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Pediatric Surgery

Pediatric Surgery Fellowship

The training program in Pediatric Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital is one of the original training programs accredited by the American Council on Graduate Medical Education/Residency Review Committee in 1975. Since then, the Hospital has been certified continuously for one trainee per year in this two-year program. The most recent review was completed in 2009, and a four-year recertification without citation was awarded.

The original Director was Thomas V. Santulli, M.D., who initiated the pediatric surgery service at the original Babies Hospital in 1965, and had been training pediatric surgeons for many years before the ACGME accreditation. Dr. R. Peter Altman succeeded Dr. Santulli on his retirement in 1980. Dr. Altman was named Vice President for Medical Affairs of the Children's Hospital in 1999. He was succeeded as Chief of the Service by Dr. Charles Stolar.

With the merger of Columbia-Presbyterian Medical Center and the New York Hospital as the NewYork-Presbyterian Hospital, the pediatric surgical service also merged. Pediatric surgical activities occur at both the NewYork-Presbyterian/Columbia campus and the NewYork-Presbyterian/Weill Cornell campus, although the training program is largely centered at NewYork-Presbyterian/Columbia and based at Morgan Stanley Children's Hospital. Weill Cornell Medical College and the College of Physicians and Surgeons of Columbia University remain separate entities.

Morgan Stanley Children's Hospital

NewYork-Presbyterian Morgan Stanley Children's Hospital was founded in 1887 in an eight-room rented house in midtown Manhattan. It was named The Babies Hospital and joined the consortium of nine hospitals, which formed the Columbia-Presbyterian Medical Center on Broadway and 168th Street in 1911. The Hospital is now one of five centers that make up NewYork-Presbyterian Hospital.

For the seventh year in a row, US News & World Report has ranked NewYork-Presbyterian Hospital among the top ten children's hospitals in the United States, and consistently ranks first in New York. The ranking accounts for NewYork-Presbyterian's two major centers for children's health care: Morgan Stanley Children's Hospital and the Komansky Center for Children's Health.

The Hospital has been at the forefront of children's health since it was established in 1887 as the first hospital for infants in the United States. To this day it maintains its status as the national leader in many areas. The following is a partial list of 'firsts' that have occurred at Morgan Stanley Children's Hospital:

• First hospital for infants (1887)
• First modern pediatrics textbook (by L. Emmett Holt, M.D.)
• First facility for premature infants (1909)
• Founding of the field of child neurology (1920)
• Founding of the field of pediatric radiology (1930)
• Development of serum therapy for H. influenza meningitis before antibiotics were introduced (1938)
• First pediatric psychiatry clinic(1938)
• First defined management of glycogen storage disease (1941)
• First identification of the pathology of cystic fibrosis (1939)
• Development of the sweat test for cystic fibrosis
• Development of the Apgar score for newborn assessment (1952)
• First pediatric microchemistry laboratory (1951)
• First blood gas measurements in premature infants (1953)
• First description of child abuse as "shaken baby" syndrome (1959)
• First intrauterine surgery for fetal exchange transfusion (1965)
• First description of necrotizing entercolitis (1965)
• First use of intravenous alimentation for premature infants (1972)
• Founding hospital in Children's Cancer Study Group (1972)
• Development and pioneering center for extracorporeal life support (1982)
• First successful heart transplant in a child
• First Level I pediatric trauma center in New York City (1997)
• Development of varicella vaccine (1995)
• First children's hospital with FDA approved program for adolescent obesity

Morgan Stanley Children's Hospital is located at 3959 Broadway at 165th Street on the campus of the Columbia University College of Physicians and Surgeons in the Washington Heights section of Manhattan. Washington Heights is on the far upper west side of Manhattan at the eastern terminus of the George Washington Bridge. The Hudson River can be seen from the Hospital. The Bergen County suburbs of New Jersey are at the western terminue of the bridge. The Riverdale suburbs of the Bronx and Westchester County are to the far north. The Hospital is easily accessible from the west side of Manhattan by subway.

Morgan Stanley Children's Hospital is exclusively dedicated to the care of children. In November 2003, the Hospital opened a new facility with 120 beds and a state-of-the-art pediatric radiology suite. All of the Hospital's nine operating rooms (one of which is in the NICU) are equipped for state-of-the-art minimal access surgery. Our surgeons perform approximately 7,500 cases per year. A pediatric endoscopy and bronchoscopy suite opened in 2007 and is also available to the pediatric gastroenterology, hematology/oncology, and pain services.

Morgan Stanley Children's Hospital is one of only three designated Level I Pediatric Trauma Services in New York State. The 54-bed Pediatric Intensive Care Unit is an important venue for the pediatric surgical service. The Neonatal Intensive Care Unit has bed space for 72 critical neonates in addition to a dedicated ECMO unit. The Pediatric Radiology Department has cardiac catheterization laboratories, MRI and CAT scanning capabilities, and a dedicated pediatric interventional radiology facility.

The philosophy of the Fellowship training program continues to emphasize graded responsibility as residents progress through the Program, assuming more and more independence with seniority. Every patient, whether privately referred or originating in the Emergency Room or Clinic, has an attending responsible for all aspects of the child's care. Attending supervision of patient care complies strictly with ACGME guidelines for resident supervision.

Pediatric surgical patients, wherever hospitalized in the institution, are the responsibility of the surgical service. In critical care environments, collegial rather than territorial relationships are encouraged. The Pediatric Surgery Fellow has the responsibility for the service and its administrative organization. He/she is the principal surgical consultative resource to the hospital. This comprehensive assignment includes organization of most conferences and assignment of the daily operations list. The Fellow is responsible for seeing all consultation in the emergency room, wards, and clinics, generally after an initial evaluation by a junior house officer.

Faculty

The faculty includes the 12 clinically active members and one emeritus member listed below. All members are board certified.

• R. Peter Altman, M.D.
• Gudrun Aspelund, M.D.
• Lawrence Bodenstein, M.D., Ph.D.
• Arnold G. Coran, M.D. (Weill Cornell Campus)
• Robert A. Cowles, M.D.
• Angela Kadenhe-Chiweshe, M.D.
• Jessica J. Kandel, M.D.
• Edmund Kessler, M.D.
• William Middlesworth, M.D.
• Steven Rothenberg, M.D.
• Nitsana Spigland, M.D. (Weill Cornell campus)
• Charles J. H. Stolar, M.D.
• Jeffrey Zitsman, M.D.
• John N. Schullinger, M.D., emeritus

There are four full time pediatric nurse practitioners who work closely with the Fellows.

• Lori Lynch, R.N., M.S.N.
• Christina Molloy, R.N., M.S.N.
• Jeanne Rubsam, R.N., M.S.
• Mary Ann Witt, R.N., Ph.D.

Four associate attending faculty are responsible for unique aspects of the Fellowship training.

• Jean Emond, M.D., Director of Liver Transplantation, NewYork-Presbyterian Hospital. Fellows work with Dr. Emond during pre-, intra-, and post-operative phases of care for children needing liver transplantation and associated procedures.
• Michael LaQuaglia, M.D., Director of Pediatric Surgery, Memorial Sloan-Kettering Cancer Center. The first year Fellow rotates with Dr. LaQuaglia for intensive exposure to pediatric surgical oncology.
• Kenneth Glassberg, M.D., Director of Pediatric Urology, Morgan Stanley Children's Hospital. First year Fellow rotates with Dr. Glassberg for intensive exposure to pediatric urology.
• Tomoaki Kato, M.D., Director of Small Bowel Transplant, Morgan Stanley Children's Hospital. Fellows are exposed to aspects of small bowel transplantation.

Clinical Programs

• ECMO
• Intestinal Rehabilitation
• Vascular Malformations
• Trauma
• Prenatal Pediatrics Surgery
• Adolescent Bariatric Surgery
• Congenital Diaphragmatic Hernia Clinic

Conferences

Daily Conferences

• Morning report

Weekly Conferences

• Pediatric surgery morbidity and mortality
• Pediatric surgery radiology
• Pediatric surgical research
• Pediatric surgery basic science/clinical science/didactics
• Pediatric surgery attending ward rounds
• Pediatric oncology tumor board
• Prenatal pediatrics

Monthly Conferences

• Pediatric surgical pathology
• Department of Surgery Grand Rounds
• Pediatric trauma

Clinical Activities

Outpatient Activities
All outpatient activities, private or clinic, are consolidated into the Doctors' offices in the Hospital. Elective surgery is scheduled by the Fellow/Attending team during these office hours. This allows an opportunity for residents to see all patients preoperatively and follow them postoperatively. It also allows attending input and supervision of outpatient activities.

Inpatient Activities
All inpatient activities take place either in the operating rooms, emergency room, or wards of the Hospital. For certain important or unusual surgical problems, the Fellow may perform surgery with the appropriate attending at a network institution. The exact numbers and types of operations are too detailed for this posting, but are available on request. It should be noted that the most recent ACGME/RRC program review had no difficulty certifying the Program for one Fellow in each of two years. The case volume was in the greater than 75 percentile in almost all categories. The operating room is staffed 7 days/week and 24 hours/day. Pediatric anesthesiology and radiology are also available as needed 24 hours/day.

Supervision/Work Rules

The Fellowship Training Program is in complete compliance with all guidelines for resident supervision established by the ACGME, United States Department of Health and Human Services, and Columbia University. The work rules are in accord with the guidelines established by the New York State Bell Commission and the ACGME.

Call, Vacation, Pay, Benefits

There is no mandatory in-house call. The Fellows have an office and access to on-call sleeping quarters if needed. The Fellows are supplied with desktop computers with the full range of information systems access and cellular phones. The two Fellows alternate on-call responsibilities from home, and are responsible for their own schedules and vacation time (four weeks/year).

The Fellows are supported by an in-house group of residents mostly at the PGY-1,-2 and sometimes -3 year level from the Columbia or affiliated programs.

Each Fellow is funded to attend at least one national meeting per year. All meetings where the Fellow is to present a peer-reviewed paper are funded without question. The second year Fellow is sponsored to visit another pediatric surgical center in the United States or abroad for one week under the aegis of the Paul Christianson Travelling Fellowship.

Salary for the first year fellow is $61,921, and for the second year fellow is $63,901. Details of the fringe benefits including health, disability, life, and malpractice insurance, university spending accounts, etc. may be obtained through the Division of Pediatric Surgery Office.

Evaluations

Evaluation occurs in two formats. Competency based formal evaluation takes place at 6-month intervals. Each full-time faculty member completes a written evaluation addressing technical, administrative, interpersonal, and teaching skills. These comments are collated and discussed between the Fellow and Program Director. This evaluation is complimented by input from members of radiology, anesthesiology, neonatology, critical care, and pediatrics.

The Fellows are involved in evaluation of the Program and faculty at the same intervals. These are discussed with the Fellow and Program director who, in turn, discusses them with the entire faculty. All discussions are confidential.

Informal evaluation occurs at the weekly conferences where the Fellow has an opportunity to articulate his/her thought process in the assesssment of patients. These presentations provide an opportunity for the faculty to evaluate intellectual honesty, fund of knowledge, candor, and constructive self-criticism.

Fellows are required to take the American Board of Surgery In-Service Examination in Pediatric Surgery annually.

Research

All laboratory investigations are carried out in the Charles Edison Laboratory for Pediatric Surgical Research, which participates in the Core Laboratory of the Department of Surgery. The Charles Edison Laboratory is directed by Dr. Jessica Kandel. The work is funded by a combination of philanthropic, foundation, and peer-reviewed monies. It is staffed by surgery residents, surgical scientists, medical students, and faculty. Current investigations center on the regulation of angiogenesis in human pediatric tumors.

Other areas of investigation include development of fetal diaphragm development, pulmonary capillary beds, control of fetal gut nutrient transport and motility in developing intestine, and computational modeling of organ development.

Clinical research concerns outcomes for solid organ blunt injuries and comprehensive evaluation of gastrointestinal dysmotility. Outcome projects in adolescent obesity and consequences of bariatric surgery are under active development. The Division also participates in clinical trials related to pectus excavatum and necrotizing enterocolitis.

Additional details and information can be obtained by contacting the Program Director or during an interview.

Interview Dates

Fellowship interviews will be conducted on:

• Thursday, February 11, 2010
• Thursday, March 4, 2010
• Thursday, March 18, 2010

Interviews must be scheduled in advance, and the dates confirmed by calling (212) 305-8402.

Hotels

There are a large number of hotels in New York City and the surrounding areas. You may wish to search for a hotel on a variety of internet sites. We will provide applicants with a list of convenient hotels that provide discounts specifically to individuals conducting business at Columbia University. For more information of for a copy of this list, please call (212) 305-8402.