Fellowship Training Program in Pediatric Surgery

The training program in Pediatric Surgery at the Morgan Stanley Children's Hospital of New York-Presbyterian is one of the original training programs accredited by the American Council on Graduate Medical Education/Residency Review Committee in 1975. This institution has been certified continuously for one trainee per year in this two-year program since then. The most recent review was completed in 2004, 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 New York-Presbyterian Hospital, the pediatric surgical service has also merged under the banner of the Children’s Hospital of New York. The Children’s Hospital is a freestanding children’s hospital and is a component of the New York-Presbyterian Hospital. The Pediatric Surgery Service is a Division of Surgery, Columbia University, College of Physicians & Surgeons. Pediatric surgical activities occur at both campuses of the merged entity. The training program is largely centered at the Columbia campus and based at the Morgan Stanley Children's Hospital NewYork-Presbyterian. Weill Cornell Medical College of Cornell University and the College of Physicians and Surgeons of Columbia University remain separate entities.

Morgan Stanley Children's Hospital of NewYork-Presbyterian

The Morgan Stanley Children's Hospital of NewYork-Presbyterian was founded in 1887 in an eight-room rented house in mid-town Manhattan. It was named "The Babies Hospital," and joined the consortium of 9 hospitals, which formed the Columbia-Presbyterian Medical Center on Broadway and 168th Street in 1911. The Hospital is now one of 35 hospitals that make up the New York Presbyterian Hospital.

For the 8th year in a row, US News and World Report has ranked Children’s Hospital of New York as one of the top ten children’s hospitals in the United States, and the only such designated hospital in the New York/Connecticut/New Jersey region. 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 occurred at Children’s Hospital of New York.

• 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 childFirst 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

The Children’s Hospital is located on the campus of the Columbia University College of Physicians and Surgeons at 168th Street and Broadway, 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 terminus of the bridge. The Riverdale suburbs of the Bronx and Westchester County are to the north. The Hospital is easily accessible from the west side of Manhattan by subway.

The Hospital is dedicated exclusively to the care of children. With the opening of the new bed tower (November 2003) the Hospital became The Morgan Stanley Children's Hospital of New York-Presbyterian. The new bed tower includes 120 beds, with a state of the art pediatric radiology suite. Fully one-half of the beds are committed to neonatal / pediatric critical care beds and bone marrow transplantation. It is contiguous with the two existing buildings, which continue to house such important activities as the operating rooms, emergency wards, and the pediatric intensive care unit. Expansion of the existing surgical suite from 6 to 8 operating rooms was completed on 1/1/2001. A 9th operating room is in the NICU. All operating rooms are equipped for state-of-the-art minimal access surgery. A pediatric endoscopy and bronchoscopy suite opens in 2007. All pediatric surgery (general and subspecialty) is performed in the Children's operating rooms (approximately 7,500 cases per year). The suite is also available to the pediatric gastroenterology, hematology/oncology, and pain services. The Children's Hospital is one of only two designated Level I Pediatric Trauma Services in New York State and makes ample use of the recently completed trauma bays in the Emergency Ward. 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 9 clinically active members and one emeritus member listed below. All members are Board certified.

• R. Peter Altman, M.D.
• Marc S. Arkovitz, M.D.
• Lawrence Bodenstein, M.D., Ph.D.
• Arnold J. Coran, M.D.
• Robert A. Cowles, M.D.
• Jessica J. Kandel, M.D. 
• Edmund Kessler, M.D. 
• Keith A. Kuenzler, M.D. 
• William Middlesworth, M.D. 
• Nitsana Spigland, MD (Cornell campus) 
• Charles J. H. Stolar, M.D. 
• Jeffrey Zitsman, M.D. 
• John Schullinger, M.D., emeritus 

• Laura Flanigan, R.N., M.S. 
• Jeanne Rubsam, R.N., M.S. 
• Mary Ann Witt, R.N., Ph.D. 

• 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 Hospital. 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 of NewYork-Presbyterian Hospital. First year Fellow rotates with Dr. Glassberg for intensive exposure to pediatric urology. 
• Dominique Jan, M.D. – Director of Small Bowel Transplant, Morgan Stanley Children's Hospital of NewYork-Presbyterian Hospital. First year Fellow rotates with Dr. Glassberg for intensive exposure to pediatric urology. 

Clinical Programs

• Clinical Programs 
• ECMO 
• Intestinal Rehabilitation 
• Vascular Malformations 
• Trauma 
• Prenatal Pediatrics Surgery 
• Adolescent Bariatric Surgery 

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 

Outpatient Activities

All outpatient activities, private or clinic, are consolidated into the Doctors’ offices in the Hospital. Elective surgery is scheduled 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 sometime -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 $52,557, for and the second year fellow is $53,916. 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:

• Sunday, January 14, 2007
• Saturday, March 3, 2007
• Sunday, March 18, 2007

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

Hotels:Here are some possible hotels for those planning to stay overnight in New York:

Hotel Ellington
610 West 111 Street
NYC 10024
Phone: (212) 864-7500
Fax: (212) 749-5852
Close to the main campus of Columbia University, and closest to the hospital
Rates start at $160.00

The Radisson Empire Hotel 1-800-333-3333 or (212) 265-7400
44 West 63rd Street (between Broadway and Columbus Avenue)
NYC  10023
You can take the #1 or #9 subway uptown to the hospital stop at 168th Street 
Rates start at $200.00

The Radisson Hotel in Englewood, New Jersey
401 VAN BRUNT STREET ENGLEWOOD, NJ 07631
(201) 871-2020
Rates start at $121.00