SPORTS MEDICINE SERVICE
OBJECTIVES AND REQUIRED COMPETENCIES
FOR ORTHOPAEDIC FELLOW EDUCATION
Each sports medicine fellow within the UCLA / Orthopaedic Hospital - Department of Orthopaedic Surgery will spend one year on the service. One fellow will be assigned to the "A-Rotation 1" service while the other fellow will be assigned to the "B-Rotation 2" service. The fellows will rotate at 3 months intervals with each fellow completing a total of 6 months on each service.
I. Patient Care
- Become highly proficient in the evaluation and treatment of patients with sports injuries in the clinic including application of physical examination tests specific to the diagnosis.
- Become highly proficient in the evaluation and treatment of injured athletes both on the field and in the training room.
- Be able to examine the injured extremity with a high level of sophistication and detail to determine any bony or ligamentous injury, tendon injury, nerve injury, or arterial injury of the extremity.
- Be able to perform a detailed clinical examination of the shoulder, elbow, knee and ankle.
- Be able to order appropriate diagnostic tests and imaging studies to assist with diagnosis and accurate assessment of the level/severity of the injury.
- Be able to interpret diagnostic test and imaging studies (Xrays, CT scan, MRI) to assist with diagnosis and accurate assessment of the level/severity.
- In consultation with the attending, provide treatment for the patient as appropriate for level of training as a fellow.
- Be able to perform arthrocentesis/ injections of the knee and shoulder.
- Be comfortable with the diagnosis and treatment of complex knee problems such as multiple ligament injuries, recurrent patellar instability and\or degeneration, articular cartilage lesions and degenerative meniscal tears.
- Be able to differentiate complex problems of the shoulder such as instability vs. impingement in the throwing athlete, rotator cuff tears, labral tears, shoulder subluxation, osteolysis of the distal clavicle, and scapulothoracic bursitis.
- Be able to determine the diagnosis and treatment of complex problems of the ankle, such as post-traumatic impingement syndrome, osteochondral injuries and chronic instability should be mastered.
- Have a complete understanding of post-operative rehabilitation guidelines and restrictions for knee ligament reconstructions and repairs, rotator cuff repairs and shoulder instability reconstructions should be achieved.
- Develop the capability to perform complex arthroscopic surgical procedures such as meniscectomy, meniscal repair and ACL reconstruction, and multiple ligament repair/reconstruction in the knee, labral repair/debridement, rotator cuff repair, arthroscopic stabilization and sub-acromial decompression in the shoulder, and debridement as well as treatment of articular cartilage lestions of the ankle.
- Be able to perform more complicated skills such as small joint arthroscopy and contemporary treatment of articular cartilage lesions.
- The fellow will become competent with open shoulder procedures such as rotator cuff repair and Bankart repair/capsulloraphy.
II. Medical Knowledge
- Develop a sophisticated understanding of the anatomy of the shoulder, elbow, knee, and ankle including the bones, ligaments, tendons, nerves and arteries.
- Have a sophisticated understanding of soft-tissue behavior including the effects of immobilization and exercise.
- Have a thorough understanding of ligament repair and graft incorporation should be developed, including the normal time course for regeneration of strength in an ACL graft, as well as knowledge of graft forces with various activities.
- Have a thorough understanding of the biomechanics of the patellofemoral joint, including the magnitude of forces with normal activities, and the effect of patellectomy and tibial tubercle transfers (eg. Hauser, Maquet).
- The fellow will give a number of 45 minute presentations on chosen topics at the Sports Medicine noon conference. Topics will be determined in discussion with Dr. McAllister.
- The fellows will alternate giving presentations at the bi-monthly orthopaedic surgery sports medicine conference including MRI correlations.
- The fellows will be asked to give didactic presentations from time to time to our residents, athletic trainers and primary care colleagues in the Student Health Center.
- The fellows will assist the residents with monthly arthroscopic skills teaching labs.
- Attend and participate at the weekly sports medicine service conferences during the rotation.
- Attend the orthopaedic residents' journal club that focuses on sports medicine, hosted 2-3 times.
- Attend the biannual lecture series on sports surgery presented at the weekly orthopaedic surgery basic science course on Wednesday mornings.
- Attend monthly Department of Orthopaedic Surgery Grand Rounds and Morbidity and Mortality conferences.
- Complete one academic project which of high, publishable quality.
III. Practice-Based Learning and Improvement
- Frequent, yet focused, use of available printed textbooks (in the orthopaedic library), online textbooks, and Medline sources for application to specific patients. The goal is to demonstrate the ability to locate and interpret scientific studies and known medical knowledge into an appropriate knowledge base that will be of direct benefit to patients.
- Frequent discussion with sports medicine fellows and attending Sports Medicine surgeons to present patients after initial evaluation, review available diagnostic tests, and to confirm the appropriate treatment plan. The fellow will be expected to formulate a plan of treatment, which will then be reviewed in detail and either confirmed or altered as necessary to achieve optimal patient outcome.
- Use of appropriate sources (e.g. textbook, selected articles from the literature, etc.) to obtain more detailed information about a specific patient or diagnosis, based on his/her experiences on the sports medicine service.
- Play an active role in the teaching of senior and junior orthopaedic residents, senior medical students (sub-interns) and junior medical students on the service.
- Demonstrate expertise in use of available information technology and hospital information systems to manage patient data (e.g. lab tests, imaging tests, etc.) and access online information that will be of direct benefit to his/her own education.
- Integrate feedback from faculty and sports medicine surgery fellows to ensure that the senior resident is able to analyze his/her own practice experience, with the goal of improving future patient care.
IV. Interpersonal and Communication Skills
- Demonstrate ability to communicate effectively with all members of the sports medicine service, including medical students, junior residents, senior residents, and Sports Medicine surgery attending staff.
- Demonstrate ability to communicate effectively and work well with all members of the hospital staff, including nurses, nursing assistants, radiology staff, social workers, discharge planners, physical therapists, hand therapists, operating room/surgery center staff, inpatient/outpatient support staff, etc.
- Demonstrate the ability to interact effectively, professionally, and empathetically with patients and family members.
- Demonstrate the ability to provide appropriate and detailed information to patients and family members, when appropriate.
- Demonstrate the ability to develop an appropriate relationship with a patient that fosters communication, respect, and ethics of the highest degree.
- Demonstrate the ability to recognize important cultural and generational differences that may affect patient care, and to apply appropriate changes in approach to these patients that respect these important differences.
- Demonstrate effective listening and communication skills with patients, which may include both verbal and non-verbal skills.
- Demonstrate ability to understand and respond appropriately to patient inquiries.
- Demonstrate a strict adherence to medical/ethical principles.
- Demonstrate a keen sensitivity to the differences and challenges that a diverse patient population may present, especially in the context of the known multi-racial and multi-cultural patient population in the Los Angeles area.
- Treat all patients with respect, empathy, and with compassionate care. All patient inquiries and requests will be considered seriously, professionally, and in a timely manner.
- Recognize the important social, economic, emotional, and work-related implications that a Sports Medicine problem or injury may represent for the patient.
- Provide patients with excellent care in all aspects.
- Maintain patient confidentiality, including strict adherence to HIPPA guidelines.
- Obtain informed consent from patients in accordance with established guidelines that ensure full patient comprehension after a detailed discussion of all pertinent issues relating to patient care/surgery. This includes the opportunity for the patient to ask and have answered questions relating to any proposed procedures.
- Demonstrate the ability to accommodate and adapt to differences in patients' culture, age, gender and disabilities.
VI. Systems-Based Practice
- Develop an awareness of how the care that they provide to patients can affect other caregivers and even the UCLA medical center in general.
- Demonstrate an ability to effectively utilize hospital resources in a way that directly benefits patient care.
- Develop a more in-depth understanding of the different types of medical practice available in the context of orthopaedic Sports Medicine surgery.
- Develop a more detailed understanding of the differences in different payer types, such as worker's compensation, managed care, HMO, PPO, Medicare, MediCal, and student health insurance plans.
- Develop a mature understanding of the necessity to provide efficient and cost-effective health care in the context of appropriate use of limited medical resources, yet without sacrificing quality of care.
- Act as a patient advocate and assist patients in obtaining the necessary care, including coordination of post-discharge care if necessary (e.g. home health care, postoperative physical therapy, placement into appropriate rehabilitation facility, etc.).