Combined Pediatric and Internal Medicine Primary Care Residency Training Program Approved by the Accreditation Council for Graduate Medical Education

4500 Parsons Blvd., Flushing, NY 11355 • (718) 670-3077

About Flushing Hospital Medical Center lushing Hospital came into being on February 6, 1884, when it was granted an official State Charter. The county of Queens had not yet become an incorporated part of the city of New York and Flushing was only a small town of 15,000 people. The idea of a local hospital was conceived by Mr. John Gihon who had to travel by horse and buggy to Brooklyn in order to reach a hospital when his maid had taken ill. Flushing Hospital opened with one room and one bed on May 30, 1887. In 1990, the hospital became known as The Hospital and Dispensary of the Town of Flushing; in 1962 the name was changed to Flushing Hospital Medical Center.

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The hospital, as it is known today, began to take shape in 1913 with the construction of a five-story brick building on Parsons Boulevard. Adjoining structures were added in 1926, 1962, 1976 and 1982. Through the years, Flushing Hospital’s progress has kept pace with community growth. Queens County now covers 118 square miles with over 2,000,000 residents, ranking it as the sixth most populated county in the United States. Flushing Hospital Medical Center is located in a residential area while still being part of the City of New York. The community of Flushing is convenient to Long Island’s beautiful beaches as well as the heart of New York City where some of the world’s most renowned theatrical and cultural attractions, including the Statue of Liberty, the Metropolitan Museum of Art, Lincoln Center and the Metropolitan Opera are only a half-hour away. Flushing Hospital Medical Center combines a wide variety of state-of-the-art medical and scientific equipment with an academic sophistication second to none to assure the delivery of the highest quality of care possible to the residents of Queens and neighboring communities. Our dynamic program, strives to remain a “community” hospital in spirit, reaching out to the people we serve. We teach our house-staff the art of medicine within a pleasant social setting and with a strong team spirit. If the prospect of working, growing and learning with an enthusiatic and dedicated group of individuals heightens your interest, please visit with us. Thousands of patients are served in our primary care subspecialty clinics in our Ambulatory Care Department. Flushing Hospital Medical Center is a voluntary, not-for-profit institution. The medical staff consists of more than 800 practitioners including physicians, dentists, psychiatrists and podiatrists. Our institution serves people annually, including more than Inpatients. Thousands of others are served via the 37 specialty clinic in our Ambulatory Care Department.

Flushing Hospital Medical Center ACGME approved residency programs include 120 residents; 52 in Internal Medicine, 13 in Obstetrics and Gynecology, 24 in Pediatrics,10 Transitional and six American Dental Association approved dental residents. There are 4 Geriatric fellows.

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Narrative Description Program in Pediatrics The Pediatric Medicine faculty of Flushing Hospital Medical Center is committed to providing a specialized educational experience that will prepare the resident for the expert care of infants, children, adolescents, adults and geriatric Every effort is made to practice comprehensive care based on scientific principles. We are constantly updating our curriculum in order to insure that we provide our staff with the latest in medical knowledge. The underlying pathophysiologic processes of each disease are always emphasized. We stress that the responsibility for a healthy community falls particularly on the physician’s shoulders. Our training will give you the skills needed to translate science into practice. Health education and counseling, in particular, provide opportunities for interdisciplinary consulting among educators, nurses, administrators, social workers and other health professionals. We aim to equip our staff with prevention expertise and with skills to share their knowledge with the public. The faculty further affirms that all trainees acquire a firm foundation of knowledge, skills, values and attitudes. We believe that every resident should be caring, compassionate and dedicated to patients - to keep them well and help them when they are ill. Sensitivity, ethical and moral integrity, combined with equanimity, humility and self-knowledge are quintessential qualities of all physicians. The ability to weigh possibilities and to devise a plan of action responsive to the personal needs of each patient is vital.

Children are our most enduring and vulnerable legacy. For nations as well as for individual families, they represent the link between the past and future, between experience and promise. The nurturing of future generations is a basic and most important human activity. (From the preamble of the American Academy of Pediatrics Constitution.)

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EDUCATIONAL PROGRAMS The day begins with the intake rounds followed by the bedside teaching rounds followed by the bedside teaching rounds by the attending on service and clinical instructor. Grand Rounds are held on a weekly basis. Conferences, round table in format, constitute the following: • • • • • • • • • • • •

Subspecialty conferences Combined Pediatric/Pathology; Internal Medicine/Pathology Mortality/morbidity conferences Pediatric Radiology review of films and other studies Perinatal/neonatal combined OB/GYN/Pediatrics Ambulatory and ER case review Growth and Development case review with pediatric psychiatry Multi-discipline conferences with Social Work Dept. Bioethic course Statistic and Epidemiology course Research design and projects case review with pediatric psychiatry Multi-discipline conferences with Social Work Dept.

Residents Rotation Plan PGY-1

BLOCKS PED

Critical Care Newborn Inpatient ER Developmental Elective Amb. Clinic Vacation PGY-2

1 1 2 1 1 1

Promotion to the PGY2 training year implies staisfactory acquisition of the skills outlined under the PGY1 section. The PGY2 year is concerned with further development of the essential skills of an internist. Clinical data is used to formulate an extended differential diagnosis, a diagnostic workup plan and a therapeutic program. In addition, the PGY2 asssumes immediate supervisory role for the PGY1 resident. He is the first link in the chain of command from the PGY2 to the attending of Record. The PGY3/PGY4 year presents the product of two intensive years of training in patient care management. Commensurate with their increased maturation, the PGY3/PGY4 functions as the senior physician, directing patient care and supervising the first and second year house officers. The PGY3/PGY4 is to synthesize his clinical experience with review of the current literature and formulate a balanced academic approach to patient management. Consistent with this view is that the assigned team, consultant for other services and a role model for the junior staff.

Critical Care Inpatient ER Amb. Clinic Elective Adolescent Vacation PGY-3

PGY-4

1 1

BLOCKS 2 1 1 1

ADULT

1 2 1 3

1 1 BLOCKS PED

ER Elective Critical Care Inpatient Amb. Clinic Vacation

2 1

1

PED

The PGY1 resident is introduced to clinical methods and patient care. The primary goals are to learn the elements of establishing a clinical data base (history, physical, examination, interviewing, and evaluation of laboratory data), following and inpatient’s course and progress, and diagnostic planning (sequence & cost effectiveness). Other training includes basic procedural skills for treatment and obtaining diagnostic information, therapeutic and obtaining diagnostic information, therapeutic planning, patient education, and primary care and continuity of care.

ADULT

1 2 1 2

ADULT

1 1 1 2 1 1

BLOCKS PED

ADULT

Inpatient

1

2

Critical Care Elective Amb. Clinic Vacation

1 3 1

1 3 1

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iNstitutional Programs FHMC is the acute care back-up institution for St. Mary’s Hospital for Children in Bayside, NY (10 minute drive from FHMC). St. Mary’s Hospital is an approved Skilled Nursing Facility for chronically ill children. Residents have the opportunity to see and participate in the care of children with chronic illnesses, severe neurological impairments, major congenital defects, genetic defects, cerebral palsy and metabolic disorders.

Integrated Training Programs As part of an integrated training program, residents spend 10 blocks out of 39 blocks at Jamaica Hospital Medical Center. The residents are assigned to inpatient and/or outpatient services, where they enrich their experience with a broad spectrum of a diverse case mix.

Preparing you for the future Faculty members are chosen based upon demonstrated teaching skills and their interest in resident training. Residents have the opportunity to evaluate the teaching attendings. Such input is considered essential as the department is responsive to the changing needs of trainees. As increasing importance is placed with the Board exams, the Hospital has increased emphasis on the technique of taking and passing these exams. Resident Responsibility The degree of patient responsibiliy will be progressive with each year of training. Accordingly, as the experience of the resident develops, so does his or her supervisory role for the junior residents and medical students. Ultimately the resident is responsible for assuring the continuity of care for a panel of patients both on an out-patient an in-patient basis.

OrganizationalStructure The Department of Pediatrics is staffed by approximately 110 Pediatricians and 12 full-time faculty members certified in their individual subspecialties. The entire teaching faculty have University appointments, are Fellows in the American Academy of Pediatrics and/or Fellows of the American College of their specialty. Each subspecialty is a division in the Department, directed by a full-time Board Certified salaried subspecialist. They are allergy/immunology, adolescent medicine,ambulatory and emergency medicine, cardiology, endocrinology, gastroenterology, hematology, neurology, pulmonary diseases, perinatal/neonatal medicine, dermatology, genetics, infectious disease, urology and developmental. The overall program involves three types of training: ambulatory and emergency medicine, inpatient care and subspecialty experience. These are combined in such a way as to provide both continuity of care to the patients and an experience which best reflects the actual practice of general pediatrics and adolescent medicine. Pediatrics consists of 24 beds for infants, children, and adolescents. Four additional beds are equipped for acutely ill children located in a dedicated area, 32 bassinets in the normal newborn nursery and 20 tertiary level neonatal intensive care beds, approximately 3,000 infants see the first light of day annually in the delivery rooms immediately adjacent to the newborn nursery and NICU.

AHands on Education The Chairperson, Clinical Instructor, and Attending Physician on service conduct daily morning intake rounds with the house staff and medical students. The admitting resident is responsible for the presentation of all new admissions admitted within the past 24 hours. History, physical findings, differential diagnosis, justification of all laboratory tests ordered and a discussion of the plan of care, and disposition are reviewed daily. Public health issues are not viewed as philosophical entities but as issues that relate to the patients that we serve. We fulfill this commitment by rotating our house staff through a general medical clinic with the ability to use a full range of subspecialty clinics for consultations. Emphasis is placed on the primary care experience. The house staff is encouraged to consult the literature on all routine as well as complicated problems. A balance is maintained among didactic lectures, work rounds, clinic hours, medical presentations and specialty conferences. The present curriculum is aimed at providing a broad based exposure to all fields of medicine. We have designed our program syllabus to provide training in patient management on a Primary Care basis. Emphasis is placed on training students in establishing continuity of patient care between the out-patient and in-patient settings. Audio-visual media are freely used and enrich the learning experience. In addition, each divisional subspecialist designs a lecture schedule so that residents have a balance of formal lectures, case presentations and bedside teaching. These subdivisions are: Allergy, Cardiology, Dermatology, Endocrinology, Gastroenterology, Gerontology, Hematology/Oncology, Infectious Disease, Neurology, Nephrology, Ob/Gyn, Ophthalmology, Otolaryngology, Orthopledics, Pediatrics, Psychiatry, Pulmonary, Rheumatology and Surgery.

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Ambulatory

DEVELOPMENTAL

This is an important component of the resident’s training. The continuity of care experience is essential to learning the art of primary care medicine. This division is directed by full-time Board Certified Physician. The Pediatric Ambulatory Clinic is designed to allow the resident to establish a continuity of care clinic comprised of patients they will follow throughout their residency training program. Within the structure of this rotation are seminars, workshops and discussion groups. Didactic teaching is provided by the teaching faculty with additional focus on anticipatory guidance and preventive medicine.

The Growth and Development Center offers complete diagnostic and developmental evaluation services to children from birth through adolescence. This is a multi-disciplinary program encompassing many Pediatric subspecialties and resources of Flushing Hospital Medical Center. Comprehensive diagnosis by a multi-disciplinary team and counseling are provided in close cooperation with the family of infants, school age children and teenagers with problems. The resident will learn to be familiar with such problems as: ❥ early intervention program

Subspecialty Clinics ❥ Adolescent ❥ Allergy

PEDIATRIC EMERGENCY-ACUTE ILLNESS CLINIC

❥ delayed mental and social development

The pediatric emergency unit is designed for the acute care of all pediatric patients through their 21st birthday. This unit is contiguous but separate from the adult emergency room. There are fully equipped examining cubicles and holding beds. Pediatric patients are received and seen 24 hours per day, seven days per week.

❥ birth defects

The residents are instructed and supervised by Board Certified emergency room pediatricians.

❥ behavioral disorders ❥ emotional disturbances ❥ academic difficulties ❥ delayed speech and language skills ❥ poor organization and study skills ❥ hyperactivity, short attention span ❥ school adjustment problems

❥ Asthma ❥ Cardiology ❥ Dermatology ❥ Developmental ❥ Endocrinology ❥ Gastroenterology ❥ Hematology ❥ High Risk/Premature ❥ Infant Apnea ❥ Infectious Disease ❥ Metabolic/Nutrition ❥ Nephrology

There are always two board certified ER physicians available for castrophic assistance when needed. All house staff and ER personnel have access to state of the art computerized programs for poisoning, drug identification, PDR information and emergency medicine. All residents are certified in BLS and ACLS throughout the Department of Emergency Medicine. The goal of the program in ambulatory care is to train responsive, compassionate, dedicated caring pediatricians in primary care who will be well equipped to continue to grow in knowledge and understanding of community needs as well as proficiency in their diagnostic skills after completion of their training years.

Infant apnea program FHMC initiated an Infant Apnea Monitoring Program in 1979 and has continued clinical research in this area of infant care. The hospital has been designated by the State of New York as a major referral center for Infant Apnea Study. All Residents have an opportunity to become involved in this study as well as other clinical investigational ongoing programs.

❥ Neurology ❥ Pulmonary

Neonatal Division

❥ Surgery

Residents spend one month in the full-term newborn nursery where they learn delivery room resuscitation, perform newborn physical exam, counsel parents for baby care, promote breastfeeding etc.

These clinics function as sites for consultation, diagnosis and treatment for children with chronic diseases or for initial subspecialty evaluation. There is a board certified faculty member serving as a supervisor and educator in each of these clinics.

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The neonatal ICU cares for the high risk, and the preterm newborn. Residents learn the specialized techniques and care of the very low birth weight babies. They participate in daily decision making, in ethical consideration, and discharge planning, requiring multi- disciplinary team approach. Supervision is done 24 hours by board certified neonatologists.

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department of pediatrics Flushing Hospital Medical center Continuing medical education An active CME program has been inexistence since 1979. It’s excellent organization and the superior quality of its educational activities has been sited by the Medical Society of the State of New York.

In addition to the CME approved CME sponsored programs in all disciplines

Department of Medicine Program Director Surendrakumar Mahadevia, MD Acting Chairman Thomas Santucci, Jr, MD Assistant Director Alessandro Solinas, MD Faculty Supervisors Kiran Bhat, MD Hita Sharma, MD Alka Arora, MD Shrevan Shresta, MD Giancarlo Buganza, MD Rajesh Patel, MD Cardiology John Hsueh, MD Pulmonary Christof Iakovou, MD Critical Care Medicine` Rick Conetta, MD Gastroenterology Donald Palmadessa, MD Neurology Jeffrey Appelbaum, MD Infectious Disease Debra Asnis, MD Hematology/Oncology Farida Chaudhri.MD Dermatology Robert Tankel, MD Allergy/Immunology Stanley Fine, MD Nephrology Bruce Garrison, MD Non-Invasive Cardiology Majeed Sayeed, MD Nutrition Jackson Kuan, MD Rheumatology Girish Sonpal, MD Endocrinology Joseph Tibaldi, MD Geriatric Medicine Anthony Vela, MD

open to the entire house Susana Rapaport, MD Chairman/Program Director

staff and attending physicians, the department

DIVISION

maintains an extensive audiovisual library in addi-

Adolescent Medicine Allergy/Immunology Ambulatory Care

tion to the main library is located in the Pediatric conference room on the Pediatric floor.

Cardiology Dermatology Developmental Emergency Medicine Endocrinology Gastroenterology Genetics Hematology Infectious Disease Neonatal Medicine Nephrology Neurology Pediatric ICU Pulmonary Medicine Social Work Department Infant Apnea Coordinator

Patricia Burris-Warmoth, MD Won Baik-Han, MD Lily Quon Lew, MD Sylvia Chen, MD Lauren Macaluso, MD Jefferey Kern, MD Robert Tankel, MD Yeou Cheng Ma, MD Kanchana Roychoudhury, MD Uri Vainchenker, MD Lily Quon Lew, MD Babu Bangaru, MD Nataline Kardon, MD Fazlul Yusuf, MD David DiJohn, MD Rajeev Mehta, MD Edna Romero Ira Greifer, MD Fredrick Kaskell, MD Rami Grossman, MD Patricia Edmondson, MD Patricia Edmondson Lewis Singer Terry Rusin, ACSW Victoria Grapham, CSW Marian Fitzpatrick, RNC

Jamaica Hospital Medical Center Chairperson Associate Chairman

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Director, Pediatric ER Director, Pediatric ICU Director, Neonatal ICU

Phyllis D. Weiner, MD Sadiq Mandani, MD Milagros Valdez, MD Elliot Friedmann, M.D. Sharanjeet Singh, M.D. Ajey Jain, M.D.