The training program for The Louise Schnaufer Endowed Fellowship in Pediatric Surgery is two years in duration beginning July 1 each year.
The first pediatric surgical fellow completed training at Children's Hospital more than 50 years ago, and since that time, more than 70 individuals have been trained. The majority have gone into academic positions either in the United States or abroad.
One fellow or two fellows are appointed in alternating years and a total of three accredited fellows are present at any one time. Each fellow is assigned to the pediatric surgical service where he/she obtains an extensive operative experience and provides comprehensive perioperative care.
In the first year, a one-month elective can be arranged in pediatric urology and additional experience with laryngotrachealbronchoscopy procedures can be obtained with the ENT service. The three fellows in combination with the international fellows provide every fourth to fifth night on-call coverage, and the operating room index case responsibilities are shared by the three accredited fellows.
The addition of the third accredited fellow position was granted by the Residency Review Committee for Surgery in 2004 and was preceded by a trial period of 3 years in which the program index case volume was divided three ways. The Children's Hospital of Philadelphia is currently the only Pediatric Surgery Training Program to receive permission for a third fellow and it is already apparent that it has improved the fellowship experience in a variety of ways. The operative experience gained by the fellows is broad based and extensive including both routine and esoteric cases. In the course of the two-year residency, the pediatric surgical resident averages over 1,300 cases as surgeon, at least one quarter of which are done on infants in the first month of life.
Each fellow will serve as Junior Attending Staff and as "Chief Surgical Resident" in Pediatric Surgery for 8 months of their 2-year fellowship. The Chief Resident has administrative charge of the clinical service including patients generated from his/her own weekly clinic. The Chief Resident is the liaison and coordinator between the pediatric, nursing and surgical services as part of Children's Hospital's commitment to total patient care. Resident assignment to cases is likewise a duty of the Chief Resident. In addition, the Chief Resident is responsible for organizing the teaching schedule and Pediatric Surgical Grand Rounds.
Fellows in pediatric surgery receive appointments as Instructor in Pediatric Surgery at the University of Pennsylvania School of Medicine. The stipend in the first year is comparable to the standard in this region. The Chief Resident is a member of the attending staff of the Children's Hospital of Philadelphia, and receives an additional salary benefit.
New and expanded programs have been developed within the Division. The Center for Fetal Diagnosis and Treatment provides comprehensive care - both before and after birth - for pregnant mothers carrying fetuses with anatomic, metabolic and genetic abnormalities. Maternal transport, planned delivery and postnatal care is coordinated between the Obstetric Service of the adjacent Hospital of the University of Pennsylvania (HUP) and the Intensive Care Nurseries at The Children's Hospital of Philadelphia (CHOP) and HUP.
We have the busiest fetal treatment program in the world. Associated with this program is an active investigative program where research fellows have clinical responsibility. There is a combined liver and kidney transplant program at CHOP and HUP. An active Level I Pediatric Regional Trauma Center with heliport has been in place since 1986 and accounts for more than 1,200 admissions to the hospital each year.
There is a full-time two-year Pediatric Trauma and Critical Care Fellowship, and this leads to eligibility for Added Qualifications in Surgical Critical Care. Several fourth-year surgical residents working in the research laboratory take trauma night and weekend call. This program is fully integrated with the trauma/surgical critical care program at HUP and will provide additional help to the pediatric surgical fellows for surgical critical care patients including those patients on ECMO.
There is also an active Minimally Invasive Surgery program for the application of robotic, laparoscopic and thoracoscopic techniques in the pediatric age group. Other features of the CHOP pediatric surgery fellowship include interaction with: the busiest pediatric oncology program in the U.S.; the Center for Inflammatory Bowel Disease (which follows more than 800 children with IBD); and the Congenital Hyperinsulinism Center, which generates 25 to 30 pancreatectomies per year.
The fellows are encouraged to be involved in academic activities in addition to their extensive clinical responsibilities. This is why they are provided with a secretary to do literature searches, help conduct clinical research projects and facilitate their program of self-study. They are also provided an opportunity and a budget to attend surgical meetings and are encouraged to present papers. All fellows who have finished in the last decade have published papers during the time they have been at CHOP and most have continued to do so after their graduation from the program. The fellows routinely attend courses on anorectal anomalies, advanced minimally invasive surgery, and pediatric surgical oncology.
The Chief Resident is permitted independent operating room privileges for cases a fully trained general surgeon could ordinarily undertake. All cases which would be considered pediatric surgery, including index cases, tumors and trauma, are personally supervised by one of the attending staff.
The educational program in pediatric surgery includes both operating room and bedside clinical teaching. An attending rounds with the Neonatal Surgical Team in the NICU on a daily basis. Thursday is the academic conference day. There is a 24-part Pediatric Surgery Core Curriculum with selected readings once per month taught by the surgical attendings. Weekly Pediatric Surgical Grand Rounds are designed to cover a large number of topics including all of the important areas of pediatric surgery as well as those areas in pediatric medicine which relate to pediatric surgery.
There is a weekly Morbidity and Mortality Conference, a monthly Surgical Pathology Conference, which is a review conference of interesting cases, and multi-disciplinary Gastroenterology-Surgery and ECMO Conferences. There is also a weekly Radiology-Surgery Conference in which interesting diagnostic radiology studies are presented. A multidisciplinary weekly Tumor Board includes pediatric surgery, oncology and radiotherapy. In addition, regular follow-ups of recently treated patients and relapse patients are presented so that all members of the patient care team can remain up-to-date on the course of tumor patients.
The Oncology Program at CHOP is one of the largest in the world. At the latter conference, the first-year surgical fellow presents pertinent cases once a month and one of the attending staff from the Department of Radiology presents the appropriate radiologic and imaging studies. There is also a weekly Trauma Morbidity and Mortality Conference, a monthly Trauma Case Conference and Lecture, and a weekly Trauma Follow-up Clinic. On Thursday, there is a weekly Patient Management Conference where difficult cases are presented and lengthy management discussions are held with all the attending and resident staff present. Morbidity and mortality review is updated and the next week's operative cases are reviewed. This is one of the most stimulating conferences of the week and provides an opportunity to discuss a variety of disease entities in depth.
The Chief Resident is responsible for selecting the cases and assigning the various residents to present them. Finally, there is a weekly Fetal Diagnosis and Treatment Conference which is multidisciplinary with maternal-fetal medicine, radiology, pediatric surgery and subspecialties, reproductive genetics, and appropriate consultative services. This program has generated a very large neonatal surgical case volume.