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Department of Orthopaedic Surgery and Rehabilitation

ROTATIONS

Year One - PGY I

At Texas Tech University Health Sciences Center - Lubbock the orthopaedic internship is included as part of the orthopaedic program. The rotating internship exposes each resident to many different aspects of medicine including general surgery, medical intensive care, rehabilitation, emergency room medicine, and orthopaedic surgery.

Month 1 (Rehab)

During this exposure to rehabilitation medicine, the residents will work as part of a medical team and learn to manage patients in a rehabilitation center. They will help monitor the patients' condition and work to prevent the complications that can accompany an extended stay in a rehab unit.

Month 2 (Anesthesia)

During this rotation, the interns will gain experience in the delivery of general anesthesia to patients, develop and understand the principles of conscious sedation, learn and practice different techniques for local anesthesia in the extremities, and develop a better understanding of how the anesthesiologist interacts with other medical professionals.

Month 3-4 (General Surgery/Trauma)

The orthopaedic interns will rotate with the general surgery faculty. They are expected to gain knowledge regarding the care and treatment of patients with multi-system trauma both in the operating room and hospital. This team also will provide an initial exposure to vascular surgery.

Months 5-6 (General Surgery/Neurosurgery)

During this two-month period, the orthopaedic interns will work with the general surgeons and the neurosurgeons at University Medical Center. They are expected to become familiar with the operating room environment, the handling of patients in this setting, and the use of CT and MRI imaging of the central nervous system.

Month 7 (General Surgery/Burns/Plastics)

This month will concentrate on patients who have suffered burn injuries and/or those requiring plastic surgery. As a level one trauma center, UMC has a burn unit that services a large region of the Texas panhandle. During this rotation, the interns are expected to develop operating room skills, particularly those required for skin grafting and the placement of muscle flaps.

Month 8 (General Surgery/Surgical ICU)

The interns should gain experience in invasive monitoring techniques and the interpretation of this information. They will be exposed to techniques required to maintain ventilatory support for critically injured individuals.

Month 9 (General Surgery/Vascular)

During this two-month period, the interns will gain knowledge and experience in the emergency room evaluation of patients with vessel damage and laceration, obtain exposure to decision-making on patients with vascular trauma, gain exposure to operating room techniques and hospital and post-operative care, gain exposure to outpatient follow-up with patients who sustain vascular trauma. Gain experience in the management of patients with diabetic vascular disease and gain exposure to the surgical management of patients with chronic vessel disease.

Month 10 (Emergency Room)

The residents will gain experience suturing lacerations and making appropriate decisions regarding the care of emergency room patients.

Months 11-12 (Orthopaedics)

This initial exposure to Orthopaedics is intended to build knowledge and experience regarding the care of orthopaedic patients in the emergency room, outpatient setting, hospital, and clinic.

Years Two & Three: PGY II and III (Junior Residents)

During the PGY II and III years, the residents begin their four years of rotations through the Department of Orthopaedic Surgery. These junior residents provide first call for orthopaedic surgery. They will provide initial patient care for trauma patients entering the emergency room and make initial evaluations. The rotations are designed to meet the requirements of the Residency Review Committee (RRC).

Months 1-3 (Orthopaedic Trauma)

The residents will gain increased exposure to the care of orthopaedic patients in the emergency room setting. They will become familiar with the techniques required to reduce fractures and dislocations. The residents will learn to handle minor trauma and will demonstrate appropriate decision-making skills regarding the treatment of individuals with major trauma.

Months 4-9 (Hand)

During this initial exposure to hand surgery, the residents will become familiar with commonly used surgical approaches to the hand. Basic knowledge should be gained in the management of patients with arthritic complications. The residents will demonstrate appropriate skills in tendon repair and the management of patients with fractures of the hand.

Months 10-12 (Sports)

The residents will learn to perform a history and physical evaluation of an injured athlete, and to answer questions from the athletes, their families, trainers, and coaches.

Months 13-15 (Adult Reconstruction/Joint Replacement)

The residents will gain knowledge regarding the various surgical approaches for exposure of the hip and knee and the placement, positioning and draping of a patient for operation.

Months 16-18 (Pediatric Orthopaedics)

To enhance the educational experience in the subspecialty of Pediatric Orthopaedic Surgery, the department sends PGY-3 residents to a four-month away rotation at Cook Children's Hospital in Fort Worth, Texas, which is a top rated facility in patient care and outcomes. The resident is furnished with a family sized apartment in close proximity to the hospital. This rotation affords extensive experiences in the evaluation and surgical treatment of pediatric orthopaedic trauma, spinal deformities and congenital diseases. Cook Children's Hospital is a privately funded institution dedicated to the treatment of all pediatric diseases and currently has seven full-time pediatric orthopaedic faulty members involved with orthopaedic education. Residents share 'at-home' trauma call with two other orthopaedic residents from a local training institution (John Peter Smith in Fort Worth) and have the opportunity to attend didactic lectures at that facility.

Months 19-21 (Foot)

During this rotation, the residents will develop an appreciation for problems that often occur in individuals with diabetes mellitus. They should learn to perform ankle and foot exams, appropriate orthotic management of common foot problems, and local anesthetic injections in the outpatient setting.

Months 22-24 (Research)

The research rotation will advance the residents' knowledge of the basic principles of research. The research conducted by the residents can be either clinical or basic science in nature. Research is expected to commence shortly after the start of the resident's internship.

Years Four & Five: PGY IV and PGY V (Senior Residents)

During the PGY IV and PGY V years, the residents will continue to read appropriate textbooks and journal articles. They will lead discussions and demonstrate increasing levels of insight into new and innovative articles covering both clinical and basic science topics. They will take lead roles in the discussions held at the journal club meetings and conferences. They will also help supervise and direct the activities of the junior residents and interns during their rotations.

Months 1-3 (Orthopaedic Trauma)

As senior residents, they are expected to take a lead role in the management of patients admitted to the orthopaedic service through the emergency room. The resident should make independent decisions regarding patient care by the end of their PGY V year and assist junior residents in all aspects of trauma management.

Months 4-6 (Hand and Upper Extremity)

The residents should demonstrate appropriate treatment of hand injuries requiring external fixation devices. The residents should also demonstrate the ability to perform micro vascular surgery, tendon repair, and repair of transected nerves.

Months 7-9 (Spine)

During this rotation, the residents will gain insight into the management of patients with spinal injury. This should include the ability to diagnose spinal disorders and recommend surgical or non-surgical treatment, as appropriate.

Months 10-12 (Pediatric Orthopaedic Surgery)

During this rotation the surgical staff will provide in-depth training in pediatric orthopedic care.

Months 13-15 (Sports)

During this rotation, the residents will formulate a differential diagnosis based on the available information and recommend appropriate treatment. The residents should be able to demonstrate diagnostic and surgical skills with the arthroscope.

Months 16-18 (Adult Reconstruction/Joint Replacement/Musculoskeletal Oncology)

The residents should demonstrate the ability to work independently when making appropriate decisions regarding patient care. This should include the ability to manage patients with rheumatoid and osteoarthritis as well as those who have suffered traumatic injury. The resident will also be able to evaluate patients with bone and soft tissue tumors and formulate an appropriate differential diagnosis.

Months 19-21 (Hand and Upper Extremity)

At this level of training, the residents are expected to make independent decisions regarding the care and treatment of patients. Frequently, they will work with the faculty to train junior residents. They will assist in completing micro vascular surgery cases and free flaps.

Months 22-24 (Adult Reconstruction/Joint Replacement/Musculoskeletal Oncology)

The residents will be able to work independently with minimal assistance while performing joint replacement surgeries. The residents will provide training to the junior residents. They will take responsibility for all aspects of the patient's care. The resident will be able to formulate and execute an appropriate treatment plan including surgical and medical management of patients with bone and soft tissue tumors.

Department Sponsored Courses

PGY I: Total Hip, Orthotics and Prosthetics

PGY II: AO Basic Trauma Resident Course

PGY III: Musculoskeletal Tumor Course

PGY IV: AO Spine Course, AAOS Academy Meeting

PGY V: Miller Board Review Course, AO Advanced Trauma Resident Course

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