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
Hernia Management
Pancreatitis and Pancreatic Carcinoma
Upper intestinal disorders
Liver, Gallbladder and Bile Duct Disease
Intestinal Obstruction
Inflammatory Bowel Disease
Colorectal Carcinoma
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Anorectal Disease
Colonic disorders
Nutritional Management of the Surgical Patient
Trauma patient evaluation and management
Workup and management of Abdominal pain,
vomiting
Appendicitis
Fluid and Electrolytes
Pediatric surgery-specific disorders—
 Intussusception
 Hirschsprung’s disease
 Pyloric Stenosis
 Neonatal hernias
 Necrotizing Enterocolitis
 Congenital anomalies
 Feeding problems
 Vascular access
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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
 venipuncture
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
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
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 Responsibility for their patients and families
 Teamwork
These 5 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 Organization
The Pediatric surgery service includes 5 attending surgeons (Drs. Weiner, Adamson, McLean,
Lange, and Erickson) a chief resident, a 3rd year resident, one or two interns and 3nurse
practitioners (Lynne Farber, Amy Lamm and Robin Deloach). 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 for each of the attendings and may also attend
the nurse practitioner clinics. The chief or 3rd year resident will assist in assigning
days/times you should go to clinic.
 Students will be assigned 3-5 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
 Dr. Lange will meet with you on the first day or two 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. There are also several clinics in our Raleigh
office at Rex Hosptial (You are welcome to join us in the Raleigh clinics as well--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 is required. Most elective
cases are admitted through these clinics.
 We can 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 written H&P’s since we have to do this on all
pre-operative patients—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.
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
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a clinic visit. New patient workups should be shared among students regarding number and
disease processes.
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 (xrays, 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. A minimum of one Student
Progress Note every day until discharge is required. 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.
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
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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. 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 not always feasible
to allow students to perform some of the technical skills
 It is generally ok 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:
1. Cross Block Lectures - 7:30 am Monday, Tuesday, Thursday; 8:30 am Wed, 8:00 am Friday OR classroom
2. Surgery Grand Rounds - 7:15 am Wednesday, Clinic Auditorium
3. Gen. Surgery M & M Conference - 5:00 pm Wednesday - OR classroom
4. Division M&M Every other Friday 6:45am PICU conference room (location may change,
check with residents)
5. Patient Management conference—every other Friday, 6:45 am PICU conference room. The
chief will choose a topic and have residents and/or students briefly review a pertinent journal
article to stimulate discussion
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6. Tutorials – As scheduled with Attending Physicians—to cover general surgery topics and
allow for question and answer session
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 in the afternoon. 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 afternoon 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. Lange if you are unable to come to work due to illness or other
extenuating circumstances.
Please contact Dr. Lange 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. Patty Lange
Division Coordinator for Medical Student Rotation
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