The surgical faculty directly supervises the pediatric surgical fellow in both inpatient and outpatient surgery and in separate pre- and post-operative surgical office visits. Current supervision and teaching participation are completed within HCFA guidelines across the academic medical center.

Direct supervision in the neonatal intensive care unit and in the pediatric intensive care unit is provided by the pediatric surgical attending staff augmented by appropriate consultation with critical care faculty in neonatology and pediatrics, respectively. The pediatric urology service directly supervises the pediatric surgical fellow during rotation on these services. ECMO, burn, transplant, endocrine, and ENT patients remain under the care of the pediatric surgery team directed by the responsible attending.

The first-year fellow operates with attending surgeons on all portions of each case. A senior fellow performs all index cases under the direct supervision of the attending surgeons; the role of the attending surgeon on these cases is modified, as the fellow matures in confidence, judgment, and ability. Gradually, the chief resident assumes complete responsibility for operative decisions. The goal of the program is to train confident, independent pediatric surgeons. This goal can only be met by direct supervision, constant instruction, and a nurturing academic environment.