THIRD YEAR MEDICAL STUDENT ROTATION

Pediatric Surgery

UCLAMedicalCenter

Students should page the intern (R1) on the Pediatric Surgery service before they begin the rotation to find out when and where to meet. The name of the intern and pager can be found on the R1 General Surgery rotation schedule located at the Surgery website:

Goals:

This clerkship is designed to familiarize the student with the evaluation and treatment of infants and children with surgical conditions. You will be participating in the daily clinical activities with the residents and attendings on the service as well as attending didactic teaching sessions and making a presentation. You will be expected to gain skills in the following areas:

  1. Comprehensive evaluation of the patient with a pediatric surgical condition.

This skill would include the performance of a comprehensive history and physical examination followed by the creation of a differential diagnosis and formulation of a plan of management. Since the types of problems and skills involved are age-dependent you should select a newborn, toddler and older child during the course of your rotation. The exercise should include the collection of the information and the preparation of a concise write-up to be reviewed and counter signed by the chief resident on the service. A copy of your write-up should be photocopied and submitted to the responsible attending for review as well.

  1. Focused Patient Evaluation

This skill can be practiced in either the inpatient, or preferably the outpatient area with preparation of concise problem oriented history and physical including a diagnosis and plan of management.

  1. Treatment of Pediatric Surgical Conditions

You should become familiar with the common conditions of the newborn (ie. tracheo-esophageal fistula / esophageal atresia (TEF/EA), congenital diaphragmatic hernia (CDH), intestinal atresia, necrotizing enterocolitis (NEC), pediatric appendicitis, hernia, hydrocele, undescended testicle, gastroesophageal reflux, pyloric stenosis, intussusception, Hirschsprung’s disease, pectus excavatum, biliary atresia, as well as the major solid tumors of childhood (Wilms tumor, neuroblastoma, rhabdomyosarcoma). You should also be familiar with the pre- and post-operative care including parenteral nutrition, fluid requirements and resuscitation as well as pediatric airway and respiratory management.

D.Participation in the Outpatient Clinics and Operating Room

With the current changes in health care, the majority of decisions regarding patient management have shifted to the outpatient setting. Your participation in the outpatient area is critical to maximizing the educational benefits of this clerkship. It is also essential that you participate in the operative care of patients that you have selected for your comprehensive evaluations as well as observing as many procedures as possible that have the common conditions listed.

E.Participation in weekly Pediatric Surgery Conference (Tuesday 4:00-6:00pm in RRMC 8234) and weekly tutorial conferences with Dr. Fonkalsrud (Tuesday 12:00-1:00pm in CHS 72-130).

F.Participation in operating room cases for the pediatric surgical service (every Monday, Wednesday, Thursday, and Friday in the RRUMC main OR and every Friday in the AmbulatorySurgeryCenter 6th floor Med Plaza 200 Bldg).

G.Participation in weekly Department of Surgery Education Conferences every Wednesday starting at 7:00am and required Core Lecture Series at 9:00am.

H.Preparation and presentation of a selected pediatric topic of student’s choosing

at the conclusion of the rotation to pediatric surgical attendings and residents (at the Tues afternoon conference). If you need assistance with topic selection, please contact the chief resident or the attending pediatric surgeon on service.

Requirements:

  1. At least one comprehensive history and physical per week, preferably two.
  2. Attendance in the outpatient area 1 to 2 days per week.
  3. Selected reading from Principles of Pediatric Surgery, 2nd Edition.by O’Neill, Grosfeld, Fonkalsrud, Coran (eds.), Mosby 2005 or Pediatric Surgery 4th Edition by Murphy, Snyder, Holcomb (eds), Saunders 2005.

Summary Sheet

THIRD YEAR MEDICAL STUDENT ROTATION – PEDIATRIC SURGERY – UCLA

Student Name: ______

Dates on Service: ______to ______

Complete workups – History and Physical Examination (patient name, diagnosis, date of H & P)

  1. ______
  1. ______
  1. ______

Outpatient Clinic patient evaluations

  1. ______
  1. ______
  1. ______

Pediatric Surgery conferences (these are OBLIGATORY, fill in date).

______1. Weekly Pediatric Surgery Conference

______2.

______3.

______1. Weekly Tutorials

______2.

______3.

______1. Presentation to faculty and residents

We would like you to observe the following INDEX CASES. We recognize that it may not always be possible. Check off if you were able to do the following.

Index Cases to seeObserve operationObserve NICU

1. Gastroesophageal Fundoplication______

2. Inguinal Hernia______

3. Newborn anomaly______

4. Pectus deformity______

5. Intestinal anastomosis______

6. Placement of central venous line______

7. Peritoneal dialysis catheter______

8. Abdominal or thoracic tumor______

We would like you to develop the following CLINICAL SKILLS. We recognize that it may not always be possible. Check off if you were able to do the following.

Pediatric Surgical clinical skills (check if completed).

______1. Examine for inguinal hernia

______2. Examine for heart murmur

______3. Auscultation of chest for pneumothorax, atelectosis

______4. Examine abdomen for peritonitis and for intestinal obstruction

______5. Perform a complete exam on a neonate

______6. Perform a rectal exam

______7. Review newborn abdominal x-ray for obstruction or peritonitis

______8. Review intake and output for infant, and child

Comments about rotation:

Please turn in completed form to Iris Mau in Room 72-215 CHS.