Program Structure and Educational Goals

ROTATION LEVEL: PGY 1

An orthopedic residency program traditionally begins with a year of clinical experience. The first year includes three months of general orthopedic and three months of general surgery. The remainder of the year is spent on one-month rotations, with a variety of medical and surgical specialties relevant to the practice of general orthopedics. These include intensive care, emergency medicine and medical specialties such as neurosurgery and radiology. Clinical responsibilities progress as the individual’s knowledge, experience and confidence grow. This first year is designed to introduce the resident to the hospital setting and appreciate the importance of cooperative and comprehensive use of wide services while continuing to gain basic knowledge and develop general clinical skills.
GOALS
  1. Develop a basic and applied knowledge regarding problems facing orthopedic patients both from an orthopedic , surgical and broad medical perspective.
  2. Understand the relationship between medical and surgical specialties in our environment and the contribution that can be made to care of orthopedic patients.
  3. Become familiar with daily operations of a hospital including the facilities in the emergency room, operating room and the inpatient and outpatient services.

ROTATION LEVEL: PGY 2

The second year is composed of general orthopedics, trauma, sports medicine and foot and ankle surgery. The resident’s responsibilities in the second year include coverage of a variety of orthopedic cases electively scheduled during the week as well as outpatient clinic coverage during the week. Also, the resident is partially responsible for responding to emergency room calls during the day. During this year the resident is closely supported and supervised by both senior level residents and attending physicians in order to advance in operative and clinical skills. The resident at this level is encouraged to learn the importance of teaching other residents particularly from allied services including general surgery and emergency medicine and also helping medical students by rotating on a service to develop basic orthopedic skills.
GOALS
  1. Increase the basic general orthopedic knowledge acquired during the PGY 1 Year.
  2. Develop basic operative skill and techniques necessary to the practice of orthopedics.
  3. Increase decision making skills to deal with a variety of orthopedic problems seen during this year.
  4. Create and begin a clinical or basic research science project.
  5. Learn principles and techniques in pediatric orthopedics (see rotation specific objectives)

ROTATION LEVEL: PGY 3

The PGY 3 year is structured to allow the resident exposure to a variety of orthopedic subspecialties, such as pediatrics, hand surgery, trauma and research. The PGY 3 resident is introduces to orthopedic research and provides dedicated time for developing a research project, which must be completed prior to graduation. Each rotation is with a dedicated staff member and upper level resident who provides one on one guidance and teaching to the resident. The resident’s responsibilities and operative experience increases steadily in proportion to the individual’s knowledge and demonstrated operative skills. At this point the PGY 3 resident takes second call for operative cases admitted after hours as well as emergency cases and pediatric fracture care when assigned to the pediatric-orthopedic services. The resident is expected to run the day to day care of the in-patients service and provide coverage of the operative cases as directed by the chief resident.
GOALS
  1. Gain knowledge and experience in the orthopedic subspecialties including trauma, pediatric, and hand surgery.
  2. Continue to increase basic knowledge particularly as relating to subspecialties in orthopedics.
  3. Develop a general understanding of pediatric orthopedics as well as the management of acute pediatric trauma.
  4. Continue to develop surgical skills and mature judgment in selecting operative and non-operative management of acute orthopedic trauma.

ROTATION LEVEL: PGY 4

The PGY 4 resident is the senior resident on the pediatric orthopaedic rotation. The duties include covering operative cases, inpatient service, and a variety of pediatric orthopedic clinics. The remainder of the PGY 4 year is spent on spine, oncology and adult reconstruction.
GOALS
  1. Develop sufficient skills to function as a pediatric orthopedic chief resident.
  2. Increase clinical and operative skills necessary to care for pediatric orthopedic patients.
  3. Improve operative skills in total joint arthroplasty, spine and oncology.

ROTATION LEVEL: PGY 5

The final year of the residency is composed of trauma, sports medicine, general orthopaedics and upper extremity reconstruction. The service chief has the responsibility of running the general orthopedic service which includes emergency call or acute trauma of operative, non-operative, and preoperative decision making for elective cases. The final six months allows the resident’s positive experience allows him to mature and fine-tune the previous experiences and training. This provides an excellent opportunity for the individual to advance to either independent practice or further fellowship training after graduation.

In addition, the resident chief is paired with a PGY 2, 3 or 4 resident during rotations to provide a satisfactory educational environment at five different locations.
GOALS
  1. Develop confidence in the leadership roles of the orthopedic program as well as community responsibilities.
  2. Complete the required research thesis for graduation.
  3. Serve as a role model for all the resident s in the program to maintain a high level of excellence overall in teaching, research and patient care.

General Core Competencies

Resident training will be competency based and will focus educational outcomes. Residents will be required to demonstrate the general core competencies as required by the Accreditation Council of the Graduate Medical Education (ACGME) in each of their respective rotations throughout the entirety of their training experience. Residents will be formerly evaluated on their success in achieving the core competencies during each of their rotations.

Patient Care

Residents are expected to:
  1. Demonstrate the ability to provide patient care that is compassionate, appropriate, and effective for the treatment of patients.
  2. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
  3. Compile essential and accurate information about their patients.
  4. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment.
  5. Develop and carry out patient management plans appropriate for individual patient scenario.
  6. Counsel and educate patients and their families in an appropriate manner.
  7. Utilize information technology to support patient care decisions and patient education.
  8. Perform all medical procedures considered essential for the area of practice competent in accordance with their level of training.
  9. Provide health care services aimed at preventing health problems and maintaining health.
  10. Work directly with health care providers from the various disciplines to provide comprehensive patient care.

Medical Knowledge

Residents are expected to:
  1. Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences (e.g. epidemiological and social-behavior) and the application of this knowledge to patient care.
  2. Critically evaluate and demonstrate knowledge in an investigatory and analytic thought approach to clinical situations.
  3. Know and apply the basic clinically supportive sciences which are appropriate to orthopaedics.
  4. Ability to apply the knowledge base acquired from the medical literature in the management of cancer patients.
  5. Ability to critically review the medical literature and apply new research findings to clinical practice.

Practice-Based Learning and Improvement

Residents are expected to:
  1. Investigate and evaluate patient care practices.
  2. Appraise and assimilate scientific evidence.
  3. Improve their patient care practices.
  4. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.
  5. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
  6. Obtain and use information technology to manage information; access on-line medical information; and support his or her education.
  7. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
  8. Use information technology to manage information ; access on-line medical information and support
  9. Develop proficiency in the multidisciplinary care of breast cancer patients in cooperation with colleagues in medical oncology, surgery, pathology, diagnostic radiology, and in multidisciplinary conferences.
  10. Ability to discuss and critique the medical literature in the conference series, including: didactic conferences, case conferences, morbidity and mortality conferences, and journal clubs.
  11. Facilitate the learning of students and other health care professionals.
  12. Critique personal practice outcomes.
  13. Demonstrate recognition of the importance of lifelong learning.

Interpersonal and Communication Skills

Residents are expected to:
  1. Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient's families and professional associates.
  2. Create and sustain a therapeutic and ethically sound relationship with patients.
  3. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills.
  4. Work and communicate effectively with others as a member or leader of a health care team or other professional group.
  5. Counsel and educate patients and their families in a caring, compassionate manner, taking the appropriate amount of time with each family.
  6. Effectively document practice activities, counseling sessions, etc.
  7. Clearly explain the rationale, procedures and potential side effects and follow-up care after radiation therapy to patients and families, colleagues, peers and ancillary personnel (nurses, therapists, physician assistants and others).

Professionalism

Residents are expected to:
  1. Demonstrate a commitment to carrying out professional responsibilities.
  2. Adhere to ethical principles and sensitivity to a diverse patient population.
  3. Demonstrate respect, compassion and integrity.
  4. Demonstrate a responsiveness to the needs of patients and society that supersedes self-interest.
  5. Maintain accountability to patients, society and the profession.
  6. Maintain a commitment to excellence and on-going professional development.
  7. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  8. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
  9. Maintain a high level of ethical behavior.
  10. Demonstrate a commitment to continuity of patient care.
  11. Maintain a high level of ethical behavior.
  12. Demonstrate sensitivity to ethnic, social and psychological concerns of patient population.
  13. Demonstrate ethical principles in personal behavior and in interactions with patients and colleagues.
  14. Fulfill commitments to patients needs in a timely manner.
  15. Complete documentation in a thorough and timely manner.
  16. Attend to clinical responsibilities punctually and efficiently.
  17. Demonstrate a respectful demeanor towards patients and families, peers, colleagues and staff.

Systems-Based Practice

Residents are expected to:
  1. Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
  2. Demonstrate knowledge of risk-benefit analysis.
  3. Understand how patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
  4. Understand how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
  5. Practice cost-effective health care and resource allocation that does not compromise quality of care.
  6. Be an advocate for quality patient care and assist patients in dealing with system complexities.
  7. Understand how to partner with health care managers and health care providers to assess, coordinate and improve health care.
  8. Understand the activities that can affect system performance.
  9. Coordinate appointments with other physicians, or schedule appropriate tests as indicated with an understanding of the patient's insurance issues and geographical preferences.
  10. Assess psychosocial needs and refer the patient to appropriate services for social, psychological or financial assistance.
  11. Coordinate the patient's comprehensive cancer care and other medical needs during their therapy.
  12. Proficiency with departmental and hospital-based computer data systems and medical records databases.
  13. Understanding of billing and coding.