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Electives - General Surgery


ACE - A. I. in Pediatric Surgery

Elective Number: 3016 (lottery)

Rotation Supervisors: Dr. Eugene McGahren

Coordinator: Heather Trainium

Duration: 4 weeks

Available: Rotations 3, 4, 5 & 6

A pager is required and will be supplied by the department.

Report to: Pediatric Surgery Chief Resident

Time to Report: As designated by the Peds Surgery Chief

Place to Report: As designated by the Peds Surgery Chief

Typical day: 6:00 am - 6:00 pm

Attendance: A student may not take time off during an ACE.

Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation:

Course Description: The Pediatric Surgery elective is considered an "acting internship" on the service. The role of the “ACE” student is distinct from the role of a third-year clerkship student. The ACE student is expected to approach the rotation as a preparation for her/his role as an intern. As such, it is anticipated that the ACE student will cover 2-3 patients as their primary patients. However, by the mid-point of the rotation, it is expected that the ACE student will become familiar enough with the entire service so as to understand and assist with service management issues and be able to present patients on daily ward rounds as necessary in the manner of an intern. In addition, the ACE student can help in the mentoring process for the third year clerkship students. The ACE student is expected to assist with the workup of new patients who present in the clinic, Emergency Department, from consults, and from pre and post-operative presentations. In the clinic, they will be initial providers for many patients. They are expected to assist in the operating room, particularly with the patients they have initially evaluated. An ACE student would be expected to be able to assist in a variety of operative cases and to be able to first assist in appropriate cases where there are no other residents who have priority. Roles that the student may assume in an operative case may include, but not be limited to, making an incision, helping with appropriate exposure, assist in dissection, tie appropriate ligatures, run the camera/scope in minimally invasive cases, help with soft tissue or skin closure, activate stapling devices, activate and use bag retrieval devices for MIS cases, placing a drain or a chest tube, drain abscesses.  They are expected to assist with post-operative management of the patients on the service. The student will share one night call per week with the overnight Resident covering this service. There is no weekend call, but the ACE student is expected to participate in weekend rounds and activities with the caveat that one day in every seven, on average, must be an off day. This day is typically a weekend day that can be arranged ahead of time by communication with the Chief Resident or attending covering the service call. The student will be expected to participate in the Division's conferences and to provide one prepared topical presentation to the team during the rotation. This presentation is not graded, but is an opportunity for the student to perform a literature search, and PowerPoint presentation to the team on a particular topic of interest to the student related to Pediatric Surgery.  The rotation supervisor will closely observe the student. Feedback will be provided halfway through and at the end of the rotation. We ask that the student provide 3 H&Ps and 3 progress notes for review and feedback from a faculty member or Chief Resident. Final evaluation will be completed by the Rotation Supervisor. However, appropriate input for this evaluation will be provided from all residents and attendings that the student has worked with during the ACE.

Goal: The goal of this elective is to introduce and involve the ACE student in the evaluation and management of the wide variety of anomalies and illnesses in children encountered by Pediatric Surgeons. This is done in the spirit of helping the student start to develop a sense of independence in the care of patients as they progress toward her/his residency.

Learning Objectives:

1. Recognize and evaluate newborn infants with signs & symptoms of bowel obstruction, such as intestinal atresia, Hirschsprung's Disease, meconium ileus, etc.; develop a differential diagnosis for the presentation; define appropriate lab and imaging studies based on the patient presentation; determine the appropriate intervention or referral
2. Understand and be able to determine the evaluation and resuscitation of pediatric trauma victims including; understanding appropriate airway assessment and management; use of crystalloid and blood product strategies in resuscitation; appropriate laboratory studies and imaging; appropriate procedural interventions; appropriate consultation of other services; and the coordination of the in-hospital care of these patients.
3. Evaluate children presenting with acute and chronic abdominal pain. Develop a differential diagnosis for the presentation; define appropriate lab and imaging studies based on the patient presentation; determine the appropriate intervention or referral
4. Know the principles of resuscitative and maintenance fluid management in children with surgical conditions; particularly calculating daily maintenance fluid volume, hourly maintenance IV fluid rates, and appropriate IV fluid components.
5. Understand principles of nutritional management of pediatric surgical patients; e.g. be able to calculate daily calorie needs and understand how that determines formula and/or breast milk management for babies; enteric caloric intake for older children; TPN management for children in general.
6. Recognize the importance of involving family members in decision-making and management of Pediatric surgical patients and the cost effective pre & postoperative care of these children.
7. Recognize and understand the importance of and indications for engagement of supporting services such as Child Life, Social Work, Child Protective Services, Occupational Therapy, and Physical Therapy. Be familiar with the resources that each of these services provides.
8. Recognize indications for and learn how to consult and engage a variety of medical and other surgical specialists in the care of pediatric surgical patients. 
9. Participate in outpatient clinic activities, exposing the student to acute and chronic patient presentations. This will include obtaining an H&P, determining a differential diagnosis, determining appropriate lab and/or imaging studies, and determining plans for care. The clinic experience will also allow the student to manage short term follow-up of patients both operative and non-operative, and long-term functional evaluation of patients after treatment for various surgical conditions.
10. Understand and participate in operating room time-out.
11. Become familiar with and participate in the process of obtaining operative consent.

Suggested Learning Resources:
Pediatric Surgery, 2-Volume Set: Expert Consult
Feb 28, 2012
by Arnold G. Coran MD and N. Scott Adzick MD

Ashcraft's Pediatric Surgery: Expert Consult - Online + Print, 6e (Expert Consult Title: Online + Print)
Mar 10, 2014
by George W. Holcomb III MD and Jerry D Murphy

Operative Pediatric Surgery
Mar 18, 2014
by Moritz Ziegler and Richard G. Azizkhan

Fundamentals of Pediatric Surgery: Second Edition
Oct 2, 2016
by Peter Mattei and Peter F. Nichol


American Pediatric Surgical Association
IPEG (International Pediatric Endosurgery Group)


Journal of Pediatric Surgery
Pediatric Surgery International

(Rotations director can provide access to these sites if needed)


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