ORSU-4021 - A/I Orthopedic Surgery - Spine Surgery

ORSU-4021 - A/I Orthopedic Surgery - Spine Surgery

Elective Type: clinical
A/I Orthopedic Surgery - Spine Surgery
Course Number
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
Successful completion of surgery clerkship. A C-form is required within a 30 day add/drop and must be signed by Bryanna Branch (blbranch@utmb.edu)
Responsible Faculty Director:
Pouya Alijanipour, MD
Other Faculty:
Location to Report on First Day
Contact Bryanna Branch(blbranch@utmb.edu) or 409-747-5701. 2.316 Rebecca Sealy
Periods Offered
including holiday period 8
Maximum Enrollment

To gain experience in the evaluation and treatment of patients with degenerative spinal conditions and spinal deformities. The experience will include opportunities to learn about adult and pediatric scoliosis and spinal deformities, including the lesser recognized abnormalities of sagittal alignment of the spine. Both adults and children are seen in clinic, the majority being performed in adults. Microscopic and minimally invasive tubular retractor spine surgery as well as open surgery is performed; new endoscopic surgical procedures are also anticipated soon.

To learn how to examine the spine and present patient encounters involving the spine with a detailed neurologic examination. Student may also learn about basic pain management in spinal disorders, including indications for facet joint injections, epidural steroid injections and bracing.

Description of course activities
Active study, participation, and preparation for surgical cases are required. The student will see and examine patients independently and summarize the cases for presentation. Student will be allowed to assist in some surgeries. There is a 2.5 hours/week of research time, 2.5 self-directed case reports or series, 2.5 hours of Quality Assurance and Improvement, and 2.5 hours of Basic Science of Spinal Disorders for a total of 10 hours of research activities.

Type of students who would benefit from the course
Type of students who would benefit from the course – Students interested in pursuing a career in Orthopedic Surgery, Neurosurgery, Anesthesia or Physical Medicine and Rehabilitation.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday OR OR
  Tuesday TDC 1,3,5 & OR 2 & 4 OR
  Wednesday OR/Various Clinic OR/Various Clinic
  Thursday 8:00 Victory Lakes Clinic Victory Lakes Clinic
  Friday Research/Clinic Research/Clinic
   Average number of patients seen per week: 40+  
   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?
    daily either in clinic or in the OR
  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?
    Residents and Faculty
  B. Frequency / Duration of Presentation(s)?
    once during the rotation
  C. Format - What guidelines are set for the student's presentation?
  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.?
    current cases or student-selected
  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)?

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.

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 perform physical exam of the spine and neurologic system

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Students will study anatomy for cases and synthesize history and exams for a differential diagnosis. Students will not be responsible for orders.

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 learn surgical anatomy, exam skills and spinal disorders.

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 have one faculty for twenty days with direct faculty/student interaction on a daily basis.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Students will have one faculty for twenty days with direct faculty/student interaction on a daily basis.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    One week into the rotation students should schedule a midpoint evaluation session with the faculty and the faculty will advise as needed.

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.
    Our courses are a 1 for 1 so pertaining to question 8, Dr. Alijanipour would write a LoR.