DEPARTMENT OF ORTHOPAEDIC SURGERY
RICHARD E. MCCALL, M.D.
CHAIRMAN
VISION STATEMENT
The Orthopaedic Residency Training Program at LSUHSCS is designed to provide the resident with state of the art training in clinical and surgical orthopaedic medicine. The residents participate in a wide variety of educational sessions in order to attain this goal. These sessions include faculty supervised clinical care of patients, faculty interactive teaching sessions, mandatory didactic teaching sessions, resident presentations, and orthopaedic basic science and clinical orthopaedic research.
This global approach to orthopaedic education is designed to teach the residents at each level the knowledge base and skills that are required to provide excellent orthopaedic patient care in all health-care settings: the outpatient department, inpatient department, emergency department, and the operating room.
The Orthopaedic Department's resident educational philosophy is to build the residents' skills in a progressive manner so they can manage patient care from initial evaluation through surgical and non-surgical management and follow-up care. The supervised responsibility that the resident progressively assumes is based on the resident's fund of knowledge, clinical skills and judgment, and level of self-confidence.
CODE OF ETHICS
All physicians, around the world, respect the philosophical guidelines as set out in the Hippocratic Oath. These philosophies are the bases of a physician's ethical standards. All orthopaedic residents at LSU Health Sciences Center, without exception, will maintain appropriate ethical relationships with patients, patient families, other physicians, and colleagues. The basis of this ethical standard arises from the respect for human life, respect for individuals, respect for family, respect for life conditions and respect for values and lifestyles that may differ from that of the individual physician.
The Department of Orthopaedic Surgery demands that each and every resident will follow the rules of moral, ethical, and professional conduct in their daily activities as a health-care professional. The resident will act accordingly in the community, reflecting a positive and ethical light on this Orthopaedic Department, LSU Health Sciences Center, on orthopaedic surgery, and on all physicians.
The orthopaedic resident will be required to attend lectures of ethics, communication skills, and quality management during their training as provided by the Orthopaedic Department. These will help guide the resident in ethical decision-making and behavior.
This Orthopaedic department believes that abiding by strong moral standards in everyday activities is the strongest expression of one's ethics. Resident and faculty are expected to behave in accordance with legal and moral standards inside and outside of the hospital. Repeated failures of ethical standards and/or a gross violation of ethical behavior may be cause for mandatory counseling and possible termination from the Orthopaedic Residency Program of LSU Health Sciences Center.
GOALS AND OBJECTIVES
Patient Care
During their residency each resident will acquire an increasing base of orthopaedic knowledge and surgical skills. They will apply this increasing knowledge to patient care in order to provide compassionate, appropriate and effective treatment and prevention of disease.
This knowledge will be acquired through structured lectures, conferences, and anatomy sessions. Daily interaction with faculty and senior residents will provide opportunities to learn how to care for patients and their diseases.
Medical Knowledge
During their orthopaedic surgical training, each resident will progressively learn the skills to demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care. They will learn, with increasing responsibility, the investigatory and analytical thinking approach to clinical situations so they can provide the "gold standard" of care for patients with musculoskeletal complaints and conditions. They will learn and be expected to apply the basic and clinically supportive sciences that are appropriate to orthopaedic surgery at the level required by their year-in-training.
Practice-Based Learning and Improvement
Each resident must learn to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents will learn to analyze practice experience and perform practice-based improvement activities using a systematic methodology. They will learn how to locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems. They will obtain and use information about their own population of patients and the larger population from which their patients are drawn. Through journal clubs, research meetings, and didactic teaching sessions, the residents will learn to apply knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. Through tools such as Grand Rounds, the resident will use information technology to manage information, access on-line medical information and learn to support their own education. It is essential in the LSU Health Sciences Center of academic medicine that the resident learns to facilitate the learning of students and other health-care professionals.
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills required for their level of training and interaction with patients, patients' families, and professional associates that result in effective information exchange. The residents are expected to create and sustain a therapeutic and ethically sound relationship with patients and their families at all times. The use of effective listening skills and the ability to elicit and provide information using effective nonverbal, explanatory, questioning and writing skills is mandatory. Residents will be expected to work effectively with others as a member or leader of a health care team or other professional group.
Professionalism
During their residency, orthopaedic residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. This commitment must carry over to resident peers, orthopaedic faculty and to LSU Health Sciences Center employees and staff. The residents must demonstrate respect, compassion and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society and the universal orthopaedic community and to the profession of physicians. The resident must be committed to providing excellent health care and the "gold standard" of orthopaedic care to all patients. The resident will be expected to commit to on-going, progressive professional development. At all times during the residency, the resident must demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. Residents will be required to demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities at all times.
Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents will learn how their patient care and other professional practices affect other health-care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice. They will learn different types of medical practice and delivery systems, including health care cost containment and resource allocation. During the residency, each resident will learn to practice cost-effective health-care and resource allocation that does not compromise quality of care. The resident will learn to advocate for quality patient care and will learn to assist patients in dealing with system complexities. They will also be expected to learn how to assist health-care managers and health-care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.
PARTICIPATING INSTITUTIONS
The institutions participating in the Orthopaedic Residency Program of LSU Health Sciences are Louisiana State University Health SciencesShreveport, Overton Brooks Veterans Administration Hospital, and Shriner's Hospital for Children Shreveport.
Presently, there are no rotations out of Shreveport, Louisiana.
Louisiana State University Health Sciences CenterShreveport is a level one trauma hospital with a surgical intensive care unit and dedicated orthopaedic ward, emergency department and a fully equipped operating room that runs twenty four hours a day. There are dedicated orthopaedic operating rooms every day. The orthopaedic service also runs an outpatient clinic every business day. The emergency department has a separate Emergency Medicine residency program to help manage the patient load. The emergency department also has minor procedure rooms and a C-arm dedicated to emergency patient management. The orthopaedic service has the pleasure of physician assistants and nurse practitioners to help with the day-to-day patient care.
Veterans Administration Hospital (Overton Brooks) is a full service Veterans Administration hospital that has a very active orthopaedic department. The hospital has a fully equipped operating room, surgical and medical intensive care units as well as a busy outpatient department and emergency room.
During their rotations at Overton Brooks, the residents will focus on elective adult orthopaedic care with an emphasis on joint reconstruction. The resident will be expected to provide orthopaedic medical care in all areas; the emergency department, outpatient department, operating room and inpatient care areas.
Shriner's Hospital for Children is a 45-bed institution, which caters to the pediatric orthopaedic patient. The hospital has two operating rooms, physical therapy and occupational therapy. The resident will be exposed to all areas of non-trauma pediatric orthopaedic surgery.
RESIDENT ELIGIBILITY
The Department of Orthopaedic Surgery will select residents who meet the required eligibility guidelines as set forth by the Louisiana State University Health Sciences Center Shreveport Graduate Medical Education Policy Manual (Section GME.V.13).
The prospective resident will submit all required information to this program via the ERAS (Electronic Resident Application System). The program director will then review all submitted applications and choose those that will be extended an interview. The selection of those to be interviewed will be based on scholastic achievement, USMLE scores, letters of recommendation, and personal statements.
RESIDENT SELECTION
Interviews will be conducted here at LSUHSC. The Program Director and Department Chairperson will interview all candidates. Selected orthopaedic faculty and residents will also interview the prospective candidates. The final selection of residents for the rank list will be made after all selected applicants have been interviewed. Almost without exception, residents will be selected through the MATCH.
The residents will be selected based on their communication skills, ability, aptitude, academic credentials, and letters of recommendation. If the applicant did a rotation here at LSU Health Sciences Center, the impression of the residents with whom they worked will be taken into consideration. The program will not discriminate with regard to gender, race, age, religion, color, national origin, disability or veteran status.
Those involved in the resident selection, may consider the applicants class ranking and other honorary academic status.
The prospective resident should meet the requirements established by the Louisiana State Board of Medical examiners for licensure.
RESIDENT SUPERVISION
Inpatients
Inpatient care is the direct responsibility of the assigned resident team, which consists of a junior and senior resident. It is expected that every patient will be seen and evaluated by their assigned team each day. The senior resident with attending staff supervision directs all major decisions made by the resident team. Emergency room and in-house consultations are initially evaluated by the assigned physician's assistant with mandatory review of each consult by the junior resident. The junior resident will discuss all consultations with their assigned chief resident who will then review the consultation with the attending staff if necessary.
Outpatients
There will be no LSU outpatient clinics without attending availability. All patients must be seen and evaluated by the senior resident assigned to clinic that day. The senior resident will be expected to make decisions on the patients in their clinics and teach and encourage the junior residents to participate in the decision making process. The VA hospital requires that an attending is present during all clinic sessions as is readily available to see patients. The patients will be seen and evaluated by a resident and the resident will seek consultation if needed. While at the Shriner's Hospital for Children, the attending is present and usually sees or discusses each patient with the resident.
The "on-call" resident will handle phone questions from patients and referring physicians. If the resident is not certain on how to proceed, they are to consult with the "on-call" senior/chief resident. At present, all requests for patient transfer will be accepted. If the "on-call" resident has reservations or concerns regarding the transfer, they will refer the issue to the "on-call" senior/chief resident. The attending will be notified and advice sought by the senior/chief resident if that senior/chief resident has concerns or reservations regarding the transfer. Patient call regarding medical matters will be handled whenever possible by suggesting a patient evaluation in the clinic or emergency department. The 'on-call" resident will not fulfill any telephone requests for narcotic medication. The residents will carry Dictaphones and will document all calls from referring physicians and patients. These documents will be kept in the orthopaedic department and placed on the patient's chart if he/she is a patient of LSU Health Sciences Center.
Operating Room
Except under extreme circumstances, no operations will be performed at any of the hospitals without the attending staff being available. The attending physician must be available to assist in positioning and the planning of the skin incision. The attending must be available to scrub for the "key elements" of the procedure. The attending should be available for the wound closure and the immediate postoperative course of the patient. The primary responsibility of each procedure is assumed by the attending, even during routine procedures in which the chief resident may be instructing the junior resident. The junior residents can perform minor procedures such as irrigation and debridements and secondary wound closures independently if the chief resident and attending staff is confident in the resident's ability. Reduction of dislocated major joints and management of pyarthorsis will always be supervised by the senior resident or the attending physician, unless emergency conditions preclude this.
The most senior resident in each operating room is responsible, along with the attending staff, to comply with LSUHSC "time-out" policies prior to starting each surgical case.
RESIDENT LEVELS OF CARE
Resident Levels of Care
1 Medical knowledge
2 Patient care skills
3 practice-based learning
4 Interpersonal and communication skills
5 systems-based practice
6 Professionalism
* - PGY 2 or greater is present and documents their presence
** - a faculty physician, other than another resident, is present physically during the key portions of the procedure or is immediately available
Resident Level: PGY 1
Clinical Diagnosis and Management
Perform and document history and physical examination ( 1,3,4)
Develop a differential diagnosis (1,2,)
Order and interpret findings of diagnostic tests (radiology, laboratory) (1,2,)
Develop and document fluid and electrolyte therapy (1,2,4)
Monitor vital signs and intake/output (1,2)
Request and evaluate appropriate consults (1,2,3,4,5,6)
Obtain and document informed consent (orthopaedic consent *) (1,4,6)
Order transfusions of blood and blood products (1,2,5)
Order pain management therapy ( 1,2,3)
Order medications and monitor for effectiveness and adverse reactions (1,2,3)
Develop and document pre and postoperative care plans (non-orthopaedic) (1,2,4,5)
Document patient status by clear and legible notes (1,2,4)
Dictate discharge summaries (1,4,5,6)
Dictate operative notes (of simple non-orthopaedic procedures) (1,4,5)
Learn and apply ICD and CPT codes and understand the documentation needed (1,3,5,6)
Collect specimens (Urine, sputum, joint fluid, drainage, etc) for submission to laboratory for examination (1,2,3,4,5)
Understand and practice sterile techniques and scrub, gown and glove and drape properly for non-orthopaedic surgery (1)
Manage surgical tubes and drains (1,2)
Understand and practice universal infection control/safety precautions (1,2,3,4,5,6)
Understand principles of triage (1,2,3,4,5)
Understand/Utilize principles of mechanical ventilation (1,2)
Understand the basic principles of anesthesia and interpret the anesthesia record (1,2,5)
Maintain a legally correct and complete medical record (1,5,6)
Use and understand nursing notes and patient data (1,4,5,6)
Interpret normal and common abnormal findings in x-rays of chest, abdomen, soft tissues (1,3)
Interpret and appropriately describe fracture patterns of simple long bone fractures (1,3)
Be familiar with common surgical instruments and suture materials and their proper uses (1)
Utilize the institutional resources and case management services for discharge planning and follow-up (1,3,4,5)
Be aware of the principles of peer review and cooperate with the GMEC and CQI process and activities ( 4,5,6)
Evaluate and diagnose compartment syndrome (1,2)
Understand the concept of risk management and needed documentation in the medical record (4,5,6)
Understand the principles of clinical research and clinical trials (3)
Be able to perform statistical analysis of data and interpretation of published results (3,5)
Develop computer skills and use available resources (3,5,6)
Understand the anatomy of the chest and pelvic cavities and the extremities (1)
Invasive Operative Management
Perform venipuncture
Start peripheral IV lines
Place central lines (subclavian or jugular vein)**
Draw blood cultures
Place foley catheters
Obtain orpharynegeal control of airway and provide ambu-ventilation
Perform oral/nasal-gastric/tracheal** intubations
Administer local anesthetics
Learn basic techniques of dissection and handling of tissues
Repair simple lacerations
Understand the principles and application of electrocautery
Perform simple wound closures
Perform wound dressing and daily wound care
Serve as operative assistant
Excise or biopsy superficial skin lesions
Perform incision and drainage of superficial (or deep**) fluid collections and/or abscesses
Place (percutaneous or open**), maintain and remove thoracostomy tubes
Perform diagnostic lumbar puncture **
Obtain and apply split thickness skin grafts **
Repair umbilical and inguinal hernias **
Perform extremity amputations **
Draw arterial blood samples
Place arterial blood pressure monitoring lines**
Remove superficial foreign bodies
Apply casts and splints
Reduce simple dislocations
Resident Level: PGY 2
Clinical Diagnosis and Management
Perform and document detailed history and physical examination
Focusing on the musculoskeletal system (1,2)
Develop a differential diagnosis, emphasizing musculoskeletal medicine (1,2)
Develop and document fluid and electrolyte therapy (1,2)
Understand the principles of radiation safety and fluoroscopy (1,2)
Provide appropriate care for urgent and emergent orthopaedic conditions (1,2,3,5)
Obtain consent for orthopaedic surgical procedures (1,2,4,5)
Learn and apply ICD and CPT codes and understand the documentation needed for
orthopaedic procedures (1,3,5,6)
Describe all long bone fractures adequately (1,2)
Understand biomechanics of fractures and its clinical correlation (1,2)
Dictate orthopaedic operative procedure notes (1)
Understand the anatomy of the hand, spine and pelvis (1)
Understand the pharmacology of antibiotics, analgesics and drugs for conscious sedation and
be able to order them appropriately (1,2)
Expand knowledge of pre and post-operative orthopaedic care with good documentation
(1,2,4,5)
Utilize the institutional resources and case management services for orthopaedic discharge
planning and follow-up (1,3,4,5)
Provide appropriate care for urgent and emergent orthopaedic conditions (1,2)
Begin to understand the specialized equipment required for orthopaedic surgery (1,3.)
Understand which equipment is kept in the hospital and which equipment required to be
called into the hospital (1,5)
Be able to tie all knots required by orthopaedic surgery (1)
Use basic surgical equipment and basic orthopaedic equipment (1)
Be able to instruct medical and allied health students in the fundamentals of orthopaedic care
(1,2,3,4,5,6)
Continue to demonstrate the importance of acquiring throughout residency, medical
knowledge about established and evolving biomedical, clinical and cognate sciences as well
as application of such knowledge to patient care (1,2,3,4,5,6)
Continue to demonstrate practice based learning and improvement that involves the
investigation and evaluation of care of patients, the appraisal and assimilation of scientific
evidence, and improvement in patient care (1,2,3,4,5,6)
Expand the understand of the concept of risk management and needed documentation in the medical record (4,5,6)
Invasive Operative Management
Insert percutaneous pins
Remove hardware (except around the pelvis)
Act as first assist for complex orthopaedic operative procedures
Perform moderately complicated wound closures
Perform wound irrigation and debridements
Repair simple lacerations
Perform incision and drainage
Perform closed reductions of all fractures
Perform open reduction and internal fixation of simple fractures*
Tie all knots required in orthopaedic surgery
Use scalpel, forceps and scissors effectively
Perform knee, wrist, elbow, ankle, hip*, small joint arthrocentesis
Perform removal of cysts, ganglions, etc *
Resident Level: PGY 3
Clinical Diagnosis and Management
Perform and document detailed history and physical examination focusing on the
musculoskeletal system (1,2)
Develop a differential diagnosis, emphasizing musculoskeletal medicine (1,2)
Develop an understanding of the pathology of inflammatory joint disease (1)
Continue to use radiological equipment in a safe and efficacious manner (1,2)
Provide appropriate care for urgent and emergent orthopaedic conditions (1,2,3,5)
Obtain consent for complicated orthopaedic surgical procedures (1,2,4,5)
Continue to learn and apply ICD and CPT codes and understand the documentation needed
for orthopaedic procedures (1,3,5,6)
Describe all acetabular and spine fractures adequately (1,2)
Understand biomechanics of fractures and orthopaedic implants, and use this knowledge to
make sound orthopaedic decisions (1,2,3,)
Dictate complex orthopaedic operative procedure notes (1)
Understand the three dimensional anatomy of the skeleton (1)
Understand the pharmacology of non-steroidal anit-inflammatories and steroids (1,2)
Expand knowledge of pre and post-operative orthopaedic care, including complications, with
good documentation (1,2,4,5)
Utilize the institutional resources and case management services for orthopaedic discharge
planning and follow-up (1,3,4,5)
Provide appropriate care for a critically ill orthopaedic patient with minimal supervision (1,2)
Understand the specialized equipment required for orthopaedic surgery (1,3.)
Understand which equipment is kept in the hospital and which equipment required to be
called into the hospital (1,5)
Be able to communicate with the instrument representative regarding the need for
instrumentation for basic orthopaedic cases (1,2,4,5,6)
Use advanced surgical equipment (1)
Be able to instruct medical and allied health students in the fundamentals of orthopaedic care
and radiology interpretation (1,2,3,4,5,6)
Continue to demonstrate the importance of acquiring throughout residency, medical
knowledge about established and evolving biomedical, clinical and cognate sciences as well
as application of such knowledge to patient care (1,2,3,4,5,6)
Continue to demonstrate practice based learning and improvement that involves the
investigation and evaluation of care of patients, the appraisal and assimilation of scientific
evidence, and improvement in patient care (1,2,3,4,5,6)
Expand the understand of the concept of risk management and needed documentation in the
medical record (4,5,6)
Understand the indications for total joint replacement (1,2)
Invasive Operative Management
Perform complex wound closures
Insert percutaneous pins for moderately complex fractures
Remove hardware
Expand the ability to assist for complex orthopaedic operative procedures
Perform wound irrigation and debridements of complex open fractures
(pelvis**)
Repair complex lacerations
Perform incision and drainage
Perform closed reductions of all fractures and dislocations
Perform open reduction and internal fixation of moderately complex fractures*
Perform nailing of tibia and femur*
Understand and use most orthopaedic equipment.
Understand the basic use of equipment required to insert a total joint replacement
Be able to negotiate the knee joint with an arthroscopy**
Perform knee, wrist, elbow, ankle, hip, and small joint arthrocentesis
Perform curettage and bone grafting of bony cysts **
Be able to perform moderately complex tendon repairs.
Be able to obtain iliac crest bone graft
Apply external fixators on long bones of lower extremity**
Perform simple hand procedures**
Resident Level: PGY 4
Clinical Diagnosis and Management
Perform and document detailed history and physical examination focusing on the
musculoskeletal system (1,2)
Develop a differential diagnosis, emphasizing musculoskeletal medicine including
musculoskeletal tumors (1,2)
Understand the pathology of malignant and benign bone disease and acquire the ability to
order and interpret appropriately ordered radiology tests
Understand the pathology of all types of inflammatory joint disease (1)
Continue to use radiological equipment in a safe and efficacious manner (1,2)
Provide appropriate care for the most emergent orthopaedic conditions (1,2,3,5)
Obtain consent for complicated orthopaedic surgical procedures (1,2,4,5)
Able to discuss with patients and families, orthopaedic diseases and their prognosis(1,2,3,4,6)
Continue to learn and apply ICD and CPT codes and understand the documentation needed
for orthopaedic procedures (1,3,5,6)
Understand the three dimensional anatomy for the spine and pelvis
Understand biomechanics of fractures and orthopaedic implants, and use this knowledge to
make sound orthopaedic decisions and plan operative intervention for complex orthopaedic
cases (1,2,3,)
Dictate complex orthopaedic operative procedure notes (1)
Provide complete pre-operative and post-operative care for most orthopaedic patients and the
more common complications that may arise including adequate documentation (1,2,3,4,5,6)
Utilize the institutional resources and case management services for complex orthopaedic
discharge planning and follow-up (1,3,4,5)
Provide appropriate care for a critically ill orthopaedic patient with minimal supervision (1,2)
Understand the specialized equipment required for orthopaedic surgery including
arthroscopic equipment and total joint equipment (1,3.)
Understand which equipment is kept in the hospital and which equipment required to be
called into the hospital (1,5)
Be able to communicate with the instrument representative regarding the need for
instrumentation for orthopaedic cases (1,2,4,5,6)
Use advanced surgical equipment. (1)
Be able to instruct medical and allied health students in the fundamentals of orthopaedic care,
radiology interpretation and basic surgical requirements (1,2,3,4,5,6)
Continue to demonstrate the importance of acquiring throughout residency, medical
knowledge about established and evolving biomedical, clinical and cognate sciences as well
as application of such knowledge to patient care (1,2,3,4,5,6)
Continue to demonstrate practice based learning and improvement that involves the
investigation and evaluation of care of patients, the appraisal and assimilation of scientific
evidence, and improvement in patient care (1,2,3,4,5,6)
Expand the understand of the concept of risk management and needed documentation in the
medical record (4,5,6)
Understand the indications for total joint replacement and pre-operatively plan for total hips,
knees and shoulders.
Be able to direct a team of orthopaedic, and other residents, along with medical and allied
health students, in the care of multiple pre- and post-operative patients (1,2,3,4,5,6)
Invasive Operative Management
Perform complex wound closures
Insert percutaneous pins for complex fractures
Perform wound irrigation and debridements of complex open fractures including pelvic
fractures
Repair complex lacerations
Repair complex tendon laceration (Zone II of hand**)
Perform incision and drainage of all abscesses
Perform closed reductions of all fractures and dislocations
Perform open reduction and internal fixation of complex fractures
Perform nailing of tibia and femur
Understand and use all commonly used orthopaedic equipment.
Be able to perform primary total knee and hip replacements**
Be able to preoperatively plan for re-do total knee and hip replacements
Be able to negotiate the knee and shoulder joint with an arthroscopy**
Perform knee, wrist, elbow, ankle, hip, and small joint arthrocentesis
Perform curettage and bone grafting of bony cysts
Be able to obtain iliac crest bone graft
Apply external fixators on long bones of lower extremity
Perform simple hand procedures**
Perform open reduction and internal fixation of all but complex fractures
Perform adequate exposure of the spine
Preoperatively plan for adult osteotomies
Resident Level: PGY 5
Clinical Diagnosis and Management
Perform and document detailed history and physical examination focusing on the musculoskeletal system (1,2)
Develop a differential diagnosis, emphasizing musculoskeletal medicine including
musculoskeletal tumors (1,2)
Understand the pathology of malignant and benign bone disease and acquire the ability to
order and interpret appropriately ordered radiology tests
Understand the pathology of all types of inflammatory joint disease (1)
Continue to use radiological equipment in a safe and efficacious manner (1,2)
Provide appropriate care for the most emergent orthopaedic conditions (1,2,3,5)
Obtain consent for complicated orthopaedic surgical procedures (1,2,4,5)
Able to discuss with patients and families, complex orthopaedic diseases including malignant
tumors (and their prognosis (1,2,3,4,6)
Continue to learn and apply ICD and CPT codes and understand the documentation needed
for orthopaedic procedures (1,3,5,6)
Understand the appropriate instrumentation for the spine and pelvis
Understand biomechanics of fractures and orthopaedic implants, and use this knowledge to
make sound orthopaedic decisions and plan operative intervention for complex orthopaedic
cases (1,2,3,)
Dictate complex orthopaedic operative procedure notes (1)
Provide complete pre-operative and post-operative care for most orthopaedic patients and the
more common complications that may arise including adequate documentation (1,2,3,4,5,6)
Utilize the institutional resources and case management services for complex orthopaedic
discharge planning and followup (1,3,4,5)
Provide appropriate care for a critically ill orthopaedic patient with minimal supervision (1,2)
Understand the specialized equipment required for orthopaedic surgery including
arthroscopic equipment and total joint equipment (1,3.)
Understand which equipment is kept in the hospital and which equipment required to be
called into the hospital (1,5)
Be able to communicate with the instrument representative regarding the need for
instrumentation for complex orthopaedic cases (1,2,4,5,6)
Use advanced surgical equipment. (1)
Be able to instruct medical and allied health students in the fundamentals of orthopaedic care,
radiology interpretation and basic surgical requirements (1,2,3,4,5,6)
Continue to demonstrate the importance of acquiring throughout residency, medical
knowledge about established and evolving biomedical, clinical and cognate sciences as well
as application of such knowledge to patient care (1,2,3,4,5,6)
Continue to demonstrate practice based learning and improvement that involves the
investigation and evaluation of care of patients, the appraisal and assimilation of scientific
evidence, and improvement in patient care (1,2,3,4,5,6)
Expand the understand of the concept of risk management and needed documentation in the
medical record (4,5,6)
Understand the indications for total joint replacement and pre-operatively plan for total hips,
knees and shoulders.
Be able to direct a team of orthopaedic, and other residents, along with medical and allied
health students, in the care of multiple pre- and post-operative patients (1,2,3,4,5,6)
Invasive Operative Management
Perform complex wound closures
Insert percutaneous pins for complex fractures
Perform wound irrigation and debridements of complex open fractures including pelvic
fractures
Repair complex lacerations
Repair complex tendon laceration (Zone II of hand**)
Perform incision and drainage of all abscesses
Perform closed reductions of all fractures and dislocations
Perform open reduction and internal fixation of complex fractures
Perform nailing of tibia and femur
Understand and use all commonly used orthopaedic equipment.
Be able to perform primary total knee and hip replacements
Be able to perform revision total knee and hip replacements**
Be able to preoperatively plan for revision total knee and hip replacements
Be able to perform a knee arthroscopy and meniscal repair/debridement
Be able to perform a shoulder arthroscopy and labral repair
Be able to perform an ACL reconstruction**
Perform knee, wrist, elbow, ankle, hip, and small joint arthrocentesis
Perform curettage and bone grafting of bony cysts
Apply external fixators on long bones of lower extremity
Perform complex hand procedures**
Perform open reduction and internal fixation of all complex fractures
Perform adequate exposure of the spine
Performing fracture and dislocation reductions of the spine**
Planning and performing adult osteotomies
Manage intraoperative emergencies (i.e., bleeding, fractures, and nerve injuries)**
RESIDENT CONFERENCES
Conferences are designed to enhance the residents' base of orthopaedic clinical and basic science knowledge. These conferences should act as a guide for the resident to continue their own education via reading, internet and with experience. As their knowledge base increases, the resident should be able to assume an increasing level of responsibility of patient care and operating room responsibilities.
All conferences have mandatory attendance by all residents. During their internship and rotations on other services, orthopaedic residents are still required to attend all orthopaedic conferences, guest lecturers, visiting professors and lectures series.
Trauma conference is held on Monday mornings. Residents present trauma cases of trauma interest. The residents and attending staff comment on the trauma, biomechanics of the trauma, complications associated with the trauma, injuries associated with the trauma. Treatment options are then reviewed. The treatment of this case is presented along with the outcome. Any known complications can also be discussed.
Tuesday consists of Grand Rounds, which is followed by a residents' conference or a journal club. Grand Rounds vary in format. Case presentations grand rounds consist of two residents each choosing a case they feel that they have learned something from. They are encouraged to present literature regarding the case and then open the presentation to discussion from attending staff and residents. This format provides the resident with opportunities to go in-depth into an area of interest and to then put together a small presentation and perform in front of an audience. They should be prepared enough to answer audience questions. Formal Grand Rounds are presented once a month. A resident and the Program Director choose a topic for the resident to research and compile an in-depth presentation of 45 minutes in length. They are required to present a bibliography and a report on information that was learned via the computer and internet. For both types of presentations, the slides shown must be submitted to the Residency Coordinator in order for the presentations to be placed in the residents file. Once a month, Morbidity and Mortality (M&M) conference will be given. The "chief" resident of each service (LSU, VA and the Shriner's) will present all the total number of cases done at each institution, divide those cases by type and then present the number of complications and the problem involved. The "chief" resident should have all appropriate radiographs to present and be prepared to answer questions regarding all aspects of the complication.
After Grand Rounds the residents will have either a variety of journal clubs, a resident round table discussion meeting or a research meeting. The journal clubs will be conducted by a variety of attending staff and they will choose the articles that will be reviewed. The resident round table discussions enable the residents to discuss with the Program Director any problems or issues which may be of concern. The research staff, along with the residents and Program Director will meet for the research meeting to discuss projects which are on going or ideas for future projects.
Friday consists of two sessions of didactic teaching. A clinical core lecture is given, followed by a basic science lecture. For three months of the year, basic science lectures will consist of anatomy sessions. These involve discussion in the anatomy lab with attending staff supervision. Other topics will be presented such as coding, compliance, legal matters and doctor/patient communication.
RESIDENT DUTY HOURS
The ACGME guidelines specify a limit of 80 hours a week average over 4 (four) weeks. The resident on-call will work until noon the following day and will then be allowed to leave the hospital after turning over all information and duty items to another assigned resident. The on-call resident may stay if patient care requires their presence or the resident believes that continuity of patient care would benefit their education. Residents will be required to submit their hours in writing to the Residency Coordinator.
If junior resident duty hours cannot be met, senior residents may have to be assigned to in-house call. Vacation, educational leave or any other type of leave, except for family emergencies, may need to be postponed in order to keep duty hours within the required guidelines.
At present, the residents at LSU are divided into two teams, which in turn have two seniors and two juniors. A set of junior and senior residents alternate every fourth night on-call. This allows the on-call in-house junior to leave at noon the following day of call.
The Shriner's Hospital for Children has two residents who alternate nights on-call. This call is out-of-house call that begins no sooner than 5:00 PM on operating room days. The residents cover every other weekend as out-of-house call.
Two residents, who alternate every other out of house call, cover the Veterans Administration.
All vacation, meetings, conferences and interviews must be made with the least amount of impact on fellow residents. Leave must be cleared by the "chief" resident of the effected service and then by the Resident Coordinator and the Program Director or the Chairperson of Orthopaedic Surgery.
RESIDENT DRESS CODE
Appropriate professional attire is required at all times. Scrubs are inappropriate outside the operating room except for brief tasks between cases. They are never to be worn outside the hospital.
Males should wear dress shirts, ties, trousers, socks and appropriate shoes. Hair should be neatly cut and clean. Facial hair must be trimmed and neat in appearance. Personal hygiene is expected at all times.
Females should wear business clothing, i.e. blouses, skirts, pants, etc Hair should be clean, neat and not kept in a manner that could cause contamination of a sterile site or require the resident to constantly touch/move their hair in the presence of a patient. Appropriate shoes are to be worn at all times. Flip-flops, open toed shoes or any shoe that would prevent a resident from running or moving quickly should not be worn while on duty.
RESIDENT VACATION AND LEAVE
The Department of Orthopaedic Surgery is compliant with the LSU Medical Education Office rules regarding vacation and leave.
First year residents are allowed three weeks (15 weekdays) vacation with pay during the educational year. Second through fifth year residents are allowed four weeks (20 weekdays) vacation with pay. It is preferred that vacation/leave is taken in one week intervals (5days). When five days of leave are applied for, it is expected that the resident will also be free of duty for one of the adjoining weekends. This weekend will not be charged to the resident's vacation. Vacation time is not cumulative and it must be used during the educational year earned and cannot be carried forward.
Each resident is allowed two weeks (10 weekdays) for sick leave each year. Sick leave may not be used as vacation time. Sick time of 3 consecutive days or greater, must be documented by a physician (not to be another resident).
Education, military, civil and leave without pay are to be arranged as far in advance as possible between the resident and the department.
All planned leave, must be approved first by the chief of the service, the Residency Director and/or the Chairperson of the Department of Orthopaedic Surgery. Once approved, the Resident Coordinator will notify the Medical Education Office of the resident's vacation/leave.
All orthopaedic services allow vacation/leave to be granted with appropriate approval. While an intern on other services, orthopaedic interns will be allowed to take vacation/leave with appropriate approval of that service.
Interviews for fellowships and jobs during the fourth and/or fifth year will be counted as educational leave. The amount of time needed will need to be discussed and planned with the resident coordinator. Once a plan has been decided, the Program Director and/or the Chairperson of the Department will grant the final approval.
Neither vacations nor leave time will be granted during the first month of the educational year or the last month of the educational year. The Residency Director, Chairperson and Hospital Administrator must approve exceptions to the above. Vacation will not be granted during the time of the Orthopaedic In-training Examination test date.
Residents, who have failed to log their surgical cases into the ACGME Residency Case Log System in a timely manner, will be prohibited from taking leave/vacation. Specifically, being one month behind in logging in will prohibit a resident from taking vacation.
RESIDENT MOONLIGHTING
As a policy, the Department of Orthopaedic Surgery does not encourage moonlighting. Moonlighting will be tolerated as long as the residents moonlighting activities do not interfere with their resident responsibilities.
If clinical or academic performance is poor and the resident is known to be moonlighting, that resident will be prohibited from further moonlighting until their performance has improved. Behavior to be monitored will be performance at conferences/lectures (i.e. sleeping, tardiness, lack of participation). Failure to log surgical cases into the ACGME Residency Case Log System in a timely manner may cause the Program Director to prohibit the resident from moonlighting.
Studies have shown a statistical association between performance on the Orthopaedic In-Training Examination (OITE) and performance on the Orthopaedic Board Examination Part I (written). Therefore, poor performance on the OITE exam may result in that resident to be prohibited from moonlighting.
RESIDENT TRAVEL
The fifth year residents will attend the American Academy of Orthopaedic Surgeons Meeting through the departmental funds or other sources. The third year residents will attend a trauma conference at no cost to the resident. Second year residents will attend the AO course.
During the residency, there will be opportunities to attending meetings sponsored by various orthopaedic implant manufacturers. These educational travel opportunities must be cleared with the chief resident on the service, the Resident Coordinator, the Program Director and/or the Chairperson of the Department.
Effort will be made to pay the way for residents who have papers and posters accepted for presentation to go to that meeting.
Time taken for educational travel will not count against paid vacation time, unless that education time was denied and the resident elected to take vacation time in order to attend that conference.
Residents, who have failed to log their surgical cases into the ACGME Residency Case Log System in a timely manner, will be prohibited from travel.
If reimbursement is desired; the travel must be pre-approved, an LSU approved travel agency/on-line agency must be used, and expenditures must be documented. This documentation must be in the form of original receipts, airline tickets, hotel bills, etc
RESIDENT ROTATIONS
PGY 1
The PGY 1 will spend no more than 3 months on orthopaedic surgery. The remainder of the year will consist of trauma, emergency department, rheumatology, Surgical ICU, plastic surgery, burn surgery, vascular surgery, neurosurgery, and an elective of pediatrics, medicine or an extra month in the emergency department.
PGY 2
After completion of the internship year, the resident will become the junior resident at the Veteran Administration Hospital, Shriner's Hospital and LSU Health Science Center.
PGY 3
The year will continue to expose the resident to orthopaedic medicine and surgery at the Veterans Administration Hospital and the LSU Health Sciences Center.
PGY 4
During this year, the resident will experience significantly more responsibility in patient management and surgery and will be expected to assume some of the "chief" resident responsibilities while rotating at the Shriner's Hospital and LSU Health Sciences Center.
PGY 5
This year will be spent as the Chief Resident at LSU Health Sciences Center and as the administrative chief resident for the entire service.
EVALUATION OF RESIDENTS
The Department of Orthopaedic Surgery will evaluate the residents on a bi-annual basis in accordance with the ACGME requirements. The residents will be evaluated on patient care, medical knowledge, practice-based learning and improvement abilities, interpersonal and communication skills, professionalism, and systems-based practice. Residents will be given additional responsibilities, both operative and non-operative, based on their ability and progression in learning orthopaedic medicine and surgery.
The following methods are used to evaluate residents:
1. Semi-annual evaluation forms completed by faculty
2. Semi-annual evaluation review by Residency Program Director
3. Annual evaluation forms completed by faculty
4. Annual evaluation review by the Residency Program Director
5. Annual 360 degree evaluations by various hospital staff (VA, LSU & Shiners)
6. Annual interview conducted by Residency Program Director
7. Annual written evaluation completed by Residency Program Director
8. Performance on the Orthopaedic In-training Examination given by the American Academy of Orthopaedic Surgeons.
The evaluation forms are completed in the fall and spring of every year. The 360 evaluations are completed in the spring of every year. The interview with the Residency Program Director is conducted after the spring evaluations and 360 evaluations are completed and turned in.
Although these formal methods of evaluation are important, the most important evaluation of a resident occurs with daily interactions on the wards, in the operating rooms, in the clinics, in conferences and at daily meetings involving patient care and personal interactions with the staff and faculty. These interactions provide the faculty and staff with evidence of the resident's development of sound clinical judgment, surgical techniques, personal communication abilities, understanding of practice-learning, systems-based practice of medicine and professionalism.
After the spring evaluations, Residency Program Director interview, and 360 degree evaluations are completed, an annual report is generated which the resident and Program Director both sign. A copy of these evaluations and the annual report will be made available to the Department Chairperson and placed in the resident's permanent and confidential record in the Department of Orthopaedic Surgery.
Residents, who have failed to log their surgical cases into the ACGME database in a timely manner, have this failure included in their evaluation.
RESIDENT ADVANCEMENT
Advancement to the next year of one's residency is not guaranteed. Advancement is based on clinical, personal and academic performance. Tools to judge these areas are the evaluation program, performance in conferences and performance on the Orthopaedic In-training Examination. Conference performance is based on the ability of the resident to compile a well thought out presentation, cover all areas pertinent to the topic, providing a copy of the presentation to the Resident Coordinator and in the resident's ability to discuss the topic and answer questions.
Residents whose performance is of concern will be notified during the semi-annual evaluation process. They will be given the opportunity to improve their performance. Failure to improve will result in further discussions and possible need for the resident to repeat the academic year.
Advancement is also dependent on residents logging their surgical cases into the ACGME Resident Case Log System in a timely manner. Those unwilling to comply may be required to complete an additional year of residency training.
EVALUATION OF FACULTY
Both full-time and part-time faculty members will be evaluated in regard to their teaching and mentoring abilities. The residents will be provided with the opportunity to semi-annually and confidentially evaluate the faculty using a pre-designed evaluation form. These forms will be turned into the Residency Coordinator, either in person, via the mail, or any other means the resident feels comfortable in maintaining their confidentiality. These evaluations will result in report collated by the Residency Director. This report will then be discussed with each faculty member in a confidential interview with the Residency Director. The results of this report and the interview will be made available to the Chairperson of the Department of Orthopaedic Surgery and will be maintained in the faculty member's confidential file.
RESIDENT DISCIPLINARY ACTION
The Department of Orthopaedic Surgery is committed to fair and consistent disciplinary procedures and to the principles of Due Process as set forth by the Louisiana State University Health Sciences Center Shreveport. When allegations or concerns are raised regarding a resident, that resident has the right to be confronted with said allegations or concerns. Evidence against the resident will be presented and the resident has the right to present evidence in their defense. Based on the evidence presented, the resident will either be exonerated of the allegations or provided with an opportunity to improve and/or correct the concern. The exception, are egregious offenses. The Resident Director and/or the Chairperson of the Department of Orthopaedic Surgery will conduct this procedure. All attempts will be made to keep disciplinary investigations and actions within the Department of Orthopaedic Surgery. Depending on the nature of the allegation, hospital administrative personal may need to be involved.
Frank insubordination or willful disobedience of the rules and regulations printed in the Louisiana State University Health Sciences Center Shreveport Medical Education Policy Manual and the Louisiana State University Health Sciences Center Shreveport House Officer's Handbook are cause for a disciplinary investigation and possible action. All Orthopaedic interns and residents are expected to be familiar with these manuals and their content.
Other areas that may result in resident disciplinary investigation/action include:
1. FAILURE TO REPORT TO WORK WITHOUT PROPER NOTIFICATION TO THE PROGRAM DIRECTOR OR, IN THEIR ABSENCE THE SUPERVISING FACULTY.
2. HABITUAL ABSENCE OR TARDINESS FOR ASSIGNED DUTIES (ROUNDS, CONFERENCES, CLINICS, OR, ETC)
3. HABITUAL TARDINESS IN COMPLETING MEDICAL RECORDS
4. PATIENT COMPLAINTS OR COMPLAINTS FROM THEIR FAMILIES
5. QUALITY MANAGEMENT CONCERNS OR COMPLAINTS
6. COMPLAINTS FROM PERSONNEL, SUPPORT STAFF, OR OTHER HOSPITAL STAFF
Once an investigation is completed and the resident has been interviewed, the Program Director will review that case and write a report. The report will be signed by the resident, with the resident's comments included in the report. The report will be available to the Chairperson of the Department of Orthopaedic Surgery and the report will be placed in the resident's confidential and permanent file.
Disciplinary action may vary from a verbal to written warning. The resident may be asked to work an unpaid day of duty. Vacation/leave time may need to be delayed until improvement has been noted. Residents may be asked to meet with an advisor/counselor to discuss their behavior in depth. The resident may be required to take an extended unpaid leave of absence. The resident may be required to repeat a year in training. In rare cases, the resident's contract may not be renewed for the following academic year.
COMMITTEE ASSIGNMENTS
The Graduate Medical Education (GME) office at Louisiana State University Health Sciences Center Shreveport has several committees that are designed to advocate and advance the concerns of the house staff. The Department of Orthopaedic Surgery encourages its residents to participate in these committees and attend committee meetings. We encourage residents to serve as officers and/or members of these committees.
During the academic year, members of the GME office will be invited to address our residents as guest lecturers. We would like our house staff to familiarize themselves with the GME office staff and participate in GME office activities.
The following are some of the committees that we would encourage our house offices to participate in.
1. Graduate Medical Education Committee
2. Trauma Committee
3. Surgical Care Committee
ACGME GENERAL COMPETENCIES
The Accreditation Council for Graduate Medical Education has established six general competencies. All residents are required to meet their department's goals for each of the six areas. These goals have been set out in this Policies and Procedure manual, the resident levels of care, and in the conference/lecture schedule. The Department of Orthopaedic Surgery recognizes the importance of these six general competencies and is striving towards providing each resident with the education opportunities required to excel in each of the six competencies. Further information regarding the six competencies can be found at the ACGME office or at their website at www.acgme.com
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (epidemiological and social-behavioural) sciences and the application of this knowledge to patient care.
3. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals.
5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
LSU HEALTH SCIENCES CENTER-SHREVEPORT
MEDICAL STAFF AND RESIDENT PERFORMANCE IMPROVEMENT
The Department of Orthoapedic Surgery is dedicated to the improved performance of their medical staff and residents alike. Therefore, we have included the Performance Improvement chart into the policy manual. Performance Improvement will also be a topic in one of the core lectures. Please see attached chart.