Typical Education Program for Residents
Residents are closely supervised on each of the rotations with increasing responsibility as they progress in their training. Subspecialty rotations include one-on-one time with the attending of each subspecialty. During the Miami Valley Hospital rotations, the residents participate in the hospital staff subspecialty clinics, allowing some autonomy for independent decision-making. In each of the settings where residents work - outpatient, inpatient, OR and Emergency Department - residents are given gradually increasing responsibility in accordance with their level of training.
Teaching time always takes precedence over "service" duties and is carefully protected. The same rules apply during all teaching activities, including the monthly Journal Club. In a similar fashion, there is a clear understanding that when the resident is not "on call," he or she is encouraged to leave the hospital at the completion of regular working hours. This philosophy of the program is known and honored by all attendings.
Approximately two or three times per year, an invited out of town visiting professor presents research at the Dayton Orthopaedic Society meeting, held on a Tuesday evening. This is followed by case presentations and a symposium at the Wednesday morning Grand Rounds. The faculty and chief residents choose the topics of both Dayton Orthopaedic Society and symposia and all residents are required to attend.
All residents are required to attend the Monday through Thursday 7-8 a.m. conferences at held at Miami Valley Hospital. The Children's Service conference held Friday mornings from 6:30-7:30 a.m. is attended by the residents on the Children's Service and all other available residents. We have essentially eliminated evening/afternoon conferences to comply with the eighty-hour work rules and to maximize attendance.
The conference schedule is as follows:
Monday: Subspecialty X-ray Conference
Rotates on a weekly basis through each subspecialty (foot and ankle, hand, joint arthroplasty, knee, pediatrics shoulder and elbow, spine and trauma,) with that service's resident presenting a specific clinical topic with case examples for discussion.
Tuesday: Basic Science
Rotates through pathology, radiology, orthopaedic science and includes basic science faculty participating in the musculoskeletal organ system teaching curriculum. Also included are lectures and discussions in ethics with Robert Reece Ph.D., Department of Community Health, using "Ethical Issues in Orthopaedic Practices" and selected articles from the Journal of Bone and Joint Surgery Orthopaedic Forum. This conference rotates through a two-year curriculum designed by Dr. Joe Rubino.
Wednesday: Grand Rounds
Rotates through trauma case review, chief resident case review, morbidity and mortality case review, and didactic presentations.
- Thursday: Journal Club/Basic Science
Friday: Pediatrics at Children's Medical Center
For residents on the pediatrics service and all other available residents.
Full-time faculty attend all resident conferences, and many volunteer clinical faculty attend the Wednesday Grand Rounds. Grand Rounds attendance varies from 30-40, including medical students, residents, full-time faculty and clinical faculty.
Residents attend a course or conference yearly. The costs for these courses are covered by funds voluntarily contributed by full-time and volunteer clinical faculty and commercial vendors. The courses attended are as follows:
- Basic A-O Course (R-I)
- Pathology (Enneking) Course (R-2)
- Orthotics/Prosthetics Course (R-3)
- AAOS Meeting (R-4)
- Orthopaedic Review Course (R-5)
Additionally, residents are encouraged to submit and present their research projects at regional and national meetings.
The Intern Year is under the control of the Program Director. The rotations follow the requirements outlined by the American Board of Orthopaedic Surgery (ABOS). General Surgery rotations include: trauma, surgical intensive care, plastic surgery/burns and vascular. Pediatric General Surgery provides experience in pediatric patient surgical and non-surgical care. Other rotations include internal medicine/infectious diseases, anesthesiology and emergency medicine. Finally, Interns complete a 3-month orthopaedic trauma rotation emphasizing poly-trauma orthopaedic care.
Second year residents spend three months with Dr. Steve Kleinhenz and other volunteer clinical faculty at a private general orthopaedic practice. Another three-month rotation with Dr. Dennis Brown at Good Samaritan Hospital provides training in joint replacement.The resident also takes in-house call approximately seven nights per month. The goal is for the second year resident is to become acquainted with common general orthopaedic conditions, hospital procedures and protocols.
Second year residents rotate for three months at the Dayton VA Medical Center. During this rotation, the resident gains experience in adult reconstructive orthopaedics by working closely with Dr. Anil Krishnamurthy who specializes in joint replacement. The resident attends clinics with Dr. Krishnamurthy and Dr. Lawless acquiring skills in evaluating patients with major joint abnormalities. The resident learns appropriate non-operative care, makes decisions on appropriate surgical candidates for joint replacement, performs and assists in hip and knee replacement surgery and manages the patients post-operatively. The resident follows these patients over this three-month rotation. The resident presents all cases in a preoperative conference, becoming acquainted with different options available for patients undergoing primary and revision total joint replacement. Dr. Michael Herbenick runs a specialty shoulder and elbow reconstruction clinic and Dr. Doug Gordon and Dr. Gene Kim staff the hand clinic. The second year resident participates in these clinics along with the chief resident at the Dayton VA Medical Center.
During the VA rotation with Dr. Krishnamurthy, the resident becomes involved in anatomy and research. During this time, the resident performs cadaver dissections and presents the anatomy portion of the basic science lectures. The resident is required to identify his research project, which may be anatomical, bioengineering, basic science animal research or clinical. The research track residents (as well as basic science faculty) are available for support. Finally, second year residents have opportunities for exposure to rehab clinics in amputations, spinal cord, EMG and chronic pain management as well as orthotics and prosthetics.
Third year residents spend three months at Children's Medical Center experiencing all aspects of pediatric orthopaedic surgery, including spine. A weekly pediatric conference is held on Fridays from 7-8 a.m. at Children's Medical Center. There are four full-time pediatric orthopaedic surgeons whose office is based at Children's Medical Center. Residents see patients preoperatively, participate in their surgery and manage them postoperatively. They also see a large volume of pediatric fractures and provide ER consultation for closed reductions and management of pediatric fractures. Residents handle call from home. Specialty clinics include myelomeningocele and cerebral palsy.
Third year residents rotate for three months on the Foot & Ankle Service with Dr. Laughlin. The resident attends the private office and the Diabetic Foot Clinic (a multidisciplinary wound clinic at Miami Valley Hospital) and gains skills in evaluating and managing foot and ankle conditions. Orthotics and prosthetics are taught on this rotation, emphasizing writing prescriptions. The resident performs proper referral management of amputations and the amputee as well.
Third year residents spend three months rotating on the Trauma Service at Miami Valley Hospital -the busiest Level I Trauma Center Emergency Department in Ohio. The Trauma Service admits over 3,000 patients per year with 65-70% having orthopaedic injuries. The resident participates in acute trauma management and also covers cases in post-traumatic reconstruction performed by the trauma staff. The resident attends a trauma clinic, providing follow-up care of all the indigent fracture patients, as well as Dr. Michael Prayson's private office. Dr. Prayson directs the orthopaedic trauma service, which includes an orthopaedic trauma fellow (R-6), a chief resident (R-5), an intern (R-1), an Emergency Medicine resident, and an advance practice nurse. All Attendings taking trauma call are fellowship-trained in trauma and are required to accumulate at least 16 trauma-related Category I CMEs every six months.
Third year residents rotate for two months on the Spine Service focusing on spine trauma. The resident works with Dr. James Lehner and Dr. Marcos Amongero, attending their private patient office as well as Miami Valley Hospital's indigent care spine clinic.
Finally, third year residents rotate for one month with Dr. Michael Herbenick on sports medicine.
Fourth year residents rotate for four months in hand surgery-two months with Dr. Peter Barre and two months with Dr. Doug Gordon, both volunteer clinical faculty in our department. The resident also operates with volunteer clinical faculty, Dr. Gene Kim. The resident gains continuity in patient care by attending the indigent care hand clinic, the hand surgeons' private offices and the hand clinic at the VA, providing preoperative, postoperative and non-operative care in these settings. All hand surgeons are fellowship-trained and have a Certificate of Added Qualification (CAQ) in hand surgery.
The resident spends four months rotating two months each on pediatrics with Dr. Michael Albert and spine surgery with Dr. James Lehner. Both rotations expand on experiences gained during the second year spine and third year pediatric rotations.
The final block concentrates on arthroscopy. The resident rotates for two months with Dr. Matthew Lawless, focusing on knee surgery and two months with Dr. Joe Rubino, focusing on shoulder and elbow surgery. Both services experience a high volume of arthroscopy and reconstructive surgery. The resident follows the Attending one-on-one in the private office, at the VA Medical Center, and in operating room, functioning as a chief resident with progressively-increasing responsibilities to prepare for the fifth year of training-the chief resident year.
The chief resident year is divided into three blocks. One four-month block is spent at Miami Valley Hospital as the chief resident on the Trauma Service. Chief residents have their own fracture follow-up clinic supervised by Dr. Michael Prayson. This expands on their third year trauma service experience, enabling the resident to start functioning more independently and transitioning them into private practice. The chief resident supervises the junior residents and advanced practice nurse on the Trauma Service, and is also responsible for presenting the Ortho Trauma Review each month at the Grand Rounds on Wednesday.
Finally, the chief resident rotates for four months on the VA Medical Center orthopaedic surgery service with Dr. Anil Krishnamurthy. Together with a second year resident, the chief resident attends clinics in adult reconstruction (Dr. Krishnamurthy), shoulder and elbow (Dr. Herbenick), and hand surgery (Dr. Gordon), participating in all the surgery generated by these clinics. During this rotation, the chief resident spends Thursdays and Fridays gaining additional total joint experience with Dr. Dennis Brown at Good Samaritan Hospital. Dr. Brown and his partner, Dr. Tom Cook, perform over 200 joint revision procedures per year and perform the majority of alternate-bearing joint replacements in our area.