Community Based Rotation

At the conclusion of the residency rotation on this service, the graduate is expected to be proficient in the management of community-based musculoskeletal problems encountered in the general practice of orthopaedics. The Department of Orthopaedics and Rehabilitation recognizes that competency as a physician extends beyond medical knowledge and direct patient care. Therefore, evaluations for the Community/Harrisburg Hospital rotation will include not only these competencies, but also demonstration of abilities in medical knowledge and patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

The purpose of the Community /Harrisburg Hospital rotation is to provide the PGY-IV resident with an educational experience which maximizes the opportunity to understand, evaluate, and treat common musculoskeletal disorders frequently seen and treated by orthopaedic surgeons practicing in a private practice setting. It is intended to be complimentary to the subspecialty rotations the resident has experienced in the previous two years, with an emphasis on joint arthroplasty, arthroscopy, hand, and spine surgery. Therefore, the rotation provides significant flexibility and can be tailored to the leaning goals of that particular resident. The resident will also be exposed to a high volume of common orthopaedic conditions seen in the private practice setting including low energy hip fractures. The PGY-IV resident will spend one three-month block on this rotation.

Reading List

Readings will be based upon the subspecialty reading lists of the residency program, with additional direction as appropriate by the faculty at Harrisburg Hospital.

Goals and Objectives

Medical Knowledge and Patient Care:

It is expected that the PGY-IV level residents on the Community/Harrisburg Hospital Rotation will:

  • Gain an appropriate knowledge base with respect to applied anatomy, be able to perform a history and physical exam, know the indications for obtaining appropriate imaging studies, and be able to formulate a differential diagnosis and treatment plan.
  • Understand the concepts of non-operative treatment and have a clear understanding of surgical indications and conditions amenable to surgery.
  • Become familiar with the principles of rehabilitation.
  • Be familiar with basic surgical approaches, arthroscopic portal site anatomy, and risks of surgery.
  • Conduct both simple and complex fracture reduction in the outpatient setting.
  • Have a strong understanding of biomechanical and biological principles guiding surgical techniques and rehabilitation.
  • Be familiar with emerging technologies, options, and controversies of surgical management.
  • Become proficient in common surgeries performed in the community orthopaedic setting to include but not limited to: knee, shoulder, and ankle arthroscopy, ACL reconstruction, primary meniscectomy/repair, primary hip and knee arthroplasty, rotator cuff repair, open shoulder stabilization and acromioplasty, carpal tunnel, wrist fracture ORIF/Ex Fix, Dequervains,, Dupytrens contracture, trigger fingers and fixation of finger fractures, lumbar spine discectomy, fusion, and decompression, ankle fractures, Achilles tendon repair, and long bone trauma.

 

Interpersonal and Communication Skills – Goal: The PGY-IV level resident will be expected to be respectful to patients and all members of the health care team at all times. This includes the following objectives:

  • Demonstrate the ability to discuss difficult matters with patients and families in a compassionate manner. The level of discussion should be commensurate with the medical knowledge and experience of the resident.
  • Demonstrate the ability to allow patients and families to fully express their concerns and/or symptoms.
  • Demonstrate the ability to explain operative procedures, risks and post-operative care to the patient/family, commensurate with their medical knowledge and experience.
  • Demonstrate the ability to develop a professional relationship with the patient/family.
  • Maintain professional communications and relationships with ancillary staff and medical colleagues.
  • Demonstrates effective communication in the informed consent process.

 

Professionalism – Goal: The PGY-IV level resident will be expected to act professionally toward patients and all members of the health care team at all times. This includes the following objectives:

  • Demonstrate sensitivity and responsiveness to differences in culture, gender, age and impairments.
  • Demonstrate sensitivity to the needs of patients/families.
  • Respect the need for confidentiality of patient information.
  • Demonstrate honesty in written and oral communications.
  • Demonstrate awareness of limitations and seek advice when appropriate.
  • Accept advice without personal offense and use it constructively.
  • Assess their performance with objectivity and accuracy.

 

Practice Based Learning and Improvement: - Goal: The PGY-IV resident will demonstrate commitment to continuous learning and improvement in their patient care, benefiting from previous experiences and ongoing review of the literature, and contributing to the education of those around them. This includes the following objectives:

  • Contribute to the education of medical students and other health care professionals.
  • Evaluate medical research/scientific evidence and apply findings to patient care. The PGY-IV resident will frequently utilize textbooks, review articles, and “classic” articles. The PGY-IV resident will actively seek out more recent and perhaps “cutting edge” manuscripts that are applicable to patient care.
  • Monitor their own practice of medicine to identify opportunities for improvement.
  • Participates in the morbidity and mortality process.
  • Effectively utilize information technology to manage and access medical information.
  • During their entire residency training, gradually assumes increasing levels of independence with decreasing need for faculty supervision, commensurate with the medical knowledge and patient care competencies outlined previously.

 

Systems Based Practice – Goal: The resident will recognize their role in a complex and financially challenged health care system, identify resources available to them to contribute to patient care, and demonstrate familiarity with internal and external regulations and policies that impact care delivery. This includes the following objectives:

  • Complete medical records accurately and in a timely manner.
  • Effectively utilize health care system resources to provide optimal patient care.
  • Be aware of the need to provide cost efficient patient care, and have a basic understanding of the factors that impact this. The resident should also have an advanced understanding of the costs associated with their treatment recommendations, and be able to justify treatment not only on medical decision making but cost considerations as well.
  • Assist patients in dealing with health care complexities and serve as advocates for patients within the health care system.
  • Be attentive to the manner in which the health care system may impact patient safety and take steps to prevent errors. This includes awareness of National Patient Safety Goals and federal and hospital quality improvement projects.
  • Residents is attentive to medication errors, surgical site infection and venous thromboembolic disease.
  • Resident adheres to the standards of surgical site identification, awareness of wrong site surgery and adherence to surgical time out.