DUKE ORTHOPAEDIC SURGERY GOALS AND OBJECTIVES PEDIATRIC ORTHOPAEDIC

							                                               DUKE ORTHOPAEDIC SURGERY

                                                    GOALS AND OBJECTIVES

                                            PEDIATRIC ORTHOPAEDIC SERVICE

PATIENT CARE

PGY-4 RESIDENT                                                    PGY-4 RESIDENT
Demonstrates competency with initial patient care and clinical     Demonstrates competency with initial patient care and clinical
skills needed to facilitate adequate evaluation, diagnosis, and    skills needed to facilitate adequate evaluation, diagnosis, and
treatment of pediatric orthopaedic patients in the emergency room treatment of pediatric orthopaedic patients in the emergency room
setting, the clinic, and the operating room. This will include     setting, the clinic, and the operating room. This will include
musculoskeletal complaints in traumatic, infectious, congenital,   musculoskeletal complaints in traumatic, infectious, congenital,
idiopathic, and inflammatory etiologies.                           idiopathic, and inflammatory etiologies.

Able to evaluate what imaging studies are most appropriate in        Able to evaluate what imaging studies are most appropriate in
evaluating patients with traumatic, infectious, inflammatory,        evaluating patients with traumatic, infectious, inflammatory,
congenital, and idiopathic pathologies.                              congenital, and idiopathic pathologies.

Competently prepares patients and manages patient care through       Competently prepares patients and manages patient care through
both simple and complex surgical treatment, assessing patient        both simple and complex surgical treatment, assessing patient
safety and comfort and establishes a meaningful discharge plan.      safety and comfort and establishes a meaningful discharge plan.

Reports to the attending surgeon his/her findings and/or treatment   Reports to the attending surgeon his/her findings and/or treatment
rendered regarding their daily functions on the nursing divisions    rendered regarding their daily functions on the nursing divisions
and emergency room regarding patient progress and/or problems,       and emergency room regarding patient progress and/or problems,
consultations, and treatment rendered.                               consultations, and treatment rendered.

Demonstrates basic skills of closed treatment necessary to provide Demonstrates basic skills of closed treatment necessary to provide
satisfactory care of patients with traumatic injury both in the    satisfactory care of patients with traumatic injury both in the
emergency room and the outpatient clinic. This includes such           emergency room and the outpatient clinic. This includes such
injuries as hand, forearm, elbow, humerus, clavicle, upper             injuries as hand, forearm, elbow, humerus, clavicle, upper
extremity, foot, ankle, and tibia fractures of the lower extremity.    extremity, foot, ankle, and tibia fractures of the lower extremity.

Demonstrates basic surgical skills essential to performing closed      Demonstrates basic surgical skills essential to performing closed
and open surgical treatment of patients with traumatic and             and open surgical treatment of patients with traumatic and
inflammatory pathology. This includes performing and assisting         inflammatory pathology. This includes performing and assisting
percutaneous fixation of open fractures and fixation of applicable     percutaneous fixation of open fractures and fixation of applicable
fractures of the ankle, tibia, femur, and forearm using the Ilizarov   fractures of the ankle, tibia, femur, and forearm using the Ilizarov
and Taylor frame techniques as appropriate. This also includes         and Taylor frame techniques as appropriate. This also includes
incision and debridement of open fractures of long bones and           incision and debridement of open fractures of long bones and
incision and drainage of septic processes of the ankle and knee.       incision and drainage of septic processes of the ankle and knee.

Demonstrates competency in taking a detailed history, complete         Demonstrates competency in taking a detailed history, complete
appropriate and accurate physical examination, ordering and            appropriate and accurate physical examination, ordering and
reviewing appropriate imaging and diagnostic studies to allow          reviewing appropriate imaging and diagnostic studies to allow
integration of information to formulate a diagnosis and treatment      integration of information to formulate a diagnosis and treatment
plan.                                                                  plan.

In the second half of the rotation (3 months) demonstrates             In the second half of the rotation (3 months) demonstrates
advanced technology skills that allow participation as the lead        advanced technology skills that allow participation as the lead
surgeon with attending assistance in the surgical treatment of         surgeon with attending assistance in the surgical treatment of
patients with pediatric orthopaedic pathology of both minor and        patients with pediatric orthopaedic pathology of both minor and
major complexity secondary to all possible etiologies.                 major complexity secondary to all possible etiologies.

Demonstrates ability to anticipate inpatient as well as outpatient     Demonstrates ability to anticipate inpatient as well as outpatient
care needs and a comprehensive plan for post discharge                 care needs and a comprehensive plan for post discharge
management and rehabilitative care of the patient.                     management and rehabilitative care of the patient.

Demonstrates skills sufficient to apply corrective casts for           Demonstrates skills sufficient to apply corrective casts for
congenital or development deformities of the upper and lower           congenital or development deformities of the upper and lower
extremities as needed in the surgical management of brachial           extremities as needed in the surgical management of brachial
plexus deformity, flexion deformity of the knee, clubfoot              plexus deformity, flexion deformity of the knee, clubfoot
deformity, DDH, and Perthes disease.                                   deformity, DDH, and Perthes disease.

Demonstrates a knowledge of and treatment plan approaches to           Demonstrates a knowledge of and treatment plan approaches to
neoplastic conditions in pediatric orthopaedics.                       neoplastic conditions in pediatric orthopaedics.

Manage hip dysplasia in the child utilizing both closed and open       Manage hip dysplasia in the child utilizing both closed and open
technique to include open reduction with or without femur or           technique to include open reduction with or without femur or
pelvic osteotomy.                                                      pelvic osteotomy.

Treat Calve-Perthes disease and slipped capital femoral epiphyses      Treat Calve-Perthes disease and slipped capital femoral epiphyses
either surgical or nonsurgical techniques.                             either surgical or nonsurgical techniques.

Demonstrate the ability to assess diagnosis and plan nonoperative      Demonstrate the ability to assess diagnosis and plan nonoperative
as well as operative treatment of spinal deformity.                    as well as operative treatment of spinal deformity.

Demonstrates ability to utilize orthotics in the treatment of spinal   Demonstrates ability to utilize orthotics in the treatment of spinal
deformities.                                                           deformities.

Demonstrate the ability to surgically approach and master              Demonstrate the ability to surgically approach and master
instrumentation of development spinal disorders.                       instrumentation of development spinal disorders.

Demonstrate the ability to perform both closed and open                Demonstrate the ability to perform both closed and open
treatment deformities about the foot and ankle, specifically that      treatment deformities about the foot and ankle, specifically that
involving congenital clubfoot, flat foot, and cavus foot               involving congenital clubfoot, flat foot, and cavus foot
deformities.                                                           deformities.

Demonstrates a working knowledge of treatment skills in treating       Demonstrates a working knowledge of treatment skills in treating
musculoskeletal aspects of neuromuscular disease such as static        musculoskeletal aspects of neuromuscular disease such as static
encephalopathy, arthrogryposis, and primary muscle diseases.           encephalopathy, arthrogryposis, and primary muscle diseases.
Demonstrates the ability to perform osteotomies on long bones     Demonstrates the ability to perform osteotomies on long bones
stabilizing the same with external fixator, Ilizarov, or Taylor   stabilizing the same with external fixator, Ilizarov, or Taylor
frames or internal fixation.                                      frames or internal fixation.
                                                DUKE ORTHOPAEDIC SURGERY

                                                     GOALS AND OBJECTIVES

                                             PEDIATRIC ORTHOPAEDIC SERVICE

MEDICAL KNOWLEDGE

PGY-4 RESIDENT                                                      PGY-4 RESIDENT
Accurately interprets imaging studies in carrying for patients in    Accurately interprets imaging studies in carrying for patients in
the emergency department, patient clinic, and in the operating       the emergency department, patient clinic, and in the operating
room.                                                                room.

Demonstrates knowledge of the anatomy of both the upper and          Demonstrates knowledge of the anatomy of both the upper and
lower extremity to sufficiently evaluate and provide definitive      lower extremity to sufficiently evaluate and provide definitive
emergency room and outpatient pediatric trauma care both soft        emergency room and outpatient pediatric trauma care both soft
tissue and osseous tissues of all aspects of the same.               tissue and osseous tissues of all aspects of the same.

Knowledge to sufficiently allow the resident to be an effective      Knowledge to sufficiently allow the resident to be an effective
assistant in the surgical treatment of rheumatic and septic          assistant in the surgical treatment of rheumatic and septic
processes in all areas of pediatric orthopaedics.                    processes in all areas of pediatric orthopaedics.

Demonstrates a working knowledge of closed and open surgical         Demonstrates a working knowledge of closed and open surgical
treatment of all types of pediatric orthopaedic pathology.           treatment of all types of pediatric orthopaedic pathology.

Demonstrates understanding of the various surgical approaches in     Demonstrates understanding of the various surgical approaches in
treating common pediatric orthopaedic conditions.                    treating common pediatric orthopaedic conditions.

Demonstrates progressive improvement in the depth of                 Demonstrates progressive improvement in the depth of
knowledge in all aspects of pediatric orthopaedic care being         knowledge in all aspects of pediatric orthopaedic care being
provided on the service. This should include awareness of            provided on the service. This should include awareness of
differential diagnoses and indepth knowledge of patho-anatomy,       differential diagnoses and indepth knowledge of patho-anatomy,
variable treatment approaches and the ability to consistently select variable treatment approaches and the ability to consistently select
a most appropriate approach for a particular patient in question.    a most appropriate approach for a particular patient in question.

Successfully complete the OKU Specialty Series for Pediatric         Successfully complete the OKU Specialty Series for Pediatric
Orthopaedics.                                                        Orthopaedics.

Successfully complete the OKU Specialty Series Self-Assessment       Successfully complete the OKU Specialty Series Self-Assessment
Examination for Pediatric Orthopaedics.                              Examination for Pediatric Orthopaedics.

Complete the AAOS Monograph series of Legg-Calve-Perthes             Complete the AAOS Monograph series of Legg-Calve-Perthes
Disease, Slipped Capital Femoral Epiphysis, Operative                Disease, Slipped Capital Femoral Epiphysis, Operative
Management of Lower Extremity Fractures in Children, and             Management of Lower Extremity Fractures in Children, and
Operative Management of Upper Extremity Fractures in Children.       Operative Management of Upper Extremity Fractures in Children.

Successfully complete the reading reference list for pediatric       Successfully complete the reading reference list for Pediatric
orthopaedics.                                                        Orthopaedics.
                                                 DUKE ORTHOPAEDIC SURGERY

                                                     GOALS AND OBJECTIVES

                                              PEDIATRIC ORTHOPAEDIC SERVICE

PRACTICE BASED LEARNING AND DEVELOPMENT

PGY-4 RESIDENT                                                     PGY-4 RESIDENT
Prepare for and present twice monthly pediatric orthopaedic         Prepare for and present twice monthly pediatric orthopaedic
subjects at Grand Rounds.                                           subjects at Grand Rounds.

Prepare for and participate in weekly Pediatric Subspecialty        Prepare for and participate in weekly Pediatric Subspecialty
Conferences.                                                        Conferences.

Complete the AAOS Monograph series of Legg-Calve-Perthes            Complete the AAOS Monograph series of Legg-Calve-Perthes
Disease, Slipped Capital Femoral Epiphysis, Operative               Disease, Slipped Capital Femoral Epiphysis, Operative
Management of Lower Extremity Fractures in Children, and            Management of Lower Extremity Fractures in Children, and
Operative Management of Upper Extremity Fractures in Children.      Operative Management of Upper Extremity Fractures in Children

Able to locate, appraise, and assimilate evidence for scientific    Able to locate, appraise, and assimilate evidence for scientific
studies related to patient health issues.                           studies related to patient health issues.

Able to obtain and use information about his/her patient           Able to obtain and use information about his/her patient
population and the larger population for which patients are drawn. population and the larger population for which patients are drawn.

Able to apply knowledge of study designs and statistical methods    Able to apply knowledge of study designs and statistical methods
to the appraisal of clinical studies.                               to the appraisal of clinical studies.

Able to use information technology to assess on-line medical        Able to use information technology to assess on-line medical
information and support his/her own education.       information and support his/her own education.

Participate in the monthly Pediatric Journal Club.   Participate in the monthly Pediatric Journal Club.
                                                 DUKE ORTHOPAEDIC SURGERY

                                                     GOALS AND OBJECTIVES

                                              PEDIATRIC ORTHOPAEDIC SERVICE

INTERPERSONAL AND COMMUNICATION SKILLS

PGY-4 RESIDENT                                                      PGY-4 RESIDENT
Demonstrates the understanding and importance of family             Demonstrates the understanding and importance of family
dynamics assuring both patient and parents that the child’s care is dynamics assuring both patient and parents that the child’s care is
of the utmost concern to the resident and the team when dealing     of the utmost concern to the resident and the team when dealing
with patients. In so doing the resident will demonstrate skills     with patients. In so doing the resident will demonstrate skills
necessary to assure a sense of comfort in the parent’s part that    necessary to assure a sense of comfort in the parent’s part that
everything reasonable and possible is being done at all times to    everything reasonable and possible is being done at all times to
facilitate care of their child.                                     facilitate care of their child.

Able to effectively provide information via various information     Able to effectively provide information via various information
technology.                                                         technology.

Able to work effectively with others as a member or leader of the   Able to work effectively with others as a member or leader of the
health care team.                                                   health care team.

Personally and professionally interacts with the hospital staff,    Personally and professionally interacts with the hospital staff,
house officers, and attending staff.                                house officers, and attending staff.

Displays effective communication skills when informing children     Displays effective communication skills when informing children
of upcoming events and assisting children throughout such           of upcoming events and assisting children throughout such
events.                                                             events.

Demonstrates ability to keep the family informed of planned         Demonstrates ability to keep the family informed of planned
treatment and possibilities of outcome in such a way that the     treatment and possibilities of outcome in such a way that the
family can readily comprehend the essentials of the pathology and family can readily comprehend the essentials of the pathology and
the planned treatment.                                            the planned treatment.
                                                 DUKE ORTHOPAEDIC SURGERY

                                                     GOALS AND OBJECTIVES

                                              PEDIATRIC ORTHOPAEDIC SERVICE
PROFESSIONALISM

PGY-4 RESIDENT                                                    PGY-4 RESIDENT
Demonstrate respect, compassion, and integrity in response to the Demonstrate respect, compassion, and integrity in response to the
needs of patients and their families.                             needs of patients and their families.

Demonstrates a commitment to excellence and ongoing                  Demonstrates a commitment to excellence and ongoing
professional development.                                            professional development.

Demonstrates ethical principles pertaining to patient                Demonstrates ethical principles pertaining to patient
confidentiality issues.                                              confidentiality issues.

Demonstrates sensitivity to culture, age, gender, and disabilities   Demonstrates sensitivity to culture, age, gender, and disabilities
of patients and fellow health care professionals.                    of patients and fellow health care professionals.
                                                  DUKE ORTHOPAEDIC SURGERY

                                                       GOALS AND OBJECTIVES

                                               PEDIATRIC ORTHOPAEDIC SERVICE

SYSTEMS BASED PRACTICE

PGY-4 RESIDENT                                                                 PGY-4 RESIDENT
Possess the ability to readily interact with all important ancillary     Possess the ability to readily interact with all important ancillary
services necessary to provide orthopaedic care to the pediatric          services necessary to provide orthopaedic care to the pediatric
patient. This would include the physical therapist, occupational         patient. This would include the physical therapist, occupational
therapist, rehabilitation therapist, social workers, and in particular   therapist, rehabilitation therapist, social workers, and in particular
the nursing staff of the emergency room, the operating room, and         the nursing staff of the emergency room, the operating room, and
the ward.                                                                the ward.

Demonstrates competency in coordinating all aspects of                   Demonstrates competency in coordinating all aspects of
perioperative and postoperative rehabilitation and physical              perioperative and postoperative rehabilitation and physical
therapy.                                                                 therapy.

Demonstrates an understanding of how patient care and other              Demonstrates an understanding of how patient care and other
professional practices affect other health care professionals,           professional practices affect other health care professionals,
health care organizations, and the largest society in how these          health care organizations, and the largest society in how these
elements of the systems affect one’s own practice.                       elements of the systems affect one’s own practice.

Demonstrates knowledge of how different types of medical                 Demonstrates knowledge of how different types of medical
practice and health care delivery systems differ from one another        practice and health care delivery systems differ from one another
including methods of controlling health care costs and allocating        including methods of controlling health care costs and allocating
resources.                                                               resources.

Has the opportunity to practice medicine in various health care          Has the opportunity to practice medicine in various health care
systems including an academic teaching hospital, Veterans           systems including an academic teaching hospital, Veterans
Administration hospital, community hospital, pediatric              Administration hospital, community hospital, pediatric
orthopaedic hospital, and community health department.              orthopaedic hospital, and community health department.

Has understanding of various health funding systems including       Has understanding of various health funding systems including
private insurance, Medicare, Medicaid, Workers Compensation,        private insurance, Medicare, Medicaid, Workers Compensation,
and Vocational Rehabilitation.                                      and Vocational Rehabilitation.

Practices cost-effective health care and resource allocation that   Practices cost-effective health care and resource allocation that
does not compromise quality of care.                                does not compromise quality of care.

Demonstrates understanding of impact of correct coding during       Demonstrates understanding of impact of correct coding during
patient office visits and surgery.                                  patient office visits and surgery.

Effectively partners with health care managers and health care    Effectively partners with health care managers and health care
providers to assess, coordinate, and improve health care and know providers to assess, coordinate, and improve health care and know
how these activities can affect system performance.               how these activities can affect system performance.

Demonstrates the ability to practice culturally competent           Demonstrates the ability to practice culturally competent
medicine.                                                           medicine.
                                                DUKE ORTHOPAEDIC SURGERY

                                          DELINEATED LINES OF RESPONSIBILITY

                                             PEDIATRIC ORTHOPAEDIC SERVICE

OUTPATIENT CLINIC

PGY-4 RESIDENT                                                      PGY-4 RESIDENT
The PGY-4 Resident works directly with the attendings in the         The PGY-4 Resident works directly with the attendings in the
clinic in evaluating and treating patients. The PGY- 4 Resident      clinic in evaluating and treating patients. The PGY- 4 Resident
performs the history, physical examination, and presents these       performs the history, physical examination, and presents these
findings to the pediatric orthopaedic attending who will assist the findings to the pediatric orthopaedic attending who will assist the
resident in the appropriate disposition.                             resident in the appropriate disposition.
                                                DUKE ORTHOPAEDIC SURGERY

                                           DELINEATED LINES OF RESPONSIBILITY

                                             PEDIATRIC ORTHOPAEDIC SERVICE

INPATIENTS

PGY-4 RESIDENT                                                       PGY-4 RESIDENT
The PGY-4 Resident is responsible for twice daily rounding on         The PGY-4 Resident is responsible for twice daily rounding on
both the inpatients and pediatric orthopaedic consults. The           both the inpatients and pediatric orthopaedic consults. The
resident reports directly to the pediatric orthopaedic attending(s). resident reports directly to the pediatric orthopaedic attending(s).
                                               DUKE ORTHOPAEDIC SURGERY

                                          DELINEATED LINES OF RESPONSIBILITY

                                             PEDIATRIC ORTHOPAEDIC SERVICE

OPERATING ROOM

PGY-4 RESIDENT                                                      PGY-4 RESIDENT
In the operating room the PGY-4 Residents responsibilities           In the operating room the PGY-4 Residents responsibilities
include assisting the pediatric orthopaedic attending surgeon(s) in include assisting the pediatric orthopaedic attending surgeon(s) in
surgery, performing surgery under the direct supervision of the      surgery, performing surgery under the direct supervision of the
attending.                                                           attending.
                                               DUKE ORTHOPAEDIC SURGERY

                                          DELINEATED LINES OF RESPONSIBILITY

                                            PEDIATRIC ORTHOPAEDIC SERVICE

EMERGENCY ROOM

PGY-4 RESIDENT                                                     PGY-4 RESIDENT
The PGY-4 Resident alternates on-call with the second PGY-4         The PGY-4 Resident alternates on-call with the second PGY-4
Resident in seeing patients and both evaluating and definitively    Resident in seeing patients and both evaluating and definitively
treating pediatric musculoskeletal trauma as appropriate. These     treating pediatric musculoskeletal trauma as appropriate. These
activities will be directly supervised by the Trauma Chief          activities will be directly supervised by the Trauma Chief
Resident and/or trauma attending as well as the pediatric           Resident and/or trauma attending as well as the pediatric
orthopaedic attending as appropriate.                               orthopaedic attending as appropriate.