STUDENT RESPONSIBILITIES FOR PEDIATRIC SURGERY.doc

8/10/2019 STUDENT RESPONSIBILITIES FOR PEDIATRIC SURGERY.doc

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STUDENT RESPONSIBILITIES FOR PEDIATRIC SURGERY (PDA)

Learning Objectives

1. Acquire knowledge in the following surgically-related problems:

Acute AbdomenNecrotizing EnterocolitisGastroesophageal Reflux DiseaseGastroschisisIntussusceptionIntestinal ObstructionDiseases of the Liver and GallbladderPediatric Solid TumorsMalrotation

Inflammatory Bowel DiseaseGastrostomy TubesCentral Venous CathetersHirschsprungs DiseaseHerniaNutritional ManagementMinimally-Invasive SurgeryCongenital AnomaliesPain management in children


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2. Learn to write structured, focused history and physical examinations and progress notes.

3. Learn to efficiently evaluate surgical patients and orally present findings, assessment andplan.

4. Develop Operating Room experience including:

Proper scrubbing technique Participation at the operating table using aseptic technique Correlation of pathological findings with signs and symptoms of disease

5. Acquire patient exposure to refine bedside manner.

6. Refine technical skills including:

Venipuncture Placement and removal of NG tubes and Foley catheters Dressing wounds and managing drains Basic suturing

Pediatric Surgery Organization

The Pediatric surgery service includes 5 attending surgeons (Drs. Von Allmen, Phillips, Weiner,Adamson and Lange) a chief resident, a 3 rd year resident, one or two interns and 2 nursepractitioners (Lynne Farber and Amy Lamm). The Chief Residents supervise the care of allpatients on Pediatric surgery. The housestaff and students are responsible to the Chief Residents.Ultimate responsibility of all patients lies with the Attending Surgeons.

Clinics

Pediatric surgery clinics are held every day except Tuesdays. There are also several clinics in ourRaleigh office (Ask the attendings the best days to come to any of those clinics). New patients,postoperative follow-up evaluations, and preoperative referrals are seen. Student attendance isrequired. Most elective cases are admitted through these clinics.

History and Physical Workups

A major source of learning is obtained from new admission workups. Students are to obtain acomplete history and perform a physical examination on all new admissions or patients seen inconsultation who ultimately come to the surgical service for an operation or management.Occasionally, workups may be done during a clinic visit. New patient workups should be sharedamong students regarding number and disease processes.

History & Physical workups should adhere to the following format:


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Referring PhysicianInfosource:Chief complaint: (c.c.)HPIPMH (medical, surgical, medications, allergy, gestational age atBirth)SH (smoking, etc)FH (any bleeding or anesthetic problems)ROS (complete, emphasis on pertinent negatives)PE (complete)DatabaseProblem list/AssessmentPlan

Progress Notes

Students are expected to write daily progress notes on the patients they are following. Theseprogress notes do not replace the housestaff notes. All progress notes should contain the pertinentsubjective (S) and objective (O) findings, as well as a concise assessment (A) and plan (P). TheStudent Progress Note must be concise and pertinent. Lab data are recorded. Assessment andplans should be discussed with a physician before writing in the chart. Remember the chart is alegal record, and statements should show responsible thinking. A minimum of one StudentProgress Note every day until discharge is required. The surgical house staff and Attendingphysician countersign Student Progress Notes and add comments, corrections, and additions.


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The Student Progress Note should follow the format outlined:

Date Student Progress NotePO Day # ______S: Events and active complaints since last roundsO: Vitals signs, I/Os including drains and tubes

Physical exam, focusedNew labs

A: Concise list of active issuesP: Plan for each active issue

Operating Room Opportunities

Each student should have the gross pathology demonstrated to him/her in the operating room onall the patients he/she is following. Student operating room assignments will be decided the daybefore surgery to give each student ample opportunity to read and prepare for the particular case.

It is expected that each student be familiar with each case on which they scrub. Students

should make every effort to see the patients pre-op. At a minimum their chart should be reviewed . Although the student following an assigned patient is expected to scrub on thatoperation, other students are encouraged to view operations whenever possible during therotation. All students are expected to be knowledgeable in operating room conduct. It is thestudent's responsibility to check on the time of the operative procedure so that he/she may planhis/her activities to be present.

Students may elect to go to WakeMed to get more exposure to surgical procedures with theattendings that operate over there. This is an excellent way for students to have more one-on-onetime with the attendings and often act as first assistants. Check with the attendings to find out thebest days to spend the morning or entire day at WakeMed.

On Call

PDA students are On-Call as directed in the clerkship orientation materials. Each on-call studentshould notify the Resident On-Call where he/she can be reached.

Orders

Students are to learn to write postoperative orders. This is done by observing the housestaff during computerized physician order entry. Proper organization of orders is a high priority.Knowledge of the correct dosage of medicine, proper laboratory tests, and nursing orders isnecessary.

Conferences

There is an abundance of formal teaching sessions that meet on a regularly scheduled basis onPDA. The students should attend as many of these sessions as possible. Priorities include:

1. Cross Block Lectures - 7:30 am Monday, Tuesday, Thursday; 8:30 am Wed, 8:00 am Friday -OR classroom


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2. Surgery Grand Rounds - 7:15 am Wednesday, Clinic Auditorium3. M & M Conference - 5:00 pm Wednesday - OR classroom4. Division M&M 7:00am 1 st and 3 rd Monday, 3010 Old Clinic Building conference room7. Tutorials As scheduled with Attending Physicians

Rounds

Early morning Work Rounds are conducted by the housestaff to determine any changes in eachpatient's condition and make decisions regarding management for the day. Students areresponsible for keeping abreast of the clinical condition of their patients and decisions formanagement. An attending (or sometimes more than one) will round with the housestaff andstudents on all of the patients in the afternoon. Questions and discussion are encouraged.Students should be able to present a brief, but concise synopsis of the patient's problem andprogress on rounds.

Evaluations

Mid-rotation feedback will be provided by faculty members and residents at the 2-week point.Specific feedback will be given related to submitted write-ups available and overall performance.Students are encouraged to seek feedback and recognize it in all its forms.

At the completion of each rotation, the attendings and housestaff meet to discuss the performanceof the students. Patient care, Knowledge, Self-improvement, Communication skills,Professionalism and system-based practice are the main areas that will be evaluated. A consensusevaluation form is then submitted to the Surgery Clerkship Office usually within two weeks of the end of the rotation. Students are encouraged to meet with the Section Chief or other facultymembers to review their evaluations.

Revised 3/6/07 PL

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STUDENT RESPONSIBILITIES FOR PEDIATRIC SURGERY.doc