Musculoskeletal complaints are extremely common in the practice of primary care. They may reflect overuse or trauma, or be a manifestation of a broad range of musculoskeletal disorders or other systemic diseases. The Orthopedics rotation will provide the resident with exposure to patients with musculoskeletal disorders of autoimmune, congenital, degenerative, or traumatic etiology. The goal of the rotation is to provide the resident with opportunities in both the inpatient and outpatient settings to diagnose and manage musculoskeletal disease. Focus will be on learning normal and abnormal anatomy, the natural history of musculoskeletal disease (untreated, treated medically, and treated surgically), basic procedural skills, and the prevention, treatment and rehabilitation of musculoskeletal disease.
Faculty will facilitate learning in the 6 core competencies as follows:
I. All residents must be able to provide compassionate, culturally-sensitive, and appropriate care for patients with musculoskeletal disorders.
II. Residents will demonstrate the ability to take a pertinent history and perform a systematic physical exam, with emphasis on the musculoskeletal and neurologic exams. PGY1s should be able to elicit the timing, intensity, and impact on functional status of a patient’s symptoms. PGY1s should be able to obtain the following historical details:
PGY2s should be able to differentiate inflammatory from mechanical joint pain and recognize the contribution of comorbidities and medication compliance to a patient’s symptoms. PGY2s should be able to perform an appropriately targeted physical exam prior to sports participation.
PGY3s should be able to independently obtain the above details for patients with a complex medical history.
III. Residents should be able to characterize the following physical findings:
IV. Residents will understand the indications, contraindications, complications, limitations, and interpretation of following procedures, and become competent in the their safe and effective use:
I. PGY1s will develop an approach to the evaluation and treatment of the following presenting conditions:
PGY1s will explore the basic pathophysiology, clinical presentation, and treatment of more common conditions, such as Baker’s cyst, bursitis, carpal tunnel syndrome, costochondritis, ganglion cyst, hallux valgus, labral and meniscal tears, plantar fasciitis, Morton’s neuroma, osteoarthritis, osteoporosis and vertebral compression fracture, rotator cuff tear, scoliosis, tendonitis, and trigger finger.
PGY2s will also develop a more complete understanding of the pathophysiology, clinical presentation, and therapy for the following conditions:
PGY3s will also
II. Residents will understand the following principles of management and therapy for musculoskeletal disease:
III. All residents will be able to understand the indications for ordering and the interpretation of the following laboratory values and procedures:
PGY3s will independently, appropriately order studies and be able to interpret results within the context of patient comorbidities, pretest probability of disease, and patient values.
IV. All residents will spend some time in the operating room and become familiar with:
V. Residents should understand and be able to counsel patients on activity and exercise, prevention of musculoskeletal injury and re-injury, and appropriate use of physical and occupational therapy and referral for rehabilitation.
I. All residents should be able to access current national guidelines (e.g. American Academy of Orthopaedic Surgeons – Research & Quality, Clinical Practice Guidelines) to apply evidence-based strategies to patient care.
II. PGY2s should develop skills in evaluating new studies in published literature, through Journal Club and independent study.
III. All residents should participate in case-based therapeutic decision-making, involving the primary care provider, orthopedic surgeon, and where appropriate, rheumatologist. Residents should learn to coordinate patient care as part of a larger team, including the nurse, physical therapist, occupational therapist, and orthotics/prosthetics specialist to optimize patient care, and PGY3s should take a leadership role.
IV. All residents should respond with positive changes to feedback from members of the health care team.
I. PGY1s must demonstrate organized and articulate electronic and verbal
communication skills that build rapport with patients and families, convey
information to other health care professionals, and provide timely documentation in
the chart.
II. PGY2s must also develop interpersonal skills that facilitate collaboration with patients, their families, and other health professionals as well as with coaches, sports organizations, school administrators, and employers.
III. PGY3s should demonstrate leadership skills to build consensus and coordinate a multidisciplinary approach to patient care.
IV. PGY3s must be able to navigate complex discussions on sensitive topics with patients and their families.
I. All residents must demonstrate strong commitment to carrying out professional responsibilities as reflected in their conduct, ethical behavior, attire, interactions with colleagues and community, and devotion to patient care.
II. PGY1s should be able to educate patients and their families in a manner respectful of gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation on choices regarding their care.
III. PGY2s should be able to use time efficiently in the clinic to see patients and chart information.
IV. PGY2s should be able to counsel patients and families both on diagnostic and treatment decisions.
V. PGY3s should be able to provide constructive feedback to more junior members of the team.
I. PGY1s must have a basic understanding that their diagnostic and treatment decisions involve cost and risk and affect quality of care.
II. PGY2s must also demonstrate an awareness of alternative therapies and their costs, risks, and benefits.
III. PGY3s must be able to identify current quality issues in orthopedic surgery, particularly issues where the primary care physician may be involved in patient counseling and/or subsequent care, such as duration of postoperative DVT prophylaxis, use of vertebroplasty, and use of supplements for osteoarthritis.
I. Supervised patient care in the inpatient and outpatient setting and in the operating room.
II. Conferences
III. Independent study
I. Mini-CEX
II. Real time weekly feedback from attendings and Orthopaedic Surgery senior residents
III. 360 Evaluation
IV. Attending written evaluation of resident at the end of the month based on rotation observations and chart review.
I. Residents will meet with the Program Director and Chief Resident on the first Monday of the rotation at 0715 in the residency trailer. A schedule for the rotation will be provided at that time.
II. Residents will divide their time between the hospital, the operating room, and the clinic to achieve the above educational goals.
III. Call and weekend responsibilities TBD by the attending physician.
IV. Residents have scheduled mandatory didactics and should be excused in a timely fashion to attend.