VCU Orthopaedic Surgery – Program expectations

Program expectations

All residents should refer to the VCU School of Medicine’s Graduate Medical Education Web site for university-specific policies and procedures. For professional standards, residents should review the Accreditation Council for Graduate Medical Education Web site.

OITE
Operating room
Operative report
Discharge summary
Quality assurance
Operative log
Grievance and appeal
Supervision document
Miscellaneous issues
Evaluations

OITE

All orthopaedic residents, PGY-2 to the PGY-5 level must take the orthopaedic in-training exam, which occurs in November of each year. A score of less than 35 percentile requires additional reading and educational requirements for the residents to approve this score.

Operating room

The patient must be seen and evaluated by the operating resident and intern, if possible, before the case begins.
The operating resident must document the evaluation by placing a pre-op note on the chart that details why the patient is undergoing surgery and lists the risk/benefits and that these have been explained to the patient and the patient understands them.
The patient must be evaluated by the operating surgeon the evening after surgery or prior to discharge for all inpatient and outpatient surgery.
All residents participating in the surgery must read about the case ahead of time and understand the indications, technical anatomy and possible complications (especially for elective cases).
The operative schedule will be given to the residents at least 24 hours in advance. The residents will be assigned to the case. Textbooks are available in the Orthopaedic Library on the ninth floor of West Hospital. This is the responsibility of the residents.
The residents must make their best attempt to meet the same standards for urgent and emergent cases for the welfare of their patients, as well as their own education.
Residents will broaden their knowledge base by becoming familiar with the illnesses and associated medical conditions of their patients.
Residents are expected to prepare and demonstrate preparedness before, during and after the surgery. They are expected to make the patient a focus of their learning.

Operative report

Operative reports must be dictated immediately after the case is completed. Residents will lose operative privileges for failure to complete the operative report and/or discharge summaries in a timely fashion. In addition, they may be lose vacation time and meal money, or be placed on probation, and even terminated from the residency, if this repeatedly occurs.

Discharge summary

Discharge summaries should be dictated at the time of or prior to the patient’s discharge from the hospital. They must be concise, accurate and contain relevant information. Ideally this summary should be dictated the evening before the patient is discharged.

Quality assurance

An appointed faculty member will keep a record and analyze monthly the quality of care of the department and report on an as-needed basis if any outstanding issues exist. Annually, this faculty member will present a review of the complications of the program.

Operative log

Each resident must keep up-to-date operative logs of all cases for which they are scrubbed. They must be recorded in the ACGME Resident Log System. Each resident is assigned an ID and password. Residents also will have a manual for entering the program as a PGY-2. A log sheet of each resident will be generated monthly and each resident will review participation. It is the resident’s responsibility to enter cases in a timely fashion. Residents who are delinquent in entering the cases may lose:

Operating rooms privileges
Vacation days, to include weekend before and after
Lunch money

Residents should not rely on operating room or medical records for this data, as it is often incomplete. The log is required for residents to successfully complete the program and sit for the qualifying exam for the American Board of Orthopaedic Surgery.

Grievance and appeal

The department has a process for appeals. The program director has certain responsibilities and duties. If the resident disagrees with a program director’s decision, he or she may appeal the decision to the Education Committee. If the Education Committee solution is still not satisfactory to the resident, then the resident can follow the procedure of the institution. All residents have been given the grievance document for the institution and do have the right to appeal.

The program director may recommend probation or termination to the residency. He or she will present confidential information to an education subcommittee, which consists of the chair and two additional faculty members with the resident present. If the resident disagrees with the decision of the subcommittee, then he or she may appeal to the education committee, which consists of six faculty member and five residents from each year. A simple majority vote applies to all committee decisions.

Supervision document

The PGY-1 resident is considered to be level one. The PGY-2 resident in order to go to level two, must complete the supervision document. He should record the name, the procedure that was done and special issues.

Supervision Document Part I [PDF]
Supervision Document Part II [PDF]

Miscellaneous issues

The orthopaedic residents are expected to participate in the education of medical students that rotate on the service. This is important because it does add to the residents own education and promotes the scholarly education environment that the department fosters. It is the policy of our department that the best way to learn is to be a teacher.

Residents are expected to check their mail boxes regularly. Mailboxes are located in the Orthopaedic Library on West 9.

We currently have services divided into generalist and specialist. Each resident will spend a certain amount of time in pediatric orthopaedics, trauma, knee, shoulder and elbow, hand, foot and ankle, sports medicine, total joint arthroplasty, spine and orthopaedic oncology. In addition the residents will typically have research rotations during the PGY2-3 years.

The generalist rotations will occur during the PGY2 and PGY5 year at the VA McGuire Hospital and during their Administrative Chief rotations.

Each sub-specialty is directed by a faculty member with expertise in that field.

Evaluations

All residents are expected to evaluate the faculty on an annual basis. These evaluations will be anonymous. Residents also are expected to anonymously evaluate the orthopaedic training program on an annual basis.

Each resident is evaluated by faculty at the end of each rotation. Every six months a formal evaluation with the program director will occur. Issues that must be corrected will be co-signed by the program director and the resident.

Residents will be evaluated on the following:

Maintains confidentiality of patients and their families
Communicates treatment plan to patient/family including explaining risks/benefits.
Obtains a thorough appropriate history from the patient/family.
Obtains and documents a thorough appropriate physical exam.
Is capable of developing a patient nonoperative management plan.
Understands indications for surgery, risks and benefits, and complete understanding of alternatives.
Works effectively as a team player.
Writes effective daily notes and dictates operative and discharge summary on time.
Takes steps to prevent wrong-site surgery and medical errors.
Respects patient confidentiality and is appropriate with patients.
Basic science knowledge: demonstrates knowledge of basic science including related to clinical issues, demonstrates understanding of assigned basic science reading material and reads avidly in basic science.
Clinical science: prepares and demonstrates knowledge of the clinical literature and is aware of outcome data for the various treatment options.
Applies knowledge base to management of patients.
Understands what is to be done and the equipment needed, including patient positioning and radiological planning (knows how to prepare the patient for surgery).
Executes the surgery in a reasonable time frame.
Is careful in execution of surgery and handles tissue well.
Analyzes the effectiveness of his/her own practice.
Uses available information and technology to obtain and manage information.
Is receptive to constructive criticism.
Shows improvement in clinical skills and medical knowledge during the rotation.
Is able to share knowledge and experience with others in training.
Understands the limitations and indications for lab and radiological tests and is judicious in their use.
Contributes to the improvement of patient care by actively identifying and promoting improvements.
Maintains rapport with staff, including nursing, clerical/administrative staff as well as other residents and staff.
Gives clear instructions to other professionals including when going off call and/or follows instructions of faculty and senior residents.
Coordinates care effectively for patients with other health care professionals.
Exhibits professional and ethical behavior toward physician colleagues.
Is sensitive and responsive to the needs of the patient/family including differences in culture, gender, age and impairments.
Is honest, ethical and trustworthy.
Is available, punctual and dedicated.
Assumes appropriate responsibility for patients.
Advocates good patient care and works with others to assure optimal outcome outside of the acute care system.
Demonstrates the ability to provide cost-effective care.
Has an appropriate concept of cost of medical care on patient and health care system.
Is attentive to timely completion of patient personal forms.