Pediatric Surgery

Colorectal

Name of Host Institution: Cincinnati Children's Hospital Medical Center

Program Specialty / Subspecialty: Pediatric Colorectal Fellowship Training Program

Program Mailing Address:
Cincinnati Children’s Hospital Medical Center
MLC 2023
3333 Burnet Ave.
Cincinnati, OH 45229-3039

Program Phone Number: 513-636-7365

Program Fax Number: 513-636-7657

Program Email: nelson.rosen@cchmc.org

Program Director: Nelson Rosen, MD

Alternate Program Contact: Meghan Wiesner, Program Coordinator, meghan.wiesner@cchmc.org.

History

This program was approved by the Graduate Medical Education Committee in January 2006. The first trainee began in July 2006.

Duration

One or two years. The second year is optional and would include an opportunity to obtain a Master’s Degree as an incidental component to the training.

Prerequisite Training / Selection Criteria

The trainee would need to have completed at least three years of residency in general surgery, and therefore would be a candidate eligible for application to a pediatric surgical training program.  It is also possible that such an individual will have already completed a general pediatric surgery residency, and now desires specialty training in pediatric colorectal surgery.

Goals and Objectives

We have established a pediatric colorectal training program in which individuals participate in the broad clinical and academic experience now available in pediatric colorectal surgery with the creation of the Colorectal Center for Children at Cincinnati Children's, under the supervision of Dr. Jason Frischer, who is the director of this program. This position could be filled by a general surgery trained individual who comes for a one year colorectal experience, and would serve as the pediatric colorectal surgery fellow, or by a trained pediatric surgeon who desires additional colorectal experience.

The goal of this position is to enable the trainee to gain expertise in pediatric colorectal surgery which will enhance their opportunity for application for a more formal general pediatric surgery fellowship in the future, or if they have already completed training in pediatric general surgery, will enhance their expertise in colorectal surgery in anticipation of a sub specialization in this area.

Program Certifications

None at this time.

Teaching Staff

• Pediatric Surgery – Drs. Jason Frischer, Beth Rymeski, Nelson Rosen, and Aaron Garrison
• Urology – Drs. Brian Vanderbrink, Pramod Reddy, Eugene Minevich, and W. Robert DeFoor
• Gynecology – Lesley Breech
• Gastroenterology – Drs, Ajay Kaul, Khalil El-Chammas, Neha Santucci, Lee Denson, and Phillip Minar

The training program director, Dr. Rosen will coordinate all aspects of the fellowship training program for the colorectal fellow.  All of the other listed faculty will be involved in specific training experiences.  The surgical faculty (pediatric general, urology, and gynecology) will supervise the colorectal fellow on all operative cases as well as on inpatient and outpatient care.   

Facilities

All training is conducted at the Cincinnati Children’s Hospital Medical Center. The Cincinnati Children’s Hospital Medical Center is a private medical center providing 580 inpatient beds. The hospital is one of the largest children’s care facilities in the United States in several categories: number of beds; number of emergency room visits; and number of operative procedures.

During the training period, this individual will be expected to participate in the Pediatric Colorectal educational programs, outpatient and inpatient care, routine and complex surgical procedures. The trainee will also be involved in clinical research projects. The trainee may also participate in shared general pediatric surgery clinical and educational experiences with our current pediatric surgery trainees when deemed to be beneficial.

The goal of this fellowship position is to enable the trainee to gain expertise in the diagnosis, medical and operative management of a wide spectrum of pediatric colorectal abnormalities. This experience will first and foremost expand the pool of specialists who will be able to care for these patients. In addition, this experience will permit the practitioner to enhance their expertise in the treatment of colorectal problems in anticipation of a sub-specialization in this area.

The ultimate responsibility for care of the patients is the attending surgeon. No patient is admitted to the hospital, undergoes a procedure, or has a consultation without the attending surgeon being made fully aware and assuming all responsibility. The fellows interact with the attendings on a daily basis to go over the patient’s progress or to raise any concerns. The attending surgeon is routinely called directly by the fellow. The fellows round with the attendings on all patients. There is frequent communication both at the bedside and in the department regarding patient management decisions.

The operative procedures and skills require at least three years of general surgery training or its equivalent.  The trainees will be performing major surgical procedures including:

• wound dehiscence closure
•  gastrostomy closure
•  colotomy bx/fb removal
• resection small bowel
• mobilization splenic flexure
• colectomy w/ anastomosis
• colectomy with resection
• ileostomy
• colostomy
• closure enterostomy
• repair bowel opening
• rectal biopsy
• proctectomy
• rectal prolapse
• anal dilatation
• rectal dilatation
• removal of fecal impaction
• anorectal exam under anesthesia
• repair high imperforate anus
• repair cloacal anomaly
• exploratory laparotomy
• laparoscopy
• ureteroneocystostomy
• continent diversion
• cutaneous appendico-vesicostomy
• enterocystoplasty
• ureterostomy
• closure vagina
• enterocystoplasty
• cutaneous vesicostomy
• cystourethroscopy
• scrotoplasty
• vulvectomy
• clitoroplasty
• perineoplasty
• colpotomy
• vaginectomy
• colpopexy
• construction of artificial vagina
• rectovaginal fistula closure
• urethrovaginal fistula closure
• pelvic exam under anesthesia

Daily

• Bedside rounds

Weekly

• Tumor Board
• UC Surgical Grand Rounds
• Pediatric Surgery Grand Rounds
• Pediatric Surgery/Radiology Conference
• Pediatric Surgery Morbidity & Mortality Conference
• Colorectal Case Conference
• Colorectal/Urology/Gynecology Conference

Monthly

• Trauma Case Review
• Trauma Morbidity & Mortality Conference
• Bowel Management Conference

The core curriculum of the pediatric colorectal fellowship program may be completed in one year with a second year for selected fellows.  The second year allows the fellow to continue to increase expertise in the diagnosis and management of more complex disorders such as cloacal malformations and cloacal exstrophy.  In addition, the fellow will gain specific knowledge and experience in clinical and translational research, including preparing a clinical trial, gaining IRB approval and executing the study.

Additional focus will be placed on preparing abstracts and presentations for national meetings, preparing and submitting peer reviewed manuscripts and writing local and national grant applications.

Describe how trainee is mentored and supervised: The trainee is mentored and supervised by the Program Director through daily interaction and feedback.

Describe the formal evaluation process: Fellows are evaluated every six months by the Program Director, and a summary evaluation is conducted at the conclusion of the fellowship. In addition, the sub-specialty residents are expected to provide formal evaluations of the individual faculty members, the program of learning, and the program resources on an annual basis. This information is collated and presented to the faculty in an anonymous fashion.