ORSU-4027 - Advanced Orthopedic Surgery - General Ortho/Ortho Trauma

ORSU-4027 - Advanced Orthopedic Surgery - General Ortho/Ortho Trauma

Elective Title: Advanced Orthopedic Surgery - General Ortho/Ortho Trauma
Course Number: ORSU-4027
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: A C-form is required within a 30 day add/drop and must be signed by Bryanna Branch (blbranch@utmb.edu)
Responsible Faculty Director: Mark A. Foreman, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Bryanna Branch Other Faculty:
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 orthopedic problems as well as complex trauma excluding pelvis and spine. The experience will be equally balanced between outpatient clinic / surgery and Inpatient care / surgery of general orthopedic conditions as well as complex fracture management and poly trauma patients.

To learn how to examine patients with general orthopedic problems and to present patient encounters involving these and related anatomical areas. Student may also learn basic procedures such as closed reductions and injections. The student should be proficient and comfortable with musculoskeletal examination of patients as well as subsequent care and be able to provide a differential diagnosis for these patients.
Surgically, the student will be exposed to and taught meticulous sterile technique in the OR and basic suturing / closure techniques and splinting. Finally, the student will learn the importance of value driven performance measures in the OR.

Description of course activities
The student will attend clinics approximately 2.5 days a week and surgery 2.5 days a week. 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 assist in surgery and learn the importance of soft tissue handling in the OR as well as basic suturing and closing of wounds and incisions.

Type of students who would benefit from the course
Any student would benefit from the course, whether interested in pursuing a career in medicine, or surgery, who want to have a 4 week immersion experience in General Orthopedics with an emphasis on Trauma care including the surgical aspects.
Students should be enthusiastic and open minded.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday OR-7:15am 1,3,5; TDC Clinic 2,4 OR-4:00pm 1,3,5; Clinic 2,4
Tuesday 8:00am Texas City Clinic 5:00pm Texas City Clinic
Wednesday JES OR 1,3,5; South Shore Clinic 9:00am 2,4 JES OR 1,3,5; PCP Clinic until 5:00pm 2,4
Thursday TDC Clinic 9:00am 1,3,5; VL OR 7:15am 2,4 TDC Clinic until 5:00pm 1,3,5; VL OR until 4:00pm
Friday 8:00am JES OR 5:00pm JES OR
Saturday Off unless call Off unless call

 Average number of patients seen per week: 80
 Call Schedule: no call

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?
    Faulty and Residents
  B. Frequency / Duration of Presentation(s)?
    Once during rotation
  C. Format - What guidelines are set for the student's presentation?
    10 minute case presentation of their most interesting encounter over their time on the rotation
  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)?
    as needed/education dictations
  B. Format - What guidelines are set for the student's written work?
    basic physician, medical/hospital/clinic notes
  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.?
    clinical based
  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.
    Clinical evaluation by upper-level residents and faculty with possible grades, pass/fail, oral presentation.

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 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 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.
    Classes are a 1 for 1 ratio.

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

Dr. Foreman 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.