The Hospital for Sick Children
Plastic and Reconstructive Surgery Rotation:
A Guide for Medical Students
Updated April 22, 2013, Gregory H. Borschel
Welcome to the paediatric plastic surgery rotation at the Hospital for Sick Children!
On behalf of our entire division, we sincerely appreciate your choosing us among the
many outstanding options available to you within the University of Toronto curriculum.
It is a pleasure to have you learn more about this fascinating surgical sub-specialty. We
expect to help deepen your understanding of broad surgical principles and the medical
care of children and their families. We hope that your time with us will be both pleasant
and productive, and we assure you that we will work diligently to provide an outstanding
learning environment.
Sincerely,
Christopher R. Forrest,
Chair, Plastic Surgery, University of Toronto
Chief, Plastic Surgery, SickKids
Gregory H. Borschel,
Director, SickKids Undergraduate Medical Education
1
INTRODUCTION
Plastic Surgery is often described as the surgical specialty that is concerned with
“the skin and its contents.” Thus, the anatomic reach of plastic surgery is broader than
any other surgical specialty. The term “plastic” is derived from the Greek word
πλαστικός [plastikos] meaning to “change the shape or form of.” It otherwise has nothing
to do with implantation of biomaterials such as silicone, although many families may ask
because of the intense lay press coverage of cosmetic plastic surgery. Fundamentally,
Plastic Surgery alters anatomy anywhere in the body in order to improve function, form,
and often both simultaneously.
Before starting your rotation with us it would be helpful to review your notes regarding
anatomy and physiology, particularly regarding the face, craniofacial skeleton, and upper
extremity, including musculoskeletal, vascular and neurologic anatomy. In addition, it
would be useful to review class notes dealing with obtaining a history and performing a
physical examination in children. A brief review of certain surgical conditions (cleft lip
and palate, craniosynostosis, burns, hand trauma, syndactyly and other common
congenital hand anomalies, nerve injuries, and vascular anomalies) before your visit to
the clinic or operating room will give you a tremendous advantage and help make your
experience more productive.
Plastic surgery (alternatively called “Plastic and
Reconstructive Surgery”) is particularly challenging and rewarding because of the
breadth of anatomic problems we treat. Don’t be surprised if you see something
extremely rare, such as a previously undescribed condition or syndrome while on our
service. You may also be involved in extremely complex procedures.
WHAT SHOULD YOU DO ON YOUR FIRST DAY?
Go to our office, which is located on the 5th floor of the hospital above the Shopper’s
Drug Mart and Tim Hortons on the University Avenue side of SickKids. Our
administrative assistants arrive between 8:30 and 9 am. Ms. Marion Wallace is our
2
clerkship coordinator. (marion.wallace@sickkids.ca; 416-813-6448). To make the most
of your rotation, you should talk to Ms. Wallace well BEFORE your scheduled first day
in order to complete all necessary paperwork and credentialing. After administrative
requirements have been satisfied, you will be directed to the Plastic Surgery clinic or to
the Operating Rooms, with plans to meet with your supervisor (Dr. Gregory Borschel,
Director of Undergraduate Medical Education for SickKids Plastic Surgery) later in the
day. Should he be unavailable, one of the other attending surgeons will meet with you
and provide a brief introduction. You will also be introduced to the fellows and residents
on service, who will serve as your immediate contact team for everyday activities. Prior
to your arrival a welcome email will be sent to all members of the Plastic Surgery team
by Ms. Wallace welcoming you to the team and informing everybody about your
scheduled rotation time with us.
While the first day of your rotation may seem a bit hectic because of the orientation and
the need to familiarize yourself with the inner workings of the system, it should be
relatively easy for you to join the team in its routine the same day.
WHO WE ARE:
Staff surgeons:
Monday Clinic
Joel Fish, MD, MSc, FRCSC, FACS
Associate Professor
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
Medical Director, Burn Program
3
Monday Clinic
Ronald M. Zuker, MD, FRCSC, FACS, FAAP
Professor of Surgery
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
Director, Facial Palsy Clinic
Tuesday Clinic
Howard Clarke MD, PhD, FRCSC, FAAP, FACS
Professor of Surgery
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
Medical Director, Brachial Plexus Program
Wednesday Clinic
Christopher Forrest, MD, MSc, FACS, FRCSC
Division Chief, SickKids Division of Plastic and
Reconstructive Surgery
Professor of Surgery
Interim Chair, Division of Plastic and Reconstructive
Surgery, Department of Surgery
University of Toronto
Medical Director, Craniofacial Program
4
Thursday Clinic
David Fisher, MD, MSc, FRCSC
Associate Professor of Surgery
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
Director, Cleft and Microtia Clinics
Thursday Clinic
Gregory Borschel, MD, FACS, FAAP
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
Co-Director, Facial Palsy Clinic
Medical student supervisor, available 24 h/day by cell
phone (647-992-0904) or pager (416-813-7500)
Friday Clinic
John Phillips MD, MA, FRCSC
Professor of Surgery
Division of Plastic and Reconstructive Surgery,
Department of Surgery
University of Toronto
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FELLOWS 2012-2013
Erika Henkelman, MD
Sally Hynes, MD
Gale Lim, MD
Marc Swan, MD
Guy Watts, MD
Mahsa Moghaddam, MD
University of Toronto Plastic and Reconstructive Surgery Residents
Numbers vary throughout the year, with 4-month rotations for junior and senior
residents; usually one or two at a time.
Photos of fellows / residents here
6
NURSES
Mary Harris, RN and Lisa Browne, RN (Plastic and
Reconstructive Surgery Clinic Nurses)
Mary and Lisa run the Plastic Surgery clinics every
day.
Charis Kelly, Burns Program Nurse Practitioner
Charis cares for all burn patients, including writing prescriptions
and ordering tests. She runs the Tuesday burn clinic.
Steve Roberts, RN
(8C inpatient unit)
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Cindy Guernsey, RN
Farah Sheikh, MSW
(Cleft Program)
(Social Worker)
Other members of the team, who you will meet and interact with during the rotation,
include:
Social workers
OR Plastic and Reconstructive Surgery nursing team
8C ward nursing team
Other services, in particular
General paediatrics
Radiology/Image Guided Therapy
Occupational and Physical Therapy
Speech Therapy
Dentistry
Intensivists (ICU/CCU and NICU)
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SCOPE OF PEDIATRIC PLASTIC AND
RECONSTRUCTIVE SURGERY
The scope of the specialty of plastic surgery is broad
and continually changing. Pediatric plastic surgeons
attend to the specialized plastic surgical needs of
children. These conditions include:
Cleft lip and palate
Craniofacial anomalies
Burns
Congenital hand and upper extremity anomalies
Extremity trauma and oncologic defects
Microtia
Giant congenital nevi
Tania D’Arpino, RN
(Plastic Surgery OR lead
nurse)
Vascular anomalies and other benign lesions
Nerve injuries
Exposure to these different conditions and joint management with other specialties
around the hospital are bound to be of interest and educational value for students
ultimately interested in every discipline.
CARING FOR CHILDREN AND THEIR FAMILIES
We face the responsibility of providing a great educational experience while being
sensitive to the needs of families. Thus, all patient contact during this rotation will be
supervised, including performing a physical exam and obtaining a history from a child
and their family. We focus on addressing to the needs of the child and the family.
Obviously many parents are understandably apprehensive in hospital, fearful that their
children could have a medical diagnosis with worrisome consequences. This should not
9
be perceived as a suboptimal learning experience, but rather, an opportunity to better
understand the intricacies of pediatric medicine.
ADDRESSING SURGICAL ISSUES
The majority of our patients present specifically for assessment for surgery, and therefore
we counsel the families on the potential risks and benefits of a surgical procedure. Many
of these procedures are elective and have an important cosmetic component. The
interplay between the “cosmetic” and the “functional” aspects of Plastic and
Reconstructive surgery will be a recurring theme of your rotation with us.
THE PLASTIC AND RECONSTRUCTIVE SURGERY TEAM
Our team is composed of many different
health care providers and we hope that during
your rotation you will become an integral part
of it. The pediatric plastic surgery and
craniofacial surgery fellows coordinate most
of the work in the wards and the operating
room with the residents that come from the
Division
of
Plastic
and
Reconstructive
Surgery at the University of Toronto. In
addition, we have nurse practitioners that help
(L-R): Lisa Lazzarotto (OT), Jamil
Lati (PT), and Stacy Robitaille (PT)
are some of the therapists you will
work with in Plastic Surgery.
us with the clinical management of many of
our patients, as well as nurses in the clinic, ward (8C) and the operating room (E and F
ORs). The operating room team includes nurses that scrub with us, help with the surgical
intervention, and provide care for the child while they are under anesthesia as well as the
time they are awake and away from their parents.
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CLINIC SCHEDULE
Day
Surgeon / NP
Clinic Nurse
Monday
Dr. Joel Fish
Mary Harris, RN
Dr. Ronald Zuker
Lisa Browne, RN
Charis Kelly, RN, NP
Tuesday
Dr. Howard Clarke
Mary Harris, RN
Ms. Charis Kelly (NP
Lisa Browne, RN
burn clinic)
Wednesday
Dr. Chris Forrest
Mary Harris, RN
Dr. Howard Clarke
Alison Miller, RN
(Brachial plexus clinic)
Thursday
Friday
Dr. Greg Borschel
Mary Harris, RN
Dr. David Fisher
Lisa Browne, RN
Dr. Dr. John Phillips
Mary Harris, RN
Dr. Philip John (Vascular
Alan George, RN
Anomalies Clinic)
We hold a Facial Paralysis Clinic usually
once a month in order to perform preoperative
assessments on patients with facial palsy of
varying etiologies. This clinic is usually held
on Wednesdays near the plastic surgery
offices, and is staffed by Drs. Zuker and
Borschel.
Every day at 8 am we hold an emergency
clinic run by the fellows. There is a microtia
clinic staffed by Dr. Fisher [days vary; Mary
Harris
keeps
the
schedule].
(L-R): Valerie Martin (Social Work, cleft and
craniofacial program), and Emily Ho (OT,
upper
extremity;
Division
Research
Coordinator)
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STAFF ROLES AND EXPERTISE
Plastic Surgeons
Paediatric plastic surgeons have a very diverse practice. Most specialize in certain areas,
which may include:

Cleft lip and palate surgery: We treat conditions related to orofacial clefting,
including that of the lips, palate and jaws, with the goal of restoring both form
(facial appearance) and function (speech).

Craniofacial anomalies: Craniofacial surgeons specialize in the correction of skull
shape abnormalities, including craniosynostosis and other conditions. Craniofacial
surgeons also correct jaw abnormalities from congenital or acquired causes.

Burns: The burn unit is on Ward 8C. We treat burns of all etiologies affecting all
regions of the body. We work closely with the critical care unit to effectively
manage these medically complex, often severely ill patients.

Congenital hand and upper extremity anomalies: We treat patients with
polydactyly, syndactyly, duplicated digits, congenital trigger thumbs as well as a
host of rarer conditions. These patients are treated in close coordination with the
Occupational Therapists and Physiotherapists.

Extremity trauma and oncologic defects: We manage all types of extremity
trauma, ranging from nonoperative hand fractures to those of devastating
proportion. We also reconstruct cancer defects of the upper and lower limbs.

Microtia: Dr Fisher heads the microtia program. These children undergo
reconstruction using rib cartilage. These operations are usually performed by Dr
Fisher at St. Joseph’s hospital.

Giant congenital nevi: Infants and children with large disfiguring nevi may
undergo serial excision or tissue expansion to remove these lesions.

Vascular anomalies: We treat a variety of lesions, including hemangiomas,
venous malformation, arteriovenous malformations and lymphatic malformations.
These cases are often jointly managed by Dr. Philip John, MD (interventional
12
radiologist) and Dr. John Phillips (plastic surgeon) – yes, these are two different
doctors! Joao Amaral, MD (interventional radiology) also staffs this clinic.

Nerve injuries: Infants and children with neonatal brachial plexus injury
(“obstetrical brachial plexus palsy”) are seen in the brachial plexus clinic on
Wednesdays headed by Dr. Clarke. Our division also treats a variety of other
nerve injuries involving other anatomic regions, and these may be either
congenital or acquired.
PAEDIATRIC PLASTIC AND RECONSTRUCTIVE SURGERY FELLOWS
Paediatric Plastic and Reconstructive Surgery Fellows in the Plastic and
Reconstructive Surgery Clinic are licensed physicians who have successfully
completed training in Plastic and Reconstructive Surgery. They are working under
supervision to develop clinical expertise and research experience in the sub specialty of children’s Plastic and Reconstructive Surgery. The Paediatric Plastic
and Reconstructive Surgery Fellowship Program at SickKids consists of in-depth
clinical surgical training and research. We usually have 4 such fellows.
We usually have one or two craniofacial surgery fellows, who concentrate their
experience in craniofacial conditions.
NURSE PRACTITIONERS
Nurse Practitioners are Registered Nurses who have obtained additional education and
training, passed an Extended Class exam, and met additional requirements for registration.
Their advanced skills and knowledge enable them to autonomously communicate
diagnoses, prescribe drugs, and order diagnostic tests. They work closely with our
Surgeons to expand and extend the advanced care the child may require.
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PLASTIC AND RECONSTRUCTIVE SURGERY
CLINIC NURSES
Nurses in the Plastic and Reconstructive Surgery clinic
utilize both their core nursing skills and advanced
knowledge of Plastic and Reconstructive Surgery to
provide patients with holistic and family-centred care.
Much of what the nurses do is specific to the Plastic
and Reconstructive Surgery population.
Alan George, RN,
Craniofacial nurse
PHYSICAL AND OCCUPATIONAL THERAPISTS
These practitioners evaluate and treat children
with a variety of conditions, ranging from cleft
lip and palate, to extremity trauma, burns, and
congenital anomalies. You will be able to learn
much from these individuals since they work
very closely with our patients providing direct
patient care.
Jocelyne Copeland, OT
Congenital hand anomalies
CHILD LIFE SPECIALISTS
Child Life Specialists help to make the inpatient and outpatient hospital experience
positive for children, using play as a tool. Specifically, they may assist children:
•
Help explain medical conditions and procedures
•
Reduce fear and anxiety during medical procedures
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•
Provide a comfortable and supportive environment using therapeutic play to
stimulate growth and development, and by celebrating special events
•
Empowering children to make realistic choices regarding their own care
SOCIAL WORKERS
The Department of Social Work provides a full range of services to patients and
families affiliated with in-patient and out-patient programs of the Hospital. Clinical
services provided by social work staff include crisis intervention, adjustment to
illness, supportive counseling for loss/bereavement, locating and arranging resources,
and consultation with Hospital staff and/or other community agencies. Staff members
are affiliated with specific patient programs where they provide specialized expertise
in the psychosocial interventions that are an essential component of the overall plan
of care.
Clinical Social Workers at The Hospital for Sick Children are trained at a Master’s
level from an accredited university and are registered with the Ontario College of
Social Workers and Social Service Workers.
WEEKLY SCHEDULE
The weekly schedule varies slightly throughout the year. As a general rule, we run one or
two whole-day clinics and two or more operating rooms every day except during the
summer months. The clinics begin between 8:30 and 9 am and finish when the last
patient is seen (customarily between 3-5 pm). The clinic is located on the main (ground)
floor near the Shoppers Drug Mart and the Tim Hortons. If you are scheduled to be in
clinic, it is expected that you will be present and ready to see patients by 9 am at the latest.
At the beginning of the clinic the is a brief meeting with the clinic personnel, nurse in
15
charge, administrative assistant, staff physician and the resident and fellow assigned to
the clinic.
The cases for the next week are informally discussed in order to address any pending
issues prior to surgery and anticipate any particular needs that have not been addressed.
The operating room starts between 7:30 and 8 am. The Operating Room is located on the
second floor of the Atrium, and entry requires use of hospital-issues scrubs (provided
during your first day meeting). At 7:30 the staff urologist and/or a designated fellow will
perform what is called a “huddle”, where there is a discussion of the cases of the day with
all the members of the operating room working together that day, establishing a plan for
care with the anesthetist and nurses. Patients are expected to arrive in the operating room
by 8 am. During the day, you will witness and participate in all the safety checks
introduced to minimize errors, such as following our standardized checklists, conducting
“time-outs” and debriefing after each case. If it is your day to spend in the OR, it is the
expectation that you will be there at 8 am.
SickKids Plastic Surgery Faculty at the Ninth Annual Lindsay-Thomson
Symposium in Pediatric Plastic Surgery. (L-R): Joel Fish, John Phillips, Chris
Forrest, Visiting Professor John Mulliken from Boston Children’s Hospital,
David Fisher, Ron Zuker, Howard Clarke, Greg Borschel and Philip John
The weekly schedule also has to take into account morning and afternoon rounds period.
These are performed before any clinical activities in the morning and in the afternoon
16
after completing the clinic or operating room duties. When possible, the attending
surgeons round with the team.
Throughout the day, there may be times when further care may need to be rendered on
the ward and this may also include consultations requested from many of the services
within the hospital as well as the emergency department. You are invited to participate in
this process by working closely with our fellows and residents on service.
Our weekly schedule also includes teaching sessions as well as presentation rounds. On
Wednesday mornings at 7 am in Rm 8704 we hold rounds during which we discuss
ongoing research endeavors and a variety of clinical subjects. There is a wonderful
opportunity to learn more about pediatric Plastic and Reconstructive Surgery and also to
become part of ongoing research projects, if you should desire to do so. We also have
case rounds and teaching presentations that are scheduled on Friday morning,
understanding the limitations imposed by some university lecture requirements. During
these rounds you will witness the review process of indications for surgery, as well as
controversies in treatment options. Lastly, Morbidity and Mortality rounds are held once
quarterly on Wednesday morning (7am), providing you with in-depth discussion of
adverse outcomes, management, and introduction of initiatives to avoid such issues for
future patients. About every other month we hold a Complex Rounds in which complex
patients with varying diagnoses undergo multidisciplinary evaluation.
The best way to make sure that you have a full understanding of what happens
every week is to discuss this regularly with the fellows running the service, as well as
by obtaining a formal copy of our weekly schedule from one of our administrative
assistants.
RESPONSIBILITIES
When you become part of the team, we will invest in you as much trust and responsibility
as appropriate for your level of training. It is expected that you will approach this rotation
17
with the desire of being as clinically active as possible given the ample and diverse
opportunities that are available to you. For that reason, your level of participation will be
highly dependent on your interest as well as how active you are in seeking those
opportunities. Ideally, we expect every medical student to be active participants in
morning and afternoon rounds, being able to understand how those rounds are conducted,
to help write notes during the daily rounds, to devise a plan of care and (with assistance
of residents, fellows and staff) complete medical orders that help take care of patients,
and assist with the admission and discharge of inpatients. We also expect you to divide
your time evenly between the operating room and the clinics, trying to interact with the
different staff physicians in the Division of Plastic and Reconstructive Surgery. It is also
expected that whenever there is an educational value, you will participate in helping
residents and fellows with performing consults within the hospital as well as seeing
patients outside of the confines of the clinic and the operating room.
TIMELINESS
Being present at the scheduled start time of the clinic or in the operating room is
considered a very important point that should not be overlooked during your rotation. Do
note that the staff, fellows and residents will not police your attendance and timeliness. In
addition, we expect that you will report to your supervisor any absences and delays.
SCHEDULE MEETINGS WITH THE SUPERVISOR
When you are approved to participate in the Plastic and Reconstructive Surgery rotation
at the Hospital for Sick Children our administrative assistants will try to make sure that
scheduled visits are coordinated with your supervisor, Gregory Borschel, on the first day
of your rotation, mid rotation, as well as the last day of your rotation. Ultimately it is your
responsibility to schedule these meetings (to be facilitated by Ms. Marion Wallace and Dr.
Borschel’s secretary, Liz Greczylo). These can be held in the OR, Dr. Borschel’s office,
or other locations. These meetings have the following objectives:
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The “beginning of rotation meeting” is scheduled in order to go over some of
the most salient features of what is indicated in this handbook. It will highlight
your responsibilities as well as take into account any potential problems that you
may foresee during your rotation, and try to coordinate your desire for a particular
aspect of care that will be of benefit considering your choice for future postgraduate training. Note how this can be adjusted depending on the level of
training (3rd year vs. 4th year vs. transition to residency program), as well as your
ultimate specialty interests, as indicated above. You will maintain an operative log
describing all operative cases. You will note the diagnosis, specific problem to be
addressed, the operative course, and what you learned. You will also be able to
note any questions that have arisen since the operation that may require answers.
The “mid rotation evaluation” should include a review of your log in terms of
your performed activities and experiences, to obtain feedback as to how the
rotation is going and to see if there are any changes that need to be introduced to
satisfy your expectations and those imposed by the curriculum.
The “end of rotation meeting” is conducted as a debriefing session addressing
how the rotation went, reviewing the experience based on the goals discussed the
first day, as well as obtaining formal feedback and determine if there are any
changes that need to be introduced for future students. The operative log will be
reviewed. At the same time, student feedback will be provided in a verbal fashion,
regarding the appreciation of the members of the team about your participation
and involvement during the rotation, and will be the first point towards clarifying
aspects of your evaluation that will be formalized and completed on line within
the timeframes expected at the University of Toronto. It is our goal to have these
evaluations in place in less than a week time after you finish your rotation.
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ROTATION OBJECTIVES
All students:
Meet with supervisor on the first day of the rotation (or the week prior, if
possible) to discuss in person learning objectives, clinic times, operating room
schedules, contact information, expectations, and to answer any questions.
Meet mid-rotation to provide formative mid-rotation feedback, evaluate the
experience, review clinical and surgical exposure and complete any form
requirements.
Meet to discuss the final summative rotation evaluation with emphasis on
constructive feedback on overall performance during the rotation (according to
student level) and conveying perceptions of strengths and weaknesses detected by
staff, fellows, residents, nurses and other involved health care team members.
Equally important, this meeting will provide a forum for formal (voluntary)
feedback provided by the student on the rotation, the fulfillment of goals, the
overall experience and recommendations for improvement.
Provide the student with a timeframe for MedSIS evaluation to be completed (as a
rule, no later than a week after the forms become available online)
3rd and 4th year medical students:
Perform under supervision a focused history and physical exam, followed by
debriefing with the supervisor for feedback and recommendations.
Admit, follow and discharge an inpatient under direct supervision.
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Actively participate with the Plastic and Reconstructive Surgery team, including
morning and afternoon rounds, consults, emergency room visits and multidisciplinary assessments.
Stay in compliance with rules and regulations regarding time spent in the hospital,
including post-call responsibilities. IN THERE ARE CONCERNS, THE
SUPERVISOR SHOULD BE INFORMED IMMEDIATELY.
Develop the skills to be comfortable evaluating children and addressing concerns
raised by parents
Perform counseling for common conditions seen in a pediatric Plastic and
Reconstructive Surgery clinic setting
Gain experience with the operating room environment, learning practical skills on
how to properly take care of children in that environment
Transition to Residency program (additional goals):
Increase familiarity and experience with the physician’s roles in common
health care settings
Develop holistic competence for students in the areas of Communication,
Collaboration,
Management,
Health
Advocacy,
Scholarship
and
Professionalism
Promote awareness and experience with health equity and health systems
issues, as dealt with in routine situations, to increase students’ effectiveness
with these issues after graduation from the MD program
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* Further information on the Transition to Residency Program is available at
http://ttrfacdev.kenlocke.org
EVALUATIONS:
Evaluations are filled out online at the end of the rotation, accepting feedback from all
staff members as well as fellows, residents and other members of the team that interacted
with the student during his/her rotation. The standardized assessment takes into account
the following aspects, based on CanMEDS objectives:
1. Knowledge of Basic and Clinical Science: Evaluates acquiring an adequate and
factual knowledge commensurate to the level of training.
2. History taking: Evaluates steps to complete an accurate and organized history.
3. Physical Examination: Evaluates ability to conduct a careful exam with findings
that are detected with a technically sound technique and an organized approach.
4. Diagnostic test interpretation: Evaluates the ability to order appropriate tests for
the clinical scenario and interpreting how to apply the result of common
investigations to patient care.
5. Appropriate formulation and management plan: Evaluates ability to solve
common problems and generate a reasonable differential diagnosis and
management plan.
6. Technical and procedural skills: Assess for evidence that the student can
participate or complete procedures well (under supervision), with a reasonable
knowledge of the intervention.
7. Communication with patient families and community aiming at conveying
interest and concern for patients and families: Evaluate if the student is able
establish a good rapport, be empathetic and respectful as well as culturally
sensitive, and uses non-verbal skills effectively.
8. Written records: Assesses if student can produce complete, accurate and legible
organized notes. Reasonably good documentation of diagnosis, therapeutic plans
and intervention is expected.
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9. Oral reports: Evaluates if these are clear, complete and accurate.
10. Team participation: Evaluate if a student contributes to the interdisciplinary team
and functions well as a team member.
11. Appropriate use of healthcare resources: Determine if the student is aware of the
available healthcare resources and knows how to appropriately offer and access
them within our hospital.
12. Patient Advocacy: Determine if the student advocates on behalf of the patient in
an appropriate manner and under the right circumstances.
13. Self directed learning: Evaluate for evidence of responsibility with own learning,
showing adequate insight with requests for constructive feedback. This
assessment also includes if the students reads about cases and obtains basic
knowledge of the conditions that he/she is dealing with.
The evaluation form also determines if the student meets professional expectations
with altruism, reliability and responsibility, self-improvement, adaptability,
relationship with students, faculty and staff, upholding student professional code of
conduct, and the determination of any possible critical events. Within this context, the
specific following parameters will be evaluated:
1. Altruism.
a. Putting patient interests before his/her own.
b. Demonstrating sensitivity to patients and families in distress
c. Takes time to confirm communication with patients in an empathetic manner.
d. Demonstrate family-centred care
e. Shows respect for patient confidentiality
2. Reliability and Responsibility
a. Timely completion of outstanding
b. Fulfills obligations
c. Provides appropriate reason for absence or lateness in a timely fashion
d. Reports accurately on all patient care activities
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e. Demonstrate
respectful
communication
with
all
members
of
the
multidisciplinary team.
3. Self improvement adaptability
a. Accepts constructive feedback
b. Recognizes own limitations and seeks appropriate help
c. Engages in self directed learning related to the elective
4. Relationship with students, faculty and staff
a. Maintains appropriate boundaries in clinical learning situations
b. Relates well with students and fellow faculty as well as allied health
professionals
c. Upholding student professional code of conduct
d. Uses appropriate language in discussion with patients and colleagues
e. Resolves conflict in a manner that respects the dignity of those involved
f. Behaves honestly
g. Respects diversity of race, gender, religion, sexual orientation, age, disability,
intelligence and socioeconomic status
h. Maintains appropriate boundaries with patients
i. Dresses in an appropriate, professional manner within the context of the
hospital.
* These aspects of evaluation equally apply to medical students from the University of
Toronto, other medical schools in Canada and schools outside of Canada.
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USE OF COMPUTER RECORDS, PACS AND KIDCARE
Limited access can be obtained (episodically, when needed and under supervision),
through Staff, fellows or residents unless prior training secured. If so desired this may be
coordinated prior to the beginning of your rotation, understanding that there is an
important time commitment and that there is value in doing so if other rotations at our
Hospital are expected or scheduled. Unfortunately, if this training were to occur during
your scheduled time with us, it would adversely impact the already limited time for
educational activities. There are current active efforts to address this issue, and provide
and straightforward and easy way to obtain access during your rotation.
It is very important that the student observes at all times the restrictions imposed by
the Privacy Office, and errs on the side of caution when accessing medical records
or any patient-related information.
TAKING CALL
Being on call is an important part of learning about medicine and surgery in particular.
We will provide ample opportunity to be able to take call, including contact information
for the house staff taking call every day of your rotation. Due to the nature of our practice
and the conditions we deal with, it is rather unlikely that you will have an onerous
clinical demand (or benefit) solely from participating in this activity. To obtain access to
a call pager and facilities in case you require overnight accommodations please ask
Marion Wallace during your preparation phase for the rotation.
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“Must know” issues:
Remember that you are a still in training. Even though we are eager to safely
delegate aspects of care it is crucial that you keep in mind that the staff physician (Most
Responsible Physician, as defined by the College of Physicians and Surgeons of Ontario)
should be aware of any actions taken in the care of his/her patient. Always try to err on
the side of informing either a fellow or staff of any pertinent patient care-related activities
you conduct during your rotation.
Be safe! Follow universal precautions at all times, particularly in the operating
room and around sharp objects.
Obtain a copy of the weekly schedule from one of our administrative assistants.
Try not to miss two conferences that are particularly important: Wednesdays at 7am in
Rm 8704), and Fridays at 7:30 am (room varies).
Address problems or conflicts early. Your supervisor is available 24 hours a
day and welcomes to be contacted at any time in order to make your learning experience
as pleasant as possible.
Don’t be shy! We love having students rotate with us. When you come to one of
our clinics or the operating room introduce yourself to the nurses and the responsible staff
physician. Expect to be very involved from the beginning of the rotation.
LEARNING EXPECTATIONS OF THE ROTATION

Fulfill learning expectations, following the above-listed aspects, adjusted to the
learner’s level of training

Gain familiarity with common conditions managed by pediatric plastic
surgeons

Become more proficient in evaluating children (including obtaining a full
history and physical exam)

Learn principles of interpretation of commonly ordered tests

Appreciate issues related to ordering invasive tests and concerns regarding
radiation exposure
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
Adjust the learning experience - as considered adequate and feasible - to the
learners needs, usually in the context of long term plans and future specialty
training.

Enjoy a safe, fun, collegiate learning environment and decrease any
apprehension or fear related to being in a surgical or pediatric rotation!
TECHNICAL EXPECTATIONS
At the end of your rotation you will also have acquired a certain numbers of procedural
skills under our supervision and these should include:

Wound closure (“Suturing skin”)

Pulling out drains and catheters

Making skin incisions and learn how to assist in gaining exposure for different
surgical interventions

Insertion of Foley catheter in a sterile fashion.

Interpretation of lab results

Proper application and removal of wound dressings

Protocol and sterility in the Operating Room

Assist during surgical procedures, becoming proficient with tying knots,
cutting sutures, using cautery and obtaining hemostasis
Additional expectations for students who participate in “Selectives” (including
Transition to Residency Program):
 Demonstrate
competence
in
Communication,
Collaboration,
Management, Health Advocacy, Scholarship and Professionalism in the
specific setting of the Selective, such that you can undertake these roles
at the PGY1 level.
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 Demonstrate an understanding of a significant health equity issue as it
pertains to the experience of ONE selective, through the production of a
written assignment. (This will be assessed centrally through the course).
 Demonstrate an understanding of a significant health systems issue as it
pertains to the experience of ONE selective, through the production of a
written assignment. (This will be assessed centrally through the course).
 Demonstrate appropriate command of the medical knowledge or other
factual content of the Selective. (This will primarily be assessed by your
supervisors using rating scales).
FEEDBACK
Feedback, verbal or written, is of the outmost importance for the program and is
taken very seriously.
It is an important element that allows future introduction of
changes that may make the experience better for other students. Similarly, it helps detects
systematic flaws that deserve correction. Just as important, it provides forum for sharing
positive aspects of the rotation and emphasize when things go well. We ask for formal
feedback during two meetings, the mid-rotation and end-of-rotation encounters. During
these, the supervisor will ask you specifically about issues that need improvement or
aspects that did not live up to your expectations. In addition, you will be give forum to
provide recommendations on how to improve.
Feedback is also accepted throughout the rotation by scheduling meetings with
your supervisor, providing it during clinical interactions or written. At any time students
are welcome to send emails to the supervisor and deal privately with specific concerns
(gregory.borschel@sickkids.ca). As a student you may elect to provide feedback, positive
28
or negative, through the channels offered by the Office of Education and the University
of Toronto.
A WORD ON PRIVACY
We are responsible for protecting personal health information by preventing accidental
data loss and privacy breaches. Please note that at our Hospital we take privacy issues
very seriously, following closely the Information Security Policy and the Law (as
described by the Ontario Privacy Commissioner). As such, there are software protections
in place on all computers at SickKids. All external media will be automatically encrypted,
and unencrypted USB keys are no longer usable at SickKids. Students are not permitted
to take photographs of patients with cameras or cell phones. Remember that removable
storage media can easily be lost or stolen and the consequences of privacy breaches are
serious and widespread. It is in your best interest to avoid taking any data (electronic or
printed) outside of the hospital. For more information on privacy and information
security
at
SickKids,
please
visit
the
internal
privacy
website
(http://kidweb.sickkids.ca/privacy/default.asp).
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IMPORTANT CONTACT NUMBERS
ALL STAFF, RESIDENTS AND FELLOWS CAN BE CONTACTED THROUGH
LOCATING: 416-813-7500.
Marion Wallace: 416-813-6448
Nurses are available Monday to Friday 8 am to 4 pm.
For medical or surgical emergencies after 5 pm week days, statutory holidays or weekends
which cannot wait until next work day please call: 416-813-7500 and ask to speak to the
Plastic and Reconstructive Surgery fellow on call.
Our surgical team is:
Administrative assistant:
Dr. Joel Fish
Dr. Ronald Zuker
Dr. Howard Clarke
Dr. Christopher Forrest
Dr. David Fisher
Dr. Gregory Borschel
Dr. John Phillips
Sandy Davies
Donna Marson
Heather Sellars
Dyanne Bechard
Wendy Beaton
Elizabeth Greczylo
Barbara Sokolowski
416-813-7654 x 208198
416-813-6447
416-813-6444
416-813-8659
416-813-6445
416-813-7654 x 208197
416-813-6197
Plastic and Reconstructive Surgery clinic: 416-813-4982 (contact number for families)
Emergency room:
416-813-5807
Operating room:
416-813-6849
For health information: AboutKidsHealth at www.aboutkidshealth.ca
For information about helping a child cope with medical procedures call the Child Life
Specialist at 416-813- 1843
In case of an emergency: Call 911 or go to SickKids emergency department or
local emergency department.
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CONCLUDING REMARKS
We understand that many students are not inclined towards surgery. Thus, the rotation is
focused on providing a well-rounded exposure to pediatrics, emphasizing skills that are
not exclusive to the practice of surgery, but apply to the practice of medicine within a
patient-centered approach.
As part of your end-or rotation meeting it is expected that the student will discuss with
the supervisor the contents of this handout, reflect on the provided information in the
context of his/her experience during the rotation, and recommend edits or additions to at
least one topic.
We will ensure flexibility whenever necessary to allow appropriate time to attend
scheduled learning activities, exams, and personal matters that require immediate
attention. Similarly, we expect some flexibility on your behalf, understanding that some
educational opportunities cannot be anticipated and there is always the possibility of
inviting you to be part of experiences that go beyond scheduled items discussed at the
beginning of the rotation or highlighted in this form.
Again, thank you for choosing Plastic and Reconstructive Surgery! We wish you an
excellent experience.
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RECOMMENDED READINGS (BOOKS):
Principles and Practice of Pediatric Plastic Surgery. Bentz, Bauer, Zuker, Eds.
Plastic Surgery. Borschel GH. In: Freeman, Ed.
Articles describing conditions seen in Pediatric Plastic and Reconstructive Surgery:
1. Acute burn care. Bezuhly M, Fish JS. Plast Reconstr Surg. 2012
Aug;130(2):349e-358e.
2. Facial palsy and reconstruction. Fattah A, Borschel GH, Manktelow RT, Bezuhly
M, Zuker RM. Plast Reconstr Surg. 2012 Feb;129(2):340e-352e.
3. The motor nerve to the masseter muscle: an anatomic and histomorphometric
study to facilitate its use in facial reanimation. Borschel GH, Kawamura DH,
Kasukurthi R, Hunter DA, Zuker RM, Woo AS. J Plast Reconstr Aesthet Surg.
2012 Mar;65(3):363-6.
4. Obsterical brachial plexus palsy. Borschel GH, Clarke HM. Plast Reconstr Surg.
2009 Jul;124(1 Suppl):144e-155e.
5. Craniofacial syndromes and surgery. Forrest CR, Hopper RA. Plast Reconstr
Surg. 2013 Jan;131(1):86e-109e.
6. Segmental LeFort I surgery: turning a predicted soft-tissue failure into a success.
Leshem D, Tompson B, Phillips JH. Plast Reconstr Surg. 2006 Oct;118(5):12136.
7. Cleft lip, cleft palate, and velopharyngeal insufficiency. Fisher DM, Sommerlad
BC. Plast Reconstr Surg. 2011 Oct;128(4):342e-360e.
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