Pediatric General Surgery Fellowship

Program description

The pediatric surgical training program at The Children's Hospital of Philadelphia originated in 1946. Since that time, more than 70 individuals have been trained. The majority have gone into academic positions either in the United States or abroad.

The training program for the Louise Schnaufer Endowed Fellowship in Pediatric Surgery is two years in duration beginning August 1 of each year. All training occurs at a single site, the Main Campus of The Children’s Hospital of Philadelphia.

The fellow’s primary training will take place within the Division of Pediatric General, Thoracic and Fetal Surgery. The clinical care team in the Division consists of:

  • Ten full-time attending pediatric surgeons
  • Three accredited pediatric surgery fellows
  • One or two non-accredited international fellows
  • Two University of Pennsylvania medical students
  • Over 40 advanced practice nurses
  • Three dedicated surgical dietitians
  • As many as five general surgical residents representing the Departments of Surgery at the Hospital of the University of Pennsylvania and several other local general surgery training programs

This team is responsible for more than 4,000 general surgical operations per year. At any given time, the Pediatric Surgical Service cares for 80-100 patients. About one-third of these patients are surgical neonates in the N/IICU.

Pediatric General Surgery works in the context of a full complement of pediatric surgical subspecialties within the Department of Surgery. There currently are approximately 100 full-time surgeons at Children's Hospital in pediatric general surgery, urology, cardiac surgery, plastic surgery, ophthalmology, otolaryngology, orthopedics and neurosurgery. These practitioners perform more than 24,000 operations each year. A close working relationship exists between all of these subspecialty areas.

The operating rooms at CHOP are state of the art. At CHOP’s Main Campus, all 23 operating rooms are fully-equipped endosurgery suites.

Program structure

Since 2004, one 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.

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 operative experience gained by the fellows is broad 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 12 months of their two-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.

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.

Sub-specialty surgical exposure

New and expanded clinical programs developed within the Division enhance surgical education:

Fetal diagnosis and intervention: Chief among these is the Center for Fetal Diagnosis and Treatment, which provides comprehensive care — both before and after birth — for pregnant mothers carrying fetuses with anatomic, metabolic and genetic abnormalities. The Center’s Garbose Family Special Delivery Unit, located within The Children’s Hospital of Philadelphia, offers delivery options for healthy mothers carrying babies with known birth defects. Additional 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. These initiatives have produced the busiest fetal treatment program in the world. Associated with this program is an active investigative program where research fellows have clinical responsibility.

Trauma: 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. These admissions provide surgical fellows rich exposure to blunt and penetrating trauma, brain injury, child abuse, burns, and critical care.

Minimally invasive surgery: An active Minimally Invasive Surgery program applies robotic, laparoscopic and thoracoscopic techniques in the pediatric age group. Advanced MIS procedures in infants and children include lobectomy, trachea-esophageal fistula repair, choledochal cyst excision, duodenal atresia repair, diaphragmatic hernia repair, and dozens of other case types. MIS is well-supported by state-of-the-art Storz OR1 endosuites, specialty trained nurses, and onsite equipment technicians. Training is enhanced by practice space in the Pediatric Endoscopic Surgical Training Advancement Laboratory (PEDESTAL). The principles-based curriculum in PEDESTAL emphasizes precision through mechanical advantage and proficiency gains from attention to surgical device design. About one-third of general pediatric surgical cases at CHOP use minimally invasive approaches.

Specialty clinical programs: Fellows benefit from working within several sub-specialty clinical programs that provide multidisciplinary care to rare or especially challenging conditions. These include:

Pediatric surgical education

Training in surgery relies upon experiential, integrated learning-by-doing and learning-by-teaching. This is a “fellow-centered” clinical service that demands efficiency, ownership, and constant reflection-in-action to build proficiency. The educational program in pediatric surgery includes operating room experience, bedside clinical teaching, and an active conference routine.

Conferences

A regular conference schedule includes:

  • Grand Rounds in Surgery
  • CORE Lecture Series
  • Pathology/Radiology/Surgery Combined Conference
  • Journal Club
  • PEDESTAL sessions
  • Tumor Board
  • Fetal Review
  • Patient Management/Morbidity and Mortality Conference

Academics

The fellows are encouraged to be involved in academic activities in addition to their extensive clinical responsibilities. All fellows starting at CHOP already have an extensive publication record. Opportunities to burnish this record abound, and fellows who have finished in the last decade have published papers during the time they have been at CHOP. Publication and presentations are supported by a full-time research coordinator, a business analyst, secretarial support, full access to the online resources of the Library of the University of Pennsylvania, and funds.

Graduated responsibility

The Chief Resident is permitted operating room privileges for pediatric 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.

Outpatient clinics

During the weekly fellow clinic, the fellows see outpatients and all postoperative index cases with the responsible attending staff, permitting regular interchange between the residents and the attending staff. Attending a series of subspecialty focus clinics within the Division allow fellows to gain longitudinal experience with a number of especially challenging clinical entities. Clinics include:

  • Trauma
  • Foregut/GERD
  • Pulmonary Hypoplasia
  • Anorectal
  • Short Gut

Off campus courses

The fellows routinely attend courses on anorectal anomalies, advanced minimally invasive surgery, and pediatric surgical oncology.

Institutional and departmental facilities

The Division of Pediatric General, Thoracic and Fetal Surgery has offices on Wood 5 for the attending pediatric surgeons, the three pediatric surgical fellows, the nurse practitioner program, the secretarial staff including the fellows' clinical secretary, nurse coordinators and associated personnel for the trauma, transplant, ECMO, and fetal diagnosis and therapy programs.

Located on the University of Pennsylvania campus, the Hospital's immediate neighbors are the Perelman School of Medicine, the Hospital of the University of Pennsylvania, and the Philadelphia Center for Health Care Sciences, a multidisciplinary clinical and research complex including the veterinary, dental and nursing schools. Within one block are the University Museum, the Palestra, Franklin Field, and the Wistar Institute. A few blocks away are the University City Science Center, a complex of commercial and not-for-profit research and educational scientific institutions, the Philadelphia Veterans Administration Medical Center, and the college and graduate schools of the University.

There is an excellent medical library within the Hospital, as well as extensive services available through the adjacent library of the Perelman School of Medicine at the University of Pennsylvania, to which the trainees have full access.

Pediatric surgical research facilities

The pediatric surgical research laboratories are part of The Children's Institute for Surgical Science on the 11th floor of the Leonard and Madlyn Abramson Pediatric Research Center. The Abramson Research Center was opened in May 1995 and is the largest pediatric research building in the world (550,000 square feet). In addition to the core facilities within the building, staffing for the pediatric surgical research laboratories includes four research technicians, a research associate, 12 research fellows, and gene vector, morphology, cell culture, and molecular biology cores.

On the 2nd floor of the building is a state-of-the-art animal facility that includes equipment and veterinary support for the perioperative care required for sophisticated fetal and pediatric surgical research. The investigative areas within the Division include scarless fetal and adult tissue repair, fetal animal models for congenital defects, fetal gene therapy, fetal hematopoietic and mesenchymal stem cell transplantation and fetoscopic therapeutic procedures.

Research funding has included support from the National Institutes of Health (NIH), the Muscular Dystrophy Association, the March of Dimes, the Cystic Fibrosis Foundation, the Juvenile Diabetes Foundation, and the Surgical Associates Research and Education Foundation. A multicenter clinical trial for fetal myelomeningocele repair is also funded by the NIH.

How to apply

Applicants for the position of Fellow in Pediatric Surgery should have completed requirements of the American Board of Surgery (five years in an approved general surgical residency program in the U.S. or Canada) by the time of the desired appointment, and at that time, they must be licensed to practice medicine in the state of Pennsylvania. ATLS certification is also required.

The Children's Hospital of Philadelphia participates in the match as organized by the American Pediatric Surgical Association. We participate with the ERAS Fellowship Application System. Visit ERAS at https://www.erasfellowshipdocuments.org.

Tobacco-free hiring policy

To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

Job applicants who apply after July 1, 2014 will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.

Contact

Nichole Adkinson, Program Coordinator
The Children's Hospital of Philadelphia
Division of Pediatric General and Thoracic Surgery
3401 Civic Center Boulevard, 5th Floor Wood Building
Philadelphia, PA 19104
215-590-5294
adkinsonn@email.chop.edu