ORSU-4013 - A/I - Orthopedic Surgery: Pediatric

ORSU-4013 - A/I - Orthopedic Surgery: Pediatric

Elective Title: A/I - Orthopedic Surgery: Pediatric
Course Number: ORSU-4013
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: None
Responsible Faculty Director: David A. Yngve, M.D. Periods Offered: 1-13 including holiday period 8 
Coordinator: Bryanna Branch Other Faculty: Kelly Carmichael, M.D.
Location to Report on First Day:
Contact Bryanna Branch(blbranch@utmb.edu) or 409-747-5701. 2.316 Rebecca Sealy

To gain experience in the evaluation and treatment of patients with pediatric orthopedic problems including those involving spine and reconstruction with emphasis on Cerebral Palsy.

To learn how to examine the spine and extremities; to learn how to apply splints.

Description of course activities
The student will attend clinics approximately 2 days a week and surgery approximately 2 days a week. Pediatric specialties include patients with cerebral palsy, scoliosis and pediatric spine cases between the ages of 0-18. Active study, participation, and preparation for surgical cases are required. The student will see and examine patients independently and will summarize one case for presentation to faculty and residents.

Type of students who would benefit from the course
All students. This course meets the requirements for the Senior Acting Internship in Surgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Alternate Faculty Assignment - Contact Coordinator Alternate Faculty Assignment - Contact coordinator
Tuesday Alternate Faculty Assignment - Contact Coordinator PCP clinic (4 hrs)
Wednesday Jennie Sealy OR (4 hrs) Jennie Sealy OR (4 hrs)
Thursday League City Campus Clinic (4 hrs) League City Campus Clinic (4 hrs)
Friday League City OR (4 hrs) League City OR (4 hrs)

 Average number of patients seen per week: 20
 Call Schedule: n/a unless interested

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Pediatric Orthopedic Faculty and residents
  B. Frequency / Duration of Presentation(s)?
    Once during the rotation
  C. Format - What guidelines are set for the student's presentation?
    Present 5 minute case presentation at a Wednesday conference
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Journal Club and resident lecture attendance

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Clinical evaluation by upper-level residents and faculty with possible grades, Pass/Fail.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    Clinical skills will be directly supervised by faculty and residents.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    Students will do physical exams of bones, tendons, ligaments and neuromuscular structures.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Surgical skills - assisting and suturing

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    Students will study anatomy for cases and synthesize history and exams for a differential diagnosis.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    Students will learn surgical anatomy, exam skills, and orthopedic diseases.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    One week into the rotation, students will schedule a midpoint evaluation session with faculty. Faculty will remediate as needed.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Students will be with 1 faculty for 20 days with direct faculty/student interaction.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    Classes are a 1 for 1 ratio.

In general, the AI student will work directly with Dr. Yngve and the resident assigned during most of the rotation. If Dr. Yngve has episodes of no clinical activity during the rotation for whatever reason he will coordinate with other orthopedic faculty to provide clinical and surgical education when he is out.

Other faculty may get to interact with the student but not enough to provided letters of recommendation.

Dr. Yngve will provide feedback weekly during the rotation and will advise the student of their performance as well as if a letter of recommendation is or is not advisable based on such performance.