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Children's Hospital at Dartmouth Hitchcock (CHad)
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Residency Levels

Pediatric level one (PL-1)

The intern (PL-1) takes responsibility as the primary doctor for the patients in all settings with graduated autonomy as skills grow.

Children on both the medical and surgical services are under the care of pediatric residents; surgical residents share the care for children on the surgical services. Interns on the inpatient service are typically responsible for the care of 6 to 10 children; in the ICN they provide care to neonates under the supervision of neonatal nurse practitioners. All CHaD inpatients have a full-time faculty attending.

In the ambulatory department, interns evaluate children of all ages and with all presenting problems, as part of their Continuity Clinics, ambulatory rotations, and subspecialty rotations. Interns are closely supervised by an ambulatory faculty member and are expected to present each case to the teaching attending or PL-3.

Interns, like supervising PL-2s and PL-3s, have significant opportunities and responsibility for teaching third-year Dartmouth medical student clerks and fourth year sub-interns. All residents, including PL-1s, attend a variety of daily, weekly, and monthly conferences.

Pediatric levels two and three (PL-2 and PL-3)

On every rotation, residents in the second and third years of training have the major responsibility for managing the patients under their care and for supervising the interns and medical students on the team. The residency program provides progressive responsibility in accord with demonstrated ability and encourages autonomy in its residents, with increased decision-making in all areas, particularly regarding triage and admission, care management and discharge.


Learn to lead multidisciplinary team in each setting. In charge of patient care and learner supervisions.


Continue to develop leadership skills as well as focus more on teaching.

Resident responsibilities and access to attendings

Our program does not have layers of fellows between the residents and the attendings, allowing residents to have much more direct access to attendings. As a result, residents, not fellows, make most patient care and triage decisions. The on-call PL-2 or PL-3 resident functions increasingly like a practicing pediatrician, performing duties including:

  • managing telephone calls from concerned parents
  • triaging children, when appropriate, to the ED, where he or she sees the patient personally
  • then making management and dispositional plans

If admission is indicated, the on-call resident is also the admitting house officer. Interns and residents in all settings are expected to develop their own plan of management.


Three weeks of vacation are provided for all year residents, with an additional 5-6 days off during the December holidays.