Pediatric Surgery Residency

Residency Program Overview

Program Director: David W. Tuggle, M.D.

Hospital Admissions per year: 13,ooo

Average cases performed by Trainees over two years:  1500>

Board Passage Rate:  100%

Educational Program

The University of Oklahoma offers a two-year ACGME accredited clinical training program with one fellowship. The Pediatric Surgery fellowship was established in 1979. The program is conducted in the Women's and Newborn Pavilion, which is a regional center for comprehensive, specialized pediatric services for the state of Oklahoma. The service is administered by the Section of Pediatric Surgery within the Department of Surgery at the Oklahoma University Medical Center. The faculty consists of four full time pediatric surgeons. More than 2400 pediatric surgical operations are performed each year.

The teaching program emphasizes responsibility, self-directed learning, and exposure to a broad spectrum of clinical material. The Chief Resident rounds twice daily on the patients and supervises three general surgery residents and 2-4 medical students assigned to the Pediatric Surgery service. Constant interaction with the faculty allows opportunity for feedback and clinical instruction. Residents are encouraged to initiate self-learning by weekly presentations on topics pertinent to recent patients on the pediatric surgical service.

This occurs within the context of a structured didactic teaching schedule that reflects a two-year cycle of core material as defined by the American Board of Surgery and The Association of Pediatric Surgery Training Directors.  The urban location results in a significant amount of "primary care" pediatric surgery. This provides a balance of "primary care" surgery with tertiary care pediatric surgery.

Basic Science

The section of Pediatric Surgery has developed a two-year teaching curriculum with the philosophy to maximize the educational benefit of the pediatric surgical trainees, surgical residents, research fellows, and third/fourth year medical students. Each Friday morning, a weekly Mortality and Morbity conference is held, which include the presentation of surgical statistics for that week and a review of in-patient management. Each week, the resident is expected to present patients that have sustained complications, errors in diagnosis, and deaths. The Chief Resident is responsible for the organization and assignment of presentations by faculty, general surgery residents, and medical students for the weekly pediatric surgery conferences. These conferences consist of didactic presentations and usually involve topics pertinent to patients with surgical problems being managed by the surgical service at the time. The department provides computer hardware, software and any audio visual aids needed for these presentations.

Supervision

Pediatric surgery training involves a closely supervised two-year period of education with the trainees having progressive responsibilities and independence. During the initial six months of training, the pediatric surgery resident is exposed to the clinical care of all common and tertiary pediatric surgery problems. The second six months is focused on directing the trainee to become more independent in his/her patient care management; build a broad fund of knowledge of pediatric physiology and pathobiology, and pursue a clinical research project in collaboration with the faculty. Constant communications between the first year trainee, the attendings and Chief Resident is expected. During the second year of training the pediatric surgery trainee is expected to perform in a more independent fashion, making important decisions regarding preoperative, intraoperative, and postoperative patient management. The Chief Resident is given additional independent operating room experience and his/ her technical operative skills are developed through one-on-one experiences in the operating room. The Chief Resident is also given additional teaching and administrative responsibilities. Progression of responsibility toward independent performance by the Chief Resident especially during the last six months of clinical training is strongly promoted by the pediatric surgery faculty. The pediatric surgery attendings continually monitor and provide appropriate feedback to the pediatric surgery resident throughout their clinical training both in and out of the operating room.

Continuity of Care

The pediatric surgery Chief Resident is responsible for the direct patient management of all patients on the pediatric surgery service. The resident is assigned to coordinate all patient care activities for the pediatric surgery service, namely in-patient care, operating room case assignments, emergency room consultation, daily rounds, consultations, coverage of outpatient office hours, and attendance at conferences and teaching rounds. The surgical caseload allows for the trainee to gain a well-rounded experience. There are a sufficient number of ambulatory surgical cases, neonatal cases, as well as complex operative procedures.

Each morning and evening the Chief Resident leads rounds with the surgical residents and medical students. Shortly after morning rounds, the on-call attending surgeon reviews patient status and service planning for the day with the Chief Resident. Operating room responsibilities for the day are assigned by the Chief Resident. Patient management plans selected by the pediatric surgery Chief Resident are reviewed with the patient's attending surgeon prior to implementation. All inpatient consults are called into the pediatric surgery office. The Chief Resident is notified as well as the appropriate attending surgeon. The Pediatric Surgery Service is responsible for all ECMO management. These are coordinated by the Chief Resident and the surgical faculty.

The Pediatric Surgical Service has outpatient office hours on Monday, Tuesday, Wednesday and Fridays. The Chief Resident may see patients along with the attending surgeons during each of these sessions. This experience allows the resident the opportunity to follow long term patients, gaining an important perspective on their growth, development, and management of complex issues throughout the patient's care on an outpatient basis. The pediatric surgery resident is responsible for chart dictations on all patients seen during these office hours. The Chief Resident is responsible for determining a diagnosis, the initial diagnostic work-up, and outlining the treatment plan for all patients. While the attending surgeon always review the course of treatment and plans with the trainee, the pediatric surgery resident is responsible for orchestrating the patient's care. As the trainee progresses during his residency, the attending promotes more independent management of these surgical patients. The surgical service also provides a follow-up clinic for any patients seen by the surgical service in the Emergency Room for burns, and minor trauma not requiring admission. These patients are seen every Thursday. The surgical residents, and a pediatric surgery resident staff this clinic, which is supervised by the on- call attending surgeon.

For information about the Pediatric Surgery Resident Match Program,  click.