Orthopaedic Surgery Residency Curriculum

Overview of Educational Goals and Objectives​

The mission and overall goal of the Orthopaedic Surgery Residency Program is to provide the knowledge, skills and attitudes necessary to develop competent, fully qualified, and ethical Orthopaedic surgeons who will dedicate themselves to a high standard of orthopaedic practice and contribute to the ongoing provision of quality patient care. The Orthopaedic Surgery residents and faculty are committed to upholding the highest professional standards while maintaining integrity and continued service to the community. They are dedicated to fostering a learning environment, as well as, demonstrating leadership and teamwork, while striving to provide compassionate patient care.  Every effort is made to enrich and promote the medical profession and lifelong advancement in the field of Orthopaedic Surgery.

The residents will provide continued and appropriate high quality orthopaedic care for a diverse, underserved patient population.  They will continue to develop and maintain a wide variety of performance improvement projects consistent with the hospital’s mission. Some of these projects include, Center of Excellence in Total Joints, development of Center of Excellence in hip fractures, and the development of a combined infectious/musculoskeletal infection clinic.

The residents will dedicate themselves to a high standard of orthopaedic practice and contribute to the ongoing provision of quality patient care.  To achieve our mission and these goals, an aggressive program of didactic learning and a full series of clinical rotations have been organized to provide the foundational knowledge and clinical experience required of an orthopaedic surgeon. 

Rotation schedules for all levels of training are designed to accommodate a "level appropriate" experience with specific learning objectives, expectations and responsibilities. Residents in training will be provided many opportunities for direct participation in operative cases and other technical procedures to satisfy the American Osteopathic Board of Orthopedic Surgery/American Board of Orthopedic Surgery application prerequisites.

PGY-1 Goals:

The first year resident rotates on the Orthopaedic Surgery Service at Riverside University Health System (RUHS).  In addition, the PGY-1 will rotate through the of Vascular Surgery, Anesthesia, Emergency Medicine, Surgical Intensive Care Unit, Surgery, Infectious Disease/Rheumatology, and Internal Medicine. The major goal of the PGY-1 year is to develop entry-level skills knowledge and abilities while helping manage the surgical and non-surgical patient.  The PGY-1 resident is responsible for the day-to-day care of patients on the service to which they are assigned under the direct supervision of senior residents and faculty. These activities will provide experience in the principles of pre- and postoperative care, experience as an assistant and an operating surgeon working under direct supervision.

PGY-1 resident should demonstrate the ability to:

• Establish basic proficiency in the evaluation of patients under routine and emergency circumstances, recognize surgical emergencies, perform a history and physical examination, order appropriate basic ancillary studies, and effectively communicate findings to other physicians.
• Establish basic proficiency in providing pre-operative and post-operative care including write appropriate pre-op and post-op orders for floor patients, handle nursing calls appropriately, and manage most routine postoperative care with minimal intervention by supervisors.
• Develop a working knowledge of common problems in orthopaedics and other non-orthopaedic services. (Achieves acceptable grade on rotation evaluation).
• Establish a working knowledge and familiarity with common procedures of the service they rotating through (achieves acceptable grade on rotation evaluation).
• Acquire basic operative skills necessary to perform less complex orthopaedic procedures.
• Develop personal values and interpersonal skills appropriate for the orthopaedic resident.
• Learn the basics of scientific methodology.
• Develop a working knowledge of the core competencies and complete the assigned curriculum for each area.
• Develop life-long habits of self-assessment, self-directed learning and reflection upon what has been learned to consciously change behaviors and practices that can improve patient care.
• Improve the communication skills with different members of the health care team.
• Develop a working knowledge of the responsibility in complying with the requirements of the Joint Commission in Hospital Accreditation and how this ultimately improves patient care.
• Examine the ethical underpinnings of clinical practice and address the ethics issues faced every day caring for patients.

PGY-2 Goals:

The goal of the second year resident is to gain experience in the outpatient and inpatient management of different orthopaedic conditions.  Operating room experience emphasizes acquiring basic psychomotor technical skills as well as teaching the fundamental principles of orthopaedic surgery, anatomy, and surgical dissection.  During each rotation, the second year resident serves as a junior resident of clinical services and receives an introduction to the operative needs of the patients on the general orthopaedics, trauma, joints, spine/research, sports and pediatric orthopaedics, and hand surgery services.

PGY-2 residents should demonstrate the ability to:

• Develop skill in the provision of pre-operative and post-operative care by managing pre-operative and post-operative care of complex patients with minimal intervention
• Establish a knowledge base and skill proficiency for the management of the critically ill/injured orthopaedic patient.
• Develop organizational and teaching skills necessary for management of an orthopaedic service (attends to routine organizational duties of service such as organizing rounds and teaching sessions).
• Develop a working knowledge of and familiarity with the management of common problems in orthopaedics.  Demonstrate skill in operative technique required for procedures of surgical complexity, such as basic fracture and wound management.
• Continue developing a working knowledge of the core competencies and complete the assigned curriculum in each area.
• Outline key professionalism principles as presented in the College’s “Code of Professional Conduct” and apply it to everyday caring for patients.
• Develop life-long habits of self-assessment, self-directed learning and reflection upon what has been learned to consciously change behaviors and practices that can improve patient care.
• Continue to improve the communication skills with different members of the health care team.
• Develop an understanding of the process followed to monitor and improve quality by the hospital as a system of care as well as medical staff in particular.

PGY-3 Goals:

At this point in the program, the resident should have gained sufficient knowledge and experience to more actively direct the care of patients.  On some rotations the third-year resident will be directly responsible to a chief resident or to the attending faculty.  Extensive experience in both inpatient and outpatient care continues at this level, as well as increasing experience in the operating room.  Cases increase in number and in complexity during this year, providing the resident with the background necessary to enter the senior resident years (four and five).

PGY-3 residents should demonstrate the ability to:

• Continue to develop technical skills necessary for the performance of more complex surgical procedures in orthopaedic surgery.
• Acquire proficiency in surgical arthroscopy, both diagnostic and operative.
• Establish a knowledge base, judgment and interpersonal skills necessary to function as an orthopaedic consultant by successfully managing entry-level consults with minimal direct supervision.
• Continue developing a working knowledge of the core competencies and complete the assigned curriculum in each area.
• Develop enhanced skills in the management of an orthopaedic service by managing service administrative duties assigned by the chief resident or faculty.  Proficiency in the rational use of Orthopaedic literature and evidence-based medicine (defends discussions and recommendation with scientific evidence).
• Outline key professionalism principles as presented in the College’s “Code of Professional Conduct” and apply it to everyday caring for patients.
• The ability to communicate and interact with patients in difficult situations.
• Learn the role of medical staff committees and function as a committee member.

PGY-4 Goals:

Responsibility for patient care continues to increase and in some rotations the fourth-year resident reports directly to the chief residents and attending staff.  Even in instances that involve the fifth-year as Chief Resident, the fourth-year will have specific clinical responsibilities that allow for functioning as the supervising resident.  Residents become more actively involved in the development of treatment plans for both out- and in-patients, while moving into the roles of primary surgeon and first assistant in the operating room.

PGY-4 residents should demonstrate the ability to:

• Continue to develop knowledge and skills necessary for the complete management of common problems in orthopaedic while managing most common problems with minimal assistance.
• Continue developing a working knowledge of the core competencies and complete the assigned curriculum in each area.
• Develop knowledge and skills necessary to function as a team leader for both adult and pediatric patients.
• Satisfactory performance as a teacher of junior residents and medical students (receives acceptable feedback from students and peers).
• Outline key professionalism principles as presented in the College’s “Code of Professional Conduct” and apply it to everyday caring for patients.
• Understand system based issues that will better prepare them to manage finances after residency.
• Ability to effectively communicate with patients about surgical errors and adverse outcomes and incorporate the critical elements of a disclosure conversation in their practice to provide optimum patient care.
• Continue life-long habits of self-assessment, self-directed learning and reflection upon what has been learned to consciously change behaviors and practices that can improve patient care.

PGY-5 Goals:

During this final year, the fifth-year resident always functions as the Chief of service.  Responsibility for all clinical activities of service, inpatient and outpatient care, as well as all operating room activity is given to the resident.  The coordination of all resident activity and the oversight of the care provided is the resident’s responsibility, working directly with the Chief of Service and other members of the teaching faculty.  The roles of primary surgeon and first assistant continue in the operating room, depending on the complexity of the case.

PGY-5 residents should demonstrate the ability to:

• Develop knowledge and skills necessary to assume complete responsibility for the management of the orthopaedic patient, including mastery of the fundamental components of surgery as defined by the American Osteopathic Board of Orthopedic Surgery/American Board of Orthopedic Surgery (achieves acceptable score on written and oral examinations and receives acceptable evaluations).
• Demonstrates proficiency in the management of complex problems in orthopaedic surgery and treats complex problems in the discipline with minimal help.
• Continue developing a working knowledge of the core competencies and complete the assigned curriculum in each area.
• Demonstrates personal and professional responsibility, leadership skills and interpersonal skills necessary for independent practice as a specialist in orthopaedic surgery and successfully manages the chief resident services.
• Outline key professionalism principles as presented in the College’s “Code of Professional Conduct” and apply it to everyday caring for patients.
• Continue life-long habits of self-assessment, self-directed learning and reflection upon what has been learned to consciously change behaviors and practices that can improve patient care.
• Incorporate good communication skills in their daily practice.
• Develop skills to organize and manage a practice after residency.

Instructional Methods

Instructional methods include:

• Clinical teaching rounds
• Weekly conferences
• Operating room supervision
• Orthopaedic grand rounds
• Journal club
• Morbidity and mortality/Department meeting
• Self-assessment exams
• In-training exam and review
• Anatomy dissection
• Monthly saw bones labs
• Quarterly cadaver skills labs
• Proficiency labs

Assessment Methods

• Feedback will be given by the attending staff through daily evaluation in both the operating room and clinic setting
• The resident will collect cases for morbidity and mortality conference, and present to the faculty in order to improve patient management and outcomes in the future
• Evaluations using global assessment form based on the six core competencies will be reviewed with each resident by the program director
• 360 degree evaluations will be performed and reviewed semi-annually by the program director
• OrthoBullets PASS Program; weekly quizzes, monthly exams and milestone skills evaluations