STUDENT RESPONSIBILITIES FOR PEDIATRIC
SURGERY (PDA)
Learning Objectives
1.
Acquire knowledge in the following surgically-related problems:
Acute Abdomen
Necrotizing Enterocolitis
Gastroesophageal Reflux Disease
Gastroschisis
Intussusception
Intestinal Obstruction
Diseases of the Liver and Gallbladder
Pediatric Solid Tumors
Malrotation
Inflammatory Bowel Disease
Gastrostomy Tubes
Central Venous Catheters
Hirschsprung’s Disease
Hernia
Nutritional Management
Minimally-Invasive Surgery
Congenital Anomalies
Pain management in children
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 and
plan.
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 3rd year resident, one or two interns and 2 nurse
practitioners (Lynne Farber and Amy Lamm). 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.
Clinics
Pediatric surgery clinics are held every day except Tuesdays. There are also several clinics in our
Raleigh 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 is
required. 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 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.
Occasionally, workups may be done during 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
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:
Date
Student Progress Note
PO 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
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
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.
Students may elect to go to WakeMed to get more exposure to surgical procedures with the
attendings that operate over there. This is an excellent way for students to have more one-on-one
time with the attendings and often act as first assistants. Check with the attendings to find out the
best 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 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.
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. M & M Conference - 5:00 pm Wednesday - OR classroom
4. Division M&M 7:00am 1st and 3rd Monday, 3010 Old Clinic Building conference room
7. Tutorials – As scheduled with Attending Physicians
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.
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 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 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.
Revised 3/6/07 PL