Pediatric Surgery
Goals and Objectives
The goal of the MGH pediatric surgery rotation is to develop the ability of first year residents to evaluate, stabilize and treat patients with a broad range of surgical problems of varying complexity and acuity. In addition to the operating suite, this rotation takes place in various settings within a tertiary care hospital including the pediatric emergency ward, inpatient pediatric floors, PICU and NICU. The team is led by a senior surgical resident working in conjunction with the attending pediatric surgeons. First year residents are both surgical and pediatric trainees who are the primary caregivers for their patients. The objectives of this rotation are designed to further the residents’ development of competency in the following six areas:
I. Patient Care
II. Medical Knowledge
III. Practice-Based Learning and Improvement
IV. Interpersonal and Communication Skills
V. Professionalism
VI. Systems-Based Practice
I. Patient Care
The resident will have primary responsibility for the initial evaluation of surgical patients at the time of presentation to the hospital. The resident will follow the patient independent of the patient’s physical location within the hospital until discharge or transfer.
The resident will respond to all requests for pediatric surgical consultation from the ED, wards, nursery and intensive care units. After performing a complete history and physical appropriate for the patient’s complaint, the first year resident will formulate a differential diagnosis and plan appropriate diagnostic and therapeutic interventions, in coordination with the senior resident and/or attending surgeon.
Residents will be involved in all cases of trauma in patients under the age of 18 presenting to this Level I pediatric trauma center.
The resident will be encouraged to participate in outpatient clinics held daily in the Pediatric Surgery offices on Warren 11.
As medically indicated, residents will perform appropriate diagnostic and therapeutic procedures after obtaining informed consent from the patient and/or family. Residents will document procedures in the chart and in their personal logbooks. On this rotation, these may include:
- Central line placement
- Endotracheal intubation
- Incision and drainage of abcesses
- Nasogastric tube placement
- Suturing
- Thoracentesis and chest tube placement
- Wound care
During this rotation, residents are expected to further develop their proficiency in the following areas related to the surgical care of children:
- Common pediatric surgical problems
- Common pediatric surgical emergencies
- Newborn surgical problems and care
- Extracorporeal membrane oxygenation
- Initial evaluation and resuscitation of critically ill patients
- Management of feeding appliances including gastrostomy and jejunostomy tubes
- Mechanical ventilator management
- Pain management
- Suturing
II. Medical Knowledge
Residents will draw from the wide range of patient diagnoses requiring surgical evaluation and/or treatment at this tertiary care referral hospital, to broaden their exposure to a wide range of complex disease processes and the role of surgery in its care and treatment.
The patient population at this city-based referral center includes patients admitted for general pediatric surgical problems, as well as those admitted or transferred for complex, rare, or life-threatening diseases.
During this rotation, it is expected that residents will manage patients diagnosed with, but not limited to:
- Appendicitis
- Congenital anatomical abnormalities (including thoracic, GI and GU tract anomalies)
- Inguinal hernia
- Undescended testis and anorchia
- Foreskin abnormalities
- Gastroesophageal reflux
- Intestinal obstruction (including pyloric stenosis, volvulus, small bowel obstruction)
- Intussusception
- Medical problems requiring central venous access
- Necrotizing enterocolitis
- Trauma
- Pediatric solid tumors
- Transplantation
- Newborn, pediatric, and adult acute respiratory failure adn the role of extracorporeal life support
III. Practice-Based Learning
In caring for patients, residents will utilize a broad range of published medical information available through web-based resources, as well as print textbooks and the hospital library. It is expected that decisions about patient care will be informed by review, synthesis and application of studies available in the literature.
All residents will take an active role teaching Harvard and visiting medical students rotating on the pediatric surgical service.
IV. Interpersonal and Communication Skills
Pediatric residents will work closely with other members of the surgical team, including pediatric surgical attendings, surgical housestaff and nurse practitioners, anesthesiologists, nurses, pharmacists, respiratory therapists, child life specialists and chaplains.
Residents will interact collaborately with the emergency room team, pediatric medical team, and ICU teams regularly when patients are shared with these services. Timely communication among team members will be essential.
Residents will address concerns of the patient and his or her family by meeting with them regularly.
Daily notes in the chart clearly documenting patient’s progress, diagnostic results and ongoing plan will be completed in order to maintain an accurate medical record and share information among team members. Upon discharge or transfer, the resident is responsible for the timely completion of a succinct discharge summary.
Residents will provide feedback to their co-residents, students and attendings on an ongoing basis throughout the rotation, completing written evaluations at the completion of the rotation. Similarly, they will receive regular verbal feedback and a final written evaluation from the surgical attendings that will be placed in their permanent record. Residents will use constructive feedback to guide their efforts in ongoing learning and self-improvement.
V. Professionalism
Residents will interact with an ethnically and socio-economically varied patient population who come to this referral hospital with diverse cultural backgrounds and beliefs. Patients will include those living in local communities, as well as those referred from a distance (including international patients) for highly specialized medical care. Residents will care for patients independent of their ability to pay for services.
Residents will continue to develop compassionate, empathic and culturally sensitive communication with patients and their parents. They will demonstrate sensitivity and responsiveness at all times to patients’ culture, gender, sexual orientation and disabilities. Care will be given in a developmentally and age appropriate manner.
Maintenance of patient confidentiality will be of highest priority.
Residents will ensure that patients and families give informed consent for all aspects of care.
VI. Systems-Based Practice
Residents will utilize appropriate consultative services (MGH Pain Service, pediatric and adult specialists) in the care of their patients whenever necessary to maximize optimal care of their patients.
At all times, residents will act in accordance with the legal mandate in the Commonwealth of Massachusetts to report any suspicions of child abuse or neglect, being familiar with the process by which such suspicions are reported. The MGH Child Protection Consultation Team will be a unique resource for residents working in the complex referral atmosphere of this rotation
