Care VAC Vacation
AMBU Ambulatory Experiences (to include community pediatrics and child advocacy)    

1st Year – Required Pediatrics

1st Year Block Diagram

Month/4wk 1 2 3 4 5 6 7 8 9 10 11 12 13
Experience or Rotation P-IP P-RS P-IP AMBU P-DB P-TN IC P-RS P-RS P-IP P-EM NICU VAC
Pediatrics Y Y Y Y Y Y Y Y Y Y Y Y Y
Medical Genetics             X            
Supervisory                          
Inpatient % 90 50 90 0 0 90 50 50 50 90 0 90 0
Outpatient % 10 50 10 100 100 10 50 50 50 10 100 10 0

Combined Pediatrics-Medical Genetics Training

Use these abbreviations for the medical genetics rotations:

MG-P Pediatric Genetics MG-MOL Molecular Genetics Laboratory
MG -B Medical Biochemical Genetics MG-BGL Biochemical Genetics Laboratory
MG-C Cancer Genetics VAC Vacation
MG-PN Prenatal Genetics Elec/ IC Experiences chosen for individualized curriculum or elective
MG-A Adult Genetics    
MG-CYL Cytogenetics Laboratory    

2nd Year – Combined Pediatrics and Medical Genetics

2nd Year Block Diagram

EU/Month/4wk 1 2 3 4 5 6 7 8 9 10 11 12 13
Experience or Rotation P-EM NICU P-ADOL P-IP AMBU/VAC PICU IC MG-CYL/MOL MG-P IC MG-P MG-P/VAC MG-A & C
Pediatrics Y Y Y Y Y Y Y Y Y Y Y Y Y
Medical Genetics Y Y Y Y Y Y Y Y Y Y Y Y Y
Supervisory   X   X       X   X
Pediatric Inpatient % 0 90 0 90 0 90 50 0 50 50 50 50 25
Pediatric Outpatient % 100 10 100 10 100 10 50 10 50 50 50 50 25

Please check appropriate box indicating whether rotation is satisfying requirement in Pediatrics or Medical Genetics Please indicate by “X” if rotation includes supervisory responsibility.


3rd Year – Combined Pediatrics and Medical Genetics

3rd Year Block Diagram

Month/4wk 1 2 3 4 5 6 7 8 9 10 11 12 13
Experience or Rotation P-EM PICU P-IP P-RS P-RS/VAC MG--PN MG-P MG-P MP-P/M-BGL MG-P MG-P MG-A/MG-C IC
Pediatrics Y Y Y Y Y Y Y Y Y Y Y Y Y
Medical genetics Y Y Y Y Y Y Y Y Y Y Y Y Y
Supervisory     X       X X   X X    
Pediatric Inpatient % 0 90 90 50 50 50 50 50 0 50 50 25 50
Pediatric Outpatient % 100 10 10 50 50 50 50 50 50 50 50 25 50

Please check appropriate box indicating whether rotation is satisfying requirement in Pediatrics or Medical Genetics Please indicate by “X” if rotation includes supervisory responsibility.


4th Year – Combined Pediatrics and Medical Genetics

4th Year Block Diagram

Month/4wk 1 2 3 4 5 6 7 8 9 10 11 12 13
Experience or Rotation P-IP P-SP P-SP P-RS/VAC MG-P MG-P MG-P MG-P MG-P MG-P/VAC MG-P/MG-C IC IC
Pediatrics Y Y Y Y Y Y Y Y Y Y Y Y Y
Medical genetics Y Y Y Y Y Y Y Y Y Y Y Y Y
Supervisory X       X X X X X        
Pediatric Inpatient % 90 50 50 50 50 50 50 50 50 50 75 50 50
Pediatric Outpatient % 10 50 50 50 50 50 50 50 50 50 75 50 50

Please check appropriate box indicating whether rotation is satisfying requirement in Pediatrics or Medical Genetics Please indicate by “X” if rotation includes supervisory responsibility.


Residency Program | Daily Conference Schedule

Monday 7:30-8:30 a.m.
12:15-12:45 p.m.
noon-12:45 p.m.
noon-1 p.m.
Residents Report
Chairman’s Rounds on a general pediatric ward
Chief Resident Rounds (interns only)
Code Training
Tuesday 7:30-8:30 a.m.
noon-12:45 p.m.
Residents Report
Clinical Case Conference
Wednesday 7:30-8:30 a.m.
noon-12:45 p.m.
noon-1 p.m.
noon-1 p.m.
Residents Report
All-Resident Conference (Emergency Series/Core twice monthly)
Mock Code Review (once monthly)
Transport Conference (once monthly)
Thursday 7:30-8:30 a.m.
noon-1 p.m.
noon-1 p.m.
Residents Report/Professionalism (once monthly) / Ethics (once monthly)
CAPs (EBM/Journal Club) (twice monthly)
All-Resident Conference Adolescent/Primary Care/Core
Friday 9:15-10:30 a.m.
noon-1 p.m.
Grand Rounds
Board Review (twice monthly) / All-Resident Conference

As an academically based program, physicians who complete our program are expected to engage in the scholarly pursuit of expanding the knowledge of human genetics. Graduates will be equipped with the essential skills to be leaders in the field of genetics, whether at the bedside, at the bench, or as a clinical researcher. Finally, acquisition of these abilities and skills will provide the basis for board eligibility in Clinical Genetics by the American Board of Medical Genetics.


Application Process

Applications for the Pediatric/Medical Genetics Combined Residency Program are accepted through the Electronic Residency Application Service (ERAS). Selected applicants will be invited to visit St. Louis to meet our faculty and residents and to see St. Louis Children’s Hospital and Washington University.


Contact

For more information on the Medical Genetics Residency Program, please contact:

Dr. Marcia Willing, MD, Ph.D.
Program Director, Medical Genetics Residency Program
or
Dru Nelson, Program Coordinator,
314-454-2863 or nelson_d@wustl.edu
Campus Box 8116, 9th FL NWT
1 Children’s Place
St. Louis, MO 63110

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