Shoulder / Elbow
At the conclusion of the residency rotation on this service, the graduate is expected to be proficient in the management of shoulder and elbow conditions problems in the general practice of orthopaedics. It is important to recognize that competency as a physician extends beyond medical knowledge and direct patient care. Therefore, evaluations for the Shoulder and Elbow Service 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 goal of the Shoulder and Elbow Service is to provide the resident with a comprehensive learning experience that maximizes the opportunity to understand, evaluate, and treat orthopaedic shoulder and elbow injuries. This is achieved by combining a structured study program that utilizes an extensive recommended reading list with clinical experience that has an appropriate balance between office evaluation and surgical treatment of shoulder and elbow injuries. Junior and senior level residents rotate through the Shoulder and Elbow Service for three-month blocks and assume responsibility based upon demonstrated knowledge, previous experience, and clinical skills.
It is recognized that advanced competence in shoulder and elbow surgery implies an additional year of specialized training. The objectives of shoulder and elbow training in this orthopaedic training program are two-fold: 1) preparation of resident for such specialized training; and 2) clinical competence in common community shoulder and elbow procedures.
The Reading List can be found on the Department of Orthopaedics and Rehabilitation Intraweb under the Residency/Curricula section.
The Shoulder and Elbow Service core curriculum will be based upon two types of reading. Level I reading will consist of specific book chapters chosen from the most current Shoulder and Elbow textbooks. The subjects covered will include: shoulder instability (anterior/posterior, traumatic/atraumatic), rotator cuff tears (acute/chronic, large/recurrent), shoulder stiffness (idiopathic/post-traumatic), fractures of the shoulder and elbow, and arthroplasty of the shoulder and elbow. Level II reading will consist of specific articles considered by Drs. Armstrong and Lyons to be classic peer review manuscripts in the shoulder and elbow literature. The book chapters are to be read by the residents during their first month of the rotation. The peer review manuscripts will be provided as a reference list to facilitate further learning and to prepare for/discuss complex cases scheduled for the operating room or seen in the clinic.
Goals and Objectives
Medical Knowledge and Patient Care:
It is expected that junior level residents on the Shoulder and Elbow Service will:
- Learn/know the relevant applied anatomy.
- Become proficient performing a history and physical exam.
- Know the indications for radiologic imaging as well as the interpretation of these tests.
- Be able to formulate a differential diagnosis.
- Understand the concepts of non-operative treatment, indications for/risks of surgery, and basic principles of postoperative rehabilitation.
- Know the basic surgical approaches, including arthroscopic and open anatomy.
It is expected that senior level residents on the Shoulder/Elbow Service will:
- Develop basic shoulder arthroscopic skills including topographical anatomy, portal placement, triangulation capabilities, an organized systematic arthroscopic examination of the glenohumeral joint and subacromial space, evaluation of cuff and labral tears, anchor placement and subacromial decompression.
- Become proficient in the basic principles of surgical exposure, fracture fixation and joint arthroplasty.
Interpersonal and Communication Skills – Goal: Both junior and senior level residents will be expected to be respectful to patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will 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.
- Both junior and senior level residents will demonstrate the ability to allow patients and families to fully express their concerns and/or symptoms.
- Both junior and senior level residents will demonstrate the ability to explain operative procedures, risks and post-operative care to the patient/family, commensurate with their medical knowledge and experience.
- Both junior and senior level residents will demonstrate the ability to develop a professional relationship with the patient/family.
- Both junior and senior level residents will maintain professional communications and relationships with ancillary staff and medical colleagues.
- Both junior and senior level residents demonstrates effective communication in the informed consent process.
Professionalism – Goal: Both junior and senior level residents will be expected to act professionally toward patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will demonstrate sensitivity and responsiveness to differences in culture, gender, age and impairments.
- Both junior and senior level residents will demonstrate sensitivity to the needs of patients/families.
- Both junior and senior level residents will respect the need for confidentiality of patient information.
- Both junior and senior level residents will always demonstrate honesty in written and oral communications.
- Both junior and senior level residents will demonstrate awareness of limitations and seek advice when appropriate.
- Both junior and senior level residents will accept advice without personal offense and use it constructively.
- Both junior and senior level residents will assess their performance with objectivity and accuracy.
Practice-Based Learning and Improvement: - Goal: Both junior and senior residents 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:
- Both junior and senior level residents will contribute to the education of medical students and other health care professionals. Although senior level residents will provide the leadership in this, the more junior level residents can play a meaningful role as well.
- Evaluate medical research/scientific evidence and apply findings to patient care. The more junior level residents will frequently utilize textbooks, review articles, and “classic” articles. More senior level residents will actively seek out more recent and perhaps “cutting edge” manuscripts that are applicable to patient care.
- Both junior and senior level residents will monitor their own practice of medicine to identify opportunities for improvement.
- Both junior and senior level residents participate in the morbidity and mortality process.
- Both junior and senior level residents will effectively utilize information technology to manage and access medical information.
- The resident, 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: Residents 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:
- Both junior and senior level residents will complete medical records accurately and in a timely manner.
- Both junior and senior level residents will effectively utilize health care system resources to provide optimal patient care.
- Junior level residents should be aware of the need to provide cost efficient patient care, and have a basic understanding of the factors that impact this. Senior level residents should 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.
- Both junior and senior level residents will assist patients in dealing with health care complexities and serve as advocates for patients within the health care system.
- Both junior and senior level residents are 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.
- Both junior and senior level residents are attentive to medication errors, surgical site infection and venous thromboembolic disease.
- Both junior and senior level residents adhere to the standards of surgical site identification, awareness of wrong site surgery and adherence to surgical time out.