Level: PGY-3

Service: Pediatric Surgery 

Supervision:  PGY-3 → Attending 

All management decisions will be discussed with the senior resident and faculty. 

Duty Hours:
Hours are to be logged into New Innovations on a weekly basis and will be reviewed weekly by the Program Director for ACGME violations and reviewed weekly for delinquencies by the Program Coordinator. Over a four week period; you will not average more than 80 hours a work week, you will have one day in seven free of clinical duty, in-house call will be no more frequent than one in three nights, you should receive 10 hours free between all duty periods and after in-house call and you will not be on duty for more than 24 consecutive hours with 4 additional hours for transitional duties. If you are assigned more hours than mentioned heretofore or have patient care duties that are extending you beyond these limits, it is your responsibility to notify your supervising resident or faculty so arrangements can be made to relieve you. 

Educational Activities: 

  1. Recommended Reading
    • Schwartz's Principles of Surgery
    • SCORE curriculum modules 
  2. Conferences
    • Wednesday Resident Educational Curriculum
    • Pediatric Surgery Curriculum
    • M&M biweekly, core curriculum lecture monthly, radiology/pathology conference monthly, GI conference monthly

Competency Based Performance Objectives: 

Patient Care: 

Goal: Through the acquired skills and knowledge of pediatric surgery principles the resident can demonstrate the ability to manage diseases and injury of the pediatric patient amenable to surgical intervention. 

Objective: The resident will be able to: 

  1. Evaluate surgical conditions in the pediatric population through a comprehensive history, physical examination, and appropriate diagnostic studies.
  2. Participate in the management of surgical problems in the pediatric population, including:
    • Integument
    • Excision of skin and subcutaneous lesions
    • incision and drainage of abscesses
    • Head and Neck
    • Excision of dermoid cysts and small skin lesions
    • Lymph node biopsy
    • Thoracic
    • Chest tube placement
    • Cardiovascular
    • Central venous catheter placement
    • Venous cutdown
    • Arterial line placement
    • Gastrointestinal
      • Pyloromyotomy
      • Appendectomy
      • Herniorrhaphy (umbilical; inguinal in patients 2 years and up)
      • Intussusception
      • Management of Gastroschisis
      • Management of Omphalocele
      • Management of Necrotizing  enterocolitis
      • Management of Acute abdomen
      • Management of esophageal atresia
      • Imperforate anus 
    • Malrotation
    • Genitourinary
    • Circumcision
    • Orchiopexy
      • Hydrocele
    • Gynecology
    • Oophorectomy, simple
    • Vaginoscopy for foreign body or biopsy
    • Musculoskeletal
    • Ganglion cyst excision
    • Excision of supernumerary digit
    • Muscle biopsy
      • Minimally invasive procedures such as appendectomy
      • Placement of feeding tubes 
  3. Develop a working relationship with Pediatricians and  members of the pediatric ICU.

Competency Based Knowledge Objectives: 

Medical Knowledge

Goal: Demonstrate knowledge of the anatomy, physiology and pathophysiology of conditions that affect neonate and children. 

Objectives: The resident will be able to: 

  1. Describe the development of children in terms of the following criteria:
    • Weight, length, and head size
    • Nutritional requirements
    • Renal function
    • Hormonal influences on development
    • Response to stress and infection
  2. Classify congenital malformations of the newborn by type, origin, and the need for surgical intervention:
    • Head and neck: thyroglossal duct cyst, lymphadenopathy, cystic hygroma
    • Gastrointestinal: pyloric stenosis, appendicitis
    • Respiratory: tracheal lesions
    • Abdominal wall defects: omphalomesenteric and urachal malformations
    • Genitourinary: polycystic kidneys, undescended testis, torsion of the testis
    • Inborn and genetic errors: trisomy 13, trisomy 18, Down's syndrome
  3. Summarize the basic approach to the diagnosis and management of more common surgical problems of infancy and childhood, such as:
    • Pyloric stenosis
    • Perforated appendicitis
    • Intussusception
    • Malrotation
    • Gastroschisis
    • Omphalocele
    • Esophageal atresia
    • Imperforate anus
    • Necrotizing enterocolitis
  4. Identify the technical aspects of the following procedures:
    • Excision of skin and subcutaneous lesions
    • Incision and drainage of abscesses
    • Lymph node biopsy
    • Chest tube placement
    • Oral intubation
    • Herniorrhaphy in older children
    • Appendectomy (laparoscopic)
  5. Describe the fundamental considerations in the pre- and post-operative care of infants and children in the cases listed above
  6. Explain the principles of diagnosis and treatment for common causes of gastrointestinal hemorrhage in the neonate, infant, child, and adolescent.

Interpersonal and Communication Skills: 

Goal: Counsel patients and obtain informed consent for pediatric surgical procedures 

Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits 

Goal: Communicate effectively to discharge patients after surgery. 

Objectives: The resident will demonstrate the ability to instruct patients regarding monitoring for pediatric surgical complications. 

Goal: Communicate effectively as a member of the healthcare team. 

Objectives: The resident will demonstrate the ability to communicate effectively by: 

  1. Providing appropriate check out when handing patients to another team member
  2. Requesting consults from other services with appropriate information
  3. Dictating operative reports in a timely fashion

Professionalism: 

Goal: Maintain patient confidentiality 

Objectives: The resident will demonstrate 

  1. The ability to protect health-related patient information per HIPAA compliance
  2. List and be aware of sites in the hospital and clinic where loss of privacy for the patient may occur

Goal: Maintain appropriate professional relationships 

Objectives: The resident will demonstrate professional interactions with: 

  1. Medical students
  2. Nursing and support staff
  3. Supervising faculty
  4. Consulting residents
  5. Physician peers
  6. Patients and their parents

Practice-Based Learning and Improvement 

Goal: Identify personal and practice improvement strategies 

Objective: The resident will demonstrate: 

  1. Receptiveness to faculty instruction and feedback
  2. Ability to use medical information with the ability to access information through traditional and online sources to support their educational experience

Goal: Use medical evidence to evaluate pediatric surgical practices 

Objective: The resident will demonstrate the ability to: 

  1. Discuss studies regarding the pediatric surgical procedures
  2. Discuss studies regarding pain management

Systems-Based Practice 

Goal: Provide safe patient care 

Objective: The resident will: 

  1. Attend Crew Resource Management courses as required by the hospital
  2. Follow recommended protocols in the OR for patient safety
  3. Demonstrate compliance with Medical Center policy for surgical site identification
  4. Demonstrate compliance with Medical Center policy for patient identification

Duties/Responsibilities: 

  1. Serve as PGY-3 on the pediatric surgical service
  2. Appropriate, professional supervision of student teaching in light of educational goals
  3. Attend pediatric surgical clinic as assigned
  4. Manage OR patients with supervision
  5. Assist with consultations to the pediatric surgical service as assigned by the Chief Resident
  6. Round on post surgical service patient's as instructed.
  7. Attend educational conferences
  8. Complete surgical case logs
  9. Dictate in a timely fashion
  10. Take night call as assigned

Evaluation: 

  1. Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed.
  2. Global evaluation will be performed by the pediatric surgical attending physicians at the completion of each rotation. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the resident's portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
  3. At the completion of this rotation, the resident is required to complete a rotation evaluation form assessing the quality of the rotation. The resident should also address the teaching undertaken by the attending physicians on the rotation at the conclusion of this rotation

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