Residency Level: PGY 2

Surgical Rotation: Pediatric Surgery

Length of Rotation: One Month at Children’s Hospital Regional Medical Center, Two Months at Swedish Medical Center

Goals and Objectives

Patient care:

·  Evaluation and preparation of the pre-operative pediatric surgical patient

·  Management skills required to independently evaluate the pediatric surgical patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision

·  Take ownership in care of the patient

·  Post-operative care of the pediatric surgical patient

·  Mechanisms and criteria for minimally invasive surgery of the abdomen in a child

·  Pediatric fluid and electrolyte management including indications for parenteral and enteral nutrition

·  Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound, CT scan, MRI and endoscopic procedures

·  Clear and timely documentation of daily progress notes

·  Develop a strong work ethic

·  Develop appropriate safe hand offs

·  Develop the ability to care for pediatric surgical emergencies in the role as the pediatric or senior surgical resident on call

Technical skill:

·  Become proficient in correct basic surgical technique such that incision, suturing, knot-tying and dissection

·  Evaluation of the acute abdomen in a newborn or child

·  After a period of learning and appropriate supervision, perform venous access, chest tube placement, etc. in the neonate and pediatric patient

·  After a period of learning and appropriate supervision, perform common surgical procedures (excisional biopsies, lipoma removal, hernia repair, appendectomy, cholecystectomy and bowel resections, etc.) in the neonate and pediatric patient

·  After a period of learning and appropriate supervision, perform advanced surgical procedures, including correction of congenital defects in the neonate or pediatric patient

·  Assist at major abdominal and minimally invasive surgical procedures in the neonate or pediatric patient

Medical knowledge:

·  Demonstrate evidence of continued increase in pediatric surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below

·  Obtain a broad knowledge base of pediatric surgery and other surgical specialties

·  Study and prepare for the ABSITE

·  Anatomy and physiology of the newborn and the pediatric patient.

·  Fluid and nutritional management of the neonate and pediatric patient.

·  Embryology, evaluation and management of congenital anomalies.

·  Peri-operative management of the neonate and pediatric patient.

·  Anatomy and physiology of the GI tract, liver, biliary tract and pancreas

·  Fluid and electrolyte management including management of parenteral and enteral nutrition

Practice-based learning and improvement:

·  Participate actively in M and M conferences, daily chief conferences and journal clubs

·  Learn to critically read the literature

·  Master the IT resources available to you to develop a commitment to lifelong learning and education

Interpersonal and communication skills:

·  Develop the appropriate skills to provide efficient, concise, patient presentations

·  Master text paging, emailing, etc.

·  Develop strong doctor patient relationships using counseling and education of patients and their families

·  Learn to master EPIC to provide proper documentation in the electronic medical record

·  Learn to properly consult other specialty services in a professional manner

Professionalism:

·  Respect every patient regardless of social or other circumstances

·  Log cases appropriately

·  Log your duty hours using My Evaluations appropriately and in a timely fashion

·  Complete all required clinical and residency documents in a timely fashion

·  Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team

·  Learn to be punctual

·  Always exemplify professional attire, appropriate grooming and hygiene

·  Demonstrate honesty, integrity and leadership skills

Systems-based practice:

·  Demonstrate the effective communication with referring physicians throughout the Swedish and University of Washington health care systems

·  Keep patients’ safety foremost while discharging patients in a timely fashion

·  Demonstrate time management and organizational skills while adhering to work hour regulations

·  Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

SCORE CURRICULUM - CATEGORY 23: PEDIATRIC SURGERY
Diseases/Conditions
BROAD
• Hypertrophic pyloric stenosis
• Umbilical hernia
• Inguinal hernia
• Malrotation
• Intussusception
• Meckel’s diverticulum
FOCUSED
• Gastroschisis
• Omphalocele
• Esophageal atresia
• Tracheoesophageal fistula
• Foreign bodies of the trachea/esophagus
• Congenital diaphragmatic hernia
• Duodenal atresia/stenosis
• Pancreas divisum
• Intestinal atresia and meconium ileus
• Imperforate anus
• Necrotizing enterocolitis
• Hirschsprung’s disease
• Biliary atresia
• Choledochal cysts
• Cryptorchidism
•Wilms tumor
• Neuroblastoma / Operations/Procedures
ESSENTIAL − COMMON
• Inguinal herniorrhaphy in children
• Umbilical hernia repair in children
ESSENTIAL − UNCOMMON
• Pyloromyotomy
• Emergency operation for malrotation
• Emergency operation for intussusception
• Excise branchial cleft anomaly
• Excise thyroglossal duct cyst
• Orchiopexy
• Open antireflux procedure
• Laparoscopic antireflux procedure
• Repair intestinal atresia/stenosis
• Repair diaphragmatic hernia
• Repair omphalocoele/gastroschisis
• Procedure for meconium ileus/necrotizing enterocolitis
• Excision Wilms tumor/neuroblastoma
• Operation for Hirschsprung’s/imperforate anus
• Repair esophageal atresia/tracheoesophageal fistula
• Repair deformity chest wall