Med-Peds Residency Program
Program Mission Statement
About our Program
Med-Peds residents transition between internal medicine and pediatric rotations every 4 months, which provides optimal time in the specialty and also allows the residents to experience seasonal changes that occur in certain disease patterns. Rotations are structured such that each experience builds on the last one.
Intern on Pediatrics (on wards)
Courtney Gaberino, MD
PGY-2, Medical College of Wisconsin
6:00-7:45 am: I arrive to the team room and receive sign-out from the overnight intern. We divide the new patients and begin pre-rounding. I review overnight events, vitals, new progress or consultant notes, labs and other data. I then go to the bedside to see my patients, check-in to see how they are doing, and perform physical exams.
7:45-8:30 am: We have group teaching every morning. Intern morning report (IMR) occurs Monday through Thursday. On Fridays, instead of IMR, we have Grand Rounds. At IMR one of the interns presents an interesting patient case from one of the teaching teams to the other learners in the room. This allows for interactive case based discussions on varied disease processes.
8:30-11:00 am: We do patient family centered rounds at the patient’s bedside with our entire team, including our attending physician. We discuss plans for the day and make sure to answer all of our patients’ and their families’ questions. These rounds also include other important support staff (i.e. nurses, pharmacists, dieticians and case managers) to help make team-based patient plans.
11:00 am-12:00 pm: This is a nice time to complete time sensitive patient care tasks. This could include calling consults that we may not have yet contacted with our mobile team phones on rounds, placing additional orders if needed, completing medication reconciliations and discharge plans for patients that will be discharged today, and writing notes.
12:00-1:00 pm: Every day I go to noon conference. There is a different topic each day. These conferences can include faculty teaching presentations, journal clubs (evidence based medicine), professor rounds, or track days.
1:00-5:00 pm: We continue to complete our patient care tasks throughout the day. We may also admit new patients to our team and follow up on consultant recommendations. I also go around and check in on my patients to make sure they were updated with any new results, plans, and/or consultant recommendations. I also make sure to update my written handoff on my patients as the shift comes to an end.
5:00-5:30 pm: We sign-out to the night team and then go home!
Lauren McIntosh, MD
PGY-2, Medical College of Wisconsin
5:45AM- First alarm goes off. Snooze that alarm and pull the covers up. I set a second one for a reason!
5:55AM- Second alarm goes off. This time its real. Blindly search for glasses on the nightstand and make my way to the bathroom to get ready for the day.
6:15AM- Make an awesome yogurt parfait to go. No time to eat it before I leave, but looking forward to the enjoying while pre-rounding.
6:20AM- Start the commute to the hospital. I have my 4 current pump up songs on a playlist (which matches the exact amount of time I have in the car), so I get that started and hit the road.
6:45AM- Head to the overnight team to get sign out on our team’s patients. Nothing big overnight and our patients with heart failure all met their net negative fluid goals! I head back to our team room to share the sign out and my co-intern, senior resident, and 2 medical students are all waiting for updates and thankfully one of the medical students has a Spotify account and already has the morning music playing.
6:55-8:45AM- This is when all the pre-rounding happens. I take out the parfait I made earlier and start looking over all the vitals, labs, overnight nursing and consult notes, new images and any other data I can extract from the medical chart. Any concerning findings are addressed right away (all that diuresing left one of our patients in need of some potassium supplementation!) and then our team splits up to see all of our patients before our attending arrives. I provide updates to my patients and let them know what I think they might hear us discussing on rounds. At least one patient is bound to have a great joke or saying to share with the team when I get back to the team room.
8:45AM- Our team meets back in our team room and we discuss and address anything pressing that we found on our physical exams or discussions with our patients. At this point it might be clear that some patients need to be seen by specialists and we put those consults in. I touch base with the medical student who is also helping to take care of some of my patients and we discuss their findings and plan for the day so they are ready to present for the day.
9AM-11:30AM- Attending arrives and it is time for formal rounds. Depending on the attending, we either do sit down/work rounds in our team room and then walk to see our patients, or we walk to each patient and present at each room. We plan on coming back to discuss a complex plan in more detail with a patient. Our team is admitting 5 new patients today and we receive a page about a new admit- the other intern will take this first one. The rest of us finish rounds and attend Care Coordination Rounds (this is a chance for our team to meet with social work, case management, nursing, physical therapy, occupational therapy, and dieticians to address the needs of each patient in a holistic manner and best prepare out patients to succeed when it is time to discharge).
11:30AM- Back to the team room. We run the list with our senior and I create my “To Do” list for my patients. I put in new orders and call any additional consults that are needed. I try to write notes that I might be able to squeeze in before conference.
12:00PM- Time for lunch and noon conference! I head to the cafeteria to get my usual, fiesta chicken salad, and then sign into conference. A patient case is presented and one of the Chief Residents walks us through creating a differential and provides teaching points (today was a new diagnosis of liver failure!). My pager goes off at 12:45 that our team has a new admit so I go back to our team room to start learning about this new patient.
1PM-5PM- The senior resident and I work on our new admit and meet him in the Emergency Department. We think he might have Endocarditis so we put in all the admit orders and get an ECHO. While we wait for that, our consult services provide recommendations on our other patients. I walk back to the patient who had more questions about their diagnosis and (poorly) draw kidneys, ureters, and a bladder to better explain kidney stones and hydronephrosis. We have more time to sit down with patients than during the morning and this is the part I truly enjoy the most. I feel accomplished as I start crossing out boxes on my to-do list. We update patients and family members and our team admits 3 more patients. This is when I would attend my continuity clinic on Thursdays and Intern Academic Half Day from 1-330pm on Wednesdays.
5PM-6:30PM- Finish up notes for the day and h&ps on our new patients and make sure all our evening orders and orders for our new admits are in. Our amazing medical students have already worked on our sign outs so I just have to add any last minute updates and then it is time to sign out to the overnight team.
6:30PM- Time to get home! Most likely play the same 4 songs that I played on the way to work- it’s just timed so perfectly- or call a friend or family member.
7PM- Time to make dinner and then go over the emails I quickly checked during the day, read (about patients and for fun), watch Stranger Things, or catch the last hour of Jazz in the Park!
10:30- How is it 10:30 already?! Time to get ready for bed! And make sure I set those two alarms for tomorrow!
Ben Lipanot, MD
PGY-4, Medical College of Wisconsin
5:00-5:35 am: I wake up and take my husky for his morning walk. Then we both have our bowls of breakfast. Sometimes we come across my wife depending on her rotation as an ED resident. If the weather allows, bike 18 minutes to the hospital or otherwise drive to work.
6:00am-7:30 am: I get signout from the overnight senior about any new admissions or overnight events and then stop by any really sick patients on my way to the team room. I check with the interns to answer any immediate questions or worries about patients before doing a brief chart review and seeing all of the new patients, sick patients, and patients I expect to discharge. If time allows, I will see all of the patients on the team.
7:30-8:30 am: I check in one more time with the interns before heading to Senior Resident Rounds. This is one of my favorite parts of the day during wards. We meet with all of the senior residents on wards teams along with several attendings, including Dr. Robert (Bob) Kliegman who is the editor of Nelson’s Textbook of Pediatrics. We discuss interesting or difficult cases and the clinical reasoning behind what to do next or what was done.
8:30-11:00 am: Depending on what time we start rounds, I run through plans for the day with interns and our sub-intern, decide how to organize rounds, and have the team start putting in orders to get tasks moving for the day. We complete family centered rounds where I am expected to lead rounds and keep the team on task. The interns and medical students are excellent at getting nursing, case management, and prior consults to round together with us to facilitate communication within the medical team and with families.
11:00 am: I help the team by making sure all consults are called and orders are in before noon conference. Since we admit all day on pediatrics, we may have to start and possibly complete an admission. I will see these patients before going to noon conference.
12:00 pm: Head to noon conference that could be a faculty topic lecture, journal club, case presentations, professor rounds, or my Global Health track conference. Lunch in provided to residents to eat during conference.
1:00 – 5:00 pm: I continue to assist interns and the sub-intern with getting daily work done. I assign new admits to an intern and guide them as much or little as they need to staff with the on-call attending. Usually there is time to go through a teaching topic with the interns and medical students led either by our attending or me.
5:00 pm: We sign out to the overnight senior resident and help clean up any last minute issues before heading home.
6:00 pm: I get home and exercise, walk the husky again, have dinner with my wife when we’re both home, and read more about the patient care or disease topics that came up through the day. Other evenings, I read for fun on my patio, go to my church group, have dinner with friends, or watch some internet TV. I try to get to bed by 10:30-11:00 pm.
Resident on Medicine (on Wards)
Peter Cote, MD
PGY-4, Medical College of Wisconsin
6:15am: I try to get up around 6:15 so I have time to eat breakfast. While I’m eating, I like to read something for 5 minutes or so, like the news on my phone or a book I’m reading for fun.
7:00am: This is the time I typically arrive at work. I check in with the interns to make sure everything went okay overnight and that they aren’t concerned about any of their patients.
7:00am-8:30am: I usually look up every patient, starting with the sickest. I’ll focus on vitals, labs, overnight events, and make sure to follow-up any consult notes from the previous day. As soon as I’m done chart reviewing, I go and see a portion of the patients on the list. I’ll see the sick patients, the patients that I have with my sub-intern, and then I’ll try to see any discharges we have for the day. Just prior to rounds I’ll touch base with the interns to make sure we have a good plan for each patient.
8:30am-11am: Rounds. We usually discuss the patients in our work-room and then we will go see the patients as a team. I like to let the medical students or the interns give the patients updates on rounds so they can get practice communicating with patients/families. Every two out of five days is an admitting day. If it’s a daytime admitting day, you can get five admits (from 7am-5pm) and if it’s an overnight admitting day, you can get eight admits (from 8am-2am). If we have started to get admits, we will generally start working on them about this time.
11am-12pm: We’ll get back to the team room and run through the to-do list for each patient. I’ll often help place orders and call consults.
12pm-1pm: Noon conference. I’ll either bring a lunch or get some food from the cafeteria (with my meal card!) and then go to noon conference. It’s usually a case presented by one of our co-residents with a teaching topic at the end. This is one of my favorite parts of the day.
1pm-4pm: If it’s an admitting day, we will be working on new admits as a team. Looking them up, examining them, and then talking through the plan. I really like to teach while working, so as we are looking up the new admission, I’ll talk with the medical students about their differential diagnosis and what else we should be considering. If it’s a non-admitting day, we make sure to follow-up on any consulting team’s recommendations, finish any work that needs to be done from the morning, and make sure to update the patients again about any updates in the plan.
4pm: Overnight admitting days are every 5th day. If we are the overnight team, myself and one of my interns will take sign-out from the other resident teams. If we are not on overnight, we get to go home!
5pm-2am: From this time period, I’ll be providing cross-coverage for two other medicine teams as well as working on new admissions with my intern. If I’m not on call, I’ll either be going out to dinner, hanging out at a friend’s house, or relaxing at home!
2am-6am: I’ll review the orders on our admits and make sure everything is ready for the morning. I’ll also lie down to sleep and hopefully get 2-3 hours.
6am-10am: Post-call rounds and then go home!
Milwaukee’s population is culturally diverse, and within the confines of Children’s Wisconsin we serve a global community. Given the current U.S. national government’s dedication to improving healthcare in this country, as well as local efforts by the Board of Directors of the Children’s Health System of Wisconsin to have the healthiest children in the nation, it is imperative that we train future physicians to confidently treat all patients, regardless of ethnic background. Sixty percent of the residents who receive training at Children’s remain in Wisconsin to care for children in our community—a community that continues to see a large influx of immigrants, international adoptees, growing healthcare disparities and increasing demand for medical pre and post-travel counseling. To best serve our community, and to equip our pediatric trainees to become competent pediatricians globally, the Department of Pediatrics offers a Global Health Training Track.
2019-20 Med-Peds Global Health Training Track Representatives:
Angelica Willis, MD-PGY2
Krista Tuomela, MD-PGY3
Peter Cote, MD-PGY4
Sona Cote, MD-PGY4
Ben Lipanot, MD-PGY4
Andrew Rose, MD-PGY4
“During my 3rd year of residency I had the opportunity to participate in a global health rotation in Nepal. I have always had a passion for global and undeserved care and this seemed like a perfect opportunity to further investigate that passion. My healthcare experience took place at an academic hospital in Patan, near the capital city of Kathmandu. The medical exposure that I received was incredible. Cases ranged from primary tuberculosis arthritis to salmonella meningitis; two things that I certainly have never seen in the US. While the cases were interesting the way that the Nepali physicians cared for their patients was also a great learning experiences. They demonstrated the value of a good physical exam, the importance of a thorough history and the skill of working in a resource limited environment. They were kind to their patients and educated families. While the medicine exposure was certainly valuable the culture exposure was also eye-opening and formative for me. The people of Nepal are incredibly generous, warm and welcoming. They are quick to invite you to lunch and learn about who you are as a person. Despite a large portion of the population living on very little you always sensed cooperation, and a desire to care for one another. Overall my rotation in Nepal provided me with an opportunity to learn about medicine, learn about people and culture and learn about myself. I feel very fortunate that I was able to participate in such an experience and I know that I will be a better physician because of it.” –Andrew C. Rose, MD (PGY4)
One of the most important aspects of our program is the camaraderie that exists between the residents. There is no shortage of fun in the Med-Peds Program. We work hard, but we always make time for relaxation and fun. Below is a sample of the social opportunities our Med-Peds Residents get to experience throughout their residency. Also, our residents are invited to the social events and activities of both categorical programs.
Med-Peds Monthly Residency Dinners
3rd Tuesday of every month, the Med-Peds monthly residency dinner is hosted at rotating Med-Peds resident and faculty homes and includes residents' families.
Med-Peds Biennial Residency Retreat
A time for residents, staff and their families to get away for some bonding time. Held off-site, this 2-day retreat gives residents the time to reflect on their residency while bonding with their colleagues.
Med-Peds Annual Brewer’s Tailgate and Game
As part of our orientation for our incoming interns, we meet and get to know one another at our annual Brewer’s Tailgate and game.
Graduation Celebrations
Dinners and more dinners during the month of June. A great time to celebrate the achievement of our graduating seniors.
Yes, Milwaukee!
Milwaukee is a wonderful community that has the advantage of an urban, metropolitan city without the stress or cost. Milwaukee offers a variety of career opportunities, excellent universities, low commute times, diverse neighborhoods, affordable housing and abundant recreational choices. Milwaukee also boasts professional sports teams, museums, outstanding restaurants and performing arts comparable to cities more than twice its size. The Milwaukee Region’s size, accessibility and friendliness are among its greatest attributes. It’s easy to meet people and maintain acquaintances. Not to mention, Milwaukee is less than 80 miles away from Chicago – a good perk if you are looking for a quick weekend getaway.
There is no shortage of recreational activities in Wisconsin. In Milwaukee County alone, there are more than 15,000 acres of parks, the greatest acreage per person in the country. In 2009, the Milwaukee County Parks System was awarded the National Gold Medal for Excellence by the American Academy for Park and Recreation Administration and the National Recreation and Park Association. We have an abundance of biking trails, golf courses and a strong running community.
Whether you are here for a day, a weekend or your residency, you can have a variety of experiences, making it a perfect place to explore. Find your perfect itinerary at Visit Milwaukee!
The Big City of Little Neighborhoods
Milwaukee is not so much a city as a large collection of neighborhoods situated on the shores of Lake Michigan, often referred to as the Big City of Little Neighborhoods. With eleven distinct neighborhoods, Milwaukee has a huge variety of affordable housing options not to mention the beautiful suburbs just to the south, west and north of the Medical Complex. Current and past MCW residents have lived everywhere from revitalized warehouse buildings overlooking Lake Michigan in the Historic Third Ward neighborhood to farmhouses with lots of extra land and everywhere in-between, all within a short commute to the Milwaukee Regional Medical Complex.
As a starting point, please feel free to visit the following sites for a look into what neighborhood or suburb might be right for you:
Visit Milwaukee
Real Estate Search