Education

Program History and Structure

The training program in Pediatric Surgery at Yale University and Yale-New Haven Children’s Hospital is an ACGME/RRC-approved 2-year fellowship. The Fellowship is intended for surgeons who have completed a full residency in General Surgery and who wish to pursue a career in Pediatric Surgery.

The Section of Pediatric Surgery at Yale University was formalized in 1964 under the leadership of Lawrence “Larry” Pickett, M.D. Eight years later, in 1972, Dr. Pickett was named Chief of Staff at Yale-New Haven Hospital and Robert J. Touloukian, M.D. was appointed as the new Section Chief in 1973. Over the ensuing 30 years, Dr. Touloukian led the Section through significant expansion. Notable accomplishments under Dr. Touloukian’s leadership include the development of an ECMO program in 1993, the establishment of the Pediatric Surgery Fellowship Training Program in 1994 and the formation of a Level 1 Pediatric Trauma Center at Yale-New Haven Children’s Hospital. From 2003 to 2010, the Section was led by R. Lawrence Moss, M.D. who expanded the faculty and broadened the research productivity of the Section. In 2011 Michael G. Caty, M.D., M.M.M. was recruited as the Section Chief of Pediatric Surgery and Surgeon-in-Chief of the Yale-New Haven Children’s Hospital.

The Yale-New Haven Hospital was originally chartered in 1826 and is considered among the first hospitals in the United States. In 2012, Yale-New Haven Hospital acquired the nearby Hospital of St. Raphael creating a merged 1,519 bed institution, the fourth largest hospital on the United States. The Yale-New Haven Children’s Hospital, an adjoining structure, was opened in 1993 and, in total, is comprised of 221 beds including 19 PICU beds and 72 NICU beds. Total Children’s Hospital operating room volume exceeds 7,000 annual cases and emergency department volume exceeds 30,000 visits annually including over 500 trauma evaluations and 351 trauma admissions from July 2012 to June 2013.

The Fellowship training program emphasizes graded responsibility as the resident progresses through the 2-year Program, assuming more and more independence with seniority. Every patient, whether electively 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 within the institution, are the responsibility of the Pediatric Surgery Service. In the critical care environments (NICU and PICU) collaborative working relationships are encouraged. The Pediatric Surgery Fellow is responsible for the daily work on 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 resident and medical students to the daily list of operations. The Fellow is responsible for overseeing all consultations in the emergency room, wards, and clinics, generally after an initial evaluation by a junior house officer or Advanced Practice Nurse.

Faculty and Staff

The Section of Pediatric Surgery has five full-time surgical faculty members, one non-surgical faculty member, and two Emeritus members as listed below. All surgical members are certified or eligible for certification by the American Board of Surgery.

Michael G. Caty, M.D., MMM – Section Chief and Robert Pritzker Professor of Surgery
Emily R. Christison-Lagay, M.D. – Assistant Professor of Surgery
Robert A. Cowles, M.D. – Program Director and Associate Professor of Surgery
Catherine A. Dinauer, M.D. – Assistant Professor of Pediatrics
Doruk E. Ozgediz, M.D., MSc  – Assistant Professor of Surgery
David H. Stitelman, M.D. – Assistant Professor of Surgery
John H. Seashore, M.D. - Professor of Surgery, Emeritus
Robert J. Touloukian, M.D. – Professor of Surgery, Emeritus

The Section also includes four Advanced Practice Nurses to support all aspects of inpatient and outpatient care:
Alefteria Manchisi, Daniela Marcoccia, Lisa Sagnella, and Isabel Torres

Educational Conferences

Daily
  • Morning Rounds with the Pediatric Surgery Attending of the Week
Weekly
  • Pediatric Surgery Grand Rounds and Curriculum Conference 
  • Tumor Board
Monthly
  • Pediatric Trauma Conference 
  • Pediatric Surgery Quality Improvement Conference (Morbidity and Mortality) 
  • Pediatric Surgery/Radiology/Pathology Conference 
  • Pediatric Surgery/Gastroenterology Conference 
  • Research Conference 
  • Fetal Board

Clinical Activity

Outpatient Clinic
All outpatient activities occur in the Specialty Clinic space on the 2nd Floor of the Yale-New Haven Children’s Hospital. The Pediatric Surgery Fellow and General Surgery Residents participate in the outpatient clinic. The Fellow is expected to attend one half-day clinic session per week and should track the types of cases seen. Surgery is scheduled by the Fellow/Attending team during these office hours. This allows an opportunity for residents and the Fellow to see patients preoperatively and follow them postoperatively. It also allows attending input and supervision of outpatient activities.

Inpatient Care
All inpatient activities take place either in the operating rooms, emergency department, or within the Hospital. The Pediatric Surgery Fellow is joined by one PGY3 resident and one or two PGY1 residents from the Yale General Surgery Residency Program and by two or three Advanced Practice Nurses as part of the inpatient care team. There are separate pediatric ORs that are staffed by Pediatric Anesthesiologists 7 days/week and 24 hours/day. The exact numbers and types of operations vary from year to year but the Fellow performs approximately 1000 major cases over the course of two years. Exact numbers and case distributions are available on request. The most recent ACGME/RRC program review resulted in full accreditation for four years.

Supervision/Work Rules

The Fellowship Program is in compliance with all guidelines for resident supervision established by the ACGME. The work hours rules are in accord with the guidelines established by ACGME. The Fellow is expected to enter daily work hours so that these may be tracked by the Program Director and by the Institution.

Call, Vacation, Pay, Benefits

There is no mandatory in-house call. The Fellow has an office with a computer and access to on-call sleeping quarters if needed. The Fellow is responsible for alternating on-call responsibilities from home with the PGY3 from the General Surgery Program. The Fellow will be permitted to participate in particularly rare or complex cases even when not formally on-call as long as there is no violation of work-hours rules. The Fellow is responsible for creating the on-call schedule and planning vacation time (four weeks/year) with appropriate communication with the Program Director and other faculty.

Details of the salary and fringe benefits including health, disability, life and malpractice insurance, university spending accounts, etc. change from year to year and may be obtained through the Section of Pediatric Surgery.

Evaluations

Evaluations occur in two formats:
First, competency-based formal evaluation takes place at 6-month intervals. Each full-time faculty member evaluates the Fellow based upon technical, administrative, interpersonal, and teaching skills. Comments are aggregated and discussed between the Fellow and Program Director. This evaluation is complemented by input from members of other services such as radiology, anesthesiology, nursing, neonatology, critical care, and pediatrics. The Fellow also evaluates 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 considered confidential.

Second, informal evaluation occurs at the weekly conferences where the Fellow has ample opportunity to present topics and discuss his/her approach to patient care. These presentations provide an opportunity for the faculty to evaluate the Fellow’s fund of knowledge and depth of understanding for pediatric surgical topics.

The Fellow is required to take the American Board of Surgery In-Service Examination in Pediatric Surgery (PSITE) annually. The results of this examination will be discussed in detail with the Fellow.

Research

Intellectual curiosity is encouraged in the Fellow and research questions often arise during the Fellowship. The Fellow will be encouraged to pursue any research project he/she desires. Clinical studies are the most practical way to pursue research during fellowship and appropriate mentoring for research will be provided as needed. A quality improvement project will be initiated by the Fellow after discussion with the Section Chief and Program Director and this project will be completed by the end of the 2-year program.

Information

For further information about the Section of Pediatric Surgery, contact us at:

Robert A. Cowles, M.D.
Program Director

Section of Pediatric Surgery 

Department of Surgery 

Yale University School of Medicine 

333 Cedar Street, PO BOX 208062 

New Haven CT 06520-8062 

Tel: 203.785.2701

Fax: 203.785.3820

robert.cowles@yale.edu

Jennifer Coughlin
Program Coordinator
Section of Pediatric Surgery

Department of Surgery

Yale University School of Medicine 

333 Cedar Street, PO BOX 208062 

New Haven CT 06520-8062 

Tel: 203.785.2701

Fax: 203.785.3820

jennifer.coughlin@yale.edu