Orthopedics PGYII and PGYIII

Description of Rotation or Educational Experience

On this four-week PGYII rotation and again on a two-week PGYIII rotation the resident will recognize, assimilate, and master those aspects of orthopedic problems/diseases that are necessary for daily patient care. The needed skills will be obtained through several resources, including the attending orthopedist’s inpatient and outpatient private patients, the resident’s panel of patients at the FMC, didactic lectures, on-line resources (UpToDate, DynaMed) and conferences.

Goal I: To gain the knowledge and skills to manage the orthopedic problems commonly seen by Family Physicians.

Goal II: Recognize the need for proper referral and consultation to a specialist for those orthopedic problems that are beyond his/her capabilities.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

• Correctly apply an appropriate brace, splint or cast.
• Correctly interpret an orthopedic x-ray.
• Correctly administer a joint injection/aspiration.
• Assist in the surgical care of the orthopedic patient.

Objectives

The resident will

• Observe, discuss, and learn the proper application of an appropriate brace, splint, or cast.

• Observe, discuss, and learn the approach to orthopedic x-ray interpretation.
• Demonstrate an understanding of the indications, contraindications and interpretation of laboratory data
• Appropriate use of MRI, CT and bone scanning
• Observe, discuss, and learn to perform appropriate joint injections based on musculoskeletal site.
• Develop an appropriate treatment plan/rehabilitation plan and follow-up

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

• Be able to assess/evaluate the patient with joint pain.
• Be able to assess/evaluate the patient with extremity pain.
• Be able to assess/evaluate the patient with an acute musculoskeletal injury.
• Be able to assess/evaluate the patient with a chronic musculoskeletal injury.

Objectives

The resident will:

• Discuss the proper approach to the patient with joint pain with the orthopedic preceptor and develop the necessary differential diagnoses and treatments needed to ensure proper patient care.
• Discuss the proper approach to the patient with extremity pain with the orthopedic preceptor and develop the necessary differential diagnoses and treatments needed to ensure proper patient care.
• Use an appropriate approach to the patient with an acute musculoskeletal injury with the orthopedic preceptor and develop the necessary differential diagnoses and treatments needed to ensure proper patient care.
• Demonstrate understanding of the proper approach to the patient with a chronic musculoskeletal injury with the orthopedic preceptor and develop the necessary differential diagnoses and treatments needed to ensure proper patient care.
• Gain cognitive knowledge in the diagnosis and management of:
  • Common pediatric orthopedic problems
  • Strains/sprains including: shoulder, wrists, knee, ankle, foot, neck, back, finger, toe and elbow
  • Simple, stable, closed and nondisplaced fractures including: ribs, clavicle, humerus, wrist and forearm, hand, fibula/tibia, foot, vertebrae, lumbar or thoracic compression-type, patella, and unimalleolar ankle
  • Painful/swollen joints
  • Shoulder syndromes
  • Bursitis/tendonitis/tenosynovitis
  • Common foot disorders
  • Common back disorders
  • Infections of bones and joints
  • Muscular pain, swelling and injury
  • Dislocation
  • Tendon and nerve injuries
  • Osteoporosis
  • Complications of musculoskeletal trauma
  • Indications for various procedures including arthrography, myelography and arthroscopy

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies, and limits in one’s knowledge and expertise
• Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

Objectives

• The resident will gain a better understanding of which patients warrant consultation or referral and the preparation needed to facilitate an appropriate referral or consultation.
• The resident will utilize appropriate and respected medical literature to further their own understanding of the orthopedic patient and to gain an understanding of any new approaches or treatments to such patients.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
• Coordinate patient care within the health care system relevant to their clinical specialty.

Objectives

• The resident will gain an understanding of the delivery of care to the orthopedic patient regardless of in-patient or out-patient setting
• The resident will learn to coordinate in-patient and out-patient care of the orthopedic patient including but not limited to: physical therapy, occupational therapy, rehabilitation medicine, wound care, etc.

·         Advocate for quality patient care and assist patients in dealing with system complexities

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Objectives

• The resident will encounter a vastly diverse group of orthopedic patients based on exposure to the private orthopedic physician’s clinic and emergency room.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to communicate effectively with other physicians, staff, patients and families.

Teaching Methods

Direct preceptor/resident interaction in the inpatient and outpatient settings. 

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

The resident is under the direct supervision of the assigned orthopedic preceptor. 

Educational Resources

References available at the AHEC Library:

Canale St. Campbell’s operative orthopaedics. 4 volume set. 9^th ed. Mosby, 1999.

Salter, RB. Textbook of disorders and injuries of the musculoskeletal system. 3^rd ed. Williams and Wilkins, 1999.

Anderson BC. Office orthopedics for primary care: diagnosis and treatment. 2^nd ed. WB Saunders, 1999.

On Line resources:

UpToDate and DynaMed