Goals and Objectives for
Surgery Residents on the
Pediatric General and Thoracic Surgery Service at
Seattle Children’s Hospital
Site: Seattle Children's Hospital
Goals
· Starting with the PGY 1 rotation and ending with the PGY 3 rotation, residents will be able to perform the pre-operative, inter-operative, and post-operative management of the pediatric surgical problems that will commonly be encountered in a general community practice. As experience grows, residents will gain increased ability to make the appropriate diagnosis and formulate a treatment plan under the supervision of the pediatric surgery fellows and attending staff.
· Residents will be able to correctly answer the pediatric surgery questions encountered on the ABSITE and ABS written and oral board examinations.
Specific Objectives
Residents on the Pediatric Surgery Rotation are expected to achieve the following objectives based on the six core competencies described below.
Patient Care
· Residents should be able to demonstrate an understanding of the differences between adults and pediatric physiology with regard to thermoregulation, cardiac, pulmonary, biliary, and renal systems. Residents will do so by writing orders appropriate to the pediatric patient regarding:
o Fluids and electrolytes
o Medications
o Nutritional requirements
o Appropriate use of incubators and heating lamps on the ward and the OR
· Residents will be able to identify instrumentation appropriate for use with pediatric patients in the OR and will begin to demonstrate appropriate technique and tissue-handling during level-appropriate cases
Medical Knowledge
· Residents should be able to discuss the diagnosis and management options for the following conditions:
o Gastroesophageal reflux in pediatric patients
o Appendicitis and abdominal pain in pediatric patients
o G-tube Complications
o Pyloric Stenosis
o Common pediatric head and neck lesions:
§ Thyroglossal duct anomalies
§ Branchial cleft anomalies
§ Adenopathy
§ Lymphatic malformation
o Pediatric thoracic lesions:
§ Mediastinal masses
§ Empyema
§ CPAM and pulmonary sequestration
§ Congenital diaphragmatic hernia
o Inguinal hernias and hydroceles
o Neonatal surgical problems:
§ TEF/EA
§ Neonatal bowel obstruction:
· Intestinal atresia
· Anorectal malformation
· Meconium ileus
· Hirschsprung’s disease
· Malrotation and volvulus
§ Abdominal wall defects
§ Necrotizing enterocolitis
Practice Based Learning and Improvement
Pediatric surgical residents will actively participate in practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in pediatric surgical patient care through:
• Exposure to computer charting.
• Attendance at weekly conferences held with the faculty including: Radiology conference, Pathology, Morbidity and Mortality, and Tumor Board conferences.
• Completion of a QA/QI project under faculty direction.
• Drawing on a case example, use of literature to present a focused topic for presentation at Educational Conference.
• Analysis and evaluation of medical literature and alternative studies that pertain to their patient's health problems.
• Responsibility for lifelong learning.
• Use of information technology such as Up-to-Date, PubMed, AccessSurgery to enhance patient care.
• Education of fellow residents and medical students basic surgical principles as they relate to the care of children.
Interpersonal and Communication Skills
Pediatric surgical residents will learn effective interpersonal and communication skills that result in accurate information exchange and collaboration with children, their parents, and other health professionals. Specific competencies will include:
• The ability to articulate common concerns expressed by children with surgical problems and their parents, and the learning of methods to provide ongoing emotional support for the entire family unit under stress.
• Active and positive participation in multidisciplinary team meetings for psychosocial and discharge planning purposes.
• Positive leadership and participation in the multidisciplinary team of care that is essential to optimize outcomes for children.
• Communication and the establishment of a therapeutic relationship with children and their parents.
• Demonstration of effective communication skills with children, their parents, and with other health care personnel.
• Presentation of clinical cases accurately and succinctly.
• Provision of timely, legible, thorough, succinct medical record documentation including histories and physical examinations, admission notes, progress notes, procedure notes and discharge summaries.
• Ability to speak clearly when addressing patient issues and management plans with parents and health care colleagues.
• Willingness to spend adequate time with parents addressing their questions and concerns.
Professionalism
Pediatric surgical residents learn about professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population by the example of the faculty. Residents will:
• Interface with referring and consulting physicians and appropriate hospital staff in a professional and respectful manner, recognizing and instituting the core competencies.
• Professionally interact with patients, parents, attending physicians and allied health care personnel.
• Establish trust with patients, parents, and staff.
• Demonstrate respect, compassion, integrity, punctuality, reliability, and honesty with regards to patients, parents, and colleagues.
• Show regard for the opinions of others.
• Display initiative and leadership.
• Acknowledge errors, and alert patients and appropriate health care providers.
• Create a plan of action to minimize errors.
• Demonstrate concern for educational development of students and residents.
• Ask for help when needed, and seek and accept feedback.
• Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
• Maintain patient confidentiality.
• Compassionately respond to issues of culture, age, gender, ethnicity, and disability in patient care.
Systems Based Practice
Residents will conduct a systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, with the ability to effectively call on system resources to provide general pediatric surgical care that is of optimal value to the patients and their families. Residents will:
• Demonstrate ability to practice medicine in a Children's Medical Center.
• Work with ancillary team members (discharge planners, case managers, and social workers) to provide high-quality, cost-effective care.
• Use systematic approaches to reduce errors.
• Practice effective allocation of health care resources to avoid compromising quality of care.
• Serve as a patient advocate in the outpatient and inpatient setting.
• Direct care in inpatient and outpatient settings as a member of a multidisciplinary team.
• Demonstrate knowledge of how the health care system (including other physicians, nurses, and health care professionals) affects their patient care practices.
The above objectives will be accomplished via:
· Active involvement of the residents in the care of patients on the pediatric surgical service including the OR ward, ICU, ER and consult services. This care will include:
o Pre-op diagnosis and management
o Operative procedures
o Post-operative management
o Clinic follow-up
It is expected that residents will have a working knowledge of the entire service. It is required that residents arrive in the OR having reviewed the patient's chart and familiarized themselves with the patient's disease process and operative procedure. Residents should keep a list of cases performed while at Children’s.
· Participation in the Thursday conferences.
· Participation in didactic lecture series, Thursday morning. These lectures cover the pathophysiology and management of pediatric surgical disease.
· Evaluation of performance, which is based on weekly review by the attending staff and fellows. Feedback to the resident can be expected weekly and at the end of the rotation. Evaluations will be sent to the residency program director of each resident’s home institution.
Questions:
Please contact Dr. Kenneth W. Gow at
Updated:
06/11