Med-Peds Residency Program
Program Mission Statement
About our Program
Intern on Pediatric Wards
Elizabeth Williams, MD
4:30-5:30 am: Is this a dream or is it actually time to wake up? Decide I do in fact need to go into work today. Go for a run with my dog then get ready for the day and enjoy breakfast with her. Look at H&P's written on new patients to be more prepared for sign out (and decide which patients I want to claim early).
5:30-6:00 am: Drive to work. Wonder why other people are also up this early.
6:00-7:00 am: Take sign-out from the overnight intern. Commiserate over unexpected events that occurred. Pre-round on my patients and try to get notes completed as much as possible. If I have time, look up primary literature to have some evidence to back up my plans on rounds. We touch base with the senior about any patients we're worried about. This is a great time to work on any possible discharges to get them out as soon as possible.
7:00-7:45 am: On my way to examine patients. Tiptoe into the rooms where I don't need to wake them up. Spend too much time with the babies informing them on just how cute they truly are. Try to keep track of all the various requests that pop up. At this point, I touch base with the medical students to make sure they feel confident for rounds.
7:45-8:30 am: During COVID-19 times, we log on to Zoom for intern morning report in the team room. Say hi to the children/dogs of our co-interns or attendings working from home until all the teams have arrived. We then either go through a case presented by an intern or a chief/resident does case-based learning. (Please mute your microphone if you aren't talking!) Prior to all the necessary distancing, all of the interns and medical students would meet in a conference room to discuss cases or radiological findings.
8:30-11:00 am: This part varies the most depending on which color team you're on. During COVID-19, we do social-distancing family-centered rounds and walk around with the team (some via Zoom) to patient rooms. Medical students and interns present the patients while seniors and attendings add in pearls of wisdom. Interns take computers and place orders for each other (yay teamwork!).
11:00-noon: Time to call consults, place final orders, update families, teach medical students how to place orders, and get discharges finalized. This can be a hectic time, but everyone's working together to get the most pressing issues completed first.
12:00-1:00 pm: Grab our lunches from the resident's lounge and finally get brief glimpses of our friends on other teams. We typically eat in our team rooms or split off into small groups to watch noon conference. (Although during non-distancing times, we meet all together in conference rooms). This typically involves an attending, fellow, or co-resident presenting a teaching topic.
1:00-5:00 pm: Follow-up on consults and test results as well as finish up any notes. This is a great time to go over any teaching points with students, especially high yield shelf questions. Admits can come at any time and we split them based on everyone's workload. For any later admissions, we work as a team to place orders, start the H&P, and look through the history for any pertinent information not readily available.
5:00-6:00 pm: It's time for sign out! Make sure we have our SSAFETIPS signout ready to present to the night team so they are prepared to take the best and safest care of our patients.
6:00-8:00 pm: Arrive home just in time for the end of supper with the family. Take time with the kids, walk the dog if it's warm enough, and then squeeze in an episode or two of Avatar.
8:00-9:00 pm: I definitely said I was going to get 8 hours of sleep tonight, but there's always something that needs to get done prior to going to bed. Work on a paper, study for Step 3, or all those pesky life things that still happen during residency.
9:00-10:00 pm: Make sure the alarm is set and go to bed!
Intern’s Day on the Medicine Wards
Luke Schroeder, MD
5:45 AM: The alarm goes off and I reset it in a bleary-eyed daze to go off two minutes later, because you know, those extra two minutes make all the difference (still looking for that RCT…)
5:47 AM: You guessed it! I reset the alarm for 5:49. This is why I live close, right?
5:49 - 6:40 AM: I finally get up, get ready, throw a small lunch together and drive over to the hospital. Thankfully, parking is close, free, and never a headache! I roll into the team room and print off our list.
6:45 - 6:50 AM: I make my way over to the overnight call team’s room and get sign-out on our patients. Everyone was pretty stable overnight so I head back to the team room and start…
6:50 - 7:30 AM: Pre-rounds!!! Okay, so maybe it’s not three-exclamation-point-level-exciting but this is a big part of my morning as an intern as it’s my responsibility to make sure I’m up to date with everything that has been going on for all of my patients and formulate my daily plan for them. I cruise through EPIC looking at the VS, I/Os, nursing notes, new consult recs, new labs/imaging, and jot down problem-based plans for everyone. I place orders if someone needs their electrolytes supplemented, a dose of diuretic or something else right off the bat. Of course, this is always colored by some friendly banter in the team room (and often soundtrack’ed by someone’s playlist).
7:30 - 8:30 AM: Time to see my patients! I make my way around the wards to see my patients. Our patients are usually geographically localized so they are close to each other (bad for my Fitbit step count, good for efficiency!). I’m back in the team room around 8:20 and talk with the medical students who are following patients with me to formalize plans and discuss their ideas about what care the patients need. If we have any questions, I ask my senior for their thoughts. If there is still time before rounds, I’ll place any consults that need to be called.
8:30 - 10:30/11:00 AM: The attending walks in and it’s now time for team rounds. Everybody has a different style for rounds, but the most common pattern is table-rounds followed by a briefer walk-rounds to see the patients. While my co-intern is presenting a patient or two, I pop away briefly to attend the Care Coordination Rounds with our case managers, social workers, PT/OT therapists, and nurses to discuss patient needs and discharge planning. Rounds wrap up once we have a plan for all of our patients. Thanks to the computers we take on rounds, I’ve already placed a lot of the new orders.
10:30/11:00 AM - 12:00 PM: Back in the team room, we briefly run the team list with the senior to make sure we are all on the same page. I put a together a checklist of the tasks I need to take care of for each patient and prioritize new consults that need to be called. I chip away at my notes before grabbing lunch and heading to noon educational conference.
12:00 - 1:00 PM: One of my co-residents is presenting a case and together we work to build a differential, organize a workup and talk through the case which wraps up with diagnosis specific teaching points. Today I learned some pointers about pneumocystis pneumonia evaluation and management!
1:00 - 4:00/6:00 PM: This is the part of the day that has the most variability depending on where my team is in the call cycle. Regardless of the day, it’s always a good time to follow up on our consultants’ recommendations, finish notes, check in on and update patients, and call families. If we are on call, I can expect to get a couple new admissions in the afternoon and am kept busy placing admission orders, evaluating my new patients, and formulating plans for additional workup and management. My senior resident is there to help me balance all these tasks and lend a hand where they can. Gradually, that checklist I made in the morning starts growing shorter as I follow-up and take care of things. This can also be a great time to read about topics or discuss patients with the medical students and help out with some teaching points!
4:00/6: 00 PM: Once everything is followed-up on and squared away, I can think about getting ready for sign-out. The medical students have done a great job on the handoffs so there aren’t many changes for me to make, but I add some “If/then” anticipatory guidance for the night team. When the team is not on call, we can sign out at 4:00 pm if all of the work is done. Our patients all have solid plans in place and are stable so we walk over and sign out to the overnight team around 4:20 pm.
If it’s a call day, I am at the hospital a little longer wrapping up the H&Ps and ensuring all the orders are in place. Most of those days, everything is taken care of by 6:30pm or a bit earlier.
6:30 - 11:30 PM: Now it’s time to enjoy dinner, look over some emails, turn on the Brewer’s game (prior to the covid pandemic), watch a movie, or spend some time with friends. When I think back over the day, I realize what I remember isn’t all of the little tasks that I mentioned above but rather all of the rewarding patient encounters, team bonding and jokes, and educational growth that takes place each day. It’s all of that which has me looking forward to heading in the next day when I shut out the lights.
Senior Resident on Pediatric Wards
Victor Redmon, MD
4:45-5:30 am: I am not a morning person, so I usually need several alarms before I get myself up. I wake up and check the baby monitor to see my son sleeping soundly. I shower and usually skip breakfast because I am intermittently fasting. I briefly look over the patient list to see what new patients we got overnight and if there was anything major that happened on my team. Finally, I drive into work feeling ready for the day.
6:00am-7:30 am: I get sign out from the overnight senior about any new admissions or overnight events. I go see any sick patients immediately, otherwise I stop by the team room to make sure my interns are doing okay. I check with the interns to answer any immediate questions or worries about patients. Then I do a brief chart review and go see all the new patients, sick patients, and patients I expect to discharge. Any patients I don’t see during pre-rounds, I see them during morning rounds.
7:30-8:30 am: I check in one more time with the interns before heading to Senior Resident Rounds. 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 have a librarian with us as well to help us search the medical literature. We discuss interesting or difficult cases and the clinical reasoning behind what to do next or what was done. I feel like I gain a lot from these discussions and I am usually able to bring something back to my team – it makes me look smarter than I am as well :).
8:30-11:00 am: If time allows, 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 conduct family centered rounds where I am expected to lead rounds and keep the team on task. During the COVID-19 pandemic, we converted to virtual family centered rounds – which usually involved an iPad for the family to hold while the intern presented the patient. Meanwhile, the interns and medical students did an excellent job 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 prioritize which post-rounds tasks to accomplish. Usually this involved calling all consults and putting in orders before noon conference. Given that we admit 24/7 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 Subspecialty track conference. Lunch is provided to residents to eat during conference. On Fridays, we have Med-Peds noon conference – which is my favorite because I get to see all my colleagues who are on the medicine side.
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. This is usually the best time to go through a teaching topic with the interns and medical students, which is led either by our attending or myself.
5:00 pm: We sign out to the overnight senior resident and intern. We help clean up any last-minute issues before heading home including helping out with admissions if necessary.
6:00 pm: I get home and usually try to exercise if I can. I have dinner with my wife and son. I then put my son to bed and hangout with my wife, usually by continuing /binging a tv show – sometimes I play video games. Before bed, I try to either do some board prep or read an article pertaining to one of the patients on my team. I try to get to bed between 10:30-11:00 pm.
Senior Resident on Medicine Wards (with overnight call)
Stefanie DiGiandomenico, MD
5:30-6:45am: If I’m feeling motivated, I try to fit in a morning workout at my favorite local gym. Otherwise, I hit snooze a couple times before grabbing a quick breakfast and heading out the door! Fortunately, I live down the street from the hospital, so my commute is very quick.
7:00-8:15am: Time to pre-round! Depending on what day in the admitting cycle we are on, we may have up to 16 patients at Froedtert or 18 patients at the VA. I review overnight events, vitals, and labs before seeing our patients, focusing on the sickest patients first.
8:15-8:30am: I call this my “coffee break”. I like to use this time to touch base with the interns and medical students on the team to make sure everyone is on the same page with the plans for our patients. All over a mug of coffee, of course!
8:30-11am: The attending arrives, and it’s time to round. As the senior, I lead rounds and keep the team on task, but the interns and sub-interns are the ones running the show. We usually “table round” first, which means we discuss the patients in the team room. Then, we go to the patients’ bedsides, where we talk about updates and answer questions. The attending will usually incorporate teaching sessions during rounds. Two out of every five days is an admitting day. We can get new patients as early as 8am, and we will generally begin working on these new admissions during this time. We also have daily care coordination rounds with services like social work, case management, and physical therapy. This is a great way to streamline patient care and help with the discharge planning process.
11-noon: Back to the team room to make the to-do list for each patient for the day. I help place orders and contact consultants. Wards is a team effort!
12-1pm: I grab my meal card and head to one of our many dining options. I personally love the fiesta salad at Patio Café! Then I head to the auditorium for noon conference, where one of our co-residents presents an interesting case followed by a teaching topic. It’s one of my favorite parts of the day!
1-4pm: This is the time where we follow up on labs, imaging, and consults from the morning and then update patients and family members. We usually have time for teaching, whether that means listening to lecture from our attending, playing a game of jeopardy, going over MKSAP questions, or taking a Buzzfeed quiz (because sometimes you just need to know what Harry Potter house everyone on the team is in!). If it’s an admitting day, we will review and see new patients as a team. Together, we go over assessments, differential diagnoses, and plans. If we are not the on-call team, we can sign out and go home!
4pm-2am: The overnight team consists of a senior, an intern, and a senior medical student. We can get sign-out from other teams starting at 4. During a call shift, I’ll cross-cover patients on other teams and work on new admissions with my intern. The best part about call, though, is the food! I like getting late-night ice cream at Patio Café or sweet potato fries from Children’s cafeteria.
2-7am: We stop admitting patients at 2am. I’ll review orders for our admissions and then try to get a few hours of sleep before it’s time to pre-round.
7-10am: The rest of the team comes in early on post-call days, so we can start rounding at 7. And there are usually bagels involved! After post-call rounds, it’s time to head home, where my bed and black-out shades are calling my name!
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.
“I had the wonderful opportunity to spend February 2020 in Punta Gorda, Belize with Hillside Healthcare International. It was a welcome change of pace from typical rotations that challenged me to think in new ways about patients, available resources, and other social determinants of health. My med-peds training was valuable in treating both adults and children in clinics both on-site and at mobile sites. We primarily managed chronic diseases, but in a new light using our available treatments and limited testing. I worked beside US medical students and attendings, but also with Belizean pharmacists, nurses, and medical assistants. It was also an awesome opportunity for self-reflection and the chance to fully immerse myself in a culture and community with the added bonus of weekend travel adventures and new friendships!” – Krista Tuomela, MD (PGY 4)
“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 (2020 Med-Peds Grad)
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