OVERVIEW OF THE ORTHOPAEDIC TRAINING PROGRAM
The Orthopaedic Residency Training Program of Tulane University School of Medicine is over 100 years old. Residents receive extensive training and firsthand experience that enables them to effectively treat patients with a full array of orthopaedic conditions. The current curriculum is devised to insure adequate exposure to adult reconstructive surgery, spine, sports medicine/arthroscopy, hand, foot, rehabilitation, trauma, and pediatric orthopaedics. Equal emphasis is placed on outpatient care, emergency care, and inpatient and operative orthopaedics. Throughout their training, residents care for outpatients in a clinic setting with the supervision of senior residents as well as attending staff. From the very beginning of their training, residents obtain extensive firsthand experience in the treatment of fractures, dislocations, soft tissue injuries, and other orthopaedic emergencies. They also assume responsibility for the care of inpatients, including preoperative assessment and postoperative care. Residents assume a primary decision making role in patient care which prepares them for clinical practice. In addition, residents serve as primary surgeon in the vast majority of cases performed at the training hospitals while being supervised by attending staff physicians. This allows them to attain a high level of technical skill by the end of their training. While senior residents serve a primary role in clinical and intra-operative decision making, they are always under the supervision of a staff physician.
Every resident has exposure to research. In the course of their training each resident completes one or more projects which are presented at various conferences. In the process of completing these assignments, residents learn the basics of performing a literature review, formulating a hypothesis, gathering and evaluating data including basic statistical analysis, drawing valid conclusions, and presenting their findings in a coherent fashion, participating in this process allows residents to assess, interpret, and evaluate orthopaedic literature and apply pertinent results that are presented in an appropriate manner to their practice so that they can continue to develop and stay current in a rapidly changing field.
The administration and operation of the program is the primary responsibility of the Residency Program Director. The Program Director directs and coordinates the process of applicant selection, resident assignment and distribution for hospitals, and the didactic educational activities. Tulane University Hospital is the main location for our patient care and teaching. The Medical Center of Louisiana is now located at University Hospital, five blocks from Tulane University Hospital. The ACGME has identified six general competencies for resident education. These six general competencies, which are well covered in our program are:
1. Medical Knowledge
Didactic lectures, morning report, journal clubs, weekly grand rounds where the residents are responsible for two presentations on a pre-selected topic with a thorough literature review. Anatomy is taught during the first semester of each year with cadaver prosections, correlated with clinical applications and surgical exposures supervised by our faculty. The residents must demonstrate medical knowledge by applying cognitive knowledge in analytical thinking and approach to clinical situations. The results of their in-training examination and board scores help in determining their learning performance.
2. Patient Care
The residents must provide compassionate, appropriate and effective care for the patients. During our residency training program, the residents will demonstrate this competency by respectful communication with their patients by gathering important information that will be needed in making appropriate decisions into their medical and surgical care. They will also counsel their patients and the patient’s families to effectively being able to deliver the care to their patients. The residents should demonstrate their ability to perform all medical and surgical procedures in the scope of their practice of orthopaedic surgery.
3. Practice Based Learning and Improvement
The residents should be able to analyze the evidence from scientific studies in the literature related to their patients and apply them in the care of their patients. They learn to analyze practice experience and perform practice based improvement activities using a systematic methodology. The resident should facilitate the learning of medical students and allied health professionals.
4. Systems Based Practice
The residents should realize that they are part of a larger health care system and they should understand and work within this system as a patient advocate. They should learn billing and coding issues and use cost effective measures in ancillary imaging and laboratory investigation, but always protecting the welfare of their patients. The residents should learn to work together with other members of the health care system including nurses, discharge planners, social workers, chaplains and others in providing quality care for their patients. This also includes patient safety in avoiding patient errors. Pre-operative surgical site identification and signature is part of this competency.
The residents should:
a. Demonstrate respect and compassion
b. Demonstrate a commitment to ethical principles
c. Demonstrate sensitivity, and responsiveness to patient’s culture, age, gender and disabilities.
Ethics are taught first by example from the members of the faculty. Role models are needed for appropriate ethical learning. A didactic lecture and discussion in ethical principles are part of our curriculum.
6. Interpersonal and Communication Skills
The residents should establish ethically sound relationships with their patients. They should be able to listen to the patient’s complaints as effectively elicit pertinent information to and then in making a sound judgment for patient care. In obtaining the permission for surgery from their patients, the resident should be able to develop skills to appropriately explain the patient and their families the benefits and possible complications resulting from their care so that an informed consent be obtained for their surgical treatment. The patient should be the most integral part in the surgical decision with appropriate guidance by the resident physician. The resident physician will demonstrate these skills when obtaining the permission for surgery with faculty presence. The resident physician should be able to communicate with other members of the health care team so that an effective plan of care can be developed for their patients.