Orthopedics

Casting clinic

The orthopedic component of the curriculum is fulfilled mainly during the second year. This main component is a four-week rotation in the orthopedics department during their second year.

Outpatient: The month-long rotation is spent mainly in the outpatient offices of Blair Orthopedics and sports medicine. Five half days per week are spent in the orthopedic office under the guidance of the orthopedic surgeons and a certified cast technician. The primary goal during this portion of the rotation is to gain exposure to evaluation and treatment of common orthopedic conditions, including, but not limited to, osteoarthritis, spinal disorders, fractures, sprains, dislocations and congenital anomalies. Residents are given the opportunity to perform various procedures including casting, splinting, aspiration and injection of joints, and tendon sheaths. They are expected to learn the advantage and disadvantages of available imaging techniques and what x-rays to order in various circumstances. Much time is spent reviewing x-rays and other imaging studies with the teaching physician. Further experience is gained in diagnostic and treatment approach to various acute and overuse injuries occurring during sports. The residents learn how to perform pre-participation and sports physical exams in the office. Two half days per week are spent in the operating room under the direction of two of our orthopedists. Emphasis is on the evaluation of all the major joints, manipulation of joints under anesthesia, and the further teaching of injection, along with assisting with basic orthopedic surgical procedures. Residents are evaluated by direct observation by the teaching physician. Evaluations are based on observation of case presentation, evaluation skills and techniques in the various procedures performed during the rotation. All evaluators complete a written evaluation of performance at the end of each phase of the orthopedic experience. The resident also spends 3-half days per week in the Family Practice Clinic.

Additionally, the residents have a series of sports medicine, orthopedic and manual medicine lectures. A minimum of four lectures is given every year; there are additional topics presented at such conferences as Manual Medicine Day and additional Family Practice conferences. A 4.5 hour lecture/practicum on evaluation of general musculoskeletal problems is done every spring at OMT day. Required reading consists of the AAFP monograph "Fractures and Dislocations".

Residents may also assist in coverage of athletic events during the three years. They may attend football games and other events. These are under the direct supervision of a teaching physician or a certified athletic trainer. Emphasis is made on rapid yet thorough evaluation of athletic injuries as well as determining ability to safely return to competition.

At the end of the month-long rotation, the residents are evaluated by the teaching physician and the evaluations are placed in their files to be reviewed by the faculty advisors and at quarterly evaluation.

Altoona Family Physicians

Orthopedics

Competency-based Goals and Objectives

Resident year: PGY 2

AFP faculty contact: Patrick Rice, MD

Specialty contact: University Orthopedics

Christopher McClellan, DO

949-4050

Please call the office prior to the start of the rotation to make arrangement of where and when to report on the first day of your rotation.

Rotation description and general goals:

The orthopedic rotation is primarily an outpatient experience. The resident will spend time with Dr McClellan evaluating patients with various orthopedic complaints of both an acute and chronic nature. They will review x-rays and perform physical examinations under his guidance. They will learn the indications for and proper technique for therapeutic joint injections primarily of the knee, shoulder and trochanteric bursa. They will spend time in the casting room learning the principles and practice of cast and splint application. This experience is augmented by scheduled noon conferences, scheduled procedural conferences as well as additional clinical experience in the Family Medicine Center and while on the emergency room rotation. Note: this rotation is done in ½ month blocks combined with a ½ month of night float. This rotation will be performed twice during the second year giving the resident an entire month of outpatient orthopedics.

Resident evaluation:

Each resident on the rotation is evaluated by the attending orthopedic surgeon using a competency-based evaluation tool at the end of the rotation. These evaluations are reviewed by the family medicine faculty quarterly and reviewed with the resident at the resident’s quarterly evaluation.

Program evaluation:

Each resident is expected to complete a written evaluation of the orthopedic rotation and the attending orthopedic surgeon(s). These evaluations and the orthopedic surgery curriculum are reassessed annually as part of the Altoona Family Physicians annual curricular review.

SAMPLE SCHEDULE:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
AM Noon PM	Ortho Conf. Ortho	Ortho Conf. AFP	Ortho Conf. AFP	Ortho Conf. Ortho	Ortho Conf. AFP
AM Noon PM	Ortho Conf. Ortho	Ortho Conf. AFP	Ortho Conf. AFP	Ortho Conf. Ortho	Ortho Conf. AFP
AM Noon PM	NF Conf. NF	NF Conf. NF	NF Conf. NF	NF Conf. NF	NF Conf. NF
AM Noon PM	NF Conf. NF	NF Conf. NF	NF Conf. NF	NF Conf. NF	NF Conf. NF

Competency 1: Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Perform an orthopedic evaluation including chief complaint, HPI, relevant past medical history and appropriate physical exam with particular focus on the injured or affected joint(s).

Recognize which orthopedic conditions can be effectively diagnosed and treated by a family physician and which problems require referral for specialty care.

Competency 2: Medical Knowledge: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Understand the basic anatomy of the upper and lower extremity

Understand the management of acute orthopedic injuries.

Learn basic x-ray interpretation of the injured extremity.

Understand the principles and practice of splint and cast application.

Perform a competent examination of the major joints including the shoulder and the knee as well as the minor joints, e.g. the wrist, hand and digits.

Learn the indications for therapeutic joint injections.

Demonstrate proper technique in performing therapeutic joint injections of the knee, shoulder and trochanteric bursa.

Competency 3: Practice Based Learning and Improvement: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to

ds to be able to meet the following goals:

o identify strengths, deficiencies, and limits in one’s knowledge and expertise;

o set learning and improvement goals;

o systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;

o incorporate formative evaluation feedback into daily practice;

Locate, evaluate and utilize evidence from relevant studies that relate to the health problems of patients who are seen on the orthopedic rotation.

Use information technology to manage information, access on-line medical information and support ongoing clinical education.

Competency 4: Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

Create and sustain a therapeutic and ethical relationship with patients.

Provide appropriate patient education on orthopedic diagnoses and treatment plans based on the literacy level of patients and their caregivers.

Help to communicate treatment plans of the orthopedic surgeons with the patient’s primary care physician.

Competency 5: Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Dress appropriately based upon the standards present for attending physicians in their office or the hospital.

Be on time for their rotations with the orthopedist(s).

Complete any readings or other adjunct educational material provided by the attending orthopedist(s).

Demonstrate sensitivity and responsiveness to patients’ perception of illness and include these perceptions and patient preferences in formulation of management plans

Competency 6: Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Describe several ways in which the primary care provider and specialist can work as a healthcare team when providing care to a patient with orthopedic conditions.

Describe the financial implications of health care evaluation and treatment decisions of patients with orthopedic conditions.

Understand the formulary implications for medication selection based upon insurance coverage (or lack of coverage) for a given patient.