ORSU-4025 - A/I Orthopaedic Surgery - Hand/Upper Extremity Surgery

ORSU-4025 - A/I Orthopaedic Surgery - Hand/Upper Extremity Surgery

Elective Title: A/I Orthopaedic Surgery - Hand/Upper Extremity Surgery
Course Number: ORSU-4025
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of year 3 Surgery Clerkship
Responsible Faculty Director: John Faillace, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Other Faculty:
Location to Report on First Day:
Contact Kathryn Gwinn (kagwinn@utmb.edu) or 409-747-5750 2.316 Rebecca Sealy Hospital

1. To achieve a basic science foundation for understanding hand/upper extremity surgery.
2. To learn the art and science of clinical diagnosis of upper extremity pathology.
3. To learn the principles of the ethical practice of hand/upper extremity surgery.
4. To learn the importance of compassion and respectfulness in interactions with patients and their families.
5. To provide and receive feedback concerning performance of students and attending staff.

1. Obtain appropriate history from patients with hand/upper extremity.
2. Appropriately perform thorough exam of the hand/upper extremity.
3. Interpret x-rays and advanced imaging of the hand/upper extremity.
4. Become familiar with the anatomy of the hand/upper extremity.
5. Accurately diagnose and devise appropriate treatment plans for common hand/upper extremity pathology based on history, physical exam and imaging.
6. Learn appropriate application of splints to the hand/upper extremity.
7. Become familiar with basic procedure techniques in the clinic such as closed reductions and injections.

Description of course activities
1. Attend clinics 3 days a week
2. Attend/assist with surgery approximately 2 days a week.
3. Active study and participation are required.
4. Examine patients independently and work them up for presentation.
5. Weekly chapters are assigned from Greens Operative Hand Surgery and will be discussed at designated time on M/T/Th
(Electronic version of this will be accessible to each student)
6. Attend weekly anatomy/cadaver session every Tuesday morning before TDC clinic.
(Anatomy syllabus will be accessible electronically to each student)

Type of students who would benefit from the course
Students interested in pursuing Orthopaedics.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday PCP Clinic (8:00am) PCP Clinic (1:00pm)
Tuesday TDC Clinic (8:00am) Admin
Wednesday League City Campus Clinic (8:00am) South Shore Clinic (1:00pm)
Thursday OR (8:00am) OR (1:00pm)
Friday OR (8:00am) OR (1:00pm)

 Average number of patients seen per week: 50
 Call Schedule: n/a unless interested

Research / Other Course 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?
    Faculty and Residents
  B. Frequency / Duration of Presentation(s)?
    Once during rotation
  C. Format - What guidelines are set for the student's presentation?
    Case presentation that is approved by the faculty
  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)?
    Anatomy Lessons before TDC clinic on Tuesdays along with Chapter reviews.

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.
    Feedback will be given to students directly by supervising faculty and residents.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Surgical skills, assisting and suturing
Students will be permitted to perform procedures such as tendon repairs/carpal tunnel release and more on the cadaver during scheduled anatomy sessions

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 be responsible for inputting 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?
    One week into 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 one faculty for twenty days with direct faculty/student interaction on a daily basis.

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.
    Most AIs have only one faculty member with whom they work closely during any one rotation. There are 2 residents on the Hand service and the AI will work with both of them as well. There is additional opportunity to work with on-call faculty if there are surgical cases occurring on the weekend. The faculty usually asks for additional input from the residents about performance to provide a more thorough, in-depth evaluation.