ORSU-4100 - A/I - Orthopedic Surgery: External Students

ORSU-4100 - A/I - Orthopedic Surgery: External Students

Elective Title: A/I - Orthopedic Surgery: External Students
Course Number: ORSU-4100
Elective Type: clinical • Direct Patient Care Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of year 3 Surgery Clerkship.
Responsible Faculty Director: Jeremy Somerson, MD Periods Offered: 3-8 excluding holiday period 8 
Coordinator: Bryanna Branch Other Faculty: Pouya Alijanipour, Burak Altintas, Jie Chen, John Faillace, John Hagedorn, Vinod Panchbhavi, Brian Smith, Ahmed Thabet Hagag, William Weiss
Location to Report on First Day:
Contact Bryanna Branch(blbranch@utmb.edu) or 409-747-5701. 2.316 Rebecca Sealy

Goals
To gain experience in the evaluation and treatment of patients with adult and pediatric orthopedic problems across a full spectrum of emergent, urgent and elective diagnoses. To become prepared for orthopedic surgery internship.

Objectives
1. Develop skills to evaluate orthopedic patients in the emergent or elective setting
2. Assist in the operating room and gain technical skills
3. Become an efficient communicator of orthopedic problems
4. Learn to interpret diagnostic imaging.

Description of course activities
The student will work with two primary faculty for two weeks each. The student will attend clinics 1-3 days a week and surgery approximately 2-4 days a week. Students will be a member of the orthopedic team and will see clinic patients, assist in the OR and shadow physicians. Students will also participate in call activities, including consultations and surgery.

Type of students who would benefit from the course
All students. This course meets the requirements for the Senior Acting Internship in Surgery.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday OR OR
Tuesday Clinic LCC Clinic LCC
Wednesday OR OR
Thursday TDC TDC
Friday OR OR
Saturday
Sunday

 Average number of patients seen per week: 100
 Call Schedule: Call schedules will be arranged individually.

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time 80
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?
    Residents and faculty
  B. Frequency / Duration of Presentation(s)?
    One 5-minute presentation
  C. Format - What guidelines are set for the student's presentation?
    Case presentation with brief background
  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)?
    Daily
  B. Format - What guidelines are set for the student's written work?
    Templates are provided by faculty/residents for written assignments.
  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.?
    Student-selected clinical encounters
  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)?
    Arrive punctually. Obtain necessary access to electronic medical record system prior to start date. Be proactive and seek opportunities to add to the clinical workflow. Review anatomy and surgical approach prior to OR days.

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, pass/fail, oral presentation

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.
    Students will perform a physical exam 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. Time management for on-call evaluations.
 
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 cases and synthesize history and exams for a differential diagnosis. Students will the ability to pend orders for faculty or resident signature.
 
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, exam skills, and orthopedic diseases.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The student will present a clinical management plan to the faculty and discuss. After determining an appropriate plan, the student will document the clinical encounter in the same manner as a resident.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The two primary faculty for the rotation will provide midpoint feedback after the first week on each respective service.
 
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.
    There will be 2 primary faculty for each student. Both faculty will work directly with the student. Feedback from residents may be incorporated into the global evaluation.