Typical Education Program for Residents

2007-2008 Resident Rotation Schedule (Revised 5/10/07)

R2 covers Spine Clinic the whole rotation. Hand resident goes to VA.

Each resident is 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, which allows them to have 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. Teaching time 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 out of town visiting professor is invited to the Dayton Orthopaedic Society meeting, which is held on a Tuesday evening. This is followed by case presentations and a symposium on the following Wednesday. The residents attend these meetings. The faculty and chief residents choose the topics of both Dayton Orthopaedic Society and symposia.

All residents are required to attend morning conferences. Monday through Thursday there is a conference at Miami Valley Hospital from 7 to 8 a.m. The Children's Service conference is Friday morning form 6:30 to 7:30 a.m. and is attended by the residents on the Children's Service and all other available residents. Evening/afternoon conferences have essentially been eliminated to comply with the eight hours work rules and to maximize attendance.  

The conference schedule is as follows:

• Monday 7–8 a.m.: Subspecialty Conference. This rotates on a weekly basis through each subspecialty area (Trauma, Spine, Foot/Ankle, Shoulder/Joints, Hand, Children's) with the resident on that service presenting a specific clinical topic with case examples for discussion.
• Tuesday 7–8 a.m.: Basic Science Topic, which rotates through pathology, radiology, orthopaedic science and includes basic science faculty from the medical school who participate in the musculoskeletal organ system teaching curriculum. Also included in this time slot are lectures and discussions in ethics with Robert Reece Ph.D., Department of Community Health, using the videotape "Ethical Issues in Orthopaedic Practices" and selected articles from the Journal of Bone and Joint Surgery Orthopaedic Forum.
• Wednesday 7–8 a.m.: Grand Rounds. This rotates each week as follows: Selected topic presentation by resident, Morbidity/Mortality Conference, Trauma Case Review, and Staff Case Review.
• Thursday 7—8 a.m.: Anatomy dissection presentation and selected clinical topics.

Full-time faculty attend all the conferences, and many 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 to a foundation by full-time and clinical faculty and commercial vendors. The courses attended are

• 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)

In addition, residents are encouraged to submit and present their research projects at regional and national meetings.

R-1

The Intern Year is under the control of the Program Director. The rotations follow the requirements outlined by the American Board of Orthopaedic Surgery (ABCS). Rotations through the General Surgery Department include: Trauma, Surgical Intensive Care, Plastic Surgery/Burns and Vascular. Pediatric General Surgery provides experience in the surgical and nonsurgical care of the pediatric patient. The R-1 resident also rotates on the Internal Medicine/Infectious Disease Service, Anesthesiology and Emergency Medicine. Finally, the R-1 resident rotates for three months on the Orthopaedic Trauma Service emphasizing orthopaedic care of the polytrauma patient.

R-2

The R-2 resident first rotates four months on a private general orthopaedic service at MVH. The resident takes in-house call approximately seven nights per month. The goal is for the resident to become acquainted with common general orthopaedic conditions, hospital procedures and protocols.

Next, the R-2 resident rotates four months at the Dayton VA Medical Center. During this rotation, the resident gains experience in adult reconstructive orthopaedics by working closely with Anil Krishnamurthy who specializes in joint replacement. The resident attends clinics with Dr. Krishnamurthy and Dr. Lawless acquiring skills in evaluation of patients with major joint abnormalities. The resident learns appropriate nonoperative care, makes decisions on who is a surgical candidate for joint replacement, performs/assists in surgery in hip and knee replacement and manages the patients post-operatively. The resident follows these patients over a four-month period. The resident presents all cases in a preoperative conference and becomes acquainted with different options that are available for patients undergoing primary and revision total joint replacement. Dr. Crosby runs a specialty shoulder & elbow reconstruction clinic and a hand clinic is staffed by Drs. Gordon and Kim. Along with the chief resident at the Dayton VA Medical Center, the resident participates in these clinics.

The R-2 resident has a two-month rotation on the Spine Service focusing on spine trauma. The resident works with Drs. Lehner and Amongero, attending their patient office as well as the hospital spine clinic.

The final two R-2 months are devoted to Anatomy, Research and Rehab. 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 fellow (as well as basic science faculty) is available for support. Finally, the resident has opportunities for exposure to rehab clinics in amputations, spinal chord, EMG and chronic pain management as well as orthotics and prosthetics.

R-3

The R-3 resident spends four months at Children’s Medical Center seeing all aspects of pediatric orthopaedic surgery, including spine. There is a weekly pediatric conference. 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. Call is from home. Specialty clinics include myelomeningocele and cerebral palsy.

The second rotation is on the Foot & Ankle Service with Dr. Laughlin. The R-3 resident attends the private office and the Diabetic Foot Clinic (a multidisciplinary wound clinic). The resident gains skills in evaluation and management of foot and ankle conditions. Orthotics and prosthetics are taught on this rotation, emphasizing prescription writing and proper referral management of amputations and the amputee is performed as well.

The third R-3 rotation is on the Trauma Service. Miami Valley Hospital, a Level I Trauma Center, has the busiest ER in Ohio. The Trauma Service admits approximately 2700 patients per year with 65-70% having orthopaedic injuries. The R-3 resident participates in the acute management of trauma and also covers cases in post-traumatic reconstruction performed by the trauma staff. The R-3 resident attends a trauma clinic providing follow-up care of all the indigent fracture patients, and also attends Dr. Prayson’ private office. The director of the orthopaedic trauma service is Dr. Prayson. This service includes a chief resident (R-5), an intern (R-1), an Emergency Medicine resident, an advance practice nurse and a Physician Assistant. All Attendings taking trauma call are fellowship trained or have equivalent experience.

R-4

The R-4 resident has a four-month rotation in hand surgery. Two months are spent with Dr. Gordon and the other two months are spent with Drs. Barre and Berrettoni. The resident also operates with Dr. Kim. The resident attends the Miami Valley Hospital Hand Clinic and the private offices of the hand surgeons. The VA Hand Clinic is available to the resident as well. All hand surgeons are fellowship trained and have their Certificate of Added Qualification (CAQ) in hand surgery. The resident has continuity in patient care by attending the private office as well as the Miami Valley Hospital Hand Clinic and providing preoperative and postoperative care. They also provide nonoperative care in these settings.

The next R-4 block consists of two months of pediatrics and two months of spine surgery. Both of rotations are intended to expand on the experiences gained on these services during the R-2 (spine) and R-3 (pediatric) rotations.

The final block concentrates on arthroscopy. Two months is spent with Dr. Lawless focusing on knee surgery and two months is spent with Dr. Crosby focusing on shoulder and elbow surgery. Both of these surgeries experience a high volume of arthroscopy and reconstructive surgery. The resident follows the Attending one-on-one in the office and operating room. He functions as a chief resident with progressively-increasing responsibilities.

R-5/Chief Resident

R-5 is divided into three blocks. The first block is spent at Miami Valley Hospital as the chief resident on the Trauma Service. The R-5 (Chief) resident has their own fracture follow-up clinic supervised by Dr. Prayson. This expands on their experience as a R-3 on this service, enabling the resident to start functioning more independently. The chief resident supervises the junior residents, Physician Assistant, and advanced practice nurse on the Trauma Service. The chief resident is responsible for presenting the Ortho Trauma Review each month at Grand Rounds.

The second block is spent in Adult Reconstruction. During this time the chief resident alternates rotations with Drs. Crosby and Lawless in shoulder & elbow and knee reconstruction. In addition, we have added a total joint experience with Dennis Brown, MD at Good Samaritan Hospital. Dr. Brown, and his partner Tom Cook, DO, performs over 200 joint revision procedures per year and also perform the majority of alternate-bearing joint replacements in our area.

The final four-month R-5 block is as chief resident at the VA. Together with the R-2, the resident attends clinics in Adult Reconstruction, Shoulder & Elbow and hand and participates in all the surgery generated by these clinics. They are supervised by Drs. Krishnamurthy, Crosby, Lawless, Kim and Gordon.

For more information, see: Rotations