Year Two and Three: ORTHOPEDICS (
4 weeks. 2 weeks)
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.
Assessment Method
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.
Level of Supervision
The resident is under the direct supervision of the assigned
orthopedic preceptor.
