ORSU-4026 - A/I- Advanced Clinical Experience in Orthopedic Surgery: Shoulder and Elbow

ORSU-4026 - A/I- Advanced Clinical Experience in Orthopedic Surgery: Shoulder and Elbow

Elective Title: A/I- Advanced Clinical Experience in Orthopedic Surgery: Shoulder and Elbow
Course Number: ORSU-4026
Elective Type: clinical • Direct Patient Care Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 1
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: Jeremy Somerson, MD Periods Offered: 1-13 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

Goals
To gain experience in the evaluation and treatment of patients with sports medicine injuries and arthritis of the shoulder and elbow. The experience will also involve arthroscopic surgery of the elbow and shoulder, soft tissue repair and reconstruction and non-surgical management and joint replacement of the elbow and shoulder.

Objectives
To learn how to examine the elbow and shoulder and to present patient encounters involving these and related anatomical areas. Student may also learn basic procedures such as closed reductions and injections

Description of course activities
Active study, participation, and preparation for surgical cases are required. The student will see and examine patients independently and summarize the cases for presentation. Student will assist in surgery. The day will start at 6:45 AM in the operating room and 7:50 AM on outpatient clinic days. The day will finish around 5:00pm or when the last patient is seen and taken care of. See weekly schedule below.

Type of students who would benefit from the course
Students interested in furthering their knowledge of Orthopedic Surgery.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Monday OR (varies) OR (varies) OR (varies)
Tuesday 7:50am - 12:00pm (LCC Clinic) Tuesday 7:50am - 12:00pm (LCC Clinic) 1:00pm - 5:
Wednesday 6 (DOSR wkly didactic) 9 (LCC), 7:15 (wk 1,3,5 JS) 12pm-5:00pm (LCC OR)
Thursday 9am (wk 2,4 TDC) 7:15 (wk 1,3,5-LCC) 12pm (wk 1,3,5 JS OR) 12pm (wk 2,4 TDC)
Friday 7:15-12:00pm (wk 2,4 JS OR) 12pm-5pm (wk 2,4 JS OR)
Saturday
Sunday

 Average number of patients seen per week: 100
 Call Schedule: n/a unless interested

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?
   
  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?
    Faculty and Residents
  B. Frequency / Duration of Presentation(s)?
    Once during rotation
  C. Format - What guidelines are set for the student's presentation?
    5 min Powerpoint 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)?
   
  B. Format - What guidelines are set for the student's written work?
   
  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)?
    Thoughtful questions, reading for surgeries

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.
   

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.
    The student will be given direct feedback on clinical skills at the time of entering orders, at handover, after emergent or urgent consultations and after obtaining informed consent. Feedback will be also given verbally at the midpoint and end of rotation and in writing at the end of rotation.
 
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.
    The student will recommend, order and interpret diagnostic tests; perform general procedures such as incision closure, arthroscopic suture cutting and in-office injections; write daily progress notes; and give hypothesis-driven clinical presentations.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    This AI will add skills such as placing orders, writing prescriptions, positioning patients, and performing additional surgical tasks.
 
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 close wounds, remove sutures, position patients for surgery and perform joint injections. There is one required case presentation. Interested students may become involved in research projects or written case reports.
 
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?
    The student will be limited to no more than 80 hours of week averaged over 4 weeks. One call night per week will provide the student with work comparable to a PGY1 on an elective rotation.
 
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 patients independently to faculty, including clinical conclusions and management plans.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Midpoint feedback will be provided by the faculty. If deficiencies are present, an action plan will be developed in consultation with the student.
 
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.
    The student will work directly with Dr. Somerson, who will have knowledge of the student’s abilities and characteristics. This will allow for a comprehensive written evaluation and, if appropriate, a letter of recommendation.