ORSU-4018 - A/I - Orthopedic Surgery: Foot and Ankle Surgery

ORSU-4018 - A/I - Orthopedic Surgery: Foot and Ankle Surgery

Elective Title: A/I - Orthopedic Surgery: Foot and Ankle Surgery
Course Number: ORSU-4018
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of year 3 Surgery Clerkship.
Responsible Faculty Director: Vinod Panchbhavi, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Bryanna Branch Other Faculty: Jie Chen, MD, MPH
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 general adult orthopedic problems including trauma and reconstruction of the foot, ankle, and lower leg, including problems associated with diabetes and infections and to gain experience in the skills and work habits desirable to function as a house officer on the Orthopedics and Foot and Ankle Surgery service.

Students should be able to perform initial and subsequent patient assessments, write appropriate admission and subsequent orders, and develop management and diagnostic plans. They should gain technical skills in examination, common diagnostic and technical procedures, and operative technique. They should recognize the commonly misdiagnosed foot and ankle disorders in which lack of prompt or appropriate treatment may lead to increased patient morbidity.

Description of course activities
This elective is within limits set by law and hospital rules will function with the same responsibilities and duties as an intern or first year house officer. This elective will have same hours as an intern. This elective is to the level that ability demonstrates will carry same patient load as an intern. This elective is in the clinics students will shadow the attending and or residents observe, learn and practice history taking and physical exam skills. They will participate in minor procedures undertaken in the outpatient clinic setting such as application of splint, removal of superficial hardware, wound debridgements. Students will accompany residents and faculty on daily rounding of patients. Students will scrub in and assist surgery in the OR and perform under supervision parts of the surgical procedure such as drilling a bone or inserting a screw or suturing the wound appropriate to level of training. Attendance and participation at the weekly divisional teaching. This elective will have preparation and presentation for a half hour talk on a topic related to Foot & Ankle Surgery during the four week period.

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
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Clinic Clinic
Tuesday Surgery Surgery
Wednesday Surgery Surgery
Thursday Clinic Clinic
Friday Surgery Surgery

 Average number of patients seen per week: 100
 Call Schedule:

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time 40
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?
    Faculty and Residence
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    daily oral 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)?
    H&P in the medical record on every patient seen by a student.
  B. Format - What guidelines are set for the student's written work?
    Student is expected to document chief complaint, history of present illness, past medical history, social and family history a review of systems and findings on examination.
  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.?
    Relate to the case
  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 (attendance optional), attendance at fracture conference on Thursday morning, weekly Tuesday morning Foot and Ankle Surgery Teaching Rounds (during which the student will typically interact with faculty, residents and Research fellows) and weekly Wednesday morning Orthopaedic Surgery Departmental Grand Rounds.

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. A basic orthopedic text will be recommended.

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 exams on 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. Students will not have the ability to do orders.

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?
    1 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 have 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.
    In general, the AI student will work directly with Dr. Panchbhavi and the resident assigned during most of the rotation. If Dr. Panchbhavi 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. Panchbhavi 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.