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Curriculum

GOALS / OBJECTIVES OF TRAINING PROGRAM

The objective of our training program is to develop a Pediatric General Surgeon who demonstrates sufficient competence to enter practice without direct supervision: that can assume complete responsibility for the preoperative, operative, and postoperative management of patients with problems within the purvey of Pediatric general surgery and who can also work together with all colleagues involved in the care of pediatric patients.

Additionally, it is expected that the resident in Pediatric General Surgery develops the sensitivity required to deal not only with pediatric patients, but their families; while maintaining the attitude and demeanor corresponding with the highest quality of primary care of pediatric patients.

Along with these objectives will be those of an ethical and academic nature that will reflect the conscience of modern Pediatric General Surgery and help shape its future. The general objectives are to train pediatric surgeons to maintain the leadership and direction of the profession of Pediatric General Surgery.

THE EXPERIENCE

The program is designed to provide a broad experience in all aspects of Pediatric General Surgery. There is an extensive minimally invasive surgery experience, with all advanced laparoscopic and thorascopic procedures being performed by all of the full time attendings and some of the voluntary faculty.  Approximately 2200 ambulatory and inpatient cases are done by the Pediatric General Surgery service at CCMC every year.

10 months of the first year are spent as Assistant Chief Resident on the General Surgery Service.  One month is spent on a rotation in the NICU at CCHMC, and one month is spent on a rotation at Memorial Sloan Kettering Cancer Center in Manhattan, focusing on Pediatric Surgical Oncology with Dr. Mike Laquaglia.  The entire second year is spent as Chief Resident on the Pediatric General Surgery Service.

CCHMC is a major referral center for many pediatric surgical problems including Anorectal Malformations, Inflamatory Bowel Disease, Chest Wall Abnormalities, Solid tumors and Congenital Diaphragmatic Hernias.  The hospital is one of two centers in the New York Metropolitan area that perform ECMO.

The average daily census for the pediatric surgical service is approximately 10 -12 patients, not including the patients in the PICU and NICU, and on the consult service

We are supported by superb clinicians in Pediatric Anesthesia, Radiology, Pathology and all pediatric sub-specialties.

EDUCATIONAL PROGRAM

The chief resident organizes the conference schedule and journal club.  Both residents lecture to the surgical and pediatric house staff on a regular basis.  A significant amount of teaching occurs on a daily basis during rounds.  Finally, the chief residents are expected to function as the teaching assistant in the OR for cases that are appropriate for a junior house officer to perform.

The basic and clinical science curriculum addresses the educational needs of the surgical residents, Pediatric Surgery Chief Residents, and surgical Attendings through a combination of daily rounds, didactic lectures, case conferences, grand rounds, and mortality and morbidity conferences.  In addition, a formal lecture series addressing the necessary basic science topics has been established. The lecture series, which spans two years, is designed to provide exposure to the basic and clinical science topics that have been identified by the ACGME as important; including embryology, genetics, wound healing, hemostasis and blood disorders, immunobiology, transplantation and the physiology and pathology of the circulatory, respiratory, gastrointestinal, genitourinary and endocrine systems.  Education is provided in fluid and electrolyte balance, nutrition, infection, metabolic response to injury and anesthesiology. 

In addition to the lecture series, regular conferences are held to supplement the formal educational series.  Regular pediatric surgical grand rounds provide a forum for didactic lectures from local, national and internationally known speakers.  Regular pediatric surgical mortality and morbidity conferences are held in conjunction with the adult general surgery mortality and morbidity conference.  This conference is attended by the pediatric surgical attending staff, the adult surgical attending staff, and the surgical house staff.  The Pediatric Surgical Chief Resident or the senior resident on the service present the cases.  All cases in which a morbidity or mortality occurs are discussed in detail.

There is a monthly combined pediatric surgical, pathological, and radiological conference in which interesting cases on the service are discussed along with the imaging studies and pathologic findings.  The general surgery house staff, the voluntary and full time pediatric surgical staff, and representatives from pediatric pathology and radiology attend this conference. 

The pediatric surgeons as well as the Division of Pediatric Hematology-Oncology attend weekly pediatric tumor board.  All patients with newly diagnosed tumors are discussed, as well as the operative and pathological findings of any patients undergoing surgery.  Routine follow up of oncology patients is also reviewed.

We hold weekly professor rounds with the 5 full time academic attendings, the pediatric surgical house staff and the pediatric house staff. Finally, daily rounds are made on the pediatric surgery service by the full time and voluntary attending pediatric surgeons with the Pediatric Surgical Chief Residents and the general surgery residents.  The residents are expected to participate in the discussion of the care of the patients on the surgical service.

The combination of the didactic lecture series, Grand Rounds, M & M and radiology/pathology conferences, Tumor Board and Professors’ and daily rounds address the cognitive component of the Trainee’s educational experience.  An emphasis is placed on the scholarly attributes of self-instruction, teaching, skilled clinical analysis, sound surgical judgment and research creativity.

Reviewing Institutional Operative Data for the last two academic years, our residents participated in close to 2300 cases.

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