STUDENTRESPONSIBILITIESFORPEDIATRICSURGERY(PDA)

LearningObjectives
1.

Acquireknowledgeinthefollowingsurgicallyrelatedproblems:
AcuteAbdomen
NecrotizingEnterocolitis
GastroesophagealRefluxDisease
Gastroschisis
Intussusception
IntestinalObstruction
DiseasesoftheLiverandGallbladder
PediatricSolidTumors
Malrotation

InflammatoryBowelDisease
GastrostomyTubes
CentralVenousCatheters
HirschsprungsDisease
Hernia
NutritionalManagement
MinimallyInvasiveSurgery
CongenitalAnomalies
Painmanagementinchildren

2.

Learntowritestructured,focusedhistoryandphysicalexaminationsandprogressnotes.

3.

Learntoefficientlyevaluatesurgicalpatientsandorallypresentfindings,assessmentand
plan.

4.

DevelopOperatingRoomexperienceincluding:
Properscrubbingtechnique
Participationattheoperatingtableusingaseptictechnique
Correlationofpathologicalfindingswithsignsandsymptomsofdisease

5.

Acquirepatientexposuretorefinebedsidemanner.

6.

Refinetechnicalskillsincluding:

Venipuncture
PlacementandremovalofNGtubesandFoleycatheters
Dressingwoundsandmanagingdrains
Basicsuturing

PediatricSurgeryOrganization
ThePediatricsurgeryserviceincludes5attendingsurgeons(Drs.VonAllmen,Phillips,Weiner,
Adamson and Lange) a chief resident, a 3 rd year resident, one or two interns and 2 nurse
practitioners(LynneFarberandAmyLamm). TheChiefResidentssupervisethecareofall
patientsonPediatricsurgery.ThehousestaffandstudentsareresponsibletotheChiefResidents.
UltimateresponsibilityofallpatientslieswiththeAttendingSurgeons.
Clinics
PediatricsurgeryclinicsareheldeverydayexceptTuesdays.Therearealsoseveralclinicsinour
Raleighoffice(Asktheattendingsthebestdaystocometoanyofthoseclinics).Newpatients,
postoperativefollowupevaluations,andpreoperativereferralsareseen. Studentattendanceis
required.Mostelectivecasesareadmittedthroughtheseclinics.

HistoryandPhysicalWorkups
Amajorsourceoflearningisobtainedfromnewadmissionworkups.Studentsaretoobtaina
completehistoryandperformaphysicalexaminationonallnewadmissionsorpatientsseenin
consultation who ultimately come to the surgical service for an operation or management.
Occasionally,workupsmaybedoneduringaclinicvisit.Newpatientworkupsshouldbeshared
amongstudentsregardingnumberanddiseaseprocesses.
History&Physicalworkupsshouldadheretothefollowingformat:

ReferringPhysician
Infosource:
Chiefcomplaint:(c.c.)
HPI
PMH(medical,surgical,medications,allergy,gestationalageat
Birth)
SH(smoking,etc)
FH(anybleedingoranestheticproblems)
ROS(complete,emphasisonpertinentnegatives)
PE(complete)
Database
Problemlist/Assessment
Plan
ProgressNotes
Studentsareexpectedtowritedailyprogressnotesonthepatientstheyarefollowing.These
progressnotesdonotreplacethehousestaffnotes.Allprogressnotesshouldcontainthepertinent
subjective(S)andobjective(O)findings,aswellasaconciseassessment(A)andplan(P).The
StudentProgressNotemustbeconciseandpertinent. Labdataarerecorded. Assessmentand
plansshouldbediscussedwithaphysicianbeforewritinginthechart. Rememberthechartisa
legalrecord,andstatementsshouldshowresponsiblethinking. AminimumofoneStudent
Progress Note every day until discharge is required. The surgical house staff and Attending
physiciancountersignStudentProgressNotesandaddcomments,corrections,andadditions.

TheStudentProgressNoteshouldfollowtheformatoutlined:
Date

StudentProgressNote
PODay#______
S:
Eventsandactivecomplaintssincelastrounds
O:
Vitalssigns,I/Osincludingdrainsandtubes
Physicalexam,focused
Newlabs
A:
Conciselistofactiveissues
P:
Planforeachactiveissue

OperatingRoomOpportunities
Eachstudentshouldhavethegrosspathologydemonstratedtohim/herintheoperatingroomon
allthepatientshe/sheisfollowing.Studentoperatingroomassignmentswillbedecidedtheday
beforesurgerytogiveeachstudentampleopportunitytoreadandpreparefortheparticularcase.
Itisexpectedthateachstudentbefamiliarwitheachcaseonwhichtheyscrub.Students
should make every effort to see the patients preop. At a minimum their chart should be
reviewed. Although the student following an assigned patient is expected to scrub on that
operation, other students are encouraged to view operations whenever possible during the
rotation. Allstudentsareexpectedtobeknowledgeableinoperatingroomconduct. Itisthe
student'sresponsibilitytocheckonthetimeoftheoperativeproceduresothathe/shemayplan
his/heractivitiestobepresent.
StudentsmayelecttogotoWakeMedtogetmoreexposuretosurgicalprocedureswiththe
attendingsthatoperateoverthere.Thisisanexcellentwayforstudentstohavemoreoneonone
timewiththeattendingsandoftenactasfirstassistants.Checkwiththeattendingstofindoutthe
bestdaystospendthemorningorentiredayatWakeMed.
OnCall
PDAstudentsareOnCallasdirectedintheclerkshiporientationmaterials.Eachoncallstudent
shouldnotifytheResidentOnCallwherehe/shecanbereached.
Orders
Studentsaretolearntowritepostoperativeorders. Thisisdonebyobservingthehousestaff
during computerizedphysician order entry. Proper organization of orders is a highpriority.
Knowledge of the correct dosage of medicine, proper laboratory tests, and nursing orders is
necessary.
Conferences
Thereisanabundanceofformalteachingsessionsthatmeetonaregularlyscheduledbasison
PDA.Thestudentsshouldattendasmanyofthesesessionsaspossible.Prioritiesinclude:
1. CrossBlockLectures7:30amMonday,Tuesday,Thursday;8:30amWed,8:00amFriday
ORclassroom

2.
3.
4.
7.

SurgeryGrandRounds7:15amWednesday,ClinicAuditorium
M&MConference5:00pmWednesdayORclassroom
DivisionM&M7:00am1stand3rdMonday,3010OldClinicBuildingconferenceroom
TutorialsAsscheduledwithAttendingPhysicians

Rounds
EarlymorningWorkRoundsareconductedbythehousestafftodetermineanychangesineach
patient's condition and make decisions regarding management for the day. Students are
responsible for keeping abreast of the clinical condition of their patients and decisions for
management. Anattending(orsometimesmorethanone)willroundwiththehousestaffand
students on all of the patients in the afternoon. Questions and discussion are encouraged.
Studentsshouldbeabletopresentabrief,butconcisesynopsisofthepatient'sproblemand
progressonrounds.
Evaluations
Midrotationfeedbackwillbeprovidedbyfacultymembersandresidentsatthe2weekpoint.
Specificfeedbackwillbegivenrelatedtosubmittedwriteupsavailableandoverallperformance.
Studentsareencouragedtoseekfeedbackandrecognizeitinallitsforms.
Atthecompletionofeachrotation,theattendingsandhousestaffmeettodiscusstheperformance
of the students. Patient care, Knowledge, Selfimprovement, Communication skills,
Professionalismandsystembasedpracticearethemainareasthatwillbeevaluated.Aconsensus
evaluationformisthensubmittedtotheSurgeryClerkshipOfficeusuallywithintwoweeksof
theendoftherotation.StudentsareencouragedtomeetwiththeSectionChieforotherfaculty
memberstoreviewtheirevaluations.
Revised3/6/07PL