STUDENT RESPONSIBILITIES FOR PEDIATRIC SURGERY (PDA)
Learning Objectives
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Surgical Knowledge: By the completion of the rotation, students will demonstrate appropriate
knowledge (by answering questions in the OR and clinic) regarding the following surgically related
problems:
Gastroesophageal reflux/swallowing disorders
Hernias
Pancreatitis
Upper intestinal disorders
Liver, gallbladder and biliary disease
Intestinal obstruction
Inflammatory bowel disease
Anorectal disease
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Colonic disorders
Nutritional management of the pediatric surgical
patient
Trauma patient evaluation and management
Workup and management of abdominal pain,
vomiting
Appendicitis
Fluid and Electrolytes
Pediatric surgery-specific disorders—
 Intussusception
 Malrotation +/- volvulus
 Hirschsprung’s disease
 Pyloric stenosis
 Neonatal inguinal hernias
 Necrotizing enterocolitis
 Congenital anomalies (TEF, intestinal atresias, imperforate anus)
 Feeding problems
 Vascular access
 Wilms tumor, neuroblastoma
 Solid organ injury in trauma
 Enteral feeding tubes (G-tubes, G-J tubes)
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Patient Care: By the end of the rotation, students will be proficient in developing assessments/plans
for the patients they are following, and make noticeable improvements in technical skills including:
 Placement and removal of NG tubes and Foley catheters
 Wound dressings and management of drains
 Basic suture techniques
3.
Communications: By the end of the rotation, students will demonstrate excellence in:
 Written Communication Skills (history and physical examinations and progress notes)
 Oral Communication Skills (rounds, clinics, ORs, conferences)
4.
Evidence-Based Practice: By the end of the rotation, students will read appropriate textbooks and
journal articles for cases and patient encounters and demonstrate, through appropriate questioning,
an understanding of the contemporary literature.
5.
Practice-Based Learning: By the end of the rotation, students will employ active learning in the
care of surgical patients to:
 Learn proper scrubbing technique
 Participate at the operating table using aseptic technique
 Correlate pathological findings with signs and symptoms of disease in your patients
Pediatric Surgery Medical Student Rotation
Last updated 5/6/13
6.
Professionalism: By the completion of the rotation and throughout medical school training, students
will develop and demonstrate:
 Good bedside manner demonstrating compassion and empathy
 Responsibility for their patients and families
 Teamwork
These 6 core competencies are what the end-of-rotation evaluations will be based on and what you should
concentrate on during your training.
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Pediatric Surgery Medical Student Rotation
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Pediatric Surgery Organization
The Pediatric surgery service includes 5 attending surgeons (Drs. Weiner, Adamson, McLean,
Lee, and Erickson) a chief resident, a 3rd year resident, one or two interns and 3nurse practitioners
(Lynne Farber, Amy Lamm and Robin Deloach Koonce). The Chief Residents supervise the care
of all patients on Pediatric surgery. The housestaff and students are responsible to the Chief
Residents. Ultimate responsibility of all patients lies with the Attending Surgeons.
 Page the chief resident the day before your rotation begins to find out when and where to
meet
 The chief resident will assign students to OR cases (ideally the day before)
 Students should attend at least one clinic each week. It is best to try to attend clinics of
different attendings. Clinic assignments should be made at beginning of rotation.
 Students will be assigned 3-4 patients to follow closely and present daily events and plans
to the team on rounds
 When not assigned to a clinic or OR, you should spend time getting to know your
patients/families, reviewing pertinent literature, studying for the next case and reviewing
general surgery texts and surgical atlas
 Dr. Erickson will meet with you on the few days of the rotation to provide additional
orientation to the service.
 Assigned lectures/skills labs, OSCE’s take precedence over OR and clinics
 We have a very comprehensive handbook that the residents use for the service with
important helpful hints, medication doses, phone numbers, etc that you can
borrow/review while on the service.
Clinics
Pediatric surgery clinics at UNC are held every day. New patients, postoperative follow-up
evaluations, and preoperative referrals are seen. Student attendance is required. Most elective
cases are admitted through these clinics.
 We will provide a schedule of weekly clinics on the first day of your rotation.
 The attending running the clinic will orient you to their clinic and assign you the patients
you will be following.
 Clinics are a great opportunity to practice outpatient assessment of the pediatric surgical
patient. It is a great opportunity to hone your history taking and physical exam skills
 Clinics usually are a great time to have more one on one time with attendings and NP’s
so you should use this time to ask lots of questions.
 Wear appropriate clothes to clinic. Review patients on clinic schedule before the day of
clinic, read on available patient histories and available records.
History and Physical Workups
A major source of learning is obtained from new admission workups. Students are to obtain a
complete history and perform a physical examination on all new admissions or patients seen in
consultation who ultimately come to the surgical service for an operation or management. The
interns can help assign these patients to the students. Occasionally, workups may be done during
a clinic visit. New patient workups should be shared among students regarding number and
disease processes.
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Pediatric Surgery Medical Student Rotation
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History & Physical workups should adhere to the following format:
Referring Physician
Infosource:
Chief complaint: (c.c.)
HPI
PMH (medical, surgical, medications, allergy, gestational age at
Birth)
SH (smoking, etc)
FH (any bleeding or anesthetic problems)
ROS (complete, emphasis on pertinent negatives)
PE (complete)
Database (x-rays, CT scans, labs etc)
Problem list/Assessment
Plan
Progress Notes
Students are expected to write daily progress notes on the patients they are following. These
progress notes do not replace the housestaff notes. All progress notes should contain the pertinent
subjective (S) and objective (O) findings, as well as a concise assessment (A) and plan (P). The
Student Progress Note must be concise and pertinent. Lab data are recorded. Assessment and
plans should be discussed with a physician before writing in the chart. Remember the chart is a
legal record, and statements should show responsible thinking. The surgical house staff and
Attending physician countersign Student Progress Notes and add comments, corrections, and
additions.
The Student Progress Note should follow the format outlined (SOAP note):
Date
Student Progress Note
PO or HD (hospital day) Day # ______
S:
Events and active complaints since last rounds
O:
Vitals signs, I/Os including drains and tubes
Physical exam, focused
New labs
*A:
Concise list of active issues
*P:
Plan for each active issue
**These are the areas that you should strive to improve on each day. Becoming more
independent in formulating assessments and plans shows understanding of the patient problem
and demonstrates advanced medical problem solving.
Operating Room Opportunities
Each student should have the gross pathology demonstrated to him/her in the operating room on
all the patients he/she is following. Student operating room assignments will be decided the day
before surgery to give each student ample opportunity to read and prepare for the particular case.
This will include review of disease process, specific patient, and surgical atlases to familiarize
yourself with the actual steps of the operation. It is expected that each student be familiar with
each case on which they scrub, including indications for surgery, anatomy, operative plan, and
possible complications. 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
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Pediatric Surgery Medical Student Rotation
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expected to scrub on that operation, other students are encouraged to view operations whenever
possible during the rotation. All students are expected to be knowledgeable in operating room
conduct. It is the student's responsibility to check on the time of the operative procedure so that
he/she may plan his/her activities to be present.
 We will try to get you as involved in the procedure as possible but it is only sometimes
feasible to allow students to perform some of the technical skills on the pediatric patients.
 It is okay to ask questions during the case and you should try to format questions that
demonstrate some basic knowledge about the procedure
 Nurses and scrub techs in the OR are excellent resources for learning OR etiquette,
obtaining extra suture material and learning some basics about certain procedures—you
will do well to introduce yourself to the circulating OR nurse and the scrub tech at the
beginning of the case.
 Write your name and pager number on the white board in the OR at the beginning of the
day or case so that the nurse can record that you were there and so you can be contacted
if the case is starting
 Notify the attending/resident if you have a mandatory meeting/lecture 10-15 minutes or
more before you have to leave the OR to attend that meeting—those meeting take
precedence over the OR case.
On Call
PDA students are On-Call as directed in the clerkship orientation materials. Each on-call student
should 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 is
necessary.
 Outpatient postoperative orders are still handwritten so this is a good opportunity to
practice.
Conferences
There is an abundance of formal teaching sessions that meet on a regularly scheduled basis on
PDA. The students should attend as many of these sessions as possible. Priorities include:
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Cross Block Lectures - 7:30 am Tuesday, Thursday - OR classroom
Surgery Grand Rounds - 7:15 am Wednesday, Clinic Auditorium
Gen. Surgery M & M Conference - 5:00 pm Wednesday – Clinic Auditorium
Friday am conference 6:30 am PICU conference room – rotation between topic presentations,
division M & M, trauma M & M, patient management conference
5. Pediatric surgery didactic conference Tuesdays 4 pm, PICU conference room (Dr. Sang Lee)
6. Tutorials – As scheduled with Attending Physicians—to cover general surgery topics and
allow for question and answer session
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7.
Once weekly meeting with Dr. Erickson to discuss patients on service and pediatric surgery
topics, address questions or concerns.
Students will be expected to prepare at 10-15 min presentation with slides on the pediatric
surgery topic of their choice at the end of the rotation. The topic chosen should be approved by
the chief resident or one of the attendings. These talks will be given during Friday am
conference.
Rounds
Early morning Work Rounds are conducted by the housestaff to determine any changes in each
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. An attending (or sometimes more than one) will round with the housestaff and
students on all of the patients each day. Questions and discussion are encouraged. Students
should be able to present a brief, but concise synopsis of the patient's problem and progress on
rounds.
 Rounds generally start in the PICU to review the radiology studies for the day
 Much of the group teaching occurs during rounds depending on time constraints. This is
a great time to ask questions to clarify patient management issues on your patients or
other patients
 Don’t be afraid to ask questions
Evaluations
Mid-rotation feedback will be provided by faculty members and residents at the 2-week point (we
often forget that two week time point so feel free to remind us). 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 performance
of the students. Patient care, Knowledge, Self-improvement, Communication skills,
Professionalism and system-based practice are the main areas that will be evaluated.
A consensus evaluation form (including feedback from interns, residents, NP’s and attending) 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 faculty members to
review their evaluations.
MISC
Please notify the chief resident or Dr. Erickson if you are unable to come to work due to illness or
other extenuating circumstances. Please contact Dr. Erickson if you have any problems or
concerns while on the rotation. All of the attendings are very approachable so please let us know
if you need anything.
Have fun and learn lots!!
Dr. Kimberly Erickson
Division Coordinator for Medical Student Rotation
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