Description of Rotation or Educational Experience

This is a one month elective rotation for the acute care surgical resident. Exposure to pediatric patients and their diseases will occur at University Medical Center. While on this rotation, residents will acquire a broad understanding of the evaluation and management of acute injuries and disorders of the neonate, infant, and child.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Develop independent skills in assessing pediatric surgery patients and decision-making in such patients
• Demonstrate knowledge of components of pediatric surgery and apply them to patients
• Demonstrate an understanding of the principles of pre- and post-operative management of pediatric surgery patients

Objectives

• Perform and document appropriate, age specific history and physical examination of the pediatric patient
• Demonstrate exposure to 3 of the below listed common surgical problems:
• hernia/hydrocele
• pyloric stenosis
• undescended testicle
• testicular torsion
• gastroesophageal reflux disease
• appendicitis
• Meckel's diverticulum
• hemangiomas/vascular malformations
• Maintain a log of one PICU patient, including a daily progress note, which demonstrates appropriate 1) ventilator management, 2) fluid, electrolyte, and nutritional management, and/or 3) antibiotic coverage
• Perform or assist on all major surgical procedures completed on the pediatric surgery service
• Perform or assist on placement of percutaneous venous access catheters and endotracheal intubations in the pediatric patient

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Demonstrate the ability to acquire medical knowledge and apply such knowledge to patient care
• Demonstrate an understanding of basic embryologic and physiologic principles that impact disease processes and care of the pediatric surgery patient
• Utilize information technology to increase medical knowledge and guide care of the pediatric surgery patient

Objectives

• Actively participate daily during formal pediatric surgery floor rounds, which would include demonstration of 1) detailed knowledge of each patient's course and ongoing care plan and 2) understanding of the patient's underlying medical condition
• Deliver a concise presentation on one of the below listed congenital surgical problems of the neonate:
• Esophageal Atresia
• Congenital Intestinal Obstructions
• Intestinal Atresias and Stenoses
• Duodenal Atresia
• Jejunoileal and Colonic Atresia and Stenosis
• Hirschsprung’s Disease
• Meconium Plug Syndrome
• Meconium Ileus
• Malrotation
• Imperforate Anus
• Abdominal Wall Defects
• Congenital Diaphragmatic Hernia
• After performance of a comprehensive history and physical exam, select appropriate diagnostic studies which will aid in disease process identification and management

Practice-Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Use information technology to optimize learning
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners
• Incorporate formative evaluation feedback into daily practice

Objectives

• Maintain a log of the pediatric surgical case experience. Document case complications, and methods/interventions that can be utilized to possibly prevent these complications when caring for future patients
• Provide a list of all informational resources utilized during the pediatric surgery elective. Example resources include:
• authoritative texts
• journals
• evidence-based web sites
• peers/consultants
• other health care specialty providers
• Actively participate in the education of fellow residents and students. The fellow will receive evaluations from the above peers, which will include feedback regarding areas for suggested improvement

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Advocate for quality patient care and optimal patient care systems
• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Demonstrate an awareness of and utilize all available resources to improve patient care quality

Objectives

• Attend weekly morbidity/mortality and pediatric quality assurance conference
• List diagnostic and therapeutic ancillary health care services utilized most frequently to optimize patient care during the pediatric surgery elective. Examples include:
• care coordinator
• child life/recreational therapist
• speech therapist
• physical/occupational therapist
• dietitian
• pharmacist
• clinical laboratory
• home health care/infusion therapy
• social worker
• child protective services
• Demonstrate ability to access the hospital's information technology system and utilize laboratory and radiographic studies to support and enhance patient care

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Demonstrate administrative competencies, which include completion of tasks as requested, following directions, responding in a timely manner to staff needs, following up on patient care issues, and being punctual
• Interact in a compassionate and respectful manner with a diverse group of patients and care takers, which includes maintaining patient confidentiality
• Recognize mistakes, and notify attending in a timely fashion when mistakes are made

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals

Objectives

• Provide thorough oral presentations regarding patient care, using appropriate medical terminology
• Effectively communicate diagnostic and therapeutic plans to patients and/or their care takers
• Following a surgical intervention, accurately describe the findings, procedure performed, and expected postoperative course to the patient and/or patient's care taker
• Provide a timely and accurate patient evaluation in response to consultant request. Evaluation should be reviewed with the pediatric surgical attending
• Work as a respectful team member, which includes interaction with students, fellow residents, attendings, consultants, and ancillary staff

Teaching Methods

• direct pediatric surgery attending supervision, to include involvement in surgical cases, patient rounds, and outpatient clinic experience
• Attendance of all lectures, conferences and quality improvement meetings.
• Review of assigned reading materials

Assessment Method (residents)

• Focused observation by faculty staff
• 360 degree evaluation by faculty at end of rotation through e-value system.
• Case log review with program director

Assessment Method (Program Evaluation)

• Using e-value system, rotation is assessed on several qualities including but not limited to value, accessibility, and relevance to practice.
• Outcome on national standardized exams.

Level of Supervision

• Residents are under direct or indirect supervision by faculty staff at all times

Educational Resources

• Pediatric Surgery: 6th Edition, 2 volume set, Grosfeld et al., Mosby, 2006
• Operative Pediatric Surgery, 6th edition, Spitz and Coran, Hodder and Stoughton, 2006