The Children’s Hospital of Wisconsin was founded more than a century ago and Dr. Marvin Glicklich established the pediatric surgical program more than 50 years ago. However, it is within the last 25 years that these have grown to rank among the major children’s academic programs in the United States. Since 1999 the Children’s Hospital of Wisconsin (CHW) has ranked among the top children’s hospitals in the U.S. in the number of annual admissions among members of the National Association of Children’s Hospitals and Related Institutions (NACHRI). The operative volume is also among the largest children’s programs in the U.S. The Children’s Hospital of Wisconsin has a long-standing affiliation with the Medical College of Wisconsin (MCW). This began as an affiliation with Marquette University School of Medicine and continued until 1970 when the School of Medicine became an independent entity and assumed the new name of Medical College of Wisconsin. The partnership with the Medical College of Wisconsin remains quite strong; the relationships with the MCW surgical and pediatrics training programs are cooperative across the disciplines. For many years MCW general surgery residents and trainees in other surgical specialties have received exceptional exposure to the surgical problems of infants and children at the Children’s Hospital of Wisconsin.
CHW was relocated from a downtown Milwaukee location to the current facility on a new public campus on the western edge of Milwaukee in 1988. Institutions on the Milwaukee Regional Medical Center campus include MCW, CHW, Children’s Research Institute, Froedtert Hospital (adults), the Blood Research Institute of Southeastern Wisconsin and the Children’s Research Institute; as well as eye, mental health and rehabilitation institutes
The pediatric surgery faculty and programs have been fully integrated into the medical school over the last 20 years. All of the current faculty are MCW faculty members with full time academic appointments. All pediatric surgeons in Southeastern Wisconsin are members of this faculty and participate actively in this training program.
The training program has been designed to maximize exposure to a high volume of diverse surgical problems in infants and children, representing all of the essential areas in contemporary pediatric surgery. The trainee will be exposed to congenital, neoplastic, infectious and other acquired conditions of the GI system and other abdominal organs; of the blood and vascular system; of the integument; of the diaphragm and thorax (exclusive of heart); of the endocrine glands; of the gonads and reproductive organs; and of the head and neck. Similar experience is afforded in traumatic conditions of the abdomen, chest, head, neck and extremities. This includes both nonsurgical and operative management of multi-organ system injury and burns. This also includes experience with and the development of competence in the complete care of the critically ill infant or child, including CPR, management of ventilators, basic and advanced monitoring techniques, nutritional assessment and management and competence in recognition and management of clotting and coagulation disorders. Advanced laparoscopic pediatric surgery is a programmatic strength and this experience is integrated into the training program. The core faculty includes nine pediatric surgeons working collectively with three pediatric cardiovascular surgeons, two dedicated plastic surgeons and five pediatric urologists within a single practice unit. The Children’s Hospital of Wisconsin and the Medical College of Wisconsin are committed to educating health care practitioners and future leaders in all areas of medical care, including pediatric surgery. The Chief of the Division of Pediatric Surgery and CHW Surgeon-in-Chief is Keith T. Oldham, MD. The Director of the residency training program in pediatric surgery is Casey Calkins, MD.
The curriculum includes exposure to, and progressive responsibility for a large volume of routine, as well as complex patients with pediatric surgical problems. Graded responsibility is given to the resident trainee for evaluation, perioperative management, and operative care of these patients. The curriculum includes a structured series of didactic sessions that address pathophysiology, relevant basic science and clinical principles. There is clinical correlation of complex congenital and acquired problems of the gastrointestinal tract, cardiorespiratory system and urologic tract as well as responsibility for surgical oncology, critical care, trauma and burns. Each component of the curriculum has an identified faculty member with principal responsibility. A three-hour block of time without scheduled elective surgery is devoted to the education program every Friday morning, in addition to a number of other pediatric surgery conferences, rounds, and other Departmental educational activities. The curriculum includes attendance at the annual Pena seminar for anorectal malformations. Both the junior and senior trainees attend one annual pediatric minimally invasive training course put on by the Association of Pediatric Surgery Training Program Directors, and the senior fellow attends a similar pediatric oncology program at St. Jude’s Children’s Hospital. In addition, each fellow attends either the AAP, Surgical Section or the APSA annual meeting.
The two-year fellowship is designed to advance the skills of the trainee in a graded fashion. During year one, the trainee will spend one month each on neonatology, the pediatric intensive care service and the urology service. In addition, elective time is available in otolaryngology and cardiac surgery. The trainees maintain night call responsibilities on the pediatric surgical service during off-service rotations. Participation with the cardiac surgery service is on an individual case basis for PDA ligations, vascular rings, coarctations, or the other occasional but relevant procedures as they arise. Airway and esophageal foreign bodies are assigned on an alternating weekly basis to the otolaryngology and pediatric surgical services. The first year includes a minimum of 6 months on the pediatric surgical service to familiarize the trainee with general pediatric surgery. The entire second year is spent on the pediatric surgical service. The trainee will have oversight responsibilities for the entire clinical service and will serve as the administrative leader of the house staff during the second year of training. At present, the junior pediatric surgery trainee, a general surgery PGY4, and two senior general surgery research residents alternate senior in-house call. A pediatric surgical critical care fellowship was approved by the ACGME in 2006 and this individual completes the in house call senior level rotation. The senior fellow takes in house call to compensate for vacations, meetings and other absences. In house call is necessary because the Children’s Hospital is a designated American College of Surgeons Level I Pediatric Trauma Center. Additionally, the generally high volume of the inpatient service, EDTC and inpatient consultations, and critical care management predict active involvement both day and night by the senior residents and fellows. General surgery PGY1 and PGY2 residents are also part of the call team with an established night float system; therefore, there is always a senior surgical trainee and a junior surgical resident in house.
The average daily Pediatric Surgical Service inpatient census is approximately 40 10 patients with a range of 15-70 plus. Of the 17 main campus operating rooms, a minimum of 2 per day, and regularly 3 or 4, are committed to the Pediatric Surgical Service. This does not include a six O.R. ambulatory Surgicenter that is part of the Children’s Health System and located about 10 minutes south of the main campus. This latter facility is a site of limited pediatric surgery ambulatory training. Ambulatory clinic experience, including dedicated long-term follow up clinics, are a weekly part of the trainee experience as well.