In the PGY4 year, all of the Med-Peds residents serve as chief residents for the program. The goal of this is to provide them with the administrative and leadership experience of helping to run the program. They accomplish this by organizing the continuity clinic schedules with the help of our Program Coordinator, overseeing the meet-and-greet events during intern recruitment season, and serving as liaisons between both categorical programs.

During an assigned period of time, each chief resident take turns on being our "Chief On Call." Responsibilities include being the liason and troubleshooter of any conflicts, eg. scheduling between IM and/or Pediatrics, calls, retreats, personalities. The Chief On Call will work closely with our Program Director and our Med-Peds faculty, the chiefs and administration on Internal Medicine and Pediatrics.

The Chief On Call is not required to be involved with every detail, but he/she is there to help with any of the more complicated matters that are sensitive or require interactions with the administration or between departments.

Other responsibilities include clinic scheduling: Scheduling requests before the schedule is made and after they are made. The Chief On Call will handle schedule changes that may require coverage, block rearrangements.

The primary goal of the fourth-year Internal Medicine curriculum for the Med-Peds PGY4s is to gain specialized knowledge in subspecialty fields. In addition general inpatient medicine wards, Med-Peds PGY4s rotate on the internal medicine consult service, which is an important experience to provide general medicine consultation services to any other specialty field (Surgery, Psychiatry, OB-GYN) requesting guidance in the management of their patients. This requires strong interpersonal and communication skills, confidence and comfort in providing clinical advice, and strong diagnosis skills and a broad knowledge base. From a teaching perspective, Med-Peds PGY4s must present a "Senior Grand Rounds" on a topic of their choice to their peers.

Med-Peds PGY4 residents in pediatrics gain more specialized knowledge and skills in the management of critically ill children by rotating through the PICU at night. During this rotation, Med-Peds PGY4 residents care for children in the PICU without the benefit of the full support staff during the day. This requires confidence in ICU knowledge and management as well as the ability to recognize the signs of decompensating conditions quickly. In addition to the PICU rotation, the Med-Peds PGY4 residents rotate through the pediatric emergency department at Harbor-UCLA Medical Center. In this setting, they are able to be the first contact for children who present with both common and complex problems, as well
as have experience with managing pediatric traumas. Finally, Med-Peds PGY4 residents also have the child advocacy rotation, which gives them specialized knowledge and skills working with children in the foster care system.