GOALS & OBJECTIVES

UCSF PGY 2

[Please note that all listed Goals & Objectives and Responsibilities & Expectations are IN ADDITION TO those listed in the UCSF Common Goals & Objectives document]

PATIENT CARE GOALS & OBJECTIVES 1. Interpret the results of focused clinical evaluations (history, physical examination) performed on pediatric patients with the following signs, symptoms and conditions a. Nausea & vomiting i. Bilious and non-bilious ii. In the neonate, infant and child b. Right lower quadrant pain c. Scrotal pain d. Abdominal wall mass e. Neck mass f. Non-accidental trauma 2. Perform at least 6 clinical evaluations of pediatric surgery patients with the above signs, symptoms and conditions 3. Assume primary responsibility for the postoperative management of at least 6 pediatric surgery patients, including a. ICN patients/neonates b. Infants c. Children/adolescents 4. Analyze the diagnostic modalities (including laboratory tests) that can be used to assess the above signs and symptoms. 5. Determine the optimal diagnostic approach to evaluate pediatric patients with the above symptoms. 6. Use the results of focused clinical evaluations and diagnostic tests to determine the treatment options for pediatric patients with the above symptoms 7. Use the results of focused clinical evaluations and diagnostic tests to determine a management plan for pediatric patients with a. Appendicitis b. Inguinal hernla c. Aerodigestive tract foreign bodies d. Testicular torsion e. f. Intussusception g. Malrotation and midgut volvulus h. Necrotizing enterocolitis i. Gastroschisis and omphalocele 8. Interpret the results of laboratory tests to develop a fluid and electrolyte management plan for pediatric patients with a. Appendicitis b. Pyloric stenosis

RESPONSIBILITIES & EXPECTATIONS 1. Write admission and inpatient orders under the supervision of the resident/fellow/attendings 2. Implement the clinical decisions made by the team (on rounds, during the day) in a timely manner a. Arrange consultations b. schedule diagnostic tests c. schedule therapeutic procedures 3. Notify the senior resident/fellow/attending if unable to implement the clinical decisions 4. Communicate the results of consultations, diagnostic tests and therapeutic procedures to the team in a timely manner 5. Attend Pediatric Tumor Board and Fetal Treatment conferences at least once.

MEDICAL KNOWLEDGE GOALS & OBJECTIVES 1. Describe the evaluation process for and construct a for pediatric patients presenting with the following signs, symptoms and conditions a. Nausea & vomiting June 2010 i. Bilious and non-bilious ii. In the neonate, infant and child b. Right lower quadrant pain c. Scrotal pain d. Abdominal wall mass e. Neck mass f. Non-accidental trauma 2. Define and analyze the management options for pediatric patients with a. Appendicitis b. Inguinal hernla c. Aerodigestive foreign bodies d. Testicular torsion e. Pyloric stenosis f. Intussusception g. Malrotation and midgut volvulus h. Necrotizing enterocolitis i. Gastroschisis and omphalocele 3. Distinguish between patients with malrotation and midgut volvulus who need urgent radiographic evaluation and those who do not. 4. Distinguish between normal and abnormal values of weight, length and vital signs for neonates, infants and children 5. Determine the relationship between medication dosing and weight for pediatric patients 6. Assess the relevance of the following aspects of patient, maternal and family history in the evaluation of pediatric patients a. Maternal history b. Maternal pregnancy history c. Familial d. Intrauterine exposure e. Genetic disorders 7. Correlate embryology and developmental errors to anomalies of a. Neck development i. branchial cleft remnants ii. thyroglossal duct cysts b. Pleuroperitoneal membrane formation c. Abdominal wall development d. Intestinal development i. Malrotation ii. Intestinal atresias iii. duplication errors

RESPONSIBILITIES & EXPECTATIONS 1. See UCSF Common G&Os

TECHNICAL SKILLS GOALS & OBJECTIVES 1. demonstrate proficiency in a. one-handed knot tying b. two-handed knot tying 2. perform at least 6 wound closures following appendectomy, hernia repair and/or subcutaneous mass excision 3. perform at least 6 procedures distributed amongst a. appendectomy b. hernia repair c. subcutaneous mass excision RESPONSIBILITIES & EXPECTATIONS 1. see UCSF Common G&Os.

PRACTICE-BASED LEARNING AND IMPROVEMENT GOALS & OBJECTIVES 1. analyze at least one procedure in which you participated to a. identify individual errors and/or systems issues b. propose potential solutions and/or preventive measures 2. demonstrate the ability to critically appraise the pediatric surgical literature 3. recognize limitations in knowledge regarding the care of children

June 2010 RESPONSIBILITIES & EXPECTATIONS 1. participate in the weekly M&M conference to review and analyze treatment outcomes 2. present at least one review of a clinical topic or complication and the relevant literature at one of the service teaching conferences 3. document patient outcomes by maintaining an up-to-date log of patients treated and their clinical results 4. incorporate assessments and critiques provided by nurses and other staff with more experience in the care of pediatric patients into your performance improvement. 5. meet with the faculty education representative at least three times during the rotation (beginning, midpoint, exit) to review goals & objectives.

INTERPERSONAL AND COMMUNICATION SKILLS GOALS & OBJECTIVES 1. communicate with pediatric patients using verbal and non-verbal skills in an age-appropriate manner 2. communicate with parents and family members with an appropriate sensitivity to their perspective, including a. sociocultural background b. the implication of the diagnosis 3. communicate clearly with parents and family members to avoid the anxiety that results from conflicting information. a. If you cannot answer a question or provide an explanation, acknowledge that and then find the information. 4. communicate with pediatricians, neonatologists, nurses (critical care, floor, practitioners), pharmacists and coordinators in a manner that a. recognizes their perspective b. acknowledges their role c. provides the appropriate information, particularly changes in treatment plans 5. incorporate the interdisciplinary care structure of the pediatric surgery service in delivering patient care 6. incorporate the unique relationship between pediatric surgeons and the neonatal and pediatric intensive care unit nurses in delivering patient care

RESPONSIBILITIES & EXPECTATIONS 1. See UCSF Common G&Os.

PROFESSIONALISM GOALS & OBJECTIVES 1. Analyze and describe mechanisms to resolve conflicts between parental interest and patient interest in clinical decision-making for pediatric patients 2. Identify medicolegal obligations regarding child abuse 3. Discuss the unique aspects of comforting interactions with children while a. Maintaining professionalism b. Respecting boundaries

RESPONSIBILITIES & EXPECTATIONS 1. see UCSF Common G&Os

SYSTEMS-BASED PRACTICE GOALS & OBJECTIVES 1. compare pediatric health care coverage to adult healthcare coverage 2. describe the role of California Childrens’ Services in the care of pediatric patients 3. identify the role of clinical practice guidelines

RESPONSIBILITIES & EXPECTATIONS 1. access the clinical practice guidelines for postoperative care of pediatric appendectomy patients 2. access pediatric clinical practice guidelines PEDIATRIC SURGERY GOALS & OBJECTIVES

UCSF PGY 3

[Please note that all listed Goals & Objectives and Responsibilities & Expectations are IN ADDITION TO those listed in the UCSF Common Goals & Objectives document and IN ADDITION TO those required of more junior residents on this clinical assignment] June 2010

PATIENT CARE GOALS & OBJECTIVES 1. Interpret the results of focused clinical evaluations (history, physical examination) performed on pediatric patients with the following clinical findings/conditions a. Gastroesophageal reflux b. Neck masses c. Abdominal tumors d. Gastrointestinal developmental anomalies i. and tracheoesophageal fistula ii. iii. Other iv. Biliary atresia v. e. Hirschsprung’s disease f. Meconium syndromes g. Congenital diaphragmatic hernia 2. Perform at least 6 clinical evaluations of pediatric surgery patients with the above findings/conditions 3. Assume primary responsibility for the postoperative management of at least 6 pediatric surgery patients with the above findings/conditions 4. Compare the diagnostic modalities (including laboratory and imaging tests) that can be used to assess the above findings/clinical conditions. 5. Determine the optimal diagnostic approach to evaluate pediatric patients with the above findings/clinical conditions. 6. Use the results of focused clinical evaluations and diagnostic tests to determine the treatment options for pediatric patients with the above findings/clinical conditions. 7. Analyze the results of focused clinical evaluations (history, physical examination, laboratory data) performed on patients undergoing assessment for the above findings/clinical conditions to construct a risk benefit analysis for the treatment options and select a management plan. 8. Optimize the preoperative preparation of patients with the above findings/clinical conditions. 9. Analyze the results of postoperative monitoring to manage patient recovery after treatment for the above findings/clinical conditions. 10. Analyze the results of postoperative monitoring to identify and manage complications after treatment for the above findings/clinical conditions. 11. Use evidence-based medicine to reduce the risk/incidence of perioperative complications after treatment for the above findings/clinical conditions

RESPONSIBILITIES & EXPECTATIONS 1. Implement the clinical decisions made by the team (on rounds, during the day) in a timely manner a. Arrange consultations b. schedule diagnostic tests c. schedule therapeutic procedures 2. Notify the attending if unable to implement the clinical decisions 3. Communicate the results of consultations, diagnostic tests and therapeutic procedures to the team in a timely manner 4. Attend Pediatric Tumor board and Fetal Treatment meeting at least once.

MEDICAL KNOWLEDGE GOALS & OBJECTIVES 1. Describe the evaluation process for and construct a differential diagnosis for pediatric patients presenting with the following findings/conditions a. Gastroesophageal reflux disease b. Neck masses c. Abdominal tumors d. Gastrointestinal developmental anomalies i. Esophageal atresia and tracheoesophageal fistula ii. Duodenal atresia iii. Other intestinal atresia iv. Biliary atresia v. Imperforate anus e. Hirschsprung’s disease f. Meconium syndromes June 2010 g. Congenital diaphragmatic hernia 2. Define and analyze the management options for pediatric patients with a. Gastroesophageal reflux disease b. Neck masses c. Abdominal tumors d. Gastrointestinal developmental anomalies i. Esophageal atresia and tracheoesophageal fistula ii. Duodenal atresia iii. Other intestinal atresia iv. Biliary atresia v. Imperforate anus e. Hirschsprung’s disease f. Meconium syndromes g. Congenital diaphragmatic hernia 3. Distinguish peritonitis from other potential differential diagnoses of abdominal pain. 4. Identify and prioritize pediatric surgical emergencies. 5. Determine the relationship between medication dosing and weight for pediatric patients. 6. Compare fetal and normal circulation. 7. Analyze the unique preoperative considerations relevant to neonates, including a. APGAR scores b. Patent ductus c. Vitamin K d. use e. Maternal history 8. Compare the optimal preoperative assessment of a. Hydrocele b. Hernia c. Incarcerated hernia 9. Assess the specific physiologic concerns posed by laparotomy in the neonate, including a. Vascular access, including umbilical artery or vein catheterization b. Maintenance of core body temperature c. Fluid replacement, including i. Calculation of relevant volumes 1. Blood 2. intravascular 3. ECF 4. ICF ii. Calculation of fluid losses 1. Blood 2. Insensible iii. Calculation of replacement requirements 1. Blood 2. Crystalloid 3. colloid

RESPONSIBILITIES & EXPECTATIONS 1. See UCSF Common G&Os TECHNICAL SKILLS GOALS & OBJECTIVES 1. Using simulation perform resuscitation and ventilation, incorporating techniques unique to pediatric patients 2. Describe mechanisms to properly identify the contents of the inguinal canal a. Vas deferens b. Artery and vein c. Hernia sac 3. Compare the surgical management of direct and indirect hernias 4. Perform at least 4 inguinal hernia repairs in infants. 5. Perform at least 2 index neck operations, specifically a. Sistrunk procedure for thyroglossal duct excision b. Branchial cleft remnant excision 6. Perform at least 2 index abdominal operations, specifically a. Intussusception June 2010 b. Repair of intestinal atresia c. Ladd’s procedure

RESPONSIBILITIES & EXPECTATIONS 1. use the unique CPT codes for index pediatric surgery procedures in case logs

PRACTICE-BASED LEARNING AND IMPROVEMENT GOALS & OBJECTIVES 1. read and critically assess the pediatric surgical literature 2. analyze clinical outcomes to improve patient care 3. recognize limitations in knowledge regarding the care of children

RESPONSIBILITIES & EXPECTATIONS 1. maintain a case log, including complications and outcomes 2. present complications at weekly M&M conferences, describing the event, precipitating factors, preventive methods, and literature analysis 3. present at least one pediatric surgery topic, with literature review and analysis, at one service educational conference 4. incorporate assessments and critiques provided by nurses and other staff with more experience in the care of pediatric patients into your performance improvement. 5. meet with the faculty education representative at least three times during the rotation (beginning, midpoint, exit) to review goals and objectives. 6. Attend Pediatric Tumor Board and Fetal treatment meeting when feasible.

INTERPERSONAL AND COMMUNICATION SKILLS GOALS & OBJECTIVES 1. communicate with pediatric patients using verbal and non-verbal skills in an age-appropriate manner 2. communicate with parents and family members with an appropriate sensitivity to their perspective, including a. sociocultural background b. the implication of the diagnosis 3. communicate clearly with parents and family members to avoid the anxiety that results from conflicting information. a. If you are unable to answer a question or provide an explanation, acknowledge that and then find the information 4. communicate with pediatricians, neonatologists, nurses (critical care, floor, practitioners), pharmacists and coordinators in a manner that a. recognizes their perspective b. acknowledges their role c. provides the appropriate information needed, particularly changes in treatment plans 5. incorporate the interdisciplinary care structure of the pediatric surgery service in delivering patient care 6. interact in an appropriate manner with nursing staff, pharmacists, nurse practitioners and coordinators, recognizing their knowledge 7. incorporate the unique relationship between pediatric surgeons and the neonatal and pediatric intensive care unit nurses in delivering patient care.

RESPONSIBILITIES & EXPECTATIONS 1. Appropriately delegate patient care and operative case activities and responsibilities to the junior resident 2. Mentor the junior resident and medical students

PROFESSIONALISM GOALS & OBJECTIVES 1. Discuss the ethical issues of end of life care for pediatric patients and their families. 2. Discuss the ethical obligations of the surgeon in cases of child abuse or neglect, including reporting responsibilities. 3. Analyze the conflict and ethics involved in fetal surgery

RESPONSIBILITIES & EXPECTATIONS 1. see UCSF Common G&Os

SYSTEMS-BASED PRACTICE GOALS & OBJECTIVES 1. describe the triage and transfer policies and procedures for pediatric patients 2. describe the role of Child Protective Services in the care of children.

June 2010 3. Analyze the specific risks and benefits of cumulative radiation exposure associated with diagnostic studies performed on pediatric patients potentially in multiple sites as related to lifetime risk of malignancy.

RESPONSIBILITIES & EXPECTATIONS 1. none

June 2010