ORSU-4406 - Hospital Based Orthopedics

ORSU-4406 - Hospital Based Orthopedics

Elective Title: Hospital Based Orthopedics
Course Number: ORSU-4406
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: UTMB students only
Responsible Faculty Director: John C. Hagedorn, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Bryanna Branch Other Faculty: Mark Foreman, MD
Location to Report on First Day:
Rebecca Sealy Orthopedic Office

This course will expose students to acute orthopedic injuries presenting to the emergency department and on the hospital floor. Time will be split between the emergency department and the operating room.

1. Learning an orthopedic evaluation and physical exam
2. Understanding the role of a consult service in patient care
3. Learn the principles of casting, splinting, and limb immobilization
4. Learn the principles of closed reduction techniques
5. Observe orthopedic operative procedures

Description of course activities
Students will shadow orthopedic mid-level residents, an orthopedic physician assistant along with the orthopedic on-call physician on the orthopedic consult service. Students will learn how to triage orthopedic specific injuries and gain understanding of the acute nature of specific injuries. At the end of the rotation, students will be able to determine the difference between common musculoskeletal injuries that require urgent intervention and those injuries that do not. Most importantly, students will have the opportunity to follow patients to the operating room that they assisted in treating in the ED. Patient presentations will be expected throughout the course.

Type of students who would benefit from the course
All students. This rotation would be beneficial to students seeking careers in both primary care as well as surgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6 6
Tuesday 6 6
Wednesday 6 6
Thursday 6 6
Friday 6 6
Saturday call call
Sunday call call

 Average number of patients seen per week: 40
 Call Schedule: 2 overnight call with post-call day off

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 30
Self-Directed Study
Data-Collection/Analysis NA
Other Resident contact time/teaching 30

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?
    All the time by either resident or faculty orthopedic surgeons
  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/or faculty
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Guidelines for orthopedic workup as well as presentation will be outlined to students during their first week.
  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)?
    Students will be encouraged to write consult notes for patients that they see in the ED and on the floor. Residents will provide verbal feedback on the students note writing skills based on the student's year-level.
  B. Format - What guidelines are set for the student's written work?
    Guidelines for orthopedic workup as well as presentation will be outlined to students during their first week.
  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)?
    Students will be encouraged to attend the orthopedic teaching conference in League City every week on Wednesday. Students that decide to take a Tuesday call and are post call will be encouraged to get rest. Students will be encouraged to take part in any of the activities of the orthopedic department while on this course. Students will be an integral part of the care team.

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.
    Students will be evaluated by both the residents and the faculty. The goals of the course will be outlined during the first week. Students will be encouraged to give daily patient presentations, participate in patient rounds, see patients with the consulting team in the ED, and participate in surgeries they are interested in seeing.

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.

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.