Department of Orthopaedic Surgery
Resident Handbook
2009-2010
Table of Contents
I. Department Mission Statement
II. History of the Department
III. Program Description
1. Participating ...
1. Board Requirements
2. Conferences
3. Meetings/Courses/Travel
4. Travel Procedures
5. Library
6. Skills Lab
VIII. Resear...
DEPARTMENT OF ORTHOPAEDIC SURGERY
MISSION STATEMENT
The mission of the Indiana University Department of Orthopaedic Surger...
History of the Department of Orthopaedic Surgery
Indiana University School of Medicine
The Orthopaedic Residency Training ...
Loder, became Interim Chairman in July 2003. In February 2005, Dr. Jeff Anglen assumed the duties
of Chairman.
Program Description
The Indiana University Department of Orthopaedic Surgery Residency Training Program is a fully
accredi...
Participating Hospitals
Indiana University Hospital first opened in 1970 and has since been renovated. This modern adult
h...
famous Indiana Center for Surgery and Rehabilitation of the Hand and Upper Extremity where the residents in
Orthopaedic Su...
Faculty
Full-Time
Thomas A. Ambrose, II, M.D. Clinical Associate Professor
Jeffrey O. Anglen, M.D. Professor and Chairman
...
Methodist Hospital
Lance Rettig, M.D.
Volunteer Clinical Assistant Professor
Methodist Sports Medicine Center
Methodist Ho...
Dr. Merrill A. Ritter
Dr. Peter Sallay
Dr. D. Kevin Scheid
Dr. David G. Schwartz
Dr. K. Donald Shelbourne
Dr. James B. Ste...
Dr. Ambrose joined the Department in 1989. He received his medical doctorate from The Ohio State
University College of Med...
international meetings on adult hip surgery. He is past president of The Hip Society and The Society for
Arthritic Joint S...
Dr. Kacena joined the Department in 2007. Dr. Kacena received her Ph.D. in Aerospace Engineering
from the University of Co...
Loder completed his fellowship as the Harrington Fellow in Pediatric Orthopaedics and Scoliosis at the
Texas Scottish Rite...
Dr. Meldrum joined the Department in 2000. His clinical specialty is total joint replacement and
osteotomies. He attended ...
Presbyterian-St. Luke’s Medical Center in Chicago, Illinois. He then returned to Indiana University to join
the faculty. H...
Lance A. Rettig, M.D. earned his undergraduate degree at Indiana University-Bloomington and obtained
his medical degree in...
Charles H. Turner, Ph.D.
Chancellor's Professor of Biomedical Engineering
and Orthopaedic Surgery
Dr. Turner received his ...
Resident Position Description and Responsibilities
Indiana University Medical Center
Resident/Fellow House Staff
Position Description
Qualifications
Residency or Fellowship ...
Patient care responsibilities assigned to residents will be commensurate with their level
of training, according to ACGME ...
• Demonstrates the knowledge and skills necessary to provide care, based on physical,
socioeconomic, psychosocial, educati...
General Orthopaedic Resident Responsibilities
The following are general responsibilities that each resident is expected to...
The following are specific orthopaedic requirements
** You are responsible for applying and obtaining your **
DEA Certific...
6. The Senior Resident on the service is responsible for supervising patient care and is to
make daily rounds with the Jun...
Junior Resident (PGY-2 and PGY-3)
1. Takes first call for emergencies and inpatient care problems.
2. Is primarily respons...
Resident Call
** The phone call to the attending regarding any patient consults seen on call will either come from
the sen...
on call. While on the Hand Service, the resident will additionally take at home call within
the confines of the RRC work h...
Hand-Off of Call
Residents should not perform any manipulations or reductions of fractures or dislocations, or provide
any...
Resident Team Functions
This policy will apply to each rotation in which multi-resident teams are assigned to cover a grou...
6. The team should make rounds with the attending surgeon at least twice weekly in which patients are
presented and discus...
Hospital Admission Protocols
Indiana University Hospital Admissions
Clinic Admissions 274-7372
Patients are seen initially by staff. Upon staff decisio...
admission. The resident on call also should leave radiographs and CT scans in the Krannert
resident room.
Referring physic...
Riley Hospital Admissions
Clinic Admissions
Patients are seen by staff in clinic. History and Physical and orders are then...
The on-call resident should notify the Riley Senior Resident (PGY-4) at 6:30 a.m. of any admission, if
the Riley Senior Re...
VA Hospital Admissions
Clinic Admissions
Patients are evaluated by residents and labs and radiographs are ordered. Patient...
Wishard Hospital Admissions
Clinic Admissions 630-7318
Patients are evaluated by residents and appropriate studies are per...
History and Physical Exam
1. Each patient admitted to the Orthopaedic Service must have a History and Physical.
This can b...
Operative Reports
1. Each surgery is to be dictated immediately after the surgery is performed.
2. The resident in charge ...
that you finish all your records. If they are not done, then the resident’s next vacation will
be postponed for that year ...
ER and Floor Consults
Fill out a consult sheet with STAMPED patient name and number.
Consult must include the following in...
Discharge of Patient
1. Pre-plan discharge by consulting the appropriate Orthopaedic Department nurse and the
Social Worke...
Residency Program Goals and Objectives
Program Objectives
1. Provide adequate clinical training for an outstanding resident experience.
2. Provide the resident w...
Rotation Goals and Objectives
(See goals and objectives for each service)
Adult Reconstruction Rotation
Rotation Goals & Objectives
PGY-2 and PGY-4
GOAL:
The Adult Reconstruction Rotation is desig...
Reconstruction 3, AAOS
Color Atlas for Osteotomy of the Hip, Macnicol
COGNITIVE OUTCOMES
After completing this rotation, r...
2. Demonstrate maturity and professional judgment in caring for patients
3. Demonstrate professional interpersonal skills ...
The PGY-2 resident will
1. Gather essential information from the patient, available charts. The resident will demonstrate
...
The PGY-4 resident will
1. Gather essential information from the patient, available charts. The resident will demonstrate
...
6) monitor themselves for fatigue
7) dress professionally, as each resident represents both the department and the attendi...
Foot and Ankle Rotation
Goals and Objectives
PGY-2
GOAL:
Orthopaedic surgery residents will develop the essential knowledg...
prospective study. Am J Sports
Med 1996;24
Eisele SA, Sammarco GJ: Fatigue fractures of the
foot and ankle in the athlete....
lesions of the ankle in soccer
players. Am J Sports Med 1987;15
Rodeo SA, O’Brien S, Warren RF, et al: Turf toe:
An analys...
5. Demonstrate reliability and responsibility for patient care
6. Communicate the details of patient progress and complica...
BASIC DUTIES, GOALS, AND OBJECTIVES
The resident will
1. Gather essential information from the patient, available charts. ...
10. complete evaluation forms for rotation and for documents requested at the conclusion of each
rotation
11. read self-as...
Chain of Command and Faculty Supervision:
Patient care is provided using an academic model with a resident team comprised ...
Foot and Ankle Rotation
Scrub Policy
If a clinic day, residents should not wear scrubs but a tie and dress shirt.
For OR d...
Hand Rotation Goals & Objectives
PGY-3
GOAL:
Orthopaedic surgery residents will develop the essential knowledge, attitudes...
Repair
The Perionychium 389-416 Tetraplegia 1271-1296
Basilar Thumb Arthritis 461-488 Brachial Plexus Injury 1297-1374
Art...
5. Evaluate periodical orthopaedic surgical literature related to the patients’ health problems
6. Demonstrate the ability...
a. Confirm and review pertinent history and physical findings with fellows and attending staff
b. Review subjective and ob...
8. The PGY-3 Resident will provide on-call support in the emergency room working closely with
the Hand Fellow at St. Vince...
2. Evaluate residents’ teaching, time management skills, professionalism, communication skills,
patient care, and medical ...
Hand Rotation
Scrub Policy
On the hand service we prefer a lab coat in the clinic. Better yet a collared shirt and or tie ...
Musculoskeletal Oncology Rotation
Goals and Objectives
The Musculoskeletal Oncology Rotation is a comprehensive course des...
--Natural History pp. 3-7
Musculoskeletal Tumor
Syllabus
Service
Hand-out by
Dr. Wurtz
--Cellular and Molecular
Biology
pp...
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  1. 1. Department of Orthopaedic Surgery Resident Handbook 2009-2010
  2. 2. Table of Contents I. Department Mission Statement II. History of the Department III. Program Description 1. Participating Hospitals 2. Faculty 3. Resident Position Description 4. Call 5. Resident Team Functions 6. Hospital Admission Protocols 7. Reports, Consults, Discharge Summaries IV. Program Goals and Objectives 1. General 2. Rotation Specific V. Administrative Procedures 1. Conduct and Appearance 2. Department Social Events 3. Moonlighting Policy 4. Leave Policy 5. Salary 6. Contracts 7. Benefits 8. Disciplinary Action 9. Ethical Relationships with the Orthopaedic Industry VI. Evaluation 1. Resident 2. Faculty 3. Quality of Resident Education Evaluation 4. Evaluation of Lectures VII. Education
  3. 3. 1. Board Requirements 2. Conferences 3. Meetings/Courses/Travel 4. Travel Procedures 5. Library 6. Skills Lab VIII. Research IX. Appendices 1. ACGME Program Requirements 2. Liability Coverage 3. Medical Licensure 4. Resident Rotation Schedule 5. Department Phone Numbers 6. AdvaMed Code of Ethics on Interactions with Health Care Professionals 7. American Medical Association Guidelines Regarding Relations Between Industry and Physicians 8. AAOS Standards of Professionalism
  4. 4. DEPARTMENT OF ORTHOPAEDIC SURGERY MISSION STATEMENT The mission of the Indiana University Department of Orthopaedic Surgery Residency Training Program is to train orthopaedic surgery residents to become proficient in all aspects of orthopaedic surgery. This experience includes clinical training to become competent with the delivery of high quality care to patients with a variety of musculoskeletal conditions and to become familiar and involved with clinical and basic science orthopaedic research. This program also has the responsibility of educating medical students and allied health personnel in the basic aspects of orthopaedic surgery.
  5. 5. History of the Department of Orthopaedic Surgery Indiana University School of Medicine The Orthopaedic Residency Training Program started in the early 1930’s. This was a program that was directed by several early Orthopaedists practicing in the city. In the 1940’s the program became more organized under the direction of George Garceau, M.D. At that time, it was the Division of Orthopaedic Surgery within the Department of General Surgery. The education was performed by private physicians within the city and there was no full-time faculty. The residents were assigned to any one of several hospitals throughout their training program. These hospitals included Marion County General Hospital (Wishard Memorial Hospital), Veteran’s Administration Hospital, St. Vincent’s Hospital, Methodist Hospital, or University Hospital. The residents did not rotate from one hospital to another with the exception that all the residents rotated through Riley Hospital for children’s orthopaedics, under the direction of George Garceau, M.D. It is this common tie to the previous graduates of the Indiana Orthopaedic Residency Training Program that the alumni organization is called the Riley Alumni Association for the Department of Orthopaedic Surgery. In 1960, Dr. Garceau was instrumental in separating the Orthopaedic Service from the Department of General Surgery and formed an independent Department of Orthopaedic Surgery. In 1966 James B. Wray, M.D. became the first full-time Chairman of the Department of Orthopaedic Surgery and joined Bob Palmer, M.D., who was the first full-time member of the Department. Richard Lindseth, M.D. joined the Department in 1967. Since that time, the Department has significantly increased its number of full-time faculty members, including two full-time doctorate researchers. After his untimely death, Dr. Wray was succeeded by Donald Kettlekamp, M.D. who ultimately retired to become President of the American Board of Orthopaedic Surgery. The next Chairman, G. Paul DeRosa, M.D., also retired from the Department in 1994 to become President of the American Board of Orthopaedic Surgery following in the footsteps of Dr. Kettlekamp. His successor, Richard E. Lindseth, M.D., then became Chairman in 1995. Dr. Lindseth recently retired from that position, but continues to work as a full-time faculty member with robust clinical and academic responsibilities. In July 2001, Dr. Stephen B. Trippel became the Departmental Chairman. His successor, Dr. Randall T.
  6. 6. Loder, became Interim Chairman in July 2003. In February 2005, Dr. Jeff Anglen assumed the duties of Chairman.
  7. 7. Program Description The Indiana University Department of Orthopaedic Surgery Residency Training Program is a fully accredited, five-year program offering prospective resident candidates a broad spectrum of orthopaedic experience as graduate medical education. This training includes an initial PGY-1 year as a general surgical internship with rotations through a variety of surgical subspecialties and other related rotations as required by the Accreditation Council for Graduate Medical Education to prepare residents for specialty education in orthopaedic surgery. Upon successful completion of the PGY-1 year, residents then enter and progress through four years of comprehensive orthopaedic training in full compliance with the requirements outlined by the ACGME for residency education in orthopaedic surgery. Service rotations during the five years of training are located at medical facilities both on and off the campus of Indiana University Medical Center. These hospitals include Indiana University Hospital, James Whitcomb Riley Hospital for Children, Wishard Memorial Hospital, Methodist Hospital, the Richard L. Roudebush Veterans Administration Hospital, and St. Vincent’s Hospital. Presently, there are no rotations outside of the Indianapolis area.
  8. 8. Participating Hospitals Indiana University Hospital first opened in 1970 and has since been renovated. This modern adult hospital serves as a tertiary referral center for the state of Indiana. Major orthopaedic surgery emphasis includes total joint arthroplasty, musculoskeletal oncology, adult spinal deformities, and reconstructive upper extremity surgery. James Whitcomb Riley Hospital for Children remains the only Indiana hospital specializing solely in the care of children. As such, it is one of the largest children’s hospitals in the United States. This facility offers state of the art comprehensive care for diverse and often rare conditions afflicting children of all age groups. A recent multimillion-dollar addition to the children’s hospital is the Riley Outpatient Center (ROC), which considerably expands outpatient care of this preeminent children’s hospital and includes ambulatory surgical suites. Wishard Memorial Hospital currently has in excess of 600 inpatient beds and is a busy city/county hospital. It is an integral part of the Indiana University Residency Training Program in all disciplines. It offers full-time faculty staffing, a wide variety of general orthopaedics, musculoskeletal trauma, reconstructive surgery, and arthroscopy, as well as foot and hand surgery. As a Level I Trauma Center, Wishard Memorial Hospital provides ample clinical experience for orthopaedic trauma. Richard L. Roudebush Veterans Administration Hospital has in excess of 600 inpatient beds with a dedicated orthopaedic surgery ward. This facility offers the orthopaedic resident a busy clinical experience with a large adult reconstructive practice, mostly in the area of total joint arthroplasty, as well as spine surgery. A full-time faculty member assisted by other part-time faculty provide ample supervision of residents during this rotation. Methodist Hospital is one of the largest private hospitals in the country and boasts greater than 1100 beds with an Orthopaedic Surgery ward. Residents gain experience in a number of areas of orthopaedic surgery while rotating at this facility to include trauma, adult reconstruction, and sports medicine. Adjacent to this facility is the Thomas A. Brady Sports Medicine Clinic, one of the largest sports medicine clinics in the country and home to the Methodist Sports Medicine Group. St. Vincent’s Hospital, located on the north side of Indianapolis, is a large private hospital with greater than 650 beds with a busy general orthopaedic surgery service. It provides the resident with an opportunity for general orthopaedics and spine surgery in a community setting. Adjacent to St. Vincent’s Hospital is the world
  9. 9. famous Indiana Center for Surgery and Rehabilitation of the Hand and Upper Extremity where the residents in Orthopaedic Surgery obtain an extremely valuable experience in the care of upper extremity conditions, both traumatic and elective reconstructive problems.
  10. 10. Faculty Full-Time Thomas A. Ambrose, II, M.D. Clinical Associate Professor Jeffrey O. Anglen, M.D. Professor and Chairman Christine B. Caltoum, M.D. Assistant Professor William N. Capello, M.D. Professor Judd E. Cummings, M.D. Assistant Professor Jan P. Ertl, M.D. Assistant Professor Paul E. Kraemer, M.D. Assistant Professor Randall T. Loder, M.D. Professor John P. Lubicky, M.D. Professor G. Peter Maiers, M.D. Assistant Professor Russell D. Meldrum, M.D. Associate Professor Alexander D. Mih, M.D. Associate Professor Brian H. Mullis, M.D. Assistant Professor J. Andrew Parr, M.D. Assistant Professor Stephen B. Trippel, M.D. Professor Mark D. Webster, M.D. Assistant Professor L. Daniel Wurtz, M.D. Clinical Assistant Professor Volunteer Clinical Faculty – Chiefs of Service Thomas J. Fischer, M.D. Volunteer Clinical Associate Professor Indiana Hand Center St. Vincent Hospital David A. Porter, M.D. Volunteer Clinical Assistant Professor Methodist Sports Medicine Center
  11. 11. Methodist Hospital Lance Rettig, M.D. Volunteer Clinical Assistant Professor Methodist Sports Medicine Center Methodist Hospital Rick C. Sasso, M.D. Volunteer Clinical Associate Professor Indiana Spine Group Volunteer Clinical Faculty with Academic Appointments Dr. Steven K. Ahlfeld Dr. Robert M. Baltera Herbert M. Biel, MD Dr. David Brokaw Dr. Michael F. Coscia Dr. Jack Farr Dr. David A. Fisher Dr. Jeffrey A. Greenberg Dr. Hill Hastings Dr. Richard Idler Dr. Philip H. Ireland Dr. William B. Kleinman Dr. Stephen L. Kollias Dr. Thomas E. Klootwyk Dr. Sanford S. Kunkel Dr. Dean C. Maar Dr. Thomas W. Marshall Dr. John R. McCarroll Dr. Gary W. Misamore Dr. Jeffery L. Pierson Dr. Arthur C. Rettig
  12. 12. Dr. Merrill A. Ritter Dr. Peter Sallay Dr. D. Kevin Scheid Dr. David G. Schwartz Dr. K. Donald Shelbourne Dr. James B. Steichen Dr. James W. Strickland Dr. Terry R. Trammell Dr. Charles D. VanMeter Jeffrey O. Anglen, MD, FACS Professor and Chairman Dr. Anglen took over as Chairman in February of 2005. He received his medical degree from the Johns Hopkins School of Medicine in Baltimore in 1983, and stayed at Hopkins for a surgical internship and orthopaedic residency. After completing training in 1988, he entered private practice in Kansas City, Missouri for the next 3 years. Pursuing an interest in orthopaedic traumatology, he spent 6 months as a clinical instructor at Harborview Medical Center in Seattle, and 6 months as orthopaedic trauma fellow at Tampa General Hospital. His next 10 years were served on the faculty of University of Missouri at Columbia, practicing academic orthopaedic traumatology. He is a recent past President of the Orthopaedic Trauma Association, a Director of the American Board of Orthopaedic Surgery, and a member of the American College of Surgeons Committee on Trauma. His clinical interests are fractures of the pelvis and acetabulum, high energy periarticular fractures, nonunion and malunion, post-traumatic infection. Dr. Anglen has four children, ages 6 to 13, and his outside interests include Anthropology and American Literature. Thomas A. Ambrose II, MD, FACS Associate Professor of Orthopaedic Surgery Chief of Service, Clarian West Medical Center
  13. 13. Dr. Ambrose joined the Department in 1989. He received his medical doctorate from The Ohio State University College of Medicine, where he also completed his specialty training in Orthopaedic Surgery. Dr. Ambrose then went on to complete fellowships in Pediatric Orthopaedics at the Denver Children’s Hospital/University of Colorado and in Orthopaedic Trauma with the AO Group in Hannover, Germany and Basel, Switzerland. He then joined the Department and for the next 13 years, worked primarily in orthopaedic trauma at Wishard Hospital, ending his tenure there as Chief of Orthopaedic Trauma. For the past few years, Dr. Ambrose has focused his clinical interests in the area of adult reconstruction, with a special emphasis on joint replacement surgery and treatment of post-traumatic complications such as nonunion, infection, malunions and post-traumatic arthritis. He is one of only two orthopaedists in the city certified by the FDA in the performance of the Oxford unicompartmental knee replacement. Dr. Ambrose continues to work with the Trauma Service in an ancillary capacity. Dr. Ambrose’s research interests include developing new technologies for the treatment of severe musculoskeletal injuries as well as methods to improve the functioning and durability of total knee arthroplasties. David B. Burr, Ph.D. Professor of Anatomy and Orthopaedic Surgery Dr. Burr is Professor and Chair of the Department of Anatomy and Cell Biology, and Professor of Orthopaedic Surgery. He received his PhD degree from the University of Colorado in 1977, and joined the University in 1990 following appointments at the University of Kansas and West Virginia University. Dr. Burr's primary research interests center on the causes, prevention and treatment of osteoporosis, and on changes to collagen in diabetes. He has served as consultant to the U.S. Congress Office of Technology Assessment, American Institute of Biological Sciences and NASA. He served as President of the Orthopaedic Research Society in 2008-2009. He is the author of more than 190 peer-reviewed journal articles, 20 book chapters and 4 books. He has won grant awards from the Orthopaedic Research and Education Foundation, the National Institutes of Health, the Bi-national Science Foundation and the National Operating Committee on Standards for Athletic Equipment. William N. Capello, M.D. Professor Emeritus of Orthopaedic Surgery Dr. Capello joined the Department in 1975 and takes an active role in the clinical teaching of residents and interns, with an emphasis on hip surgery. Over the years, he has been instrumental in the development of several hip prostheses and related research investigations of these implants. He has given international and national symposiums on hip replacement and has participated in many other national and
  14. 14. international meetings on adult hip surgery. He is past president of The Hip Society and The Society for Arthritic Joint Surgery. He was elected to the prestigious International Hip Society in 1995. Judd E. Cummings, M.D. Assistant Professor of Clinical Orthopaedic Surgery Dr. Cummings joined the faculty in 2008. He received his medical degree in 2002 and completed his orthopedic surgery residency at The Campbell Clinic / University of Tennessee in 2007. He completed his fellowship training in Musculoskeletal Oncology at the University of Utah Huntsman Cancer Institute in 2008. His specialty interests include the treatment of both benign and malignant tumors of the musculoskeletal system in adults and children. Thomas J. Fischer, M.D. Volunteer Associate Professor of Orthopaedic Surgery Thomas J. Fischer, M.D. is a graduate of Butler University and earned his medical degree from Indiana University School of Medicine. Following his residency in Orthopaedic surgery at the University of Washington Affiliated Hospitals in Seattle, Dr. Fischer completed fellowships in hand and microsurgery at The Indiana Hand Center, Duke University in Durham, North Carolina, and a six-month fellowship in Switzerland and Germany. In 1986, Dr. Fischer joined The Indiana Hand Center staff where he is active in clinical practice, research, and teaching. In addition, Dr. Fischer is a Clinical Associate Professor in the Department of Orthopaedics at the Indiana University School of Medicine. He is in charge of the full-time hand surgery rotation for Indiana University Orthopaedic residents. In addition to publications in scientific journals and presentations before physicians, Dr. Fischer has been recognized for his written and spoken contributions to industry, insurance companies, and safety organizations alike. He is a member of the Hand Education Committee for AO North America and is a member of the Hand Expert Group for the AO Technical Committees. He is Chairman of the AONA Hand & Wrist Course and is the Co-Chair of the AO Trauma Hand and Wrist Course in Davos. He is a member of the Board of Trustees for Butler University and a team Physician for the Butler Athletic Department. Melissa A. Kacena, Ph.D. Assistant Professor of Orthopaedic Surgery
  15. 15. Dr. Kacena joined the Department in 2007. Dr. Kacena received her Ph.D. in Aerospace Engineering from the University of Colorado, Boulder in collaboration with Harvard Medical School and NASA Ames Research Center. Dr. Kacena completed her postdoctoral training in the Department of Orthopaedics and Rehabilitation at Yale University School of Medicine. While at Yale she was promoted to Assistant Professor of Orthopaedics and Rehabilitation. Dr. Kacena’s research focuses on the regulatory interactions between skeletal and hematopoietic cells. She has received numerous honors, young investigator awards, and grants for her research, including NIH funding. Paul E. Kraemer, M.D. Assistant Professor of Orthopaedic Surgery Paul E. Kraemer, M.D., an orthopaedic spine surgeon recently joined Indiana Spine Group. Additionally, he is an assistant professor at Indiana University School of Medicine, Department of Orthopaedics. Dr. Kraemer specializes in all aspects of spine surgery, including cervical, thoracic and lumbar. Dr. Kraemer received his medical degree from the University of Iowa College of Medicine in Iowa City, Iowa. He completed his residency at the University of Wisconsin in Madison, Wisconsin. Dr. Kramer completed his fellowship in orthopaedic spine surgery at Harborview Medical Center, University of Washington in Seattle. His special medical interests include orthopaedic spinal trauma, adult spinal deformity, and the prevention and treatment of adjacent segment disease. Involved in clinical research, Dr. Kraemer was the recipient of the OREF Resident Research Award in 2004 for his research study entitled, The Correlation of Microdiscectomy Outcomes with Apolipoprotein E and Catechol-O-Methyltransferase Genotype. He is a member of the North American Spine Society. Randall T. Loder, M.D. Professor of Orthopaedic Surgery Chief of Pediatric Orthopaedics, James Whitcomb Riley Hospital for Children Residency Program Director Dr. Loder joined the Department in 2002. Dr. Loder obtained his M.D. at Washington University School of Medicine, St. Louis and completed his orthopaedic residency at the Medical College of Ohio, Toledo. Dr.
  16. 16. Loder completed his fellowship as the Harrington Fellow in Pediatric Orthopaedics and Scoliosis at the Texas Scottish Rite Hospital for Crippled Children in Dallas. Dr. Loder is nationally known as a clinician, researcher, and educator, and is the recipient of multiple honors and awards. Dr. Loder will devote his clinical practice to the treatment of pediatric orthopaedic disorders. John P. Lubicky, M.D. Professor of Orthopaedic Surgery Dr. Lubicky joined the Department in 2006. His clinical interest is pediatric spine surgery, including all types of deformities (including fusionless techniques; vertebral body stapling and growing rods), tumors, infections and trauma; chest wall/thoracic insufficiency surgery; VEPTR; limb lengthening and deformity correction, spinal cord injury; neuromuscular and bone dysplasia conditions and general pediatric orthopaedics and trauma. Dr. Lubicky obtained his M.D. at Jefferson Medical College, Philadelphia and completed his orthopaedic residency at the Medical College of Virginia in Richmond. Dr. Lubicky completed a pediatric orthopaedic fellowship at Shriners Hospitals for Children in Chicago and a spine fellowship at Rush-Presbyterian-St. Luke’s Medical Center in Chicago. His current research interests include spinal deformities, limb length discrepancies and deformities, and pediatric spinal cord injury. G. Peter Maiers, II, M.D. Assistant Professor of Orthopaedic Surgery Dr. Maiers earned his undergraduate degree at Indiana University-Bloomington and obtained his medical degree in 2001 at the Indiana University School of Medicine. Following his residency in Orthopaedic Surgery at Indiana University, Dr. Maiers completed a Fellowship in Sports Medicine at the Cincinnati Sports Medicine and Orthopaedic Center in Cincinnati, Ohio, and then completed a Fellowship in Hip Arthroscopy at Nashville Sports Medicine in Nashville, Tennessee In 2007 Dr. Maiers joined the Department of Orthopaedic Surgery and Methodist Sports Medicine Center where he is active in clinical practice, teaching and research. His clinical interests include sports medicine with a focus on total knee care, ligament reconstruction, cartilage restoration and hip arthroscopy. He is also the team physician for Hanover College. Russell D. Meldrum, M.D. Assistant Professor of Orthopaedic Surgery
  17. 17. Dr. Meldrum joined the Department in 2000. His clinical specialty is total joint replacement and osteotomies. He attended medical school at the University of Utah and did his internship at UCLA-Harbor Medical Center. His orthopaedic residency was at the San Francisco Orthopaedic Residency program and fellowship at Massachusetts General Hospital in adult reconstructive surgery. His research interests include the mechanical testing of prosthetic implants and their biocompatibility. Alexander D. Mih, M.D. Associate Professor of Orthopaedic Surgery Dr. Mih joined the Department in 1990. His clinical specialty is hand and upper extremity surgery. He received his medical doctorate from the Johns Hopkins University School of Medicine and completed his residency at the Mayo Clinic. Dr. Mih completed his fellowship training at the Indiana Center for Surgery and Rehabilitation of the Hand and Upper Extremity in Indianapolis. His research interests are the study of patients undergoing repair of the brachial plexus, congenital hand disorders and tendon transfers. Brian H. Mullis, M.D. Assistant Professor of Orthopaedic Surgery Chief of Orthopaedic Trauma Service Dr. Mullis joined the Department in September 2006 and became Chief of Orthopaedic Trauma in December 2006. His clinical interests include acute trauma (periarticular, pelvis and acetabulum), malunions, nonunions and acute and chronic infections. He received his M.D. from the University of North Carolina School of Medicine in Chapel Hill and completed his residency at the University of North Carolina Department of Orthopaedics in Chapel Hill. Dr. Mullis completed his trauma fellowship training at Florida Orthopaedic Institute in Tampa. His research interests include basic science, biomechanical, retrospective, and prospective trauma projects. J. Andrew (Drew) Parr, M.D. Assistant Professor of Orthopaedic Surgery Chief of Adult Services, Indiana University Hospital Dr. Parr joined the Department in September 2004. He received his M.D. from Indiana University. He then completed his orthopaedic surgery residency at Case Western Reserve University School of Medicine. A fellowship in Adult Total Joint Reconstructive Orthopaedics was performed at Rush-
  18. 18. Presbyterian-St. Luke’s Medical Center in Chicago, Illinois. He then returned to Indiana University to join the faculty. His primary clinical interests are in the treatment of adult degenerative joint disease, primarily involving total arthroplasty techniques and osteotomies. His research interests are in the basic science areas of total joint prosthetic fixation and prosthetic interface mechanics with the bone. His clinical research interest is in the long-term follow up studies of patients with total joint arthroplasties. David Porter, M.D., Ph.D. Volunteer Assistant Professor of Orthopaedic Surgery David Porter, M.D., Ph.D. is a graduate of Ball State University and earned his medical degree from Indiana University School of Medicine. Dr. Porter also received his Ph.D. in Human Bioenergetics (Sports and Exercise Physiology) from Ball State University’s internationally recognized Human Performance Laboratory. Following his residency in Orthopaedic surgery at Wright State University in Dayton, OH, Dr. Porter completed his fellowship in Foot and Ankle surgery with Tom Clanton, M.D. and Don Baxter, M.D. in Houston, TX. Prior to his fellowship Dr. Porter also completed a 3 month senior elective in Foot and Ankle surgery with James Amis, M.D. in Cincinnati, OH. In 1996, Dr. Porter joined Methodist Sports Medicine Center staff where he is active in clinical practice, research, and teaching. In addition, Dr. Porter is a Volunteer Clinical Instructor in the Department of Orthopaedic Surgery at the Indiana University School of Medicine. He participates and is the primary instructor in the foot and ankle surgery rotation for Indiana University Orthopaedic residents. In addition to publications in scientific journals and presentations before physicians, Dr. Porter has been involved in written and spoken contributions to the NFL team physicians, American Orthopedic Foot and Ankle Society, and the American College of Sports Medicine. Dr. Porter just released his first book entitled “Baxter’s, The Foot and Ankle in Sports”. He is the Chief Editor of this international treatise on the diagnosis, care and treatment of athletic injuries to the foot and ankle. Dr. Porter also serves as the Foot and Ankle consultant to the Indianapolis Colts, Indiana and Purdue University as well as numerous other colleges in central Indiana. Dr. Porter has also been integrally involved in the care of professional athletes including the NFL, NBA and professional Ballet performers. Lance Rettig, M.D. Volunteer Assistant Professor of Orthopaedic Surgery
  19. 19. Lance A. Rettig, M.D. earned his undergraduate degree at Indiana University-Bloomington and obtained his medical degree in 1997 at the Indiana University School of Medicine. Following his residency in Orthopaedic Surgery at Indiana University, Dr. Rettig completed a fellowship in hand and microsurgery at the Curtis National Hand Center in Baltimore. In 2003, Dr. Rettig joined the Methodist Sports Medicine Center staff where he is active in clinical practice, teaching, and research. He is also a member of Reconstructive Hand Surgeons of Indiana. Dr. Rettig is in charge of the sports medicine rotation for Indiana University Orthopaedic residents. In addition, he is team physician for Lebanon High School and is an upper extremity consultant for Indiana State University. Rick C. Sasso, M.D. Volunteer Associate Professor of Orthopaedic Surgery Dr. Sasso earned his undergraduate degree at Wabash College in Crawfordsville, Indiana and obtained his medical degree in 1986 at the Indiana University School of Medicine. Dr. Sasso completed a residency in Orthopaedic Surgery at the University of Texas. Dr. Sasso is the Chief-of-Service of the Spine Rotation for Indiana University Orthopaedic residents. In addition, he is the Vice-Chairman of the Department of Orthopaedic Surgery at St. Vincent Hospital in Indianapolis. Stephen B. Trippel, M.D. Professor of Orthopaedic Surgery Dr. Trippel joined the Department in 2001. His clinical specialty is arthritis surgery. His research interests are in cartilage cellular and molecular biology. He received his medical doctorate from Columbia University College of Physicians and Surgeons. His internship and general surgical residency years were at the Peter Bent Brigham Hospital in Boston. His orthopaedic training was in the Harvard Combined Orthopaedic Residency Program. Fellowships included an Orthopaedic Research Fellowship at Massachusetts General Hospital and a Pediatric Endocrinology Fellowship at the University of North Carolina, Chapel Hill. Prior to coming to Indiana University School of Medicine, he served on the faculty at Harvard Medical School and practiced at Massachusetts General Hospital.
  20. 20. Charles H. Turner, Ph.D. Chancellor's Professor of Biomedical Engineering and Orthopaedic Surgery Dr. Turner received his Ph.D. degree in biomedical engineering from Tulane University in 1987 and joined the faculty at Indiana University in 1991 after four years with the Osteoporosis Research Center at Creighton University. He has won numerous awards for his research in musculoskeletal biomechanics and bone biology. Dr. Turner is the Director of Orthopaedic Research and the Associate Chair for Biomedical Engineering at IUPUI. Mark D. Webster, M.D. Assistant Professor of Clinical Orthopaedic Surgery Chief, Veteran’s Administration Hospital Dr. Webster joined the Department in August 2004. He received his M.D. from the State University of New York in Syracuse. He performed his orthopaedic residency at Northwestern University in Chicago. He has been in private practice in Illinois since that time. His practice is that of a general orthopaedist in the private community and is a significant asset to our general orthopaedic rotations. He has interests in sports medicine, total joints, and common trauma. L. Daniel Wurtz, M.D. Associate Professor of Clinical Orthopaedic Surgery Dr. Wurtz joined the faculty in 1997. He received his medical doctorate in 1984 and completed his orthopaedic surgery residency at Wilford Hall USAF Medical Center in 1991. After he served as an active duty orthopaedic surgeon in the U.S. Air Force, he completed his fellowship training in Musculoskeletal Oncology at the University of Chicago in 1996. his special area of expertise is the treatment of both benign and malignant tumors of the musculoskeletal system. He has a continuing interest in soft tissue and bone sarcomas.
  21. 21. Resident Position Description and Responsibilities
  22. 22. Indiana University Medical Center Resident/Fellow House Staff Position Description Qualifications Residency or Fellowship appointment from the Indiana University Medical Center and affiliated hospitals with a signed appointment letter on file in the Office of House Staff Affairs. • Valid Indiana medical license (temporary or permanent) Supervision The Resident/Fellow is supervised by Attending Physicians for all aspects of patient care. The Attending Physician is a credentialed member of the teaching and medical staff. The Attending Physician maintains full responsibility for patient care. Ultimately, resident/fellow performance is under the direction of the director of the residency training program. The competence of the house staff is evaluated on a regular basis. The program maintains a confidential record of the evaluation. Responsibilities The Resident/Fellow: • Provides initial medical care to assigned patients in ambulatory/outpatient or inpatient settings appropriate to the resident’s experience and ability.
  23. 23. Patient care responsibilities assigned to residents will be commensurate with their level of training, according to ACGME Special Requirements for the training program and the judgment of the Program Director. • Where appropriate, formulates a plan of care based on a thorough assessment of the patient’s history, current condition, and needs. • Writes orders for the implementation of the plan of care. • Coordinates consultations with physicians and other members of the multidisciplinary health team. • Facilitates communications regarding the plan of care with the patient, family, Attending Physician(s), and any other involved member(s) of the health team. • Performs and/or assists in procedures according to the level of delegation appropriate to the resident’s experience and ability. • Participates in education, research, and patient care experiences required by the particular program within which he/she is a trainee. • Supervises and teaches other house staff and medical students as appropriate. • Adheres to all policies and procedures for the Medical Staff of the Indiana University Medical Center and affiliated hospitals, including the “Personal Information for House Staff” and the Bylaws, Rules, and Regulations for the Medical Staff of the Indiana University Medical Center Hospitals. • Before rotating to another assignment, completes, in a timely fashion, all medical records assigned to him/her. • Participates in institutional orientations, relevant committees, projects, and other leadership assignments and activities involving the clinical staff.
  24. 24. • Demonstrates the knowledge and skills necessary to provide care, based on physical, socioeconomic, psychosocial, educations, safety and related criteria, appropriate to the age of patients served in the assigned service area. • Reflects a fundamental concern with and respect for patients’ rights. • Develops an understanding of ethical and medical/legal issues surrounding patient care, hospitals’ policies governing these issues, and structures available to support ethical decision making. • Sensitive to and employs cost containment strategies while caring for patients. • Conducts him/herself professionally, ethically, and personally in a manner consistent with the standards and aims of the medical staff of the hospitals.
  25. 25. General Orthopaedic Resident Responsibilities The following are general responsibilities that each resident is expected to fulfill: 1. Be on time for surgery. 2. If the surgical case is first in the morning, the resident is required to be there at 7:15 a.m. and assist in preparing the patient for surgery. 3. Maintain the dress code as outlined previously in the Orthopaedic Resident’s Handbook. 4. Be courteous, kind, and tactful in all relationships. 5. Promptly answer all pages. 6. A good resident history and physical must be on the chart of each patient. 7. Each resident is expected to attend clinic when scheduled, unless excused by the faculty Service Chief. 8. The first-call beeper is never to left unattended. It is to be handed off at 7:00 a.m. and new patients should be signed out at that time. 9. The chain of command is to be used at all times concerning on-call patients. 10. After the on-call resident evaluates a patient for admission, he/she should notify the Senior Resident on call and discuss the plan. The patient is then discussed with the faculty member on call. 11. While junior residents should discuss patients with senior residents, the faculty member on call is available to educate residents at any level of training and help with patient care issues. 12. Residents are expected to attend all conferences and be on time unless they are involved in surgery or urgent patient care. 13. All orthopaedic patients are the direct responsibility of every resident. When asked to see a patient, respond immediately, act appropriately and cheerfully. 14. No one leaves the hospital on surgery days without permission of the Senior Resident. Remember, the surgery schedule is a team effort. 15. A team member for each service will be responsible for that service’s patients and rounding on those patients every weekend.
  26. 26. The following are specific orthopaedic requirements ** You are responsible for applying and obtaining your ** DEA Certificate immediately upon receiving your Permanent Medical License (a copy should be placed in your file in the Administrative Office) Chief Resident (PGY-5) 1. Is responsible for the daily activities of the service, which includes inpatient, outpatient, and the operating area. 2. Is responsible for resident schedules to insure adequate attendance/coverage for surgeries. 3. Is responsible for getting staff okay and/or coverage for each case going to the operating room. 4. Is responsible for coordinating resident call coverage and working with the Academic Coordinator to publish the On-Call Schedule. 5. Is responsible for the overall management of the inpatients. 6. Is responsible for mentoring and teaching other residents and medical students. 7. Is responsible for organizing and maintaining control in all conferences. Senior Resident (PGY-4) 1. Is to support the Chief Resident. 2. Serves in a direct supervisory category for the Junior Resident. 3. The Senior Resident on the service of the on-call staff for the day is responsible for seeing consults received for the day. 4. If a specific staff member is consulted, the Senior Resident on his service is responsible for the consult and its presentation to the staff member. 5. A Junior Resident is not permitted to perform surgery unless he can demonstrate a workable knowledge of the anatomy entailed. The Senior Resident and staff member are to determine if the Junior Resident is properly prepared.
  27. 27. 6. The Senior Resident on the service is responsible for supervising patient care and is to make daily rounds with the Junior Residents. 7. The Senior Resident is responsible for discussing with the appropriate staff member patient care issues and management decisions. 8. The Senior Resident notifies and consults with the staff on all surgical patients and admissions. 9. The Senior Resident is responsible for mentoring and teaching junior residents and medical students.
  28. 28. Junior Resident (PGY-2 and PGY-3) 1. Takes first call for emergencies and inpatient care problems. 2. Is primarily responsible for histories and physicals, preoperative notes, discharge summaries, daily visits to the inpatients, the work-ups on new patients which should be complete, and for completing charts. 3. To directly support the Senior Resident. 4. To provide leadership and teaching for third and fourth year medical students. 5. The Junior Resident should consult with the appropriate Senior Resident when making medical management decisions. 6. Junior Residents are primarily responsible for all ward care and are to write meaningful daily progress notes. 7. A Junior Resident is not permitted to perform surgery unless he/she can demonstrate a workable knowledge of the anatomy entailed. The Senior Resident and staff member are to determine if the Junior Resident is properly prepared. 8. A Junior Resident is not to leave the hospital during the day without notifying his/her Senior Resident first. All Residents (PGY-1 through PGY-5) KNOWLEDGE ACQUISITION Education is an active process, not a passive process. It is very important that each resident create their own reading and studying schedule. At least 2 or 3 hours each day (weekends included) is strongly recommended. Start with the OKU, and continue with standard texts, especially for the rotations which you are on. Similarly, spend time reviewing old OITE exams, and review why the correct response was correct, and why the incorrect response was incorrect, and how they relate. Similarly, in addition to your standard reading schedule, you should also additionally read regarding cases the next day. If the resident comes unprepared regarding the anatomy, exposure, procedure, etc, then the attending surgeon is at liberty to take the case over and/or proceed with other courses of action.
  29. 29. Resident Call ** The phone call to the attending regarding any patient consults seen on call will either come from the senior/chief resident on call, or from the junior AFTER he/she has spoken with the senior/chief on call about the case. It is the responsibility of the senior/chief resident to make sure that the history obtained by the junior is correct and complete, that the physical exam findings are correct and complete, that adequate radiographs have been obtained and properly evaluated, and that the plan of care submitted to the attending is correct and reasonable. In many cases this will require the senior resident to evaluate the patient personally, but if you decide not to do that, better be sure the junior is right when he calls the attending. ** I. Guidelines 1. Prompt, courteous response to all calls is expected and mandatory. 2. All first call residents are to notify the Senior Resident on call if there are any problems, back ups, or surgeries. 3. Residents at any level of training should always ask for the advice or assistance of a more senior resident, then faculty, when presented with problems exceeding his/her level of training or knowledge. 4. All first call personnel should never be away from the hospital. 5. The staff physician on call is to be notified of all patients going to surgery or admitted to the hospital. II. Coverage 1. During the second year of training, the resident will take in house call for the on campus rotations. The resident will be the Junior Resident on call and cover the following hospitals: University Hospital, Riley Hospital, and VA Hospital. The resident, if not busy, is to assist the senior in house resident in coverage of Wishard Hospital. 2. During the third year of training, the resident will take in house call for the on campus rotations. The resident will be the Senior Resident on call and cover Wishard Hospital while on the Adult Reconstruction, Pediatric Orthopaedic, Trauma, and Tumor rotations. The resident will take the Junior Resident in house call while on the VA Hospital rotation. The Senior Resident in house, if not busy, is also to assist the Junior Resident
  30. 30. on call. While on the Hand Service, the resident will additionally take at home call within the confines of the RRC work hour limitations. This will be conducted under the strict supervision of the fellow or staff. 3. During the fourth year of training, the resident will take a combination of in house and home call for the on campus rotations. During the Trauma, Pediatric Orthopaedic, Sports, and Private Practice rotations, the resident will function as the Senior Resident taking in house call. During the Adult Reconstruction rotation, the resident will take home call and function as back up for University, Riley, VA, and Wishard call. 4. During the fifth year of training, the resident will take home call for the on campus rotations. The resident will function as the back up Chief Resident for the Wishard, University, Riley, and VA hospitals. III. Call Rooms and Meals 1. The primary call room is located on the fourth floor of Wishard Hospital. The additional call rooms are located at the following: University Hospital (seventh floor, penthouse floor – above the ICU’s, multi-service resident call rooms) and VA Hospital (fourth floor, surgery resident call room area). 2. Gold cards (meal cards) are distributed to residents in their PGY-1 year. The Residency Coordinator is responsible for making sure your card is credited the appropriate number of meals to cover your call schedule. Also, meal tickets are available for use at the Wishard cafeteria for on call residents. IV. Schedule 1. The call schedule for residents on each rotation is made by the Chief residents and submitted to the Program Director for approval.
  31. 31. Hand-Off of Call Residents should not perform any manipulations or reductions of fractures or dislocations, or provide any closed treatment of fractures or dislocations in the Emergency Department of any hospital without discussing it with the attending on call beforehand. There are significant issues of supervision, liability and billing for services involved in care of even the simplest fracture. If nothing else, we lose the opportunity to bill for this care if the attending can't be there because he or she was not told about it until after. On the weekend hand-off of call Saturday morning, Sunday morning and Monday morning, there should be a physical, face-to-face meeting of BOTH the senior and junior residents coming on and going off call. At that time, the team should go through the list not only of patients going to the OR, but fresh post-ops, consults, and any inpatients or outpatients treated in the last 24 hours, or with any pending issues. If someone is in the OR, then delay the hand-off until they are out or have it in the OR. The on call resident team must be familiar with patients treated the day before and with any active consult patients who need follow-up or monitoring. It might be helpful to use an actual written list with check off boxes, patient names, numbers, locations and pending issues - hand the list off like it is a baton. A casual phone call from one junior who has already left to another on campus is not an adequate handoff, and is a recipe for problems and missed issues, and errors in care. It is the responsibility of the PGY-5 Chief residents to make sure this occurs. If necessary, one of them should come in to make sure this handoff procedure happens.
  32. 32. Resident Team Functions This policy will apply to each rotation in which multi-resident teams are assigned to cover a group of patients at one or more hospitals: Trauma (Wishard), Pediatrics (Riley), Veterans Hospital, Adult Reconstructive (IU/Methodist). Team rounds have a long tradition in academic medical centers, on both medical and surgical services. Led by a senior or chief resident, team rounds consisting of all residents, interns, sub-interns, students and ancillary personnel, are central to both the teaching and patient care missions of the teaching hospital. These rounds provide the key opportunities for resident-to-resident and resident-to-student teaching, and maximize resident exposure to patients and clinical problems, which is of increased importance in the era of 80-hour work week restrictions. They optimize the care of the patient by providing for senior resident direction and supervision of all care, and facilitating communication by involving all residents in each patient’s care. Therefore, it is the policy of the Orthopaedic department that: 1. Every resident team should perform team rounds at least once daily, either in the morning before surgery, or in the evening after the surgery schedule is completed, or both. All residents and students will be involved and every patient will be seen. Patients will be presented to the chief or senior resident. 2. If necessary, the residents can perform individual pre-rounds to collect data such as labs, vitals, drain outputs, PT progress, nursing issues on some subset of patients, in order to facilitate the progress of team rounds. 3. The chief or senior resident on the service is responsible for organizing rounds, directing care, communicating important information to the attendings involved. 4. Every resident should be familiar with the history, exam, treatment and progress of each patient on the service each day. 5. In order to minimize pages interrupting the OR, all patient issues should be anticipated and dealt with on rounds. Ask the floor nurses for any concerns before leaving the floor. Make sure all orders are written, prescriptions, forms filled out, clear PT plans, discharge plans. Ask the patient or family if they have any questions.
  33. 33. 6. The team should make rounds with the attending surgeon at least twice weekly in which patients are presented and discussed. 7. Every surgical case and every clinic is a valuable learning opportunity. No resident on the team should forego helping in clinic or the OR during working hours in order to read, study, do academic work, prepare for conference or do any other activity unless on approved vacation time. Every resident assigned to a team should be involved in clinical activity during weekday working hours. If there is no clinical activity on the team due to attending absence or other reasons, residents are expected to help out with other teams who may have uncovered clinics or surgeries, e.g. if there are no cases at Riley due to the POSNA meeting, those residents should cover cases/clinics on adult reconstruction, trauma, or the VA, or with other attendings. 8. Residents should not leave for the day before sign-out or team rounds, unless they are post-call. Residents should not leave before the team’s work is done for the day unless excused by the Chief resident. No team clinics or cases should be left uncovered by residents going home. 9. Formal presentation of patient cases to senior residents and attendings on rounds, in clinic, or after consults is very important to the learning process. Preparing for case presentations helps to organize thinking, reduces the risk of overlooking key issues, identifies teaching opportunities, and increases efficiency of care. It is an important skill to master for oral Board exams. The case presentation should be clear, organized, comprehensive, focused and CONCISE. It should never take more than 3-5 minutes. It should include the following elements in approximately this order: a. Identification: name, age, gender, occupation b. Chief complaint c. Brief, chronologic history of the present illness d. Significant past medical history (including pertinent negatives) e. Treatment history f. Studies g. Current vitals and labs h. Examination results i. Plan
  34. 34. Hospital Admission Protocols
  35. 35. Indiana University Hospital Admissions Clinic Admissions 274-7372 Patients are seen initially by staff. Upon staff decision to admit the patient, the resident is notified. Whichever resident is out of the operating room then evaluates the patient and completes the History and Physical Examination and admission orders. Bed control is notified (274-7903) with patient’s name, medical record number, diagnosis, and anticipated length of stay – i.e. 23 hour observation or regular admission. Emergency Room Admissions 274-4705 The patient is evaluated by one of the residents on University service during weekdays from 7 a.m. – 5 p.m., or by the resident on call after 5 p.m. weekdays and on weekends. Appropriate labs and radiographs are obtained. The resident then develops an assessment and plan, with the help of the Senior Resident. Staff is then notified. If the patient is known and followed by a particular staff, then that staff member is notified. If unable to contact the staff then the resident calls the Clarian on-call staff. New patients are staffed with the Clarian staff on call. Bed Control is notified, as above. Outside of the hours of 7:00 a.m. – 5:00 p.m. and on weekends, the on call resident must contact the Senior Resident on call to discuss any patient needing admission or surgery. The residents on call will then notify the staff member on call. The on-call resident should notify the University Senior Resident at 6:30 a.m. of any overnight admissions, if the University Senior Resident was not on back up call at the time of the
  36. 36. admission. The resident on call also should leave radiographs and CT scans in the Krannert resident room. Referring physicians with potential transfers are deferred to the on-call staff. Residents do not accept transfers.
  37. 37. Riley Hospital Admissions Clinic Admissions Patients are seen by staff in clinic. History and Physical and orders are then done by the resident assigned to admitting staff for the day. If the staff does not have a resident in clinic, then one of the other Riley residents is then notified. Bed Control is then notified (274-7903) with the patient’s name, medical record number, diagnosis, and anticipated length of stay. Emergency Room Admissions 274-3936 Weekdays 7 a.m. – 5 p.m. Whichever Riley resident is available evaluates the patient and orders appropriate labs and x-rays. The patient is then staffed with the Riley staff on consults for the day (consult schedule is posted in the Riley residents room). If the staff decides to admit the patient, then the resident writes History and Physical and admit orders. Bed Control is notified, as above. Weekdays after 5 p.m. and weekends The junior resident on call evaluates the patient and orders labs and x-rays. The senior resident on in- house call is then notified with any questions. If the senior in-house call resident cannot answer the question or is unavailable, the junior resident should contact the chief resident on home call. The Pediatric on-call staff is then notified and the resident performs the History and Physical and admit orders. Bed Control is notified, as above.
  38. 38. The on-call resident should notify the Riley Senior Resident (PGY-4) at 6:30 a.m. of any admission, if the Riley Senior Resident was not on backup at the time of the admission. Films should be left in the Riley residents room. Referring physicians with potential transfers are deferred to the Riley on-call staff. Residents do not accept transfers.
  39. 39. VA Hospital Admissions Clinic Admissions Patients are evaluated by residents and labs and radiographs are ordered. Patient is then staffed with Dr. Meldrum during General Orthopaedic Clinic, or the staff responsible for specialty clinics, i.e. Spine and Foot. History and Physical and orders are then done by the resident and/or medical student. The residents or staff must countersign all medical student signatures. Emergency Room Admissions Patients are seen by the on-call resident and labs and x-rays are ordered. The senior resident is contacted for questions. Orders and History and Physical are done by the on-call resident, then the resident should contact the Clarian on-call staff. The on-call resident should notify the V.A. Chief of any overnight admissions at 7 a.m. and leave films in the Ortho call room. Transfers Any transfers must be accepted by staff physician on call. Do not accept transfers from outside hospitals to the Orthopaedic Service unless the patient is known to the Ortho Service and is healthy. Have the referring physician send the patient to the Emergency Room to be evaluated by the ER physician and Orthopaedic resident.
  40. 40. Wishard Hospital Admissions Clinic Admissions 630-7318 Patients are evaluated by residents and appropriate studies are performed. Patients are then staffed with whichever Wishard staff is responsible for the clinic. Orders and History and Physical are then done by residents. Admitting is notified by clinic nurses. Emergency Room Admissions From 7 a.m. – 5 p.m., Emergency Room consults are seen by residents and staffed with the Wishard staff on consults for the day. After 5 p.m. weekdays and on weekends, patients are evaluated by the on-call resident. The Wishard PGY-5 on backup call is contacted for questions. The on-call resident then staffs the patient with the Wishard staff on call. Orders and History and Physical are then done by the resident. Admitting is notified by the resident or Emergency Room nurses (630-7306). The resident on call then reviews admissions and consults with the Wishard team at morning report at 6:00 a.m. the following morning.
  41. 41. History and Physical Exam 1. Each patient admitted to the Orthopaedic Service must have a History and Physical. This can be dictated – one History and Physical per patient, per admission. 2. Student History and Physical’s must be cosigned by a physician. 3. The format for the History and Physical must include the following: • Chief complaint in patient’s own words • History of present illness • Past medical history • Past surgical history • Medicines • Allergies • Social history • Family history • Review of systems • Physical exam of all systems – with emphasis on range of motion of joints, description of wounds, muscle strength (0/5 – 5/5) and neuro exam. • Laboratory results at admission excluding EKG. • X-rays – within normal limits or if abnormal, a description of findings of all x-rays, including CT scans, MRI’s, tomograms, etc. • Diagnosis • Suggested plan of treatment • Work status – please write clearly with distinct answers
  42. 42. Operative Reports 1. Each surgery is to be dictated immediately after the surgery is performed. 2. The resident in charge of each case is responsible for the dictation. 3. Each Operative Report must include the following: • Staff name (State if staff was present – Very Important) • Date of Surgery – VERY IMPORTANT – not always the date dictated • State whether in-house patient or outpatient – VERY IMPORTANT • Surgeon and assistant • Anesthesia method (general, regional, etc.) • Pre and post op diagnosis • Name of procedure – VERY IMPORTANT • Short summary before procedure outlining the history and indications. • Work related injury or non work related injury • Dictation of definitive procedure to include amount of blood loss, hardware used, etc. • Include whether “sign your site” was followed, whether pre-operative antibiotics were given, whether “time out” was performed. • No abbreviations may be used 4. Please understand that dictation is a requirement for our Department by the hospital. This is monitored by the Department. Should this dictation not be done as required, the hospital could lose accreditation and the surgeon may lose privileges. 5. Never dictate “opinion” in medical record – only the facts! MEDICAL RECORDS, DICTATIONS, ETC. It is important that you keep these up and not get into delinquency situations. We need to have all records completed on the 15 th and 30 th of each month. Finally, at the end of each rotation we will ask
  43. 43. that you finish all your records. If they are not done, then the resident’s next vacation will be postponed for that year until finished.
  44. 44. ER and Floor Consults Fill out a consult sheet with STAMPED patient name and number. Consult must include the following information in a LEGIBLE fashion: 1. Date and time 2. Chief complaint 3. HPI – pertinent to reason consulted, referring physician 4. PE – pertinent to reason consulted 5. X-rays – description of each taken 6. Pertinent lab work 7. Diagnosis 8. Procedure with CPT code (do not forget post splinting/casting x-rays) Each consult sheet must have the following: 1. Staff on call 2. Diagnosis 3. Treatment 4. Follow up
  45. 45. Discharge of Patient 1. Pre-plan discharge by consulting the appropriate Orthopaedic Department nurse and the Social Worker, if necessary. 2. Write the discharge order. Write discharge prescriptions. 3. In the progress notes write a FPN (Final Progress Note) to include: • Diagnosis • Operation (if any) • Disposition 4. Fill out entirely the Patient Discharge Summary (Face Sheet). No abbreviations are allowed. No space can be left out. If nothing is applicable to the patient, write none. Write out diet and activity under discharge instructions. (You may use abbreviation for disposition only – example: “See Discharge Orders”) 5. A Discharge Summary must be dictated when the patient is discharged. When dictating the Discharge Summary, be sure to dictate the date of admission, the date of discharge, and indicate copies to be sent to other physicians involved.
  46. 46. Residency Program Goals and Objectives
  47. 47. Program Objectives 1. Provide adequate clinical training for an outstanding resident experience. 2. Provide the resident with opportunities to learn how to perform procedures under graduated supervision, and master surgical judgment and technique. Ultimately the resident will be capable of performing orthopaedic surgical procedures independently. 3. Guide the resident in development of critical diagnostic and analytic skills, both in patient care and in interpretation of orthopaedic literature. 4. Stimulate and develop the resident’s investigative skills through opportunities for clinical and basic research guided by orthopaedic faculty. 5. Help the resident to develop teaching, writing, and speaking skills to enhance career options and opportunities. 6. Provide the resident with the skills, resources and motivations to be a life-long learner, and continue their professional development after formal training ends. 7. Stimulate, encourage and reward professionalism in accordance with the values of Orthopaedic Surgery.
  48. 48. Rotation Goals and Objectives (See goals and objectives for each service)
  49. 49. Adult Reconstruction Rotation Rotation Goals & Objectives PGY-2 and PGY-4 GOAL: The Adult Reconstruction Rotation is designed to provide the Orthopaedic Resident a broad exposure to adult reconstructive extremity surgery. This is a unique opportunity to gain valuable insight to the way in which patients are managed in a health delivery system that emphasizes efficiency, technology, cooperation, patient education, compassion and empathy. The resident will experience the entire spectrum of orthopaedic care delivery, from initial evaluation, diagnosis, evaluative studies, determination of treatment plan, performance of therapeutic intervention, peri-operative care and post-operative follow-up and rehabilitation. EDUCATIONAL STRATEGY The duration of the Adult Reconstruction rotation is 10 weeks for each level resident. In addition to partaking in this rotation residents participate in teaching conferences. Suggested reading assignments to improve patient care and knowledge base for this rotation: TEXTBOOKS JOURNALS Pages : Pages : Campbell’s Operative Orthopaedics Journal of Bone and Joint Surgery - american Insall’s Surgery of the Knee Journal of Arthroplasty Hungerford and Krackow: Total Knee Arthroplasty Orthopaedic Knowledge Update: Hip and Knee
  50. 50. Reconstruction 3, AAOS Color Atlas for Osteotomy of the Hip, Macnicol COGNITIVE OUTCOMES After completing this rotation, residents will be able to: 1. Perform a thorough history and physical examination of adult patients with extremity complaints of pain, deformity or impairment 2. Evaluate, diagnose, and manage patients with the following: - Osteoarthritis of the hip, knee, and ankle - Degenerative joint disease of the upper extremity - Avascular necrosis of the femoral head - Limb malalignment - Joint infection 3. Support and execute the preoperative preparation of each patient 4. Support and execute the postoperative care and follow up for each patient 5. Anticipate, identify and manage common post-operative complications 6. Practice the principles of peri-operative patient protection and demonstrate an awareness of surgery associated safety issues 7. Construct a sophisticated knowledge base (sufficient to teach others, including patients) in: - preoperative preparation, especially in consideration of existing comorbid factors - operative procedure including pertinent anatomy and technical considerations - cost-effective strategies for patient evaluation - management of post-op care considering comorbid factors, basic disease process, and conduct of the procedure - surgical decision-making principles - outcomes based on principles of Evidence based medicine 8. Evaluate periodical orthopaedic surgical literature related to the patients’ health problems 9. Demonstrate the ability to execute care for patients on the service on a day-to-day basis AFFECTIVE OUTCOMES After completing this rotation, residents will be able to: 1. Put into practice self-directed learning habits
  51. 51. 2. Demonstrate maturity and professional judgment in caring for patients 3. Demonstrate professional interpersonal skills with patients, family members, and other medical personnel 4. Demonstrate reliability and responsibility for patient care 5. Communicate the details of patient progress and complications to attending in a timely fashion 6. Judge when to seek available assistance from attending 7. Counsel as to the risks and benefits of surgery as well as expectations and alternatives to surgery PSYCHOMOTOR OUTCOMES After completing this rotation, residents will be able to: 1) Show appropriate written documentation skills, especially with consult information 2) Demonstrate surgical technique appropriate for level under supervision of attending 3) Interpret radiologic studies that are common in the evaluation of the orthopaedic patient 4) Record and demonstrate competency in performing various surgical procedures including: a. total knee arthroplasty b. unicompartmental knee arthroplasty c. total hip arthroplasty d. hip hemi-arthroplasty e. revision total joint surgery f. osteotomy about the knee and hip g. knee and ankle arthrodesis 5) Demonstrate teaching skills essential for creating an excellent learning environment including: a) Confirm and review pertinent history and physical findings with attending staff b) Review subjective and objective evidence of patient progress or complications with attending staff c) Review pertinent laboratory and imaging data with attending staff d) Educate medical students in basic orthopaedic disorders, and the conduct of pre, intra, and postoperative care of orthopaedic patients BASIC DUTIES, GOALS, AND OBJECTIVES BY PG YEAR PGY-2 Resident
  52. 52. The PGY-2 resident will 1. Gather essential information from the patient, available charts. The resident will demonstrate an ability to perform an adequate physical examination of the entire musculoskeletal system, specifically the upper and lower extremities, including observation of gait. The combination of the history and physical examination information will then allow the resident to present his/her findings to the attending staff. 2. After discussion with the attending staff, the PGY-2 resident will be able to discuss the differential diagnosis and prognosis for the patient, and list treatment options with pros and cons, including both surgical and non-surgical treatment options. 3. The PGY-2 resident will become competent in preparing patients for surgery in the operating room by assisting in obtaining consent, appropriate pre-op consultations and clearances, writing appropriate pre-op orders, patient set-up and draping in conjunction with the attending physician. 4. The PGY-2 resident will be able to demonstrate the qualities of a good surgical assistant, including retraction, suction, wound closure. The resident will demonstrate use of orthopaedic tools and instruments in portions of each procedure consistent with their knowledge, experience and talent. 5. The PGY-2 resident will be able to satisfactorily demonstrate awareness of patient safety issues, and patient protection measures both in and out of the operating room, including confidentiality. The resident will demonstrate the ability to manage post operative care in patients undergoing standard orthopaedic procedures. 6. The PGY-2 resident will show appropriate respect and compassion to family needs concerning the patient’s progress, complications, and future plans for rehabilitation. The resident will demonstrate appropriate respect and reverence for their elders, especially attendings. 7. The PGY-2 resident will improve their skills in obtaining historical and physical examination information, by taking advantage of every patient contact as a learning experience. They will be able to begin formulating differential diagnoses and treatment plans on their own and then present those to the attending staff. 8. The PGY-2 will become proficient in common surgical procedures, such as placement of IV lines and foley catheters, and begin to learn the techniques of more advanced skills, such as arthroplasty and osteotomy. PGY-4 Resident
  53. 53. The PGY-4 resident will 1. Gather essential information from the patient, available charts. The resident will demonstrate an ability to perform an adequate physical examination of the entire musculoskeletal system, specifically the upper and lower extremities, including observation of gait. The combination of the history and physical examination information will then allow the resident to present his/her findings to the attending staff, including a differential diagnosis and proposed treatment plan. 2. After discussion with the attending staff, the PGY-4 resident will be able to formulate the treatment plan for common musculoskeletal disorders. 3. the PGY-4 will demonstrate the ability to perform a comprehensive pre-operative plan, and will teach this skill to more junior residents. 4. The PGY-4 resident will be able to perform and teach simple orthopaedic surgical. The PGY-4 will be able to perform the surgical exposure for many of the common procedures (proximal femoral osteotomy, open reduction of fractures, etc.). 5. The PGY-4 resident will be able to satisfactorily manage post operative care in patients undergoing standard orthopaedic procedures. The PGY-4 resident will demonstrate leadership by organizing daily rounds on inpatients to address patient concerns and teach more junior residents. 6. The PGY-4 resident will show appropriate respect and compassion to family needs concerning the patient’s progress, complications, and future plans for rehabilitation. 7. The PGY-4 resident will continue to improve their skills in obtaining historical and physical examination information. 8. The PGY-4 will become proficient in common surgical procedures, and begin to master the techniques of more advanced skills, and become more independent in performing common orthopaedic reconstructive procedures, such as primary total knee and hip arthoplasty. REQUIREMENTS Residents are to assume the following responsibilities: 1) develop a personal program of self-study and professional growth, including a personal reading schedule 2) participate in 1 full day or 2 half days of patient care clinics per week 3) complete medical records promptly 4) document duty hours 5) document all procedures in the ACGME Surgical Operative Log
  54. 54. 6) monitor themselves for fatigue 7) dress professionally, as each resident represents both the department and the attending physicians 8) participate in effective and compassionate patient care 9) organize M&M reports 10)provide a formal educational forum for medical students and junior staff at least once a week 11)complete evaluation forms for rotation and for documents requested at the conclusion of each rotation EVALUATION 1. Evaluate residents’ clinical performance and professionalism by having attending complete the Orthopaedic Department Resident Performance evaluation. 2. Review faculty evaluations with the residents at least every six months with the Program Director. Residents receiving multiple or repetitive check marks indicating problem areas must undergo remediation. 3. Review residents’ lists of procedures (SOL) at least every 6 months by Program Director. Chain of Command and Faculty Supervision: Patient care is provided using an academic model with a resident team comprised of junior level residents and medical students led by a chief resident. The team cares for all patients, making daily rounds both independently and with faculty supervision. Residents perform primary assessment of patients prior to surgery and assume progressive operative responsibility according to their level of experience and skill. Delegation of responsibility is made by the responsible attending faculty and chief resident. The degree of supervision varies with the level of training and knowledge of the individual resident’s experience, ability, and technical skills. Senior residents may act as teaching assistants to junior residents for certain types of cases; however, attending faculty are always present and/or immediately available at each institution including nights, weekends, and holidays based on 24-hour on-call schedules. Faculty supervision is required for all operative cases. The attending faculty is ultimately responsible for both the legal and ethical decision-making and the overall care and for supervision of the residents. Although sometimes difficult to master, faculty should strive to balance supervision in a manner that does not conflict with development of resident confidence, accountability, and independent decision-making.
  55. 55. Foot and Ankle Rotation Goals and Objectives PGY-2 GOAL: Orthopaedic surgery residents will develop the essential knowledge, attitudes, and skills in the diagnosis, operative care, and postoperative management of patients with foot and ankle ailments. The major thrust of the rotation is to allow the resident to be involved in the evaluation and care of patients with a wide range of foot and ankle disorders, as well as do initial evaluation, become proficient in foot and ankle examinations. In addition, the resident will be trained and educated in an office based orthopaedic practice, which includes learning appropriate closure techniques including patient instruction and post op dressing, bracing and cryotherapy. The residents will understand the duties and responsibilities of each team member and function accordingly within this training schema. EDUCATIONAL STRATEGY The duration of the Foot and Ankle rotation is 10 weeks for each PGY-2 level resident. In addition to partaking in this rotation residents participate in teaching conferences. Suggested reading assignments to improve patient care and knowledge base for this rotation: Pages Pages Mann RA, Coughlin MJ (eds). Surgery of the Foot and Ankle. 2nd ed. St Louis: Mosby-Year Book, 1993. Baxter DE: The foot in running. In Mann RA, Coughlin MJ (eds). Surgery of the Foot and Ankle. 2nd ed. St Louis: Mosby-Year Book, 1993. Beckham SG, Grana WA, et al: A comparison of anterior compartment pressures in competitive runners and cyclists. Am J Sports Med 1993;21 36-40 Bourne RB, Rorabeck CH: Compartment syndromes of the lower leg. Clin Orthop 1989;240 97-104 Eisele SA, Sammarco GJ: Chronic exertional compartment syndrome. Instr Course Lect 1993;42 213-217 Bennell KL, Malcolm SA, et al: The incidence and distribution of stress fractures in competitive track and field athletes. A twelve month 211-217
  56. 56. prospective study. Am J Sports Med 1996;24 Eisele SA, Sammarco GJ: Fatigue fractures of the foot and ankle in the athlete. Instr Course Lect 1993;42 175-183 Kaufman KR, Brodine SK, et al: The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 1999;27 585-593 Rettig AC, Shelbourne KD, McCarroll JR, et al: The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia. Am J Sports Med 1988;16 250-255 Bassett FH, Speer KP: Longitudinal rupture of the peroneal tendons. Am J Sports Med 1993;21 354-357 Brage ME, Hansen ST: Traumatic subluxation/dislocation of the peroneal tendons.. Foot Ankle 1992;13 423-430 Leach RE, Schepsis AA, Takai H: Long term results of surgical management of Achilles tendonitis in runners. Clin Orthop 1992;282 208-212 Lutter LD: Hindfoot problems. Instr Course Lect 1993;42 195-200 Maffulli N: Rupture of the Achilles tendon. J Bone Joint Surg 1999;81A 1019-1036 Maffulli N, Binfield PM, King JB: Tendon problems in athletic individuals. J Bone Joint Surg 1998;80A 142-144 Mandelaum BR, Myerson MS, Forster R: Achilles tendon rupture. A new method of repair, early range of motion, and functional rehabilitation. Am J Sports Med 1995;23 392-395 Porter DA, Mannarino FP, Snead D, et al: Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int 1997;18 557-564 Baxter DE: Functional nerve disorders in the athlete’s foot, ankle, and leg. Instr Course Lect 1993;42 185-194 Lau JT, Daniels TR: Tarsal tunnel syndrome: A review of the literature. Foot Ankle Int 1999;20 201-209 Schepsis AA, Bill SS, Foster TA: Fasciotomy for exertional anterior compartment syndrome: Is lateral compartment release necessary? Am J Sports Med 1999;27 430-435 Gill LH, Kiebzak GM: Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int 1996;17 527-532 Kwong PK, Kay D, Voner RT, White MW: Plantar fasciitis: Mechanics and pathomechanics of treatment. Clin Sports Med 1988;7 119-126 Marotta JJ, Micheli LJ: Os trigonum impingement in dancers. Am J Sports Med 1992;20 533-536 Marumoto JM, Ferkel RD: Arthroscopic excision of the os trigonum: A new technique with preliminary results. Foot Ankle Int 1997;18 777-784 Barrett JR, Tanji JL, et al: High- versus low-top shoes for the prevention of ankle sprains in basketball players, A prospective randomized study. Am J Sports Med 1993;21 582-585 Baumhauer JF, Alosa DM, et al: A prospective study of ankle injury risk factors. Am J Sports Med 1995;23 564-570 Gerber JP, Williams GN, et al: Persistent disability associated with ankle sprains: A prospective examination of an athletic population. Foot Ankle Int 1998;19 653-660 Hamilton WG, Thompson FM, Snow SW: The modified Brostrom procedure for lateral ankle instability. Foot Ankle 1993;14 1-7 Hopkinson WJ, StPierre P, Ryan JB, et al: Syndesmosis sprains of the ankle. Foot Ankle 1990;10:325-330. 325-330 Feder KS, Schonholtz GJ: Ankle arthroscopy: Review and long-term results. Foot Ankle 1992;13 382-385 Ferkel RD, Scranton PE: Current concepts review. Arthroscopy of the ankle and foot. J Bone Joint Surg 1993;75A 1233- 1243 Kumai T, Takahura Y, et al Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg 1999;81A 1229-1235 Loomer R, Fisher C, et al: Osteochondral lesions of the talus. Am J Sports Med 1993;21 13-19 McCarroll JR, Schrader JW, Shelbourne KD, et al: Meniscoid 257
  57. 57. lesions of the ankle in soccer players. Am J Sports Med 1987;15 Rodeo SA, O’Brien S, Warren RF, et al: Turf toe: An analysis of metatarsal phalangeal joint pain in professional football players. Am J Sports Med 1990;18 280-285 Sammarco GJ: Turf toe. Instr Course Lect 1993;42 207-212 COGNITIVE OUTCOMES After completing this rotation, the resident will be able to: 1. Evaluate, diagnose, and manage patients with the following: - Bunion, hallux rigidus, neuroma, hammertoes - Midfoot and Hindfoot arthritis - Achilles, peroneal, posterior tibial tendon tears, acute and chronic - Lateral ankle instability, anterior ankle impingement - Fractures of ankle, syndesmosis, metatarsals, calcaneus - Midfoot dislocations, ankle sprains, turf toe 2. Support and execute the preoperative preparation of each patient 3. Support and execute the postoperative care and follow up for each patient 4. Construct a sophisticated knowledge base (sufficient to teach others) in: a. preoperative preparation, especially in consideration of existing comorbid factors b. operative procedure including pertinent anatomy and technical considerations c. cost-effective strategies for patient evaluation d. management of post-op care considering comorbid factors, basic disease process, and conduct of the procedure e. surgical decision-making principles 5. Evaluate periodical orthopaedic surgical literature related to the patients’ health problems 6. Demonstrate the ability to execute care for patients on the service on a day-to-day basis AFFECTIVE OUTCOMES After completing this rotation, the resident will be able to: 1. Put into practice self-directed learning habits 2. Demonstrate maturity and professional judgment in caring for patients 3. Demonstrate professional interpersonal skills with patients, family members, and other medical personnel 4. Show the ability to work in an orthopaedic care team
  58. 58. 5. Demonstrate reliability and responsibility for patient care 6. Communicate the details of patient progress and complications to attending in a timely fashion 7. Judge when to seek available assistance from attending 8. Counsel as to the risks and benefits of surgery as well as expectations and alternatives to surgery PSYCHOMOTOR OUTCOMES After completing this rotation, the resident will be able to: 1. Show appropriate written documentation skills, especially with consult information 2. Demonstrate surgical technique under supervision of attending 3. Interpret radiologic studies that are common in the evaluation of the orthopaedic patient 4. Record and demonstrate competency in performing various surgical procedures including: a. ankle arthroscopy b. closure of all foot and ankle wounds c. ankle fractures d. Achilles repair 5. Demonstrate teaching skills essential for creating an excellent learning environment for the team including: a. Confirm and review pertinent history and physical findings with attending staff b. Review subjective and objective evidence of patient progress or complications with attending staff c. Review pertinent laboratory and imaging data with attending staff d. Educate medical students in basic orthopaedic disorders, and the conduct of pre, intra, and postoperative care of orthopaedic patients
  59. 59. BASIC DUTIES, GOALS, AND OBJECTIVES The resident will 1. Gather essential information from the patient, available charts. The resident will demonstrate an ability to perform an adequate physical examination of a patient for the entire musculoskeletal system, specifically the foot and ankle and leg, including observation of gait. The combination of the history and physical examination information will then allow the resident to present his/her findings to the attending staff. 2. After discussion with the attending staff, the resident will be able to formulate the treatment plan for patients with common foot and ankle ailments, common fractures, common bone and joint infections, and common acquired disorders [flat foot, Achilles rupture, ankle sprain]. 3. The resident will become competent in preparing patients for surgery in the operating room by assisting in patient set-up and draping in conjunction with the attending physician. 4. The resident will be able to perform simple orthopaedic surgical procedures such as removal of hardware. 5. The resident will be able to satisfactorily manage post operative care in patients undergoing standard orthopaedic procedures, such as ankle fracture, Achilles repair, ankle reconstruction. 6. The resident will show appropriate respect and compassion to family needs concerning the patient’s progress, complications, and future plans for rehabilitation. REQUIREMENTS The residents is to assume the following responsibilities: 1. develop a personal program of self-study and professional growth 2. participate in 1 full day or 2 half days of patient care clinics per week 3. complete medical records promptly 4. document duty hours 5. document all procedures in the ACGME Surgical Operative Log 6. monitor themselves for fatigue 7. dress professionally, as each resident represents both the department and the attending physicians 8. participate in effective and compassionate patient care 9. organize M&M reports
  60. 60. 10. complete evaluation forms for rotation and for documents requested at the conclusion of each rotation 11. read self-assessment exam foot/ankle, foot/ankle sports text EVALUATION 1. Evaluate residents’ clinical performance and professionalism by having attendings complete the Orthopaedic Surgery Department Resident Performance evaluation. 2. Review faculty evaluations with the residents at least every six months with the Program Director. Residents receiving multiple or repetitive check marks indicating problem areas must undergo remediation. 3. Review residents’ lists of procedures (SOL) at least every 6 months by Program Director.
  61. 61. Chain of Command and Faculty Supervision: Patient care is provided using an academic model with a resident team comprised of junior level residents and medical students led by a chief resident. The team cares for all patients, making daily rounds both independently and with faculty supervision. Residents perform primary assessment of patients prior to surgery and assume progressive operative responsibility according to their level of experience and skill. Delegation of responsibility is made by the responsible attending faculty and chief resident. The degree of supervision varies with the level of training and knowledge of the individual resident’s experience, ability, and technical skills. Senior residents may act as teaching assistants to junior residents for certain types of cases; however, attending faculty are always present and/or immediately available at each institution including nights, weekends, and holidays based on 24-hour on-call schedules. Faculty supervision is required for all operative cases. The attending faculty is ultimately responsible for both the legal and ethical decision-making and the overall care and for supervision of the residents. Although sometimes difficult to master, faculty should strive to balance supervision in a manner that does not conflict with development of resident confidence, accountability, and independent decision-making.
  62. 62. Foot and Ankle Rotation Scrub Policy If a clinic day, residents should not wear scrubs but a tie and dress shirt. For OR days residents can wear scrubs in between cases with a white coat if we see a patient. Residents are not to wear scrubs from home to wear in the OR.
  63. 63. Hand Rotation Goals & Objectives PGY-3 GOAL: Orthopaedic surgery residents will develop the essential knowledge, attitudes, and skills in the diagnosis, operative care, and postoperative management of patients with upper extremity orthopaedic conditions. The major thrust of the rotation is to allow residents to be involved in the evaluation and care of adults and children with a wide range of including traumatic, pathologic, rheumatologic, idiopathic, and congenital musculoskeletal disorders. In addition, each resident will be trained and educated in an office based private orthopaedic practice, which includes routine hand, wrist, and elbow pain and deformity. Residents will understand the duties and responsibilities of each team member and function accordingly within this training schema. EDUCATIONAL STRATEGY The duration of the IHC Upper Extremity Orthopaedic rotation is 10 weeks for each PGY3 level resident. Residents are assigned to Dr. Thomas Fischer. In addition to partaking in this rotation, residents participate in teaching conferences. Suggested reading assignments to improve patient care and knowledge base for this rotation: Green’s Operative Hand 5 th ed Green’s Operative Hand 5 th ed Pages: Pages: Acute and Chronic Infections in the Hand 55-158 Elbow Dislocation and Instability 907-938 Dupuytren’s Contracture 159-188 Elbow Arthroscopy 959-972 Extensor and Flexor Tendon Injuries 187-276 Elbow Arthroplasty 973-998 Fractures of the Metacarpals and Phalanges 277-342 Compression Neuropathies 999-1046 Dislocations and Ligament Injuries of the Hand 343-388 Nerve Palsy and Nerve 1075-1196
  64. 64. Repair The Perionychium 389-416 Tetraplegia 1271-1296 Basilar Thumb Arthritis 461-488 Brachial Plexus Injury 1297-1374 Arthrodesis of the Wrist 489-534 Embryology 1375-1380 Carpal Instability 535-604 Deformities of the Forearm and Hand 1381-1506 Distal Radius Fractures 645-710 Principles of Microvascular Surgery 1529-1568 Carpal Fractures 711-768 The Mangled Upper Extremity 1569-1628 Wrist Arthroscopy 769-808 Grafts and Flaps 1629-1776 Fractures About the Elbow 809-906 Compartment Syndrome 1985-2006 COGNITIVE OUTCOMES After completing this rotation, residents will be able to: 1. Evaluate, diagnose, and manage patients with the following: a. common rotational and angular deformities b. osteomyelitis and septic arthritis c. superficial and deep space infections of the hand d. nerve compression syndromes e. common tendonopathies, including DeQuervain’s, stenosing tenosynovitis, rupture, and fibrosis f. tumorous conditions of the upper extremity g. progressive or traumatic arthropathies 2. Support and execute the preoperative preparation of each patient 3. Support and execute the postoperative care and follow up for each patient 4. Construct a sophisticated knowledge base (sufficient to teach others) in: a. preoperative preparation, especially in consideration of existing comorbid factors b. operative procedure including pertinent anatomy and technical considerations c. cost-effective strategies for patient evaluation d. management of post-op care considering comorbid factors, basic disease process, and conduct of the procedure e. surgical decision-making principles
  65. 65. 5. Evaluate periodical orthopaedic surgical literature related to the patients’ health problems 6. Demonstrate the ability to execute care for patients on the service on a day-to-day basis AFFECTIVE OUTCOMES After completing this rotation, residents will be able to: 1. Put into practice self-directed learning habits 2. Demonstrate maturity and professional judgment in caring for patients 3. Demonstrate professional interpersonal skills with patients, family members, and other medical personnel 4. Show the ability to work in a private community based upper extremity orthopaedic care team 5. Demonstrate reliability and responsibility for patient care 6. Communicate the details of patient progress and complications to attending in a timely fashion 7. Judge when to seek available assistance from attending 8. Counsel as to the risks and benefits of surgery as well as expectations and alternatives to surgery PSYCHOMOTOR OUTCOMES After completing this rotation, residents will be able to: 1. Show appropriate written documentation skills, especially with consult information 2. Demonstrate surgical technique appropriate for each level under supervision of attending 3. Interpret radiologic studies that are common in the evaluation of the hand and upper extremity 4. Record and demonstrate competency in performing various surgical procedures including: a. fractures, both closed and open reductions b. nerve compression releases c. mechanical re-alignment (ulnar shortening osteotomy, distal radius wedge osteotomy) d. surgical care of septic arthritis and osteomyelitis e. surgical procedures in arthropathy (CMC arthritis, SLAC wrist) f. surgical management of basic tendonopathy (STS, DeQuervain’s, epicondylitis) g. excision or resection of tumors h. wrist and elbow arthroscopy 5. Demonstrate teaching skills essential for creating an excellent learning environment for the team including:
  66. 66. a. Confirm and review pertinent history and physical findings with fellows and attending staff b. Review subjective and objective evidence of patient progress or complications with attending staff c. Review pertinent laboratory and imaging data with attending staff d. Educate medical students in basic orthopaedic disorders of the hand, and the conduct of pre, intra, and postoperative care of upper extremity orthopaedic patients BASIC DUTIES, GOALS, AND OBJECTIVES BY PG YEAR PGY-3 Resident The PGY-3 resident will 1. Gather essential information from the patient. The resident will demonstrate an ability to perform an adequate physical examination for the entire upper extremity. The combination of the history and physical examination information will then allow the resident to present his/her findings to the attending staff. 2. After discussion with the attending staff, the PGY-3 resident will be able to formulate a treatment. 3. The PGY-3 resident will become competent in preparing patients for surgery in the operating room by assisting in patient set-up and draping in conjunction with the attending physician. 4. The PGY-3 resident will be able to perform common upper extremity procedures, such as closed reductions of forearm and hand fractures, drainage of joint infections, carpal tunnel releases, and pulley releases. The PGY-3 will be able to perform the surgical exposure for many of the common procedures (wrist, elbow, forearm) 5. The PGY-3 resident will be able to satisfactorily manage post operative care in patients undergoing standard orthopaedic hand procedures. 6. The PGY-3 resident will show appropriate respect and compassion to family needs concerning the patients progress, complications, and future plans for rehabilitation. 7. The PGY-3 resident is expected to spend time in the Hand Rehabilitation Center, which provides acute and long-term hand therapy and functional rehabilitation for our patients. The close relationship between the staff surgeons and the therapists is an indispensable part of our program, improving final hand function and lessening the degree of impairment. Through this association, the residents are expected to learn proper therapeutic management and the benefits of a close working liaison between surgeon and therapist.
  67. 67. 8. The PGY-3 Resident will provide on-call support in the emergency room working closely with the Hand Fellow at St. Vincent’s Hospital. This is in conjunction with his call duties at the University and in compliance with work hour guidelines. 9. The PGY-3 Resident is expected to review data and prior treatment plans for patients scheduled for surgery, and dictate all Admission History and Physicals and provide postoperative notes and orders following surgery. 10. The PGY-3 Resident must make daily rounds on patients in the hospital and keep accurate and timely notes, communicating and working closely with the Hand Fellow. 11. PGY-3 Residents must maintain good professional relations with all referring entities, internal staff and external health care professionals. They are expected to conduct themselves in a courteous and professional manner at all times. 12. PGY-3 Residents must attend all required educational meetings including Fracture Conference, Journal Club, and monthly physician lectures, as directed by Dr. Fischer. REQUIREMENTS Residents are to assume the following responsibilities: 1. develop a personal program of self-study and professional growth 2. participate in all clinical and surgical cases 3. complete medical records promptly 4. document duty hours 5. document all procedures in the ACGME Surgical Operative Log 6. monitor themselves for fatigue 7. dress professionally, as each resident represents both the department and the attending physicians 8. participate in effective and compassionate patient care 9. complete evaluation forms for rotation and for documents requested at the conclusion of each rotation EVALUATION 1. Evaluate residents’ clinical performance and professionalism by having attendings complete the online Surgery Department Resident Performance evaluation.
  68. 68. 2. Evaluate residents’ teaching, time management skills, professionalism, communication skills, patient care, and medical knowledge by having peers complete an evaluation after each rotation. 3. Review faculty, and peer evaluations with the residents at least every six months with the Program Director. Residents receiving multiple or repetitive check marks indicating problem areas must undergo remediation. 4. Review residents’ lists of procedures (SOL) at least every 6 months by Program Director and Medical Educator. Chain of Command and Faculty Supervision: Patient care is provided using an academic model with a resident and staff. Residents perform primary assessment of patients prior to surgery and assume progressive operative responsibility according to their level of experience and skill. Delegation of responsibility is made by the responsible attending faculty. The attending faculty are always present and/or immediately available at this institution including nights, weekends, and holidays based on 24-hour on-call schedules. Faculty supervision is required for all operative cases. The attending faculty is ultimately responsible for both the legal and ethical decision-making and the overall care and for supervision of the residents. Although sometimes difficult to master, faculty should strive to balance supervision in a manner that does not conflict with development of resident confidence, accountability, and independent decision-making.
  69. 69. Hand Rotation Scrub Policy On the hand service we prefer a lab coat in the clinic. Better yet a collared shirt and or tie underneath the lab coat. If it is a day when we do both office and OR or office and ER call, then a lab coat over the scrubs will suffice. Name badge and lab coat are more preferable than anything else. No scrubs alone. No dirty scrubs with ANY kind of body fluids on them.
  70. 70. Musculoskeletal Oncology Rotation Goals and Objectives The Musculoskeletal Oncology Rotation is a comprehensive course designed to introduce Orthopaedic Surgery residents to all aspects of contemporary evaluation and treatment of patients with benign and malignant bone and soft tissue tumors of the extremities, pelvis, and spine. This course includes didactic lectures and clinical experience in managing patients with these and related conditions. Currently, this course is designed as a 10-week rotation for the PGY-3 level residents; however, other year level residents also receive continued exposure throughout their residency to the oncology service lectures and weekly unknown cases. GOAL: Orthopaedic surgery residents will develop the essential knowledge, attitudes, and skills in the diagnosis, operative care, and postoperative management of patients with musculoskeletal tumors and related conditions. Residents will be involved in the evaluation and care of adults and children with a wide range of conditions, including both benign and malignant tumors of bone and soft tissue. Each resident will be trained and educated in aspects of inpatient and outpatient care in orthopaedic oncology. Residents will understand the duties and responsibilities of each team member of a multi- disciplinary oncology team. They will function accordingly within this training schema. EDUCATIONAL STRATEGY The duration of the Musculoskeletal Oncology rotation is 10 weeks for each PGY-3 level resident. Residents are assigned to Dr. Daniel Wurtz. In addition to partaking in this rotation residents participate in teaching conferences, as well as other pathology and oncology conferences. Suggested reading assignments to improve patient care and knowledge base for this rotation: Surgery for Bone and Soft Tissue Tumors Simon and Springfield, 1998 Musculoskeletal Oncology Service (Resident Duties and Responsibilities) Service Hand-out by Dr. Wurtz
  71. 71. --Natural History pp. 3-7 Musculoskeletal Tumor Syllabus Service Hand-out by Dr. Wurtz --Cellular and Molecular Biology pp. 9-20 Orthopaedic Knowledge Update – Musculoskeletal Tumors AAOS 2002, First Edition --Diagnostic Strategies pp. 21-30 Soft Tissue Tumors S. Weiss 4 th Edition --Diagnostic Imaging pp. 31-45 Musculoskeletal Surgery for Cancer – Principles and Techniques Sugarbaker, Malawar, Thieme 1998 --Staging Systems pp. 47-53 --Biopsy pp. 55-65 --Management of Surgical Specimens pp. 67-75 --Surgical Margins pp. 77-92 --Radiation Therapy pp. 93-95 --Principles of Chemotherapy pp. 97-103 Section: Benign Bone Tumors --General Classification pp. 119-124 --Common Benign Bone Tumors and Treatment pp. 181-206 Section: Malignant Bone Tumors --General Considerations pp. 227-232 --Chemotherapy pp. 239-244 --Common Malignant Bone Tumors pp. 265-298 Section: Soft Tissue Tumors --General Considerations pp. 499-508 --Diagnostic Strategies and Biopsy pp. 509-524 --Management pp. 525-576

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