ORSU-4012 - A/I in Orthopedic Surgery-Pelvis/Hip/Knee

ORSU-4012 - A/I in Orthopedic Surgery-Pelvis/Hip/Knee

Elective Title: A/I in Orthopedic Surgery-Pelvis/Hip/Knee
Course Number: ORSU-4012
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of year 3 Surgery Clerkship
Responsible Faculty Director: Kelly Stephenson, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Bryanna Branch Other Faculty: Michael Britt, MD
Location to Report on First Day:
Contact Kathryn Gwinn (kagwinn@utmb.edu) or 409-747-5750. 2.316 Rebecca Sealy Hospital

Goals
1. To gain experience in the evaluation and treatment of patients with general adult orthopaedic problems with a special emphasis on afflictions and injuries of the pelvis/hip/knee.
2. To gain experience in the skills and work habits desirable to function as a house officer on the Adult Orthopedic Pelvis/Hip/Knee Service.

Objectives
1. Should be able to perform initial and subsequent patient assessments, write appropriate admission and subsequent orders, and develop management and diagnostic plans.
2. Should gain technical skills in examination, common diagnostic and technical procedures, and operative technique.

Description of course activities
1. Within limits set by law and hospital rules will function with the same responsibilities and duties as an intern or first year houseofficer.
2. Will have same hours and call responsibilities as an intern.
3. To the level that ability demonstrates will carry same patient load as an intern.

Type of students who would benefit from the course
All students.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday wks 1,3,5 Jennie Sealy OR wks 1,3,5 Jennie Sealy OR
Tuesday wks 2,4 PCP Clinic wks 2,4 PCP Clinic
Wednesday wks 1,3,5 PCP Clinic wks 1,3,5 PCP Clinic
Thursday wks 1,3,5 Jennie Sealy OR & wks 2,4 TDCJ Clinic wks 1,3,5 Jennie Sealy OR & wks 2,4 TDCJ Clinic
Friday wks 2,4 League City Campus Clinic wks 2,4 League City Campus Clinic
Saturday n/a n/a
Sunday n/a n/a

 Average number of patients seen per week: 50
 Call Schedule:

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


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?
    Daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    N/A
  B. Frequency / Duration of Presentation(s)?
    N/A
  C. Format - What guidelines are set for the student's presentation?
    N/A
  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)?
    N/A
  B. Format - What guidelines are set for the student's written work?
    N/A
  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
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

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, 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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Clinical evaluation by upper level residents and faculty with possible grades; Satisfactory, Fail. A basic orthopaedic text 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.
    Clinical skills will be directly supervised by faculty and residents.
 
B.
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.
    There will be physical exams of bones, tendons, ligaments and neuromuscular structures.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Surgical skills - assisting and suturing
 
D.
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 case and synthesize history and exam for a differential diagnosis. Students will not have the ability to do orders.
 
E.
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, learn exam skills, and learn orthopedic diseases.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    One week into the rotation, student will schedule a midpoint evaluation session with faculty. Faculty will remediate as needed.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Student will have one faculty for 20 days and there will be direct faculty/student interaction.
 
H.
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. Stephenson and the resident assigned during most of the rotation. If Dr. Stephenson 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. Stephenson 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.