Pediatric Surgery

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PEDIATRIC SURGERY

From previous students:

  • This rotation has a tough reputation and it’s a lot of work, but peds surg can also be a lot of fun. Surgical Recall is an excellent quick-recall for Peds Surg as well as Gen Surg, and will cover a lot of the common pimp questions, as well as make you feel smarter in the OR.
  • You and your fellow students will be responsible for a lot of the groundwork in this rotation – you round early (5:15 am) and pre-round before that, but you go home at 4:30 every day, more or less. In between you’ll split up watching surgeries, going to clinic, and writing your notes. Get the interns to co-sign them. Don’t worry too much about the A/P section of your SOAP note; you’ll often just scribble that down on the note as you round in the morning.
  • Rounds in Peds Surg are fast-paced and as efficient as possible. When you meet in the morning you’ll get a list of all the patients on the service, sorted by floor. Students are not expected to pick up any overnight or late afternoon admissions before rounds, but you’ll want to divide them up as fairly and completely as possible. The service is huge, up to 35 patients or more, and you only have a few hours to get through them all, so everything is geared toward efficiency.
  • There are two Peds Surgery fellows, and each fellow will lead a team during rounds. Teams will be formed on the first day of the rotation.
  • Be ready to split up as you’re rounding – students who don’t have patients on a particular wing should run ahead to the next wing, gather all the bedside and note charts (grey and blue) and stack them in order according to the list. This is especially important on Infant wing, where you may have ¾ of the unit patients at any one time.*
  • When your patient is up, talk fast. The best way to present efficiently is to stick to the Line Score Card without any deviations. They’ll rattle off orders to the intern writing them down, you scribble just as fast, and they’re off to the next patient.
  • When you give a medical record number, give it 4+4 (1234-5678), not like a social security number (123-45-678). This is a sacred tradition.
  • Afternoon rounds are a little more leisurely, but still efficient. Either you’ll get a text page telling everyone when rounds are (sometimes it’s “Rounds in the conference room”, sometimes you have 20 minutes’ notice) or you should make sure your interns know to page you when they get paged to rounds. Unless surgeries run long, you’ll do afternoon rounds around 4-4:30.

Recently, the service decided to assign one of the medical students on the team as the “late person”. This person’s duty is to obtain change over from the other students and present them during afternoon rounds while the rest of the medical students go home. All of the medical students will alternate being the late person. So make sure to keep tabs on your patients throughout the day.

  • Go to surgeries – there should be a student at every surgery. Meet up in the afternoons and decide who’s going to what the next day.
  • When you go to a surgery on a patient, follow that patient. If that means you have to change who you’re following, do it. The surgeons expect that you’re going to keep track of patients before, during, and after their surgeries, and they get upset if student A goes to a surgery but student B writes the notes. However, if a particular patient is assigned to the other team following surgery, don’t worry about trying to follow them, because one of the other students will pick them up.
  • When in surgery, especially with Dr. Billmire, tie two-handed knots.
  • If you scrub with Dr. Engum, you must know the following (because he will ask you before he allows you to scrub in): the name of the patient, why they are having a particular procedure, common complications of the procedure, alternatives to the procedure, and what you hope to learn by participating in the case. You should, of course, know these things for every case, regardless of who the attending is, but Dr. Engum will definitely expect you to know them for his cases.
  • You’ll probably have downtime in the afternoons before rounds or when surgeries aren’t scheduled. Find a nice comfortable place to read. There’s a classroom in the Heart Center that’s lovely.
  • In addition to dividing the medical students, residents, and fellows into 2 teams, the attendings will also be divided into 2 groups of 4 and assigned to each team. The reason for this is to obtain more complete and accurate evaluations as the attending will only evaluate the students assigned to their group. This means that you should try to do clinic with the attendings that were assigned to your group as this is the best time for them to get to know you. In addition, try scrubbing in with them because this is an opportune time to show them your knowledge base.
  • In addition to the long hours and massive patient load this is the only general surgery rotation that requires its own separate test on the last week of the rotation. This means that some students will have the misfortune of having the general peds surgery exam and the general surgery shelf exam within a couple of days of each other. The exam contains about 30 multiple choice questions and 2 free response essays. On the first day, the fellow will hand you a packet from which the exam questions are pulled from.
  • On Mondays, around noon, there’s usually lunch, but you’ll have case conferences whether there’s lunch or not – and you get to present the cases. Keep an eye out for interesting patients or neat presentations that you’d like to talk about. Brush up on differentials, case history, and everything you know about your patient’s disease, because staff likes to ask questions. They really aren’t all that scary, and you’ll be surprised at how much you know.
  • Weekends you’ll round at 6:00, and usually only two students need to come in on a weekend day, one from each team, but you cover all the patients in the Infant unit, and all the others if you can. You’ll wind up coming in about the same time, writing your notes on the go, getting them signed, and being done around 10 AM, when you can go back home and sleep. As during the regular week, there will be a “late person,” though most people didn’t stay more than an hour or two longer.
  • THE MOST IMPORTANT ADVICE I CAN GIVE YOU ON THIS ROTATION IS TEAMWORK, TEAMWORK, TEAMWORK. This can be a miserable rotation if your team hates you. Trust me – even if you are the ultra gunner of the class, this rotation is too much for one person to handle alone. The better you work together as a team, the more fun (and this rotation can be a lot of fun!) you will have, the better you will do your job, and the quicker things will get done.
  • There is a copy of a format that worked for the line score on rounds. Carry the line score card with you at all times!