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General Pediatric Surgery Fellowships
The Pediatric Surgery Training Program offers intensive and broad exposure to the practice of pediatric surgery over a two-year period. Candidates for the program are selected through the Pediatric Surgery Resident Matching Program.
To apply for residency at the Division of Pediatric Surgery please visit the Electronic Residency Application Service (ERAS) website.
ACGME Accredited Fellowship
Our Division is committed to training one fellow in pediatric surgery annually. The program has been cooperatively provided by the Johns Hopkins Medical Center and the University of Maryland for over 30 years. Both divisions of Pediatric Surgery perform more than 3,200 operations annually and have a staff of 13 pediatric surgeons.
General Description
Clinical Faculty and Staff
Housestaff
Nurse Practitioners
Research
Specific Research
Clinical and Research Facilities, University of Maryland Hospital, Affiliated for Six Month Rotation
First Year of Training Program, Senior Resident in Pediatric Surgery
Second year of Training Program, Chief Resident in Pediatric Surgery
Alumni
General Description
Under the direction of Johns Hopkins pediatric surgeon Samuel M. Alaish, M.D., the post-doctoral training program in Pediatric Surgery at The Johns Hopkins Hospital and University of Maryland Hospital is unique in concept because it utilizes the clinical population of two large university services for a broad clinical experience in pediatric surgery over the prescribed two years. Completion of the basic two year program will qualify the trainee to take the examination for a “Certificate of Special Competence in Pediatric Surgery,“ which is given by the American Board of Surgery.
Candidates for the two year program are selected through the Pediatric Surgery Resident Matching Program established by the American Pediatric Surgery Association. Selection is made approximately thirteen months prior to beginning the two year program. Prerequisites for post-doctoral training in pediatric surgery include:
- Anticipated successful completion of an accredited general surgery residency, which qualifies the candidate for certification in general surgery by the American Board of Surgery.
- A completed ERAS application.
- Four letters of recommendation.
- Personal interviews with the staff at Johns Hopkins and University of Maryland.
- Participation in the Matching Program in Pediatric Surgery.
Clinical Faculty and Staff
The Johns Hopkins Hospital occupies approximately fourteen acres in East Baltimore adjacent to The Johns Hopkins University School of Medicine and School of Public Health and Hygiene. This 1100-bed complex includes a Children's Center with approximately 205 beds. Patients from age 0-21 are admitted to the Children's Center. The facility is equipped for all aspects of general pediatric care, with a 40-bed intensive care unit (PICU), a 45-bed neonatal intensive care unit (NICU), laboratory and radiology facilities. In addition, the facility is the Maryland State Regional Pediatric Trauma Center and a newborn surgical referral center. A pediatric medical and surgical oncology ward (14 beds), psychiatric wards and general pediatric age-determined wards complete the inpatient facility. A suite of 10 operating rooms for children's surgery and a pediatric recovery room adjacent to the PICU are utilized by pediatric general surgery, urology, orthopedics, neurosurgery, and otolaryngology services. The Johns Hopkins Outpatient Center houses the clinical facilities for outpatient visits (approx. 45,000/year). The Park Building, adjacent to the Children's Center, has a pediatric emergency room, oncology and hematology clinics, and a perfusion center.
The pediatric surgical staff at the Johns Hopkins Hospital is under the direction of David J. Hackam, M.D., Ph.D., the Robert Garrett Professor of Pediatric Surgery and co-director of Johns Hopkins Children’s Center. There are also full-time specialty surgeons in pediatric orthopedics, urology, neurosurgery, otolaryngology, plastic and cardiovascular surgery.
To complement the surgical staff, the medical staff comprises all subspecialties, including pediatric intensive care and neonatology at Johns Hopkins Children's Center.
Housestaff
Housestaff coverage for the pediatric surgery service includes the Chief Resident (year 2) and Senior Resident (year 1) in pediatric surgery, two senior general surgery residents and two general surgical interns. In addition, third year medical students rotate as clinical clerks in pediatric surgery and fourth year medical students may elect a sub-internship in pediatric surgery.
Nurse Practitioners
To complement the team we have seven Nurse Practitioners. The Inpatient Nurse Practitioners include Cathy Baldino, Michelle Felix, Alicen Kershaw and Kristin Wharton who work side by side with the Residents, Fellows and Attending’s caring for all patients on the Pediatric Surgery Service. Kim McIltrot and Margaret Birdsong attend outpatient surgical and wound clinics providing wound, ostomy, continence, surgical and post-operative care of the pediatric patient. They are also available for wound ostomy consultative services for the Children’s Center.
Susan Ziegfeld is the Trauma and Burn Program Manager and additionally provides care for the Trauma and Burn clinics.
Research
The Hackam Lab is committed to understanding the cellular and molecular events leading to necrotizing enterocolitis development and identifying novel therapies for this devastating disease.
The Alaish laboratory focuses on the molecular mechanisms underlying short bowel syndrome. The complications of short bowel syndrome including Intestinal barrier loss, cholestasis and intestinal dysbiosis are investigated with the goal to design novel therapies directed at specific sites in the molecular pathways. A major component of this translational research is the use of genetically engineered mice as a model for short bowel syndrome.
Specific Research
Generation of an Artificial Intestine
To grow and propagate intestinal stem cells onto a customized intestinal scaffold bearing the properties of human intestine, which will allow for nutrient absorption in the treatment of children with short bowel syndrome.
TLR4 Regulation and Signaling
Decreased expression of the EGFR in the intestinal epithelium is associated with development of necrotizing enterocolitis.
Toll-like receptor-4 (TLR4) is an innate immune receptor that detects lipopolysaccharides (LPS). Previously, we have shown increased TLR4 expression and signaling on enterocytes in necrotizing enterocolitis, which leads to an exaggerated release of cytokines and impairs gut migration and proliferation. This discovery provides novel insights into a potential therapeutic strategy to reduce the severity of necrotizing enterocolitis and other intestinal diseases.
Gut Development
To understand the pathogenesis of necrotizing enterocolitis, it is crucial to understand the changes of the gut during fetal development and birth. This has led us to explore the role of TLR4 and TLR9 in gut development of preterm infants.
Stem Cell Biology
Our lab is seeking to understand the role of intestinal stem cells in gut injury, such as necrotizing enterocolitis.
Drug Discovery
Using specialized drug discovery methods, we are identifying new molecules that have the ability to decrease the amount of inflammation in the intestine in models of necrotizing enterocolitis. These reagents include natural products that are found in breast milk and amniotic fluid, as well as synthetic compounds.
And in collaboration with other labs, we have developed highly efficient drug screening assays to test novel compounds that may modulate toll-like receptors.
Brain
Understanding how gut inflammation leads to brain injury in premature infants.
Lung
Understanding how to harness the body’s ability to regenerate the lung.
Clinical and Research Facilities, University of Maryland Hospital, Affiliated for Six Month Rotation
The University of Maryland Hospital is a 1600-bed facility located near the Baltimore Harbor, with approximately 120 beds devoted to the care of children. Facilities include a pediatric intensive care unit (12 beds), a neonatal intensive care unit (35 beds) and age-determined wards (annual ER visits of 15,276 and annual outpatient visits of 39,023).
Pediatric Surgery at Maryland is a section in general surgery under the direction of Dr. Roger Voigt with Dr. Eric Strauch, Dr. James Moore, Dr. Jeannie Chun, Dr. Kimberly Lumpkins and Dr. Helena Crowley providing general and thoracic pediatric surgical supervision. Drs. Voigt and Lumpkins also provide pediatric urologic expertise. In addition, there are surgical subspecialists in plastics, cardiovascular and neurosurgery, and full-time subspecialists in pediatrics, neonatology, oncology, cardiology, neurology, anesthesia, pediatric radiology and pathology.
The first year resident in Pediatric Surgery is the Chief Resident on the pediatric surgical service at the University of Maryland for six months. His/her team consists of a general surgery resident, surgical intern and a senior pediatric resident.
Research facilities that are housed in the Preclinical Teaching Facility provide for the care of small and large animals as well as the sophisticated equipment necessary for fetal and newborn surgery in animals.
First Year of Training Program, Senior Resident in Pediatric Surgery
The first year of the training program is designed to expose the resident to general pediatric surgery and a number of surgical and pediatric subspecialties.
The first two months are spent at Johns Hopkins Hospital with August rotations in both the pediatric intensive care unit and the neonatal intensive care unit, and a September rotation on the General Pediatric Surgery Service. The following six months are spent as the Chief Resident in pediatric surgery at the University of Maryland Hospital under the supervision of Dr. Voigt and staff.
Patients admitted to the pediatric surgical service are evaluated and treated under the Chief Resident’s direction. Care of surgical patients in the pediatric and neonatal intensive care units is the responsibility of the surgical housestaff under the supervision of this Chief Resident in pediatric surgery. This resident is the initial contact for all surgical and pediatric consultations.
At the University of Maryland, the Chief Resident is responsible for housestaff and student teaching on rounds and in the operating room. He/she organizes the weekly pediatric surgery conference and professors walk rounds as well as presentation of patients at the weekly General Surgical Morbidity and Mortality Conference, monthly Pathology Conference and monthly Radiology Conference.
The pediatric surgery faculty at the University of Maryland have active clinical and laboratory research projects and the Chief Resident is encouraged to participate in ongoing research or guided to begin an independent project.
During the last four months, the first year Resident returns to The Johns Hopkins Hospital as the Senior Resident in pediatric surgery. During this time, the senior resident may elect to rotate on the pediatric urology service under the supervision of Dr. John Gearhart, Chief of Pediatric Urology, on the pediatric gastroenterology service under the supervision of Dr. Maria Oliva-Hemker, Chief of Pediatric Gastroenterology, or on other subspecialty services as elective at the time. The Senior Resident will otherwise assist the Chief Resident in clinical care on the ward.
The Senior Resident alternates night call with the Chief Resident, attends ward rounds and, in general, assists the Chief Resident in the management of the clinical pediatric surgical service. During this first year of training, the resident is encouraged to initiate and/or collaborate in clinical research activities.
Second year of Training Program, Chief Resident in Pediatric Surgery
The second year of the two-year program is a diverse clinical year as Chief Resident. The responsibility of the Chief Resident is to supervise and coordinate pre-operative and post-operative care of all children with surgical conditions in the Johns Hopkins Children's Center. The Chief Resident renders direct surgical care to patients with problems in general pediatric, gynecologic, and all non-cardiac thoracic surgery. The Chief Resident coordinates patient care in the statewide regional pediatric trauma center and thus supervises the initial neurosurgical, orthopedic, plastic surgical and critical care for more than 1000 severely injured children each year.
He/she provides surgical consultation services for all divisions of the Children's Center and is thus involved in the general management of patients on the medical and surgical subspecialty services. He/she is the consultant for most surgical problems in the pediatric emergency room and outpatient clinics, particularly in the comprehensive child care clinic where more than 18,000 children are seen annually.
Overall management of surgical patients in the pediatric ICU and neonatal ICU is the primary responsibility of the Chief Resident and pediatric surgical housestaff working with the attending pediatric surgeons, staff intensives and neonatologists who attend in these units.
Surgical patients in the pediatric intensive care unit (PICU) remain on the pediatric surgery service and are cared for by an integrated housestaff. The responsibility for moment-to-moment ventilator adjustment and respiratory support is delegated to the pediatric intensive care residents, but the overall responsibility for the writing of medication orders and patient management, including cardiorespiratory support, remains with the pediatric surgery housestaff. The physician of record is the Staff Pediatric Surgeon.
Neonatal surgical patients are managed in a combined medical and surgical newborn intensive care unit (NICU), which is supervised by full-time neonatologists. The surgical patients in this unit remain on the pediatric surgical service and the responsibility for their management is in the hands of the Chief Resident in pediatric surgery. The physician of record is the staff surgeon. Direct patient management is rendered by the pediatric surgical service working with the pediatric housestaff assigned to a particular surgical patient in the NICU. The pediatric surgical team is responsible for daily management decisions on these patients. There is consultative input from the neonatologists in the management of these patients and they serve in an important teaching capacity for the pediatric surgical housestaff.
Teaching responsibilities of the Chief Resident include a weekly Morbidity and Mortality Conference, Pediatric Surgery Grand Rounds and combined Surgery/Neonatology Rounds. Additional conferences include a monthly Trauma, Basic Science, Pathology and Radiology Conference, Prenatal Conferences (with the Neonatology, OB-GYN and Sonography personnel), weekly Pediatric Grand Rounds, Surgery Grand Rounds, Neonatal Grand Rounds, a Surgery Research Conference, a Pediatric Morbidity and Mortality Conference and Pediatric Nutrition Rounds.
Both the Chief Resident and Senior Resident share teaching responsibilities with the full-time surgical staff. Housestaff and student teaching on afternoon ward rounds, as well as weekly formal discussions for students, are the responsibilities of the residents in pediatric surgery.
To meet the individual training needs of the fellow in pediatric surgery, elective time can be arranged during either the first and/or second year in a number of disciplines. Urology experience during the regular training program includes renal/adrenal tumors, genitourinary trauma, hernia/hydrocele, undescended testicle, testicular torsion and the initial management of cloacae exstrophy. One month intensive experience in pure pediatric urology (cystoscopy, diversion/undiversion and urethral surgery) can be scheduled with Dr. John Gearhart, Chief of Pediatric Urology, during the first year of training. Extended experience can be arranged beyond this rotation during the pediatric surgery residency.
The Johns Hopkins Children’s Center is designated by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) as a level one Pediatric Trauma Center and was recently re-verified in July of 2015. The Pediatric Trauma Center (PTC) treats patients less than and equal to 14 years of age arriving by EMS, and patients up to 17 years of age transferred from another facility. The PTS has a tiered trauma activation system, which includes Alpha, Bravo, trauma consults and Pediatric Emergency Department (PED) traumas. In 2014, the multidisciplinary PTS treated 956 injured patients; 566 of those patients were admissions to the Children’s Center. The adult and pediatric emergency departments share six trauma rooms; 4 rooms are adult-designated with pediatric capabilities, and 2 rooms are pediatric-designated with adult capabilities. All injured patients, regardless of stability, arrive through the PED in order for the PTC to complete primary and secondary surveys.
The Johns Hopkins Children’s Center was designated by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) as a Pediatric Burn Center in 2006 and was recently re-verified in July of 2015. The Pediatric Burn Service treats patients less than and equal to 14 years of age arriving by EMS, and patients up to 17 years of age transferred from another facility. The Johns Hopkins Bayview Medical Center is designated by MIEMSS to treat patients 15 years and older.
In 2014, the multidisciplinary Pediatric Burn Service treated a total of 416 pediatric burn patients arriving through the Pediatric Emergency Department; 188 of those patients were admitted. Critically injured burn patients are managed in the 40-bed Pediatric Intensive Care Unit, while other patients are managed on the 20-bed unit specifically designed for the care of burned children and their families. Additionally, approximately 400 outpatient burned children are treated each year in the Pediatric Outpatient Burn Clinic located in the David M. Rubenstein Child Health Building.
Alumni
Since 1965, a long line of talented and accomplished people have graduated from our fellowship. Notable alumni include James Talbert ’65, Paul Colombani ’83, Richard Azizkhan ’85, Francisco Cigarroa’93 and Jessica Kandel ’95 to name just a few.
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