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									    UNMC Orthopaedic Surgery

Rotating Medical
    Student
  Orientation
                     Department of Orthopaedic Surgery
                                     and Rehabilitation
             Introduction
 This presentation will give you an
  introduction to your rotation at UNMC.
 You should use it as a reference both
  before and during your rotation as it
  contains important information regarding
  your month with us.
                  Welcome
   Welcome to the orthopaedic surgery
    experience at the University of Nebraska
    Medical Center. We hope you find this
    rotation both challenging and rewarding.
    This rotation should allow you to expand
    your knowledge of basic orthopaedics as
    well as participate in diagnosis, treatment,
    and care of various orthopaedic patients.
                  WELCOME
   We are here to
    teach you about
    the basic
    foundations of
    and help you gain
    a feel for a career
    in Orthopaedic
    Surgery
UNMC Orthopaedics
               About our hospital
   Nebraska Medical Center
    – This is the combination of two hospitals that merged in 1997
      including
         Clarkson (Private)
         Univ of Nebraska Medical Center (Academic)
   The Nebraska Medical Center is one of the region's premier
    health systems.
    – 735 bed state of the art hospital
    – Recent addition of new clinical center that includes nearly 30 new
      operating rooms, radiology suites, and a brand new emergency
      department.
   To learn more about our hospital and medical school
    – www.unmc.edu
    – www.nebraskamed.com
            About our program
   UNMC Department of Orthopaedics
    – A full description of our program is available
      on the department website. This includes a
      list of current and past residents, information
      about applying for a residency position,
      information regarding salaries, benefits and
      call, and finally information about our faculty
    – http://www.unmcphysicians.com/ttg-
      ortho/new/index.cfm
              About our program
 4 residents per year (20 total)
 Divided among:
    –   Interns (4)
    –   Children’s Hospital (2)
    –   VA Hospital (3)
    –   UNMC Sports (1)
    –   Private Sports / Foot&Ankle (2)
    –   Adult Reconstruction (2)
    –   Trauma / Foot&Ankle / Tumor (3)
    –   Hand & Upper Extremity (2)
    –   Spine (1)
           Rotation Schedule
 There are generally many medical students on
  the main orthopaedic service each month
 In order to expose each of you to a broad
  experience and to expose you to several of the
  faculty and residents we generally provide you
  four one week blocks on different services.
 This is the only fair way to accommodate all of
  the students rotating and allow the staff and
  residents to get to know you.
 Requests for different services will be taken, but
  keep in mind that we have to make it fair for
  everyone.
                Rotation Schedule
   Students will or may be assigned to the following
    services:
    – ADULT RECONSTRUCTION (UNMC)
         The GOLD service with Dr. Garvin
    – TRAUMA / FOOT & ANKLE (UNMC)
         The GREEN service with Drs. Mormino, Reed
    – ONCOLOGY (UNMC)
         The GREEN service with Dr. Mcgarry
    – UPPER EXTREMITY (UNMC)
         The BLACK service with Drs. Fehringer, Lauder, Nystrom
    – PEDIATRICS (Children’s Hospital and UNMC)
         With Drs. Esposito, Scherl, Hasley, Ginsburg
    – SPORTS MEDICINE (UNMC)
         With Drs. Dietrich, Daccarett
    – VA HOSPITAL
               Rotation Schedule
   An example of a typical month for a student
    would be:
    – Week 1
        Gold Service with Dr. Garvin and a 5th and 2nd year resident
    – Week 2
        Green Service with Drs. Mormino, Reed, McGarry, and a 4th,
         3rd, and 2nd year resident
    – Week 3
        Pediatric Service with Drs. Esposito, Ginsburg, Hasley, Scherl,
         and a 5th and 3rd year resident
    – Week 4
        Sports with Drs. Dietrich, Daccarett, and a 5th year resident
               Expectations
 Each of you is interested in an orthopaedic
  residency and a career in orthopaedics.
 You will be rotating with us not only to learn
  about our residency program, but also to allow
  us to evaluate you as a potential resident.
 Please read through the following expectations
  carefully and try to use them as a guide for what
  we are looking for in a potential resident.
         Expectations: General
   We expect you to:
    – Show up on time, be available, and work hard
    – Read before surgical cases (anatomy and
      surgical plan)
    – Be helpful, be inquisitive, ask questions
    – Learn basic management of common
      musculoskeletal problems
    – Participate actively in rounds, clinics,
      conference, and general discussions about
      Orthopaedic problems
   The best medical students:
    – Work hard and ask appropriate questions at appropriate
      times
    – Take initiative and do things without being asked
    – Help write notes including chart notes, post op notes,
      and post op orders
    – Have labs ready for rounds in the morning
    – Update patient list with current patient rooms
    – Are sure case notes and x-rays are available for the
      current day and next day cases
    – Are prepared for daily conferences, clinics, and cases by
      reading beforehand
    – Function at an intern level
   Clinical functioning at the level of an intern
    – Think about the patient care plan:
        Pre-op planning
        Medical workup before surgery
        Antibiotics
        Pain control
        DVT prophylaxis
        Therapy goals & restrictions
        Dressing changes / drain output
        Discharge planning & clinic follow-up
        Read other consult service notes for their plan
              Note writing
 We expect you to be able to write chart
  notes, post op notes, and assist with post-
  op order writing
 Several examples follow. Use them as a
  guide for what we are looking for in notes.
                    Chart note example
   Subjective
            Pt was comfortable overnight, no pain issues, no nausea/vomiting. Good PO intake
             and had a bowel movement
   Objective
              Hgb 11
              Inr 2.1
              Walked 110’ with PT
              Afebrile
              Alert/oriented
              Wound is clean and dry
              Neurovascular exam is intact
   Assessment
            S/P Right Total Hip
   Plan
              Continue pain mgt
              Increase activity
              DVT prophylaxis
              Discharge planning
                    Post op Note
   We write standard post op notes for each
    surgery
    –   Pre-op Diagnosis
    –   Post-op Diagnosis
    –   Procedure
    –   Surgeon
    –   Assistant
    –   Anesthesia
    –   EBL
    –   Fluids
    –   Complications
    –   Post op status
                  Post op note example
   Pre-op
     –    Left Closed Femur Fracture
   Post op
     –    Same
   Procedure
     –    Closed reduction IM fixation
   Surgeon
     –    Dr. Mormino
   Assistant
     –    Dr. Buck HOV and Dr. Johnston HOIII
   Anesthesia
     –    GETA
   EBL
     –    50cc
   Fluids
     –    1000cc crystalloid
   Complications
     –    None
   Status
     –    Return to floor in stable condition
             Post Op Orders
   Most of the staff have standard post op
    orders. The residents will help you to
    figure out where these are and what they
    specifically want. We do not expect you
    to know what each staff wants, but we do
    expect you to have an understanding of
    typical post op orders for specific
    surgeries.
CALL
 Divide call on trauma nights between the
  students such that you average no more
  frequently than q4 during your month.
 Be sure to get at least one full weekend
  off. We’d like you to be able to both have
  a life and also get to know a little about
  our city.
 The actual schedule is left up to the
  students to arrange. Be fair to each
  other.
 Carry the on-call pager and notify the
  junior resident on-call that you will be
  taking call with them that evening.
 The best opportunity to learn how to
  suture, splint, cast, and possibly do
  reductions as a medical student takes
  place on-call and in the ER/trauma bay.
CONFERENCES
         Conference Schedules
   Three rules
    – Read assigned material before conference,
      if you are unsure, ask the junior resident
      on your service.
    – No scrubs in conference, dress
      appropriately.
    – Be on time. Tardiness to conference will
      be looked upon very poorly.
         Conference Schedules
  Mon          Tues         Wed         Thurs          Fri
600am        630am        600am        600am        600am
Textbook     Gold Joint   Pediatric    Trauma       Hand/upper
Conference   Conference   Ortho        Conference   extremity
                          Conference                Conference
630am
Grand
Rounds


UNMC Ortho UNMC Ortho Children’s       UNMC Ortho UNMC Ortho
Library    Library    Hospital         Library    Library
                      Glow Aud.
                      3rd Floor
Lectures
                           Lectures
 Each week the rotating medical students will
  participate in a lecture given by one or more of the
  residents in the orthopaedic library.
 These lectures are interactive meaning that we
  expect you to read about the topic beforehand and
  be able to answer questions.
 Weekly Educational Topics (1700 Wednesday)
    –   Week   1:   Trauma / Radiographs / Splinting
    –   Week   2:   Lower Extremity Injuries
    –   Week   3:   Upper Extremity Injuries
    –   Week   4:   Case Conference
Library
         Orthopaedic Library
 We have an extensive collection of current and
  past textbooks and journals in our departmental
  library. It is a resource for everyone. Please
  take advantage of it. We only ask that you do
  not remove any of the books or journals.
 There is no excuse for not being prepared
  for a procedure, lecture, or clinic. The
  resources are available to you.
          Commonly used books and
                 websites
   Useful textbooks
    –   Hoppenfeld’s Surgical exposures
    –   Hoppenfeld’s Physical Examination of the Spine and Extremities
    –   Netter’s Anatomy
    –   Miller’s Review of Orthopaedics Textbook
    –   The Handbook of Fractures
    –   Campbell’s Operative Orthopaedics
    –   Browner and Jupiter and Rockwood and Green Trauma
        Textbooks
   Useful websites
    –    http://www.wheelessonline.com/
    –   http://www.aaos.org/
    –   http://www.ota.org/
    –   http://osrr.orthosurg.net/
Miscellaneous
 Information
               Contact person
   Geri Miller is the contact person rotating
    medical students.
    – Email
        gmiller@unmc.edu
    – Phone
        1-402-559-2258
          Key Phone Numbers
 Geri Miller           559-2258
 Ortho Clinic          559-5360
 Resident Room         559-5614
 Radiology File Room   559-1001
 Emergency Room        559-6637
 Univ OR Pre-Op        559-5859
 Univ OR Recovery      559-4133
                      Nuts & Bolts
   Accessing computers
    – The computers in the resident room are password protected.
      You will need to get access to these.
   Accessing electronic x-rays (Magic Web)
    – All of our x-rays are digital. Students are not given a password
      for magic web, but should be able to view x-rays with an
      available resident.
   Accessing medical record (Last Word)
    – Last word is for patient information including labs, notes, and
      other reports. You will get access to this.
   Scrub valet codes
    – Scrub codes will be given for the scrub valet. This is done at the
      OR front desk on your first day. You will be allotted 3 sets of
      scrubs while you are here.

								
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