C. SPECIFIC OBJECTIVES AND RESPONSIBILITIES BY YEAR OF TRAINING (PROGRESSIVE LINES OF RESPONSIBILITY)
The residency program’s curriculum develops the competency necessary for the practice of quality and safe medical care. Competency is defined by level of training and the venue of medical care. Specific objectives and responsibilities are evaluated using the above methods.
1. PGY-1 Residents:
First year residents are accepted through the National Residency Matching Program. The intern is assigned to the 2015-2016 DEPARTMENT OF ORTHOPAEDIC SURGERY Service at one of the participating training institutions. He or she is under the supervision of the Chair of the Department, the Program Director, full time faculty, and supervising residents.
The goal of the first year is to acquire diagnostic, therapeutic and prognostic skills through participation in direct patient care in supervised inpatient and outpatient settings. A typical year includes:
7. Six months ortho
a. General Knowledge: The first-year resident obtains knowledge related to the presenting manifestations, natural history, complications, pathophysiology, differential diagnosis, and appropriate diagnostic and management plans for the most common diseases and conditions in the practice of the specialty. This includes diseases and conditions seen in ambulatory patients, emergency departments, regular hospital services and intensive care units. The intern develops proficiency in the interpretation of diagnostic studies used in the evaluation of common diseases in the specialty. First year residents also acquire knowledge about the indications, limitations, complications and cost effectiveness of common diagnostic tests and procedures. The first year resident obtains knowledge of the therapeutic indications used for the management of the common diseases in the specialty.
First year residents learn systems-based care by participation in a longitudinal instructional curriculum on the systems of medical care, including didactic lecture/seminars, clinical practice, morbidity/mortality conferences, and participation in Quality Improvement experiential learning projects. First year residents are introduced to medical research by participating in a year-long, longitudinal curriculum including a monthly journal club and basics of research sponsored by the Department’s faculty., or original research) to a local or national organization.
PGY 1 Residents – General Trauma
Beginning July 1, 2000, the design, implementation, and oversight of the PGY 1 is under the direction of the Orthopaedic Residency Program Director. There are six months of structured education in surgery, and six months of orthopaedics. This includes two months as a resident on one of the surgical trauma teams at University Hospital. During this time residents are involved with every aspect of care of the polytrauma patient including pre-operative, intra-operative, and post-operative care. The high volume of trauma patients seen at this institution gives the resident an opportunity to participate in all facets of the management of patients with trauma. Overall supervision for the rotation is by the faculty in the Department of Surgery here at Tulane.
The educational goal of this rotation is to provide the resident with exposure to the care of patients requiring operative management of complex wounds, cosmetic procedures, and reconstructions. The environment of a large tertiary care teaching hospital offers an experience in the multidisciplinary management of patients and the working relationships among surgeons, referring physicians and consultants. Residents receive experience in skin grafting, muscle flaps, free flaps and other experience with soft tissue wounds and wound coverage.
Physical Medicine and Rehabilitation (Physiatry)
The educational objectives for residency education in physiatry are:
1. to provide a base fund of knowledge and organized clinical approach to the subspecialty of Physiatry as part of the general education of orthopaedic residents;
2. to provide the resident with the ACGME Residency Review Committee Core Competencies.
The residents will learn to diagnose and treat patients of all ages in three major categories of medical care. The first is the diagnosis and treatment of acute musculoskeletal pain syndromes. These run the gamut from industrial or sports injuries to degenerative conditions as common as arthritis or low back pain.
The second category involves working with professionals such as physical therapists, occupational therapists, recreational therapists, rehabilitation nurses, psychologists, social workers, speech-language pathologists and others.
The third category is electrodiagnostic medicine. The resident is exposed to and gains experience in electromyography, nerve conduction studies, and somatosensory evoked potentials. There will be close interaction and supervision of the residents by involved faculty.
Musculoskeletal Radiology Rotation
This rotation provides the resident with ample exposure to individual and didactic instruction on radiologic examination of the musculoskeletal system. Fellowship-trained musculoskeletal radiologists provide in-depth training in the interpretation of plain radiographs, ultrasound, computed tomography, Magnetic Resonance Imaging and nuclear medicine techniques.
Emergency Medicine Rotation
The Emergency Medicine rotation provided the resident with invaluable experience in the initial management and triage of a variety of medical conditions. This rotation also fosters good working relationships with fellow residents and emergency medicine attending physicians with which the resident will be considerable interaction during his orthopaedic consultations in the ER throughout his training.
Orthopaedic Surgery Rotation
The PGY 1 residents will spend six months on orthopaedic surgery during which time they will learn the basics of pre- and post-operative care of orthopaedic patients. They will also learn assessment and management of orthopaedic injuries including the application of splints, casts and traction.
2. PGY-2 Residents:
The rotation schedule for the second-year residents is adjusted to individual preference when possible. The goal of the second-year resident is to expand the diagnostic and clinical skills learned in year one. Residents learn the principles of subspecialties within the field via rotations on inpatient, outpatient and consultative services. Ambulatory and inpatient skills are enhanced. Residents learn leadership and educational skills via supervision of the junior residents. A typical second-year resident’s schedule is as follows:
A typical year includes:
2. Eight months University Hospital, orthopaedic service
a. General Knowledge:
The second-year resident is expected to expand the fundamental knowledge obtained in the first year of training. Specifically, knowledge on the diagnosis and treatment of less common diseases is acquired during the second year. By the beginning of the second year, the resident should have performed enough procedures and/or patient encounters to begin to demonstrate mastery of each. During the second year, the resident improves mastery of these skills.
Second-year residents are expected to continue to develop interpersonal skills, leadership, self-reflection and improvement, an understanding of systems of care, clinical education and ethical and professional refinement.
3. PGY-3 Residents:
The longitudinal development of the resident’s clinical and diagnostic skills culminates in the third year. The goal is to solidify the knowledge and skills of the specialty. The major emphasis is on supervision of junior residents. Additional experience in a supervisory capacity is provided in all rotations. Additional electives prepare the resident for clinical practice. As a consultant, the resident learns to provide consultation of the specialty to other specialties. A typical third-year schedule includes six months of dedicated pediatric orthopaeadics.
a. General Knowledge:
The third-year resident increases his or her knowledge of core topics in the specialty, with special interest in subspecialty areas of the specialty. The curriculum is tailored to the resident’s individual interests. The resident continues improving the life-long habits of self-study, self-reflection and improvement, reading the medicine literature, teaching and research.
4. PGY 4 Resident: a typical PGY 4 year consists of:
1. Four months University orthopaedic surgery service
2. Eight months Tulane subspecialty services
5. PGY 5 Resident: a typical PGY 5 year consists of:
1. four months University Hospital orthopaedic surgery service
2. eight months Tulane subspecialty services
D. SUMMATION OF A SAMPLE CLINICAL CURRICULUM/ BLOCK DIAGRAMS
Multi-system trauma 2 months 8
Emergency room 1 month 4
Plastic Surgery 1 month 4
Radiology 1 month 4
PM&R 1 month 4
Orthopaedic Surgery 6 months 24
12 months 48
Year 2 Trauma/University Hospital 8 32
Tulane Sub-specialty services 4 16 12 48
TMC/Children’s 6 24
TMC sub-specialty services 6 24
Year 4 Trauma/University Hospital 8 32
TMC sub-specialty services 4 16
Year 5 Trauma/University Hospital 4 16
TMC sub-specialty services 8 32
TOTAL 60 months