Evelyn Siu ’15, The Children’s Hospital of Philadelphia

Day 1

On our first day at CHOP, we spent the day in clinic shadowing Dr. Howard Snyder ’65, a Senior Urologist in the Department of Urology. Everyone was really welcoming, and took time to accommodate our arrival. Dr. Snyder’s assistant, Ms. Brown, showed us around the urology department, and introduced us to all of the staff. Dr. Snyder had a full day lined up, and we were able to learn about the symptoms of common infections. Many of the cases were urinary tract infections. It was interesting to see how much Dr. Snyder relied on ultrasounds and other types of imaging in order to make a diagnosis. The nurse practitioner, Ms. Rudick, also took time to explain to us how to read the ultrasounds, and what abnormalities to look for. Throughout the day, Dr. Snyder also explained to us his work in lobbying Congress, and his role on different medical associations. It was eye opening to learn just how important government policy is to the day-to-day task of delivering medical care.

Day 2

Today we spent the day in the operating rooms. This was very exciting for me, since I had never observed any surgeries before. Though Dr. Snyder himself doesn’t operate anymore, we shadowed his colleague Dr. Lambert and the residents. The surgeries lined up for the day included testicular realignment, and hernia repairs. We were told that these surgeries were very typical. Dr. Lambert and the residents were very welcoming in answering questions, and made sure we understood what was going on. She was also very accommodating in making sure we could see what was going on. The entire operating room was equipped with video screens, and she also let us stand up on stools so we could view the surgery directly. Throughout the day, I also had a chance to talk with the residents about medical school, and why they decided to choose urology.

Day 3

Dr. Snyder, and the Princeterns

On our last day at CHOP, we spent half the day in clinic and half the day in the operating room. The cases in clinic this morning were more varied; there were cases of blood in the urine, a bike accident, and kidney stones. In the operating room, the cases were fairly similar to the ones we saw the previous day. We shadowed a different doctor today, and it was interesting to see the different approaches different surgeons had to the same cases. Once again, we had the opportunity to talk to the residents, and learn not only about the case going on, but also about life as a doctor. Overall, this was an amazing experience. Dr. Snyder is a great teacher, and has an extensive knowledge in all aspects of medicine. I would highly recommend this opportunity to anyone else interested in medicine!

Katherine Pogrebniak ’14, The Children’s Hospital of Philadelphia

Day 1

On the first day of our Princeternship, the other Princerterns and Itook three trains, walked about fifteen minutes, and arrived at nine o’clock at the Children’s Hospital of Philadelphia.  Sharon Brown, one of the administrators who works with Dr. Snyder, greeted us and gave us a tour of the Urology Department.  She showed us around the clinic, including the exam rooms, scheduling desks, and physician offices, introduced us to the residents, who would, later in the day, take me to the OR.  After the tour, the other two Princeterns spent the day shadowing Dr. Snyder in the clinic, while I spent the day in the operating room.  Due to the small size of the exam rooms, all three of us could not shadow Dr. Snyder at once, so we took turns alternating between the clinic and the OR.  I spent the first day observing three surgeries by Dr. Pat Casale.  Before today, I had never observed a surgery or been in an OR, so this was something I was looking forward to experiencing.  I felt quite professional in my blue scrubs and mask!  Dr. Casale is the Director of Minimally Invasive Surgery for the Urology Department: he specializes in laparoscopic and robot-assisted surgeries.  Today I was fortunate to see him, as well as the residents and fellow, Dr. Tasian, perform two laparoscopic surgeries as well as one surgery that required a larger incision due to the particularly complicated nature of the case.  Everyone in the OR was very welcoming, and Dr. Tasian was kind enough to explain to me the basics of each surgery before it began.  It was interesting to see how an OR is run with the urologists and anesthesiologists working together.  Care is put into every surgery.  For example, before an incision is ever made, the attending physician has to do a “time out” recognizing the OR team members present, reviewing the procedure that is to be done, and any relevant patient history.  After the surgeries for the day had ended, we returned to Dr. Snyder’s office and discussed various aspects of medicine, including his personal life story, public policy, and the Mutter Museum of Medical Sciences in Philadelphia.  He explained to us how there is a need for more young urologists.  Right now, the number of urologists is in decline and the average age of urologists is getting older.  This first day was an incredible way to start my Princeternship!  My biggest accomplishment:  not fainting or feeling sick during the OR procedures- Yeah!!

Day 2

Dr. Snyder, and his Princeterns

I spent today shadowing Dr. Snyder in clinic.  Dr. Snyder works closely with Nurse Practitioner Kristen Rudnick, so I was able to observe them working together as a team.   Dr. Snyder was often able to console anxious patients, telling them that surgery was unnecessary after reviewing the patients’ charts and medical tests.  Dr. Snyder explained that radiologists tend to report pathology instead of explaining what is actually seen on the ultrasound, causing patients to end up in Urology for a normal variant, rather than a pathological kidney.  I watched Dr. Snyder read multiple renal ultrasounds that day.  Dr. Snyder interacted amiably with both the patients and the parents, taking the time to make sure that the patient’s parents understood the diagnosis.  He then dictated a letter on each patient, while the patient was offered a sugarless lollipop!  In the evening we attended a radiology rounds meeting with the residents and attending physicians.  During this meeting, various residents presented the radiology images from particularly complicated cases so that all of the physicians could discuss the case and help the treating physicians ensure that they are following the most appropriate course of treatment.  I noticed during the meeting the amount of respect that the other physicians had for Dr. Snyder, the most senior attending physician.  They often said, “What do you think, Howard?”  What I learned today:  being a physician is not like what is seen on the TV show House.  Respect and teamwork are essential!

Day 3

On the final day, I spent the morning in the OR and the afternoon in the clinic.  In the morning, I observed Dr. Kolon, another of Dr. Snyder’s partners, in the OR.  I observed two of his procedures.  We spent some time talking about the best way to prepare academically for medical school.  In the afternoon, I shadowed Dr. Snyder again, learning more about methods for effective patient care.  Dr. Snyder gave me articles to read concerning common urological conditions that we had been seeing in patients that day.  Final thought:  this Princeternship crystallized my desire to become a physician.  I recommend this Princeternship to anyone interested in an up close and personal medical experience with multiple doctors and perspectives in a premier medical setting!   


Marina Nogueira ’15, The Children’s Hospital of Philadelphia

Tuesday, January 10, 2012

This morning I rode the train to Philadelphia with two other students to meet Dr. Howard Snyder ‘65 at the Children’s Hospital of Philadelphia. Dr. Snyder is a renowned urologist who helped establish the division at CHOP. When we arrived, Dr. Snyder and his assistant, Sharon Brown, were very welcoming and showed us around the Division of Urology. Evelyn Siu ’15 and I decided to shadow Dr. Snyder today in clinic. By 9:30 am, we were quickly absorbed into Dr. Snyder’s routine. His first patient was a baby girl who had recently been taken to the emergency room for a very high fever. She was suspected to have had a urinary tract infection (UTI). Dr. Snyder explained UTIs very carefully to the girl’s mother and I was impressed by Dr. Snyder’s focus on education. With all his patients, he made sure to explain to the parents what was occurring. It was clear that the parents found Dr. Snyder’s explanations very helpful, and reassuring in some cases. Other patients that came to Dr. Snyder today ranged in the ages from eight months to thirteen years old. Some of them had recent UTIs while others came in for kidney and reflux concerns. I learned the differences between the symptoms of a bladder infection versus a kidney infection and how to look at renal scans. I am really impressed by how much I learned today. Shadowing Dr. Snyder was very exciting and I cannot wait to come back tomorrow.

Wednesday, January 11, 2012

Dr. Snyder and his Princeterns

Instead of shadowing Dr. Snyder today in clinic, we were given the opportunity to shadow one of Dr. Snyder’s colleagues, Dr. Sarah Lambert, in the operating room (OR). We were introduced to the urology residents and were then shown to the locker rooms where we dressed in scrubs. In the OR, I saw the anesthesiologist team prepare the patient for surgery. Once the patient was anesthetized and doing well, Dr. Lambert and the resident surgeons were allowed to proceed with the operation. The three surgeries today included a hernia repair and an orchiopexy (an orchiopexy is an operation to move an undescended testicle into the scrotum). The duration of each operation ranged from 90 minutes to two hours and we were allowed to stand near the operating table to get a closer view of the operation. Throughout each operation, the residents and Dr. Lambert explained to me the process of the operation and what they were doing. I understood the general idea of each operation, but as for the specific steps, I was a little lost trying to distinguish the vas deferens, for example! The hernia repair was very interesting to watch as well because it proved to be a challenge and more difficult than expected. I was impressed to see the teamwork involved. The surgeons and nurses discussed the operation and what ought to be done, almost like working through a puzzle.

After Dr. Lambert finished operating for the day, Dr. Snyder took us to a meeting for the entire urology division. The residents presented difficult or challenging cases and asked for input. The cases provoked much discussion among all the surgeons as they presented various suggestions and ideas. I really enjoyed the opportunity to see on a first-hand basis the collaboration necessary in medicine. It was a long and tiring day, but I rode the train back to campus feeling very enthusiastic and satisfied with my day.

Thursday, January 12, 2012

In the morning, I first shadowed Dr. Snyder in clinic. Many of the cases were very similar to Tuesday. Dr. Snyder once again exhibited his expertise and dedication to teaching the parents of his patients. After seeing a few patients, I shadowed another surgeon in the OR. This time I saw two operations, a cystoscopy and another orchiopexy. The procedure for the orchiopexy was almost the same as what I had seen yesterday. The cystoscopy on the other hand was very different. The original intent of the procedure was to apply deflux inside the bladder at the opening of the ureters to prevent reflux. The surgeon inserted a camera through the urethra of the patient and into the bladder. The image was displayed on multiple screens throughout the room and I was able to clearly see the tissue lining the urethra and the bladder. The residents looked for the openings to the ureters, which proved to be very difficult due to the anatomy of the patient’s bladder. As a result, they were unable to proceed with the procedure and had to finish the cystoscopy as they discussed further possible treatments. After the cystoscopy, we talked for some time with the residents about pursuing a career in medicine and surgery. I found that talking to the residents was very valuable because they recently had finished medical school and were familiar with the process in general. Soon it was time to say good-bye to everyone at the urology division of CHOP. We all felt a little sad about leaving, as we had just gotten to know everyone and we were having a fantastic time. I thoroughly enjoyed my experience at CHOP and I am so thankful to Dr. Snyder and everyone in Urology for giving me the opportunity to really see what a career in surgery entails.