OBJECTIVES AND REQUIRED COMPETENCIES FOR ORTHOPAEDIC RESIDENT EVALUATION
Junior Residents:
A junior (RII) resident within the UCLA / Orthopaedic Hospital - Department of Orthopaedic Surgery will perform a four-month rotation at OH/UCLA.
I. Patient Care
a. Correctly prescribe medications and intravenous fluids in weight-appropriate doses for pediatric patients.
b. Demonstrate appropriate evaluation and treatment of pediatric patients with traumatic orthopaedic injuries and acute musculoskeletal infections presenting to the OHMC Urgent Care. This includes conducting a diagnosis-specific physical exam and ordering diagnosis-specific laboratory and radiologic studies.
i. Demonstrates proper casting technique for reduction of common pediatric orthopaedic fractures.
c. Demonstrate appropriate evaluation (including diagnosis-specific physical evaluation tests) and treatment of pediatric patients after elective orthopaedic, spine, and hand surgery performed by OH attending at SM-UCLA OH Hospital.
d. Be able to treat pediatric patients with specific disease processes according to the chart in "appendix 1: patterns of care: junior and senior residents" for the complete list. It should be emphasized that the designated competencies are a minimum, and many residents may possess competencies exceeding those listed on the curriculum. Patterns of care generally fall into one of five categories:
i. Complete: resident can provide complete care of these patients
ii. Usual: resident can fully assess these patients and manage straightforward cases within the given diagnosis. The resident may need to refer patients with atypical cases or complications of treatment for these disorders.
iii. Discretionary: resident can assess and treat straightforward cases within the given diagnosis with some supervision, and will probably refer patients with complications of previous treatment.
iv. Co-caregiver: resident can evaluate and non-operatively treat/monitor these patients with some supervision; will likely refer these patients for operative treatment if necessary.
v. Screen and refer: resident can triage these patients for appropriate referral.
II. Medical Knowledge
a. Develop a thorough understanding of the topics listed on the attached "sample resident learning objectives", except for those topics listed in bold, in which a basic understanding should be achieved2.
b. Read:
i. Core topics in Lovell and Winter's Pediatric Orthopaedics 6th ed by Drs. Morrissy and Weinstein (available in the OHMC outpatient clinic office).
1. Core topics are those listed on the "sample resident learning objectives", except those listed in bold.
ii. Applicable chapters in Morrissy's Atlas of Pediatric Orthopaedic Surgery textbook before elective operative cases, for which the resident is expected to participate.
iii. Assigned reading for the Friday didactic teaching series. See individual attending physician for reading assignment on the Monday before lecture
iv. Read the summary information from the POSNA Pediatric Orthopaedic Study Guide (POSG) as listed on the POSNA website (http://www.posna.org/education/StudyGuide/index.asp) on the following topics: (note that, in the absence of a reading assignment before the Friday didactic teaching series, reading of two articles from the POSG on the relevant topic is required)
1. Under the "General" category:
a. All sections under the "infection" tab
b. All sections under the "trauma" tab
2. Under the "Regional" category:
a. Fractures of the Hand and Wrist
b. Fractures of Distal Radius and Galeazzi Fracture
c. Fractures of Radial Head and Neck
d. Fractures of the Shaft of the Radius and Ulna
e. Monteggia Fractures
f. Fractures of the Humeral Shaft
g. Fractures of the Proximal Humerus
h. Fractures of the Lateral Humeral Condyle
i. Fractures of the Medial Humeral Epicondyle
j. Supracondylar Fracture of the Humerus
k. Distal Tibial Physeal Fractures
l. Fractures of Tibial Tubercle
m. Tibial Shaft Fractures
n. Fractures of the Tibial Spine
o. Fractures of the Distal Femur
p. Fractures of the Femoral Neck
q. Fractures of Femoral Shaft
r. Septic Arthritis - Hip
s. Transient Synovitis of the Hip
c. Prepare and present one 30-minute oral slide presentation on developmental dysplasia of the hip for the relevant Friday didactic session.
d. Attend and participate in all orthopaedic surgery conferences and lectures at the hospital during the resident's rotation. (Monday and Thursday fracture and postoperative conference, Wednesday preoperative indications conference, and Friday didactic teaching series).
e. Attend the annual combined UCLA-Orthopaedic Hospital, Children's Hospital - Los Angeles, and SHC-LA visiting professor day.
f. Attend and participate in the annual Lowman visiting professor day. Participation involves presenting case histories, relevant physical exam findings, relevant imaging studies, and treatment plans and results of preselected patients with pediatric orthopaedic disorders in the subspecialty of the visiting professor.
III. Practice-Based Learning and Improvement
a. Apply knowledge garnered from printed textbooks, POSNA web-based POSG, and the medical literature as found via Medline sources in the treatment of specific patients encountered through the rotation.
b. Discuss with senior residents, pediatric orthopaedic fellows, or attending staff the findings of every patient initial and follow-up outpatient and inpatient evaluation, including the results of history, physical examination, and diagnostic testing. The resident is expected to formulate a treatment plan, which is discussed with the attending physician and confirmed or altered as necessary to achieve optimal patient outcome. The format for presentation should follow the "SNAPPS" format (see attached document).
c. Play an active role in the teaching of medical students and visiting residents from other medical disciplines during the pediatric orthopaedic rotation.
d. Demonstrate expertise in use of available information technology and hospital information systems to manage patient data (computer medical record) and to access online information relevant to patient care.
e. Integrate feedback from attending faculty and pediatric orthopaedic fellows to ensure that the junior resident is able to analyze his/her own practice experience, with the goal of improving future patient care. Feedback to the junior resident is provided systematically at daily resident teaching conferences (excluding Tuesday), which include quality assurance during fracture conference to identify areas of potential improvement for all members of the pediatric orthopaedic service with regard to care delivered in the urgent care.
IV. Interpersonal and Communication Skills
a. Demonstrate ability to communicate effectively with all members of the pediatric orthopaedic surgery team at OH/UCLA, including medical students, resident colleagues, fellows, and attending staff .
b. Demonstrate ability to communicate effectively and work well with all members of the SM/UCLA OH Hospital staff, including resident and attending physicians from other disciplines within the hospital, inpatient and outpatient nursing staff, translators, radiology staff, social workers, perioperative nursing staff, recreational therapy staff, etc.
c. Demonstrate the ability to interact effectively, professionally, and empathetically with patients and family members.
d. Demonstrate the ability to develop and appropriate relationship with a patient that fosters communication, respect, and ethics of the highest degree.
e. 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.
f. Demonstrate effective listening and communication skills with patients, which may include both verbal and non-verbal skills.
g. Demonstrate the ability to understand and respond appropriately to patient inquiries.
V. Professionalism
a. Demonstrate a strict adherence to medical/ethical principles.
b. 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 treated at OH/UCLA (Southern California and Northern Mexico).
c. 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.
d. Provide patients with excellent care in all aspects.
e. Maintain patient confidentiality, including strict adherence to HIPPA guidelines.
i. Complete the required annual UCLA HIPPA computer-based training, and forward a copy of the HIPAA certificate obtained from that training to the OH/UCLA Medical Staff Department, before beginning the resident's rotation.
f. Obtain informed consent from patient's parents or patients, and patient assent in accordance with established guidelines that ensure full patient/parent understanding after a detailed discussion of all pertinent issues relating to patient care/surgery. This includes the opportunity for the patient/parent to ask and have answered questions relating to any proposed procedures or operations.
g. Demonstrate the ability to accommodate and adapt to differences in patients' culture, age, gender, and disabilities.
VI. Systems-Based Practice
a. Develop an awareness of how the care that they provide to patients can affect other caregivers. The resident must recognize that he/she is a representative of OH/UCLA, and must act in accordance with their guidelines for patient care.
i. To that end, effectively communicate with referring physicians through dictated outpatient and inpatient notes and/or letters.
b. Demonstrate an ability to effectively utilize hospital resources in a way that directly benefits patient care.
c. Begin to develop an 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.
d. 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).
e. Begin to develop an understanding of proper medical diagnostic and procedural coding (ICD-9 and CPT) for patients evaluated by the resident.
OBJECTIVES AND REQUIRED COMPETENCIES FOR ORTHOPAEDIC RESIDENT EVALUATION
Senior Residents:
A senior (RIII) resident within the UCLA / Orthopaedic Hospital - Department of Orthopaedic Surgery will perform a total of two-months of clinical rotations at OH/UCLA.
I. Patient Care
a. Correctly prescribing medications and intravenous fluids in weight-appropriate doses for pediatric patients.
b. Demonstrate appropriate evaluation and treatment of pediatric patients with traumatic orthopaedic injuries and acute musculoskeletal infections. This includes conducting a diagnosis-specific physical exam and ordering diagnosis-specific laboratory and radiologic studies.
i. Demonstrates proper casting technique for reduction of common pediatric orthopaedic fractures.
c. Demonstrate appropriate evaluation (including diagnosis-specific physical evaluation tests) and treatment of pediatric patients after elective orthopaedic, spine, and hand surgery. This includes correctly prescribing medications and intravenous fluids in weight-appropriate doses.
d. Be able to treat pediatric patients with specific disease processes according to the chart in "appendix 1: patterns of care: junior and senior residents" for the complete list. It should be emphasized that the designated competencies are a minimum, and many residents may possess competencies exceeding those listed on the curriculum. Patterns of care generally fall into one of five categories:
i. Complete: resident can provide complete care of these patients
ii. Usual: resident can fully assess these patients and manage straightforward cases within the given diagnosis. The resident may need to refer patients with atypical cases or complications of treatment for these disorders.
iii. Discretionary: resident can assess and treat straightforward cases within the given diagnosis with some supervision, and will probably refer patients with complications of previous treatment.
iv. Co-caregiver: resident can evaluate and non-operatively treat/monitor these patients with some supervision; will likely refer these patients for operative treatment if necessary.
v. Screen and refer: resident can triage these patients for appropriate referral.
II. Medical Knowledge
a. Develop an advanced understanding of all topics listed on the attached "sample resident learning objectives"2.
b. Read:
i. In addition to reviewing the reading assignments for a junior resident, further reading on advanced core topics in Lovell and Winter's Pediatric Orthopaedics 6th ed by Drs. Morrissy and Weinstein (available in the OHMC outpatient clinic office).
1. Advanced core topics include are those listed on the "sample resident learning objectives".
2. Applicable chapters in Morrissy's Atlas of Pediatric Orthopaedic Surgery textbook before elective operative cases, for which the resident is expected to participate.
ii. Be familiar with the topics in the POSNA Pediatric Orthopaedic Study Guide (POSG) previously reviewed as a junior resident. (http://www.posna.org/education/StudyGuide/index.asp)
iii. Read the summary information listed in the POSG for the remaining topics
iv. Assigned reading for the Friday didactic teaching series. See individual attending physician for reading assignment on the Monday before lecture.
c. Develop a clinical research project in conjunction with a member of the orthopaedic medical staff suitable for presentation at an annual national medical society meeting either during the RIV or RV year.
d. Attend and participate in all orthopaedic surgery conferences and lectures at the hospital during the resident's rotation. (Monday and Thursday fracture and postoperative conference, Wednesday preoperative indications conference, and Friday didactic teaching series).
e. Attend and participate in the annual combined UCLA-Orthopaedic Hospital, Children's Hospital - Los Angeles, and SHC-LA visiting professor day. Participation involves presenting case histories, relevant physical exam findings, relevant imaging studies, and treatment plans and results of preselected patients with pediatric orthopaedic disorders.
f. Attend and participate in the annual Lowman visiting professor day. Participation involves presenting case histories, relevant physical exam findings, relevant imaging studies, and treatment plans and results of preselected patients with pediatric orthopaedic disorders in the subspecialty of the visiting professor.
III. Practice-Based Learning and Improvement
a. Apply knowledge garnered from printed textbooks, POSNA web-based core curriculum, and the medical literature as found via Medline sources in the treatment of specific patients encountered through the rotation.
b. Discuss with junior residents, pediatric orthopaedic fellows, and attending staff the findings of every patient initial and follow-up outpatient and inpatient evaluation, including the results of history, physical examination, and diagnostic testing. The resident is expected to formulate a treatment plan, which is discussed with the attending physician and confirmed or altered as necessary to achieve optimal patient outcome.
c. Play an active role in the teaching of junior orthopaedic surgery residents, medical students, and visiting residents from other medical disciplines on the pediatric orthopaedic service.
d. Demonstrate expertise in use of available information technology and hospital information systems to manage patient data (computer medical record) and to access online information relevant to patient care.
e. Integrate feedback from attending faculty and pediatric orthopaedic fellows to ensure that the senior resident is able to analyze his/her own practice experience, with the goal of improving future patient care. Feedback to the senior resident is provided systematically at the biweekly resident teaching conferences, which include a quality assurance conference to identify areas of potential improvement for all members of the pediatric orthopaedic service.
IV. Interpersonal and Communication Skills
a. Demonstrate ability to communicate effectively with all members of the pediatric orthopaedic surgery team at OH/UCLA, including medical students, resident colleagues, fellows, and attending staff.
b. Demonstrate ability to communicate effectively and work well with all members of the SM/UCLA OH Hospital staff, including resident and attending physicians from other disciplines within the hospital, inpatient and outpatient nursing staff, translators, radiology staff, social workers, perioperative nursing staff, recreational therapy staff, etc.
c. Demonstrate the ability to interact effectively, professionally, and empathetically with patients and family members.
d. Demonstrate the ability to develop and appropriate relationship with a patient that fosters communication, respect, and ethics of the highest degree.
e. 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.
f. Demonstrate effective listening and communication skills with patients, which may include both verbal and non-verbal skills.
g. Demonstrate the ability to understand and respond appropriately to patient inquiries.
h. Develops a weekly outpatient clinic, urgent care, and operating room schedule that is fair and equitable with regard to each residents
V. Professionalism
a. Demonstrate a strict adherence to medical/ethical principles.
b. 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 treated at OH/UCLA (Southern California and Northern Mexico).
c. 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.
d. Recognize the important social, economic, emotional, and work-related implications that acute and chronic pediatric orthopaedic conditions have on the patient as well as the parents of the patient.
e. Provide patients with excellent care in all aspects.
f. Maintain patient confidentiality, including strict adherence to HIPPA guidelines.
i. Complete the required annual UCLA HIPPA computer-based training, and forward a copy of the HIPAA certificate obtained from that training to the OH/UCLA Medical Staff Department, before beginning the resident's rotation.
g. Obtain informed consent from patient's parents or patients, and patient assent in accordance with established guidelines that ensure full patient/parent understanding after a detailed discussion of all pertinent issues relating to patient care/surgery. This includes the opportunity for the patient/parent to ask and have answered questions relating to any proposed procedures or operations.
h. Demonstrate the ability to accommodate and adapt to differences in patients' culture, age, gender, and disabilities.
VI. Systems-Based Practice
a. Develop an awareness of how the care that they provide to patients can affect other caregivers. The resident must recognize that he/she is a representative of OH/UCLA, and must act in accordance with their guidelines for patient care.
i. To that end, effectively communicate with referring physicians through dictated outpatient and inpatient notes and/or letters.
b. Demonstrate an ability to effectively utilize hospital resources in a way that directly benefits patient care.
c. More fully develop an 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.
d. 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).
e. More fully develop an understanding of proper medical diagnostic and procedural coding (ICD-9 and CPT) for patients evaluated by the resident.
Appendix 1
Patterns of care: junior and senior residents
General Subject Specific Subject Pattern of Caregiver: Junior Resident Pattern of Caregiver: Senior Resident
infections acute osteomyelitis complete complete
infections subacute osteomyelitis usual complete
infections chronic osteomyelitis usual usual
infections septic arthritis, hip usual usual
infections septic arthritis, other usual complete
infections puncture wound, foot usual complete
fractures/dislocations hand, wrist usual usual
fractures/dislocations both bones forearm usual complete
fractures/dislocations monteggia usual usual
fractures/dislocations radial neck/head usual usual
fractures/dislocations elbow condyles usual usual
fractures/dislocations elbow epicondyles usual complete
fractures/dislocations elbow supracondylar usual usual
fractures/dislocations elbow dislocation usual usual
fractures/dislocations humeral shaft usual complete
fractures/dislocations proximal humerus usual usual
fractures/dislocations physeal usual usual
fractures/dislocations child abuse discretionary usual
spinal deformity idiopath scoli, <40º co-caregiver discretionary
spinal deformity idiopath scoli, >40º co-caregiver co-caregiver
spinal deformity congenital screen and refer co-caregiver
spinal deformity neuromuscular screen and refer screen and refer
spinal deformity other screen and refer screen and refer
spinal deformity postural kyphosis usual usual
spinal deformity scheuermann's screen and refer co-caregiver
spinal deformity congenital screen and refer co-caregiver
spinal deformity other screen and refer co-caregiver
spinal deformity spondylolysis discretionary usual
spinal deformity spondylolisthesis co-caregiver discretionary
upper limb cong deficiency screen and refer co-caregiver
upper limb cong rad hd disloc screen and refer co-caregiver
upper limb cong rad/ul synost screen and refer co-caregiver
upper limb panner's dz discretionary usual
upper limb sprengel's screen and refer co-caregiver
hip cdh, newborn discretionary discretionary
hip cdh, older infant co-caregiver co-caregiver
hip cdh, walking age co-caregiver co-caregiver
hip cdh, teratologic screen and refer screen and refer
hip coxa vara discretionary usual
hip toxic synovitis usual usual
hip scfe usual usual
hip idiop chondrolysis screen and refer screen and refer
leg length discrepancy <2cm usual usual
leg length discrepancy 2-5cm discretionary discretionary
leg length discrepancy >5cm screen and refer co-caregiver
lower limb cong deficiency screen and refer co-caregiver
lower limb torsional problems usual usual
lower limb tibia vara discretionary discretionary
lower limb cong pseudo tibia screen and refer screen and refer
lower limb postmed tibial bow discretionary discretionary
lower limb patellofem pain usual usual
lower limb patellofem dis/sublux co-caregiver co-caregiver
lower limb osgood-schlotters usual complete
lower limb OCD discretionary usual
lower limb discoid meniscus discretionary usual
lower limb cong dis/sublux knee screen and refer screen and refer
lower limb meniscal tear usual complete
lower limb clubfoot screen and refer screen and refer
lower limb cong vert talus screen and refer screen and refer
lower limb metatarsus adductus usual complete
lower limb flex calcaneovalgus foot usual complete
lower limb planovalgus discretionary usual
lower limb tarsal coalition discretionary usual
lower limb adolesc bunion discretionary usual
lower limb accessory navicular discretionary usual
lower limb curly toes usual complete
lower limb cavus foot co-caregiver co-caregiver
lower limb polydactyly discretionary discretionary
lower limb growing pains usual complete
lower limb overuse syndromes usual complete
lower limb osteochondroses discretionary discretionary
lower limb other foot deform co-caregiver co-caregiver
lower limb amputations co-caregiver discretionary
lower limb prosthetics/orthotics discretionary usual
skeletal dysplasias achondroplasia screen and refer co-caregiver
skeletal dysplasias MED screen and refer co-caregiver
skeletal dysplasias SED screen and refer co-caregiver
skeletal dysplasias ollier's screen and refer co-caregiver
skeletal dysplasias mult hered exostosis co-caregiver discretionary
skeletal dysplasias fibrous dysplasia co-caregiver co-caregiver
skeletal dysplasias OI co-caregiver co-caregiver
metabolic bone rickets screen and refer screen and refer
metabolic bone mucopolysacchiridoses screen and refer screen and refer
metabolic bone calcium/phos disorders screen and refer screen and refer
metabolic bone renal osteodystrophy screen and refer screen and refer
metabolic bone parathyroid screen and refer screen and refer
metabolic bone thyroid screen and refer screen and refer
metabolic bone heavy metal intox screen and refer screen and refer
metabolic bone juv osteoporosis screen and refer screen and refer
metabolic bone hypervitaminosis A screen and refer screen and refer
metabolic bone scurvy screen and refer screen and refer
metabolic bone cortical infantile hyperostosis screen and refer screen and refer
connective tissue ehlers danlos screen and refer screen and refer
connective tissue marfan's screen and refer screen and refer
connective tissue down's screen and refer screen and refer
hemotalogic gaucher's screen and refer screen and refer
hemotalogic hemoglobinopathies screen and refer screen and refer
hemotalogic hemophilia screen and refer screen and refer
neoplasia fibrous cortical defect usual usual
neoplasia UBC discretionary usual
neoplasia EG co-caregiver discretionary
neoplasia ABC co-caregiver discretionary
neoplasia chondroblastoma screen and refer co-caregiver
neoplasia osteoid osteoma discretionary usual
neoplasia solitary osteochondroma discretionary usual
neoplasia giant cell tumor co-caregiver co-caregiver
neoplasia ewings screen and refer screen and refer
neoplasia osteosarcoma screen and refer screen and refer
neoplasia fibrous dysplasia co-caregiver co-caregiver
neoplasia soft tissue sarcoma screen and refer screen and refer
neuromuscular muscular dystrophies screen and refer co-caregiver
neuromuscular inflammatory myopathies screen and refer screen and refer
neuromuscular SMA screen and refer screen and refer
neuromuscular HMSN's co-caregiver co-caregiver
neuromuscular cerebral palsy discretionary discretionary
neuromuscular myelodysplasia co-caregiver co-caregiver
arthritis jra co-caregiver discretionary
arthritis spondylarthropaties co-caregiver co-caregiver
cervical spine muscular torticollis discretionary usual
cervical spine congenital malformations co-caregiver co-caregiver
cervical spine atlantoaxial rotator fixation discretionary usual
cervical spine hypermobility co-caregiver co-caregiver
Appendix 2: Sample resident learning objectives
Casting Principles
Peds Ortho Physical Exam
Supracondylar Humerus Fractures
"Other" elbow fractures
Pediatric Hand Fractures
Musculoskeletal Sepsis
Ankle Fractures
Torsional and angular lower extremity problems
Slipped Capital Femoral Epiphysis
Foot Deformities
The Limb Deficient Child
DDH Before Walking Age
DDH After Walking Age
Congenital Scoliosis
Idiopathic Scoliosis
Legg Calve Perthes
Pediatric Benign Bone Tumors
Muscular Dystrophy
Pediatric Sports Medicine
Scheuerman's, Spondylolisthesis
Cerebral Palsy
Myelodysplasia
