ORSU-4053 - Applied Orthopedic Principles in Lower Extremity Surgery

ORSU-4053 - Applied Orthopedic Principles in Lower Extremity Surgery

Elective Title: Applied Orthopedic Principles in Lower Extremity Surgery
Course Number: ORSU-4053
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: Jie Chen, MD Periods Offered: 1-12 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

1. To learn the basic science and principles behind common orthopedic conditions afflicting the lower extremity. Will learn basics of fracture healing, implant science, mechanisms of injury, classification systems.
2. To gain comfort and experience in the operating room including basic knowledge of setup, positioning, assisting, and closing.
3. To participate in the care of patients seen on call including hip fractures, femur fractures, ankle fractures. While most of the pathology will be foot and ankle conditions, there will also be other lower extremity injuries who present from the emergency room.

1. Independently be able to perform a thorough history and physical examination of a foot and ankle patient in clinic and make a concise presentation.
2. Develop treatment plans for patients with a variety of lower and upper extremity conditions including hip fractures, femur fractures, tibia fractures, foot and ankle pathology
3. Position patients, close wounds, place hardware as indicated
4. Placing orders in the clinical setting including prescriptions, imaging orders, labs. Orders will need to be cosigned by resident or attending
5. Taking call with the orthopedic trauma service on one weekend, including seeing orthopedic consults, recognizing urgent ones such as open fractures or septic joints, and presenting them to transition care
6. Obtaining informed consent in clinic for surgical procedures

Description of course activities
1. On clinical days, student will observe a few patients, but will quickly function independently at the level of an intern including examining patients, developing treatment plans, presenting and writing notes. The student will have the ability to enter orders.
2. In the operating room, students will develop all the habits of a house officer including seeing the patient in the holding room, positioning the patient, assisting during the case, placing hardware as indicated, and closing/splinting.
3. Student will participate in rounding on inpatients as necessary.
4. Students will attend in weekly departmental conferences and prepare a 10-minute presentation to give during their rotation.
5. Students will take call on average one weekend per rotation with the orthopedic trauma team where they will see consults, identify which ones are urgent or emergent as appropriate, and handover information to the rest of the call team.
6. Students will obtain informed consent in clinic for surgical patients.

Type of students who would benefit from the course
All students interested in Orthopedics.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Surgery Surgery
Tuesday Clinic Clinic
Wednesday Surgery Surgery
Thursday Clinic Clinic
Friday Clinic Clinic

 Average number of patients seen per week: 50
 Call Schedule: N/A

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?
  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 Resident's
  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's 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.?
    Related 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 Orthopedic 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 grade of Satisfactory/Unsatisfactory. Free, online orthopedic resources 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.

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.