Residency Manual
INDEX
Introduction
Mission Statement
Educational Goals
Professional Conduct
Resident Evaluation Process
Annual Awards
Scholarship
Resident Research
Resident Responsibilities
Patient Care Responsibilities
Consultations
Surgery
Call Schedule
Memorial Hermann Hospital
ER Day Call
Night Call
LBJ Hospital
ER Day Call
Night Call
Call Schedule Changes
Annual Leave
Vacation
Approval
Guidelines
Sick Leave
Education Leave
Depositions, Insurance, and Medical/Legal Problems
External Employment
Summary of Chief Resident Responsibilities
Call Schedule
OR Assignments
Consults
Journal Club
Grand Rounds
Fracture Conference
Weekly Conference Schedule
Conferences
Shrine Grand Rounds
Journal Club
Outline for Presentation of Articles
Journals for Journal Club
Primary Journals
Supplemental Journals
Trauma Conference
Core Knowledge Lecture
Anatomy Conference
Fracture Conference
Research Conference
Grand Rounds
Morbidity and Mortality Conference
Format for Conference Presentation
Lectureships
Presentation of Papers
Educational Fund
Taylor K. Smith Library
Resident Research Projects
Overview
Resident Research Requirements
Overview of the Scientific Method
Identification of a topic or problem
Formulation of a research protocol
Data Collection
Data Analysis
Preparation of a Manuscript
Preparation and Presentation of Scientific Data
Guidelines for Slide Presentation
Presentations at Meetings
Research Rotations
Rights and Responsibilities
Overview of Research Deadlines
Format for Research Project Proposal
Reading Schedule and Recommended Textbooks
Medical Student
PGY-1
PGY-2
PGY -3
PGY-4
PGY-5
Other Suggested Reading
Guidelines for Lyndon B. Johnson General Hospital (LBJ) Rotations
Guidelines for M.D. Anderson Cancer Center Rotation
The Institution
Clinic and Consult Information
Sarcoma Conference
Preoperative Evaluation
Operating Room
Discharge
Academic Training
Weekly Schedule
References
Important Numbers
Staff
Others
Commonly Used Extensions
Ancillary Services
To Dictate
Computer Function
Guidelines for Shriners Hospital For Children, Houston
Educational Schedule
Clinical And Surgical Responsibilities
Field Clinics
In-Patient Responsibilities
Library Facilities
Research Project
Annual Pediatric Orthopaedic Symposium
Vacations
Written Evaluation
RESIDENCY MANUAL
The University of Texas-Houston Medical School Orthopaedic Residency Program provides five years of accredited graduate medical education fulfilling the educational requirements of the American Board of Orthopaedic Surgery. This document provides an organizational framework for the residency training program. It contains information concerning the educational program, patient care responsibilities, and policies regarding research, conferences, journal club, meetings, and vacation. It also contains a set of goals, a five-year curriculum, and a suggested reading list.
The Department of Orthopaedics will strive for excellence as a model orthopaedic training ground for physicians of the 21st century.
This pursuit encompasses . . .
Education - We will provide the best possible educational experience for both students and faculty as we empower them to effectively apply their increasing fund of orthopaedic knowledge. We will instill the commitment to a lifetime of learning.
Research - We will stimulate and foster scholarly research in both basic and applied medical science as we continue to create and evaluate new knowledge, particularly as it relates to the cause, prevention and treatment of musculoskeletal conditions.
Patient Care - We will provide compassionate, contemporary medical care in a professional, effective and cost conscious manner as we encourage a multi- disciplinary team approach to address the needs of the patient as a whole person.
Community Service - We will engage our students and faculty in providing both medical care and health education to members of our community who might otherwise remain unattended.
Personal Development - We will seek to develop in our students, faculty and staff those qualities that will be critical to leadership as we meet the challenges of health care in the 21st century - integrity, professionalism, scholarship, collegiality, creativity and compassion.In order to accomplish its mission, the Department of Orthopaedics has defined its educational objectives as an orthopaedic residency training program. These are enclosed in a separate document that is provided to each orthopaedic resident.
The practice of orthopaedic surgery is a serious responsibility that requires the orthopaedic resident to act professionally at all times with colleagues, nurses, orthopaedic and nonorthopaedic attendings, and the administrative and clinical staff in the Department of Orthopaedic Surgery (Department) and at affiliated institutions. Any breach of this professional code of ethics will be considered a major impediment in the ability of the resident to become an effective orthopaedic surgeon. By the same token, the Program Director will insist that all other members of the Department act in a professional and ethical manner. As part of this behavioral code, it is expected that the resident will always be punctual, courteous, and truthful. It is also expected that the resident will avoid all confrontations with other medical personnel and consult with either the Orthopaedic Attending (Attending) or the Program Director so that the proper steps can be taken to alleviate the conflictual situations. Each resident is a representative of the Department, and any negative or inappropriate behavior is a reflection on us all. In order to maintain this level of professionalism, it is important that the resident dress appropriately at all times. With these principles in mind, the resident can develop the level of professionalism expected of orthopaedic physicians, and specifically of those graduating from this program.
Resident performance on each rotation will be evaluated by the Attendings and Chief Resident (CMR) with whom they work. An interim evaluation will be given verbally by the Rotation Chief at the mid-point of the rotation. Formal written evaluations will be made at the end of the rotation by the Rotation Chief, other Attendings who have worked with the resident, and the CMR during that rotation. Residents should review these evaluations and discuss them with the Rotation Chief. The evaluation should then be signed and dated and forwarded to the Residency Office for incorporation into the permanent record. Each resident will also evaluate each rotation. A copy of the standard evaluation forms are attached (Appendix A). All evaluations are kept on file in the Residency Coordinator's office.
The evaluations from the attending staff, the Director's observations, and results of the Orthopaedic In-Training Examination will be used to monitor each resident's performance. The Director will meet with each resident annually to discuss their OITE scores and overall evaluation. Additional meetings between the Director and resident will be held as necessary. This communication process will lead to early identification of problem areas. Failure to rectify problems so identified will lead to a formal sequence of disciplinary actions which can extend from probation to dismissal. Disciplinary action will be administered according to the guidelines stipulated by the Office of Graduate Medical Education (See Contract Definitions, J, K, and L, pages 7-9).
The Director will determine if each resident's continued professional growth and performance have been satisfactory enough to allow the Director to recommend the resident for promotion each year and as an eligible candidate for the certifying examination of the American Board of Orthopaedic Surgery.
The following awards will be given annually to the residents:
Scholarship
Given to the resident having the highest year-in-training percentile score on the Orthopaedic In-Training Examination.Resident Research
Given to the resident judged to have the most outstanding research project as presented at Resident Research Day.Patient Care Responsibilities
By assuming responsibility for patient care, the resident will develop the skills necessary to practice orthopaedic surgery. Recognizing this, an attempt has been made to delegate as much responsibility for patient care as possible to residents. It must be understood that discretion and tact should be used at all times in discussing patient care with the patient and family.Under the overall supervision of the attending staff, the resident will be responsible for carrying out the appropriate clinical plan for each patient. It is the responsibility of the resident to sign out to the on-call resident any patient who is medically unstable or requires special attention.
All residents are responsible for prevention or early recognition of problems associated with bed rest, cast, application (e.g. pressure sores, friction burns, nerve palsies, thromboembolic problems, urinary retention, infection, pneumonia). Appropriate documentation should be made in the chart for all diagnostic and therapeutic management. The patient's attending physician, not just the attending on call, should be notified of any significant change in the patient.
All residents are expected to see the patients on their respective services. Residents should be familiar with the patient's progress each morning, prior to formal rounds, and upon entering the operating room.
Residents are responsible for timely response to requests for assistance from the wards and emergency room. Resident pages will be issued through the Memorial Hermann Hospital page operator at 713-704-4284. It is expected that the resident will call the Hermann page operator during times when he/she will be unavailable for specific and important reasons. In this way, the Hermann page operator will be able to instruct the person issuing a page that the resident is unavailable. This will prevent any confusion that might arise when someone attempts to page a resident that is unavailable. If the resident has not signed off page, it will be assumed that he/she is available and it is expected that the resident respond to the page within 10 minutes. Repeated violation of this time constraint will result in disciplinary action.
All hospital consultations will be managed by the CMR on the service for later presentation to the appropriate attending physician. The CMR should insure that the consult is registered with the Department before proceeding. The CMR may delegate the consultation to a junior resident, if necessary, to expedite the process; but definitive treatment recommendations should be determined by the CMR in consultation with the attending physician. Consultations should be carried out as quickly as possible and staffed within 24 hours.
No patient will go to surgery without the knowledge and approval of a member of the attending faculty. The residents should confirm that a consent form has been signed and placed on the chart prior to a patient going to surgery. A preoperative note should appear on the chart confirming that surgery is indicated and that the reasons for surgery have been explained, risks associated with the surgery have been discussed, all questions posed by the patient have been answered, and the results of surgery have in no way been assured.
The resident is responsible for entering into the medical record a preoperative check list to insure that all necessary tests and preparations have been completed.The responsible resident is expected to be in the operating room at least 15 minutes prior to start of the operation and before the induction of anesthesia unless there is a mandatory conference or Departmental educational activity that prevents this.
The resident is responsible for x-rays and other equipment necessary to perform the operation. The resident is expected to supervise the positioning, prepping, and draping of the patient. Residents will help transfer the patient from the OR table and a resident will remain with the patient until the patient reaches the recovery room. A brief operative note will be entered into the chart specifying the type of anesthesia, surgeon, assistants, procedure done, drain placement, tourniquet time, and condition of the patient at the end of the procedure. When indicated by the attending, the resident will dictate the operative report on the day of surgery in addition to writing postoperative orders for the patient.
Every effort should be made to identify as early as possible the patients whom the resident will participate in their surgery. Residents should be prepared to do the surgery. No resident should come to surgery expecting the staff to lead them through the procedure. All residents should have reviewed the anatomy and the surgical technique, know the purpose of the surgery, the risks involved, and the necessary postoperative care. If the responsible resident has questions about the details of the procedure, the attending should be asked prior to the day of surgery or called at home the night before. With the attending surgeon's approval, the resident should meet the patient before surgery and perform a history and physical examination. Demonstrated knowledge of the patient, their diagnosis, treatment options, and the specific operative procedure will be an integral part of the evaluation of the resident's performance on a rotation.
In an effort to reduce the possibility of postoperative infection, it is imperative that surgical scrubs not be worn outside of the operating room. The only exceptions are the on-call resident, if the resident is between surgical cases, and during trauma clinic. The resident will change scrub suits prior to returning to the operative suite.
Memorial Hermann Hospital (HH)
ER Day Call will be from 7:00 AM until 5:00 PM. The day call responsibilities will include coverage of the Emergency Room and the Day Surgical Unit. Patient history and physical examinations will be performed by the resident responsible for assisting in the surgery.
Night Call will be shared by all residents as determined by a schedule prepared by the responsible CMR. The resident will be on call weekdays from 5:00 PM to 7:00 AM and weekends from 7:00 AM to 7:00 AM the next day. Hospital night call coverage includes coverage of HH.
First call at HH will be shared by the HH PGY-2 residents. This call is approximately every third night and the resident will remain in-house. Second call will be shared by the third year through the fifth year residents. Second call may be taken out of the hospital.
First call responsibilities will be coverage of the Emergency Room and in-house orthopaedic patients. If the first call resident is required to take a patient to the operating room and other patient require attention in the emergency room or on the ward, the second call resident is to be contacted to come in to the hospital.
Second call responsibilities will be to ensure that appropriate care is provided in conjunction with the first call resident.
LBJ Hospital
ER Day Call will consist of coverage by the first and second year LBJ residents from 7:00 AM to 7:00 PM.
Night Call will be shared by all residents as determined by a schedule prepared by the responsible CMR. A resident will be on call from 7:00 PM to 7:00 AM, seven days a week.
First call will be shared by the first and second year LBJ residents.
Second call will be shared by the CMR, third year LBJ resident, and third year resident the on total joint rotation (Christus St. Joseph's Hospital).
Changes in the call schedule must be approved in advance by the respective CMR. Notify the Residency Office so that an "official" call schedule can be accurately maintained (required for accreditation purposes). The call schedule is to be determined and given to the Residency Coordinator by the 15th of the month prior. Failure to comply withthis will result in disciplinary action and/or the Program Director determining the call schedule.
All requests for leave must be arranged in advance (one month lead time) with the respective CMR and approved by the attending for the rotation during which you plan to leave. A Request for Leave form must be filled out and signed by all parties as noted below. Leave will be granted only after signatures are obtained, in order, from the following:
1. CMR
2. Attending
3. Residency Coordinator
4. Program Director or Chairman
5. Cross - covering resident (s)Details concerning the different types of leave are described below.
Residents classified as PG1 are permitted the equivalent of two (2) calendar weeks of vacation each year.
Residents classified as PG2 and above are permitted the equivalent of three (3) calendar weeks of vacation each year.
This must all be used during the current academic year, there is no carry forward or borrowing of vacation days. No more or less than seven (7) days of vacation may be taken at any one time except as noted below for interviews. Vacation that is not taken by June 15 of the academic year will be lost.
A maximum of five (5) days off will be allotted for interviews for fellowship or post-residency positions during the Junior and Senior years. This must be cleared with the Program Director and will require a letter of invitation from the program/group you are visiting. This time will be charged as vacation time and a Request for Leave must be turned in.
The Request for Leave form is due in the Residency Office two weeks before the end of your current rotation for vacation to be taken in the next or any subsequent rotation. Vacation begins on Saturday at 7:00 AM and runs through the following Saturday at 7:00 AM.
Copies of the Request for Leave form are available in the Residency and CMR offices at the Medical School. A copy is also in the Appendix.
Approval of Vacation
Will be granted only after signatures are obtained, in order, from the following:
- CMR
- Attending
- Residency Coordinator
- Director
- Cross - covering resident (s)
Guidelines for Vacation
Vacations may not be taken during:
- The last two weeks of June or the first two weeks in July.
- The first or last week of a rotation.
- Christmas week.
- The week before or during the AAOS Meeting.
- Exception: presentation at a national orthopaedic meeting
The signed Request for Leave must be in the Residency Office two (2) weeks prior to the beginning of the rotation.
Violations or abuses of this policy will result in a reduction of the resident's allotted vacation time.
Sick leave accrual is eight (8) hours per month and accumulates to a maximum of thirty (30) days. Sick leave carries forward from year to year and is lost when you leave the program.
A Program Director may authorize a Resident (PG2 and above) to take a leave of absence to attend an educational meeting each academic year. Such leave is limited to one (1) week each year and will not be considered part of the Resident's vacation. The following meetings are currently the only ones that can be authorized as educational leave.
1. American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting (PG4 or PG5)
2. Dallas Short Course: Orthotics & Prosthetics (PG2 or PG3)
3. Tachdjian Course (PG3 or PG4)
4. AO/ASIF Orthopaedic Residents Basic Course or OTA Residents' Basic Fracture Course (PG1, PG2, PG3)
5. Southwestern Orthopaedic Surgery Board Review (PG1 - PG5)
6. Chicago Board Review Course (PG4, PG5)
7. Other courses at the discretion of the DirectorIn order to use education leave, the Department must pay the airfare and the UT Travel Agency must issue the ticket. No direct outside sources of financing (e.g. orthopaedic companies) is allowed. If an outside vendor wishes to pay for your travel expenses, the money must be donated to the Department's Edward Smith Fund for Resident Education. The money will be "earmarked" for your travel to the respective meeting. Any money not used will revert to the Fund for use in other resident expenses. Any arrangements other than this must be approved by the Chairman.
DEPOSITIONS, INSURANCE, AND MEDICAL/LEGAL PROBLEMS
Residents should not communicate with attorneys, give depositions, or sign documents of a medical/legal nature until such matters have been discussed with the Director and the involved attending staff.
Medical practice activity outside of residency will not be allowed to interfere with deriving maximum benefit from the education experience. Residents may not engage in such activities without the specific prior approval of the Director. Failure to follow these guidelines will subject the resident to disciplinary action and possible termination from the program.
SUMMARY OF CHIEF RESIDENT RESPONSIBILITIES
The CMRs at HH and LBJ will be responsible for administrating the numerous resident functions and will assist in providing organizational and administrative leadership for the residency program. His/her responsibilities include.
Call Schedule - The preparation of the residents' day and night call schedules for HH and LBJ. This should ensure adequate coverage at all times for the various hospitals. The monthly schedule is due in the office of the Residency Coordinator by the 15th of the preceding month.
OR Assignments - Residents are to be assigned to cases the day prior to surgery or sooner, if possible. Attendings who will go unassisted will be notified the day before when possible.
Consults - Ensure that all consults are seen on the same day that they are placed. A note is to be made in the progress note section and a consult sheet completed. The CMR should see the consults personally or assign the responsibility to the appropriate resident. The appropriate attending should be contacted immediately so the case can be staffed within 24 hours.
Journal Club - Arrange and administrate Journal Club including assignment of journal articles and distribution of information concerning Journal Club to the appropriate parties.
Grand Rounds - Planning all aspects of Grand Rounds including audio/visual in conjunction with the Chairman. The list of speakers for the following month should be given to the Residency Coordinator no later than the 15th of the preceding month. No speaker is to be contacted without prior approval by the Chairman.
Fracture Conference - Planning of monthly schedule for Fracture Conference for a resident and staff moderator in conjunction with the orthopaedic trauma attending designate for this conference.
Weekly Conference Schedule - Preparation and distribution of weekly schedule of conferences for each month. The following months schedule should be given to the Residency Coordinator by the 15th of the preceding month. The Basic Science and Anatomy schedule are to be formulated in conjunction with the faculty designated for this conference.
Shrine Grand Rounds - 7:00 - 8:00 AM, Each Monday
This conference is the primary pediatric teaching conference for the residents and faculty. All residents other than those at LBJ Hospital attend.
The topics and presenters are chosen by the Program Director and the CMR. The topics are generally those of clinical rather than research interest. The presenters are noted experts from the medical school, or other medical institutions within the Texas Medical Center, or outside institutions. The speaker provide instructional course level lectures to the faculty and residents. They highlight current approaches to pediatric problems, new medical treatments, and surgical techniques. Included in this conference are lectures on medical liability, ethics in medicine, billing and collections issues, and other socioeconomic topics pertinent to the practice of medicine. This conference is attended by all residents and faculty as well as by physicians and health care workers and medical students from the local community.
Journal Club - 5:30 -6:30 PM; Second and Fourth Monday of the Month
Presentations are chosen by both the Director and the CMR. These articles are from The Journal of Bone and Joint Surgery (JBJS), and the Journal of the American Academy of Orthopaedic Surgeons. Faculty and residents attend this session. These sessions are used to develop the residents' abilities in critically evaluating medical literature and research, support continuing education, and promote awareness of newer methods and research.
Outline for Presentation of Articles at Journal Club
- Emphasize discussion rather than presentation
- Assume everyone has read the article
- Briefly summarize the pertinent aspects of the article in 2-3 minutes maximum
- Avoid reading the text, i.e. summarize from memory
- Critically evaluate the article
- Is it well organized, written and understandable
- If an experiment is presented, is it soundly devised and can you accept their basic premises?
- Are there flaws in the materials or methods of the experiment?
- Are the conclusions warranted from the experimental data?
- Are the conclusions or findings significant?
- Does the article contribute anything to your personal knowledge?
- Is the information presented applicable to our current practice?
- Is anything new presented? How does it relate to current standard of practice?
- Do you know of the authors, their reputation. integrity, etc.?
- The resident should have looked up and become familiar with any key references in the bibliography.
- What was your overall impression?
Journals for Journal Club
Primary Journals
Journal of Bone and Joint Surgery
Journal of The American Academy of Orthopaedic SurgeonsSupplemental Journals
Acta Orthopaedic Scandinavica
American Journal of Sports Medicine
Journal of Hand Surgery
Journal of Pediatric Orthopaedics
Journal of Orthopaedic Research
Journal of Trauma
Spine
Foot and Ankle International
Journal of ArthroplastyTrauma Conference - 5:00 - 6:00 PM Each Tuesday, Memorial Hermann Hospital x-ray viewing room
This conference provides the forum for an x-ray review of all inpatients who were admitted on the orthopaedic trauma service. It is held under the direction of the Director of Orthopaedic Trauma (Dr. Allen Criswell). In addition, other full and part time faculty members interested in trauma participate in this conference. All residents who are at HH attend this conference. There is no formal didactic presentation, but scholarly discussion is encouraged based on each inpatient x-ray. Treatment options are reviewed along with potential or actual complications.
Core Knowledge Lecture - 5:00 - 6:00 PM, Each Wednesday of the Month
Basic Science sessions termed "Orthopaedic Knowledge Sessions" are conducted for a total of forty-eight sessions per year. Topics have been selected based upon recommendations of the ACGME and various preferred orthopaedic review texts in order to provide an overall review of orthopaedic basic science and core clinical knowledge over a two year program. Each session comes under the direct supervision of a full-time or part-time faculty member. All residents in the program are required to attend (with the exception of the Shrine resident). The Department provides a review textbook for each resident. Specific Basic Science lecture series are conducted in the basic medical sciences, pathology, and biomechanics as well as OITE review questions.
Anatomy Conference - 6:00 - 7:00 PM, First and Third Wednesday of the Month
The CMR at HH is responsible for the topic and presentation of this conference. The anatomy sessions may include didactic and slide presentations or cadaveric dissections (depending upon the availability of materials). These sessions are under the direction of the CMR and an invited attending physician with specialty interest in the anatomical region. Various anatomic regions are covered in a regular rotation throughout the year. Surgical skills sessions using sawbones models, and/or cadaveric specimens may be substituted during the year for formal didactic lectures or dissections.
Fracture Conference - 7:00 - 8:00 AM; Each Thursday of the Month except for research conference and spine multidisciplinary conference.
These conferences are moderated by orthopaedic trauma service faculty. The topics are assigned by the Director of Orthopaedic Trauma and the CMR to various residents. These will include a didactic presentation on a specific fracture each week to allow coverage of all fracture types and anatomical regions in a two year period. Case presentations then follow and open up discussion by all residents and faculty in attendance. Trauma protocols will be developed, discussed, and modified. Trauma outcomes research will be presented. All residents and faculty attend this conference.
Research Conference - 7:00 - 8:00 AM; one Thursday per quarter
This conference serves as a forum in which the organization and progress of the individual research projects are reviewed by the appropriate faculty. The conference is under the direct supervision of Dr. Timothy Harrigan, Director of Orthopaedic Research and Dr. Terry Clyburn, Director of Clinical Research. This conference also serves to promote a spirit of inquiry and scholarship. Instruction is given in experimental design, hypothesis testing, statistical methodology, and current research design.
Grand Rounds - 8:00 - 9:00 AM; first, each Thursday of the month except Quarterly Morbidity and Mortality Conference (last Thursday of each quarter).
The topics and presenters are chosen by the Program Director and the CMR. The topics are generally those of clinical rather than research interest. The presenters are noted experts from the medical school, or other medical institutions within the Texas Medical Center, or outside institutions. The speaker provide instructional course level lectures to the faculty and residents. They highlight current approaches to musculoskeletal problems, new medical treatments, and surgical techniques. Included in this conference are lectures on medical liability, ethics in medicine, billing and collections issues, and other socioeconomic topics pertinent to the practice of medicine. This conference is attended by all residents and faculty as well as by physicians and health care workers and medical students from the local community.
Morbidity and Mortality Conference - 8:00 - 9:00 AM; Fourth Thursday during each quarter
This serves the peer review requirements for Memorial Hermann Hospital and LBJ Hospital along with the Department. All complications are reviewed under the supervision of the Chairman of the Department. Recommendations for avoiding problems in the future are made by the faculty. This conference is mandatory for all residents and faculty.
Format for Conference Presentation
Cases are presented in conference to:
- obtain group consultation for therapy
- obtain group consultation for diagnosis
- share interesting cases
- discuss complications
A list of case types and descriptions presented at each conference should be recorded by the resident responsible for the conference, This will ultimately be kept on file with the Director. Didactic conferences presented by residents should have an accompanying outline and bibliography which is circulated to the attendees at the beginning of the conference. A copy of this handout will be kept on file with the Residency Coordinator.
The format of presentation can vary with the purpose.
- Presentation for therapeutic consideration should be the most complete containing vital (but not extraneous) information of the work-up adequate for diagnosis plus the psychological and social factors necessary for determination of therapy. In general, present the history and lab work first, show pertinent examination features, then show x-rays. The resident should read about the case ahead of time. The resident should be ready to discuss all aspects used in the decision-making process and the available alternatives to therapy. The resident should have formulated a diagnosis and a complete plan of therapy and be ready to defend them.
- Presentation for diagnosis should contain a complete basic work-up. You should have your own suggestions for further work-up as well as soliciting suggestions from the conference. Again, the resident should read ahead of time and have a differential diagnosis. The resident should also be prepared to extend the discussion into therapy.
- Interesting cases should be presented concisely, getting to the "interesting part" as quickly as possible.
- Discussion of complications should also be concise. Deal with information which bears directly upon the complication. The resident should be prepared to explain the complication and have recommendations for future prevention. When presenting a case in the Morbidity and Mortality conference, the resident who presents the case should have a complete knowledge of the facts of that case.
The principal event of the academic year is the Edward T. Smith Orthopaedic Lectureship. The lectureship was established in 1956 to honor the founder of our orthopaedic program. Each year, a symposium on a specific topic is held with current leaders in that field. Residents are freed from all but emergency requirements for this event.
Residents are also free from their usual clinical responsibilities when possible to attend other significant orthopaedic lectureships that are conducted annually in the city of Houston. These include:1. Shrine Lectureship
2. St. Luke's Symposium
3. Others as designated by Department Chairman (e.g. Houston Orthopaedic Society meeting)
PRESENTATION OF PAPERS AND/OR POSTER EXHIBITS
As a means of encouraging resident participation in the process of continuing education and scholarly activity, the Department provides time off from clinical duties and money for travel when the resident is presenting a paper at a national orthopaedic meeting.
Prior to submission, any abstract or paper must be reviewed and approved by an Attending, the Director of Research and the Program Director. Submission of papers should be targeted to the AAOS and specialty societies.
The following guidelines apply to expenses and presentation at such meetings:
- A paper presented at the Annual Meeting of the AAOS or the annual meeting of affiliated organizations held with the AAOS meeting will entitle the resident to tourist class round trip airfare, conference site hotel, and meals.
- Presentation of papers at any other national orthopaedic meeting must be approved in advance by the Director before travel expenses will be reimbursed.
- Expenses will be reimbursed according to UT policy which requires that receipts be furnished prior to reimbursement. Cab fare is not generally reimbursable, but transportation to and from an airport to the host hotel is reimbursable.
- Coverage of expenses and time off only include a period extending from the day prior to the first presentation and including the day after the last presentation. Extension of this time period will be considered vacation time and cannot be reimbursed.
The policy concerning all other meeting invitations will be discussed on an individual basis with the Director.
For all meetings, a Request for Leave form must be filled out and the procedures followed as explained in the section on Annual Leave. The CMR must be notified well in advance of the preparation of schedules. All residents making trips to meetings shall be prepared to summarize the meeting for other residents and staff at the next Wednesday basic science lecture.
Through the generosity of the Edward T. Smith Fund, up to $1000 per year will be awarded to each resident in the PG2 - PG5 years for the purposes of attending approved courses and meetings and/or purchase of textbooks or other approved educational materials (e.g. CD ROM). Funds from one year may be carried over to another year. It is important that these funds be managed in an appropriate manner to maximize the number of meetings that can be attended. Reimbursement for expenses incurred in this way will be provided according to UT policy as described above.
It is inappropriate and unacceptable for a resident to approach any outside source for travel or educational funds. Any breach of this stipulation will result in the resident losing travel funds for a one year period.
All residents are encouraged to make use of the Departmental Library. No books may be taken out of the library without signing for them and no bound journals or reference books may be checked out. The Departmental Library's purpose is to provide a ready reference for all residents and this cannot be accomplished if books are missing from the library. Please sign books out with the Residency Coordinator so that their location is known at all times. No food or drink is allowed in the Library.
The purpose of the resident research project is to provide the resident with a valuable educational experience in orthopaedic research. The project will allow the resident to gain experience in critical thought processes and the scientific method.
Resident Research Requirements
As a requirement for completing the residency training program, each resident must complete at least one significant clinical or basic science research project. This does not include the Shrine project. A completed manuscript suitable for submission to a peer-review journal will be required prior to completion of the final academic year. All residents will present and defend their research projects on Resident Research Day which will be held in May or June of each year. A panel consisting of faculty and a visiting professor (s) will act as referees for the defense of the project.
Due to the large number of ongoing research projects within the Department, each resident is strongly encouraged to become involved in a project during their first year in residency. As projects are completed, the resident should become involved in other research in order to foster continued scholarly achievement.
Overview of the Scientific Method
Identification of a topic or problem in basic science or of a specific clinical nature and thorough review of the literature
A topic is selected by the resident after discussion with a faculty sponsor and the Director of Orthopaedic Research (Research Director). A complete typed bibliography and literature review must be submitted along with the topic at the 1st quarterly research conference of the PG2 year. Residents are encouraged to seek advice from the Research Director and appropriate faculty for the selection and execution of their project. To assist all residents in the selection of a topic, a list of unassigned projects will be available in the office of the Research Director.
Formulation of a research protocol (for approval at the quarterly research conference)
A research protocol will be constructed, typed, and presented for approval at the quarterly research conference.
The protocol format will be compatible for submission to the UT-HHSC Institutional Review Board. Some projects will require approval from The Committee for the Protection of Human Subjects (CPHS) and Memorial Hermann Hospital (submission deadline the first Friday of each month) or the Animal Welfare Committee (A\/VC) (submission deadline the first Wednesday of each month). Forms for these committees will be available in the Residency Office and must be completed and approved prior to commencement of a project.
Data will be analyzed and statistical analysis performed in conjunction with a biostatician/epidemiologist as needed.
Preparation of a Manuscript
A completed, typed manuscript suitable for submission to a journal will be due by Jan lst of the senior year (PG5). Follow the "Instructions for Authors for Submission of Papers" for the specific journal as discussed with the Research Director and the appropriate faculty. If undecided about which journal, the formatting guidelines of JBJS should be followed. The manuscript will include:
1. Title page
2. Abstract
3. Introduction (including an historical review of the topic/problem and purpose of the study).
4. Materials and Methods
5. Results (including statistics and Tables & Figures of publishable quality).
6. Discussion (including interpretation of the results in the context of existing literature).
7. Tables/Figures
8. Bibliography with references annotated in the text
9. AcknowledgmentsPreparation and Presentation of Scientific Data at Resident Research Day and National Meetings
The format for scientific presentation is different than that of a manuscript. The historical review in the presentation should be kept to a minimum. Emphasis is placed on Materials and Methods, Results and Discussion.
All residents are strongly encouraged to present a scientific work at Resident Research Day. A research project must be presented by the Senior Year. An award will be given for the most outstanding paper/presentation.
Guidelines for Slide Preparation
Slides should compliment and clarify the presentation not detract or complicate. Each slide should follow these guidelines:
1. Simple is better than complex
2. Less data is better
3. Minimize the number of lines per slide
4. Slides should be easily read from the back of the room
5. Choose colors carefully (dark background, light tent)
6. Use a consistent format
7. Highlight major points in diagrams, photographs, figures and illustrations
8. Use a pointer when appropriate.Residents are encouraged to present their scientific work at local, regional and national meetings. All abstracts must be approved by the Program Director, the Director of Orthopaedic Research, and the appropriate faculty prior to submission to a meeting.
Papers accepted for presentation at regional and national meetings will be funded by the Department per guidelines outlined elsewhere.
Research rotations in clinical or basic science may become available on an individual basis. Interested residents should discuss this with the Chairman, the Director of Research, and the appropriate faculty.
The only way to disseminate scientific knowledge to the medical community is by publication in a reputable journal or presentation at a conference . Good research requires truthfulness, objectivity, fairness and proper acknowledgment of original ideas. Please see the editorial entitled "On Authors and Authoring" contained in the Appendix.
In an effort to maximize productivity and minimize conflicts, the rights and responsibilities of all principle parties involved in each research project will be discussed and agreed upon prior to initiation of the project.
Disputes in authorship will be arbitrated by the Chairman, the Director of Research, and the appropriate faculty.
Overview of Research Deadlines
lst Quarter Selection of a research topic (PG2 yr) Completed typed bibliography and literature review due for presentation of research protocol for approval by Director of Research and/or Program Director.
- Sept - Nov Data collection
- December Statistical analysis
- Jan lst Completed, typed manuscript due (by PG5 year at the latest)
- April 10th Abstracts due for the American Academy of Orthopaedic Surgeons (Abstract forms will be available in the Residency Office. It is strongly encouraged that all residents submit an abstract for this meeting during their residency.)
- April - May Preparation of slides and practice sessions for Resident Research Day
- June Resident Research Day
Attendance by all Residents is mandatory- vacation may not be scheduled during the week of Resident Research Day
NOTE: All materials needed for your presentation (slides/videos, etc) Must be ready two weeks before research Day. This will allow time for practice of your presentation and to make any improvements in materials necessitated by critiques of your practice presentation.
Format for Research Project Proposal
Part I Cover Page
- Investigators
- Principal Investigator
- Co-investigators
- Title
- Brief Abstract
Part 11 IRB Protocol (see guidelines of the CPHS or the AWC)
- Subjects at Risk.
- Introduction (with references)
- Objectives of Study
- Material and Methods
- subject selection
- subject exclusions
- number of subjects
- Location of study
- Method of study
- experimental group
- treatment for each group
- method of recording results
- evaluation of results (including statistical methods)
Part III (Enclosures)
1. Bibliography
2. Data sheets
3. Informed consent formsData will be collected in an orderly fashion on specific data sheets (formulated as part of the approved research protocol). Data collection should be completed by December 3lst of the PG4 year at the very latest.
Medical Student
SALTER- Musculoskeletal SystemPGY-1
CAMPBELL's - Operative Orthopaedics (must purchase)
HOPPENFELD- Examination of the Spine and Musculoskeletal Injuries
(must purchase)
BROWNER- General Section of Skeletal Trauma
ROCKWOOD & GREEN Fractures
SIMON - Orthopaedic Basic Science (must purchase)PGY-2
BROWNER: Skeletal Trauma (must purchase this or Rockwood & Green)
SCHATZKER/TILE: Rationale for Operative Fracture Care
AO Manual
SIMON - Orthopaedic Basic Science
ROCKWOOD & GREEN -FracturesPGY-3
LISTER- Hand Surgery (must purchase)
DAHLIN- Musculoskeletal Tumors (must purchase)
LOVELLWINTER- Pediatric Orthopaedics
SIMON - Orthopaedic Basic SciencePGY-4
PETTY or MORREY & OKU-Hip & Knee Joint Replacement (must purchase Petty or Morrey)
DELEE/DREZ- Sports Medicine
ROTHMAN/SIMEONE- Spine
MANN /COUGHLIN- Foot & Ankle
SUBSPECIALITY OKU
SIMON - Orthopaedic Basic SciencePGY-5
OKU 1-5,
JBJS
ICL - at least two years
Subspecialty OKU
SIMON - Orthopaedic Basic ScienceAll OKU's should be used throughout residency training but should be used as a supplement and not the primary source
Suggested Reading
- Musculoskeletal Disorders. Regional Examination and Differential Diagnosis. R D'Ambrosia. JB Lippincott, 1977
- Surgery of the Musculoskeletal System (2e), Vols 1-5. DM Evarts et al. Churchill Livingstone, 1990.
- Campbell's Operative Orthopaedics (7e), Vols 1-4. AH Crenshaw et al. CV Mosby, 1987.
- Manual of Internal Fixation (2e). ME Mueller et al. Springer-Verlag, 1979.
- Fractures in Children, Vol 3. Rockwood & Green. JB Lippincott, 1984.
- Children's Fractures. M Rang, JB Lippincott, 1083.
- Pediatric Orthopaedics, Vol 2. MO Tachdjian. VVB Saunders,
- Musculoskeletal Tumor Surgery, Vols 1-2. WF Enneking. Churchill Livingstone, 1983.
- Operative Hand Surgery (2e), Vols 1-3. DP Green. Churchill Livingstone, 1988.
- Anatomy for Surgeons- Back and Limbs, Vol 3. VVH Hollinshead. Harper, 1969.
- Extensile Exposure (2e). AK Henry. Churchill Livingstone, 1973.
- Basic Mechanics of the Skeletal System. VH Frankel & M Nordin. Lea and Febiger, 1980.
- Handbook of Traction: Casting and Splinting Techniques. RC Lewis. JB Lippincott, 1977.
- Tumors of Bone and Cartilage. HJ Spjut et al. AFIP, 1971.
- Anthology of Orthopaedics. M Rang. E.& S. Livingston Ltd, 1975.
- Roentgen Diagnosis of Diseases of Bone (3e), Vols 1-2. J Edeiken. Vvilliams and Vvilkins, 1981.
- Bone Tumors, Dahlin.
- Surgery of the Foot and Ankle (6th ed). RA Mann. & M. Coughlin CV Mosby, 1993.
- Orthopaedics- Principles and Their Application (3e). Turek. JB Lippincott, 1977.
- Fractures of the Acetabulum. E Letournel & R Judet. Springer-Verlag, 1981.
- Instructional Course Lectures. CV Mosbv. published yearly.
- An Atlas of Anatomy
- Closed Treatment of Common Fractures (3e). J Charnley. Churchill Livingstone, 1974.
- Bone Dysplasia - An Atlas of Constitutional Disorders of Skeletal Development. Spranger et al. WB Saunders, 1974.
- Pediatric Orthopaedics. Lovell & Winter. JB Lippincott,
- Operative Orthopaedics, Vols 1-3. MW Chapman. JB Lippincott,
- The Spine, Vol 11. Rothman & Simeone. WB Saunders, 1975.
- Rehabilitation Medicine: Principle and Practice. Delisa & Joel. JB Lippincott, 1988.
- The Science and Practice of Intramedullary Nailing. Browner & Edwards. Lea and Febiger, 1987.
- Spinal Fusion- Science and Technique. JM Cotler & HB Cotler. Springer-Verlag, 1990.
- Skeletal Trauma. Browner, et al. WB Saunders,
GUIDELINES FOR LYNDON B. JOHNSON GENERAL HOSPITAL (LBJ) ROTATIONS (Chief of Service: Tery Clyburn, MD)
LBJ Hospital is a member institution with 332 beds that is part of the Harris County Hospital District. It provides care to the disadvantaged citizens of Harris County without regard to ability to pay. Within the residency program, it provides an opportunity for increasing levels of responsibility in patient management while remaining under the supervision of a faculty attending. The rotation includes experience in adult reconstructive orthopaedics, orthopaedic trauma, and pediatric orthopaedics.
Resident rotations at LBJ consist of the following: PGY 5 = Chief (CMR); PGY 4 = Senior Resident; PGY 2 = Junior Resident; PGY 1 = Intern. PGY 1 and 2 residents are directly responsible for ward patient care. Rounds will be conducted at least once a day. Both the Senior and CMR will be kept constantly informed of the condition of the service generally, and each patient specifically, at all times. To satisfy Residency Review Committee (RRC) educational requirements, the resident will review the condition of each hospitalized patient with the Chief of Service every Monday. X-ray rounds will be held on a set day and time as determined by the Chief of Service. All residents and the Chief of Service will attend. Every preoperative patient scheduled for surgery for the following week, as well as every patient who has either had surgery, or had x-rays and treatment by the orthopaedic service in the emergency department the prior week, will be presented.
The senior resident is responsible for notifying the OR in writing of the cases scheduled for surgery by 12 noon the day preceding that surgery. The CMR will review that list before 3 PM and the appropriate order of cases determined and appropriately notated. Every effort should be made to avoid changes after an OR has already been opened for a scheduled case. Any special equipment that is unavailable in the OR and must be ordered from outside will be handled by Operative Services.
The outpatient clinic patient volume will be managed in a way that allows good patient care and completion of the clinic in the time of the residents to attend teaching conferences.
From time to time, patients become very difficult for a variety of reasons common to inner city hospitals. It is recommended that when such problems occur, the nurse manager from the floor or, the hospital administrator on call, be immediately called into the situation to participate with and record the events and the recommended management of the patient.
GUIDELINES FOR M.D. ANDERSON CANCER CENTER ROTATION
(Chief of Service Alan Yasko, MD)Check-In
- Go to the Houston Main Building (HMB) at 1100 Holcombe, 16th Floor, Room 16.151, Office of Education. You will be given an MD# and a dictation card. This MD# is used for dictation and on request forms for various tests.
- Parking is no longer subsidized by MDACC. If a resident wishes to pay for parking he/she may do so in either the TMC or the Fannin Braeswood lot operated by UT. Otherwise, the resident is expected to utilize HH resident parking and walk/ride the shuttle bus to MDACC.
The Institution
The buildings of concern are the Hospital Building and the Clark Clinic Building. These two buildings are connected on Floors 1 through 7.
The hospital's primary orthopaedic floor for adults is 7 Purple. 7 Rose is the adolescent ward and 7 Blue is the pediatric floor (ages 12 and under). Patients may, however, be located on any floor. The operating room is located on the 5th floor and Radiology is on the 3rd floor. Pathology is on the 4th floor. The Emergency Center is on the 2nd floor. The Orthopaedic Clinic is on the 9th floor. The Sarcoma Center is on the 9th floor also.
Clinic and Consult Information
Head Nurse - Orthopaedics: Margaret Batangan
Head Nurse - Sarcoma: Wenonah NelsonLocated on the 9th floor, the Orthopaedic Clinic begins promptly at 7:00 AM on Tuesday and Thursday with Dr. Yasko. An average of 35 patients will be seen per clinic. Clinic ends when all the patients are seen.
Clinic patients include primary orthopaedic patients as well as orthopaedic consults from other services at MDA. Patients eligible for care have either a primary bone tumor problem or have a different primary with an associated orthopaedic complaint. Injuries occurring at MDA are also evaluated at the clinic. Patients not followed at the Orthopaedic Clinic are those who have an orthopaedic problem not related to a tumor disease currently under treatment or supervision at MDA. Evaluation and disposition of these patients will be made on an individual basis with staff.
New clinic patients are usually referred with outside films and, occasionally, path slides. You need to obtain repeat MDA plain films of the involved extremity regardless if they present with current outside x-rays. These new patients will also frequently require a skeletal survey, CSR, lab work and a PME/H&P (Primary Medical Evaluation/History & Physical). Note that a skeletal survey will not include the extremities unless specifically stated on the request form, "Skeletal Survey to include long bones."
There is a limit to how many patients are seen during a Clinic day. If this number is exceeded, you will be called directly by the various services for approval to over book the Clinic. Usually, you approve it unless there is an extremely high number, i.e. greater than 40.
If you need to consult another service at MDA, place a simple note labeled "To Service" in the progress note, along with the specific reason for the consult. If done in the Clinic, the CSR form must be checked off indicating a consult was placed to another service, thus, alerting the clerk to effect it. On the floor, it is done similarly except that an order is written on the chart and the ward clerk will contact the service you wish to consult. As a courtesy, you should order specific tests that might be required by the consulting service, e.g. EKG by Cardiology. If practical, contact the service personally.
The Orthopaedic Clinic sees non-emergent orthopaedic consults. If an emergency orthopaedic problem occurs outside of working hours, refer the patient to the Emergency Center for medical evaluation. If the ER physician feels it is an emergency, they will contact you. If it is not, they will refer the patient for a routine Orthopaedic Clinic appointment. If a patient seen in the ER with an orthopaedic problem needs admittance, it is the primary service's responsibility. Metastatic disease is admitted to the primary care service.
When consulted about lower extremity fractures, place the patient in Buck's traction with bed rest, review the case, and then discuss it with staff prior to making definitive treatment recommendations. When you are called for a consult, make sure current x-rays are available because this is not always the case. Also, make sure you obtain the patient's medical record number. A special form is now used for consultations and staff needs to co-sign it. All consultation notes should be dictated with a summary statement written in the chart.
Important information regarding a pathologic fracture is the patient's expected survival, level of pain/discomfort, prior ambulatory status, recent chemotherapy or radiation (including total dose, fractionation, and time of last dose), as well as the clinical effects of these. Knowledge of the patient's absolute neutrophil count and platelets is important if you're contemplating surgery. Keep in mind that the effects of radiation are not fully seen for 4-6 weeks. Also, radiation is usually safe to administer 10-14 days postoperatively assuming that the wound is healing well. If a case needs to go to the OR immediately and occurs during off work hours, contact staff at home. Certain tumors require special tests preoperatively, i.e. hypernephroma needs embolization in some cases, and this is another reason to discuss your preop plan with staff first.
The Orthopaedic Clinic is the only place where orthopaedic supplies are available. These supplies are limited and are listed below. If supplies are needed after working hours, contact Security (2-2890) to open the supply room. There are limited traction supplies available and most of these are Buck's traction. Any other type of traction supply or set up needs to be set up by you and supplies borrowed from Memorial Hermann Hospital.When performing a PME/H&P on a new patient, make sure you examine organ systems associated with your working diagnosis, i.e. breast, prostate, lymph nodes, spleen, liver, and testes. When performing a breast exam, make sure you have a nurse stand-by.
Much of the work at the Clinic is done by the nurses, i.e. setting up appointments, calling patients, etc. Make sure, however, you follow-up with your staging requests since it is not unusual for things to be forgotten. To obtain crutches, braces, or other special order supplies, a green PT consult is written and PT handles it.
Clinic supplies include: cast saw, cast spreaders, scissors, plaster, fiberglass, webril, cast padding, stockinette, xeroform gauze, chux's, staple remover, suture removal kit, steri-strips, Benzoin, Hydrogen peroxide, Kerlex, 4x4's, tape, bandages, Ace wraps, syringes, needles, Xylocaine, Cortisone, Neosporin, and Bacitracin. Make sure that a charge sheet is filled out when using these supplies so that they may be restocked.
Sarcoma Conference (Tuesday and Thursday)
Skeletal tumors are presented by various services including Orthopaedics. You may be expected to give a concise presentation of the patient and the radiologist will review all available x-rays. The case is then discussed as to further indicated work-up or management. Patients are presented if the physical examination is felt to contribute to the evaluation /recommendation by staff.
A Clinic note is dictated by you summarizing the x-ray interpretations, probable diagnosis, and recommendations made. You must also state the doctors present in the discussion and whether the patient was present or not. You will need to notify the patient of the results of the conference and the plan of management. Make sure you discuss your understanding of the finding with the staff prior to communicating this to the patient.
To schedule a patient for Sarcoma Conference, you need to call the Sarcoma Center at extension 2-8863. You will be expected to disclose the following information: patient's name, medical record number, age, working diagnosis, attending, patient's initial date seen at MDA, and whether there are outside/inside films and/or outside/inside path slides. These items are brought to the conference by Dr. Benjamin's staff. That is not your responsibility. An easy way to keep all this information straight is to use a stamped label with the patient's ID card when you first evaluated them in the Clinic. This has the same name, medical record number, and date. The remainder of the information can be filled in and filed away. Wait until after clinic to post patient, since many times you may have more than one patient to present.
The patients' charts will be at the Sarcoma Conference room if you need to quickly review them prior to your presentation that day.
Preoperative Evaluation
All preops are done in the Clinic and include a PME, current labs, x-rays, and EKG if patient is 40 or has a cardiac history. All patients need a CBC, PT/PTT, UA, and at least a T&S, even if you don't think blood is required, so that anesthesia will not hold up the case. Labs are valid on the following schedule without positive history or ROS:
CBC with PLTS
CXR > 60 yrs.
EKG > 40 yrs. with/out previous EKGForms to be filled out include a CSR sheet, (if not same day admit, in-patient physician's orders), x-ray request forms, preop consent, and consent for blood. All patients are referred to PT preop for preop teaching. A green PT form must be completed. If autologous blood is requested, a quick blood bank consult is also requested in the progress note. If a prosthesis or allograft needs to be ordered, you must request "measurement films with measuring device at level of bone". A prescription with the dimensions of the wanted item along with this x-ray is given to the head nurse in surgery who orders the item. You will usually do this in conjunction with staff.
Preop indices are an absolute neutrophil count of greater then 1500, and platelets of greater than 70,000. Patients who are to have an osteoid osteoma excised or a segmental bone resection need 24 hours of TCN 250 mg, QID and at least 24 hours prior to surgery. A pre-printed prescription is available at the Clinic.
Surgery scheduling usually reminds the patients of their admission dates, but it is wise to also have the Clinic nurse call them for you so that your are positive the patient is informed and will be present.
Cases need to be scheduled in surgery scheduling as early as possible at 2-6343.
Operating Room
Located on the 5th floor of the main hospital building, the locker room for residents and fellows is labeled as such. Be present in the OR at least one-half hour prior to the start of any case.
To obtain a fine needle aspiration (FNA) and core biopsy you need to get it approved by any interventional radiologist and then schedule it with the techs. They require a current platelets and coag profile (PT/PTT). If it is going to be done the same day, make sure you send these labs STAT. CT scan scheduled require a current BUN and CR.
Discharge
When discharging a patient, obtain post-op x-rays, which need to be done during the week prior to discharge since the weekend crew will not do elective films. Dictate a discharge summary and schedule via a CSR for the follow-up appointment, accompanying it with an x-ray request if follow-up films are required. If a patient lives quite a distance away, or if they are out of state, then the postop follow-up at 2 weeks can be done with their local doctor. Give them supplies for this, i.e. either staple/suture removal and steri-strips.
Academic Conferences
Academic training is done on several levels. Sarcoma conference, Pathology conference, clinic patient and floor consults.
Monday, 4:00 to 5:00 PM, 4th floor Pathology Seminar Room - Wednesday 4:00 pm New Patient presentation: Sarcoma Center (9th Floor).
There is a learning resource center (LRC) located on the 10th floor of the Clark Clinic Building. The key punch code for entry after hours is 325. This is a convenient place to study.
Weekly Schedule
Clinic Days: Tuesday & Thursday - 7:00 AM until completed
OR Days: Friday - 7:30 AM until completed
Wednesday - 8:30 AM until completedOrthopaedic Pathology Conference: Monday - 4:00 to 5:00 PM
Sarcoma Conference: Tuesday - 4:00 to 5:00 PM
New Patient Conference: Wednesday - 4:00 - 5:00 PM
Sarcoma Conference: Thursday - 4:00 to 5:00 PM
References
1. Dahlin & Uhni: Bone Tumors: General Aspects.
2. Orthopaedic Knowledge Update 3, Chapter 10, pp. 115-144.Important Numbers at MD Anderson Cancer Center
Staff
- Dr. Alan Yasko (Room R10.2213) Office: 4-5242, Beeper: 404-2207,
Home: (281) 438-4154- Janie Rutledge, RN, APN© (Room R10.2218) Office: 792-3078, Beeper: 404- 6481, Home: (281) 242-4297
- Robert Benjamin (Head, Melanoma/Sarcoma) Office: 792-3626 Clinic: 792-8863
- Interventional Radiology Office: 792-2774; to schedule biopsies: 792-2729
- Dr. Jaffe (Pediatrics) Office: 792-6620
- Dr. Kevin Raymond (Pathologist-Special Osteosarcoma) Office: 792-3105
- Dr. Syreyaskum Patel (Melanoma/Sarcoma) Office: 792-3626
- Dr. Nora Janjan (Radiotherapy) Office: 792-3432
Others
Paula Barber (Ortho OR Nurse) assists in ordering prostheses & allografts.
Office: 792-2480 (OR)Commonly Used Extensions
Admissions: 2-6136
Angiogram Scheduling: 2-7929 and 2-2774
Blood Bank: 2-2655
Floors
6 Lutheran Pod A (odd #'s 2-6650)
Pod B (even #'s 2-6655)
6 E Anderson Pediatrics: 2-2465
6 W Anderson Adolescents: 2-2460
Medical Records: 2-6700
MRI: 2-7579
Microbiology: 2-3518
Pathology:
Expediter 2-3205
Cytology 2-3140
Physical Therapy: 2-3192
Page Operator: 2-7090
Direct Page: 2-7333
Radiology:
File Room 2-6210
CT 2-2743
Fluoroscopy 2-2729 (Needle biopsy)
Orthopaedic Clinic:
Clerk's Line 2-6110
Nurse's Line 2-6115
M.D. Conf Room 2-6118 or 2-6235
Recovery Room: 2-2470
Emergency Center: 2-3722
Security: 2-2890
Surgery:
Schedule 2-6133
Room 16 2-2486
Central Desk 2-2480
XRT Consults 2-3443
X-Ray Reports 796-0565 - Pt. MR#Ancillary Services
Prostheses: Mr. Muilenberg - 524-3949 (Consult thru Social Services)
Special Shoes: Newkirk's Orthopaedic Shoes - 666-7461
Braces: Medical Center Brace 799-1005
Eagle Brace 664-8759
To Dictate
A: 2-7505
B: M.D.#
C. M.R.#
D. Work Type: 10) STAT Dictations
20) H&P/PME
30) D/C Summary & S.S.
40) Letters Only
50) Clinic Notes
60) OP
70) Initial Summary Sheet
80) Consultation Report
90) Edit
99) DNR NoteComputer Function
1. LAB
2. Pt #
...(A + all current labs that day)
...(PH = all prior labs)
3. ...(Specify lab date requested)
...(For "all" labs)
GUIDELINES FOR SHRINERS HOSPITALS FOR CHILDREN, HOUSTON
(Chief of Service Richard Haynes, MD)University of Texas, Houston, Orthopedic Surgery Residents spend a total of eight months at the Shriners Hospital Houston. The first four months are as a junior resident and the second four month are as a senior resident.
Shriners Hospital Houston is actively involved all types of pediatric orthopaedic care. The hospital has large group of children with orthopaedic problems that the Shriners organization has given us the opportunity to treat. This privilege is cherished by the entire staff and it is expected that the Residents rotating at the hospital will respect that privilege and the opportunity that the Shriners have given them.
Residency Staff
Residents from four institutions are present at the Shriners Hospital Houston with rotations of different lengths. Because of this time variance a Chief Resident system is place. Currently the Chief Resident is the senior resident on his/her second four month rotation at the Shriners Hospital. If the rotation lengths are modified for any reason, the Chief of Staff will make the Chief Resident assignment taking into consideration seniority at the Shriners Hospital, orthopaedic training and past performance. The Chief Resident is responsible for coordinating all resident responsibilities of patient care and education. All Resident requests are routed through the Chief Resident.
EDUCATIONAL SCHEDULE:
- Monday, 7:30 - 8:00 am; CHIEF OF STAFF ROUNDS.
- Tuesday, 7:00 - 8:00 am; JOURNAL CLUB, PEDIATRIC BASIC SCIENCE, OR PEDIATRIC ORTHOPAEDIC CONFERENCE.
- Tuesday, 8:00 - 9:15 am; GRAND ROUNDS.
- Tuesday, 6:00 - 7:00 pm; HOUSTON PEDIATRIC ORTHOPAEDIC CONFERENCE, SHRINERS HOSPITAL.
- Thursday, 4:30 - 6:00 pm; PRE- & POST- OPERATIVE CONFERENCE.
- Friday, 7:30 - 8:00 am; CHIEF OF STAFF ROUNDS
Chief of Staff Rounds: All residents not in operating room will round with the Chief of Staff or designee on all patients. Residents not in the operating room will be responsible for knowing and presenting all patients. Appropriate Xrays will be available for presentation. These rounds will emphasize plans & goals.
Journal Club, Pediatric Basic Science, OITE or Pediatric Orthopaedic Conference: All residents will prepare to present at this conference. Journal Club articles will be prepared by all, addressing methods & materials & results only. Conclusions will be deducted from the material by the resident.
Basic Science topics will be reviewed by all and presented by selected residents with faculty assistance. OITE questions will be reviewed, and addressed considering all answers. References used in presenting each answer will be discussed and documented. Pediatric Orthopaedic Conferences will be patient & subject based. Appropriate references will be presented & discussed.Grand Rounds occur on the wards and involve ancillary & nursing staff as well as the Medical Staff. Patient evaluation, plans, & and goals are again emphasized. Since some of our patients are hospitalized for a sizable post-operative period, ongoing evaluation is an important consideration. Appropriate Xrays are to be picked out and presented with the patient.
The Houston Pediatric Orthopaedic Conference is a formal conference with presentations being made by the assigned resident in coordination with his/her assigned staff. It is anticipated that the presentation will utilize slides and appropriate materials. The format for each conference differs according to the desires of the assigned resident and staff. The subjects are assigned as are the attending staff. Attendees is the local pediatric othopaedists, other staff orthopaedists, as well as the seven residents on the pediatric orthopaedic rotations here in Houston ( Five at the Shriners Hospital & Two at Texas Children's Hospital). The conference is held here at the Shriners Hospital, and attendance has been excellent.
The Pre- & Post-operative conference involves appropriate preparation by the resident of cases scheduled for surgery. The resident will formulate, present, and anticipate defending his/her surgical plan. Post-operative cases are presented & reviewed including appropriate X-rays.
CLINICAL AND SURGICAL RESPONSIBILITIES
The Shriners Hospital-Houston, has clinics occurring each day, morning, and afternoon. Each resident is assigned in the clinic when not present in the operating room. Two operating rooms run Monday, Tuesday, Wednesday with one operating room Thursday and Friday. It is anticipated the Resident involved in the surgical case will see the patient pre-operatively in the clinic will present the patient in the Pre & Post Operative Conference. The attending physician for that patient in the clinic will be the attending physician at surgery.
Most clinics begin at 8:00 am and run until noon, with the afternoon clinics beginning at either 12:30 or 1:00 pm. It is anticipated that each resident will attend the clinic in a punctual manner, and participate for the duration of the clinic. The experience at the Shriners Hospital-Houston, involves all areas of pediatric orthopaedics resulting in many sub-speciality clinics that are staffed by area experts in the field. The only exceptions to punctual clinic attendance involves the Baylor College of Medicine Orthopaedic Resident, who when assigned to the Wednesday Clinic, is expected to be present by 8:15 am, and the UNIVERSITY OF TEXAS RESIDENTS, WHO WHEN ASSIGNED TO THE THURSDAY CLINIC, ARE EXPECTED TO BE PRESENT BY 9:15 AM. These exceptions are based on the Grand Rounds at the respective institutions. Each resident will be involved in a broad range of clinics, to ensure that each resident has a similar experience.
Any requests for absences because of conferences involving other aspects of the Residents training program must be cleared by the Chief of Staff or his designee. These requests should be from the Director of the Residency Program and not from the respective Resident. When Residents are scheduled for afternoon teaching conferences it is anticipated that they will have completed their clinic patients assignments before leaving for the conference.
FIELD CLINICS: (Outreach Clinic)
Each month a field clinic is held in either Amarillo, El Paso, or the Rio Grande Valley. Two residents will be attending the El Paso and Amarillo clinic, and three residents will attend the Rio Grande Valley clinic. The El Paso Clinic is a one-day obligation, with the entire group leaving Hobby Airport early in the morning, and returning in the late afternoon. The Amarillo and Valley Clinics involve leaving Hobby Airport Thursday afternoon, and returning to Houston on late Friday afternoon. Each of these clinics presents a different aspect of pediatric orthopaedics, and a significant amount of pediatric orthopaedic experience. A large number of patients are seen in each clinic, with a significant number of resultant surgical experiences. These clinics represent unique aspects of pediatric orthopaedic health care, and allow us to see patients that might not otherwise avail themselves to pediatric orthopaedic care.
During each of these clinics, the residents see a large number of patients, and arrange for appropriate care and consultation with the attending orthopaedist.
IN-PATIENT RESPONSIBILITIES:
During the rotation at the Shriners Hospital in Houston, inpatient Resident coverage is necessary. From Monday morning to Saturday morning a Resident will be present in the hospital at all times. On weekends the assigned resident will be present in the hospital on a 24-hour schedule. The Resident may away from the hospital for two hours for eating or other activities. Prior to leaving the hospital the Resident must present himself on the wards to assure that any problems are being addressed and that the staff is aware of his location. The Resident must be within a 10 minute range of the hospital. If there is a patient in the Step-Down unit leaving the hospital is not appropriate. During this period of time a resident call room is provided, which is next to the complete Pediatric Orthopaedic Library. During the call period, the pediatric orthopaedic resident is the only physician present in the hospital.
Expectations are the complete evaluation and recommendations for the care of all hospitalized patients when indicated, many of whom are recently postoperative. The Resident is expected to be involved in the complete care of the postoperative patients including evening rounds.
LIBRARY FACILITIES
A complete Pediatric Orthopaedic Library is available, with a librarian present three days a week. The librarian will help each resident with literature searches, and preparation of presentations, as well as literature searches involving ongoing research projects. Access to other material not present in our library is available through our librarian.
RESEARCH PROJECTS
(Beginning in 1997)
Each resident from the University of Texas is responsible for completion of a pediatric orthopaedic research project. This will be completed prior to completion of the final rotation, in a format suitable for publication in a referred journal. Requirement includes that this publication be submitted to the a referred journal. Data collection support staff, as well as library staff is available for this effort. Although not a formal requirement for residents present for less than five months, resident research projects are strongly encouraged. Pediatric orthopaedic staff support for each residents anticipated projects will be provided. The resident completing a Shrine research project, who has this project accepted for presentation at an approved meeting, will have their trip and presentation funded by the Shriners Hospital-Houston. The project may be presented at multiple approved meetings, i.e. suitable project if accepted, and may be presented to the American Academy of Orthopaedics, American Academy of Pediatrics, and The Pediatric Orthopaedic Society of North America. If the project is accepted for presentation in each of these meetings, the resident's participation will be funded by the Shriners Hospital at each meeting. All resident research projects will be hypothesis-based with an appropriate protocol necessary before funding is assigned. No opportunity for research is more supported that at Shriners Hospitals for Children, Houston.ANNUAL PEDIATRIC ORTHOPAEDIC SYMPOSIUM
The Shriners Hospital-Houston, has held a pediatric orthopaedic symposium for twenty-five years each Spring. This is a two-day symposium involving a guest professor of national prominence. The first day of the symposium on Thursday consists of resident presentations of patients to the guest professor, followed by a presentation of the guest professor of a resident-oriented topic. Dinner occurs that evening with the guest professor. The following morning, on Friday, is the formal symposium, with formal presentations by the guest professor, and one or more of the Senior University of Texas resident involving their ongoing research project. Additional resident presentations will be facilitated, but are not presently required. This requirement, however will be present for future residents with rotations of more than four months.
No resident may be on vacation for more than one week of each rotation. The exception will be rotations longer than four months in duration. A resident may be absent from the rotation for other professional purposes, including only presentations at approved meetings. Requirements for the resident to attend additional programs must come from the Chairman of the training program to the Chief of Staff. Approved meetings include major sub-speciality organizations, and the American Academy of Orthopaedic Surgeons. Ski and similar meetings would be considered to be a portion of the resident's vacation time.
All requests for vacation and presentations must be made by the Friday of the first week of each resident's rotation. No further request for vacation time or meeting presentations will be accepted. All anticipated absences for any other reason must be presented for consideration by the first Friday, the first week of each rotation. All requests must be approved by the Chief
Resident with anticipated coverage presented. Specific requirements are: 1. No more than one resident may be on vacation during any specific week. 2. Resident vacation will not be approved during the week of field clinics (outreach clinics). 3. Coverage of resident obligations: Other resident coverage must be documented and approved by the Chief Resident before submission to the Chief of Staff for consideration.
Requests for scheduling vacation prior to the beginning of the beginning of the rotation will be accepted. These however, must be forwarded through the scheduled Chief Resident for his/her review and approval before they will be considered.
Failure of the resident staff to coordinate their vacation requests will result in the Chief of Staff or his designee assigning vacation time.
At the end of each rotation, a formal written evaluation will be discussed with each resident completing their rotation, and submitted to Program Chairman of the residents' home program. In addition, each resident is required to present a formal written evaluation of the rotation to the Chief of Staff, and discuss it with him. Written evaluation of the rotation by the resident should address the educational aspects of the rotation, including didactic conferences, the available patient experiences, both operative and non-operative, as well as the availability, support, and teaching of both the voluntary and the full time staff.
All of the above information is identical to that provided to each resident rotating at the Shriners Hospital-Houston
